goodduck

-- "respiratory secretion"
2. infect respiratory epithelium -> epithelium damage 
       [disease] -- " entire repiratory system"
        otitis media (young child)
        laryngitis
        croup
        bronchitis
        primary viral pneumonia (adult, hospitalized cause)
        secondary bacterial pneumonia (more than 1/3 adult)
3. primary viremia to RES -> infected all WBCs -> direct invade T cell/ IL-4 increase -> celluar immunity decrease
      [disease]
       cervical adenitis / lymphadenopathy
       hepatitis
       splenomegaly
4. secondary viremia  -> fever (up tp 40.6)
5. distal disseminated
       [skin]                                   [CNS]                                    [GI]
        koplik's spot                      encephlalitis                       AGE, appendicitis, ileocolitis
        skin rash                            SSPE                                   hepatitis
                                                                                                   mesenteric adenitis
[clinical course]
infection  --->   onset of S&S  -->  rash  appear  -->  rash begin fade / fever resolve
  day0                     day10                  day14                                          day18

[Lab]                                              
1. lymphopenia and neutropenia (infect all WBCs ->cell death) 
2. leukocytosis (may herald bacteria superinfection)
3. CSF protein high, lymphocytosis (if encephalopathy)
[Dx]
1. classic: Koplik's spots, cough, coryza, conjuctivitis, rash

[self-examination]
1. Is a child with agammaglobulinemia at high risk of severe complication?
      No, because his celluar immunity remains normal.
2. Does a person got measles without rash or spots have better prognosis?
     No, no skin lesion represents deficiency in immune reaction, careful!!