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Measles
Measles
Measles: Presentation
Prodromal phase is marked by malaise, fever, anorexia, and the
classic triad of conjunctivitis, cough, and coryza (the 3 Cs)
HIGH FEVER - often >104o F [40o C]; lasting 4-7 days
Other possible associated symptoms include photophobia, periorbital edema,
and myalgias
Koplik spots bluish-gray specks or grains of white sand on a red base
develop on the buccal mucosa opposite the second molars
Rash appears 2-4 days after the onset of the prodrome (1-2 days after
the appearance of Koplik spots) and lasts 3-5 days.
Entire course of uncomplicated measles, from late prodrome to
resolution of fever and rash, is 7-10 days. Cough may be the final
symptom to appear.
Measles: Rash
Measles: Complications
Atypical measles syndrome
previously immunized with the original killed-virus measles vaccines (1963-1968)
Pneumonia
occurs in about 5% of patients, even during apparently uncomplicated infection; in infants, it is a common cause of
death
Bacterial superinfection
pneumonia, laryngotracheobronchitis, and otitis media. Measles transiently suppresses delayed hypersensitivity,
which can worsen active TB
Encephalitis
in 1/1000 to 2000 cases; usually 2 days to 2 wk after onset of the rash, often beginning with recrudescence of high
fever, headache, seizures, and coma
Transient hepatitis
with diarrhea may occur during an acute infect
Measles: Differential Dx
Differential diagnosis includes rubella, scarlet fever, drug rashes, serum sickness, roseola
infantum, infectious mononucleosis, erythema infectiosum, and echovirus and coxsackievirus
infections.
Manifestations can also resemble Kawasaki disease and cause diagnostic confusion in areas
where measles is very rare.
Atypical measles, because of its greater variability, can simulate even more conditions than
typical measles, including Rocky Mountain spotted fever, toxic shock syndromes, and
meningococcemia.
Some of these conditions can be distinguished from typical measles as follows:
Rubella: A recognizable prodrome is absent, fever and other constitutional symptoms are absent
or less severe, postauricular and suboccipital lymph nodes are enlarged (and usually tender), and
duration is short.
Drug rashes: A drug rash often resembles the measles rash, but a prodrome is absent, there is
no cephalocaudal progression or cough, and there is usually a history of recent drug exposure.
Roseola infantum: The rash resembles that of measles, but it seldom occurs in children > 3 yr.
Initial temperature is usually high, Koplik spots and malaise are absent, and defervescence and
rash occur simultaneously.
Measles: Treatment
Supportive care
For children: Vitamin A
Hospitalized patients with measles should be managed with standard contact and airborne
precautions. Single-patient airborne infection isolation rooms and N-95 respirators or similar
personal protective equipment are recommended. Otherwise healthy outpatients with measles
are most contagious for 4 days after the development of the rash and should severely limit
contact with others during their illness.
Vitamin A supplementation has been shown to reduce morbidity and mortality due to measles
in children in the developing world. Because low serum levels of vitamin A are associated with
severe disease due to measles, vitamin A treatment is recommended for all children with
measles. The dose is given orally once/day for 2 days and depends on the childs age:
> 1 yr: 200,000 IU
6 to 11 mo: 100,000 IU
< 6 mo: 50,000 IU
In children with clinical signs of vitamin A deficiency, an additional single, age-specific dose of
vitamin A is repeated 2 to 4 wk later.