welcome to another MedCram lecture in our last lecture we talked about measles
or Ruby Ola and we talked about the different types
of infections that it could cause and also signs of the infection with the
different stages including the incubation period the prodrome period
the exam time period and in the recovery phase we're gonna talk about the
diagnosis and the treatment of measles so I'd like to refer you back to the
first video to make sure that the clinical signs are being obtained
specifically you want to remember the three C's which is cough conjunctivitis
and coryza coryza remember is just basically rhinitis
it's a runny nose okay and then of course you definitely want to know about
complex spots these are inside the buccal mucosa and if you want to think
about a very red erythema this backgrounds so if you're looking inside
the buccal mucosa it's gonna be red and then if you were to look on there think
about grains of salt on a very red hot background and this is usually around
the molar so we know kind of a clinical scenario what about the diagnostic
scenario what is it gonna look like on lab so you know it's very nonspecific
but you'll see platelets lo you'll see lo WBC's occasionally specifically you
also see low T cells and this can sometimes be a problem in patients who
are immunocompromised they can sometimes get flares of for instance tuberculosis
or other t-cell mediated diseases that measles would cause because they reduce
the T cells sometimes on a chest x-ray you might see a pneumonitis so
inflammation of the lungs however the thing that you probably would see and
this is the the way that we make the diagnosis is antibodies
so there are circulating antibodies to measles one is called the IgM and the
other one is called the IgG now if you remember from immunology IgM is the type
of antibody that comes out immediately they're sort of the first responders if
we see an IgM that's elevated then we know that this is an acute infection
then the IgG comes out this is the antibody that remembers so if we were to
give a vaccine to somebody we would expect the after years and years of that
vaccine to be circulating IgG antibodies but not AGM antibodies if we saw IgM
antibodies for any kind of infection that would be a telltale sign that this
patient had a recent infection so it's a giving example if we saw a herpes
simplex virus IgM and IgG if both were elevated that would indicate an acute
infection if the IgM was not elevated but the IgG was that would indicate a
past infection that is no longer current so how does it work for measles the way
we detect whether or not you've got a measles infection is by checking not to
see if the virus is present they sometimes do this in epidemiological
studies but to actually see if your body's immune system has a response to
the virus now when the rash comes on within one to
two days there will be a rise in the IgM and it will rapidly go down within a
month and this is an IgM that is specific for measles the other name is
Ruby Ola now there's two ways of doing this and you'll you might run into this
this is very specific here there's something called the IgM Captur ELISA
and there's another type called the IgM in direct
Elysa the key here is the word capture versus indirect the capture technique
there both are actually very fast capture usually can be done in about two
and a half hours whereas the indirect usually takes about three and a half
hours they're both very sensitive specific and have good negative and
positive predictive values the key however with the indirect Eliza is that
you have to remove the eye g-gee from the assay whereas you don't
need to do that in the IgM and so there is this added step that could complicate
things and give you inaccurate results so the one that's probably superior is
the IgM capture Eliza however the one that's used probably most often is the
indirect light so just so just be aware of false positive results if you use the
indirect Eliza there are two other techniques that can be used one is
called the plaque reduction neutralization test this one can take up
to ten days probably not the best and it's not an easy test to do the other
one is a hemoglobin hemoglobin inhibition test and it requires two
samples both acute and convalescent this can take up to two days after the
receipt of the convalescent serum so if you want a rapid I would recommend the
ELISA okay so now that you've made the diagnosis how do we treat these people
well it's a virus and so as a result of that supportive treatment this means if
they're dry you give them fluids if they're having fever you give them
antipyretics so fluids antipyretics and
just treatment of bacterial infections so they may need antibiotics because
they have superimposed bacterial infections for instance like pneumonia
or bronchitis the second thing that's very interesting that they found
is vitamin a now they don't know exactly why this works but they've seen it
especially in developing countries where vitamin A deficiency is higher than it
is in developed countries so giving vitamin A may be helpful and there's a
different dosing for infants or children the other thing that is not really
fda-approved there hasn't really undergone rigorous prospective
controlled studies is rip of ayran they noticed that if it was given
intravenously early on that patients had a larger chance of surviving but this
was in a very small population so the question is on vitamin A the question is
on vibra rip of ayran were not sure the key however is supportive care thanks
for joining us
you