morbili case anak
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SECTION I
Case Report
IDENTITY
Patient Name : L.A
Birth Date : May 4th, 200
A!e : "0 years # mo$ths
%e$&er : Ma'e
A&&ress : (p Ta$!si RT#)R*+ Ciara$!, East -aarta
Natio$a'ity : I$&o$esia
Re'i!io$ : Mos'em
MR No. : +0//
Date o1 a&missio$ : A!st 2th 20"
Date o1 eami$atio$ : A!st 2th 20"
Father Mother
Name Mr. S Mrs. M
Age 40 years o'& # years o'&
Job Emp'oyee 3osei1e
Nationality I$&o$esia$ I$&o$esia$
Religion Mos'em Mos'em
Education 3i!h S5hoo' 3i!h S5hoo'
Earning/month Rp..000.000,
Address (p Ta$!si RT#)R*+ Ciara$!, East -aarta
ANAMNESIS
The a$am$esis as tae$ o$ A!st 2th 20", si$! a''oa$am$esis metho&.
The a$am$esis tae$ at room $o.+ A$!!re II *ar&, RS 6OLRI R Sai& Sa$to
hie! com#lain $ 7e8er si$5e 1or &ays prior to a&missio$ at hospita'.
Additional com#lains :Rash, 5o!h, 1', hea&a5he, $asea, 8omiti$!, &iarrhea,
a9&omi$a' pai$
3istory O1 6rese$t I'$ess
A "0 years # mo$ths o'& 9oy ith 9o&y ei!ht 2+ !, 5ame to Ra&e$ Sai&
Sa$to 6o'i5e Ce$ter 3ospita' ER at 0/.#0 am, ith a 5hie1 5omp'ai$ o1 1e8er. The
1e8er 'asts 1rom 4 &ays 9e1ore a&missio$ to the hospita'. The mother says that the
1e8er are s&&e$ 9e5ame hi!h a$& o$t !oes &o$. The 1e8er 5ame p hi!h at $oo$.
The mother !a8e pa$a&o' to &e5rease the temperatre. This 5omp'ai$s a'so 1o''oe&
9y rash a'' o8er his 9o&y, 5o!h, 1', hea&a5he, $asea, 8omiti$!, &iarrhea, a9&omi$a'
pai$ si$5e 4 &ays a$& sa''oi$! pai$ si$5e " &ay 9e1ore a&missio$.
3istory O1 6ast I''$ess
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6hary$!itis)To$si'itis ;
Bro$5hitis
6$emo$ia
Mor9i''i
6ertssis
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De(elo#ment %istory
7irst &e$titio$: + mo$ths o'&
6sy5homotor &e8e'opme$t
Smi'e : " mo$th o'&
S'a$t : 2 mo$ths o'&
Spee5h I$itatio$ : 2 mo$ths o'&
6ro$e 6ositio$ : 4 mo$ths o'&
Sitti$! : + mo$ths o'&
Cra'i$! : = mo$ths o'&
Sta$&i$! : "0 mo$ths o'&
*a'i$! : "2 mo$ths o'&
Co$5'sio$: !roth a$& &e8e'opme$ta' is sti'' i$ the $orma' 'imits a$& as
appropriate a55or&i$! to the patie$ts a!e
Post Natal %istory
A1ter 9irth, the 9a9y 5he5e& at 'o5a' &o5tor a$& the i$1a$t state is hea'thy.
3istory o1 Eati$!
Breast Mi' : + mo$ths.
7orm'a mi' : S%M si$5e / mo$ths o'&
Ba9y 9is5its : Mi'$a, Re!a'
7rit a$& 8e!eta9'es : Ba$a$a, papaya
So'i& 1oo&s a$& si&e &ishes : Ba9y porri&!e
Imm$i?atio$ 3istory
Imm$i?atio$ [email protected]$5y Time
BC% " time " mo$th o'&
3epatitis B # times 0, ", + mo$ths o'&
D6T # times 2, 4, + mo$ths o'&
6o'io 4 times 0, 2, 4, + mo$ths o'&
3i9 4 times 2, 4, +, mo$ths o'&
Meas'es " time mo$ths o'&
7ami'y 3istory
• 6atie$ts 1ather &i&$t ha8e hyperte$sio$ $or &ia9etes me''its
• 6atie$ts mother &i&$t ha8e hyperte$sio$ $or &ia9etes me''its
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The patie$t has " sister, a$& he is the 1irst 5hi'& o1 2 si9'i$!s.
Bor$ &ie& :
Chi'& &ies :
Mis5arria!e :
3istory o1 Disease i$ Other 7ami'y Mem9ers ) Aro$& the 3ose
3er $ei!h9ors so$ ha& meas'es a ee a!o.
P%YSIA) E*AMINATI+N ,August -.th -0.1
2eneral Status
- %e$era' 5o$&itio$ : Mi'&'y i''
- Co$s5ios$ess : Compos Me$tis
- 6'se : "00 )mi$, re!'ar, 1'', stro$!.
