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Sunday, June 15, 2008

Some aspects of Measles with homoeopathic mode of treatment -

Measles is an acute, highly infectious disease of childhood occurring worldwide and is caused by measles virus, a RNA virus belonging to the family of paramyxoviruses. The virus is antigenically uniform. Humans are the only natural hosts. One attack confers solid immunity and second attacks are uncommon. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries but it is still now a very common disease of childhood in the developing countries. Although it is a relatively mild disease in the healthy child, it carries a high mortality in the malnourished as well as in those with other diseases. In the nonimmune, infection almost always causes clinical manifestation.

Age- Peak incidence is in young children between 1-5 years of age. It is rare in first six months of life due to the presence of maternal antibody.

Season- Epidemics occur mostly in late winter and early spring, with a peak in April.

Spread of infection- This infection spreads by droplet during the prodromal stage and in early eruptive stage. Infectivity is maximum at the prodrome and diminishes rapidly with the appearance of rash. It starts from 3 days prior to the onset of symptoms and lasts until the rash desquamates.

Pathogenesis-The virus enters the body through the respiratory tract or the conjunctiva and multiplies locally as well as in the adjoining lymph nodes. The virus spreads to the reticuloendothelial system via blood where it multiplies and then a secondary viraemia carries the virus to the epithelial surfaces including the skin, mouth, respiratory tract and conjunctiva.

Incubation Period- 8-14 days.

Clinical Features- The course of the disease is divided into two distinct phases-

(1) The infectious pre-eruptive and catarrhal stage-
This is the stage of viraemia and viral dissemination and lasts for about 4 days. There are sudden onset of malaise, acute fever, rhinorrhoea, cough, conjunctivitis, photophobia and hoarseness of voice. The cough is hacking and occasionally painful. After 3-4 days of prodromal illness, the rash which is a characteristic of the next stage appears and a day or two before the onset of rash, the pathognomonic Koplik’s spots develop. Koplik’s spots are tiny whitish irregular spots against a reddish background characteristically around the opening of the parotid duct opposite the second molar teeth. Koplik’s spots may occasionally develop on the conjunctiva and the intestinal mucosa. On the 3rd day the temperature usually comes down to a low level and is so known as day of remission.

(2) The non-infectious eruptive or exanthematous stage- This stage is characterized by the appearance of a maculopapular rash which appears usually on the 4th day and initially occurs on the face, mainly on the forehead and behind the ears at the junction of skin and hair. It then spreads rapidly to involve whole of the body, including palms and soles. Initially they are discrete, pink in colour, blanch on pressure but later it become confluent and patchy, particularly on the face and neck. It fades in about a week in the same sequence, leaving behind a brownish discolouration of skin and areas of desquamation. The rash represents an immune reaction between T lymphocytes and cells in which viral replication is going on. During this stage, there is again a high rise of temperature with puffiness of face, headache, cough, photophobia and myalgia. Lymph nodes may also enlarge.

Complications- Although most patients recover uneventfully, a few may develop complications which are due to secondary bacterial infection or to the virus itself and are found in those who are malnourished or have other diseases. Complications include bacterial pneumonia, bronchitis, otitis media and gastroenteritis. Rarely the virus may cause fatal giant cell pneumonia. Less common complications are myocarditis, hepatitis and encephalomyelitis. A rare late complication is subacute sclerosing panencephalitis. Protracted diarrhea may also occur as a complication in children in poor countries. Maternal measles may cause spontaneous abortion and premature delivery.

Laboratory Investigations-
(1) Blood examination -Blood examination shows leucopenia or normal count. Leucocytosis may be seen with secondary bacterial infection.
(2) Immunofluorescence-Detection of measles virus antigen by immunofluorescence in multinucleated giant cells which may be demonstrated in Giemsa stained smears of nasal secretions may be used to confirm the diagnosis. This is very simple and may be used a diagnostic test even before the appearance of rash.
(3) Serological tests- Serological tests like complement fixation test( CFT), haemagglutination inhibition test etc may also be used to confirm the diagnosis. High titre measles antibody if can be demonstrated in CSF is diagnostic of subacute sclerosing panencephalitis, a rare and late complication of measles.
(4) Virus culture- Virus culture may also be used to confirm the diagnosis.

Prophylaxis-Normal human gammaglobulin administered within 5 days of exposure can prevent or modify the disease. This is particularly valuable in previously unimmunized children below the age of 3 years, children with immunodeficiency, during pregnancy and others at special risk. Active unimmunization may be done with single antigen measles vaccine or with combined vaccine, MMR.

Treatment- Bry. ( Bryonia) 30, Kalibich. (Kali bichromicum) 6 or 30, Puls. (Pulsatilla) 30 etc are some of the medicines used most frequently. The dose administered and the frequency maintained depends on the state of condition and the severity of the disease. Bryonia is the prime medicine. It is especially useful in fever with dry cough as well as in fever with internal heat. If there is associated cough, Kalibi is to be added. If there is any abdominal distress or diarrhoea, Pulsatilla should be used in addition to Bryonia.
Labels-Abortion, Antibody , CFT, Epidemics, Gammaglobulin, Giemsa Stain, Haemagglutination, Inhibition Test, Immunodeficiency, Immunofluorescence, Serological Test, Viraemia, Bry. ( Bryonia), Kalibich. (Kali bichromicum) , Puls. (Pulsatilla), Sclerosing panencephalitis, CCF , Otitis media, Gastroenteritis, Peumonia, Bronchitis, Giant Cell, Myocarditis, Hepatitis, Encephalomyelitis.

IN SHORT-Measles, an acute, highly infectious disease of childhood is caused by measles virus, a RNA virus & begins with sudden onset of malaise, acute fever, rhinorrhoea, cough, conjunctivitis, photophobia and hoarseness of voice. The disease is characterized by the appearance of the pathognomonic Koplik’s spots which is soon followed by the appearance of a maculopapular rash. The disease may be associated with some complications which are due to secondary bacterial infection or to the virus itself. Prevention may be done with active unimmunization with single antigen measles vaccine or with combined vaccine, MMR. Treatment is as mentioned above.

But in every case a doctor should be consulted.

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