Measles

(rubeola)
 Measles
Definition
A communicable disease manifested with fever,
cough, coryza, lacrimation and Koplik spots in
preeruptive phase and a maculopapular rash
starting on the 4th or 5th day of illness..
 Measles
Epidemiology
Most common and most infectious of the viral
infections of childhood
Mode of transmission: droplet spread from the
secretion of the nose and throat; direct and
indirect contact
Communicable period; usually 4 days before
and 5 days after appearance of rash
Occurs in all seasons, more in winter and
spring..
 Measles
Epidemiology
Ill health and morbidity in undernourished
infants and children <3 years but benign course
in healthy children
Unusual before 3 months and mild till 9 months
(maternal antibodies); more common in 1 to 5
years of age
Incubation period
8 to 12 days (average 10-11 days)..
 Measles
Pathology
Causative organism: paramixovirus (RNA,
measles virus)
Pathological changes are essentially limited to
superficial blood vessels of skin and mucous
membrane, forming the co-called inclusion
bodies
Invasion of respiratory epithelium local
multiplication viraemia secondary viremia
(systemic symptoms)..
 Measles
Clinical features
3 stages
1. Prodomal (catarrhal) phase
2. Eruptive phase
3. Convalescent phase..
 Measles
Clinical features
Prodomal (catarrhal) phase
Acute onset with moderate elevation of
temperature, dry cough, running nose,
sneezing, redness of eyes and excessive
lacrimation.
Koplik spots on 2nd or 3rd day..
 Measles
Clinical features..
Eruptive phase
Fever rises after rash appears on the 4th day.
Rash blanches on pressure initially
First appears behind ears, forehead, face
and neck and spreads to trunk, extremities,
palms & soles within 3 days.
Now rash is brownish and doesnt fade on
pressure..
 Measles
Clinical features
Rash starts disappearing after 4-5 days in the
order it appeared leaving brawny (light brown)
desquamation.
Fever and rash last about a week.
Modified measles is seen in partially immune
individuals.
Hemorrhagic measles is characterized by high
fever, convulsion, delirium , stupor and even
coma..
 Measles
Clinical features..
Convalescent phase
Disappearance of fever, other constitutional
symptoms and the rash..
 Measles

Diagnosis
Primarily clinical diagnosis (Kopliks spot is
pathognomonic) and need no investigations
Blood
Low WBC but slowly rise to normal as the rash fades
High WBC if superadded bacterial infection
Measles-specific IgM antibody (ELISA &
Haemagglutination test)
Isolation of virus from nasopharynx or blood (in
acute stage)..
 Measles
Differential diagnosis
Roseola infantum (viral infection of infant &
toddlers)
Pink macular rash appears on trunk, neck and
proximal site of extremities only
Lasts just for 24 hours (measles rash last for 4 to 7
days)
Rubella
Prodromal phase is slight (minimal symptoms) and
short
Rash is pink, discrete & mild
Significant posterior occipital lymphadenitis..
 Measles
Differential diagnosis..
Infectious mononucleosis (glandular fever caused by
EB virus)
Rash (often followed by ampicillin), fever, generalized
lymphadenopathy and hepatosplenomegaly
Drug rash
History of rash following drug intake
Meningococcemia
Rash within 24 hrs
Other features of disease like meningitis, toxaemic
state..
 Measles
Differential diagnosis..
Typhus
Rash is centripetal
Patient is very toxic
Miliaria rubra (prickly heat, sudamina, heat rash)
Pinhead sized erytheatous papules over the areas
where weat glands re in abundance
Usually seen in summer..
 Measles
Complications
Complication bears potential danger rather than
the disease itself
Respiratory tract
Otitis media, bronchopneumonia, tracheobronchitis,
laryngotracheobronchitis, bronchiolitis, interstitial
pneumonia, measles pneumonia is AIDS (without
rash & fatal) , flare up of primary TB, subcutaneous
emphysema (other causes of emphysema are
trauma, asthma, pertussis, foreign body, violent
cough, pneumonia, etc.)..
 Measles
Complications..
GI tract
Stomatitis, enteritis, appendicitis, Persistent
diarrhoea, hepatitis, ileocolitis
Eyes
Keratitis & corneal ulceration secondary to vitamin A
deficiently
Haematological (black measles)
Haemorrhagic measles- stormy onset with high
fever, convulsions, delirium, coma and bleeding..
 Measles
Complications..
CNS
Encephalitis (rare, 0.1% but most serious): Usually
within a week after onset of rash; residual sequelae
including mental retardation
Guillain-Barre syndrome, hemiplegia, retrobulbar
neuritis
Subacute sclerosing panencephalitis (SSPE) is very
rare and fatal, characterized by myoclonic jerks,
mental deterioration & fatal course within 6 months.
Occurs 3-8 years of primary measles infection..
 Measles
Complications..
Malnutrition
Others
Acute glomerulonephritis, Stevens Johnson
syndrome, transient ECF change and myocarditis
(uncommon)..
 Measles
Prognosis
Usually self limiting if not complicated
Convalescence is prolonged with respiratory
complications
Death may occur
90% of deaths are due to respiratory (in younger
children) and neurological causes (in older children)
Patients with measles encephalopathy
death of 1/3rd cases
severe neurological deficit in another 1/3rd cases..
 Measles
Prevention
1. Active immunization
Live attenuated measles vaccine at 9-12 months of
age
MMR at 15-18 months of age
Vaccination contraindicated in leukaemia,
lymphopenia, during steroid or antimetabolite therapy,
active TB..
 Measles
Prevention..
2. Passive immunization (Ig) in exposed infants &
younger children.
Gamma globulin (IM) 0.25 ml/kg for <1 year old & 0.5
ml/kg for >1 year old child (max. dose 15 ml)
Offers short term immunity and modifies illness..
 Measles
Treatment
1. Symptomatic & supportive
Body & oral hygiene (taking bath, brushing teeth)
Enough fluid, adequate nutritious diet
Paracetamol and hydrotherapy for fever
Severe cough- humidification or saline nebulization; no
cough suppressants
Vitamin A: 200,000 IU for 2 consecutive days
Antiviral (ribavirin) has no proved efficacy..
 Measles
Treatment..
2. Treatment of complication
Prophylactic antibiotics for streptococcal &
staphylococcal infection
Oxygen
Diazepam or phenobarbitone for convulsion
No role of steroids in the management of measles
encephalitis..