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MEASLESMEASLES((campakcampak,, rubeolarubeola,, gabakgabak,,keru utkeru ut

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Infectious and Tropical Pediatric DivisionInfectious and Tropical Pediatric Division

Department of Child Health,Department of Child Health,Medical Faculty, University of SumateraMedical Faculty, University of SumateraUtaraUtara


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Maculapapular eruptionMaculapapular eruption ::

1.1. MeaslesMeasles

2.2. Atypical measlesAtypical measles

3.3. RubellaRubella4.4. Scarlet feverScarlet fever

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6.6. Staphylococcal toxic shock syndromeStaphylococcal toxic shock syndrome

7.7. MeningococcemiaMeningococcemia

8.8. Typhus and Tick feversTyphus and Tick fevers9.9. ToxoplasmosisToxoplasmosis


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10. Cytomegalovirus infection10. Cytomegalovirus infection

11. Erythema infectiosum11. Erythema infectiosum

12. Roseola infantum12. Roseola infantum

13. Enteroviral infections13. Enteroviral infections14. Toxic erythemas14. Toxic erythemas

15. Dru eru tions15. Dru eru tions

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16. Sunburn16. Sunburn

17. Miliaria17. Miliaria

18. Mucocutaneous lymph node syndrome18. Mucocutaneous lymph node syndrome(Kawasaki disease)(Kawasaki disease)


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DefinitionDefinition : Measles is an acute, highly: Measles is an acute, highly

contagious, ancient viral diseasecontagious, ancient viral diseasecharacterized by fever, coryza,characterized by fever, coryza,conjunctivitis, cough, spesific enanthemconjunctivitis, cough, spesific enanthem(Kopliks spot)(Kopliks spot) generalizedgeneralizedmaculopapular eruption, usually appearsmaculopapular eruption, usually appears

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EtiologyEtiology : Genus : Morbillivirus: Genus : Morbillivirus

Family : ParamyxoviridaeFamily : Paramyxoviridae


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PathologyPathology : Measles is a generalized infection: Measles is a generalized infection pathological lesions are widespread/pathological lesions are widespread/

Prodromal periodProdromal period : hyperplasia of the: hyperplasia of thelymphoid tissue in the tonsils, adenoids,lymphoid tissue in the tonsils, adenoids,lymphnodes, spleen, and appendix.lymphnodes, spleen, and appendix.

Kopliks spotKopliks spot : foci of syncytial epithelial: foci of syncytial epithelial

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-- ,,intercellular and intracellular edema, andintercellular and intracellular edema, andparakeratosis and dyskeratosis.parakeratosis and dyskeratosis.

LungsLungs : peribronchiolar inflammatory reaction: peribronchiolar inflammatory reactionwith a mononuclear cell infiltrate in thewith a mononuclear cell infiltrate in theinterstitial tissuesinterstitial tissues


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Clinical manifestationsClinical manifestations ::

Incubation period of 10Incubation period of 10

11 days11 days fever andfever and

malaise, within 24 hoursmalaise, within 24 hours

coryza, conjunctivitis,coryza, conjunctivitis,Cough. Eruption on theCough. Eruption on the

fourth day.fourth day.

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Kopliks spot appear on theKopliks spot appear on thebuccal mucous membranesbuccal mucous membranes

opposite the molars (2 daysopposite the molars (2 days

before the development ofbefore the development ofthe rash)the rash)


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FeverFever : a stepwise increase until the fifth or: a stepwise increase until the fifth orsixth day of illness at the height of thesixth day of illness at the height of theeruption.eruption.

CoryzaCoryza : the early sneezing: the early sneezing nasalnasalcongestion, mucopurulent discharge. Itcongestion, mucopurulent discharge. Itclear very rapidly after the patientclear very rapidly after the patient

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becomes afebrile.becomes afebrile.ConjunctivitisConjunctivitis : conjunctival inflammation: conjunctival inflammation

with edema of the lids and the caruncles,with edema of the lids and the caruncles,increased lacrimation, photophobia.increased lacrimation, photophobia.