- Breathi$! rate : 20 )mi$
- Temperatre : #=.#o C per ai''a
Anthro#ometry Status
-*ei!ht : 2+ i'o!ram
-3ei!ht : "#" 5m
Ntritio$a' Stats 9ase& NC3S Natio$a' Ce$ter 1or 3ea'th Statisti5s year 2000:
*7A Weight for Age: 2+)#" "00 =# !oo& $tritio$
37A 3ei!ht 1or A!e: "#")"#/ "00 !oo& $tritio$
*73 *ei!ht 1or 3ei!ht: 2+)2+ "00 "00 !oo& $tritio$
Conclusion: The patient has good nutritional status.
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%ead to Toe E3amination
%ead
Normo5epha'y, hair 9'a5, $orma' &istri9to$, $ot easi'y remo8e& si!$ o1
trama , 'ar!e 1o$ta$e''e 5'ose&. Rash ,41
Eyes
I5teri5 s5'era ), pa'e 5o$F$5ti8a ), hy#eraemia con5uncti(a 4/4,
'a5rimatio$ ), s$e$ eyes ), ppi's #mm)#mm isoor, Dire5t a$& i$&ire5t
'i!ht respo$se ;;);;
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Ears
Norma' shape, $o o$&, $o 9'ee&i$! ,se5retio$ or serme$. Rash ,41
Nose
Norma' shape, mi&'i$e septm, se5retio$ ). Rash ,41
Mouth
− Lips: &ry
− Teeth: $o 5aries
− M5os: moist
− To$!e: Not &irty
− To$si's: T")T", No hyperemia
− 6hary$: hyperemia
Nec6
Lymph $o&e e$'ar!eme$t ;, s5ro1'o&erma , Rash ,41
Thora3 :
i7 I$spe5tio$ : symmetri5 he$ 9reathi$! 8 $o retra5tio$, i5ts 5or&is is $ot
8isi9'e. Rash ,41
ii7 6a'patio$ : mass , ta5ti'e 1remits ;);
iii7 6er5ssio$ : so$or o$ 9oth '$!s
i(7 As5'tatio$ :". Cor : re!'ar S"S2, mrmr , !a''op
2. 6'mo : 8esi5'ar ;);, *hee?i$! ) , Rho$5hy )
Abdomen :
i7 I$spe5tio$ : Co$8e, epi!astri5 retra5tio$ , there is $o a i&e$i$! o1 the
8ei$s, $o spi&er $e8i. Rash ,41
ii7 As5'tatio$ : 9oe' so$& $orma' , 9rit
iii7 6a'patio$ : spp'e, 'i8er a$& sp'ee$ $ot pa'pa9'e, 1'i& a8e ,
a9&omi$a' mass
i(7 6er5ssio$ : The e$tire 1ie'& o1 tympa$i5 a9&ome$, shi1ti$! &''$ess
9ertebra : There &oes $ot appear s5o'iosis, yphosis, a$& 'or&osis, &o $ot
'oo a$y mass a'o$! the 'i$e o1 the 8erte9ra'
E6stremities : arm, 5api''ary re1i'' time G 2 se5o$&, e&ema rash ,41
S6in : %oo& tr!or.
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Neurological E3amination
Meningeal Sign
Motoric E3amination
Po:er
3a$& 7eet
) )
Tonus
3a$&
7eet
Normoto$s ) Normoto$s
Normoto$s ) Normoto$s
Tro#hy
3a$&
7eet
Normotrophy ) Normotrophy
Normotrophy ) Normotrophy
Physiologic Re!le3
Hpper etrimities
Bi5eps
Tri5eps
Loer etrimities
6ate''a
A5hi''es
; ) ;
; ) ;
; ) ;
; ) ;
Pathologic Re!le3
Hpper etrimities
3o11ma$
Trommer
Loer etrimities
Ba9i$sy
Cha&&o5
Oppe$heim
%or&o$
S5hae11er
)
)
)
)
)
)
)
lonus
6ate''a
A5hi''es
)
)
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Autonom E3amination
De1e5atio$
Hri$atio$
Seati$!
Norma' " times &ai'y, $orma' 5o$siste$5y
Norma' 4 times &ai'y
Norma'
)aboratory In(estigation
%ematology August -.th -0.
3emato'o!y Res'ts Norma'
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O %e$era' 5o$&itio$: Compos Me$tis
3eart rate "00 )mi$
Respiratory rate 2+ )mi$
Temperatre #/.C
Car&io : S")S2, re!'er, $o mrmr, $o !a''op
6'mo$ary : 8esi5'er ;);, rho$5hi ), hee?i$! )A9&ome$ : &iste$tio$ , 9oe' so$& ; $orma'
Rash ,41
A Mor9i''i
6 − I
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7e8er
Rash ;
Cory?a ;
O %e$era' 5o$&itio$: Compos Me$tis
3eart rate ""0 )mi$
Respiratory rate 24 )mi$Temperatre #+C
Car&io : S")S2, re!'er, $o mrmr, $o !a''op
6'mo$ary : 8esi5'er ;);, rho$5hi ), hee?i$! )
A9&ome$ : &iste$tio$ , 9oe' so$& ; $orma'
Rash ,41
A Mor9i''i
6 − I
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SECTION II
LITERATHRE O7 RE
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o1 rash. Approimate'y 0 o1 epose& ss5epti9'e i$&i8i&a's eperie$5e meas'es.
