Publish date: Posted on
Last updated: February 17, 2024
Keywords #
measles
rubeola
subacute sclerosing panencephalitis
MMR
Diagnosis #
Measles is a highly contagious, airborne, vaccine-preventable illness caused by infection with the measles virus. Infection is characterized by a macular or maculopapular exanthem which spreads cephalocaudally with associated fever, cough, coryza, Koplik spots (white macules on buccal mucosa), and conjunctivitis, though these associated features may not always be present. [1] Exanthem typically resolves within 1 week of onset, though patients are at risk for several possible complications and remain contagious for several days after resolution.
Key Concepts #
- Measles is a leading cause of vaccine preventable illness worldwide. [2]
- In addition to rash and fever, measles is classically presents with the “3C’s”: cough, coryza, conjunctivitis.
- Infants, pregnant women, and immunocompromised people are at increased risk for complications. [1]
Epidemiology #
While vaccination against measles virus is widely available in the form of the MMR vaccine and the virus was eliminated from the United States in 2000, the virus was reintroduced into the population recently and continues to spread through unvaccinated groups within the US.[3] Worldwide, measles causes over 100,000 deaths annually.[2] If an unvaccinated person is exposed to measles virus, there is a 90% chance they will become infected. [3 ]Infected persons are contagious four days prior to the onset of rash and four days after resolution. [4]
Clinical Features #
- On the fourth febrile day, erythematous macules and papules appear and spread cephalocaudally. Lesions may initially be distinct and become confluent over the course of several days. Exanthem typically fades within 4-6 days of onset. [1]
- Associated symptoms include cough, coryza, conjunctivitis, Koplik spots, and fever.
- Complications most commonly occur in infants, pregnant women, and immunocompromised persons and most frequently include pneumonia, otitis media, diarrhea, keratoconjunctivitis (which may lead to blindness).
- Acute disseminated encephalomyelitis presents in approximately 1 in 1000 infections within days to weeks. Approximately 1 in 10000 infections will result in subacute sclerosing panencephalitis (SSPE) years after infection. [1]
- In pregnant women, infection with measles virus may result in intrauterine fetal demise. [1]
Differential Diagnoses #
- Rubella
- Roseola Infantum
- Erythema infectiosum
- Drug eruptions
Diagnostic Workup #
Measles is a reportable disease, and a clinician must report suspected cases to their local health department within 24 hours. In a patient with suspected measles, a blood sample should be collected for measurement of IgM antibodies, a nasopharyngeal swab should be collected for viral culture, and a urine sample should be collected for viral culture. It is important to note that within 4 days of the onset of rash, IgM antibody testing is subject to a high rate of false negatives. [1] Other diagnostic testing options include IgG antibody titers and RT-PCR for viral RNA. There is ongoing research for development of point-of-care testing for measles.[1]
Treatment #
Patients with suspected measles should be isolated from others and educated that the infection is highly contagious. Supportive therapy is sufficient for most patients and clinicians should monitor for the potential complications discussed above. Vitamin A administration has been associated with reduced mortality in young children. [1] Nonspecific antiviral therapies may be used for severe cases.
High risk for complication, non-immune close contacts should be offered immunoglobulin as post-exposure prophylaxis. Those who are unvaccinated or partially vaccinated, 1 year or older, and not otherwise high risk should be offered vaccination as post-exposure prophylaxis.[4]
Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/References #
- Moss, W. J. (2017). Measles.The Lancet,390(10111), 2490-2502.
- Dabbagh, A., PhD., Laws, R. L., PhD., Steulet, C., Dumolard, L., PhD., Mulders, M. N., PhD., Kretsinger, K., M.D., . . . Goodson, J. L., M.P.H. (2018).Progress toward regional measles elimination -worldwide, 2000–2017.(). Atlanta: U.S. Center for Disease Control.
- Paules, C. I., Marston, H. D., & Fauci, A. S. (2019). Measles in 2019 —going backward.The New England Journal of Medicine,380(23), 2185-2187.
- Cockbain, B. C., Bharucha, T., Irish, D., & Jacobs, M. (2017). Measles in older children and adults.BMJ : British Medical Journal (Online),356.
