Measles

MEASLES

♡ Introduction

Measles is an acute viral respiratory illness.

Measles, also known as rubeola, is one of the most contagious infectious diseases, with at least a 90% secondary infection rate in susceptible domestic contacts.Despite being considered primarily a childhood illness, measles can affect people of all ages.Measles is marked by prodromal fever, cough, coryza, conjunctivitis, and pathognomonic enanthem (ie, Koplik spots), followed by an erythematous maculopapular rash on the third to seventh day.Infection confers life-long immunity.

♡ Causes

Agent
       The cause of measles is the measles virus, a single-stranded, negative-sense enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae.

Host.
 Humans are the natural hosts of the virus; no animal reservoirs are known to exist.

Environment.
           Travel to areas where measles is endemic or contact with travelers to endemic areas could cause measles.

Mode of transmission.
                     This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.

Immunodeficiency.
           Children with immunodeficiency due to HIV or AIDS, leukemia, alkylating agents, or corticosteroid therapy, regardless of immunization status, are likely to contract measles.

Absence of antibodies.
                       Infants who lose passive antibody before the age of routine immunization easily contracts measles.

♡ Pathophysiology

                          In temperate areas, the peak incidence of infection occurs during late winter and spring.
Infection is transmitted via respiratory droplets, which can remain active and contagious, either airborne or on surfaces, for up to 2 hours.Initial infection and viral replication occur locally in tracheal and bronchial epithelial cells.After 2-4 days, measles virus infects local lymphatic tissues, perhaps carried by pulmonary macrophages.Following the amplification of measles virus in regional lymph nodes, a predominantly cell-associated viremia disseminates the virus to various organs prior to the appearance of a rash.Measles virus infection causes a generalized immunosuppression marked by decreases in delayed-type hypersensitivity, interleukin (IL)-12 production and antigen-specific lymphoproliferative responses that persist for weeks to months after the acute infection.

♡ Clinical Manifestations

                     The incubation period from exposure to onset of measles symptoms ranges from 7 to 14 days (average, 10-12 days).

High fever.
             The first sign of measles is usually a high fever (often >104o F [40oC]) that typically lasts 4-7 days.

Prodromal phase symptoms.
                          This prodromal phase is marked by malaise, fever, anorexia, and the classic triad of conjunctivitis, cough, and coryza (the “3 Cs”).

Exanthem.
       The characteristic exanthem generally appears 2-4 days after the onset of the prodrome and lasts 3-5 days; the exanthem usually appears 1-2 days after the appearance of Koplik spots; mild pruritus may be associated, on average, the rash develops about 14 days after exposure, starting on the face and upper neck (see the image below) and spreading to the extremities.

Koplik’s spots. 
             Small spots (Koplik spots) can be seen inside the cheeks during this early stage.

♡ Diagnostic Evaluation

Although the diagnosis of measles is usually determined from the classic clinical picture, laboratory identification and confirmation of the diagnosis are necessary for the purposes of public health and outbreak control.

Antibody assays. 

               The measles virus sandwich-capture IgM antibody assay, offered through many local health departments and through the CDC, is the quickest method of confirming acute measles; laboratories can confirm measles by demonstrating more than a 4-fold rise in IgG antibodies between acute and convalescent sera, although relying solely on rising IgG titers for the diagnosis delays treatment considerably.

Viral culture.
             Throat swabs and nasal swabs can be sent on viral transport medium or a viral culturette swab to isolate the measles virus; urinespecimens can be sent in a sterile container for viral culture.

Reverse-transcription polymerase chain reaction (PCR). 

     Reverse-transcription polymerase chain reaction (PCR) evaluation is highly sensitive at visualizing measles virus RNA in blood, throat, nasopharyngeal, or urine specimens and, where available, can be used to rapidly confirm the diagnosis of measles.

Chest Radiography
                 If bacterial pneumonia is suspected, perform chest radiography; the frequent occurrence of measles pneumonia, even in uncomplicated cases, limits the predictive value of chest radiography for bacterial bronchopneumonia.

♡ Medical Management

Treatment of measles is essentially supportive care.

Hydration

         Maintenance of good hydration and replacement of fluids lost through diarrhea or emesis is a primary concern.

Vitamin A

             Vit A supplementation, especially in children and patients with clinical signs of vitamin A deficiency, should be considered.

Hospitalization

              It may be indicated for the treatment of measles complications 

(eg, bacterial superinfection, pneumonia, dehydration, croup)

Antibiotic therapy

     secondary infections (eg, otitis media or bacterial pneumonia) should be treated with antibiotics; patients with severe complicating infections (eg, encephalomyelitis) should be admitted for observation and antibiotics, as appropriate to their clinical condition.

Postexposure prophylaxis

              Prevention or modification of measles in exposed susceptible individuals involves the administration of measles virus vaccine or human immunoglobulin (Ig).

♡ Pharmacologic Therapy

             Medications used in the treatment or prevention of measles include vitamin A, antivirals (eg, ribavirin), measles virus vaccine, and human immunoglobulin (Ig).

Vitamin A
      Vitamin A treatment for children with measles in developing countries has been associated with a marked reduction in morbidity and mortality; thus, two doses of vitamin A given 24 hours apart are recommended; a third age-specific dose should be given 2 to 4 weeks later to children with clinical signs and symptoms of vitamin A deficiency.

Antivirals.
          Measles virus is susceptible to ribavirin in vitro; although ribavirin (either IV or aerosolized) has been used to treat severely affected and immunocompromised adults with acute measles or SSPE (IV plus intrathecal high-dose  alfa), no controlled trials have been conducted; ribavirin is not approved by the US Food and drug administrate (FDA) for this indication, and such use should be considered experimental.

Vaccines.
            The live MMR vaccine is used to induce active immunity against viruses that cause measles, mumps, and rubella.

Immunoglobulins.
          Human Ig prevents or modifies measles in susceptible individuals if administered within 6 days of exposure.

Nursing Management
          Nursing Assessment
Assessment of the patient with measles include:

Physical exam
   Assess the child for symptoms that may indicate the presence of measles.Knowledge of the disease. Assess the patient’s or significant other’s knowledge regarding the disease.Hygienic practices. Assess the family’s hygienic practices to prevent the spread of the disease.

♡ Nursing Diagnosis

              Based on the assessment data, the major nursing diagnoses are:

impaired social interaction to isolation from friends.

♡ risk for impaired skin integrity related to raking pruritus.

♡ high risk infection related to the host and infectious agents.

♡ acute pain related to skin lesions and irritated mucous membranes.

DISCLAIMER

The information contained on My TAMILNADU NURSING blog is for general
information purposes only. My Company TAMILNADU NURSING assumes no responsibility for errors or
omissions in the contents on the Service.
In no event shall My Company TAMILNADU NURSING can be liable for any special, direct, indirect, consequential,
or incidental damages or any damages whatsoever, whether in an action of contract, negligence or
other tort, arising out of or in connection with the use of the Service or the contents of the Service.
My Company TAMILNADU NURSINGreserves the right to make additions, deletions, or modification to the
contents on the Service at any time without prior notice. My Company TAMILNADU NURSING  does not
warrant that the website is free of viruses or other harmful components

Disclaimer link here

https://www.termsfeed.com/disclaimer/0c8a5963b14c2d4643c3f99894b67dd7

2019 

ALL RIGHTS RESERVED.COPYRIGHT POLICY.TAMILNADU NURSING