Measles (Rubeola)
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Introduction
- An acute viral infection caused by an RNA virus of the genus Morbillivirus in the family Paramyxoviridae
- Only one serotype is known
- Endemic throughout the world
- A major contributor to childhood mortality,
- 79% reduction in deaths from measles due to the global push to improve vaccine coverage
- A major cause of preventable blindness
- Transmission is by droplet infection during the prodromal stage
- Incubation period: 9 - 11 days
- Time of exposure to appearance of rash: about 14 days
Clinical features
The essential lesion is found on the skin, mucous membranes of the nasopharynx, bronchi, intestinal tract and conjunctivae
Three stages:
- Incubation period
- Prodromal stage with an enanthem
- Final stage
Incubation period:
- Mild fever; 10 - 11 days
Prodromal stage:
- 3-5days
- Low grade to moderate fever
- Dry cough
- Coryza
- Conjunctivitis
- Koplik spots
- Photophobia
Final stage:
- Temperature rises abruptly as the rash appears
- Rash begins from the upper lateral part of the neck, behind the ears, along the hairline and posterior parts of the cheek then spreads to the rest of the body
- Rash fades in the same pattern in 3 - 4 days
- Associated lymphadenopathy
Differential diagnoses
- Rubella
- Roseola infantum
- Infections from Echovirus, Coxsackie Virus and
- Adenovirus
- Infectious mononucleosis
- Toxoplasmosis
- Meningococcaemia
- Drug rashes
Complications
- Diarrhoea
- Otitis media
- Pneumonia
- Laryngo-tracheobronchitis
- Malnutrition
- Encephalitis
- flaccid paralyses
- Seizures or Blindness
- Subacute sclerosing panencephalitis
Investigations
- Isolation of the virus by tissue culture
- ELISA: first IgM and later IgG response
- Demonstration of Warthin Finkeldy giant cells in smears of the nasal mucosa
- Full Blood Count
- Lumbar puncture
Treatment goals
- Relieve symptoms
- Hydrate adequately
- Treat secondary bacterial infection
- Prevent complications
Non-drug treatment
- Humidification of the room for those with croup
- Protection from strong light for those with
- photophobia
- Nutrition
- Fluids
Drug treatment
- If RTI is present, administer antibiotics
- Those in final stage with fever need antipyretics
- Some children require supplemental vitamin A
- 100,000 IU stat for age 6 months - 1 year
- 200,000 IU stat for age above 1year
- Repeat on days 2 and 14 for those with ophthalmologic evidence of vitamin A deficiency
- Specific treatment of complications:
- Use of dexamethasone for Croup
Notable adverse drug reactions, contraindications and caution
Vitamin A may cause features of pseudotumour cerebri
- Nausea, vomiting, drowsiness, bulging fontanelle, diplopia, papilloedema and cranial nerve palsies
Prevention
Isolation precaution from the 5th day of exposure until 5 days after appearance of the rash
Measles vaccine at 9 months
- Vaccine may be given at 6 months for measles post-exposure, and in outbreak prophylaxis
Post-exposure prophylaxis
- Passive immunization with immune globulin within 6 days of exposure