7a5eto1a5e 5o$ta5t is $ot $e5essary, 9e5ase 8ia9'e 8irs may 9e sspe$&e& i$ air 1or
as 'o$! as " hor a1ter the patie$t ith the sor5e 5ase 'ea8es a room. Se5o$&ary 5ases
&e to sprea& o1 aeroso'i?e& 8irs ha8e 9ee$ reporte& i$ physi5ia$s o11i5es a$& i$
hospita's.
Meas'es i$1e5tio$ 5ases $e5rosis o1 the respiratory tra5t epithe'im a$& a$
a55ompa$yi$! 'ympho5yti5 i$1i'trate. Meas'es pro&5es a sma'' 8esse' 8as5'itis o$
the si$ a$& o$ the ora' m5os mem9ra$es. 3isto'o!y o1 the rash a$& ea$them
re8ea's i$tra5e'''ar e&ema a$& &yseratosis asso5iate& ith 1ormatio$ o1 epi&erma'
sy$5ytia' !ia$t 5e''s ith p to 2+ $5'ei.
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C'i$i5a' Ma$i1estatio$s
Meas'es is a serios i$1e5tio$ 5hara5teri?e& 9y hi!h 1e8er, e$a$them 5o!h, 5ory?a,
5o$F$5ti8itis, a$& a promi$e$t ea$thema. A1ter a$ i$59atio$ perio& o1 ="2 &ays,
the pro&roma' phase 9e!i$s ith a mi'& 1e8er 1o''oe& 9y the o$set o1 5o$F$5ti8itis
ith photopho9ia, 5ory?a, a promi$e$t 5o!h, a$& i$5reasi$! 1e8er. (op'i spots
represe$t the e$a$them a$& are the patho!$omo$i5 si!$ o1 meas'es, appeari$! " to 4
&ays prior to the o$set o1 the rash. They 1irst appear as &is5rete re& 'esio$s ith 9'ish
hite spots i$ the 5e$ter o$ the i$$er aspe5ts o1 the 5hees at the 'e8e' o1 the
premo'ars. They may sprea& to i$8o'8e the 'ips, har& pa'ate, a$& !i$!i8a. They a'so
may o55r i$ 5o$F$5ti8a' 1o'&s a$& i$ the 8a!i$a' m5osa. (op'i spots ha8e 9ee$
reporte& i$ 0/0 o1 meas'es 5ases 9t pro9a9'y o55r i$ the !reat maFority.
Symptoms i$5rease i$ i$te$sity 1or 24 &ays $ti' the "st &ay o1 the rash Erptio$
phase. The rash 9e!i$s o$ the 1orehea& aro$& the hair'i$e, 9ehi$& the ears, a$& o$
the pper $e5 as a re& ma5'opap'ar erptio$. It the$ sprea&s &o$ar& to the torso
a$& etremities, rea5hi$! the pa'ms a$& so'es i$ p to 0 o1 5ases. The ea$them
[email protected]$t'y 9e5omes 5o$1'e$t o$ the 1a5e a$& pper tr$.
*ith the o$set o1 the rash, symptoms 9e!i$ to s9si&e. The rash 1a&es o8er a9ot /
&ays i$ the same pro!ressio$ as it e8o'8e&, o1te$ 'ea8i$! a 1i$e &[email protected]$ o1 si$
i$ its ae Co$8a'es5e$ts) Re5o8ery 6hase . O1 the maFor symptoms o1 meas'es, the
5o!h 'asts the 'o$!est, o1te$ p to "0 &ays. I$ more se8ere 5ases, !e$era'i?e&
'ympha&e$opathy may 9e prese$t, ith 5er8i5a' a$& o55ipita' 'ymph $o&es espe5ia''y
promi$e$t
I$ i$&i8i&a's ith passi8e'y [email protected]& a$ti9o&y, s5h as i$1a$ts a$& re5ipie$ts o1
9'oo& pro&5ts, a s95'i$i5a' 1orm o1 meas'es may o55r. The rash may 9e i$&isti$5t,
9rie1, or, rare'y, e$tire'y a9se$t. Lieise, some i$&i8i&a's ho ha8e re5ei8e&
8a55i$e, he$ epose& to meas'es, may ha8e a rash 9t 1e other symptoms. 6erso$s
ith i$appare$t or s95'i$i5a' meas'es &o $ot she& meas'es 8irs a$& &o $ot tra$smit
i$1e5tio$ to hoseho'& 5o$ta5ts.
Chi'&re$ ho ha& re5ei8e& the ori!i$a' 1orma'i$i$a5ti8ate& meas'es 8a55i$e at times
&emo$strate& a more se8ere 1orm o1 &isease 5a''e& atypi5a' meas'es. S5h patie$tsha& o$set o1 hi!h 1e8er a$& hea&a5he 1o''oe& 9y the appeara$5e o1 a ma5'opap'ar
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rash o$ the etremities that 9e5ome pete5hia' a$& prpri5 a$& pro!resse& i$ a
5e$tripeta' &ire5tio$. 6$emo$ia a$& p'era' e11sio$s [email protected]$t'y 5omp'i5ate& the
i''$ess. It is tho!ht that atypi5a' meas'es as 5ase& 9y &e8e'opme$t o1 5ir5'ati$!
imm$e 5omp'ees that 1orme& as a res't o1 a$ a9$orma' imm$e respo$se to the
8a55i$e.
