儿科学PPT课件：麻疹（英文版）-

1、,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Measles,Outline,Etiology,Epidemiology,Pathogenesis,Clinical manifestations,Lab findings,Treatment,Complications,Preventions,Introduction,Historically widespread but now very rare,Characterized by,fever,coryza,cough,Kopliks 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 an

2、d 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,:

3、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,End

4、othelial 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 typic

5、al symptoms,immunocompetent children who didnt receive measles vaccine,or vaccine failure,and didnt receive immunoglobulin,Four stages,Incubation stage:6-12d,may transmit virus by 9-10th day,Prodromal stage:3-5d,fever,cough,coryza,Koplik spots,Rash stage:rash erupts for 2-3d,and fades,Recovery stage,Prodromal stage,Last 3-5d,low-grade to moderate fever,dry cough,coryza,and,conjunctivitis,photophobia,Koplik spots,.,Koplik spots and Stimson line,Koplik spots:1-2d before rash,grayish white dots,as

6、small as grains,opposite the lower molars,may spread over the buccal mucosa,last 12-24hr,Stimson line:transverse line of inflammation along the eyelid margin,Rash stage,Temperature rises,abruptly,as the rash appears,and often reaches 40 or higher,The rash appears and fade,downward sequence,:stars(faint macules)on the upper lateral part of neck,behind the ears,along the hairline,cheek,spreads to entire face(maculopapular),neck,upper arms,chest back,abdomen,entire arm,thighs,and finally reach feet

7、 on the 2,nd,-3,rd,day,In uncomplicated cases,as the rash appears on the legs and feet,the patients may appear desperately ill,but the,symptoms subside within 2d,Branny desquamation,within 7-10d,Black measles,Hemorrhagic type of measles,Bleeding may occur from mouth,nose,or bowel,thrombocytopenia,Occurs in immunocompromised or secondly infection patients,Rash is confluent,petechiae,Often accompanied with pneumonia,heart failure,disseminated intravascular coagulation(DIC),high mortality,Modified

8、measles,Mild cases,Occurs in person with partial protection against measles,such as vaccine,immuoglobulin,Laboratory findings,Cytopathic change,Warthin-Finkeldey cells:consist of multinucleated giant cells with intranuclear inclusions,Antigen:in nasal mucosa,PCR,Virus isolation,Antibodies,IgM and IgG become detectable when,the rash appears,Leucocytopenia with a relative lymphocytosis,Chest radiograph,May show interstitial or perihilar infiltrates,but do not distinguish measles pneumonia and bact

9、erial superinfection.,Diagnosis,Contact history,Characteristic clinical picture,Laboratory confirmation is rarely needed,Differential diagnosis,All kind of fever with red rashes,Such as:Rubella,roseola,scarlet fever,meningococcemia,drug fever,Kawasaki disease,serum sickness,infectious mononucleosis,toxoplasmosis,etc,Differential diagnosis,Enteroviral and adenoviral infections,rubella:The rashes are less striking without desquamation,Roseola infantum:the rash appears as fever disappears,Serum ill

10、ness and drug fever:The absence of administration of a drug history,Red rash in bacterium infection,Acute meningococcemia,The rash is,petechial,and,purpuric,without cough and conjunctivitis,Streptococcal scarlet fever,The diffuse,finely papular rash has a“,goose flesh,”texture,“,sandpaper,”texture,strawberry tongue,red pharynx.,Perioral,and periorbital area,palm,and soles have no rash,.Rash desquamates after 7-14d,Staphylococcal scarlet fever,Resembles streptococcal scarlet fever,Except strawber

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