1、MEASLESDivision Of Infectious Diseases And Gastroenterologyl Acute respiratory infectious disease caused by measles virusl Clinical feature:Fever,Cough,Coryza,Conjunctivitis,Exantheml Specific sign:Kopliks Spots Division Of Infectious Diseases And Gastroenterology:ssRNAvirus Family:paramyxoviridaeDi
2、vision Of Infectious Diseases And Gastroenterology Only onePatients respiratory secretions Blood,Urine of patientsCharacterization:1.Sensitive to heat,ultraviolet light and disinfectant 2.Low temperature resistanceDivision Of Infectious Diseases And Gastroenterology infective stage:lThe infective st
3、age is from the late of incubation stage to the 5th day after rash eruption.lIf complication occurs,the infective stage prolongs to the 10th day after rash eruption.Infectious sources-PatientsDivision Of Infectious Diseases And GastroenterologyRoutes of transmissionDivision Of Infectious Diseases An
4、d GastroenterologyPopulation susceptibilityl It is susceptible to all the people without infection or inoculation.l The age of peak incidence is from 6 months to 5 years old.Division Of Infectious Diseases And GastroenterologyPrior to the use of vaccineAfter the use of vaccineMorbidity(1/100000)Majo
5、r epidemics:500-1000Mild epidemics:4009.5 in 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics appear by 2-4 yr intervalsLonger cycle Sporadic cases increasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complica
6、tionshigh mortality Atypical cases increasedmild manifestationsless complicationsrarely deathEpidemiological FeaturesDivision Of Infectious Diseases And GastroenterologyIncubation periodApparent manifestationsRespiratory epitheliumregional lymph nodesPrimary viremiamononuclear phagocytic system Resp
7、iratory tract,conjunctiva,skin,etcVirus eliminationsecondary viremiaDivision Of Infectious Diseases And GastroenterologyReported mechanisms of measles immune suppression.1.Functional Impairment1)Suppression of lymphocyte proliferation2)Altered cytokine profiles3)Lymphoproliferation defect due to MV-
8、infected DC4)Immune modulation mediated by viral proteins5)Modulation of cell membrane components6)Inhibition of hematopoiesis2.Depletion1)Lymphocyte infection&depletion2)Bystander lymphocyte apoptosis3)DC infection&depletion4)T-cell apoptosis after interaction with MV-infected DCDivision Of Infecti
9、ous Diseases And Gastroenterology-Multinucleated giant cell(MGC)=15-100m MGC is the basic pathological change,with early diagnosis value.Division Of Infectious Diseases And Gastroenterology2 2、Maculopapular rash Branny desquamation Brownish discoloration3 3、Kopliks Spots1.Respiratory tract involveme
10、nt widelyDivision Of Infectious Diseases And Gastroenterology13Typical measlesAtypical measleskey pointDivision Of Infectious Diseases And GastroenterologyIncubation period Prodromal periodExanthemperiodConvalescent period10-14 daysExposureDivision Of Infectious Diseases And GastroenterologyKopliks
11、SpotslA kind of rash present on mucous membraneslGrayish spots as small as grain of sand on bright red background of mucosalMucous membrane opposite the 2nd lower molar,but may spread over the rest of the buccal mucosa.l Appear and disappear rapidly (1-2 days before the rash to 2-3 days after the ra
12、sh)Division Of Infectious Diseases And GastroenterologyProdromal stage:3-4days Fever Catarrh Kopliks Spots Other symptoms:anorexia,malaise,diarrhea,and generalized lymphadenopathy.Division Of Infectious Diseases And Gastroenterologyl Fever:temperature risesl Catarrh is more seriousExanthem stage:3-5
13、daysDivision Of Infectious Diseases And GastroenterologyMaculopapular rashDivision Of Infectious Diseases And GastroenterologylFeverlCatarrhlMaculopapular rashl Other manifestations:light hepatomegaly and splenomegaly,enlarged lymph nodes gastrointestinal symptoms Exanthem stage:3-5daysDivision Of I
14、nfectious Diseases And GastroenterologyConvalescent stage:3-5 days l All symptoms relieve gradually.l The rash fades in the same order it erupts Division Of Infectious Diseases And Gastroenterology1.Branny desquamation 2.Brownish discoloration(hyperpigmentation)Significant for the restrospective dia
15、gnosis for measlesConvalescent stage:3-5 days Temp Kopliks spots皮疹皮疹色素沉着及脱屑色素沉着及脱屑 414039383736临床分期临床分期前驱期前驱期出疹期出疹期恢复期恢复期Days 1-1412345678910 11 12 13 14眼结合膜炎眼结合膜炎咳嗽咳嗽Division Of Infectious Diseases And GastroenterologyAtypical clinical manifestations of measles1.Mild measles2.Severe measlesDivision
16、 Of Infectious Diseases And GastroenterologylPneumonia is the most frequent complication of measles and it is the leading cause of death in measles.lThe younger the children,the more frequent of pneumonia.l Two causes may involved:(1)Primary pneumonia (2)Secondary pneumonia-PneumoniaDivision Of Infe
