MEASLES （麻疹） MEASLES (RUBEOLA) Department of Pediatrics Soochow University Affiliated Children’s Hospital

MEASLES （麻疹）

MEASLES(RUBEOLA)

Department of Pediatrics

Soochow University Affiliated Children’s Hospital


SUMMARY

1.Measles is an acute infectious disease 2.caus

ed by the measles virus. 3. sy

mptoms and signs such as fever, sneezing, cough,

conjunctivitis （结膜炎） , koplik spots （科氏斑） and rashes


ETIOLOGY

1.be of paramyxoviridae （副粘病毒属）

2.only one serum type

3.the habit and resistance

4.can be from secretions （分泌物） , urine,blood


1.Measles is an RNA virus

2. be found in nasopharyngeal （鼻咽

部的） secretions,blood,and urine.

3. can remain active for at least 34 hr

at room temperature.


EPIDEMICOLDGIC FEATURE

Before widely using Measles virus’s attenuat

ed （减毒的） vaccine,Measles epidemiced

once per 2~4 years.But now this epidemic dis

appears and the adult patients gradully incre

ase.


1. epidemic throughout the world

2. In the past,epidemiced in the spring , 2~4 yr

intervals ,new groups of susceptible （易感者） children

3. be rarely subclinical

4. the age of peak incidence was 5~10yr

5. Individuals born before 1957 are considered

to be immune from natural infection.


Infectious resourse:

Patient,only

Measles is very contagious （传染的） ;approximately

90% of susceptible family contacts acquire the diseas

e. Maximal dissemination of virus occurs by droplet sp

ray during the prodromal period ( 前驱期 ). Transmissi

on to susceptible contacts often occurs prior to diagno

sis of the original case


1. Infants acquire immunity transplacentally（经胎盘） from mothers who have had measles or measlesimmunization.

2. This immunity is usually complete for the first 4~6mo of life and disappears at a variable rate.

3. Although maternal antibody levels are generally undetectable in the infant by the usual tests performed after 9 mo of age, some protection persists, which may interfere with immunization


1. infants of mothers with measles vaccine-induced immunity lose passive antibody at a younger age than infants of mothers who had measles infection.

2. Infants of mothers who are susceptible to measles have no measles immunity and may contract the disease with the mother before or after delivery.


Infectivity

① People are easily affected

② Covert （隐性） infection is rare

③ ＜ 8M infant, ＞ 8M people

④ Immunocompetence （免疫力） is foreve

r


PATHOGENESIS

Two virus toxemic （毒血的） symptoms

1.Invade the mucosal cells

2.Virus blood symptom


1. 1.The essential lesion （损害） is found in the skin, in the mucous membrances of the nasopharynx,bronchi, and intestinal tract,and in the conjunctivae.

2. Serous exudate （渗出） and proliferation of mononuclear cells and a few polymorphonuclear cells occur around the capillaries.


3. Hyperplasia （肿大） of lymphoid tissue usua

lly occurs,perticularly in the appendix,where m

ultinucleated giant cells （多核巨细胞） of up

to 100 uM in diameter(Warthin-Finkeldey giant

cells) may be found.


Koplik spots consist of serous exudate and proliferation of endothelial cells similar to those in the skin lesion.

A general inflammatory reaction of the buccal and pharyngeal mucosa extends into the lymphoid tissue and the tracheobronchial mucous membrane. Interstitial pneumonitis resulting from measles virus takes the form of Hech giant cell pneumonia.Bronchopneumonia may be due to secondary bacterial infection.


CLINICAL MANIFESTATION

Typical measles

1.Incubation period （潜伏期）

6~18 days,ordinally 10~14 days,even to 21~2

8 days;

low fever,uncomfortable


The patient may transmit the virus by the 9th-19th

day after exposure and occasionally as early as

the 7th day, before the illness can be diagnosed.



2.Prodroma period

（前驱期） about 3~5 days.

Fever,low-grade to mo

derate fever



URI

a dry cough,coryza,anconjunctivitis. These sym

ptoms nearly always precede the appearance o

f Koplik spots ,the pathognomonic sign of mea

sles,by 2-3 days.



Koplik spots

they are grayish white dots, usually as small as grains of s

and, that have slight,reddish areolae,occasionally they are

hemorrhagic （出血的） .They tend to occur opposite the

lower molars but may spread irregularly over the rest of th

e buccal mucosa.Rarely they are found within the midporti

on of the lower lip,on the palate,and on the lacrimal carunc

le （泪埠） .



Koplik spots

Koplik spots appear and disappear rapidly, usually withi

n 12-18 hr.As they fade a red,spotty discoloration of the

mucosa may remain.


