1、MEASLESDivision of Infectious Diseases and Gastroenterologyl Acute respiratory infectious disease caused by measles virusl Clinical feature:Fever,Cough,Coryza,Conjunctivitis,Exantheml Specific signs:Kopliks Spots hyperpigmentationDivision of Infectious Diseases and GastroenterologyDivision of Infect
2、ious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologylSince the beginning of September,2009,Johannesburg,a city in Gauteng,South Africa reported about 48 cases of
3、measles.lOn February 19,2009,505 measles cases were reported in twelve provinces in the North of Vietnam,with Hanoi accounting for 160 cases.lOn The 1st of April 2009,an outbreak has happened in two schools in North Wales.lIn 2007,a large measles outbreak in Japan caused a number of universities and
4、 other institutions to close in an attempt to contain the diseaselApproximately 1000 cases of the disease were reported in Israel between August 2007 and May 2008(in sharp contrast to just some dozen cases the year before).l As of 2008 the disease is endemic in the United Kingdom with 1,217 cases di
5、agnosed in 2008 and epidemics have been reported in Austria,Italy and Switzerland.lIn March 2010,Philippines declared an epidemic about the continuously rising cases of measles.(WHO)Division of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologylIn 2011,large
6、 measles outbreaks were reported in all these countries and several others in:DRC(134 042 cases)Ethiopia(3255 cases)France(14 949 cases)India(29 339 cases)Italy(5189 cases)Nigeria(18 843 cases)Pakistan(4386 cases)Spain(3802 cases)(WHO)2011：9,943 cases 2012:6,182 cases2013:27,646 cases2014:52,628 cas
7、es2015:42,361 cases2016:24,820 casesDivision of Infectious Diseases and Gastroenterology Division of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and Gastroenterologymeasles virusDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and Gastro
8、enterology:ssRNA virus Genus:morbillivirus Family:paramyxoviridae Only one Patients respiratory secretions Blood,Urine of patientsCharacterization:Sensitive to heat,ultraviolet light and disinfectant Low temperature resistanceDivision of Infectious Diseases and GastroenterologyDivision of Infectious
9、 Diseases and GastroenterologyInfectious sourcesRoutes of transmissionPopulation susceptibilityEpidemic featuresDivision of Infectious Diseases and Gastroenterology infective stage:lThe infective stage is from the late of incubation stage to the 5th day after rash eruption.lIf complication occurs,th
10、e infective stage prolongs to the 10th day after rash eruption.Infectious sources-PatientsDivision of Infectious Diseases and Gastroenterology Isolation periodlPatients without complication:5 days after rash eruption.lPatients with complication:10 days after rash eruption.The period of maximum conta
11、giousness is the prodromal stage.Infectious sources-PatientsDivision of Infectious Diseases and GastroenterologyRoutes of transmissionDivision of Infectious Diseases and Gastroenterology2023-1-16Other Routes of transmissionDivision of Infectious Diseases and GastroenterologyPopulation susceptibility
12、l 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)Mild epidemics:400Major epidemics:500-10009.5 i
13、n 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics appear by 2-4 yr intervalsEpidemic cycle disappeared,Sporadic cases increasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical
14、casesmild manifestationsless complicationsrarely deathEpidemiological FeaturesDivision of Infectious Diseases and GastroenterologyPrior to the use of vaccineAfter the use of vaccineMorbidity(1/100000)Major epidemics:500-1000Mild epidemics:4009.5 in 1990Peak seasonIn winter and springIn any time of a
15、 yearEpidemic cycleMajor epidemics appear by 2-4 yr intervalsEpidemic cycle disappeared,Sporadic cases increasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical casesmild manifestationsless complicationsrarely deat
16、hEpidemiological FeaturesDivision of Infectious Diseases and GastroenterologyPrior to the use of vaccineAfter the use of vaccineMorbidity(1/100000)Major epidemics:500-1000Mild epidemics:4009.5 in 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics appear by 2-4 yr i
17、ntervalsEpidemic cycle disappeared,Sporadic cases increasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical casesmild manifestationsless complicationsrarely deathEpidemiological FeaturesDivision of Infectious Disea
18、ses and GastroenterologyPrior to the use of vaccineAfter the use of vaccineMorbidity(1/100000)Major epidemics:500-1000Mild epidemics:4009.5 in 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics appear by 2-4 yr intervalsEpidemic cycle disappeared,Sporadic cases inc