La9oratory Data
The &ia!$osis o1 meas'es is a'most a'ays 9ase& o$ 5'i$i5a' a$& epi&emio'o!i5
1i$&i$!s. La9oratory 1i$&i$!s i$ the a5te phase i$5'&e re&5tio$ i$ the tota' hite
9'oo& 5e'' 5o$t, ith 'ympho5ytes &e5rease& more tha$ $etrophi's. A9so'te
$etrope$ia has 9ee$ $o$ to o55r, hoe8er. I$ meas'es $ot 5omp'i5ate& 9y
9a5teria' i$1e5tio$, the erythro5yte se&ime$tatio$ rate a$& Crea5ti8e protei$ 'e8e' are
$orma'.
A$ti9o&y Assays
The meas'es 8irs sa$&i5h5aptre I!M a$ti9o&y assay, is the
@i5est metho& o1 5o$1irmi$! a5te meas'es. Be5ase I!M may $ot 9e
&ete5ta9'e &ri$! the 1irst 2 &ays o1 rash, o9tai$ 9'oo& 1or meas'esspe5i1i5
I!M o$ the thir& &ay o1 the rash or o$ a$y [email protected]$t &ay p to " mo$th a1ter
o$set to a8oi& a 1a'se$e!ati8e I!M res't.
Amo$! perso$s ith 5o$1irme& meas'es i$1e5tio$, the seropositi8ity
rate 1or 1irst samp'es is a9ot // he$ 5o''e5te& ithi$ /2 horsP the rate
rises to "00 he$ 5o''e5te& 4"" &ays a1ter rash o$set. A'tho!h the meas'es
serm I!M 'e8e' remai$s positi8e #0+0 &ays a1ter the i''$ess i$ most
i$&i8i&a's, the I!M titer may 9e5ome $&ete5ta9'e i$ some s9Fe5ts at 4
ees a1ter rash o$set. 7a'sepositi8e res'ts 5a$ o55r i$ patie$ts ith
rhemato'o!i5 &iseases, par8o8irs B" i$1e5tio$, or i$1e5tios
mo$o$5'eosis.
Imm$o!'o9'i$ %
La9oratories 5a$ 5o$1irm meas'es 9y &emo$strati$! more tha$ a 41o'&
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rise i$ I!% a$ti9o&ies 9etee$ a5te a$& 5o$8a'es5e$t sera, a'tho!h re'yi$!
so'e'y o$ risi$! I!% titers 1or the &ia!$osis &e'ays treatme$t 5o$si&era9'y. The
ear'ier the a5te serm is &ra$, the more re'ia9'e the res'ts. I!% a$ti9o&ies
may 9e &ete5ta9'e 4 &ays a1ter the o$set o1 the rash, a'tho!h most 5ases ha8e
&ete5ta9'e I!% a$ti9o&ies 9y a9ot a ee a1ter rash o$set.
A55or&i$!'y, it is re5omme$&e& that spe5ime$s 9e &ra$ o$ the
se8e$th &ay a1ter rash o$set. B'oo& &ra$ 1or 5o$8a'es5e$t serm sho'& 9e
&ra$ "0"4 &ays a1ter that &ra$ 1or a5te serm, a$& the a5te a$&
5o$8a'es5e$t sera sho'& 9e teste& sim'ta$eos'y as paire& sera.
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Dia!$osis
I$ the a9se$5e o1 a re5o!$i?e& meas'es ot9rea, 5o$1irmatio$ o1 the 5'i$i5a'
&ia!$osis is o1te$ re5omme$&e&. Sero'o!i5 5o$1irmatio$ is most 5o$8e$ie$t'y ma&e
9y i&e$ti1i5atio$ o1 imm$o!'o9'i$ M I!M a$ti9o&y i$ serm. Sero'o!i5
5o$1irmatio$ may a'so 9e ma&e 9y &emo$stratio$ o1 a 1or1o'& rise i$ I!% a$ti9o&ies
i$ a5te a$& 5o$8a'es5e$t spe5ime$s 5o''e5te& 24 ees 'ater.
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(op'i spots a$& a se8ere pro&roma' 5o!h, a$& typi5a''y 'ea&s to e'e8atio$s o1
$etrophi's a$& a5tephase rea5ta$ts. I$ a&&itio$, the 5hara5teristi5 throm9o5ytosis
o1 (aasai sy$&rome is a9se$t i$ meas'es. Dr! erptio$s may o55asio$a''y 9e
mistae$ 1or meas'es.
