儿科学课件：麻疹

1、Pediatric Department of the First Affiliated Hospital of GZMU2岁时患麻疹麻疹，高烧不退，误用了过量链霉素，导致失聪“流行病学调查流行病学调查”请各位同学回忆一下，自己小时候得过麻疹吗？或者家里人得过麻疹吗？有几个人得过？有什么主要症状？当时是怎样预防和治疗的？1.1.了解了解麻疹的病因及流行病学麻疹的病因及流行病学2.2.掌握掌握典型麻疹、非典型麻疹的临床特点和诊断要点典型麻疹、非典型麻疹的临床特点和诊断要点3.3.掌握掌握麻疹与小儿常见急性出疹性传染病的鉴别要点麻疹与小儿常见急性出疹性传染病的鉴别要点4.4.熟悉熟悉麻疹常见并发症

2、麻疹常见并发症5.5.掌握掌握麻疹的防治原则及方法麻疹的防治原则及方法 Acute respiratory infectious disease caused by Measles virus Clinical features: High fever, Cough, an enanthem, coryza, conjunctivitis, photophobia and a prominent exanthem Specific sign: KoplikS spots Etiology Epidemiology Pathogenesis Clinical Manifestation Labo

3、ratory Findings Diagnosis Differential Diagnosis Treatment Prevention Summary and Answer Classification: RNA virus Family: Paramyxoviridae Genus: MorbillivirusHumans are the only host of measles virus Serotype: only oneLocation: Nasopharyngeal secretions, Blood, Urine of patientsInfectious sources:

4、Patients are infectious from 5days before the rash up to 5-10days after its onset Routes of transmission： Droplet sprayPeak season: winter and spring Population susceptibility：l It is susceptible to all the people without infection or inoculation. l The age of peak incidence is 6 months to 5 years o

5、ld. l The incidence of baby under 6m is lower. Routes of transmissionPrior to the use of vaccineAfter the use of vaccineMorbidity (1/100000)Major epidemics: 500-1000Mild epidemics: 4009.5 in 1990Peak seasonIn winter and springIn any time of a yearEpidemic cycleMajor epidemics appear by 2-4 yr interv

6、alsEpidemic cycle disappeared, Sporadic cases increasedAge6m-5y (98%10y)Below 6m and above 5yClinical manifestationsTypical casessevere manifestationsmore complicationshigh mortality Atypical casesmild manifestationsless complicationsrarely deathMultinucleated giant cells(Warthin-Finkeldey giant cel

7、ls)= 100m, several nucleus inside the cell, formed by confluence of several virus infected In smears of the nasal mucosa in the prodromal stagePathogenesisMeasles virusRespiratory epithelium regional lymph nodesFirst viremiaMonocytes/Macrophage1. Incubation period 6-18 days2. Prodromal period3-4 day

8、sVirus eliminationSecond viremiaRespiratory tract, conjunctiva, skin, etc3.Exanthematous phase3-5 days4. Recovery3-5 daysTypical MeaslesAtypical MeaslesIncubation stage: 6-18 daysProdromal stage: 3-4daysThe prodromal phase begins with fever followed by respiratory infectious features and lasts until

9、 rash appear.l Feverl Coughl Coryzal Conjunctivitisl Photophobial Kopliks spots Fever The magnitude and pattern of fever are variable in patients, from a low-grade to moderate fever or a sudden high fever may occur. Cough Coryza They are not specific symptoms for measles, which are identical to a co

10、mmon cold but catarrhal symptoms maybe more severe. Conjunctivitis May suggest measles before Kopliks spots. Kopliks Spots Pathognomonic sign Kopliks SpotsExanthem stage: 3-5daysl MaculopapularMaculopapular rash: rash: l Fever: temperature rises abruptlyl Catarrh: l Other manifestations: enlarged ly

11、mph nodes, a prominent cough,slight splenomegaly, gastrointestinal symptoms such as diarrhea and vomiting Convalescent stage: 3-5 days u In uncomplicated cases, as the rash appears in the palms and soles the symptoms subside rapidly within about 3 days usually with an abrupt drop in temperature to n

