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Chapter 246
Wilbert H. Mason
Nelson's Textbook of Pediatrics 20th Edition
Earl Mel Dustin B. Lao
P-3
February 11, 2019
Greetings
• Good day everyone, this will be the second topic to be reported under the Post
Graduate Interns entitled, “Measles”. As of the time of this report, this condition is
currently making headlines throughout the country as the number of victims is now
by the hundreds, and had already claimed a few unfortunate lives. Thus it is
imperrative for us physicians to know the basic behind this disease, especially that
we are already receiving and documenting a few cases from time to time in our
institution.
• With this report, I hope I could share to everyone a good chunk of knowledge
pertaining to this condition and its significance in the overall pediatric setting. Thank
you.
• Earl Mel Dustin B. Lao
Objectives and Outline
To be able to discuss and learn the disease through its various pathologic components
and process.
I. Introduction
II. Etiology and Epidemiology
III. Transmission
IV. Pathology
V. Pathogenesis
VI. Clinical Manifestations
VII. Diagnosis and Differentials
VIII.Complications
IX. Treatment and Prevention
Measles: Introduction
• Measles is a highly contagious viral disease that remains as one of the global health
threats.
• Though this disease is uncommon in developed countries due to widespread
vaccination, it still has a foothold in most underdeveloped nations due to poor health
care.
Measles: Etiology and Epidemiology
• Measles is caused by the Measles Virus
– It is a single stranded, lipid enveloped RNA virus
– Part of the family Paramyxoviridae
– Part of the genus Morbillivirus
1. Incubation Phase
• Duration of 8 - 12 days
• In this phase, the virus migrates to the regional lymph nodes
• Primary viremia disseminates the virus to the reticuloendothelial systems
• Secondary viremia spreads the virus the body surface
2. Prodromal Phase
• Duration of 3 - 5 days
• This phase begins after the secondary viremia
• This phase is associated with necrosis and giant cell formation
Measles: Pathogenesis
3. Exanthematous phase
• Begins with the appearance of the Koplik spots, the pathognomonic sign of
measles
4. Recovery phase
• This phase starts upon the onset of rashes, wherein the other manifestations
began to subside.
Measles: Clinical Presentation
• Measles is a serious infection characterized with high grade fever, usually with the
following manifestations:
– 3 Cs: Cough, Coryza and Conjunctivitis
– Enanthem and Exanthem
• The Prodromal phase usually begins with low grade to moderate fever, associated
with the following:
– a prominent cough
– conjunctivitis
– coryza
These symptoms nearly always preceeds the appearance of Koplik spots.
Measles: Clinical Presentation
• The Koplik spots represent the
enanthem and are the pathognomonic
signs of Measles
– appears 1 - 4 days prior to the onset
of rashes
– characterized as discrete red lesions
with bluish white spots in the center
of the inner aspects of the cheeks at
the level of the Premolars
– they can spread involving lips, hard
palate and gingiva
Measles: Clinical Presentation
• The Rashes
– the rashes of Measles are characterized
as red maculopapular eruptions
– they usually begin at the forehead
(hairline) or behind the ears and the
upper neck
– these rashes would later spread
downward towards the trunk and the
extremities and can become confluent on
both the face and trunk
– the onset of rahes heralds the time
wherein the other symptoms begin to
subside
– rashes fades after 7 days in the same
manner as it first appeared
Measles: Clinical Presentation
• Among the major symptoms of measles, the cough is usually the one that last the
longest, usually up to 10 days.
• Mycoplasma pneumoniae and group A streptococcus may also produce rashes similar
• to that of measles.
• Kawasaki syndrome can cause many of the same findings as measles but lacks the
following
– discrete intraoral lesions (Koplik spots)
– severe prodromal cough
– elevations of neutrophils and acute-phase reactants.
– thrombocytosis of Kawasaki syndrome is absent in measles
Measles: Complications
• Morbidity and mortality from measles are greatest in patients younger than 5 yr of
age (especially <1 yr of age) and older than 20 yr of age.
Measles: Complications
• Patients shed measles virus from 7 days after exposure to 4-6 days after the onset of
rash.
– Exposure of susceptible individuals to patients with measles should be avoided
during this period
• Measles Vaccine is given as part of the Expanded Program in Immunization in the
country.
Measles: Treatment and Prevention
• Postexposure Prophylaxis
– Susceptible individuals exposed to measles may be protected from infection by
either vaccine administration or immunization withimmune globulin.
– The vaccine is effective in prevention or modification of measles if given within
72 hr of exposure.
– Immune globulin may be given up to 6 days after exposure to prevent or modify
infection.
– Immunocompetent children should receive 0.25 mL/kg intramuscularly, and
immunocompromised children should receive 0.5 mL/kg (maximum dose in both
cases is 15 mL/kg).
Quotation for the Day
• “You treat a disease: you win, you lose. You treat a person, I guarentee
you win - no matter the outcome”
-Patch Adams
Thank You!