Measles

Background

  • Also known as Rubeola, which is not to be confused with German Measles (Rubella)
  • Patients are contagious from about 4 days before to 4 days after onset of rash
Koplik's Spots on Cheek
Koplik's Spots on Palate
Measle's Rash on Face
Measle's Rash on on Thorax

Clinical Features

  • Consider measles in a patient of any age who has an acute RASH and FEVER
  • Incubation period - 10 days
  • Prodrome of high fever, cough, coryza, and conjunctivitis (lasts ~3 days)
  • Koplik's spots (appears day 2-3) - pathognomonic enanthem
    • Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
  • Rash (begins day 4 - lasts to day 7)
    • Red, blotchy, and maculopapular; rapidly progresses to confluence
    • Usually starts on the face (hairline and behind the ears)
    • Rapidly spreads to the chest, back, and finally the legs and feet
    • Rash resolves in order of appearance between days 7-9
  • Obtain a history of measles immunization, contact with known outbreak, travel outside of the Americas, or contact with international travelers in recent weeks

Differential Diagnosis

Pediatric Rash

Oral rashes and lesions

Evaluation

  • Measles IgG and IgM
  • Culture and PCR of nasopharyngeal swab
  • Urine PCR

Management

  • Alert local health department ASAP
    • The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately

Isolation Precautions

  • For suspected patients
    • Mask the patient and isolate immediately in an airborne infection isolation room
    • All personnel entering the room should use respiratory protection at least as effective as an N95 respirator
    • If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room
    • Do not use the room for at least 2 hours after the patient leaves.

Post-Exposure Prophylaxis (Non-Immune Contact)

  • Immunocompetent:
    • MMR Vaccine (within 72 hours of exposure)
  • Immunocompromised, children <12 months, and others at high risk of complications:
    • IM Immune globulin (up to 6 days after exposure)
    • Consider checking with your local health authorities

Complications

  • Secondary infection
    • Measles virus can directly infect T cells, leading to systemic immune suppression and secondary infections
  • Gastrointestinal
    • Diarrhea is the most common complication
    • Others: gingivostomatitis, gastroenteritis, hepatitis, mesenteric lymphadenitis, and appendicitis
  • Pulmonary
    • Pneumonia is the most common cause of measles-associated death in children
  • Neurologic
    • Encephalitis
    • Acute disseminated encephalomyelitis
      • Demyelinating disease thought to be a postinfectious autoimmune response
    • Subacute sclerosing panencephalitis
      • A fatal, progressive degenerative disease of the CNS that usually occurs 7 to 10 years after natural measles virus infection

See Also

References