MEASLES

Measles is a highly infectious
disease caused by measles virus,

characterised by a maculopapular
Definition rash, cough, coryza, conjunctivitis,
and a pathognomonic enanthem
(Koplik's spots) with an incubation
period of about 10 days.
 Measles virus is the only member of
the genus Morbillivirus
that infects humans,part of the family
Paramyxoviridae.
It is related to viruses causing similar
Aetiology infections in other mammals:
distemper, rinderpest, morbilli, and
peste des petits ruminants
 Measles virus is transmitted via droplets and infects epithelial cells of
the nose and conjunctivae.
 Virus multiplies in these epithelial cells and then extends to the

regional lymph nodes.
 Primary viraemia occurs 2 to 3 days after infection, and measles

virus continues to replicate in epithelial and reticuloendothelial
system tissue over the next few days.
 Secondary viraemia occurs on days 5 to 7 >>> infection becomes

established in the skin and other tissues including the respiratory
tract on days 7 to 11.
 The prodromal phase, which lasts 2 to 4 days, occurs at this time

with fever, malaise, cough, coryza, and conjunctivitis
 Koplik's spots may develop on the buccal mucosa
about 1 to 2 days before the rash and may be
apparent for 1 to 2 days after rash onset. At the
time when rash appears virus can be found in
blood, skin, respiratory tract, and other organs.
Over the next few days, viraemia gradually
decreases as the rash coalesces and gradually
resolves along with the other signs and symptoms.
Viraemia and presence of virus in tissue and
organs ceases by days 15 to 17 corresponding to
the appearance of antibody
 Mucosa may be inflamed, and the lips
may be reddened.
 The characteristic erythematous,
nonpruritic, maculopapular rash of
measles begins at the hairline and
behind the ears, spreads down the

trunk and limbs to include the palms and
soles, and often becomes confluent
 Worldwide, measles remains a common infection. A joint
publication by the World Health Organization and the US
Centers for Disease Control and Prevention reported that
following a global decrease in 2000 to 2016, measles
infections increased in all six WHO regions during 2017-
2019.
 In 2019, 869,770 cases were reported, the most cases
reported since 1996. Estimated global mortality from measles
also increased nearly 50%, with 207,500 deaths in 2019.
 Failure to vaccinate on time with two doses of measles-
containing vaccines is suggested as the main cause of these
increases. Reported cases were lower in 2020; however,
vaccination has been disrupted during the COVID-19
pandemic, and WHO estimates that as of November 2020,
94 million people were at risk of missing vaccines due to
paused measles campaigns.
Measles begins with a 2- to 4-day respiratory
prodrome:
 Malaise
 Cough
Clinical features  Coryza

 Conjunctivitis with lacrimation
 Nasal discharge
 Increasing fever with temperatures as high as
40.6°C
 Lymphadenopathy
 Diarrhea
Clinical
manifestation  Vomiting
 Splenomegaly are common
 Clinical symptoms + epidemiology
 Measles virus can be demonstrated : culture
or polymerase chain reaction in respiratory
secretions or urine
Diagnosis  Serology Testing for IgM and IgG
Specific IgM antibodies are detectable within

1–2 days after rash onset and the IgG titer rises
significantly after 10 days
Otitis media - Very common in infants with measles
Pneumonia - May be primary viral pneumonia
or bacterial superinfection
Croup - Occasionally severe, requiring intubation in infants
Gastroenteritis - Diarrhea can be life threatening
in infants
Cervical adenitis -Due to lymphoid hyperplasia as
Complications host response to virus
Acute encephalitis - May be mild to severe/fatal; occurs
in 1 in 1000 cases of measles; cerebral and cerebellar forms;
Subacute sclerosing panencephalitis
Gastrointestinal complications :gastroenteritis,
hepatitis, appendicitis, ileocolitis, and mesenteric
adenitis
 Lymphopenia and neutropenia are common
in measles and may be due to invasion of
leukocytes by the virus, with subsequent cell
death.
Lab.Checking  Leukocytosis may herald a bacterial

superinfection. Patients with measles
encephalitis usually have an elevated protein
concentration in CSF as well as
lymphocytosis.
The differential diagnosis :
 Kawasaki disease
 Scarlet fever
Differential
diagnosis  Infectious mononucleosis
 Toxoplasmosis
 Drug eruption
 Symptom based
 Supportive
 Vit A
 Ribavirin - treatment of measles pneumonia in patients
<12 months, patients ≥12 months with pneumonia
Treatment requiring ventilatory support, and immunosuppressed
patients. Ribavirin dosing consists of 15 to 20 mg/kg
per day orally in two divided doses. The optimal
duration of therapy is not known; a duration of five to
seven days may be reasonable
 Agents for treatment subacute sclerosing
panencephalitis- Isoprinosine has in vitro activity
Investigational against mRNA viruses; it is administered orally and

generally well tolerated
therapies  Interferon-alpha or beta has antiviral activity; it may
be delivered both intrathecally and intravenously.
 Vaccine :live or attenuated – MMR OR
Prevention and MMRV
profilaxis  Post exposure prophylaxis : Specific

immunoglobulin injection
Thanks for attention

MEASLES

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MEASLES

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Measles is a highly infectious

disease caused by measles virus,

 Virus multiplies in these epithelial cells and then extends to the

 Primary viraemia occurs 2 to 3 days after infection, and measles

 Secondary viraemia occurs on days 5 to 7 >>> infection becomes

 The prodromal phase, which lasts 2 to 4 days, occurs at this time

behind the ears, spreads down the

Clinical features  Coryza

Diagnosis  Serology Testing for IgM and IgG

Specific IgM antibodies are detectable within

Lab.Checking  Leukocytosis may herald a bacterial

Investigational against mRNA viruses; it is administered orally and

profilaxis  Post exposure prophylaxis : Specific

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