PRESBYTR TRIAN UNIVERSIT SITY OUTSPAN MEDICAL L COLLEGE B BY - - PDF document

PRESBYTR UNIVERSIT MEDICAL

B P.K.K CLINICIAN/ANA EXP

TRIAN SITY OUTSPAN L COLLEGE

BY K.KUBAI NAESTHETIST/MPH XPERT

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

MCP 211 C COMMO COMMO CONDI CT. ON VIRAL ON VIRAL DITIONS

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

MEAS MEAS (MOR ASLES ASLES RBILI)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Definition

n An acute systemic vir

by inhalation of infect by inhalation of infect virus viral infection transmitted ective droplets of measles ective droplets of measles

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Epidemiology

n Highly infectious dise n Humans are the only

Humans are the only

n Average incubation p

days, varying from 7- to onset of fever. isease ly reservoir ly reservoir period 10-12

• 18 days from exposure

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

§ Direct contact with nasa

infected persons.

§ Spreads slightly before

4 days after the appear

§ All people who have no

immunized are suscept immunized are suscept asal or throat secretions of re the onset of symptoms to arance of rash. not had the disease or not ptible. ptible.

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Reported cases Vs un

1500 134 1500 2000 2500 1200 1243 134 500 1000 2002 2003 2004 20005 Reported measles cases Confirm

unvaccinated children

1344 1677 1344 1877 2100 1344 1344 2006 2007 2008 2009 irmed measles cases Unvaccinated children

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Incidence

n Its highest incidence

• nce infected with me
• nce infected with me

permanent immunity ce is in young children and measles one acquires measles one acquires ity (natural immunity)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

n Its more virulence (co

greater during eruptio long as the rash rema (communicability) is tion/rapturing stage or as mains

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Typical case of measl asles

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Common Charac

n Kopliks spots- unique

membrane esp. on bu

n Conjunctivitis – inflam n Cough n Cough n Coryza/flu n Rash- maculo papura

****KC3R

racteristic

ue spots on mucous buccal cavity lamed conjunctiva ura in character

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Incubation Perio

n Usually 10 – 12/7 n Time taken before the

riod

the onset of s/s

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Mode of Transmiss (moi)

n Route nasal – pharyn

droplets from an infe crying, sneezing and

ission the infection

rynx by the infective fected person during nd oughing

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Key Information to Key Information to Suspected Measles Suspected Measles

Person

Age Measles vaccination

Time

Date of rash onset

Place

Residence at onset Potential exposures

to Collect on to Collect on les Cases les Cases

ion status et es (places, persons)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Measles Disea

n .

Maculopapular Rash

+

Fever

+

OR

Clinician Susp

ease

Cough OR Runny nose (Coryza) OR

+

OR Red eyes (Conjunctivitis)

+

OR

uspects Measles

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Clinical manifest

v Divided into various stag q Prodromal Phase

v High fever v Cough, v runny nose (coryza) an v red eyes (conjunctivitis

festations

ages and/or itis)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Clinical Course of M Clinical Course of M

.

• 18 -17 -16 -15 -14 -13 -12 -11 -10 -9
• 8
• 7
• 6
• 5

Incubation Period (7-18 days before Rash)

• 18 -17 -16 -15 -14 -13 -12 -11 -10 -9
• 8
• 7
• 6
• 5

Rash minus 18 days is earliest possible exposure date Rash minus 4 days is probable start of infectiousness

f Measles f Measles

5

• 4
• 3
• 2
• 1

+1 + +3 +4 +5 +6 +7 +8

Prodrome (about 4 days) Rash (about 4-8 days)

5

• 4
• 3
• 2
• 1

+1 + 2 +3 +4 +5 +6 +7 +8

Onset of rash Rash plus 4 days is probable end of infectiousness Communicable Period

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Catarrhal stage o

n

Its characterized by:

q Catarrhal Rash

v Onset 2-4 days after onset v Incubation period: 14 days v Red, blotchy (maculopapula v Moves from face to trunk of v Lasts 5-6 days v Fades in order of appearan

q

Common S/S in this stage

1.

Coryza – occurs between day 2

2.

Conjunctivitis which may have

3.

Running nose

4.

Apathy/malaise

5.

