Measles is a communicable disease manifesting with fever , cough , coryza , lacrimation and koplik spots in the pre – eruptive phase and a maculopapular rash starting at 4th or 5th day of the illness.

Coryza : profuse discharge from the mucous membrane of the nose

koplik spot : small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of measles.

Koplik spots

Coryza

Agent: Measles( paramyxovirus ,RNA virus) Age: children (6months -3 years) Measles tend to be very serious in malnourished tend to be very serious in malnourished

children, mortality is 400 times higher.children, mortality is 400 times higher. Both sexes are affectedBoth sexes are affected Immunity : - : -

one attack of measles gives immunity for life.one attack of measles gives immunity for life. Infants acquire immunity transplacentally from mothers

who have had measles or measles immunization. This immunity is usually completed for the first 4–6 months of life.

Reservoir : - Man is only the reservoir of infection.

Incidence is higher in spring and winter Incidence is higher in densely populated

urban areasNatural history Reservoir is a case of measles Source of infection: nasopharyngeal

secretions, lacrimal secretion, urine Infectious period: 4 days before, and 5 days

after the onset of rash

Directly from person to person by droplet infection, droplet nuclei

Other modes –fomites, airborne

Incubation period: 8 – 12 days

Virus infects by invasive of respiratory tract . After entering the viral particles infects the respiratory epithelium and

local multiplication leads to primary viremia ( day 2 – 3 ) and subsequently spread to the reticuloendothelial system.

Cells of reticuloendothelial system necrose , causing secondary viremia ( day 5 – 7 ) which is responsible for systemic symptoms.

Multinucleated gaint cells can be demonstrated in both epidermis and oral epithelium by 7 – 11 days

Two types of gaint cell are seen : - Warthin – Finkeledy cells of reticuloendothelial system Epithelium gaint cells of respiratory tract

During infection , CD4T and CD8 cells are activated and participate in clearance of virus and development of rash. During recovery,level of interleukin 4 is elevated

IL-4: protein that stimulates the immune system to develop mast cells,

resting T-cells, and activated B-cells.

A. Prodromal :

- onset is acute with moderate elevation of temperature , cough , running of nose , sneezing , redness of eyes and excessive lacrimation

- on second or third day : koplik spots appear on the inner side of the cheek, opposite to the second molars .

- Koplik spots increase in number for 2 to 3 days and disappear by the end of second day of the rash

Koplik’s spot:

Eruptive phase :

With the appearance of rash on the 4th day the fever tends to rise again

Early rash is erythematous and blanches on pressure ( blotchy ) First appears behind the ears , near the hair line on the

forehead , face and neck and spread to trunk , extremities , palms and soles within 3 days.

The rash now appears brownish , and does not fade on pressure.

Rash start disappearing after 4 to 5 days in the same order in which it appeared

Fever and rash lasts for about a week in uncomplicated cases May complain anorexia , malasie , generalised lymphadenopathy

Maculo-papular rash:

Clinical diagnosis: Laboratory diagnosis: Blood count – leucocytosis in early stages

followed by increased lymphocytes Sputum or urine culture Serological testsComplement fixation testHaemagglutination test Enzyme-linked immunosorbent assay

(ELISA)

Differential diagnosis Rubella : rash is pink , maculopapular and

discrete Infectious mononucleosis : rash is associated

with generalised lymphadenopathy and hepatosplenomegaly

Meningococcemia : rash appears within 24 hours. Fever , vomiting , irritability and possibly stiff neck are present

Drug rash : H / o drugs administration Sunburn Roseola infantum : - faint pink maculopapular

rash.

Treatment : It is a self limiting disease unless it is

complicated Symptomatic and supportive Body and oral hygiene are attended to Parents are encouraged to give bath to the child

and mouth is washed and teeth are brushed daily

Adequate amount of fluids orally Fever (paracetamol and hydrotherapy ) Severe cough ( saline nebulization ) Vitamin A decrease the severity , complication

rate and mortality. Dose : 2 lac units , orally children older than one year of age for 2 consecutive days.

Control measures Isolation Bed rest Supportive Tx- vit. A , Immunization of contacts within 2 days of exposure Preventive measures Active immunization(9 months, 0.5cc,IM/SC,deltoid) Passive immunization (Human gamma

globuline0.25ml/kg IM within 5 days of exposure)

Dose and schedule: 0.5ml – S/C – 9months Adverse reactions:Measles like illness, febrile convulsion, toxic

shock syndrome, transient thrombocytopenia Contraindications: acute illness, untreated

malignant diseases, immunodeficiency, pregnancy, received any live vaccine within 3 weeks

Respiratory tract : otitis media , cervical lymphadenopathy , laryngitis ,

laryngotracheitis , interstitial pneumonia ,bronchopneumonia

Encephalitis Digestive system :

Persistent diarrhea , appendicitis ( lymphoid tissue blocking the lumen of appendix ) , hepatitis , ileocolitis

Malnutrition : PEMOthers : acute glomerulonephritis , disseminated

intravascular coagulation .