mEASLES

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mEASLES

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  1. Karen Urban

    Slide 1 - Karen Urban

    • NURS526 Pathophysiology
    • Dr. Acker
    • mEASLES
  2. Acute viral infection

    Slide 2 - Acute viral infection

    • Humans are the only host
    • Highly contagious
    • Measles: AKA Rubeola
  3. The Virus

    Slide 3 - The Virus

    • Morbillivirus (MV) from the paramyxovirus group
    • Spherical virus with a single RNA serotype
    • Life-long immunity from disease of any strain
    • Enclosed with a lipid envelope
    • Two glycoprotein spikes
    • Fusion protein
    • Hemagglutinin protein
    • (Dardis, 2012)
    • (DiPaola et al., 2012)
    • (Griffin et al.,2012)
    • (Sips et al., 2007)
  4. Attachment

    Slide 5 - Attachment

    • 2. Fusion
    • 3. RNA replication
    • 4. Assembly of viral particles and their release
    • Pathophysiology: Four Stages
  5. Fig. 1. Schematic diagram of the MV virion and genome.

    Slide 6 - Fig. 1. Schematic diagram of the MV virion and genome.

    • Yusuke Yanagi et al. J Gen Virol 2006;87:2767-2779
    • SGM
  6. Virus enters lympahtic system from respiratory tract

    Slide 7 - Virus enters lympahtic system from respiratory tract

    • Virus replicates in the upper respiratory tract initially
    • Further replication occurs in the reticuloendothelial system
    • Monocytes and lymphocytes are the primary infected cells in the blood
    • Infection is found in skin, conjunctivae, lung, GI tract, liver, kidney & genital mucosa
    • Rash caused by cytotoxic T cells attacking virus in skin
    • Mechanisms underlying severe immunosuppression, characteristic of measles, is not well understood
    • Infection triggers humoral & cellular immune responses and once it resolves, lifelong immunity is achieved
    • Yanagi, Takeda, & Ohno, 2006
    • Pathophysiology
  7. Airborne or droplet

    Slide 8 - Airborne or droplet

    • Coughing & sneezing
    • MV infects cells of the immune system
    • End result is up to 6 months of immunosuppression
    • Increased susceptibility to secondary infections
    • Sips et al., 2007
    • Mode of Transmission
  8. Pre-vaccine era:

    Slide 11 - Pre-vaccine era:

    • measles infected 500, 000 Americans per year
    • 100 deaths per 55,000
    • Immunization reduced incidence 98 % by year 2000
    • In 2011
    • 105 of 118 cases in unvaccinated persons
    • 40% required hospitalization
    • 9% developed pneumonia
    • 1/1,000 reported cases of encephalitis in USA
    • Risk of death is > for infants, young children & adults.
    • Eplinger, 2014
    • Epidemiology
  9. Rash lasting at least three days

    Slide 12 - Rash lasting at least three days

    • Fever for at least one day
    • At least one of the three Cs:
    • cough, coryza, or conjunctivitis
    • Koplik spots
    • Clinical manifestations
  10. IgM  antibodies indicate primary infection

    Slide 13 - IgM antibodies indicate primary infection

    • RNA by real-time polymerase chain reaction (RT-PCR)
    • IgG antibodies peak 2 weeks after rash onset
    • Lab Tests
  11. Other diagnoses to be considered include the following:

    Slide 14 - Other diagnoses to be considered include the following:

    • Kawasaki disease
    • Rubella infections
    • Coxsackie
    • Parvovirus B19
    • Dengue fever
    • Serum sickness
    • Syphilis
    • Systemic lupus erythematosus
    • Toxic shock syndrome
    • Pull, Brichler, Bouchaud, & Siriez, 2012
    • Differential dx
  12. Measles

    Slide 15 - Measles

    • Rash
    • Fever
    • Cough
    • Coryza
    • Conjunctivitis
    • Koplik spots
    • Kawasaki Disease
    • Fever
    • Irritability
    • Conjunctival injection
    • Cervical lymphadenopathy
    • Rhinorrhea
    • Oral mucosa changes
    • Abdominal pain
    • Joint pain
    • Comparison 1
  13. Measles

    Slide 16 - Measles

    • Rash
    • Fever
    • Cough
    • Coryza
    • Conjunctivitis
    • Koplik spots
    • Rubella (German Measles)
    • Rash
    • Fever (low-grade)
    • Cough
    • Coryza
    • Lymphadenopathy
    • Malaise
    • Copstead & Banasik, 2014
    • Comparison 2
  14. Measles

    Slide 17 - Measles

    • Rash
    • Fever
    • Cough
    • Coryza
    • Conjunctivitis
    • Koplik spots
    • Coxsackie
    • Fever
    • Respiratory symptoms
    • Cough
    • Sore throat
    • Oral blisters/ulcerations
    • Rash (hands & feet)
    • Conjunctivitus
    • Comparison 3
  15. COMMON

    Slide 18 - COMMON

    • diarrhea/gastroenteritis (8%)
    • otitis media (7%)
    • bronchopneumonia (6%)
    • LESS COMMON
    • febrile seizures
    • death (0.2%)
    • encephalitis
    • Eplinger, 2014
    • complications
  16. Acute disseminated encephalomyelitis

    Slide 19 - Acute disseminated encephalomyelitis

    • Measles inclusion body encephalitis
    • Subacute sclerosing panencephalitis
    • Sips et al., 2007
    • SERIOUS complications
  17. Prodromal

