麻疹-英文課件

麻疹MEASLES重慶醫(yī)科大學(xué)兒童醫(yī)院DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY1麻疹-英文MEASLESKeypointsDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY

Acuterespiratoryinfectiousdisease

causedbymeaslesvirusclinicalfeature:Fever,Cough,Runnynose,Conjunctivitis,ExanthemSpecificsign:Koplik’sSpots(akindofenanthem)2麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY

Classification:ARNAvirusGenus:morbillivirus

Family:paramyxoviridae

Serotype:Onlyone

Location:Nasopharyngealsecretions,Blood,UrineofpatientsPathogen3麻疹-英文PathogenDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYmeaslesvirus4麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYEpidemiologyInfectioussources：Measlespatientsinacutestage

Routesoftransmission：DropletsprayPopulationsusceptibility：4.Epidemicfeatures：Itissusceptibletoallthepeoplewithoutinfectionorinoculation.Theageofpeakincidencewas6monthsto5yearsold.Theincidenceofbabyunder6mislower.5麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYRoutesoftransmissionEpidemiologyDropletspray6麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPriortotheuseofvaccineAftertheuseofvaccineMorbidity(1/100000)Majorepidemics:500-1000Mildepidemics:4009.5in1990PeakseasonInwinterandspringInanytimeofayearEpidemiccycleMajorepidemicsappearby2-4yrintervalsEpidemiccycledisappeared,SporadiccasesincreasedAge6m-5y(98%<10y)Below6mandabove5yClinicalmanifestationsTypicalcasesseveremanifestationsmorecomplicationshighmortalityAtypicalcasesmildmanifestationslesscomplicationsrarelydeathEpidemiologyEpidemicFeatures7麻疹-英文8麻疹-英文9麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY0003MeaslesVaccineInoculationinwholeChina(1968)EpidemiologyMeaslescasesofin-patientsinCHCUMS

10麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathophysiology

11麻疹-英文RespiratoryepitheliumregionallymphnodesFirstviremiaMonocytes/MacrophageSecondviremiaRespiratorytract,conjunctiva,skin,etcViruseliminationMeaslesvirusPathophysiology

1.Incubationperiod10-14days2.Prodromalperiod3-4days3.Apparentmanifestationperiod3-5days4.Convalescentperiod3-5days12麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathology13麻疹-英文Multinucleatedgiantcell(Warthin-finkeldeygiantcells)Pathology–CytopathicchangePATHOGNOMONICFORMEASLESΦ=100μm,severalnucleusinsidethecell,formedbyconfluenceofseveralvirusinfectedreticuloendothelialcellsInsmearsofthenasalmucosaintheprodromalstage14麻疹-英文MultinucleatedgiantcellPathology–CytopathicchangePATHOGNOMONICPRESENTATIONFORMEASLES15麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathologyRespiratorytractSkinKoplik’sspots16麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYPathology–skinRedmaculopapule17麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsTypicalmanifestationsAtypicalmanifestations

18麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsIncubationstage:10-14daysProdromalstage:3-4daysTheprodromedevelopsonthedaysymptombegins(fever)andlastsuntilrashappear.

FeverCoughCoryzaConjunctivitisKoplik’sspots19麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsProdromalstage:3-4days2.

FeverThe

magnitudeandpatternoffeverarevariableinpatients,fromalow-gradetomoderatefeverorasuddenhighfevermayoccur.CoughCoryzaTheyarenotspecificsymptomsformeasles,whichareidenticaltoacommoncoldbutcatarrhalsymptomsmaybemoresevere.ConjunctivitisMaysuggestmeaslesbeforeKoplik’sspots.

Koplik’sSpots:

Pathognomonicsign20麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationstypicalfacialappearanceofmeaslesinprodromalstage21麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestations22麻疹-英文TypicalclinicalmanifestationsDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYExanthemstage:3-5daysMaculopapularrash:

Fever:

temperature

rises

abruptlyCatarrh:Othermanifestations:enlargedlymphnodes,slightsplenomegaly,gastrointestinalsymptomssuchasdiarrheaandvomiting23麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestations24麻疹-英文TypicalclinicalmanifestationsMaculopapularrashDIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGY25麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherashTherashusuallystartsontheupperlateralpartsoftheneck,behindtheears,alongthehairline,andontheposteriorpartsofthecheek.26麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherashItbecomeincreasinglymaculopapularastherashspreadsrapidlyovertheentireface,neck,upperarms,andupperpartofthechestwithinapproximatelythe24hr.27麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsappearingsequenceoftherash28麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsConvalescentstage:3-5days

Inuncomplicatedcases,astherashappearsinthelegsandfeetthesymptomssubsiderapidlywithinabout3daysusuallywithanabruptdropintemperaturetonormal.Astherashfades,brannydesquamationandbrownishdiscoloration(hyperpigmentation)occurandthendisappearwithin2-3weeks.29麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYTypicalclinicalmanifestationsBrannydesquamationandbrownishdiscoloration(hyperpigmentation)Convalescentstage:30麻疹-英文Temp℃Days1-141234567891011121314ClinicalperiodsProdromalstageExanthemstageConvalescentstageCoryzaandconjunctivitisKoplik’sspotsRashCoughBrannydesquamation&hyperpigmentation

Summaryoftypicalclinicalfeatures41403938373631麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsAtypicalmanifestations

32麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYClinicalmanifestationsAtypicalmanifestations

MildmeaslesMeaslesinadultsSeveremeaslesOccursinthepatientwithpartialimmunityOccursinthepatientswithimmunocompromised33麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYComplications34麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYComplicationsPneumoniaSubacutesclerosingpanencephalitis(SSPE)&EncephalitisLaryngitisExacerbationoftuberculosisMalnutritionandVitaminAdeficiencythemostfrequentcomplicationofmeasles

(1)Primarypneumonia

(2)Secondarypneumonia

35麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYLabstudies36麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYLabstudies

Thewhitebloodcellcounttendstobelowwitharelativelymphocytosis.

Multinucleatedgiantcellscanbedemonstratedinsmearsofthenasalmucosaduringtheprodromalstage.TestingofspecificIgMinserumMeaslesvirusisolation37麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosis38麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisEpidemiologicdataClinicaldata

Laboratorydata39麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisEpidemiologicdataAgeSeasonHistoryofcontactwithpatientHistoryofinoculation40麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDiagnosisClinicaldataProdromalperiodExanthemperiodConvalescentperiodKoplik’sspotsTypicalrash;correlationofrashandfever;catarrhBrannydesquamationandbrownishdiscoloration41麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialDiagnosisDifferentialDiagnosis42麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisRubellaRoseolainfantumEnterovirusinfectionExanthemcausedbydrugs

43麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisRubella

44麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisRubella(GermanMeasles

)45麻疹-英文DIVISIONOFINFECTIOUSDISEASEANDGASTROENTEROLOGYDifferentialdiagnosisMeaslesRos