17、ctious Diseases And Gastroenterologyl The second most frequent complicationl Causes:measles virus,other viruses or bacterial Laryngitis is more common and more severe in younger children.-LaryngitisDivision Of Infectious Diseases And GastroenterologyHeadache,nausea,vomiting,meningeal irritation,conv
18、ulsion,conscious disturbancel Clinical feature:2-5 days after the rash eruption similar to encephalitis caused by other virus-EncephalitisDivision Of Infectious Diseases And Gastroenterologyl SSPE is a quite rare complication with a low incidence of 1/1,000,000 l It is a chronic encephalitis caused
19、by persistent infection of mutational measles virus in central nervous system l Long interval between the onset of measles and SSPElThe high risk of age is 5-15 years old.-Subacute sclerosing panencephalitis(SSPE)Division Of Infectious Diseases And Gastroenterology-Exacerbation of tuberculosis infec
20、tionUnderlying tuberculosis change to active TB disseminated TB tuberculous meningitislA temporary loss of hypersensitivity reaction to tuberculin skin testingDivision Of Infectious Diseases And Gastroenterology-Malnutrition and Vitamin A deficiencyl Persistence of high fever l Malfunction of gastro
21、intestinal tractl Old bad traditionl Clinical features:night blindness,corneal ulceration,blindness,etc l Routine administration of vitamin A with measles Division Of Infectious Diseases And Gastroenterologyl The white blood cell count and differential WBC tends to be low and LC is relatively high l
22、 Multinucleated giant cells can be demon strated in smears of the buccal mucosa during the prodromal stage.l Testing of specific IgM in serum l Measles virus isolationDivision Of Infectious Diseases And Gastroenterology Epidemiologic data Clinical data Laboratory dataDivision Of Infectious Diseases
23、And Gastroenterology-Epidemiologic dataAgeSeasonHistory of contact with patientHistory of inoculationDivision Of Infectious Diseases And Gastroenterology-Clinical dataProdromal periodConvalescent periodKopliks spotsTypical rash Correlation of rash and feverCatarrhBranny desquamation Brownish discolo
24、rationExanthem periodDivision Of Infectious Diseases And Gastroenterology-Laboratory datal Multinucleated giant cells l Testing of specific IgM in serum The diagnosis is usually made from the characteristic clinical picture,laboratory confirmation is rarely needed.Division Of Infectious Diseases And
25、 Gastroenterologyl Rubellal Roseola infantum Division Of Infectious Diseases And GastroenterologyDivision Of Infectious Diseases And GastroenterologyDivision Of Infectious Diseases And Gastroenterologyl Control of sources of infections The susceptible contacts will be isolated for clinical observati
26、on for 3 weeks after exposure.Quarantine period l Abrupt the ways of transmission Sterilize wardDivision Of Infectious Diseases And Gastroenterologyl Control of sources of infections l Abrupt the ways of transmissionl Protect the susceptible passive immunization active immunizationDivision Of Infect
27、ious Diseases And Gastroenterologyl Post-exposure prophylaxis by immune globulin can prevent or modify measles in susceptible contactsl To be effective,it must be given within 5 days after exposure-Passive immunizationImmune globulin can be given intramuscularly at a dose of 0.25ml/kgFor immunocompr
28、omised individuals the dose is 0.5ml/kgDivision Of Infectious Diseases And Gastroenterology Measles VaccinelComposition:attenuated live viruslEfficacy:95%(range,90%-98%)lSchedule:2 doses，decided by the susceptible groups in different regions-Active immunization 2 doses starting at age 8 months,then
29、at age 7 yearsDivision Of Infectious Diseases And Gastroenterologyl Pregnant womenl Children with immunodeficiencyl Children with untreated tuberculosisl Cancer patientsl Organ transplantation receptorl Children with long term immunosuppressive therapy-Contraindication:Division Of Infectious Disease
30、s And Gastroenterologyl Antipyretics for feverl Bed restl Maintenance of an adequate fluid intakel Good nutrition and adequate vitamin A intakel Humidification of the room l To keep the room comfortably warm than cooll Be protected from exposure to strong lightl Appropriate antibiotic therapyl Tradi
31、tional Chinese medicine with antiviral effects There is no specific antiviral therapy;treatment is entirely symptomatic and supportive.Division Of Infectious Diseases And Gastroenterologyl What is the pathogen of measles?l What is the infection source?How is measles virus transmitted?l Who is the su
32、sceptible to measles?l How many times does a person suffer from measles in his lifetime?l What are the typical clinical manifestations of measles?What are the complications of measles?l How to diagnose measles?l How to treat it?l Can it be preventable?What kind of method to take?Division Of Infectious Diseases And Gastroenterology