    Slide 20 - Prodromal

    • 2-4 days
    • Exanthema
    • Rash, 14 days after exposure
    • Cervical & Mesenteric Lymphadenitis
    • Splenomegaly
    • Abdominal pain
    • Recovery
    • Improvement 48 hours after rash appears
    • Bentley, Rouse, & Pinfield, 2014
    • Phases of illness
  18. Duration: Two - Four days

    Slide 21 - Duration: Two - Four days

    • ↑ Fever
    • Malaise
    • Cough
    • Coryza
    • Conjunctivitis
    • Photophobia
    • Anorexia
    • Peri-orbital edema
    • Koplik’s spots
    • Bentley, Rouse, & Pinfield, 2014
    • Clinical Stages: Prodromal
  19. Duration: Three – Seven days

    Slide 22 - Duration: Three – Seven days

    • Blanching, erythematous macules & papules
    • May be itchy
    • Cervical lymphadenitis
    • Splenomegaly
    • Abdominal pain
    • Bentley et al., 2014
    • Clinical Stages: Exanthema
  20. Clinical Improvement within 48 hours of rash onset

    Slide 24 - Clinical Improvement within 48 hours of rash onset

    • Fever & rash subside in seven- ten days
    • Cough may persist for weeks
    • Clinical Stages: Recovery
  21. Increased Risk for:

    Slide 25 - Increased Risk for:

    • Spontaneous abortion
    • Miscarriage
    • Stillbirth
    • Preterm labor
    • Low birth weight infant
    • Higher risk for more severe measles & complications
    • Wait 30 days after MMR before trying to get pregnant (CDC)
    • Administer Immune serum globulin within six days of an exposure
    • Breast-feeding is not a contraindication to MMR immunization
    • Pregnancy concerns
  22. Natural immunity in infants should not be assumed

    Slide 26 - Natural immunity in infants should not be assumed

    • Infants may acquire antibodies from the mother
    • May provide some protection for the first six months
    • Natural immunity in infants
  23. Measles Mumps Rubella (MMR)

    Slide 27 - Measles Mumps Rubella (MMR)

    • Measles Mumps Rubella Varicella (MMRV)
    • Both:
    • 1st dose: infants @ 12-15 months
    • 2nd dose: 4-6 years of age
    • Common reactions:
    • Fever, malaise, rash for 2-3 days
    • Vaccines
  24. Immunosuppressed

    Slide 28 - Immunosuppressed

    • Confirmed history of anaphylactic reaction to vaccine
    • High grade fever or severe illness
    • Pregnancy
    • CDC, 2015
    • Contraindications to vaccine
  25. Slide 29

    • Ensure all persons at risk are immunized or have acceptable immunity
    • Notify local health department of all suspicious findings
    • Do not await lab confirmation
    • CDC, 2015
    • Recommendations during an outbreak
  26. Slide 30

    • Bentley, J., Rouse, J., & Pinfield, J. (2014). Measles: pathology, management and public health issues. Nursing Standard, 28(38), 51-5
    • Center for Disease Control. ( 2015, March 30). Measles cases and outbreaks. Retrieved from: http://www.cdc.gov/measles/cases-outbreaks.html
    • Center for Disease Control. ( 2015, April 1). Who should NOT get vaccinated with these vaccines. Retrieved from: http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.html
    • Copstead, L., & Banasik, J. (2014). Pathophysiology (5th ed.). St. Louis, Mo: Elsevier.
    • DiPaola, F., Michael, A., & Mandel, E. D. (2012). A casualty of the immunization wars : The reemergence of measles. JAAPA: Journal Of The American Academy Of Physician Assistants 25(6), 50-54.
    • Durkin, M.T. (2013). Professional guide to diseases (10th ed.).Philadelphia: Lippincott Williams, & Wilkins.
    • Epling, J. W., Savoy, M. L., Temte, J. L., Schoof, B. K., & Campos-Outcalt, D. (2014). When vaccine misconceptions jeopardize public health. Journal Of Family Practice, 63(12), E1-E7.
    • McLean, H. Q., Parker Fiebelkorn, A., Temte, J. L., & Wallace, G. S. (2013). Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013. MMWR Recommendations & Reports, 62(4), 1-35.
    • Pull, L., Brichler, S., Bouchaud, O., & Siriez, J. (2012). Differential Diagnosis of Dengue Fever: Beware of Measles!. Journal Of Travel Medicine, 19(4), 268-271. doi:10.1111/j.1708-8305.2012.00628.x
    • REFERENCES
  27. Sips, G. J., Chesik. D., Glazenburg, L., Wilschut, J., De Keyser, J., & Wilczak, N. (2007). Involvement of morbilliviruses in the pathogenesis of demyelinating disease. Reviews in Medical Virology.  DOI: 10.1002/rmv

    Slide 31 - Sips, G. J., Chesik. D., Glazenburg, L., Wilschut, J., De Keyser, J., & Wilczak, N. (2007). Involvement of morbilliviruses in the pathogenesis of demyelinating disease. Reviews in Medical Virology. DOI: 10.1002/rmv

    • Tankeshwar A. (2013, August 5) Measles virus: structure, pathogenesis, clinical feature, complications and lab diagnosis. Microbeonline. Retrieved from: http://microbeonline.com/measles-virus-structure-pathogenesis-clinical-feature-complications-and-lab-diagnosis/
    • Yanagi, Y., Takeda, M., & Ohno, S. (2006) Measles virus: cellular receptors, tropism and pathogenesis. Journal of General Virology, 87(10): 2767-2779. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/16963735
    • REFERENCES