MEASLES (CAMPAK)

Introduction
Measles = morbili = rubeola
Acute and highly contagious viral disease
Near universal infection of childhood in

prevaccination era
Serious complications involving the gastrointestinal
respiratory tracts and CNS occur in 5-15% patients in
highly developed countries
The widespread use of live attenuated measles virus
vaccine followed by a sharp decline in the incidence
of the disease

Measles virus

PARAMYXOVIRUS (RNA)
RAPIDLY INACTIVATED BY HEAT AND
COLD AND ULTRAVIOLET LIGHT

Overview : Virologi

Pathology
Hyperplasia

of the lymphoid tissue in the tonsils,

adenoids, lymph nodes, spleen and appendix
Large (100 m) multinucleated giant cells in the
pharyngeal and bronchial mucosa
Suringa et al (1970) Kopliks spots and the skin
lesions of measles : syncytial epithelial giant cells
Intercellular and intracellular edema
Parakeratosis and dyskeratosis

Clinical Manifestation

Measles virus is transmitted via droplets and infects epithelial

cells of the nose and conjunctivae. Virus multiplies in these
epithelial cells and then extends to the regional lymph nodes.
Primary viraemia occurs 2 to 3 days after infection, and
measles virus continues to replicate in epithelial and
reticuloendothelial system tissue over the next few days.

Secondary viraemia occurs on days 5 to 7, and

infection becomes established in the skin and other
tissues including the respiratory tract on days 7 to
11.

The prodromal phase, which lasts 2 to 4 days, occurs at this

time with fever, malaise, cough, coryza, and conjunctivitis.
Koplik's spots may develop on the buccal mucosa about 1 to 2
days before the rash and may be apparent for 1 to 2 days after
rash onset.

The rash then develops at about 14 days after

infection; at this time virus can be found in blood,
skin, respiratory tract, and other organs.

Over the next few days, viraemia gradually decreases as

the rash coalesces and gradually resolves along with the
other signs and symptoms. Viraemia and presence of virus
in tissue and organs ceases by days 15 to 17 corresponding
to the appearance of antibody

Prodrome
Stepwise increase in fever
Cough, coryza, conjunctivitis
Koplik spots

Pathognomonic of measles
Consist of bluist white dots 1 mm in diameter surrounded by
erythema
Appear first on the buccal mucosa opposite the lower molars
but rapidly increase in number to involve the entire buccal
mucosa
Fade with the onset of rash

Measles Koplik Spot

HERPANGINA or HFMD

AINLESS
EVER INCREASE
PAINFULL
FEVER DECREASE

Measles Koplik Spot

Rash
2-4 days after prodrome, 14 days after exposure
Maculopapular, becomes confluent
Begins as erythematous macules behind the ears and

on the neck and hairline.

The rash progresses to involve the face, trunk and
arms with involvement of the legs and feet by the
end of the second day
Persists 5-6 days
Fades in order of appearance, usually beginning on
the third or fourth day after onset

Morbiliform Rash
Early Rash

Latest Rash

CONVALESENT
RASH

Diagnostic evaluation
Kopliks spots : appear early and pathognomonic
CDC :

Generalized maculopapular rash of at least 3 days duration

Fever of at least 38,3oC
Cough, coryza, or conjunctivitis

Mortalitas: measles pneumonia

A 9-year-old boy presented with fever,
rash, coryza, and photophobia. Throat
cultures were negative. Over the next 4
days the rash worsened significantly
and the boy developed a dry barking
cough and difficulty breathing. He died
11 days after the rash initially appeared.
Throat cultures, blood cultures, and sputum cultures all failed
to grow pathogenic bacteria. PPD was negative and there was
neither caseaous necrosis nor granulomas in his lungs.
http://pathmicro.med.sc.edu/pathology%
20images/LRI-Barking-cough.htm

Treatment
Humidification of the patients room may be

necessary for laryngitis or an excessively irritating

cough.
It is best to keep the room comfortably warm
rather than cool.
Avoid exposure to strong light during the period of
photo-phobia

http://www.who.int/mediacentre/factsheets/fs286
/en/
Tatang Kustiman Samsi, MD. JPOG MAR-APR
1999

An adequate fluid intake should be maintained to

prevent dehydration.
Administer antipyretics to reduce high fever.
(Salicylate must be avoided as this will increase the
risk of developing Reyes syndrome).

http://www.who.int/mediacentre/factsheets/fs286
/en/
Tatang Kustiman Samsi, MD. JPOG MAR-APR
1999

Vitamin A

Barclay et al (1987) and Hussey & Klein (1990) : striking

beneficial effects of giving vitamin A to children with severe
measles
400,000 IU within 5 days of onset of rash
WHO recommended vitamin A supplementation for all
children in regions :

Vitamin A deficiency exists

Measles mortality rate is 1% or higher

Pencegahan
Imunisasi

Imunisasi campak
MMR

Pemahaman tentang Vaksinasi Campak, Jadwal

Berapa kali seorang anak harus mendapat

imunisasi Campak ??

Terima Kasih