CASE REPORT

MORBILI

Pembimbing :
dr. Alfred Siahaan, Sp.A

Disusun oleh :
Firda Diah Utami
1261050045

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

PERIODE 26 FEBRUARI – 5 MEI 2018
FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN INDONESIA
TAHUN 2018
 CHAPTER 1
INTRODUCTION

The name measles is derived from the latin, misellus, meaning miserable.
The disease is also sometimes known as rubeola (from rubeolus, latin for
reddish) or morbili (from morbus, latin for disease).
Measles is highly infectious, potentially fatal and mostly affects children.
Measles continues to be an important cause of childhood mortality in
developing countries.
 CHAPTER 2
LITERATURE REVIEW
Definition

Measles disease is also known as morbili or measles, a highly

infectious disease (infectious) caused by viruses.
Humans are estimated to be the only reservoirs, although monkeys
can be infected but do not play a role in transmission
Measles is an acute viral disease caused by the RNA virus of the
genus Morbillivirus, Paramyxoviridae family.
Epidemiology

In 1980, before immunization, it was estimated that over 20 million

people in the world were exposed to measles with 2.6 million deaths
each year, most of them children under the age of five.
Since 2000, more than one billion children in high-risk countries have
been vaccinated through immunization programs, so that by 2012
measles deaths have fallen by 78% globally In temperate regions, the
incidence is highest in late winter and spring.
Reports of measles cases in the U.S. have dramatically declined since
the pre-vaccine era.
In 2000, the Centers for Disease Control and Prevention (CDC)
declared that measles was eliminated from the U.S., although
outbreaks resulting from foreign travel still occur.
Etiology

Measles, or rubeola, is an RNA virus, belonging to the Morbillivirus

genus, which is in the Paramyxoviridae family.
Humans are the only natural host of this highly contagious virus.

• size-> Measles virus is 100-250 nm

•single stranded RNA with a lipid protective layer.
•inactivated with hot temperatures (> 37ᵒC), cold temperatures
(<20ᵒC), ultraviolet light, and extreme (pH <5 and> 10)
•The virus -> short-lived (short survival time) = less than 2 hours
 Pathophysiology

Inhaled droplet in virus enters through the virus

the air that comes the respiratory tract replicates and is
from the patient and adheres to the followed by
airway epithelial cells. spread to the
regional lymph
nodes

day 5 to 7 infection- secondary viremia primary viremia followed by viral

occurs throughout the body, especially multiplication in the
in the skin and respiratory tract reticuloendothelial system in the
spleen, liver, and lymph nodes.

day 11 to day 14, the virus is in the 2-3 days later the virus
blood, respiratory tract, and other begins to decrease.
organs
Clinical Manifestation

The prodromal stage occurs 10 to 12 days after exposure

•two to three days of fever
•anorexia
•malaise
•combined with the triad of cough, conjunctivitis, and coryza

Towards the end of the prodromal stage

•Koplik's spots, an enanthem comprised of blue-white spots, appear on
the buccal surfaces of the mouth -> pathognomonic of measles infection
http://accessmedicine.mhmedical.com/content.aspx?bookid=1020&sectionid=56968699
 •an exanthemic stage-a maculopapular rash with centrifugal spreading
starting from the hairline behind the ear, then spreads to the face, neck,
chest, upper extremities, buttocks, and ultimately the lower limb.
•This rash may occur for 6-7 days. Fever generally peaks (reaches 400C)
at 2-3 days after onset of rash.
•If fever persists after day 3 or 4 generally indicates complications

•the convalescent stage-> Stage healing (convalesens): after 3-4 days

generally the rash fade away in accordance with the pattern of
incidence.
•The skin rash disappears and turns brownish which will disappear
within 7-10 days
• A persisting cough -> which may persist up to one to two weeks after
the rash resolves
•The most commonly complications -> diarrhea (8%), otitis media (7%), and
pneumonia (6%).
•The leading cause of death in adults is acute encephalitis, a rare
complication of measles (0.1%).
• Historical data suggest that complications are more severe in pregnant
women
 Diagnosis

