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

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