19、reasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical casesmild manifestationsless complicationsrarely deathEpidemiological FeaturesDivision of Infectious Diseases and GastroenterologyVaccinationNatural InfectionL
20、ife-attenuated strainWild strainBoth antigenicity and pathogenicity are declinedBoth antigenicity and pathogenicity are strongThe antibody level is lowerThe antibody level is higherVaccine related epidemicDivision of Infectious Diseases and GastroenterologyVaccinationNatural InfectionProtecting leve
21、lTimeAntibody levelInfectionvaccination Division of Infectious Diseases and GastroenterologyPrior to the use of vaccineAfter the use of vaccineMorbidity(1/100000)Major epidemics:500-1000Mild epidemics:4009.5 in 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics app
22、ear by 2-4 yr intervalsEpidemic cycle disappeared,Sporadic cases increasedAge6m-5y(98%10y)Below 6m and teenageClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical cases increasedmild manifestationsless complicationsrarely deathEpidemiological FeaturesDiv
23、ision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologyIncubation periodApparent manifestationsRespiratory epitheliumregional lymph nodesPrimary viremiamononuclear phagocytic system Respiratory tract,conjunctiva,skin,etcVirus eliminationsecondary viremia
24、Division of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and Gastroenterology-Multinucleated giant cell(MGC)l=100mlseveral nucleus inside the cell formed by confluence of several virus infected reticulo-endothelial cellslIn smears of the nasal or cheek mucosa in the prodro
25、mal stageDivision of Infectious Diseases and Gastroenterology-Formative process of MGCDivision of Infectious Diseases and Gastroenterology-Formative process of MGCDivision of Infectious Diseases and Gastroenterology-Formative process of MGCDivision of Infectious Diseases and Gastroenterology-Formati
26、ve process of MGCDivision of Infectious Diseases and Gastroenterology-Multinucleated giant cell(MGC)l=100mlseveral nucleus inside the cell formed by confluence of several virus infected reticulo-endothelial cellslIn smears of the nasal or cheek mucosa in the prodromal stageDivision of Infectious Dis
27、eases and Gastroenterology-Cytopathic changeMGC in lung of a measles pneumonia Division of Infectious Diseases and Gastroenterology-Othersl Respiratory tract_general inflammatory reactionl Skin lRed maculopapular_capillary inflammation at the dermislHyperpigmentation_hemoglobin realised from red cel
28、ls leak to the outside of the blood vessellDesquamation_cells cornificationDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and GastroenterologyIncubation period Prodromal periodExanthemperiodConvalescent period10-14 days3-4 days3-5 days3-5 daysExposureDivision of
29、Infectious Diseases and Gastroenterology Incubation stage:10-14 days Incubation stage(from exposure to the symptoms appearing)lasts 1014 days averagely,but it can as short as 6 days or as long as 21 days sometimes.1.Infected person have contagiousness in the later period of incubation stage.Division
30、 of Infectious Diseases and GastroenterologyIncubation period Prodromal periodExanthemperiodConvalescent period10-14 days3-4 days3-5 days3-5 daysExposureDivision of Infectious Diseases and GastroenterologyProdromal stage:3-4days2.Fever:The magnitude and pattern of fever are variable in patients,from
31、 a low-grade to moderate fever or a sudden high fever may occur.Cough Coryza They are not specific symptoms for measles,which are identical to a common cold but catarrhal symptoms maybe more severe.Conjunctivitis May suggest measles before Kopliks spots.Kopliks Spots:Pathognomonic sign Other symptom
32、s:anorexia,malaise,diarrhea,and generalized lymphadenopathy.Division of Infectious Diseases and GastroenterologyProdromal stage:3-4days2.Fever:The magnitude and pattern of fever are variable in patients,from a low-grade to moderate fever or a sudden high fever may occur.Cough Coryza They are not spe
33、cific symptoms for measles,which are identical to a common cold but catarrhal symptoms maybe more severe.Conjunctivitis May suggest measles before Kopliks spots.Kopliks Spots:Pathognomonic sign Other symptoms:anorexia,malaise,diarrhea,and generalized lymphadenopathy.Division of Infectious Diseases a
34、nd GastroenterologyProdromal stage:3-4days2.Fever:The magnitude and pattern of fever are variable in patients,from a low-grade to moderate fever or a sudden high fever may occur.Cough Coryza They are not specific symptoms for measles,which are identical to a common cold but catarrhal symptoms maybe
