acute stage patients in
2.Routes transmission： 2.Routes of transmission： Droplet spray 3.Population susceptibility： 3.Population susceptibility：
It is susceptible to all the people without infection or inoculation. The age of peak incidence was 6 months to 5 years old. The incidence of baby under 6m is lower.
Pathophysiology
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathophysiology
Measles virus
Respiratory epithelium regional lymph nodes First viremia Monocytes/Macrophage Second viremia Respiratory tract, conjunctiva, skin, etc Virus elimination
Typical clinical manifestations
typical facial appearance of measles in prodromal stage
21
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Fever
Cough Coryza
Conjunctivitis
Koplik’s spots.
May suggest measles before
Koplik’s Spots: Pathognomonic sign
ቤተ መጻሕፍቲ ባይዱ20
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathology – Cytopathic change
Multinucleated giant cell (Warthin(Warthin-finkeldey giant cells)
Φ= 100µm, several
nucleus inside the cell, formed by confluence of several virus infected reticuloendothelial cells In smears of the nasal mucosa in the prodromal stage
Typical manifestations
Atypical manifestations
18
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations Incubation stage: 10-14days Prodromal stage: 3-4days
24
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Maculopapular rash
25
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
2.Prodromal stage: 3-4days
The magnitude and pattern of fever are variable in patients, from a low-grade to moderate fever or a sudden high fever may occur. They are not specific symptoms for measles, which are identical to a common cold but catarrhal symptoms maybe more severe.
3
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathogen
measles virus
4
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Epidemiology
1.Infectious 1.Infectious sources ： Measles
2
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathogen
Classification: Classification A RNA virus Genus: morbillivirus Family: paramyxoviridae Serotype: Only one Location: Nasopharyngeal secretions, Blood, Urine of patients
After the use of vaccine
9.5 in 1990 In any time of a year Epidemic cycle disappeared, Sporadic cases increased Below 6m and above 5y Atypical cases mild manifestations less complications rarely death
nodes, slight splenomegaly, gastrointestinal symptoms such as diarrhea and vomiting
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
PATHOGNOMONIC FOR MEASLES
14
Pathology – Cytopathic change
Multinucleated giant cell
PATHOGNOMONIC PRESENTATION FOR MEASLES
15
Pathology
• Respiratory tract • Skin • Koplik’s spots
The prodrome develops on the day symptom begins (fever) and lasts until rash appear.
Fever Cough Coryza Conjunctivitis Koplik’s spots
19
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
appearing sequence of the rash
The rash usually starts on the upper lateral parts of the neck, behind the ears, along the hairline, and on the posterior parts of the cheek. 26
2. Prodromal period 3-4 days 3.Apparent manifestation period 3-5 days 4. Convalescent period 3-5 days
12
1. Incubation period 10-14 days
Pathology
13
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
4.Epidemic features： features：
5
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Epidemiology
Routes of transmission
Droplet spray
6
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
8
9
Epidemiology Measles cases of in-patients in CHCUMS in2000
麻疹病例数
1728
1800 1600 1400
1125
Measles Vaccine Inoculation in whole China (1968)
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
appearing sequence of the rash
It become increasingly maculopapular as the rash spreads rapidly over the entire face, neck, upper arms, and upper part of the chest 27 within approximately the 24hr.