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MEASLES

(Other name: Rubeola, Morbilli, Seven Day Measles, Red Measles) What is Measles? Measles is an acute, contagious and exanthematous disease that usually affects children who are susceptible to Upper Respiratory Tract Infection (URTI). This maybe one of the most common and most serious of all childhood diseases.

NICE TO KNOW! Who Discovered Measles? A Persian physician was the first person to describe the symptoms of measles so that it could be differentiated from smallpox. This was done in the 9th century. The physician's name was Ibn Razi. His description of measles was translated into English only in 1847. However, the credit for discovering the characteristics of measles goes to Henry Koplik. He did this in 1856. The term measles comes from a Middle English word known as maselen, which means many little spots. This describes the characteristic rash that develops. Rubeola, the scientific term for measles, describes the red color of the rash. The measles virus was discovered in the 1930s, and it was John Enders who managed to isolate the virus in 1954 in search for a vaccine against the infection. In the 1960s, the first measles vaccine made from live but weak strain of virus became available. Today, in the US, children are vaccinated Etiologic Agent:

Filtrable Virus that belongs to genus Morbilivirus and a family of Paramyxoviridae which is the agent for measles. *Measles virus is rapidly inactivated by heat, ultraviolet light, and extreme degree of acidity and alkalinity.

*Paramyxoviridae: A family of RNA-containing viruses about twice the size of the influenza viruses (Orthomyxoviridae) but similar to them in morphology. Virions are 150-300 nm in diameter, enveloped, ether sensitive, and contain RNA-dependent RNA polymerase. Nucleocapsids are helical, considerably larger than those of the influenza viruses, and contain single-stranded unsegmented RNA. Four genera are recognized: Paramyxovirus, Morbillivirus, Rubulavirus, and Pneumovirus, all of which cause cell fusion and produce cytoplasmic eosinophilic inclusions. Diseases associated with these viruses include croup and other upper respiratory infections, measles, mumps, and pneumonia.

Pathophysiology of Measles Virus enters respiratory tract and replicates

Spread to lymph nodes followed by primary viraemia

Spread to GI tract, liver, CNS and thymus. Also proliferates in endothelial cells of vessels, macrophages and white cells (mainly monocytes) These phases stimulate sellmediated and humoral immunity- the rash represents clean-up of infected cells, especially those in capillaries by T-

After viral infection is controlled an immunodeficiency state ensues for months(Observed

CNS complications

How serious is Measles? Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die.

Incubation Period: *The incubation period is from 10 to 12 days(the longest is 20 days and the shortest is 8 days) *Single attack conveys a lifelong Period of Communicability: 1. Measles usually lasts about 9 to10 days, measured from the beginning of the Prodromal symptoms 2. The disease is communicable 4 days before and 5 days after the appearance of rashes 3. The disease is most communicable during the height of rash Source of Infection: The virus has been found in the patients blood, as well as in the secretions from the eyes, nose, and throat. Who is at risk for getting measles? Those people at high risk for measles include: children less than 1 year of age (although they have some immunity passed from their mother, it is not 100% effective), people who have not received the proper vaccination people who received immunoglobulin at the time of measles vaccination, and people immunized from 1963 until 1967 with an older ineffective measles vaccine

Mode of Transmission: 1. The disease is transmitted through direct contact with the droplets spread through coughing or sneezing. 2. It can also be transmitted indirectly through articles or fomites freshly contaminated with respiratory secretions of infected patients. 3. Probably Airborne 4. Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections. 5. Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while the inactivated antigen gives an immunity 0f 6-18 months.

What is the danger of getting measles while pregnant? If you contract measles while you are pregnant, you may have a miscarriage, a stillbirth, or a preterm delivery. There appears to be relatively lower risk of having birth defects compared to some other infections such as Rubella (German measles).

Pathognomonic Sign of Measles

Kopliks spots are pathognomonic of measles. These are inflammatory lesions of the buccal mucous glands with superficial necrosis. 1. They appear on the mucosa of the inner cheek opposite to the second molars, or near the junction of the gum and the inner cheek. 2. They usually appear one to two days before the measles rash. Clinical Manifestations: Clinical manifestations come in three satges:

1. Pre-Eruptive stage a. Fever b. Catarrhal symptoms ( rhinitis, conjunctivitis, photophobia, coryza) c. Respiratory symptoms start from common colds to persistent coughing d. Enanthema sign ( Kopliksspot, Stimsons line)

Stimsons line- edeme of lower lid

1. Eruptive Stage a. The rash is usually seen late on the 4th day b. Maculo-papular rash appears first on either the cheeks, bridge of the nose, along the hairline, at the temple or at the earlobe (Maculo-papular rash)

c. The rash is fully developed by the end of the second day and all symptoms are at their maximum t this time d. High grade fever comes on and off e. Anorexia and irritability f. Abdominal tympanism, pruritus, lethargy g. The throat is red and often extremely sore h. As fever, subsides, coughing may diminish, but more often it hangs on for a week or two, become looser and less metallic. 1. Stage of Convalescence a. Rashes fade away in the manner as they erupted b. Fever subsides as eruption disappears c. When the rashes fade, desquamation begins d. Symptoms subside and appetite is restored. Diagnostic Procedure 1. Nose and Throat swab

2. Urinalysis 3. Blood exams (CBC, leukopenia, leukocytosis) 4. 4. Complement fixation or hemoglobin test

Modalities of Treatment Anti-viral drugs (Isoprenisone) Antibiotics if with complications Supportive theraphy Complications

Bronchopneumonia Otitis Media

Pneumonia/Bronchitis Nephritis

Encephalitis; encephalo-myelitis

Blindness (seldom)

Unfavorable Signals Violent onset with high grade fever Fading eruption with rising fever Hemorrhagic or black measles Persistence of fever for 10 days or more Slight eruption accompanied by severe symptoms, especially those of encephalitis

Nursing Management:

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