MEASLES

MEASLES
IMRAN TARIQ.
UNIVERSITY COLLEGE OF PHARMACY
University OF THE PUNJAB
DEFINITION
Measles(khasraa) is…
an acute viral infection characterized by a

maculopapular rash erupting successively
over the neck, face, body, and extremities
and accompanied by a high fever.
ETIOLOGY
Measles virus
An RNA virus of the genus Morbillivirus in the family of
Paramyxoviridae
One serotype, human’s only host
Stable antigenicity
Rapidly inactivated by heat and light
Survival in low temperature.
Epidemiology
Measles is endemic(infection is
maintained in the population)
throughout the world.
In the past, epidemics tended to occur
irregularly, appearing in the spring in
large cities at 2-4-yr intervals as new
groups of susceptible children were
exposed.
4 06/14/24
Epidemiology (Cont.)
It is rarely subclinical.
Prior to the use of measles
vaccine, the peak incidence
was among children 5-10 yr of
age.
5 06/14/24
Infection sources
 Patients of acute stage and viral carriers of atypical
measles
Transmission
 Highly contagious, approximately 90% of susceptible
contacts acquire the disease.
 Respiratory secretions: maximal dissemination of virus
occurs by droplet spray during the prodromal period
(catarrhal stage).
 Contagious from 5 days before symptoms, 5 days after
onset of rash
 Seasons: in the spring, peak in Feb-May
PATHOGENESIS(the manner of development of a disease.) AND
PATHOLOGY(Pathology is a branch of medical science primarily concerning the examination of
organs, tissues, and bodily fluids in order to make a diagnosis of disease)
Portal of entry
 Respiratory tract and regional lymph nodes
 Enters bloodstream (primary viremia)  monocyte – phagocyte system  target
organs (secondary viremia).viremia is the presence of virus in blood
Target organs
 The skin; the mucous membranes of the nasopharynx,
bronchi, and intestinal tract; and in the conjunctivae, ect
Resulting In-----
1) Koplik spots and skin rash: serous exudation and proliferation of endothelial cells
around the capillaries
2) Conjunctivitis
PATHOGENESIS AND
PATHOLOGY
3) Laryngitis, croup(inflammation of windpipe),
bronchitis :general inflammatory reaction
4) Hyperplasia(enlargement) of lymphoid tissue:
multinucleated giant cells (Warthin-Finkeldey giant cells)
may be found
5) Interstitial pneumonitis(inflammation of alveoli):
6) Bronchopneumonia: due to secondary bacterial infections
7) Encephalomyelitis: perivascular demyelinization occurs in
areas of the brain and spinal cord.
CLINICAL MANIFESTATION
Typical Manifestation:
patients havn’t had measles immunization, or vaccine failure with

normal immunity or those havn’t used immune globulin
1. Incubation period (infection to symptoms) :

6-18days (average 10 days)
2. Prodromal period:
 3-4 days
 Non-specific symptoms: fever, malaise, anorexia, headache
 Classical triad: cough, coryza (runny nose), conjunctivitis (with
photophobia, lacrimation)
Koplik spots
An enanthem or red mottling is

usually present on the hard and
soft palates
the pathognomonic sign of
measles:
Enanthem (Koplik spots):
 Pathognomonic for measles

 24-48 hr before rash appears
 1mm, grayish white dots with
slight, reddish areolae
 Buccal mucosa, opposite the
lower 2nd molars
 increase within 1day and spread
 fade soon after rash onset
Koplik spots
3. Rash period
3-4days
Exanthem:
Erythematous, non-pruritic, maculopapular
 Upper lateral of the neck, behind ears, hairline,
face  trunk  arms and legs feet
 The severity of the disease is directly related to

the extent and confluence of the rash
,
Temperature:
 Rises abruptly as the rash appears
 Reaches 40℃ or higher
 Settles after 4-5 days – if persists, suspect secondary
infection
Coryza, fever, and cough:
 Increasingly severe up to the time the rash has covered the
body
Lymphadenopathy (posterior cervical region, mesenteric)
splenomegaly, diarrhoea, vomiting
Chest X ray:

May be abnormal, even in uncomplicated cases
4. Recovery period
3-4days
Exanthem:
 Fades in order of appearance
 brownish discoloration
Entire illness – 10 days

COMPLICATIONS
1. Respiratory Tract
Laryngitis, tracheitis, bronchitis – due to measles
itself
Laryngotrachobronchitis (croup) –cause airway
obstruction to require tracheostomy
Secondary pneumonia – immunocompromised,
malnourished patients. pneumococcus, group A
Streptococcus, Staphylococcus aureus and
Haemophilus influenzae type B.
Exacerbation of TB
COMPLICATIONS
2. Myocarditis
3. Malnutrition and Vitamin A deficiency

