Measles: Case Study

Hiro Landazuri Karla Gonzalez Jonathan Chen

Case
An 18 yr old freshman complained of a cough, runny nose, and conjunctivitis. The physician in the campus health center noticed small white lesions inside the patients mouth. The next day, a confluent red rash covered his face and neck.

Overview
Rubeola Paramyxovirus Morbillivirus Negative-sense ssRNA F (fusion) protein/H (hemoagglutanin) protein
http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm

Overview
Systemic infection Respiratory transmission Primary site of infection = nasopharynx Primary viremia (2-3 days post exposure) Secondary viremia (5-7 days post exposure)
http://www.homehealth-uk.com/image_01/image/throatdiagram.gif

Physical Diagnosis
The 3 Cs Cough, coryza, conjunctivitis Kopliks spots MV rash Maculopapular
Macule red lesion flushing Papule raised red lesion

dermatlas.med.jhmi.edu

Conjunctivitis Kopliks Spots

http://en.wikipedia.org/wiki/Conjunctivitis

MV rash

http://www.cdc.gov/vaccines/vpd-

vac/measles/photos.htm

Laboratory Diagnosis
Isolation of MV from clinical specimen Serodiagnosis IgM ab (ELISA) IgG ab
ELISA, HI, Indirect flourescent ab test, microneutralization, plaque reduction neutralization, complement fixation

Complement Fixation Assay

Positive Negative

http://web.indstate.edu/thcme/PSP/labtests/complementfix.htm

Treatment
No treatment Supportive Care Only
Tylenol, Non-steroidal anti-inflammatory drugs like Advil, Aspirin, Motrin etc. Isolation Vitamin K Hydration Post-exposure Prophylaxis

Antibiotics for serious complications (rare)

Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).

When was this patient contagious?

Course of the infection
Incubation 7-14 days Initial symptoms immediately following incubation: cough, coryza, conjunctivitis, fever Kopliks spots 2-3 days after initial symptoms Rash appears 4-5 days after the initial symptoms

Infection communicable four days before his rash appeared to four days after
MayoClinic.com Tools for Healthier Lives, Measles, http://www.mayoclinic.com/print/measles/DS00331/DSECTION=all&METHOD=print (Oct. 29, 2007). Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).

Why is this disease not common in the United States?

the United States is a developed country
most children are immunized with MMR (Measles Mumps Rubella) vaccination required proof of MMR immunization

the Measles Initiative is working on standard global immunization for measles

Several possible reasons for patients susceptibility to measles at 18 years of age.

if the patient did not receive MMR vaccinations
allergic reaction to component of MMR
recent studies have shown no direct correlation

poor healthcare
undeveloped countries without required MMR

linking of MMR and autism

studies lacked substantial scientific evidence

if patient did receive MMR vaccinations

may not have developed immunity

either way, patient was susceptible to measles and was exposed via
traveling dorms/college campus