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CoughCough : caused by inflammatory reaction of: caused by inflammatory reaction of

the respiratory tract. Increases inthe respiratory tract. Increases infrequency and intensity, and its climax atfrequency and intensity, and its climax atthe height of the eruption, persists muchthe height of the eruption, persists much

longer, gradually subsiding over the nextlonger, gradually subsiding over the nextseveral weeks.several weeks.

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appearappear small irregular spots of brightsmall irregular spots of brightred color (1896), and disappear by the endred color (1896), and disappear by the end

of the second day of the rash.of the second day of the rash.


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RashRash : first makes its: first makes its

appearance 3appearance 3--4 days4 daysafter the onset of illness.after the onset of illness.It appears first at theIt appears first at the

hairline and involves thehairline and involves theforehead, the area behindforehead, the area behindthe earlobes, and thethe earlobes, and theu er art of necku er art of neck

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face, neck, upperface, neck, upperextremities, and trunkextremities, and trunkdownward until it reachesdownward until it reaches

the feet by the third day.the feet by the third day.After 3After 3--4 days4 days brownishbrownishappearanceappearancedesquamation.desquamation.


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Other manifestationOther manifestation : Anorexia, malaise, diarrhea: Anorexia, malaise, diarrhea

(common in infants). Generalized(common in infants). Generalizedlymphadenopathy ( in moderate to severe cases).lymphadenopathy ( in moderate to severe cases).Enlargement of postauricular, cervical, and occipitalEnlargement of postauricular, cervical, and occipital

lymph nodes. Laryngotracheitis, bronchitis,lymph nodes. Laryngotracheitis, bronchitis,bronchiolitis, and pneumonitis are present.bronchiolitis, and pneumonitis are present.

Atypical measlesAtypical measles : previously immunized with: previously immunized with

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inactivated measles virus vaccineinactivated measles virus vaccine fever,fever,pneumonitis, pneumonia with pulmonarypneumonitis, pneumonia with pulmonaryconsolidation, pleural effusion, and unusual rash forconsolidation, pleural effusion, and unusual rash for

measlesmeasles urticaria, maculopapular, petechial,urticaria, maculopapular, petechial,purpuric, and vesicular. Edema of the hands andpurpuric, and vesicular. Edema of the hands andfeet, myalgia, severe hyperesthesia of the skin.feet, myalgia, severe hyperesthesia of the skin.


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Severe hemorrhagic measlesSevere hemorrhagic measles

(black measles)(black measles) ::

Rare with sudden onset of hyperpyrexia (40.6Rare with sudden onset of hyperpyrexia (40.6 41.141.1ooC), convulsion, delirium, or stuporC), convulsion, delirium, or stupor

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confluent hemorrhagic eruption of the skinconfluent hemorrhagic eruption of the skinand mucous membranes. Bleeding from theand mucous membranes. Bleeding from themouth, nose, and bowel may be severe andmouth, nose, and bowel may be severe anduncontrollable. This type of measles is oftenuncontrollable. This type of measles is oftenfatal, because it involves DIC.fatal, because it involves DIC.


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Modified measlesModified measles : develops on children: develops on children

who have been passively immunized withwho have been passively immunized withimmune globulin after exposure to theimmune globulin after exposure to thedisease. The incubation period prolongeddisease. The incubation period prolongedto 14 or even to 20 days. The illness isto 14 or even to 20 days. The illness ismilder than ordinary measles. Prodromalmilder than ordinary measles. Prodromal

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per oper o -- ays or a sen . e ever s oways or a sen . e ever s owgrade, coryza, conjunctivitis, coughgrade, coryza, conjunctivitis, coughminimal or absent. Kopliks spot (minimal or absent. Kopliks spot (--). The). The

rash sparse and discrete.rash sparse and discrete.