The &ia!$osis o1 meas'es is sa''y &etermi$e& 1rom the 5'assi5 5'i$i5a'
pi5tre, i$5'&i$! the 5'assi5 tria& o1 5o!h, 5ory?a, a$& 5o$F$5ti8itisP the
patho!$omo$i5 (op'i spotsP a$& the 5hara5teristi5 5epha'o5a&a' pro!ressio$ o1 the
mor9i''i1orm ea$them.
It is orthhi'e to 9e mi$&1' o1 the sy$&rome $o$ as atypi5a' meas'es,
hi5h has 9ee$ &es5ri9e& i$ i$&i8i&a's ho ere i$1e5te& ith i'& meas'es 8irs
se8era' years a1ter imm$i?atio$ ith a i''e& meas'es 8a55i$e a 8a55i$e se& i$ the
H$ite& States 1rom "+#"+/. This sy$&rome te$&s to 9e more pro'o$!e& a$&
se8ere tha$ re!'ar meas'es a$& is mare& 9y a pro'o$!e& hi!h 1e8er, p$emo$itis,
a$& a rash that 9e!i$s periphera''y a$& may 9e rti5aria', ma5'opap'ar,
hemorrha!i5, a$&)or 8esi5'ar.
The assme& patho!e$esis o1 atypi5a' meas'es is hyperse$siti8ity to meas'es
8irs i$ a partia''y imm$e host. La9oratory tests re8ea' a 8ery 'o meas'es a$ti9o&y
titer ear'y i$ the 5orse o1 the &isease, 1o''oe& soo$ therea1ter 9y the appeara$5e o1
a$ etreme'y hi!h meas'es imm$o!'o9'i$ % I!% a$ti9o&y titer e!, ":",000,000
i$ the serm.
Other &ia!$oses to 9e 5o$si&ere& i$5'&e the 1o''oi$!:
(aasai &isease
De$!e
Serm si5$ess
Syphi'is
Systemi5 'ps erythematoss
Toi5 sho5 sy$&rome
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Treatme$t
Ma$a!eme$t o1 meas'es is spporti8e. A$ti8ira' therapy is $ot e11e5ti8e i$ the
treatme$t o1 meas'es i$ otherise $orma' patie$ts. Mai$te$a$5e o1 hy&ratio$,
oy!e$atio$, a$& 5om1ort are !oa's o1 therapy. A$tipyreti5s 1or 5om1ort a$& 1e8er
5o$tro' are se1'. 7or patie$ts ith respiratory tra5t i$8o'8eme$t, airay hmi&i
1i5atio$ a$& spp'eme$ta' oy!e$ may 9e o1 9e$e1it. Respiratory 1ai're &e to 5rop
or p$emo$ia may [email protected] 8e$ti'atory spport. Ora' rehy&ratio$ is e11e5ti8e i$ most
5ases, 9t se8ere &ehy&ratio$ may [email protected] i$tra8e$os therapy. 6rophy'a5ti5 a$ti
mi5ro9ia' therapy to pre8e$t 9a5teria' i$1e5tio$ is $ot i$&i5ate&.
Meas'es i$1e5tio$ i$ imm$o5ompromise& patie$ts is hi!h'y 'etha'. Ri9a8iri$
is a5ti8e i$ 8itro a!ai$st meas'es 8irs. A$e5&ota' reports o1 ri9a8iri$ therapy ith or
ithot i$tra8e$os !amma !'o9'i$ s!!est some 9e$e1it i$ i$&i8i&a' patie$ts.
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Comp'i5atio$s
Comp'i5atio$s o1 meas'es are 'ar!e'y attri9ta9'e to the patho!e$i5 e11e5ts o1
the 8irs o$ the respiratory tra5t a$& imm$e system Se8era' 1a5tors mae
5omp'i5atio$s more 'ie'y. Mor9i&ity a$& morta'ity 1rom meas'es are !reatest i$
patie$ts years o1 a!e espe5ia''y " years o1 a!e a$& 20 years o1 a!e. I$
&e8e'opi$! 5o$tries, hi!her 5ase 1ata'ity rates ha8e 9ee$ asso5iate& ith 5ro&i$!,
hi5h are possi9'y attri9ta9'e to 'ar!er i$o5'm &oses a1ter hoseho'& eposre.
Se8ere ma'$tritio$ i$ 5hi'&re$ res'ts i$ s9optima' imm$e respo$se a$& hi!her
mor9i&ity a$& morta'ity ith meas'es i$1e5tio$. Meas'es i$1e5tio$ 'oers serm
reti$o' 5o$5e$tratio$s, so s95'i$i5a' 5ases o1 hyporeti$o'emia may 9e ma&e
symptomati5 &ri$! meas'es. Meas'es i$1e5tio$ i$ imm$o5ompromise& perso$s is
asso5iate& ith i$5rease& mor9i&ity a$& morta'ity. Amo$! patie$ts ith ma'i!$a$5y
i$ hom meas'es &e8e'ops, p$emo$itis o55rs i$ = a$& e$5epha'itis i$ 20.