12、ormal.u As the rash fades, branny desquamation and brownish discoloration (hyperpigmentation) occur and then disappear within 2-3 weeks.Branny desquamation and brownish discoloration (hyperpigmentation) Temp Days 1-141234567891011121314Clinical periodsProdromal stageExanthem stageConvalescent stageC

13、oryza and conjunctivitisKopliks spotsRashCoughBranny desquamation & hyperpigmentation 414039383736l Mild measlesl Allotype Measles l Severe measlesOccurs in the patient with partial immunityOccurs in the patients with immunocompromised MILD MeaslesIndividuals with passively acquired antibody,suc

14、h as infants or recipients of blood productsA subclinical form of measles Allotype measlesFrequently complicated by pneumoniaAbnormal immune response to the vaccineSevere measles The illness was frequently complicated by pneumonia and pleural effusions.l Respiratory System Laryngitis ,Pneumonial Cen

15、tral Nervous System Encephalitis ,SSPEl Circulatory System myocarditisl Exacerbation of tuberculosis l Malnutrition and Vitamin A deficiency lA relative Lymphocytosis is characteristic.Total leukocyte count tends to be normal or below. lMultinucleated giant cells can be demonstrated in smears of the

16、 nasal mucosa during the prodromal stage.lTesting of specific IgM in serum lMeasles virus isolationlMolecular detection(PCR)l Epidemiologyl Clinical findingsl Laboratory FindingsEpidemiologyAgeSeasonHistory of contact with patientHistory of inoculation Clinical FindingsProdromal periodExanthem perio

17、dConvalescent periodKopliks spotsTypical rash; correlation of rash and fever; respiratory symptoms(catarrh; cough)Branny desquamation and brownish discolorationMV-IgM(+)Measles Viral isolation(+) Laboratory Findingsl Rubellal Roseola infantuml Scarlet Feverl Enterovirusl Varicellal Drug allergy病原病原全

18、身症状和其他特全身症状和其他特征征皮疹特点皮疹特点发热与皮疹的发热与皮疹的关系关系麻疹麻疹(measles)麻疹病麻疹病毒毒卡他症状卡他症状结膜炎、发热结膜炎、发热Koplik斑斑红色斑丘疹，特别红色斑丘疹，特别的出疹顺序，退疹的出疹顺序，退疹后有色素沉着及细后有色素沉着及细小脱屑小脱屑发热发热34天，天，出疹时体温更出疹时体温更高高风疹风疹(rubella)风疹病风疹病毒毒耳后、颈后、枕后耳后、颈后、枕后淋巴结肿大淋巴结肿大退疹后无色素沉着退疹后无色素沉着及脱屑及脱屑发热半天或发热半天或1天后出疹天后出疹幼儿急疹幼儿急疹(exanthe-ma subitum ) 人疱疹人疱疹病毒病毒6型型一

19、般情况好，耳后一般情况好，耳后、颈后、枕后淋巴、颈后、枕后淋巴结可肿大结可肿大头面颈及躯干部多头面颈及躯干部多见，见，1天出齐，次日天出齐，次日消退消退高热高热35天，天，热退疹出热退疹出猩红热猩红热(scarlet fever)乙型溶乙型溶血性链血性链球菌球菌高热，中毒症状重高热，中毒症状重，咽峡炎、杨梅舌，咽峡炎、杨梅舌、环口苍白圈、扁、环口苍白圈、扁桃体炎桃体炎皮肤弥漫充血，密皮肤弥漫充血，密集针尖大小丘疹，集针尖大小丘疹，1周后全身大片脱皮周后全身大片脱皮发热发热12天出天出疹，出疹时高疹，出疹时高热热 Measles Rubella (German Measles ) Measles Roseola infantumThe rash typically appears when the elevated temperature has abated, and can last for only a few hours before subsiding. Roseola infantum Scarlet FeverScarlet FeverScarlet FeverScarlet FeverScarlet FeverVaricellaVaricellaVaricellal Antipyretics