COMPLICATIONS
4. CNS
The incidence of encephalomyelitis is 1-2/l,000 cases of
measles
Onset occurs 2-5 days after the appearance of the rash
No correlation between the severity of the rash illness and
that of the neurologic involvement
 Earlier - direct viral effect in CNS
 Later – immune response causing demyelination
LABORATORY EXAMINATION
Isolation of measles virus from a clinical specimen (e.g.,
nasopharynx, urine)
Significant rise in measles IgG by any standard serologic
assay
Positive serologic test for measles IgM antibody
Immunofluorescence detects Measles antigens
Multinucleated giant cells in smears of nasal mucosa
Measles encephalitis – raised protein, lymphocytes in CSF
DIAGNOSIS
characteristic clinical picture:

Measles contact
Koplik spot
Features of the skin rash
The relation between the eruption and fever
Laboratory confirmation is rarely needed

DIFFERENTIAL DIAGNOSIS
The rash of measles must be differentiated from that of
rubella;
roseola intantum;
enteroviral infections;
scarlet fever;
and drug rashes.
Pathogen Features Rash fever Vs Rash
Measles Measles virus Cough coryza, conjunctivitis Red maculopapule fever for3-4days
Koplik spot after the Face  trunk  limbs rises abruptly as
2nd -3rd fever Desquamation and the rash appears
discoloration
Rubella Rubella virus Disease is mild, postau- Maculopapule fever for1-2days
ricular lymphadenopathy Face  trunk  limbs low or absent

No desquamation and during the rash
discoloration
Roseola Human Generally well, Seizures Rose colored, spreads high fever for3-5
Infantum herpesvirus 6 (5-10%) due to high to the neck and the days, ceases with
fever trunk the onset of rash
Scarlet fever Group A High fever, toxicity, Gooseflesh texture on fever for1-2days
Streptococcus Angina, strawberry tongue an erythematous base higher as the

Circumoral pallor, tonsillitis for 3-5 day, desquam- rash appears
ation after 1 week
Enteroviral Echovirus, Accompanied by respiratory Scattered macule or Rash appears
Infections Coxsackievirus or gastrointestinal maculopapule, few during or after
manifestation confluent, 1-3 days, fever
no desquamation
DIFFERENTIAL DIAGNOSIS
Scarlet fever
TREATMENT
Supportive, symptom-directed
Antipyretics for fever
Bed rest
Adequate fluid intake
Be protected from exposure to strong light
Antibiotics for otitis media( group of inflammatory
diseases of the middle ear), pneumonia
High doses Vitamin A in severe/ potentially severe
measles/ patients less than 2 years
100,000IU—200,000IU
Prevention.
Isolation precautions, especially in
hospitals and other institutions, should be
maintained from the 7th day after
exposure until 5 days after the rash has
appeared.
VACCINE
The initial measles immunization, usually as

measles-mumps-rubella (MMR) vaccine, is
recommended at 12-15 mo of age
MMR vaccine may be given for:
1. Measles postexposure
2. Outbreak prophylaxis as early as 6 mo
of age.
VACCINE (cont.)
A second immunization, also as MMR, is
recommended routinely at 4-6 yr of age
MMR may be administered at any time during childhood
provided at least 4 wk have elapsed since the first dose.
Second measles immunization should be given to :
1. Children who have not previously received the
second dose should be immunized by 11-12 yr of
age.
2.Adolescents entering college or the workforce
VACCINE (cont.)
A tuberculin test prior to or concurrent

with active immunization against measles
is desirable if tuberculosis is under
consideration.
VACCINE (cont.)
* Measles vaccine is not recommended for:

1. Pregnant women
2. Children with primary immunodeficiency
3. Untreated tuberculosis, cancer, or organ
transplantation
4. Those receiving long-term immunosuppressive
therapy
5. severely immunocompromised HIV-infected
children
PREVENTION
3. Postexposure Prophylaxis
Passive immunization with immune globulin (0.25mL/kg)
is effective for prevention and attenuation of measles within
5 days of exposure.
THANK YOU

MEASLES

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MEASLES

an acute viral infection characterized by a

patients havn’t had measles immunization, or vaccine failure with

1. Incubation period (infection to symptoms) :

An enanthem or red mottling is

 Pathognomonic for measles

 The severity of the disease is directly related to

Entire illness – 10 days

3. Malnutrition and Vitamin A deficiency

characteristic clinical picture:

Laboratory confirmation is rarely needed

ricular lymphadenopathy Face  trunk  limbs low or absent

Streptococcus Angina, strawberry tongue an erythematous base higher as the

The initial measles immunization, usually as

A tuberculin test prior to or concurrent

* Measles vaccine is not recommended for:

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