6$emo$ia is the most 5ommo$ 5ase o1 &eath i$ meas'es. It may ma$i1est as
!ia$t 5e'' p$emo$ia 5ase& &ire5t'y 9y the 8ira' i$1e5tio$ or as sperimpose&
9a5teria' i$1e5tio$. The most 5ommo$ 9a5teria' patho!e$s are Strepto5o55s
p$emo$iae, 3aemophi's i$1'e$?ae, a$& Staphy'o5o55s ares. 7o''oi$! se8ere
meas'es p$emo$ia, the 1i$a' 5ommo$ pathay to a 1ata' ot5ome is o1te$ the
&e8e'opme$t o1 9ro$5hio'itis o9'itera$s. 5rop, tra5heitis, a$& 9ro$5hio'itis are
5ommo$ 5omp'i5atio$s i$ i$1a$ts a$& to&&'ers ith meas'es. The 5'i$i5a' se8erity o1
these 5omp'i5atio$s [email protected]$t'y [email protected] i$t9atio$ a$& 8e$ti'atory spport $ti' the
i$1e5tio$ reso'8es.
Meas'es i$1e5tio$ is $o$ to sppress si$ test respo$si8e$ess to pri1ie&
t9er5'i$ a$ti!e$. There may 9e a hi!her rate o1 a5ti8atio$ o1 p'mo$aryt9er5'oses i$ pop'atio$s o1 i$&i8i&a's i$1e5te& ith My5o9a5terim t9er5'osis
ho are the$ epose& to meas'es.
Diarrhea a$& 8omiti$! are 5ommo$ symptoms asso5iate& ith a5te meas'es,
a$& &i11se !ia$t 5e'' 1ormatio$ is 1o$& i$ the epithe'im the !astroi$testi$a' tra5t.
Dehy&ratio$ is a 5ommo$ [email protected]$5e, espe5ia''y i$ yo$! i$1a$ts a$& 5hi'&re$.
Appe$&i5itis may o55r 1rom o9str5tio$ o1 the appe$&i5ea' 'me$ 9y 'ymphoi&
hyperp'asia.
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7e9ri'e sei?res o55r i$ # o1 5hi'&re$ ith meas'es. E$5epha'itis
1o''oi$! meas'es has 9ee$ a 'o$!asso5iate& 5omp'i5atio$, o1te$ ith a$ $1a8ora9'e
ot5ome. Rates o1 "#)",000 5ases o1 meas'es ha8e 9ee$ reporte&, ith !reater
$m9ers o55r ri$! i$ a&o'es5e$ts a$& a&'ts tha$ i$ pres5hoo' or s5hoo'a!e&
5hi'&re$. E$5epha'itis is a posti$1e5tios, imm$o'o!i5a''y me&iate& pro5ess a$& is
$ot &e to a &ire5t e11e5t 9y the 8irs. C'i$i5a' o$set 9e!i$s &ri$! the ea$them a$&
ma$i1ests as sei?res +, 'ethar!y 4+, 5oma 2=, a$& irrita9i'ity 2+.
7i$&i$!s i$ 5ere9rospi$a' 1'i& CS7 i$5'&e 'ympho5yti5 p'eo5ytosis i$ = o1
5ases a$& e'e8ate& protei$ 5o$5e$tratio$. Approimate'y " o1 patie$ts ith
meas'es e$5epha'itis &ie, a$& 2040 s11er 'o$!term [email protected]'ae, i$5'&i$! me$ta'
retar&atio$, motor &isa9i'ities, a$& &ea1$ess.
Meas'es e$5epha'itis i$ imm$o5ompromise& patie$ts res'ts 1rom &ire5t
&ama!e to the 9rai$ 9y the 8irs. S9a5te meas'es e$5epha'itis ma$i1ests ""0 mo
a1ter meas'es i$ imm$o5ompromise& patie$ts, parti5'ar'y those ith AIDS,
'ymphoreti5'ar ma'i!$a$5ies, a$& imm$osppressio$. Si!$s a$& symptoms i$5'&e
sei?res, myo5'o$s, stpor, a$& 5oma. I$ a&&itio$ to i$tra5e'''ar i$5'sio$s,
a9$&a$t 8ira' $5'eo5apsi&s a$& 8ira' a$ti!e$ are see$ i$ 9rai$ tisse. 6ro!ressi8e
&isease a$& &eath a'most a'ays o55r.
A se8ere 1orm o1 meas'es rare'y see$ $o is hemorrha!i5 meas'es or 9'a5
meas'es. It ma$i1este& as a hemorrha!i5 si$ erptio$ a$& as o1te$ 1ata'. (eratitis,
appeari$! as m'tip'e p$5tate epithe'ia' 1o5i, reso'8e& ith re5o8ery 1rom the
i$1e5tio$. Throm9o5ytope$ia sometimes o55rre& 1o''oi$! meas'es.
Myo5ar&itis is a rare 5omp'i5atio$ o1 meas'es. Mis5e''a$eos 9a5teria'
i$1e5tio$s ha8e 9ee$ reporte&, i$5'&i$! 9a5teremia, 5e'''itis, a$& toi5 sho5 sy$&rome. Meas'es &ri$! pre!$a$5y has 9ee$ asso5iate& ith hi!h mater$a'
mor9i&ity, 1eta' asta!e a$& sti''9irths, a$& 5o$!e$ita' ma'1ormatio$s i$ # o1 'i8e
9or$ i$1a$ts.
