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麻疹MEASLES1MEASLESKeypointsDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY
Acuterespiratoryinfectiousdisease
causedbymeaslesvirusclinicalfeature:Fever,Cough,Runnynose,Conjunctivitis,ExanthemSpecificsign:Koplik’sSpots(akindofenanthem)2DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY
Classification:ARNAvirusGenus:morbillivirus
Family:paramyxoviridae
Serotype:Onlyone
Location:Nasopharyngealsecretions,Blood,UrineofpatientsPathogen3DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYEpidemiologyInfectioussources:Measlespatientsinacutestage
Routesoftransmission:DropletsprayPopulationsusceptibility:4.Epidemicfeatures:Itissusceptibletoallthepeoplewithoutinfectionorinoculation.Theageofpeakincidencewas6monthsto5yearsold.Theincidenceofbabyunder6mislower.5DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYRoutesoftransmissionEpidemiologyDropletspray6DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPriortotheuseofvaccineAftertheuseofvaccineMorbidity(1/100000)Majorepidemics:500-1000Mildepidemics:4009.5in1990PeakseasonInwinterandspringInanytimeofayearEpidemiccycleMajorepidemicsappearby2-4yrintervalsEpidemiccycledisappeared,SporadiccasesincreasedAge6m-5y(98%<10y)Below6mandabove5yClinicalmanifestationsTypicalcasesseveremanifestationsmorecomplicationshighmortalityAtypicalcasesmildmanifestationslesscomplicationsrarelydeathEpidemiologyEpidemicFeatures78DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY0003MeaslesVaccineInoculationinwholeChina(1968)EpidemiologyMeaslescasesofin-patientsinCHCUMS
10RespiratoryepitheliumregionallymphnodesFirstviremiaMonocytes/MacrophageSecondviremiaRespiratorytract,conjunctiva,skin,etcViruseliminationMeaslesvirusPathophysiology
1.Incubationperiod10-14days2.Prodromalperiod3-4days3.Apparentmanifestationperiod3-5days4.Convalescentperiod3-5days12Multinucleatedgiantcell(Warthin-finkeldeygiantcells)Pathology–CytopathicchangePATHOGNOMONICFORMEASLESΦ=100μm,severalnucleusinsidethecell,formedbyconfluenceofseveralvirusinfectedreticuloendothelialcellsInsmearsofthenasalmucosaintheprodromalstage14MultinucleatedgiantcellPathology–CytopathicchangePATHOGNOMONICPRESENTATIONFORMEASLES15DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathology
RespiratorytractSkin
Koplik’sspots16DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathology–skinRedmaculopapule17DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsTypicalmanifestationsAtypicalmanifestations
18DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsProdromalstage:3-4days2.
FeverThe
magnitudeandpatternoffeverarevariableinpatients,fromalow-gradetomoderatefeverorasuddenhighfevermayoccur.Cough
Coryza
Theyarenotspecificsymptomsformeasles,whichareidenticaltoacommoncoldbutcatarrhalsymptomsmaybemoresevere.ConjunctivitisMaysuggestmeaslesbeforeKoplik’sspots.
Koplik’sSpots:
Pathognomonicsign20DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationstypicalfacialappearanceofmeaslesinprodromalstage21TypicalclinicalmanifestationsDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYExanthemstage:3-5days
Maculopapularrash:
Fever:
temperature
rises
abruptlyCatarrh:Othermanifestations:enlargedlymphnodes,slightsplenomegaly,gastrointestinalsymptomssuchasdiarrheaandvomiting23DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestations24DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherashTherashusuallystartsontheupperlateralpartsoftheneck,behindtheears,alongthehairline,andontheposteriorpartsofthecheek.26DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherashItbecomeincreasinglymaculopapularastherashspreadsrapidlyovertheentireface,neck,upperarms,andupperpartofthechestwithinapproximatelythe24hr.27DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherash28DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsBrannydesquamationandbrownishdiscoloration(hyperpigmentation)Convalescentstage:30Temp℃Days1-141234567891011121314ClinicalperiodsProdromalstageExanthemstageConvalescentstageCoryzaandconjunctivitisKoplik’sspotsRashCoughBrannydesquamation&hyperpigmentation
Summaryoftypicalclinicalfeatures41403938373631DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsAtypicalmanifestations
32DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsAtypicalmanifestations
MildmeaslesMeaslesinadultsSeveremeaslesOccursinthepatientwithpartialimmunityOccursinthepatientswithimmunocompromised33DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYComplications34DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYComplications
Pneumonia
Subacute
sclerosing
panencephalitis(SSPE)&EncephalitisLaryngitisExacerbationoftuberculosisMalnutritionandVitaminAdeficiencythemostfrequentcomplicationofmeasles
(1)Primarypneumonia
(2)Secondarypneumonia
35DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYLabstudies36DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYLabstudies
Thewhitebloodcellcounttendstobelowwitharelativelymphocytosis.
Multinucleatedgiantcellscanbedemonstratedinsmearsofthenasalmucosaduringtheprodromalstage.TestingofspecificIgMinserumMeaslesvirusisolation37DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosis38DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisEpidemiologicdataClinicaldata
Laboratorydata39DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisEpidemiologicdataAgeSeasonHistoryofcontactwithpatientHistoryofinoculation40DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisClinicaldataProdromalperiodExanthemperiodConvalescentperiodKoplik’sspotsTypicalrash;correlationofrashandfever;catarrhBrannydesquamationandbrownishdiscoloration41DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialDiagnosisDifferentialDiagnosis42DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosis
Rubella
Roseola
infantum
Enterovirusinfection
Exanthemcausedbydrugs
43DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisRubella
44DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisRubella(GermanMeasles
)45DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisMeaslesRoseolainfantumTherashtypicallyappearswhentheelevatedtemperaturehasabated,andcanlastforo
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