Measles (Rubeola)

Posted on: Monday, June 11th, 2018 @ 8:53 AM - By: Mohemet - Seen 226 Times

Measles (Rubeola): is a highly contagious viral disease caused by single stranded RNA measles virus.
The portal of entry is through the respiratory tract or conjunctivae following contact with air droplets.
The virus remains viable in air for up to 1 hour, so when a patient coughs in a room, till 1 hour after leaving the room the virus remains alive and can infect susceptible individuals who enter the room!

CLINICAL MANIFESTATION

*Incubation period: no signs or symptoms.

*Prodromal phase:

  • fever with 3Cs: Cough, Coryza (runny nose) and Conjuctivitis.
  • Koplik spots (Enanthem) appear 1-4 days prior to the onset of the rash -Koplik spots: are whitish granules on a red base that appear in the oral cavity and sometimes in  conjuctiva and vagina- see  images below.
  • Symptoms increase in intensity for 2-4 days until the 1st day of the rash.

*Exanthematous phase:

  • Red maculopapular eruption in Cepalocaudal progression
  • With the onset of the rash, symptoms begin to subside but cough persists.
  • The rash fades over 7 days cephalocaudally

*Recovery phase: all signs and symptoms subside apart from cough which still persists.

Warning: patient is infectious 3 days before and 4-6 days after onset of rash, so he/she should be isolated during this period.

DIAGNOSIS:

  • Clinically
  • WBC ↓ed, Lymphopenia
  • CRP and ESR are normal (unless there is secondary bacterial infection)
  • Serology: Measles IgM Ab, 4 fold ↑ in Measles IgG Ab
  • Viral culture and Viral PCR

DIFFERENTIAL DIAGNOSIS

  • Rubella
  • Adenovirus,  enterovirus infection, and Epstein-Barr virus infection.
  • Mycoplasma pneumoniae and group A streptococcus may also produce rashes similar to that of measles.
  • Kawasaki syndrome.
  • Drug eruption.

COMPLICATIONS

  • Acute otitis media
  • Pneumonia, croup, tracheitis, and bronchiolitis
  • Encephalitis and Subacute sclerosing panencephalitis (SSPE).

TREATMENT

  • Supportive: Antipyretics and analgesia e.g Paracetol 10-15mg/kg, antitussive for coughing, IVF if there is dehydration
  • Antibiotics: Only if there is secondary bacterial infection e.g. ceftriaxone vial 50-75 mg/kg÷2
  • Vitamin A capsule: Is indicated for all patients with measles, administered once daily for 2 days at doses of:

         -200,000 IU for children ≥12 months

         -100,000 IU for infants 6-11 months

         -50,000 IU for infants younger than 6 months.

Filed under: Infectious diseases