Measles

PARAMYXOVIRUS

Characteristics:
Paramyxovirus (enveloped ss-RNA), Genus morbillivirus, possesses HA activity.: Only one serotype, Only humans are infected with it. It is highly infectious

 95% clinically apparent).

Measles is a disease of children. Adult measles is a serious disease with high mortality rate.

Route of infection & Incubation period:

Respiratory: Droplet infection (Inhalation of

virus or conjunctival contamination. Incubation period: 9 days to 2 weeks.

Pathogenesis
Entry through respiratory mucosa (no lesions) local lymphatics (as free virus or infecting macrophages) regional lymphnodes + Spleen (virus multiplication without serious damage to lymphoid tissue). All T cells are susceptible to infection Viraemia (6 days later) tract. (mucosal ulceration of respiratory tract mucosa, conjunctiva).

Infects all epithelial oropharynx, skin surfaces,

conjunctiva,
bladder, alimentary

mucosal ulceration of

respiratory tract mucosa, conjunctiva

 Infected skin epithelial cells are

targeted by T cells (Maculopapular rash) with No ulceration The virus rarely may result in demyelination of the CNS, or even more rarely infects the CNS).

Immune Responce
One attack of measles is followed by long lasting

immunity. Although antibodies may play a role in neutralization of the virus during the viraemia, cell mediated immunity is more important. Maternal antibodies protect the infant during the first 6 months. Infection with measles causes transient depression of cell mediated immunity against other intracellular organisms e.g. M. tuberculosis leading to loss of tuberculin skin test reactivity

Clinical Picture
High abrupt onset of fever, cough, conjunctivitis,

(Kopliks spots) These are bluish-white ulceration of the buccal mucosa opposite the lower molars Rash appears 6 days later back of ears , face, trunk & upper limbs then lower limbs. The rash is caused primarily by cytotoxic T cells attacking the virus-infected vascular endothelial cells in the skin. Lymphadenopathy, diarrhea are common. In uncomplicated disease children recover completely within 2 weeks.

 Common complications:
otitis media croup

bronchiolitis
bronchopneumonia.

Complications in malnourished Children: Secondary bacterial pneumonia. (usual cause of death) Otitis media (may be severe leading to deafness) Bronchiectesis.

Complications in immunodeficient children: Giant cell pneumonia. Inclusion body encephalitis

 Rare/Very rare complications: Post-infectious encephalomyelitis

(Mortality 15%) subacute sclerosing panencephalitis (Fatal) Measles in a pregnant woman causes stillbirth.

Atypical measles

 Lab Diagnosis: Often rarely needed. In difficult cases:

a) saliva, b) urine, c) CSF virus isolation in MK cells. Blood (serum) for virus-specific IgM by ELISA.

 Prevention: MMR 1 year, and a booster:

4-6 years.