Measles

A highly contagious acute viral infection caused by Morbillivirus(of Paramyxoviridae family).

Background

  • Spread is airborn (coughing/sneezing), close personal contact or direct contact with nasal/throat secretions.  The incubation period is around 10 days/
  • It is now a notifiable disease and quite rare after the introduction of the MMR vaccine (<600 cases in England and Wales)

Presentation

  • Prodromal phase (fever, malaise, anorexia) may be present for several days before cutaneous symptoms appear
    • Conjuntivitis, cough and coryza (classic triad- at least one is usually present)
  • Koplick spots
    • also appear 1-2 days before the rash
    • blue/grey specks on red base in the buccal mucosa in the mouth
    • koplik
  • Morbilliform (Measle-like) Rash
    • Appears on the face/shoulders first before extending down the trunk and finally on the palms and soles last
    • Erythematous, maculopapular and may peel.  It usually fades to a pinky/brown colour and can remain for up to a week

Investigations

  • Although generally a clinical diagnosis, lab confirmation is required for public health
  • Salivary swab/serum sample for measles-specific IgM taken within 6 weeks of onset.

Management

  • Most cases just require supportive care (bed rest, high fluid intake etc)
  • Make sure to notify health protection (public health)- they will usually contact all contacts to offer post-exposure vaccination and/or prophylaxis (human normal IgG) where necessary (e.g. immunocomprimised individuals).

Complications

  • Respiratory superinfection can occur in children/immunocomprimised individuals
    • Usually staph aureus or herpes simplex or adenovirus (Bronchopneumonia) and Strep pneumoniae (lobar pneumonia)
    • Giant cell pneumonitis can also occur
  • Otitis media infection
  • Hepatitis
  • Neurological
    • Acute demyelinating encephalitis (1 in 1000)
      • children are most commonly affected, particularly if infected very young
  • In pregnancy, measles can cause miscarriage, prematurity, low birth weight

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