麻疹(英文)課件

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