Measles is a red skin rash and buccal mucosa on the measles rash spots and pigmentation left back with bran-like desquamation is characterized, measles is the most common acute viral infectious diseases, contagious, respiratory tract droplets as the main route of transmission. Lasting immunity after measles, relapses are rare, not found specific antiviral drugs. Patients clothing should be in the sun exposure; patients should have ventilation between the housing and UV irradiation, the epidemic season in propaganda work, susceptible children go to public places as little as possible.
Measles Rash/Rubeola - Overview:
Measles (or Rubeola) is the most common acute viral infectious diseases. Measles is highly infectious, in densely populated areas without general vaccination epidemic prone to occur about 2 to 3 years a pandemic. Persian physician Muhammad ibn Zakaria Razi first explain the disease, and smallpox to distinguish. Clinical disease with fever, upper respiratory tract inflammation, conjunctivitis, etc., to red skin rash and buccal mucosa on the measles rash spots and pigmentation left back with bran-like scaling of features. World Health Organization (WHO) estimates that globally there are still cases of measles each year about 40 million, of which 100 million children die from measles and its complications, the vaccine-preventable viral disease in the largest number of death cases.
Measles Rash/Rubeola - etiology
Measles virus is a virus, Vice mucosal viruses, is also a DNA virus, and other viruses, vice mucosa no special place for the neuraminidase.
Spherical electron microscopy of measles virus, diameter 150-300nm, capsid outside envelope, envelope with hemagglutinin (HL), hemolysis. Low resistance to this virus is not strong, dry, sun, are sensitive to heat, UV, peracetic acid, formaldehyde, such as lactic acid and ether are killing effect of measles virus.
Measles virus RNA is a single stock, Deputy mucus type virus, the virus with droplets of respiratory tract and conjunctiva invading epithelial cells of a small amount of propagation, causing local inflammation, into the blood by the local formation of viremia, widespread lesions. Small number of patients measles pneumonia. Because non-specific immunity in patients with measles is easy to reduce secondary bacterial infection.
Measles Rash/Rubeola - epidemiology
Measles - the source of infection
Patients with acute measles is the only source of infection, the incubation period from the last 1-2 days to 5 days after the rash are contagious. The patient's mouth, nose, throat, eye secretions contain the virus, and excreted with the droplets, it is the main route of transmission of respiratory droplets. Incidence of both seasons, winter and spring up to 6 months to 5 years the highest incidence in children. Illness lasting immunity, relapses are rare.
Measles - transmission
Measles virus with those infected droplets into the nasopharynx and eye or be inhaled directly to the trachea, bronchi, epithelial cells in the local breed, and after the flow of lymphatic cells reach the lymph node, continue to multiply and spread into the blood stream to form a The first viremia. After the virus enters the blood lymphocytes in lymphoid tissue to the body, liver, spleen organs, tissues and organs in the extensive proliferation of these again into the bloodstream, leading to a second viremia, widespread disease, skin and mucous membranes of the body capillary endothelial cells were also infected with measles virus.
Measles Rash/Rubeola- susceptible
The disease is highly contagious, susceptible contacts are more than 90% after onset. In densely populated areas without general vaccination about every 2 to 3 years once popular, l-5-year-old children with the highest incidence. Measles incidence rates have dropped after use. But not lasting immunity, so the age of onset after the shift. Disease did not receive the vaccine in preschool children. Immune failure in children and young teens more common and even popular within the community can be formed.
Baby from the placenta to be the mother antibodies within 4-6 months after birth passive immunity. Then gradually disappeared, although the vast majority of infants at 9 months the mother of antibody within the blood could not have been measured, but some children are still there even sustainable for up to 15 months. Will affect the vaccination. Susceptible infants of mothers without immunity to measles may be sick before and after birth.
Measles - Pathogenesis
When inhaled measles measles patients susceptible nasopharyngeal secretions or droplets containing the virus, the measles virus in the local mucosal short-term breeding, while a small amount of virus invasion of the blood. Since then the virus in distant organs of the monocyte-macrophage cell system in the replication and infection after about 5-7 days into the blood that is, for a large number of clinical prodromal period. In this period, such as body tissue in children: airway epithelial cells and lymphoid tissues, can be found virus in nasopharyngeal secretions and urine and blood and other secretions and body fluids. At this point most contagious.
Rash appears, viral replication is reduced to 16 days after infection, the virus can still only in the urine for several days. 2 days after rash, serum antibodies is almost 100% positive clinical symptoms are significantly improved. As the systemic and local immune response at this time is still suppressed in some patients it is often secondary to sinusitis, otitis media and bronchopneumonia.
10% of children with cerebrospinal fluid lymphocytes was significantly increased by 50%. When in peak condition EEG changes, but only 0.1% had signs and symptoms of encephalitis, which often occurs several days after acute onset. At this time serum antibody has been increased and has not found the virus, so consider autoimmune encephalitis.
Incubation period of measles:
A typical incubation period of measles than the rule, usually 7 to 14 days, up to 21 days.
Measles - the type of
There are many types of measles:
Typical measles
1, the prodromal phase
To the onset of rash from about 3 to 5 days. The main symptoms are fever and upper respiratory catarrhal symptoms, generally low to moderate degree of fever, there are sudden high fever with seizures. Runny nose, irritating cough, conjunctival hyperemia, tearing, photophobia gradually increased, lethargy, anorexia, pulmonary rales could be heard to dry. Children often vomiting, diarrhea, in the soft palate, hard palate arch, there may be small in a transient red rash.
