Measles

Every year worldwide, about 50 million children with measles, in which an estimated 722,000 children <5 years of age die from complications from measles and 40% of deaths due to malnutrition. The disease usually occurs in African countries and South East Asia.

Ads by Google

Measles in baby

Measles is detected

• Measles is a disease first described in the tenth century by the physician Rhazes Persan. Until the eighteenth century, the Home began to work on the experimental transmission of measles. Especially the study of measles in babies. Measles virus of the family paramyxovirus influenzae. This group of viruses antigenically similar to, but measles virus neuraminidase does not own them, so it is not absorbed by the receptors of cells containing acid neuraminidic. Measles virus containing erythrocyte agglutination factor, while the virus paramyxovirus group as Rinderpest and Canine distemper is not there.
• Measles virus is easily destroyed by high heat. At 560 ° C it was destroyed in 30 minutes. It was inactivated by light, ultrasound and a number of other physical and chemical agents. Conversely it himself survived more than 5 years at room temperature - 700 degrees C. Like the kind Myxovirus, measles virus is sensitive to ether and virus breaks into small pieces.

Epidemiology

• Measles in children is acute viral infection, very strong transmission occurs year-round, the highest in the spring and everywhere in the world. The disease is caused epidemics cycle 3-4 times year 1. Prior periods have vaccines, widespread disease at the age of 2-6. Currently the country is the use of vaccines ROR measles incidence decreased 99%. Measles tends to shift to older children. In 1994 in Vietnam epidemic, up to 11,000 children with measles cases. Status of measles in the past 20 years (1979-1999) of children nationwide suffer from 579 678 cases, 2190 cases of death.
• Every year worldwide, about 50 million children with measles, in which an estimated 722,000 children <5 years of age die from complications from measles and 40% of deaths due to malnutrition. The disease usually occurs in African countries and South East Asia. 
• Measles virus pathogenic to humans through the respiratory tract, in addition conjunctival route is also very important. With direct transmission path through the saliva particles containing the virus, it attacks the lining of the nose, oral mucosa, pharyngeal mucosa or localized mucosal, conjunctival. Viruses multiply in the respiratory epithelium and lymphoid system, then through the circulatory system and spread to other organs in the body.

Risk factors of measles are: 

• Children <1 year of age and older children. 
• Children suffering from malnutrition. 
• Children who are not immunized against measles. 
• Children with HIV infection. 
• The parents of children with measles does not comply the direction of medical staff. 

Pathogenesis

• When measles virus enters the upper respiratory tract or the conjunctiva, then the virus to multiply in the mucosa and lymph nodes. On day 5 and 6 viremia occurs and causes recurrent infection in the tissue. On day 11, the prodromal symptoms begin to appear until about the 14th day and the rash appears. From 24-48 hours after the rash appears, the antibodies appear quickly. Typically quantitative antibody on day 2 and 3 after the rash. The rate increased rapidly achieve 1/256, 1/512 in a few days. This rate decreased only slowly and often people also found antibodies to 1/16 or 1/32 after 10 or 15 years after measles infection.
• During the two-phase viremia, measles virus spread primarily in the white blood cells. Government of virus replication in leukocytes explain the increased neutropenia and the incidence of chromosome breakage of the cell. The decrease in oxygen production and enzyme deficiencies in leukocyte biology measles virus in at the moment which can easily give the secondary ascending infection of bacteria. 
• Koplik particles derived from submucosal glands as an inflammatory lesions, including serum exudate and proliferation of endothelial cells.
• In gray matter encephalitis subacute fibrosis, one can isolate the virus in brain biopsy and also have antibodies of patients with high titration.

Clinical 

• The incubation period 
• Lasted 10-12 days. No specific symptoms, there may be a slight fever and respiratory signs are not clear. 
• Intrusive phases 
• Lasts for 3-4 days, high fever 39 - 400C, gradually the clinical signs more clearly: 
• Nasal drip - eyes. 
• Appears board connectors: That is nuts Koplik or mucosal lesions in the vulva is valuable for diagnosis. 
• Coordinate with occasional signs: Accounting major, initial transient, loss of appetite, nausea.

Phase rash 

• Appear about 14 days after infection. You are currently productive land from head to toe. Since the rash appears until the flight ban lasts from 5-6 days.

Phase exfoliative skin 

• When flying measles, skin desquamation, leaving blackened spots uneven, with images like leopard. After 7-10 days was back to normal. 
• In addition to the usual measles, hemorrhagic measles also, this is a very severe clinical manifestations of dengue in skin, oral mucosa - the nose and gut, often fatal pediatric patients.

Complications

Upper respiratory tract 

• Purulent rhinitis, pharyngitis erythema. Otitis media is a common complication in children, occurring in advanced stages of the disease. 
• Croup usually occurs soon. 

Lower respiratory tract 

• Pneumonia is a common complication of measles. It is the result of: 
• Infectious virus spread. 
• Multiple infections like pneumococcal bacteria, streptococcus, staphylococcus or HI .. 
• Combine both viruses and bacteria. 
• Giant cell pneumonia, also known as Hecht pneumonia, pneumonia is a prolonged, dangerous, threatening death, usually occurs in immunocompromised children. 

Central Nervous System 

• Encephalitis or encephalomyelitis level. Prevalence of 0.1 - 0.2% in children with measles but rare in children <2 years of age. The mortality rate of about 5-10%.

Measles and HIV

• In children infected with HIV , measles mortality by more than 10 times higher than normal children . In America and Africa are the same for complications and death .
• The mortality rate in measles complications of pneumonia among HIV ( + ) of about 33-45 % .
• Otitis
• Happens about 10 % of patients with measles , usually in children with a history of ear infections and can then be secondary to mastoiditis .

Eyes

• Keratitis , corneal ulcers , ulcerated eyes wide.

Gastrointestinal tract

• Abdominal pain due to nonspecific lymphoid hyperplasia affecting the mesenteric lymph nodes . There may be acute appendicitis in advanced disease stages . Also possible diarrhea .

Measles with pregnant mothers

• Gestation period , if measles will result in : stillbirth , miscarriage or premature birth but no birth defects . Some diseases , such as asthma , kidney damage , eczema may temporarily decrease in measles infection stage .

Malnutrition

• Malnutrition occurs during disease progression is due to the amount of food taken in sufficient quantity and quality not so young anorexia accompanied by oral infection such as oranges ship , gangrene or infection Candida or Herpes .

Differential Diagnosis

Rubella 

• This is an infection that is granted a German physician first described. Patients expressed a high fever, sore glands behind the ears, armpits and groin. Then the whole body rash maculopapular form. After the flight can not leave black stains, and no skin desquamation phenomenon. Especially with no seeds Koplick. 
• Intestinal infections caused by viruses 
• High fever, loose stools several times a bowel movement; rash accompanied by systemic hemodynamics form. 
• Committee existed within 2-3 days. After initial flight does not leave black stains. 

Adenovirus infection 

• High fever, signs of inflammation dragon. Rash systemic hemodynamics form. After initial flight no skin desquamation and no black and blue marks. 

Treatment and care 

• Children with measles need is a cool place - Cleaning the body, it should be noted three agencies: Eyes - Nose - Mouth. Having adequate nutrition.

Drugs 

• Vitamin A: Treatment in 2 days: 
• Children> 1 year of age for oral 200,000 IU / day. 
• Children <1 year old to take 100,000 IU / day. 

Antipyretic. 

Treating symptoms. 

• Antibiotics when complications.