1.
Muhammad Saleem

2.
A 2 Years Old Child is brought to OPD with Complaints of
High Grade Fever for last 4 Days. He has Cough and
Rhinorrhea for last 4 days. O/E, he is having
Rash on Ear and along the Hair Line spreading to Trunk
small WHITE LESIONS inside patient mouth. Rest of the
Examination is not Specific.
What can be the diagnosis?

3.
Measle
s

4.
Differential
Diagnosis

5.
MEASELS(MORBILLI/RUBEOLA)
• Measles virus is a single stranded RNA Virus
• Family : Paramyxoviridae
• Genus: Morbillivirus
• Measles is an acute highly contagious viral disease characterized by final stage of
maculopapular rash erupting successively over the neck,face,boday,arms,legs and is
accompanied by high grade fever
• Highest incidence is in winters

6.
• Mode of transmission is by direct or indirect contact and droplets spray
• Unusual below the age of 4-6 months
• Period of infectivity 4 days before and 5 days after the appearance of rash

7.
CLINICAL FEATURES
• There are 3 clinical stages of measles
• Incubation stage
• Prodromal stage
• Maculopapular rash stage

8.
INCUBATION STAGE
• Last approximately 10_12 days
• Body temp may increase slightly 9-10 days from the date of infection and then
subside for 24 hrs or so
• The patient may transmit virus by 9th-10th day after exposure and occasionally as
early as 7th day, before the illness can b diagnosed

9.
PRODROMAL STAGE
• Last for 3-5 days
• Low to moderate grade fever
• Cough
• Coryza
• Conjunctivitis
• These symptoms nearly almost precedes the appearance of KOPLIKS spots(whitish
spots, presents on buccal mucosa opposite to lower molar,Pathogonomic sign of
measles)by 2-3 days

10.
KOPLIK SPOTS

11.
MACULOPAPULAR RASH STAGE
• High grade fever (104-105 F)
• Rash usually starts as faint macules on the face behind the ears and along the
hairlines
• Fading of rash proceeds downward in same sequence as it appearance
• Post cervical lymphadenopathy and slight splenomegaly may be present
• Abdominal pain may be present due to mesenteric lymphadenopathy

12.
DIAGNOSIS
• Diagnosis of measles is primarily clinical
• Serology is most common method of laboratory diagnosis
• Detection of measles virus-specific IgM in a single specimen of serum or oral fluid
is considered diagnostic of acute infection
• Fourfold increase in measles virus specific IgG antibody levels between acute and
convalescent phase serum specimens

13.
COMPLICATIONS
• Respiratory system : otitis media,pneumonia
• GI complications : post measles gastroeneteritis,gangrene of mouth
• Haemorrhagic measles
• Thrombocytopenia
• Subacute scerolosing panencephalitis(very rare)
• Eye :corneal ulcerations, conjunctivitis,optic nerve damage occur rarely
• Heart : myocarditis, cardiac failure

14.
TREATMENT
• No specific antiviral therapy needed
• Good nursing care is essential
• Antipyretics for high grade fever
• Sedatives
• Bed rest
• Adequate fluid intake
• Relief of cough(humidification of room may relief irritating cough )
• Antibacterial therapy for superadded infection
• Vitamin A (reduce morbidity and mortality)
50,000 IU in < 6 months
1 lac IU < 1 year
2 lac IU > 1 year

15.
• Prognosis
• Self limited disease lasting 7-10 days often without sequelae
• Prevention
• Attenuated live measles vaccine : 95% protection against natural disease
• Immunity appears to be life long
• Should b administered at 6-9 months of age
Acc to EPI schedule
• MR at 9 Months of age (0.5ml S/C) : left deltoid
• MR at 15 Months of age (0.5ml S/C) : Left deltoid

16.
IMNCI CLASSIFICATION