hi welcome to another MedCram lecture we could 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 its 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 them is 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 ok 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 are 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
could 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 pots 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
complex spots are 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 anorexia cough conjunctivitis coryza
and complex spots the thing you ought to know about colic 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 the rash start
usually about two to three days after the rash there will be a fever or high
fever which will then deaf or VES 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 two 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