The onset of the first 2 to 3 days can be on the bilateral buccal mucosa occurred at near molar gray fine sand-like dots, around to flush, said early measles disease-oriented features of mucosal plaques. Mucosal plaques can be gradually increased, convergence, also seen in the lower lip and gum mucosa inside, occasionally in the palate, the general maintenance of 16 to 18 hours, sometimes until 1 to 2 days, mostly in 1 to 2 days after the rash disappears.
2, the rash phase
Onset of about 3 to 5 days later, symptoms and upper respiratory symptoms increased, body temperature can be as high as 40 ℃, listlessness, lethargy, anorexia. First, the ear hair skin rash, rapid development to the face and neck, top-down one day spread to the chest, back, abdomen and limbs, about 2 to 3 days throughout the palm of the hand, foot, head and facial rash have been available at this time begin retreat. Rash about 2 ~ 3mm size, the beginning of pale red, scattered, gradually after intensive bright red, then to dark red, rash normal skin between. Rash when the body lymph nodes, liver, spleen may be enlarged, the lungs dry coarse rales could be heard.
3, recovery
Rash by rash after a homogeneous order of retreat, leaving brown pigmented spots, with bran-like scaling, there are about 2 to 3 weeks. Retreat with the rash to reduce systemic symptoms, heat back, spirit, appetite improved, cough improved recovery. Throughout the course of about 10 to 14 days.
Light measles
More common in those who received the vaccine. Currently more common in patients with light. Low fever, mild upper respiratory symptoms, mucosal plaque measles is not obvious, less rash, with few complications.
Heavy measles
Benedict severe illness. High fever, delirium, convulsions were toxic for the measles; with those of shock and circulatory failure of measles; hemorrhagic rash, pressure of those who do not fade as hemorrhagic measles.
Atypical measles
Seen after vaccination with inactivated measles vaccine vaccinated again six months later. China with the live attenuated vaccine, therefore type is rare.
Measles - complications
The most common complications of bronchial pneumonia, myocarditis, laryngitis and otitis media, encephalitis can occur in other, subacute sclerosing panencephalitis, cardiovascular insufficiency and tuberculosis spread etc.
Measles/ Rubeola- diagnosis
Clinical diagnosis
Typical treatment of measles based on epidemiological data and clinical manifestations can be diagnosed. Susceptible in 2-4 weeks history of exposure to measles, fever, coughing, sneezing, runny nose, conjunctival hyperemia, tearing and other symptoms, should be suspected and measles, such as measles mucosal plaques can be diagnosed. Characteristics according to the rash after rash, rash, and rash distribution of the order is also easy to make a diagnosis. Rash with desquamation and pigmentation back in the recovery of diagnostic significance.
Laboratory tests
1, the blood: WBC normal or slightly higher prodromal period, rash period slightly reduced the relative increase in lymphocytes.
2, nasopharyngeal, or urine sediment smears stained looking multinucleated giant cells, 1-2 days before the rash can be positive, the positive rate of the first week of the course can be as high as 90%, and has important reference value. Can be found using immunofluorescence antigen measles, can be used as the basis for early diagnosis.
3, serum antibody detection: enzyme-linked immunosorbent assay or immunofluorescence assay of serum measles antibodies 2-3 days after the onset can be measured, can be used as an early specific diagnosis. Serum hemagglutination inhibition antibody, neutralizing antibodies and complement fixation antibodies, recovery increased by 4 times more side diagnosis, only as a retrospective diagnosis.
4, measles virus isolation: taking the patient's nasopharyngeal secretions or early blood leukocytes inoculated on monkey kidney, human embryonic kidney cells or other sensitive, separable to the measles virus, but positive rate of reduction.
Measles - treatment:
Of measles virus present (2011) have not yet found specific antiviral drugs, so treatment focuses on strengthening care, symptomatic treatment and prevention of complications.
Measles - Nursing -Measles Care:
Should rest in bed, single room isolation, indoor air fresh and maintain proper temperature and humidity, not too much clothing, eyes, nose, mouth, skin clean. Digestible diet should be nutritious and should be more warm water to feed. Can not avoid the mouth, there should be recovery snacks. Heat can be given a small dose of antipyretic, antitussive cough to be so when the drama. Early to frail ill may intramuscular gamma globulin, a small amount of repeated blood transfusion or plasma.
MeaslesRubeola/ - prevention
Prevention to improve population immunity against measles is the key, so the implementation of immunization susceptible people is very important. Found measles patients should take comprehensive measures to prevent spread and popular.
Autoimmune
Susceptible should receive live attenuated measles vaccine. First kind of not less than 8 months of age, due to fear from the mother's antibodies and the vaccine virus, so failure.
Passive immunity
Young frail and sick patients, such as exposure to measles, 5 days a passive immunization against disease, 5 to 9 days you can only alleviate the condition.
Intramuscular gamma globulin (10%) 0.2ml/kg, or placental globulin 0.5 ~ 1.0ml/kg, or adult plasma 20 ~ 30ml. Passive immunity can only maintain 3 to 4 weeks, 3 weeks after contact with measles patients had to be injected.
Comprehensive prevention
Found for the epidemic of measles cases should be immediately reported to the rash and 5 days after isolation, have complications until 10 days. Where contact with vulnerable children should be quarantine for 3 weeks, and under the circumstances to give auto-immune or passive immunization, immunization agents, shall be to extend the quarantine to four weeks. During the measles epidemic, should vigorously promote the patient does not go out, medicine sent home, susceptible children do not suffer from the door, the collective institutions to strengthen morning inspection of the suspect should be isolated for observation.
Cut off the transmission
Patients clothing should be in the sun exposure; patients should have ventilation between the housing and UV irradiation, the epidemic season in propaganda work, susceptible children go to public places as little as possible.