Others

The conjunctival inflammation and photophobia （畏

光） may suggest measles before Koplik spots appear.In

particular,a transverse line of conjunctival inflamma-tion,sh

arply demarcated （以为划界的） along the eyelid margin,

may be of diagnostic assistance in the prodromal stage.As

the entire conjunctiva becomes involved,the line disappear.



3.Rash period: about 3~5 days.

The turn usually starts as faint macules on the upper late

ral parts of the neck,behind the ears,along the hairline,an

d on the posterior parts of the cheek.The individual lesio

ns become increasingly maculopapular as the rash sprea

ds rapidly over the entire face,neck,upper arms,and upp

er part of the chest within approximately the first 24 hr.



① During the succeeding 24 hr it spreads over the back,abdomen,entire arm,and thighs.

② As it finally reaches the feet on the 2nd-3rd day,it begins to fade on the face.The rash fades downward in the same sequence in which it appeared.

③ The severity of the disease is directly related to the extent and confluence of the rash.In mild measles the rash tends not to be confluent,and in very mild cases there are few.




Rash period


Rash period


colour and shape

The rash is often slightly hemorrhagic,in sever

e cases with a confluent rash,they are maculo

papular( 斑丘疹） .As the rash fades ,branny

desquamation （糠麸状脱屑） and brownish

discoloration （棕色色素沉着） occur and th

en disappear within 7-10 days.


Symptoms accompany

The temperature rises abruptly as the rash appear

s and often reaches 40oC(104oF) or higher.In unc

omplicated cases,as the rash appears on the legs

and feet the symptoms subside rapidly within abo

ut 2 days usually with an abrupt drop in temperatu

re to normal.


① Patients up to this point may appear desperat

ately ill,but within 24 hr after the temperature d

rops,they appear essential well.

② Lymph nodes at the angle of the jaw and in th

e posterior cervical( 颈的） region are usually

enlarged.


③ Otitis media （中耳炎 ),bronchopneumonia, and

gastrointestinal symptoms such as diarrhea

（腹泻） and vomitting are more common in inf

ants and small children than in older children.


4.Recover period: 3~5 days after the onset of rashes

1) Rashes fade from face,completely gone within 6

days

2)branny desquamation, brownish

discoloration

3) Fever falls



LABORATORY FINDINGS

1. Tolal leukocyte counts

2. Multinucleated giant cells

3. Measles IgM antibody

4. Tissue culture

5. Measles antigen


COMPLICATIONS AND SEQUELAE（并发症和后遗症）

1.Respiratory complications

①Bacterial superinfections

②Pneumonia,bronchotitis,bronchospasm （支

气管痉挛） , croup （哮吼）


2.Cerebral complications

①Encephalitis （大脑炎）

②Subacute sclerosing panencephalitis(SSPE) （亚急性硬化性全脑炎）


3.Other complications:

① Black measles

② Thrombocytopenia （血小板减少症） ,appendicitis

（阑尾炎） ,keratitis （角膜炎） , myocarditis （心肌炎）

③ Reactivation or progression of TB(tuberculosis)

④ Premature delivery or stillbirth ( 死产）

⑤ Mild liver function test elevation


DIAGNOSIS1. Exposure to measles 10~14 days previously

2. Prodroma of fever,cough,conjunctivitis and c

oryza （鼻炎）3. Koplik sports

4. Maculopapular rash

5. Leukopenia


TREATMENT,PROGNOSISand PREVENTION

Recovery generally occurs 7~10 days after on

set of symptoms

1.Therapy:

①Eye care,cough relief,fever reduction

②Second bacterial infections:antimicrobial

③Ribavirin

④Vitamin A


2.Active vaccination

①First time is after 8M

②Revaccination upon entrance into primary

or second school

3.Patient should be isolated 5 days from rashes

4.Exposed individuals:

①Vaccination within 72 hours

②immune globulin within 6 days


5.Morbidity and mortality rates （致病率与死亡

率） are substantial because malnutrition （营

养不良） and secondary infections

6.Suspected cases should be diagnosed promp

tly and reported to local health department.


课后练习

1.何为麻疹早期与恢复期诊断标志

2.麻疹病人该隔离多长时间，何时传染性最强

3.麻疹的鉴别诊断

4.Koplik spot,

5.SSPE


参考文献尼尔逊儿科学儿科学，人民卫生出版社，薛辛东主编Paediatrics, 北京大学医学出版社


Documents

MEASLES （麻疹） MEASLES (RUBEOLA) Department of Pediatrics Soochow University Affiliated Children’s Hospital