儿科学：麻疹.ppt

Measles
Outline
Etiology
Epidemiology
Pathogenesis
Clinical manifestations
Lab findings
Treatment
Complications
Preventions
Introduction
Historically widespread but now very rare
Characterized by fever, coryza, cough, Koplik’s spots, and maculopapular rash
Etiology
Measles virus, a single-stranded RNA paramyxovirus with one antigenic type. Humans are the only natural host
Found in nasopharyngeal secretions, blood and urine, during the prodromal period and for a short time after the rash appears
Remain active for 1-2 days at room temperature
Epidemiology
Spread throughout the world, vaccine-preventable disease
For susceptible persons, 90% of the exposed acquire disease
Infection sources: patients and person with latent infection
Contagious period: 5 days before and after the rash appearance, accompanied with pneumonia, prolonging to 10th day
Transmission: airborne and contact
Season: spring, Age: 5-10yr
New trends: measles appears in <8m infants and elders, due to inadequate vaccination as well as vaccine failure
Pathogenesis
Process of virus in the body
(two times of viremia)
Invade airway endothelial cells, portal lymph node, and multiply (warthin-Finkeldey giant cell)
Some invade to blood
Captured by Monocyte - macrophage system, and replicates greatly,
Invade blood second time, cause disseminated lesions, some target T cells
The host immunity decrease, induce secondary bacterial infection and TB reactivation
Endothelial cells
Dendritic cell
T cells
Pathogenesis
Koplik spots
Consist of serous exudate and proliferation of endothelial cells
Interstitial pneumonia due to measles virus
Bronchopneumonia may due to secondary bacterial infection
Perivascular demyelinization in brain and spinal cord
Subacute sclerosing panencephalitis (SSPE)
Degeneration of the cortex and white matter with inclusion bodies, occur 7-11yr after measles, measles antibodies are detected in CSF
Clinical manifestaions
Persons with typical symptoms