•Anamnesis
-> fever, cough, runny nose, red eyes, and rash that began to arise from
behind the ear to the entire body

•Physical examination
-> high body temperature (> 380C), red eyes, and maculopapular rash
 •Diagnosis with a seropositive antibody response using a serological and
detection of measles in clinical specimens (urine, nasopharyngeal
secretions, throat swabs, or blood) by viral culture.
•Blood samples for serological assays should be drawn at the same time as
the collection of clinical specimens; clinical specimens should be collected
no later than seven to ten days after the rash onset.
•The IgM capture assay can only be performed within 72 hours after rash
onset, whereas serological tests performed in a medical laboratory at a
hospital or medical facility can detect IgM one to two months after the
onset of symptoms.
 Treatment

•uncomplicated measles treatment -> supportive, bed rest, antipyretics

(paracetamol 10-15 mg / kgBB / dose can be given up to every 4 hours),
adequate fluids, nutritional supplements, and vitamin A

*Vitamin A -> immunomodulator that increases the antibody response to

measles virus, reduce the incidence of complications such as diarrhea and
pneumonia.
Vitamin A is given once per day for 2 days with the following dosage:
•200,000 IU in children 12 months or older
•100,000 IU in children aged 6 - 11 months
•50,000 IU in children less than 6 months
•Provision of vitamin A in addition to a single dose with a dose
equivalent to the age of the patient is given between weeks 2 to 4 in
children with vitamin A deficiency symptoms

In measles with complications otitis media and / or bacterial

pneumonia can be given antibiotics.

Diarrhea complications are treated with dehydration according to

the degree of dehydration
 Prevention

Measles vaccinations or MMR vaccinations (Measles, Mumps, Rubella).

•given at 9 months of age -> 2 years of age
•If the MMR vaccine is given at 15 months of age, there is no need for
measles vaccination at 2 years of age.
•MMR replay is given at the age of 5-6 years.
• Measles vaccine dose or 0.5 mL subcutaneous MMR vaccine.
•Immunization is not recommended in pregnant women, children with
primary immunodeficiency, untreated tuberculosis patients, cancer
patients or organ transplants, long-term immunosuppressive or
immunocompromised HIV-infected children.
 Prognosis

Measles is self-limited disease, but it is highly infectious.

Mortality and morbidity increase in patients with risk factors that affect
the onset of complications.
In developing countries, deaths reach 1-3%, may increase to 5-15%
when a measles outbreak occurs.
 CHAPTER 3
CONCLUSION

Measles is a highly infectious disease caused by measles virus that is

transmitted through a droplet intermediate.
Clinical manifestations include fever, cough, runny nose, conjunctivitis,
and a full body rash.
Management is generally supportive supplement with the provision of
vitamin A according to the age of the patient.
Prevention is done by immunization of measles vaccine or MMR
vaccine.
 REFERENCES
• World Health Organization. Manual for the laboratory diagnosis of
measles and rubella virus infection. 2nd edition. Department of
Immunization, Vaccines and Biologicals. 2007.
• Subuh HM, Soepardi J, Yosephine P. Petunjuk Teknis Kampanye Dan
Introduksi Imunisasi Measles Rubella (Mr). Direktorat Jenderal
Pencegahan Dan Pengendalian Penyakit Kementerian Kesehatan RI. 2017.
• White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, Mumps,
and Rubella. Clin Obstet Gynecol . 2012 June ; 55(2): 550–559.
• Halim RG. Campak pada Anak. CDK-238. Vol.43 no.3. 2016.
• De Swart RL. The Pathogenesis of Measles Revisited. The Pediatric
Infectious Disease Journal. Vol 27. No 10. October 2008.
• Gahr P et all. An Outbreak of Measles in an Undervaccinated Community.
Pediatrics. Vol 134. No 1. July 2014.
• Koth SM, Descourouez JL, Hayney MS. Measles, mumps, and rubella
(MMR) vaccination: An update. Journal of the American Pharmacists
Association. Vol 54. No 3. June 2014.