Measles Flashcards
What is the cause of measles
Caused by Paramyxovirus (spherical RNA)
Transmitted airborne via droplets
Infects epithelial cells of the nose and conjunctivae
Person is infectious from when symptoms first appear (4 days before the rash)
Infects nearly all susceptible people who come into contact with it
Once infected, the person develops lifelong
What are the symptoms of measles
10-12 day prodromal phase (cough, fever, malaise, rhinorrhoea, conjunctivitis), followed by a maculopapular rash
Cough
Coryzal symptoms
Conjunctivitis (painful, irritated, red eye)
Fever >39
Rash: erythematous, maculopapular, face and behind the ears → descends, may become confluent
What are the differentials for measles
Parvovirus B19
Streptococcal infection
Roseola infantum
Rubella
Meningococcal disease
Kawasaki disease
Infectious mononucleosis
What are the signs of measles on examination
Basic obs: Fever, HR, RR
ENT:
Koplik’s spots (Found on the buccal mucosa at the end of the prodromal phase/beginning of rash): Consists of 2-3mm red spots with white or blue-white centres
Dermatology
Rash: Erythematous and maculopapular, discrete, becoming blotchy and confluent
What are the investigations for measles
Bedside:
- throat/nasopharyngeal swabs for PCR: positive for measles
- Urine sample: positive for measles RNA
Bloods: ELISA IgM and IgG serology: identifies measles IgM
What is the management for measles
- NOTIFY local health protective team (HPT)
- Supportive
- Self-limiting (1 week), will cause unpleasant symptoms
- Rest, drink, adequate fluids
- Paracetamol and ibuprofen - Isolation: 4 days after the initial development of the rash and avoid contact with susceptible people
- safety net: SOB, uncontrolled fever, convulsions
Eye disease present: vitamin A supplementation
What are the complications of measles
Increased susceptibility to opportunistic infection for several weeks post-recovery e.g. otitis media, pneumonitis, tracheobronchitis, pneumonia
CNS complications: Convulsions, Encephalitis, Blindness, Subacute sclerosing panencephalitis (SSPE)
Diarrhoea → dehydration
Pregnancy: Miscarriage, Premature birth, IUD, Stillbirth
Describe subacute sclerosing panencephalitis (SSPE)
Rare but serious degenerative disease of the CNS
Seizures and decline in motor, cognitive, behavioural function
Common in those who contract measles <1yo
What is the prognosis for measles
Most people with measles make a full recovery with symptomatic management after around seven days of symptoms
Death from measles is rare in developed countries, but is much higher in non-developed (90,000 measles deaths worldwide in 2016)