35、more severe.Conjunctivitis May suggest measles before Kopliks spots.Other symptoms:anorexia,malaise,diarrhea,and generalized lymphadenopathy.Kopliks Spots:Pathognomonic sign Division of Infectious Diseases and GastroenterologyKopliks SpotslA kind of rash present on mucous membraneslGrayish spots as
36、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.Division of Infectious Diseases and GastroenterologyKopliks spots on cheek mucosa Kopliks spots on palate l Appear and disappear rapidly (1-2 days
37、before the rash to 1-2 days after the rash)Division of Infectious Diseases and GastroenterologyProdromal stage:3-4days2.Fever:The magnitude and pattern of fever are variable in patients,from a low-grade to moderate fever or a sudden high fever may occur.Cough Coryza They are not specific symptoms fo
38、r measles,which are identical to a common cold but catarrhal symptoms maybe more severe.Conjunctivitis May suggest measles before Kopliks spots.Kopliks Spots:Pathognomonic sign Other symptoms:anorexia,malaise,diarrhea,and generalized lymphadenopathy.Division of Infectious Diseases and Gastroenterolo
39、gytypical facial appearance of measles in prodromal stage Division of Infectious Diseases and GastroenterologyExanthem stage:3-5daysl Maculopapular rash:main manifestationlAppearance lSequence lFever:temperature rises abruptly lCatarrh:l Other manifestations:3.Division of Infectious Diseases and Gas
40、troenterologyMaculopapular rashlRed blotchy lFlat or slightly raised rash.lUneven with 0.1-1.0 cm in diameter.lLesions blanch with fingertip pressure.lInching is generally slightDivision of Infectious Diseases and GastroenterologylStarts as individual lThe skin among rash looks like normal lBlend in
41、to each other as more appear Maculopapular rashDivision of Infectious Diseases and GastroenterologyExanthem stage:3-5daysl Maculopapular rash:main manifestationlAppearance lSequence lFever:temperature rises abruptly lCatarrh:l Other manifestations:3.Division of Infectious Diseases and Gastroenterolo
42、gy-appearing sequence of the rashThe rash usually starts on the upper lateral parts of the neck,behind the ears,along the hairlineDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and Gastroenterology-appearing sequence of the rashIt become increasingly maculopapula
43、r as the rash spreads rapidly over the entire face,neck,upper arms,and upper part of the chest within approximately the 24hr.Division of Infectious Diseases and Gastroenterology-appearing sequence of the rashDivision of Infectious Diseases and Gastroenterology Sequence:behind the earalong the hairli
44、nefaceneckchestbackabdomenlimbshand and feet(palm,sole)Division of Infectious Diseases and Gastroenterologyl Maculopapular rash:main manifestation l Fever:temperature risesl Cough Coryza Conjunctivitisl Other manifestations:Exanthem stage:3-5days3.Division of Infectious Diseases and Gastroenterology
45、lFever:temperature rises abruptlylCatarrh:lMaculopapular rash:main manifestation l Other manifestations:light hepatomegaly and splenomegaly,enlarged lymph nodes gastrointestinal symptoms Exanthem stage:3-5days3.Division of Infectious Diseases and GastroenterologyConvalescent stage:3-5 days l All sym
46、ptoms relieve gradually.Fever,Cough,Coryza and Conjunctivitis relievel The rash fades in the same order it erupts l Branny desquamation brownish discoloration disappear within 2-3 weeks.4.Division of Infectious Diseases and GastroenterologyBranny desquamation Brownish discoloration(hyperpigmentation
47、)Significant for the restrospective diagnosis for measlesConvalescent stage:3-5 days 4.Division of Infectious Diseases and Gastroenterologyl The rash appears after 34 days of onset of fever l The rash is maculopapular.l It starts on the skin behind the ears.Within 35 days,it spreads from the head do
48、wn to the full body gradually.l It fades in the same order it appears.With fading,branny desquamation and brownish discoloration occur.-Summary of rashDivision of Infectious Diseases and Gastroenterology Temp Kopliks spotsRashBranny desquamation&hyperpigmentation 414039383736Clinical periodsProdroma
49、l stageExanthem stageConvalescent stageDays 1-1412345678910 11 12 13 14Coryza and conjunctivitisCoughDivision of Infectious Diseases and GastroenterologyDivision of Infectious Diseases and Gastroenterology 1.Pneumonia 2.Laryngitis 3.Encephalitis and Subacute sclerosing pan-encephalitis(SSPE)4.Exacer
50、bation of tuberculosis 5.Malnutrition and Vitamin A deficiencyDivision 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
