Measles is an acute, highly contagious viral disease caused by the measles virus. It is characterized by fever, upper respiratory tract inflammation, Koplik's spots, and a maculopapular rash. The measles virus is spherical and contains RNA. It is transmitted via airborne droplets from the respiratory tract of infected patients. Complications can include respiratory infections, encephalitis, and gastrointestinal involvement. Diagnosis involves detecting measles virus or antibodies in samples from patients showing symptoms.

1. DR.ARUN R NAIR
Dept. Of P.M
“MEASLES”

2. ETIOLOGY
• Measles is an acute highly contagious viral disease caused by measles
virus.It is characterized by fever,URT catarrhal inflamation, koplik’s
spots and maculopapules.
• caused by a virus in the family paramyxovirus, genus Morbillivirus.
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3. 1 .Pathogen is measles virus. it has been classed as a paramyxovirus.it is
spherical in appearance ,measuring about 100~150nm in diameter. It has
an outer envelope composed of M-protein, H-protein, F-protein, and
internal core is RNA.
2 .Site of the measles virus exists - measles can be detected from blood and
nasal, pharyngeal secretions.
3. Three kinds of antibodies are produced after infection,that is
3.1 complement combining antibody;
3.2 hemagglutinin inhibiting antibody
3.3 neutralizing antibody
4 .Only one antigenic type of measles virus is known.
5.Resistance:measles virus is sensitive to heat or disinfectant , it is also
inactivated by ultraviolet light easily.
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4. 1.Source of infection - The patients are the only source of infection.
2 .Routes of transmission - AIR-BORNE
3. Susceptibility of population
3.1 All age person is susceptible; 90% of contact people acquire the disease.
3.2 The permanent immunity acquire after disease.
4. Epidemic features
SEASON:WINTER AND SPIRING
AGE:6 MONTHS TO 5 YEARS OLD
EPIDEMIOLOGY
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5. PATHOGENESIS AND PATHOLOGY
Measles virus
↓ Through respiratory tract
Epithelial cells(multiply)
↓ Through blood stream
Reticuloendothelial
System
↓ Infects
White Blood Cells
↓ Viremia, Viruria develops
Establish infection to skin,resp.
system, other organs1/23/2015 DR.ARUN NAIR 5

6. CLINICAL MANIFESTATIONS
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1.Incubation period is approximately 6-18days,10days is the most
common.(3-4weeks)
2.predromal phase - 3-4 days.
2 .1 Fever;Catarrhal inflammation of URT;
2 .2 Koplik’s spots;
2 .3 Transient prodromal rashes.
Additional prodromal symptoms may include malaise, myalgia's,
photophobia, and periorbital oedema.
The prodromal phase is marked by malaise, fever, anorexia, and
conjunctivitis, cough, and coryza (the "3 Cs").

7. CLINICAL MANIFESTATIONS
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3. Eruption stage
3.1. Time: 3-5 days after fever;
but the 4th day is most common;
3.2. Shape: Maculopapular
4 . Convalescent stage brown staining. Fine branny desquamation.
Sequence:
Behind the ear → Along the hairline → Face → Neck → Chest →
Back → Abdomen → Limbs → Hand & feet ( palm , sole )
Typically begins at the hairline and spreads caudally over the
next 3 days as the prodromal symptoms resolve.

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Koplik Spots leading clue to Measles
Just before the onset of the rash, Koplik’s
spots appear as 1- to 2-mm blue-white
spots on a bright red background Without
adequate illumination for examination, they
may be overlooked.
Koplik’s spots are typically located on the
buccal mucosa alongside the second
molars and may be extensive; they are not
associated with any other infectious
disease. The spots wane after the
onset of rash and soon disappear. The
entire buccal and inner labial
mucosa may be inflamed, and the lips may
be reddened.

9. The complications of measles
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DIVIDED INTO THREE GROUPS,
ACCORDING TO THE SITE INVOLVED:
THE RESPIRATORY TRACT,
THE CENTRAL NERVOUS SYSTEM (CNS),
AND
THE GASTROINTESTINAL TRACT.
Respiratory tract involvement,
manifested as laryngitis, croup, or
bronchitis, occurs in the majority of
cases of uncomplicated measles. In
young children, otitis media is the
most common complication
CNS disease
Subacute sclerosing panencephalitis
(SSPE)—
a protracted, chronic, extremely rare form of
measles encephalitis—sometimes follows
measles and is particularly common among
children who have measles before the age
of 2 years
Gastrointestinal complications of measles
include gastroenteritis,hepatitis, appendicitis,
ileocolitis, and mesenteric adenitis.
Other, rare complications include
myocarditis, glomerulonephritis,and
postinfectious thrombocytopenic purpura.

10. OTHER FORMS
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ATYPICAL MEASLES -
After a several-day
prodrome of fever, myalgia,
and headache, the rash
appears. Unlike the rash of
typical measles, that of
atypical measles begins
peripherally and moves
centrally; it can be
urticarial,maculopapular,he
morrhagic, and/or vesicular.
MEASLES IN THE
IMMUNOCOMPROMISED HOST
Patients with defects in cell-
mediated immunity are at risk for
severe protracted and fatal
measles. measles may not be
accompanied by a rash.
Complications are primary
measles pneumonia, progressive
encephalitis beginning weeks to
months after initial infection
MEASLES IN ADULTS
Measles is naturally a
disease of childhood and,
like many other viral
infections. Hepatitis and
bronchospasm are more
common among adults with
measles

11. Patients on Physical examination
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•Patients tend to appear moderately ill and uncomfortable because of
their viral prodromal symptoms.
•The Koplik spots are 1-2 mm, blue-gray macules on an
erythematous base.
•The measles rash is a Maculopapular eythematous rash that involves
the palms and soles.
•Lesion density is greatest above the shoulders, where macular lesions
may coalesce

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LABORATORY FINDINGS
Lymphopenia and neutropenia are common in
measles and may be due to invasion of
leukocytes by the virus, with subsequent cell
death. Patients with measles encephalitis
usually have an elevated protein
concentration in CSF as well as
lymphocytosis.
DIAGNOSIS
A specific diagnosis of measles can be
made quickly by immunofluorescent staining
of a smear of respiratory secretions for
measles antigen; Measles virus can be
isolated from respiratory secretions or urine
and rapidly identified in tissue culture with
fluorescein-labeled monoclonal antibodies.
The presence of measles virus RNA has
been demonstrated by diagnostic reverse-
transcription polymerase chain reaction.
Specific IgM antibodies are detectable within
1 to 2 days after the appearance of rash,
and the IgG titer rises significantly after 10
days.

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The differential diagnosis
of measles includes
 Kawasaki disease,
 Scarlet fever,
 Infectious mononucleosis,
 Toxoplasmosis,
 Drug eruption,
 Mycoplasma pneumoniae infection.
QUESTION SECTION

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Good bye till we meet again with good news....take care…