MEASL

ES
MEASLES
• AKA Rubeola, Morbilli, hard
measles, red measles
• Measles is an acute highly
contagious viral disease that
usually affect’s children who
are susceptible to upper
respiratory tract infection
(URTI). This may be one of
the most common and most
serious of all childhood
diseases.
• Etiologic Agent: Specific virus of Genus
Morbillivirus, a member of paramyxovirus
family.

• Incubation Period: From 8-12 days (The longest is 20 days and the
shortest is 8 days)
• Reservoir: Virus has been found in patient’s blood as well as in the
secretions from the eyes, nose and throat.
• Symptom: Fever, malaise, 3Cs: Cough, coryza, conjunctivitis (pink eye)
• Period of infectivity: From 4 days prior to onset of rash to 5 days after
appearance of rash (patients are contagious)
• Mode of Transmission: Via airborne droplet spread
 The disease is transmitted through direct contact with droplets spread
through coughing or sneezing.
 It can also be transmitted indirectly through articles freshly contaminated
with respiratory secretions of infected patients.
PATHOGNOMONIC SIGN
• Koplik’s sign – are pathognomonic
of measles. These are inflammatory
lesions of the buccal mucous glands
with superficial necrosis.
1. They appear on the mucosa of the
inner cheek opposite to the
second melars or near the
junctions of the gum and the
inner cheek.
2. They usually appear 1-2 days
before measles rash.
MEASLES HAVE 4 PHASES: INCUBATION,
PRODROMAL, EXANTHEMATOUS AND RECOVERY
PHASES
1. Incubation Phase
 Duration of 8-12 days (10 days is the most common)
 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 after the secondary viremia (fever, catarrhal inflammation of URT)
 This phase is associated with necrosis and grant cell formation
3. Exanthematous Phase
 The 3-5 days after fever, but the 4th day is most common
 Begins with the appearance of the koplik spots, the pathognomonic sign of measles
 Sequence: Behind the ear -> along the hairline -> face -> neck -> chest -> back -> abdomen
-> limbs -> hand and feet (palm, sole)
4. Recovery Phase
 Course: 10-14 days
 This phase starts upon the onset of rashes, wherein the other manifestations began to subside
and the rash fades over about 7 days in the same progression as it evolved, often leaving a fine
desquamation of skin
 Of the major symptoms of measles, cough last longer (up to 10 days)
 TREATMENT
SUPPORTIVE CARE:
1. Maintenance of good hydration and replacement of fluids lost through diarrhea or vomiting
• IV rehydration may be necessary for severe dehydration (affected patients may be highly
febrile and consequently become dehydrated)
2. Continue breastfeeding and continue feeding for older infants and children.
3. Antipyretics for fever at 10-15 mg/kg/dose given every 4 hours for fever.
4. Airborne precautions for hospitalized childre during the priod of communicability (4 days
before to 4 days after the appearance of the rash in healthy children and for the duration of
illness in immune complromised patients)
5. Among susceptible health care workers, they should be excused from work from the fifth to the
21st day after exposure.
 Administer Vitamin A immediately on diagnosis and repeat the next day.

The recommended age – specific daily doses are

• 50,000 IU for infants aged <6 months
• 100,000 IU for infants aged 6-11 months
• 200,000 IU for children ages >12 month
• Give Isoniazid at 10 mkd

ANTIVIRAL DRUGS: Isoprinisone

ISOLATION
• In addition to standard precautions, airborne transmission precautions are indicated for 4
days after the onset of rash in otherwise healthy children and for the duration of illness in
immunocompromised patients.
• Exposed susceptible patients should be placed on airborne precautions from day 5 after
first exposure until day 21 after last exposure.

VACCINATION
• Monovalent or trivalent vaccine (contains measles, mumps, rubella and varicella) maybe
used for infants 12 months to 12 years of age

Age of Routine Immunization

• The first dose of MMR vaccine should be given at 12 through 15 months of age.
• The second dose is recommended routinely at school entry (4 through 6 years of age) but
can be given at any earlier age (eg. During an outbreak or before international travel),
provided the interval between the first and second MMR doses is at least 28 days.
• Catch-up second dose immunization should occur for all school children (elementary,
middle, high school) who have received only 1 dose, including @ the adolescent visit @
11 through 12 years of age and beyond.
MALARIA
 MALARIA
• Derived from Italian word Mal’aria or bad air (Mala means bad
and aria means air).
• Malaria remains the world’s most devastating human parasite
infection. Affects over 40% f the world’s population. WHO,
estimates that there are 350-500 million cases of Malaria
worldwide.
 Malaria a vector borne Disease
• Malaria is a vector-borne
infectious disease caused by
protozoan parasites. It is
widespread in tropical and
subtropical regions. (including
parts of the Americas, Asia and
Africa)
• Malaria is transmitted through
the bite of an infected female
Anopheles mosquito
 Parasites Cause of Malaria
• Malaria is caused by an infection by one of protozoan
parasites:
 Plasmodium falciparum (most dangerous)
 Plasmodium vivax (most widely spread species because it
exists in both temperature and tropical climates)
 Plasmodium ovale
 Plasmodium malariae
 Plasmodium knowlesi (forested regions of South East Asia)
Newer species
 How is Malaria transmitted?
• Malaria parasites are transmitted from one person to another by
the bite of a female anopheles mosquito.
• The female mosquito bites during dusk and dawn and needs a
blood meal to feed her eggs.
• Male mosquitos do not transmit malarias they feed on plant
juices and not blood.
• Like all mosquitos, anopheles breed in water – hence
accumulation of water favours the spread of the disease.
 How Malaria present clinically
STAGE 1 (COLD STAGE)
• Cold stage characterized by shivering and a feeling of cold for 15 to 60
minutes
• Present with nausea, vomiting, headache

STAGE 2 (HOT STAGE)

• 2-to-6 hour hot stage
• There is fever, sometimes reaching 41oC, flushed, dry skin, and often
headache, nausea and vomiting, rapid respiration and marked thirst

STAGE 3 (SWEATING STAGE)

• Patient starts sweating and temperature falls by crisis (2-3 hours)
• No fever – 24-48 hours
Diagnostic tools/Investigations:
1) Blood Film Examination for Malaria Parasite (BFMP)
2) QBC – Quantitative Buffy Coat Test
> It involves staining of the centrifuged and compressed red cell layer
with acridine orange and its examination under VV light source.
3) Rapid Diagnostic Tests (RDT)
> Detects malarial antigens
4) Polymerase Chain Reaction (PCR)
> Specific test for detecting all species of malaria
5) Other investigations:
*Complete blood counts *Urine analysis
*Blood levels of glucose *Liver function test
*Renal profile *Other’s rapid test to rule out dengue or
leptospirosis
Treatment
• Anti-malarial therapy
1. Cinchona alkaloids: Quinine, Quinidine
2. Artemisisin derivatives: Artemether and Artesunate
3. Other antimalarials: Halofantrine, Mefloquine, Atavaquone,
Doxycycline and Tetracycline
Prevention:
• Apply mosquito repellent lotion/cream on exposed body surfaces
• Drape mosquito netting over beds
• Put screens on windows and doors
• Wear long pants and long sleeves to cover your skin (specially in
the evenings)
• Drain the water reservoir regularly
• Close the water reservoir
• Use mosquito repellent spray inside bedroom/house
• Remove all discarded containers that might collect water
• Repairing leaking taps, water pipes or drains that may provide a
place to breed