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DiagnosisDiagnosis ::

1.1. Confirmatory clinical factorsConfirmatory clinical factors

2.2. Isolation of causative agent from blood,Isolation of causative agent from blood,

urine, nasopharyngeal secretions duringurine, nasopharyngeal secretions duringthe febrile period of illness.the febrile period of illness.

3.3. Serologic testSerologic test HI test, EIA. A significantHI test, EIA. A significant

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t ter o may e etecte wee s a tert ter o may e etecte wee s a terthe onset of illness.the onset of illness.

4.4. Other laboratory findings : leucopenia,Other laboratory findings : leucopenia,

multinucleated giant cell in sputum andmultinucleated giant cell in sputum andnasal secretions during the prodromalnasal secretions during the prodromalperiod.period.


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Differential diagnosisDifferential diagnosis ::

1.1. MeaslesMeasles

2.2. Atypical measlesAtypical measles3.3. RubellaRubella

4.4. Scarlet feverScarlet fever5.5. SS446.6. STSSSTSS

7.7. MeningococcemiaMeningococcemia8.8. Typhus and tick feversTyphus and tick fevers

9.9. ToxoplasmosisToxoplasmosis

10.10. Cytomegalovirus infectionCytomegalovirus infection

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12.12. Roseola infantumRoseola infantum13.13. Enteroviral infectionsEnteroviral infections

14.14. Infectious mononucleosisInfectious mononucleosis

15.15. Toxic erythemasToxic erythemas16.16. Drugs eruptionsDrugs eruptions17.17. SunburnSunburn18.18. MiliariaMiliaria

19.19. Kawasaki diseaseKawasaki disease


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ComplicationComplication ::

1.1. Otitis mediaOtitis media

2.2. MastoiditisMastoiditis

3.3. PneumoniaPneumonia

4.4. Obstructive laryngitis and laryngotracheitisObstructive laryngitis and laryngotracheitis

5.5. Cervical adenitisCervical adenitis

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6.6. Acute encephalomyelitisAcute encephalomyelitis7.7. Subacute sclerosing panencephalitisSubacute sclerosing panencephalitis

8.8. Purpura, anergy, corneal ulceration, appendicitis,Purpura, anergy, corneal ulceration, appendicitis,

severe diarrhea and dehydration, kwashiorkor,severe diarrhea and dehydration, kwashiorkor,pyogenic infection of the skin and septicemia.pyogenic infection of the skin and septicemia.


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PrognosisPrognosis : better in older children. The: better in older children. The

majority of deaths are the result of severemajority of deaths are the result of severebronchopneumonia or encephalitisbronchopneumonia or encephalitis

ImmunityImmunity : one attack of measles is generally: one attack of measles is generallyfollowed by permanent immunityfollowed by permanent immunity

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TreatmentTreatment : Measles is self: Measles is self--limited disease.limited disease.Treatment is chiefly supportive.Treatment is chiefly supportive.


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Complication therapy:Complication therapy:

-- HospitalizedHospitalized isolated roomisolated room

-- Vit. A 100.000 IU/orally, once, ifVit. A 100.000 IU/orally, once, if

malnutrition 1500 IU/daymalnutrition 1500 IU/day-- Antibiotic : Ampicillin 100mg/kgbw/4Antibiotic : Ampicillin 100mg/kgbw/4

divided doses/iv combine withdivided doses/iv combine with

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c oramp en co mg g w v v ec oramp en co mg g w v v edoses (Bronchopneumonia), cotrimoxazoledoses (Bronchopneumonia), cotrimoxazole--sulfametoxazole (TMP 4mg/kgbw/2 dividedsulfametoxazole (TMP 4mg/kgbw/2 divided

doses) for otitis mediadoses) for otitis media-- Evaluation of clinical symptom & giveEvaluation of clinical symptom & give

adequate fluid and dietadequate fluid and diet


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Preventive measuresPreventive measures1.1. Immune globulinImmune globulin

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