S9a5te s5'erosi$! pa$e$5epha'itis SS6E is a 5hro$i5 5omp'i5atio$ o1
meas'es ith a &e'aye& o$set a$& a$ ot5ome that is $ear'y a'ays 1ata'. It appears to
res't 1rom a persiste$t i$1e5tio$ ith a$ a'tere& meas'es 8irs that is har9ore&
i$tra5e'''ar'y i$ the CNS 1or se8era' years. A1ter /"0 years the 8irs appare$t'y
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re!ai$s 8ir'e$5e a$& atta5s the 5e''s i$ the CNS that o11ere& the 8irs prote5tio$.
This s'o 8irs i$1e5tio$ res'ts i$ i$1'ammatio$ a$& 5e'' &eath, 'ea&i$! to a$
i$eora9'e $ero&e!e$erati8e pro5ess.
The patho!e$esis o1 SS6E remai$s e$i!mati5. 7a5tors that seem to 9e
i$8o'8e& i$5'&e &e1e5ti8e meas'es 8irs a$& i$tera5tio$ ith a &e1e5ti8e or immatre
imm$e system. The 8irs iso'ate& 1rom 9rai$ tisse o1 patie$ts ith SS6E is missi$!
" o1 the + str5tra' protei$s, the matri or M protei$. This protei$ is respo$si9'e 1or
assem9'y, orie$tatio$, a$& a'i!$me$t o1 the 8irs i$ preparatio$ 1or 9&&i$! &ri$!
8ira' rep'i5atio$. Immatre 8irs may 9e a9'e to resi&e, a$& possi9'y propa!ate, ithi$
$ero$a' 5e''s 1or 'o$! perio&s. The 1a5t that most patie$ts ith SS6E ere epose& at
a yo$! a!e s!!ests that imm$e immatrity is i$8o'8e& i$ patho!e$esis. I$
a&&itio$, the i$tra5e'''ar 'o5atio$ o1 the 8irs [email protected] it 1rom the imm$e system,
espe5ia''y 1rom hmora' imm$ity.
C'i$i5a' ma$i1estatio$s o1 SS6E 9e!i$ i$si&ios'y /"# years a1ter primary
meas'es i$1e5tio$. S9t'e 5ha$!es i$ 9eha8ior or s5hoo' per1orma$5e appear,
i$5'&i$! irrita9i'ity, re&5e& atte$tio$ spa$, a$& temper ot9rsts. This i$itia' phase
sta!e I may at times 9e misse& 9e5ase o1 9re8ity or mi'&$ess o1 the symptoms.
7e8er, hea&a5he, a$& other si!$s o1 e$5epha'itis are a9se$t. The ha''mar o1 the
se5o$& sta!e is massi8e myo5'o$s, hi5h 5oi$5i&es ith ete$sio$ o1 the
i$1'ammatory pro5ess site to &eeper str5tres i$ the 9rai$, i$5'&i$! the 9asa'
!a$!'ia. I$8o'$tary mo8eme$ts a$& repetiti8e myo5'o$i5 Fers 9e!i$ i$ si$!'e ms5'e
!rops 9t !i8e ay to massi8e spasms a$& Fers i$8o'8i$! 9oth aia' a$&
appe$&i5'ar ms5'es. Co$s5ios$ess is mai$tai$e&. I$ the thir& sta!e, i$8o'$tary
mo8eme$ts &isappear a$& are rep'a5e& 9y 5horeoathetosis, immo9i'ity, &ysto$ia, a$&
'ea& pipe ri!i&ity that res't 1rom &estr5tio$ o1 &eeper 5e$ters i$ the 9asa' !a$!'ia.
Se$sorim &eteriorates i$to &eme$tia, stpor, a$& the$ 5oma. The 1orth sta!e
is 5hara5teri?e& 9y 'oss o1 5riti5a' 5e$ters that spport 9reathi$!, heart rate, a$& 9'oo&
pressre. Death soo$ e$ses. 6ro!ressio$ thro!h the 5'i$i5a' sta!es may 1o''o
5orses 5hara5teri?e& as a5te, s9a5te, or 5hro$i5 pro!ressi8e.
The &ia!$osis o1 SS6E 5a$ 9e esta9'ishe& thro!h &o5me$tatio$ o1 a
5ompati9'e 5'i$i5a' 5orse a$& at 'east " o1 the 1o''oi$! spporti$! 1i$&i$!s:
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" meas'es a$ti9o&y &ete5te& i$ CS7,
2 5hara5teristi5 e'e5troe$5epha'o!raphi5 1i$&i$!s,
# typi5a' histo'o!i5 1i$&i$!s i$ a$&)or iso'atio$ o1 8irs or 8ira' a$ti!e$ 1rom 9rai$tisse o9tai$e& 9y 9iopsy or postmortem eami$atio$.