Fever

e of measles

et of prodrome s (range, 7-18 days) ular)

• f body, then to arms/legs

ance

y 2 -4 /7 after infection (range ) e secondary bacterial infection

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

n Most of the time this s

because the s/s are li except for Kopliks spo except for Kopliks spo greyish, white dots us sand/table salt, reddis haemorrhagic on the is stage passes unnoticed e like for other disease spots – Nb. they are spots – Nb. they are usually like grains of dish and sometimes the palate/buccal cavity

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

NB:

n Kopliks spots may als

• 1. Cheeks
• 2. Conjunctiva folds
• 3. Vagina mucous mem
• 3. Vagina mucous mem
• 4. The tongue will be c

grains on the margin

• 5. Lymphadenopathy is
• 6. Followed by fever (4

also appear on the embranes embranes e coated with reddish gins is common r (40 – 41 Oc ) and rash -

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Measles Rash

n Begins as faint macu n Starts from lateral sid

along the hairline

n Post auricular / cheek n Post auricular / cheek n Individual lesions late

papular rash

n Then it later spreads

then upper limbs, che lower limbs cules side of the neck/head eks eks ater changes to macular – ds to the whole face, neck hest abdomen , back and

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Generalized Typi ypical Measles Rash

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

NB

n Rash which appears

fades off by 2-3/7

n Itching may occur as n The rash affects all b n The rash affects all b

externally and interna rs first on face and necks as it fades off l body systems i.e. l body systems i.e. rnally

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

O/E

n General condition of t n Vital signs n S/E or Regional Exam

• f the child

am

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

S/E/REVIEW or

n P/A – splenomegally

some patients

n

GIT – Symptoms - d common common

n R/S: Are common w

like Otitis media and

n Lab. CBC – Low WBC

• r Regional Exam

lly may be an evidence in diarrhea and vomiting are with assoc. complications d pneumonia BCS with lymphocytosis

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

DXX

n Purely by hx and exa n Throat swab for lab b

virus because of late xamination but it rarely yields the te diagnosis or lack of it

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Differential Diag

DDX of measles are d with with

iagnosis (DDX)

e diseases which present ith RASH ith RASH

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Rash

Rubella Dengue Measle

Rash Illness

Roseola Infantu Toxoplasmosis Scarlet Fever

h

Other Viral Exanthems Kawasaki

les

h

tum Meningococcemia Mononucleosis

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

GERMANY MEAS RASH)

n Common in pregnant

very severe and fatal

n Mild and transient in n n The rash has same a n The rash has same a

but no constitutional s in measles morbili i.e , diarrhoe, conjunctivi

ASLES (RUBELLA

nt women and usually tal in non pregnant women appearance and pattern appearance and pattern al signs and symptoms like i.e. fever tivitis and vommiting

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Complications of

n Common in malnouris

• f their weak immune

n In normal children the

they have antibodies they have antibodies

• 1. Head Structures –

a) Conjunctivitis – ulce b)

Otitis Media – Bact

s of Measles Morbili

urished children because ne system/HIV or ISS there may be non because es from their parents es from their parents lcerations/neuritis/blindness acterial infxn may occur

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

c) Cervical adenitis in 1 d) Mouth ulcers – sepsi bacterial 15% of children psis of kopliks spots by

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Respiratory Syste

n Viral/bacterial bronch

OF children with mea leads to high mortality

n Tracheo- bronchiolitis

Tracheo- bronchiolitis may lead to LTB

n Flaring of T.B. n Bronchitis - rare n Lung abscess - rare

ystem Complications

ncho pneumonia in 50% easles associated RDS lity litis – due edema of R/S litis – due edema of R/S

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

CNS Complicatio

• 1. Encephalitis - occurs

cases of children with

• Presents with
• Vommiting
• Vommiting
• Convulsions
• Severe neurological s
• Coma
• Without proper mnx a

high mortality or perm

ations

urs in 1 out of every 1000 ith measles al signs and rx its assoc. with rmanent disability

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

CNS ct..

