Disease/Syndrome

Measles

Category

Infection, Occupational

Acute/Chronic

Acute-Moderate

Synonyms

Rubeola;

Biomedical References

Search PubMed

Comments

INITIAL SYMPTOMS: Prodrome of fever, cough, coryza (runny nose), conjunctivitis, and Koplik spots; then on day 3-7: rash on head and neck, spreading peripherally and lasting 4-7 days; Leukopenia is common. [CCDM] FINDINGS: Koplik spots (stomatitis) are white, raised, and 1-2 mm in diameter. They are located on the buccal mucosa near the lower molars, starting 2 days before the onset of the rash and fading after about 4 days. Lymphadenopathy (cervical, postauricular, and/or occipital) is common. Vomiting, diarrhea, and abdominal pain occur occasionally in younger children. [ID, p. 1181-2] Measles can cause severe pharyngitis. [Cohen, p. 267] Measles does not cause sore throat. The rash covers the entire body, but the palms and soles may be spared. [Cecil, p. 2105-6] Desquamation follows the disappearance of the rash. [Merck Manual, p. 1459] Atypical measles has been described in patients who received inactivated measles vaccine and then were exposed to measles virus 2-4 years later. The rash was maculopapular, urticarial, or petechial; it was sometimes on the palms and soles and sometimes vesicular. Respiratory distress was common. Atypical measles has also been reported in patients who had received live measles vaccine. [ID, p. 1182] COMPLICATIONS: Pneumonia is the most common severe complication, and it is responsible for the majority of deaths. Complications strike most frequently children <5 years and adults >20 years. [Cecil, p. 2106] Giant-cell pneumonitis occurs in AIDS patients. Most complications are due to secondary bacterial infections, e.g., otitis media and pneumonia. [Harrison ID, p. 1013] Complications of measles caused by either the virus or bacterial superinfection include pneumonia, otitis media, diarrhea, and encephalitis. In malnourished children, measles may precipitate a hemorrhagic rash, acute kwashiorkor, and blindness. Subacute sclerosing panencephalitis occurs several years after the infection in about 4-11 per 100,000 cases. Adults may have hepatitis, hypocalcemia, and elevated creatinine phosphokinase levels. [CCDM, p. 389-90] The incidence of acute encephalitis is 1 in 1000-2000 cases of measles. Pneumonia is common. [PPID, p. 1970] Subacute sclerosing panencephalitis is a complication months to years after the initial infection. Risk factors are not known. Symptoms include progressive mental impairment, seizures, coma, and death. [Cohen, p. 1522] Transient hepatitis may occur during the acute phase. Encephalitis may present with seizures. Features of atypical measles may include abdominal pain, pneumonia, hilar adenopathy, and a rash that is vesicular, urticarial or purpuric. Severe bleeding may accompany acute thrombocytopenic purpura. [Merck Manual, p. 1459] At risk for severe measles: patients with AIDS, immune suppression, cancer, or vitamin A deficiency; [ABX Guide] Case mortality rates range from <1% (developed countries), to 5-10% (sub-Saharan Africa), to 20-30% (refugee camps). [Harrison ID, p. 1013] PREVENTION: Health care personnel (HCP) are immune if they have received 2 doses of measles vaccine or have antibodies to measles virus. [Harrison ID, p. 1010] "Persons infected with measles are infectious 4 days before rash onset through 4 days after rash onset. . . . When a person who is suspected of having measles visits a health-care facility, airborne infection-control precautions should be followed stringently. . . . If possible, only staff with presumptive evidence of immunity should enter the room of a person with suspect or confirmed measles. . . . Because of the possibility, albeit low (~1%), of measles vaccine failure in HCP exposed to infected patients, all HCP should observe airborne precautions in caring for patients with measles. . . . Case-patient contacts who do not have presumptive evidence of measles immunity should be vaccinated, offered intramuscular immune globulin of 0.25 mL/kg (40 mg IgG/kg), which is the standard dosage for nonimmunocompromised persons, or quarantined until 21 days after their exposure to the case-patient. . . . Available data suggest that live virus measles vaccine, if administered within 72 hours of measles exposure, will prevent, or modify disease. [ACIP, 2011] Immune globulin can be effective if given to household contacts within 6 days of exposure. [Cecil, p. 2107]

Latency/Incubation

Fever: 7 days to 2 weeks; Koplic's spots: 2-4 days after fever onset; Rash: 3-5 days after fever onset; [Merck Manual, p. 1458]

Diagnostic

Clinical; IgM antibodies (Confirm with culture or RT-PCR in low incidence area.); Paired sera; Detection of antigen in nasal wash by FA; Culture; RT-PCR to detect in urine, blood, or nasal mucous; [CCDM]

ICD-9 Code

055

Available Vaccine

Yes

Reference Link

CDC - Measles

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