CS7 a$a'ysis re8ea's $orma' 5e''s 9t e'e8ate& I!% a$& I!M a$ti9o&y titers i$
&i'tio$s ":=. E'e5troe$5epha'o!raphi5 pat ter$s are $orma' i$ sta!e I, 9t i$ the
myo5'o$i5 phase, sppressio$9rst episo&es are see$ that are 5hara5teristi5 o1 9t $ot
patho!$omo$i5 1or SS6E. Brai$ 9iopsy is $o 'o$!er roti$e'y i$&i5ate& 1or &ia!$osis
o1 SS6E.
Ma$a!eme$t o1 SS6E is primari'y spporti8e a$& simi'ar to 5are pro8i&e& to
patie$ts ith other $ero&e!e$erati8e &iseases
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The 5rre$t re5omme$&atio$s i$5'&e a 1irst &ose at mo$ths o'& 1o''oe& 9y a
se5o$& &ose at 24 moths o'& a$& + years o'& 1or meas'es a$& 1irst &ose at " mo$ths
o'& a$& 1o''oe& 9y se5o$& &ose at + years o'&.
A&8erse e8e$ts 1rom the MMR 8a55i$e i$5'&e 1e8er sa''y +"2 &ays
1o''oi$! 8a55i$atio$, rash i$ a9ot o1 8a55i$es, a$&, rare'y, tra$sie$t
throm9o5ytope$ia. Chi'&re$ pro$e to 1e9ri'e sei?res may eperie$5e a$ e8e$t
1o''oi$! 8a55i$atio$, so the riss a$& 9e$e1its o1 8a55i$atio$ sho'& 9e &is5sse&
ith pare$ts. E$5epha'opathy a$& atism ha8e $ot 9ee$ sho$ to patie$ts ith 3I<
ho are $ot se8ere'y imm$o5ompromise& sho'& 9e imm$i?e&. Be5ase meas'es
8irs may sppress the 5ta$eos respo$se to t9er5'os a$ti!e$, si$ testi$! 1or
t9er5'osis sho'& 9e per1orme& 9e1ore or at the same time as a&mi$istratio$ o1 the
8a55i$e. I$&i8i&a's i$1e5te& ith M. t9er5'osis sho'& 9e re5ei8i$! appropriate
treatme$t at the time o1 a&mi$istratio$ o1 meas'es 8a55i$e.
6osteposre 6rophy'ais
Ss5epti9'e i$&i8i&a's epose& to meas'es may 9e prote5te& 1rom i$1e5tio$
9y either 8a55i$e a&mi$istratio$ or imm$i?atio$ ith imm$e !'o9'i$. The 8a55i$e
is e11e5ti8e i$ pre8e$tio$ or mo&i1i5atio$ o1 meas'es i1 !i8e$ ithi$ /2 hors o1
eposre. Imm$e !'o9'i$ may 9e !i8e$ p to + &ays a1ter eposre to pre8e$t or
mo&i1y i$1e5tio$. Imm$o5ompete$t 5hi'&re$ sho'& re5ei8e 0.2 mL)!
i$trams5'ar'y, a$& imm$o5ompromise& 5hi'&re$ sho'& re5ei8e 0. mL)!
maimm &ose i$ 9oth 5ases is " mL) !. Imm$e !'o9'i$ is i$&i5ate& 1or
ss5epti9'e hoseho'& 5o$ta5ts o1 meas'es patie$ts, espe5ia''y i$1a$ts + mo$ths o'&,
pre!$a$t ome$, a$& imm$o5ompromise& perso$s.
6ro!$osis
I$ the ear'y 20th 5e$try, &eaths &e to meas'es 8arie& 9etee$ 2,000 a$&
"0,000, or a9ot "0 &eaths per ",000 5ases o1 meas'es. *ith impro8eme$ts i$ hea'th
5are a$& a$timi5ro9ia' therapy, 9etter $tritio$, a$& &e5rease& 5ro&i$!, the &eathto
5ase ratio 1e'' to ")",000 5ases. I$ 20"4, *3O estimate& that there ere #0 &eaths
5ase& 9y meas'es i$ I$&o$esia, ith a &eathto5ase ratio o1 ".=2.)"00,000 5ases o1
meas'es. 6$emo$ia a$& e$5epha'itis ere 5omp'i5atio$s i$ most o1 the 1ata' 5ases,a$& imm$o&e1i5ie$5y 5o$&itio$s ere i&e$ti1ie& i$ "4"+ o1 &eaths.
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Re1ere$5es
". ('ie!ma$ RM, Sta$to$ B7, S5hor N7, Behrma$ RE, St.%eme -* 20""
Ne'so$ Tet9oo o1 6e&iatri5s, "th e&., H$ite& States o1 Ameri5a: E'se8ier
I$5.
2. (e$$eth To&ar H$i8ersity o1 *is5o$si$Ma&iso$ Departme$t o1 Ba5terio'o!y.
200+. Meas'es. O$'i$e, .9a5t.is5.e&)themi5ro9ia'or'&)Meas'es.Fp!,
A55esse& "2th may 20".
#. Ameri5a$ A5a&emy o1 6e&iatri5s. Meas'es. I$: 6i5eri$! L, Baer C,
(im9er'i$ D, Lo$! S, e&s. Re& Boo: 200 Report o1 the Committee o$
I$1e5tios Diseases. 2=th e&. E' %ro8e