Measles

♦ The First Teaching Hospital

of Zhengzhou University ,
Department of Infectious Disease

谷
军生

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Summarization
♦ Infected by measle virus
♦ Transmitted through respiratory tract
♦ With fever and exanthem

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 Etiolody
♦ Paramyxoviruses
♦ Measles virus
♦ Only one serotype

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 Epidemiology
♦ Source of infection:
♦ Acute patients
♦ Patients are infectious during 2 days
before prodrome period to 5 days after
the onset of exanthem and are most
infectious during the late prodrome.
♦ The virus remains infectious in small
particle `aerosols for several hours.

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Epidemiology
♦ Transmitting routes:
♦ Through respiratory tract or
conjunctiva by airborne droplets
♦ By direct contact with infectious
secretions

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 Epidemiology
♦ Susceptible groups:
♦ Almost all are susceptible.
♦ The transfer of maternal antibodies gives
protection for babies within 6 months.
♦ After this, the incidence rises rapidly to a
peak in early childhood.
♦ Infection confers lifelong protection.
♦ Almost all adults have antibodies and lifelong
immunity.

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 Epidemiology

♦ Characteristics:
♦ With a high morbidity in winter
and spring
♦ Apparent infection is high (> 90%
in susceptible groups

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Pathogenesis

♦ Initially infects the respiratory

epithelium.
♦ Then viremia, especially the infection
of Monocyte-Macrophage system.
♦ Then a secondary viremia and
virus dissemination to other tissues and
organs.
♦ Then occurred symptoms.

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Pathogenesis
♦ Leukopenia, particularly
lymphocytopenia, may be
secondary to direct destruction
of leukocytes.

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 Pathogenesis
♦ Measles virus infection always
induces host immune suppression.
♦ --Suppression of delayed
hypersensitivity reactions
♦ --And depressed natural killer cell
activity for at least 3 weeks after the
rash onset.
♦ Nephrotic syndrome abated
♦ Tuberculosis aggravated

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Pathogenesis

♦ Cellular immunity plays a

major role in viral clearance.

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 Clinical Features of typical Measles

♦ Typical Measles:
♦ Incubation period: usually 10~14 d
♦ Prodromal period: 3~4 d
♦ Eruptive Period: 3~5 d
♦ Convalescent period: 1~2w

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 Clinical Features of typical Measles
♦ The prodrome period lasts 2 to 4 days
and is characterized by the followings:
♦ 1. High fever, with malaise, anorexia
♦ 2. Upper respiratory tract
inflammation always with coryza, cough (a
characteristic dry cough is always present)
♦ 3. Conjunctivitis with photophobia and
excess lacrimation

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 Clinical Features of typical Measles
♦ The prodrome period lasts 2 to 4 days
and is characterized by the followings:
♦ 4. Koplik’s spots: in late prodrome
period, always on the third day of fever
onset, redbased lesions with central bluish
gray specks, appear on the buccal (or
labial) mucosa, typically opposite the
second molars, toward the end of the
prodromal period and last for 2-3 days.
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 Clinical Features of typical Measles

♦ Eruptive Period: 3~5 d

♦ Skin eruption begins about the face and
neck behind the ears as discrete
erythematous macules, which proceed
downward to cover the trunk and
extremities, including the palms and soles in
the end. (3 days)
♦ Lesions often enlarge, become
maculopapular, and coalesce.
♦ The exanthem may become hemorrhagic
in a few cases.
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 Clinical Features of typical Measles
♦ Eruptive Period: 3~5 d
♦ When the rash is at its height, fine
crepitations can sometimes be heard
throughout both lung fields due to a
pneumonitis caused by the measles virus
rather than secondary invaders.

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 Clinical Features of typical Measles
♦ Convalescent period: 1~2w
♦ The eruption clears after 5 to 6 days
in the order of its appearance, often with
brownish discoloration and fine
desquamation.

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 Atypical Measles
♦ Vesicles singly or in crops, petechiae,
purpura, and/or urticarial lesions can
develop. Because of the polymorphous
nature of the eruption, atypical measles
may be mistaken for varicella, scarlet
fever, meningococcemia, etc.

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 Atypical Measles
♦ Sometimes face spared, Koplik’s
spots absent
♦ Conjunctivitis and glossitis with
strawberry tongue

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Complications
♦ Measles pneumonia
♦ Secondary bacterial pneumonia is
commonly associated with measles
pneumonia and more severe than the
latter.
♦ Myocarditis
♦ Laryngitis

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Other Clinical Presentations
♦ Tuberculin reactivity may be
depressed, for up to 4 weeks after
infection. Measles may activate
tuberculosis.

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Laboratory Diagnosis
♦ Classic measles is easily diagnosed
clinically, but laboratory diagnosis may
be helpful in cases of atypical measles.

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 Laboratory Diagnosis
♦ Leukopenia:
♦ Common during the prodrome and
early eruptive stage
♦ Associated with a poor prognosis
♦ The development of leukocytosis
suggests bacterial superinfection or other
complications.

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Laboratory Diagnosis
♦ Detection of measles virus RNA in
respiratory secretions by RT-PCR has
been developed and is potentially more
practical than cell culture.

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Laboratory Diagnosis
♦ Serologic studies of paired specimens
constitute the most practical method of
laboratory diagnosis of measles.

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Laboratory Diagnosis
♦ Detection of measles-specific IgM is
a sensitive indicator of recent infection
and can yield positive findings within 1
week of rash onset.

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Prevention
♦ Hospitalized patients require
respiratory isolation.

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 Prevention
♦ Live attenuated measles virus
vaccine, a safe, effective vaccine has
been developed.
♦ This vaccine provides durable
immunity in at least 95% of recipients
vaccinated at 8 months or older.

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Prevention
♦ Combined measles-mumps-rubella
(MMR) vaccine is preferred because
mumps can also occur in highly
vaccinated populations, with the first
dose at age 8 months and the second at
entrance to school.

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 Treatment
♦ There is no specific antiviral therapy
for measles.
♦ Bed rest is the `essence of treatment
in benign self limited disease.

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 Treatment
♦ Short-term administration of Vitamin
A reduces mortality in severe measles in
children.
♦ Ribavirin and immunoglobulin have
been used in immunocompromised
patients with measles pneumonia.

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Treatment

♦ Symptomatic therapy:
♦ Antipyretics

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Class is over!
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