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P G I K R I S T E L M A G N E Z A R A S P E
MEASLES
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General Data
D.A
21 years old
Male
Single Catholic
Tabangao, Ambulong, Batangas City
Admitted on December 15, 2013
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Chief Complaint
Rashes
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History of Present Illness
1 week PTA
on and off undocumented fever
Cough non productive, whitish phlegm
Colds
No consult done
Self medicate with Paracetamol 500mg/tab every 4 hours andIbuprofen
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5 days PTA
Loss of appetite
Post prandial pain
Throat pain
Generalized body weakness
No consult done
Continue self medication
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2 days PTA
Rashes, pruritic
Cough, productive, yellowish phlegm
Few hours PTA Rashes progressively spread all over his body
Difficulty of breathing
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Past Medical History
Unrecalled course of immunization
(-) surgery, accidents and blood tranfusion
(-) heredofamilial diseases
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Family History
(-) HTN, DM
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Personal and Social History
Occasional alcoholic drinker
3-4 sticks/day
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Review of System
General: (-) weight loss, (-) weight gain, (-)chill, (-)fatigue, (-) night sweats
Skin: (-) color change, (-) soreness, (-) scaling
Head and Neck: (-) headache, (-) stiffness, (-)trauma Eyes: (-) corrective lenses, (-)pain, (-) blurring of
vision, (-) dryness
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Ears: (-) hearing loss, (-) pain, (-) tinnutus
Nose: (-) nasal discharges
Mouth: (-) bleeding gums, (-) hoarseness, (-) pain,(-) dryness
Respiratory: (-) cough, (-) chest, (-) dyspnea
Cardiac: (-) orthopnea, (-) PND, (-) palpitation
Nervous: (-)dizziness, (-) seizures Extremities: (-) pain, (-) weakness, (-) tenderness,
(-) cramps
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Physical Examination
General Survey: The patient is conscious, coherent,ambulatory, weak looking and not in cardio-respiratory distress.
Vital signs:BP: 90/60 mmHg
Cardiac rate: 83beats/minute
Respiratory Rate: 19 cycles/minute
Temperature: 38.20C
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Skin: brown, warm, moist with good skin turgor , (+)maculopapular rashes all over
HEENT: conjunctival injection, hyperemic sclera, no
sunken eyeball, dry lips, (+)nasal watery discharge,moist buccal mucosa, no tonsillopharyngealcongestion, no cervicolymphadenopathy, no neck
vein engorgement, no anterior neck mass, no neck
bruit
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CHEST/LUNGS: symmetrical chest expansion, nolagging, no retractions, (+) crackles on midbasal lungfields bilateral
HEART: Adynamic precordium, point of maximalimpulse is located at the 5thICS left midclavicularline, normal rate and regular rhythm, no murmurs
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ABDOMEN: flabby abdomen, normoactive bowelsounds , soft, non-tender on light and deep palpation
EXTREMITIES: grossly normal extremities, nocyanosis and edema with full and equal pulses on
brachial and radial.
DRE: not done
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Neurological Exam
Cerebral Function: awake, alert, oriented to time,person and place, with intact remote, recentmemory,can do simple calculations, with good
judgement
Cerebellar Function: able to perform finger to nosetest, alternating supination and pronation.
Cranial Nerves: Intact
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Motor Function: no muscle atrophy, muscle strengthis 5/5 on both upper and lower extremities, notremors noted
Sensory Function: reacts to pain, touch, position andvibration sense
Reflexes: (+) deep tendon reflexes
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Admitting Impression
Measles
Community Acquired Pneumonia
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Admission: ER
IVF: D5LR 1L x 40 gtts/ min
Diet: Diet as Tolerated; Increased oral fluid intake
Diagnostics:
CBC with PC Urinalysis
Chest Xray
Sodium, Potassium
BUN, Creatinine
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U/A Color SpecificGravi
ty
pH Sugar
Albumin
PusCells
RBC AmorpUrat
es
Epithcells
Bacteria
Amber
1.025 6 (-) (-) 2-4 1-2 Moderate
Few Few
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Blood Chemistry 12/15/13
Sodium 121
Potassium 3.06
BUN 11.5
Creatinine 94.8
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Chest Xray BasalPneumonia,Left
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Course in the wards
1stHospital Day S: (+) cough
Potasium: 3.06
O: afebrile ; stable vital signs
A: Measles: Community Acquired Pneumonia
P: Continue present management
Start Kalium Durule TID for 2 days
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2ndHospital Day S: decreased severity of cough
O: stable vital signs; decreased crackles
A: Measles; Community Acquired Pneumonia
P: Continue present management
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3rdHospital Day S: no subjective complaints
O: afebrile
A: Measles; Community Acquired Pneumonia
P: May go home
Home Meds:
Cefixime 200mg/tab BID x 7days
Azithromycin 500mg/tabs OD x 3 days
Salbutamol + Ipratropium Bromide neb every 8 hours
Loratadine 10mg/tab OD as needed
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Measles
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Definition
highly contagious viral disease that is characterizedby a prodromal illness of fever, cough, coryza, andconjunctivitis followed by the appearance of ageneralized maculopapular rash
The Centers for Disease Control and Prevention :(1)a generalized maculopapular rash of at least 3 days'duration; (2) fever of at least 38.3oC (101oF); and (3)
cough, coryza, or conjunctivitis.
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Etiology
spherical, nonsegmented, single-stranded, negative-sense RNA virus
Morbillivirus
family of Paramyxoviridae antigenically monotypic virus
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Epidemiology
most highly contagious directly transmittedpathogens
common among household contacts, school-age
children, and health care workers Endemic measles has a typical temporal pattern.
As measles vaccine coverage increases or populationdensity decreases
Persons with measles are infectious for several daysbefore and after the onset of rash.
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Pathophysiology
Transmission Respiratory droplets
Small-particle aerosols
Airborne transmission
Direct contact with infected secretions
Incubation Period
10 days to fever onset 14 days to rash onset
Adults up to 3 weeks
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Clinical Manifestations
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Kopliksspots
pathognomonic ofmeasles
bluish white dots 1 mm in
diameter surrounded byerythema
buccal mucosa oppositethe lower molars but
rapidly increase innumber to involve theentire buccal mucosa
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Rash
erythematous maculesbehind the ears and onthe neck and hairline
progresses to involve theface, trunk, and armswith involvement of thelegs and feet by the end
of the second day Areas of confluent rash
appear on the trunk and
extremities
petechiae may be present
The rash fades slowly -
usually beginning on thethird or fourth day afteronset
Resolution of the rash
may be followed bydesquamation
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Differential Diagnosis
Rubella
Kawasaki disease
Infectious mononucleosis
Roseola Scarlet fever
Rocky Mountain spotted fever
Enterovirus Adenovirus infection
Drug sensitivity
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Laboratory Diagnosis
Serology
Culture
PCR
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Complications
Most common Otitis Media
Bronchopneumonia
Respiratory Tract Acute laryngotracheobronchitis
Giant-cell pneumonitis
Central Nervous System
Encephalomyelitis Measles inclusion body encephalitis
Subacute sclerosing panencephalitis
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Prevention
Passive Immunization Human immunoglobulin
within 72 h of exposure - immunocompetent persons
Administered up to 6 days after exposure
Prophylaxis - children
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Active Immunization Mumps and rubella (MMR)
Mumps, rubella, and varicella (MMR-V)
first vaccination varies from 6 to 15 months
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T H A N K Y O U !