Measles

Question 1

What is the cause of measles

Answer 1

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

Question 2

What are the symptoms of measles

Answer 2

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

Question 3

What are the differentials for measles

Answer 3

Parvovirus B19
Streptococcal infection
Roseola infantum
Rubella
Meningococcal disease
Kawasaki disease
Infectious mononucleosis

Question 4

What are the signs of measles on examination

Answer 4

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

Question 5

What are the investigations for measles

Answer 5

Bedside:
- throat/nasopharyngeal swabs for PCR: positive for measles
- Urine sample: positive for measles RNA

Bloods: ELISA IgM and IgG serology: identifies measles IgM

Question 6

What is the management for measles

Answer 6

1. NOTIFY local health protective team (HPT)
2. Supportive
   - Self-limiting (1 week), will cause unpleasant symptoms
   - Rest, drink, adequate fluids
   - Paracetamol and ibuprofen
3. Isolation: 4 days after the initial development of the rash and avoid contact with susceptible people
4. safety net: SOB, uncontrolled fever, convulsions

Eye disease present: vitamin A supplementation

Question 7

What are the complications of measles

Answer 7

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

Question 8

Describe subacute sclerosing panencephalitis (SSPE)

Answer 8

Rare but serious degenerative disease of the CNS
Seizures and decline in motor, cognitive, behavioural function
Common in those who contract measles <1yo

Question 9

What is the prognosis for measles

Answer 9

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)