A 2-year old boy presents with fever, cough, runny nose and sticky eyes for 4 days. He has now developed a rash around his ears and hairline that is spreading over his body. He is lethargic. Measles is diagnosed based on clinical presentation and history of contact. Measles is highly contagious and caused by an RNA virus. Complications can include encephalitis, eye issues, ear infections and pneumonia. Treatment is supportive with antipyretics, fluids and antibiotics for secondary infections. Prevention involves vaccination at 6-9 months which provides 95% protection.

1. MEASLES
Dr. Zaid Bin Tariq
Paeds Unit 1 AHF

2. CASE:
• A 2 year old boy presents with fever, cough, blocked runny nose(coryza)
and sticky eyes (conjuctivitis) for 4 days. Now, he has developed
a maculopapular rash around his ears and hairline. Rash is
continuing to spread over most of his body. He is lethargic for the last 5 days. On
examination, temperature is 104 ‘’F. There is no respiratory distress but he is coughing.
Pharynx is red. He has conjunctivitis.

3. ORGANISM:
• Measles is an RNA virus.
• Present in Nasopharyngeal secretions, Blood and urine during the prodromal stage
for short time.
• Highly contagious.

4. CLINICAL STAGES:
• Incubation Stage.
• Prodromal Stage / Catarrhal stage.
• Maculopapular rash Stage.

5. • Incubation period is 10-12 days.
• Prodromal stage Koplik spot and Mild Symptoms.
• Prodromal phase usually last 3-5 days and is characterized by high fever and
lassitude, which persists and is accompanied by cough , coryza and conjunctivitis
over next 3 days.
• These almost always precede Koplik spots,which are present on intensely red base
on the buccal mucosa and tend to occur opposite the lower molars.They disappear
within 12-18 hours. posterior cervical lymphadenopathy may accompany these
early manifestation. this phase is also called catarrhal phase.

6. MACULOPAPULAR STAGE:
• Temperature rises abruptly and reaches 104’-105’F.
• The rash usually starts as faint macules on the face behind the ears and along the
hairline.
• The lesions become increasingly maculopapular as the rash spreads to the trunk and
limbs.
• As it finally reaches the legs and feet on the second or third day it begins to fade on the
face.
• The fading of rash proceeds downwards in the same sequence as its appearance.
• Posterior cervical lymphadenopathy may be present.
• There may be abdominal pain due to mesenteric lymphadenopathy.

7. Koplik’s Spot Maculopapular Rash

8. COMPLICATIONS:
• Encephalitis Encephalitis
SSPE
• Eye
• Otitis Media
• Respiratory system Giant cell pneumonia
Pneumonia (Bacterial)
• Heart
• GIT complications
• Hemorrhagic (black) measles
• Thrombocytopenia
• Miscellaneous

9. DIAGNOSIS:
• Diagnosis is primarily clinical.
• History of contact with the patient of measles can usually be elicited.
• Diagnosis the prodromal stage, multinucleated giant cells can.be demonstrated in
smears of nasal mucosa.
• Virus can be isolated in tissue culture or antibody titer can be detected in serum..
• White blood cell count is low with relative lymphocytosis.
• Lumbar puncture in encephalitis shows an increase in protein and a small increase
in lymphocytes.

10. TREATMENT:
• Treatment is mainly supportive.
• Good nursing care is essential.
• There is no specific antiviral therapy.
• Antipyretics for high fever, relief of cough, maintenance of clear nasal passages, sedatives, bed rest
and adequate fluid intake are essential.
• Humidification of the room may relieve the irritating cough by making the room comfortably warm.
• Bacterial superinfections should be treated with antimicrobial therapy.
• Vitamin A
• Once daily for two days.
• 200,00 IU (for children 12 months of age or older)
• 100,000 IU for infants 6 months through 11 months of age.
• 50,000 IU for infants younger than 6 months of age.
• In Children with sign and symptoms of vitamin A deficiency, a 3rd dose according to age is recommended 2-
4 weeks after the 2nd dose.

11. SSPE
• CASE:
A 10 year old boy presents with deteriorating school performance and
psychological withdrawal for last 8 months. There are episodes of abnormal
behavior. On examination, he has hypertonia, sluggish reflexes and myoclonic
jerks. There is suppression burst pattern on EEG.

12. DIFFERENTIAL DIAGNOSIS:
• Measles
• Scarlet fever
• Kawasaki disease
• Meningococcemia
• Rubella
• Drug Rash

13. PREVENTION:
Pre Exposure:
• Attenuated measles vaccine gives 95% of protection
• Immunity appears to be life long
• Attenuated vaccine should be administered at 6-9 months
Post Exposure:
• If vaccine is given up to 3 days after exposure to natural disease
It can be prevented
• If exposure has occurred , then measles immune globulin 0.25ml/kg and vaccinate 6-8
weeks later

16. THANK YOU
Any Questions?