Measles

Question 1

What is the family?

Answer 1

Paramyxovirus

Question 2

How is it transmitted?

Answer 2

Spread by aerosol and extremely contagious

Question 3

Where does it replicate in?

Answer 3

Viraemia, virus replication in respiratory epithelium and skin

Question 4

What are the clinical presentations?

Answer 4

• Fever
• Conjunctivitis
• Rhinorrhoea
• Cough
• Koplik’s spots around parotid duct orifices herald onset
• Few days later - typical maculopapular rash from face and spreads to entire body

Question 5

How long is the incubation period?

Answer 5

10-14 days

Question 6

Does it confer life-long immunity?

Answer 6

Yes

Question 7

What is it an ubiquitous infection in?

Answer 7

Early childhood

Question 8

What are the mucosal infections?

Answer 8

• Conjunctivitis
• Otitis media

Question 9

What are the respiratory complications?

Answer 9

• Bronchopneumonia
• Giant cell pneumonia (rare progressive measles lung infection in immunocompromised/malnourished)

Question 10

What is the gastrointestinal complication?

Answer 10

Diarrhoea due to measle virus or secondary bacterial infection

Question 11

What kind of complications can it result in?

Answer 11

Mucosal infections, respiratory, gastrointestinal, Neurological

Question 12

What are the neurological complications?

Answer 12

• Encephalitis (high mortality)
• Sub-acute sclerosing panencephalitis (develops long period following apparent recovery, persistent latent infection of neurons by defective measle virus? abnormal immune response to measles virus? impaired host immunity?)
• Myoclonic seizures, intellectual deterioration, characteristic suppression burst EEG pattern, rapidly fatal
• Cytoplasmic inclusions in neuronal cells

Question 13

What are the neurological complications?

Answer 13

• Encephalitis (high mortality)
• Sub-acute sclerosing panencephalitis (develops long period following apparent recovery, persistent latent infection of neurons by defective measle virus? abnormal immune response to measles virus? impaired host immunity?)
• Myoclonic seizures, intellectual deterioration, characteristic suppression burst EEG pattern, rapidly fatal
• Cytoplasmic inclusions in neuronal cells

Question 14

How to diagnose?

Answer 14

• Cell culture (virus ioslated from pharynx, conjunctiva, urine)
• RT-PCR
• Serology (IgM assay for recent infection, IgG for retrospective diagnosis)

Question 15

Describe the immunisation

Answer 15

• Live attenuated vaccine adminstered at age 12 months and 15-18months
• New MMRV vaccine includes VZV antigens
• Confers effective and long-lasting immunity
• Mild pyrexia but serious complications are rare
• Contraindcated in severely malnourished and immunocompromised children, pergnant women (passive immunisation with immune gammaglobulin for contacts with immunodeficiency)

Question 16

What is a slow disease it causes?

Answer 16

Subacute spongioform encephalopathies (Neurological diseases due to unconvential agents)
- Spongioform/vacuolating degeneration in brain