Rainy season

From June to July is a rainy season（梅雨 ）in Japan, Korea and eastern china.

Rice seedling

The backyard of my Clinic is the small land for rice.
Today, rice seedlings are done by automatic rice transplanter machine.

Measles: An epidemic of Measles in Yamaguchi, 1991.

1) An epidemic of Measles in Yamaguchi Prefecture:
---In the past, an epidemic of Measles was noted in 1991(the peak was May) in
---Yamaguchi Prefecture (Population=1,560,000).

--------------------------- Reported numbers of Measles in Yamaguchi from 1991~1993.

---------Since then, no epidemics were occurred, except for small outbreaks, 

--------- in Yamaguchi prefecture.

2) The complication of Measles:

----Here, an example of the Measles's cases, who were hospitalized at Yamaguchi

--- University Hospital in 1991, with;

--------------- i) Pneumonia: 17 cases ( one case needed artificial ventilation)

-------------- ii) Encephalomyelitis: 5 cases

------------- iii) Croup: one case

------------- iv) Febrile convulsion: one case

Measles: 16 year old

~~~~~~~~~~~~~~~~~~
Measles: 16 year old boy
~~~~~~~~~~~~~~~~~~
He received Measles vaccine at 1 year old. So in this case, vaccine immunity
was disappeared.


1991.
January 14: started fever
----------15: high fever
----------16: high fever
----------17: Skin rash appeared from face, then upper trunk and extrimity.
----------18: Hospitalization. WBC 2,700(44%band. 22%seg, 20%lym.14% mon)，
--------------- CRP=3.3mg/dl
----------19: high fever, cough. Skin rashes appeared all over the body.
---------------------------------------But conjunctivitis was not severe.
---------------------------------------taken the photos;
-----------------------------1) Face:

-----------------------------------2) chest;

------------------------3) chest: enlarged

----------------------4) Koplik's spot: not so clear one.

----------------- January 20th:  skin rash of the arm.

        
------------------January 26:  skin pigmentation of arm. 10 yen coin for reference.

Measles:4 year old

Here show the case of Measles : 4 year old.

-----------Day 1:  fever start

ーーーーDay 2:  fever, cough and nasal discharge.

ーーーーDay 3:  Koplik spot appeared at night.

ーーーーDay 4:  Skin Rash appeared at Face.

ーーーーDay 5:  Rash from upper trunk and extremity to lower. 

------------------- WBC 7,000(Lym39%, Mon9%, Seg 45% ,Band7% ), CRP 0.43mg/dl.

ーーーーDay 6:  peak of Rashes.

ーーーーDay 8: no fever.  WBC 5,900(Atypical cells 36%, Lym 44%, Mon2%, Band5%, ーーーーーーーーーEos4%)

ーーーーDay 9: skin pigmentation.

Measles

I have seen no patients with Measles since 1999. In April, 1997, I opened
my clinic and only 3 infants with Measles until 1999.



What is Measles?

1) Etiology:  Measles virus

2) A typical case of measles begins with fever, cough, runny nose, red eyes, 

------- and sore throat.  2~3 days after, tiny white spots (Koplik’s spots) may

------- appear inside the mouth.

------- 3~5 days after, a red or reddish-brown rash appears. 

------- The rash usually begins on a person’s face at the hairline and 

------- spreads downward to the neck, trunk, arms, legs, and feet. 

------  When the rash appears, a person’s fever may spike to more than 

------- 104 degrees Fahrenheit.

------- After a few days, the fever subsides, the rash fades and 

------- skin pigmentation appear.

3) Clinical course of Measles:

麻疹＝Measles, 体温=Body Temperature, 発疹=skin rash，

コプリック斑=Koplik's spots,  結膜炎=conjunctivitis

はなかぜ=nasal congestion，せき=cough

4) Complications: 

------ i)  Pneumonia:  frequently in infant. usually, caused by bacteria

-------------------------such as H. influenzae or streptococcus pneumoniae.

------ ii) Otitis media: freuently in infant and toddler.

------ iii) Croup: acute laryngitis.

------ iv) Measles encephlo-myelitis: 6~15 year old are at risk.

---------- usually occur in recovery phase. Urinary and walking disturbance

---------- are the early sigh. Don't worry . Most cases recover without of 

-----------neurological sequerae

------ v)  Encephlitis:  1/1,000

------ vi) keratitis:  infant in the countries with vitamin A deficiency

------ vii) SSPE:  vary rare

Here, show the old photos of Measles:

1) high fever, cough, eye dischrges and skin rash:

2) Koplik's spot: look like candida infection.

3) skin pigmentation.