SGD Case Presentation 8

SGD CASE PRESENTATION
RESPIRATORY TRACT INFECTIONS

SGD GROUP
• Leader: Jon Edison Amores
• Members:
Darshankumar Gulabbhai Admane
Ananyaa Bhuyan
Kim Jean S. Canin
Gajendra Choudhary
Karen C. Del Rosario
Lapaswarint Atithdaechaphoom
CASE
The patient was a 3-year-old male who presented with a 4-day history of fever. He
became acutely ill and vomiting during lunch. Over the next 4 days he developed fever as
high as 40°C that were controlled by Tylenol. He also developed cough, rhinorrhea, and
conjunctivitis. He appeared to be fatigued and his parents reported that he was “very
sleepy". Over the past two days, his eyes begun to itch and were painful. His parents noted
that his eyes were puffy and he was sensitive to light. He had no rashes. The patient‘s lips
were dried and cracked, and he had a greatly reduced urinary output.
Other history pertinent to his illness is that he attended preschool twice per week,
where he had multiple sick contacts. His 1-year old sibling had otitis, some wheezing,
vomiting, and a productive cough.
On physical examination he had a temperature of 38.6°C pulse rate of 126/min, and

respiratory rate of 28/min. The significant findings included bilateral conjunctivitis with
exudate in the left eye, bleeding, cracked lips and rhinorrhea. He had shotty
lymphadenopathy, but no rash. His feet were slightly edematous. His respiratory examination
was normal. Laboratory findings were all normal. A nasopharyngeal swab was sent for rapid
antigen testing for RSV and influenza A virus.
HISTORY OF PRESENT ILLNESS:
• 3yr old male who presented 4-day history of fever
(acutely ill and vomiting)
• Developed high fever >40֯C over the next 4days
(controlled by tylenol)
• Developed cough, rhinorrhea, conjunctivitis
• Fatigued and very sleepy
• Eyes begun to itch and very painful over the past 2days
(puffy and sensitive to light)
• No rashes
• Lips dried and cracked and urinary output
Past Medical History
• Attended pre-school (x2 per week) with
multiple sick contacts
V/S
• Temperature of 38.6 ֯C
• Pulse rate of 126/min
• Respiratory rate of 28/min
LABORATORY FINDINGS
• Respiratory examination
-normal
• Nasopharyngeal swab (rapid antigen testing
for RSV and influenza)
-all normal
INITIAL DIAGNOSIS
ACUTE VIRAL INFECTION
CLINICAL MANIFESTATIONS
• Shotty lymphadenopathy (no rash)
• Bilateral conjunctivitis w/ exudate (L eye)
• Bleeding, cracked lips and rhinorrhea
• Slightly edematous (feet)
DIFFERENTIAL DIAGNOSIS
• Rubella
• Kawasaki syndrome
• Infectious mononucleosis
FINAL DIAGNOSIS
• MEASLES
• Based on the signs and symptoms, patient is

suffering from 3 Cs of measles: cough, coryza
and conjunctivitis
Measles (Rubeola) Virus Infections
• Measles is a highly contagious disease
characterized by fever, respiratory symptoms,
and followed by maculopapular rash.
• It has atleast a 90% secondary infection rate in
susceptible domestic contacts
EPIDEMIOLOGY
• Measles is endemic throughout the world.
• Before the availability of the vaccine, measles
infected over 90% of children before they
reached 15years of age.
• 2 million deaths and between 15,000 and 60,000
cases of blindness annually worldwide
• In the past, epidemics tended to appear in the
spring in large cities at 2-4yr intervals as new
groups of susceptible children were exposed.
ETIOLOGY
• Spherical, nonsegmented, single-stranded
negative-sense RNA virus
• Morbillivirus genus
• Antigenically monotypic
• Killed by UV light and heat
VIRULENCE FACTORS
1. Attachment:
Hemaglutinin protein binds to CD46, a
glycoprotein found on the surface of most
cells
VIRULENCE FACTORS
2. Evade the immune system:
The F (fusion) “Fusion Protein” is responsible
for fusion of virus and host cell membranes.
Immunosuppression: The measles virus blocks
T H proliferation response to IL-2. The measle’s
Hemagglutinin protein and Fusion proteins bind
to lymphocytes and interrupt IL-2 cell
signalling.
VIRULENCE FACTORS
3. Destruction of tissue:
The maculopapular rash, which starts at the hairline
and spreads over the whole body, is caused by immune
T cells targeted to the infected endothelial cells of the
small blood vessels.
T-cell deficient individuals do not have the rash, but do
have uncontrolled disease which usually results in
death.
The damage, as well as the control of the disease, is
mostly caused by the immune system.
PATHOGENESIS
• Measles virus is transmitted primarily by
respiratory droplets over short distances and
less commonly, by small-particle aerosols that
remain suspended in the air for long periods.
PATHOGENESIS
• Incubation period: 8-15 days
• Contagious during Prodromal phase (2-4days)
and first 2-5days of rash
• Maculopapular rash appears about day 14 just
as circulating antibodies become detectable,
the viremia disappears, and the fever falls
CLINICAL MANIFESTATIONS
• Measles is a serious infection characterized by
high fever, an enanthem (Koplik’s spots),
cough, coryza, conjunctivitis with
photophobia, and a prominent exanthem
LABORATORY DIAGNOSIS
• Antigen and Nucleic Acid Detection
RT-PCR
• Isolation and Identification of Virus

Monkey or human kidney cells or lymphoblastoid cell line
(B95-a)
Shell vial culture tests
• Serology
Measles-specific IgM antibody (EIA or IFA)
TREATMENT
• No specific antiviral therapy
• Vitamin A treatment
• Supportive measures:
hydration
administration of antipyretic drugs
COMPLICATIONS
COMPLICATIONS
PREVENTION
• Measles vaccine
monovalent form and in combination with
live attenuated rubella and mumps vaccine
(MMR) and live attenuated varicella vaccine
(MMRV)
highly effective and safe
PREVENTION
• 2 doses of vaccine are recommended for
children, and for adults at high risk of exposure,
healthcare workers and school personnel
• 1st dose at 12mos of age
• 2nd dose 18mos or 4-6yrs of age before entry to
school
• People born before 1956 are considered
immunised
PREVENTION
• The efficacy of 1 dose at 12mos of age is about
95%, whereas 2 doses provide immunity in
99% of recipients
• Common side effects of MMR vaccine
sore arm from the shot
fever
mild rash
temporary pain and stiffness in the joints
PROGNOSIS
• Mostly recovers and develop long-term
protective immunity to re-infection
THANK YOU!

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SGD CASE PRESENTATION

RESPIRATORY TRACT INFECTIONS

On physical examination he had a temperature of 38.6°C pulse rate of 126/min, and

• Based on the signs and symptoms, patient is

• Isolation and Identification of Virus

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