hi welcome to another MedCram lecture we're going to talk about
measles there's been an outbreak of measles recently so I want to talk about
the clinical syndromes that measles can cause the stages of infection the
diagnosis and the treatment and I think there's some high-yield things that any
healthcare provider should know first thing you should know is that it's a
virus okay specifically it's the Ruby olla virus Ruby Ola now you may remember
the MMR vaccine this is measles mumps rubella rubella is German measles it's a
more milder type of disease this is the first and the measles mumps rubella okay
and it's the Ruby ola virus it's very infectious in fact the estimate is is
that if somebody has the virus during it's transmissible phase they can infect
up to 12 to 18 people so it's very infectious as we've seen in the news and
it can spread very rapidly now just to be complete there are six different
clinical syndromes that the Ruby Ola or the measles virus can cause of course
the first one is the classic type of measles otherwise known as classic
measles we're gonna talk about that one more that's the you know your three C's
which we'll get into the complex spots which you've heard about we'll talk
about that one next one is called modified measles modified measles is
where someone who has been immunized in the past but maybe don't have a good
antibody response may get a sort of a lower-level classic measles
it's called modified measles usually the onset is longer and the course is not as
severe as would be with classic measles so yeah it's possible that you could be
immunized against measles and still get a measles type of syndrome but it's a
little bit less third one is called atypical measles
we don't see it much anymore because it has to do with people who got the dead
virus vaccine now most measles-mumps-rubella in fact all of
them are a live virus this is why we don't give it to people who are
immunocompromised but the dead virus which was given back in the in the mid
60s would not give the proper immune response and so it was possible for
these people who were immunized with the dead virus could get this atypical
measles just something you should know about a couple of other things or three
other things that you can get is a post infectious neurological symptoms so post
infectious neurological okay these are some of the things that you might hear
about called a d e em that's acute disseminated encephalomyelitis and the
other thing you may have heard about is s s P E which is a subacute sclerosing
pan encephalitis these are not good these for complications will talk about
those briefly the other way you can get a severe measles I'm not going to talk
much about that and then other complications such as things called
giant cell pneumonia P na is my abbreviation for pneumonia and then you
can even get something called a measles
inclusion body encephalitis
so these things here basically four-five-six these are complications
which we'll talk about briefly later but the one that I want to focus in on is
the most common and that's the classic measles how are you going to be able to
identify that in patients that you see in the clinic in the emergency room etc
so let's talk about that there are four stages of the infection of the
measles virus and I've got them abbreviated hair.i P E and R I stands
for the incubation period P stands for the prodrome e stands for the X anthem
and R stands for recovery and immunity so in the first phase called the
incubation period so in queue vation the patient is usually asymptomatic they
don't feel any symptoms very rarely will they feel symptoms and the key here is
that that can last from eight to ten days okay so they're walking around for
eight to ten days and they don't even know that they've been infected
now the prodrome is an interesting period it's here where you see the three
C's prodrome what the first thing that comes on is constitutional symptoms such
as fever and malaise and anorexia this doesn't mean that they're skinny it just
means that they don't want to eat but the other thing that you see here that's
very characteristic is something called the three C's and what are those three
C's you ought to know what those three C's are the three C's Arkoff
conjunctivitis that means that the area around the eye is inflamed and it is red
and the last C is coryza basically another name for coryza is rhinitis or
inflamed nasal mucosa so runny nose eyes that are kind of red and cough so these
are kind of nonspecific but if you see those three together with fevers
especially when you're thinking about an outbreak you want to think about that
okay the next thing you want to think about too is something that's very
classic that they'll test you on in this pro drum phase and those are complex
spots
now what a complex pot some people have described this as grains of salt on a
red background if you were to look in someone's mouth
imagine the mouth is very inflamed and it looks red back there and you can
imagine either whitish grayish or bluish so if I were to pick a color like that
you would see these whitish grayish or bluish spots right where the molars are
on the buccal mucosa they could also see it in in other mucosal areas genital is
specifically but this is typically where you see these complex spots now the
interesting thing about complex spots is that they usually show up 48 hours
before the next stage which is the rash or the example exposure known as an N
anthem the rash is known as the eggs anthem so if you see complex spots the
rash is probably gonna be coming in within the next 48 hours by the way the
incubation period we said lasts about eight to ten days the prodrome period
usually lasts between two and eight days but mostly it lasts about two days so if
it's lasting about two days and complex spots usually pop up 48 hours before the
next stage usually the prodrome comes on with fevers malaise anorexic cough
conjunctivitis coryza and complex spots the thing you ought to know about copic
spots is there's nothing else that causes them if you see complex spots
it's what we call pathognomonic for measles okay now let's talk about the
rash the rash is a maculopapular rash
okay and it starts on the head and moves down it usually spares the palms and the
soles which is important too to understand now the other thing about
this is that after the rash so that the rash
it's usually about two to three days after the rash there will be a fever or
high fever which will then deaf for vests and in fact after the rash appears
usually clinical improvement occurs about 48 hours after the rash appears so
again another 48 hours so let's review that 48 hours we have to 48-hour marks
be 48 hours before the rash appears is when we'll see the complex spots and 48
hours after the rash appears we'll see fevers but then they will start to go
down if we don't see resolution of symptoms after 48 hours of the rash
these people are at increased risk for getting complications the other thing
you should know is when the rash appears is usually when the complex spots
disappear finally let's talk about recovery usually this could last a
couple of weeks but eventually the patient is going to get better the COFF
may persist for one or two weeks after the infection but again if you start to
see fevers beyond three four or five days after the rash usually that may be
leading toward a complication so fever 48 hours plus post rash equals
questionable complications occurring
let's review the key portions here there are four stages the incubation period
lasts for more than a week when the prodrome comes there's fever malaise
anorexia the three C's complex spots appearing 48 hours before the rash and
then when the rash comes the complex spots go away
they'll have fevers continuing but after 2 to 3 days of the rash the rash will
then start to coalesce and then basically slough off and then if fevers
continue after 48 hours after the rash that's usually not a good sign finally
the recovery phase is about 2 weeks great in the next video we're going to
talk about the diagnosis and the treatment of measles
you