• 2. Sub acute sclerosis e
• 3. Hemiplegia rare
• 4. Cerebral phlebitis

is encephalitis rare

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Blood Compl

n Thrombocytopenia –

mplications

– leads to parpura

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

GIT

n Gastro enteritis asso

• sociated. with dehydration

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

CVS Compli

n Rare n Myocarditis may occu

plications

ccur leading to heart failure

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

What Should Heal What Should Heal When When He/She He/She Susp Susp

v Manage case (give vitam

treat symptoms or compl

v Report case to District D v Collect a blood serum sp

v Quantity-4-8mls of blo v Quantity-4-8mls of blo v Container v Reverse cold chain

v Fill out a case investigati

ealth Provider Do ealth Provider Do uspects Measles? uspects Measles?

amin A, encourage fluids, and plications, if present) t Disease Surveillance Officer specimen blood blood ation form (IDSR)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

MNX

n By virtue of it being a

no definitive managem

n Mnx and treat and pr

• 1. Secondary bacterial
• 1. Secondary bacterial
• 2. Mild measles – prop
• 3. I.V fluids incase of G
• 4. Keep eyes and mou

a viral infection there is gement prevent complications i.e. ial infxn Rx with antibiotics ial infxn Rx with antibiotics

• phylaxis may be given

f G.E/Pneumonia

• uth clean to INFXNS

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

n Conjunctivitis – T.E.O 1 n Otitis Media - Broad sp

BSA) chloramphenicol ciproflaxin etc Pneumonia - Broad sp

n Pneumonia - Broad sp n Tracheo bronchiolitis –

& cough suppressants/ linctus

n

NB never give expecto O 1% TID/BID spectrum antibioticxs (

• l eye drops/gentamicin or

spectrum antibioticxs ( BSA) spectrum antibioticxs ( BSA) – steam inhalation /inhalers ts/linctuses e.g. actifed ctorant

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

n T.B. – After confirmin

scoring Ant T.B regimen ma Diet is key Diet is key

n G.E. – Rehydrate with

depending on degree

n SUB acute sclerosing

nursing care ing the DXX by T.B ay be started ith ORS or I.V.F ee of dehydration ing Panencephalitis -

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

.

Heart Failure - Antifailu & vasodilators ilure regimen i.e. diuretic

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Preventive Mnx St

Vaccinations/immunizations

• 1. Health promotion/

immunization

v Strengthening of v Conduct Supplem v Conduct Supplem

up) immunizatio

• 2. Strengthening o

and mnx of meas

• 3. Strengthening o

management.

Strategies –

• ns

n/education – on

• f routine immunization

lemental (catch-up,Follow- lemental (catch-up,Follow- ation. g of measles surveillance easles outbreaks g of measles case

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Effect of 2nd Oppor Vaccination to Chi

After 1st dose at 9 m wit 1.0 x 0.80 x 0.85 = After 2nd opportunity wit 0.32 x 0.90 x 0.95 = 0.32 x 0.90 x 0.95 = 1st + 2nd dose = 0.6 immunity)

Ł

Herd immunity th

portunity of Measles Children >12 m Old

with 80% coverage: 0.68 immune with 90% coverage: = 0.27 immune = 0.27 immune 0.68 + 0.27 = 0.95 (95% threshold achieved

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Why give a child a Measles Vaccine? n For those who do no

against measles (do n

n For children who did n For children who did

against measles throu immunization service

a 2nd Opportunity of e?

not develop protection

• not seroconvert)

id not get vaccinated id not get vaccinated rough routine ices (drop-outs)

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Why Conduct Surv Why Conduct Surv Measles? Measles?

• Identify cases
• Identify population
• Detect and invest
• Detect and invest
• Evaluate vaccinat

measles control

urveillance for urveillance for

tions or areas at high-risk stigate outbreaks stigate outbreaks ation strategies to improve

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Steps in Outbrea Steps in Outbrea

1) Complete case investigation fo confirmation for every su

• Linelist all cases aft

incase of cluster 2) Notify DDSC/DMOH/DPHN

• District health office

the area the area 3) Conduct active case finding in identify other suspected c 4) Investigate other suspected ca

• Collect blood and k

status) 5) Analyze data and give feedba

reak Investigation reak Investigation

n form and collect blood for laboratory suspected case after first 5-10 with key information ice should notify all health facilities in in health facilities and villages to d cases cases key information (age, vaccination back to community

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Ref Books

n Disease s of Children

653 – 657

n Diseases of children

17/11/ 17/11/

n MoH policy framewor n WHO recommendatio

ren by Vellard & Mac pgs n by Hugh Jolly pgs

• rk paper

tions

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

THANKS YO GOD BLE KS YOU LESSINGS

Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.