CAUSED BY A PARAMYXOVIRUS, measles (rubeola) is a highly contagious, potentially severe and deadly acute viral disease spread via respiratory droplets that can remain in the air for up to 2 hours after an infectious person leaves the area. Approximately 9 out of 10 susceptible persons who've been in close contact with a person with measles will develop the disease. Risk factors for measles include: Being unvaccinated. If you haven't had the measles vaccine, you're much more likely to get measles. Measles disease is also known as rubeola which is a highly contagious infection that is caused by the measles virus. Measles is an airborne disease that spreads easily through the coughs and sneezes of the infected one. Traveling internationally. If you travel to countries where measles is more common, you're at higher risk of catching measles. Having a vitamin A deficiency. If you don't have Pathophysiology: enough vitamin A in your diet, Respiratory droplets from infected persons serve as vehicles of transmission by delivering infectious virus to respiratory tract mucosa of susceptible hosts. you're more likely to have more- 1. Invades the nasopharynx and respiratory epithelium, incubates and multiple there for 7-14 dyas. 2. Infect Respiratory epithelium (epithelial cells of trachea/bronchi) – the virus has a protein, HEMAGLUTININ or H protein, that binds to the target receptors of the host cells (CD46, SLAM, NECTIN-4). Once it is bound with the F Protein (Fusion Protein), it helps the virus fuse with the membrane, and it will ultimately get inside the cell 3. Since it is SSRNA negative, the RNA Polymerase will transcribed it into positive SS mRNA. Then, translated into viral proteins wrapped in the cell’s lipid envelope and sent out in the cell as a newly made virus. 4. Within days, the Measles virus spreads through the local tissue and is picked by dendritic cells and alveolar macrophages and carried from the local tissue in the lungs to the local lymph nodes. Then, spread to the other parts of the body. Eventually gets into the blood and spreading to more lung tissues as well and other organs, such as: Intestines and the brain. severe symptoms and complications of measles S/Sx: Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include: Fever Dry cough Runny nose (Coryza) Inflamed eyes (conjunctivitis) Tiny white spots with bluishwhite centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots A skin rash made up of large, flat blotches that often flow into one another The infection occurs in stages over 2 to 3 weeks. Infection and incubation. For the first 10 to 14 days after infection, the measles virus spreads in the body. There are no signs or symptoms of measles during this time. Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often with a persistent cough, a runny nose, inflamed Since it affects the Lungs, Intestines and the Brain, measles will complicate to: eyes (conjunctivitis) and a sore throat. This relatively mild illness may last 2 to 3 days. Acute illness and rash. The rash is made up of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first. Over the next few days, the rash spreads down the arms, chest and back, then over the thighs, lower legs and feet. At the same time, the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). Pneumonia Diarrhea Encephalitis - About 1 in 1,000 people with measles can develop a complication called encephalitis. Encephalitis is irritation and swelling (inflammation) of the brain. The condition can be especially dangerous for people with weakened immune systems. Encephalitis may occur right after measles, or it might not occur until months later. Encephalitis can cause permanent brain damage. All leads to death Additionally, it also suppresses the immune system for up to 6 weeks that causes bacterial superinfections, such as: Otitis Media – an ear infection Bacterial Pneumonia laryngotracheobronchitis (croup) Pregnancy problems. If you're pregnant, you Recovery. The measles rash may need to take special care to avoid measles last about seven days. The rash because the disease can cause premature birth, gradually fades first from the face low birth weight and fetal death. and last from the thighs and feet. As other symptoms of the illness go away, the cough and darkening or peeling of the skin where the All of the complications are worst among infants. rash was may stay for about 10 days Most contagious: 4 days before and 4 days after the onset of rash Once recovered, you will have life long immunity Other severe complication for children under 2 years old: For Immunocompromised people – ex: ppl with HIV/AIDS - if they get measles, they might not develop any certain symptoms: Enanthem and Exanthem Subacute Sclerosing Panencephalitis - will happen 7-10 years later - it is an inflammation of entire brain - cause by a persistent measles infection: maybe due to abnormal immune response and mutated strain. Symptoms: subtle at first: mood changes; and eventually become severe: seizures, coma, death - higher rates of: Pneumonia and Encephalitis DIAGNOSTIC test: Complications: Serology – detects measles-specific IgM antibody in serum RT-CPR – detection of measles rna in respiratory specime; nasopharyngeal swab 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; urine specimens can be sent in a sterile container for viral culture. Reverse-transcription polymerase chain reaction (PCR). Reversetranscription 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. - he measles vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine. Health care providers recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school. Measles vaccine in adults Preventing measles during an outbreak or known infection: If someone in your household has measles, take these precautions to protect family and friends without immunity: Isolate. Because measles is highly contagious from about four days beforeto four days after the rash appears, people with measles should stay home and not return to activities where they interact with other people during this period. People who aren't vaccinated — siblings, for example — should also stay away from the infected person. Treatment: No specific treatment exist. Vaccinate. Be sure that anyone Severe complications can be reduced through supportive care. who's at risk of getting measles - ensures good nutrition, adequate fluid intake and treatment of dehydration with WHOrecommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. receives the measles vaccine as All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have also been shown to reduce the number of measles deaths. Prevention: Measles Vaccine in children who hasn't been fully vaccinated soon as possible. This includes infants older than 6 months and anyone born in 1957 or later who doesn't have proof of immunity. 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 supplementation. Vitamin A supplementation, especially in children and patients with clinical signs of vitamin A deficiency, should be considered. Hospitalization. Hospitalization may be indicated for the treatment of measles complications (eg, bacterial superinfection, pneumonia, dehy dration, 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. Post Exposure prophylaxis. Prevent ion or modification of measles in exposed susceptible individuals involves the administration of measles virus vaccine or human immunoglobulin (Ig). Nursing Interventions Interventions for a child with measles are: 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 related to isolation from friends. Risk for impaired skin integrity related to raking pruritus. High risk of infection related to the host and infectious agents. Acute pain related to skin lesions and irritated mucous membranes. Isolation. Patients will need to be on isolation precautions to decrease transmission within the community; emphasize the need for immediate isolation when early catarrhal symptoms appear. Skin care. Measles causes extreme pruritus; nursing interventions include keeping the patient’s nails short, encourage long pants and sleeves to prevent scratching, keeping skin moist with health care provider recommended lotions, and avoiding sunlight and heat. Eye care. Treat conjunctivitis with warm saline when removing eye secretions and encourage patient not to rub eyes; protect the eyes from the glare of strong light. Hydration. Encourage oral hydration; medical literature encourages the use of oral rehydration solution. Temperature control. Antipyretics should be administered to the patient as ordered for a temperature greater than 100.4 Fahrenheit unless directed elsewise by a healthcare provider; be sure to remind parents not to administer aspirin due to the risk of Reye’s syndrome.
