Makindo Medical Notes

Related Subjects: |Herpes Varicella-Zoster (Shingles) Infection |Chickenpox Varicella Infection |Varicella Cerebral Vasculopathy |Herpes Viruses |Herpes Zoster Ophthalmicus (HZO) Shingles |MonkeyPox |Mumps |Measles |Rubella (German Measles) |Epstein-Barr Virus infection

Look for Koplik's spots which are like a grain of salt on a red background. They are pathognomonic. The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 per cent are common. In immunocompromised patients, the fatality rate is approximately 30 per cent

About

• Epidemics usually on a 2-3 year cycle.
• It has an incubation period of about 8-14 days.
• Vaccination maintaining herd immunity is key

Virology

• Measles is caused by RNA paramyxovirus.
• Highly infectious spread by aerosol.
• Neonates (up to 6/12) are protected by maternal immunoglobulins

Mortality rates

• Mortality in developing countries and immunocompromised can be as high as 25%
• Mortality rates in developed countries of 0.1%

Epidemiology

• It is a notifiable disease
• One attack gives life long immunity

Measles Rash

Koplik Spots in Oral cavity

Clinical

• Fever for at least three days and four "K"s cough, coryza, conjunctivitis, Kopliks spots
• Diagnostic Koplik's spots on the inner buccal mucosa with white centre and surrounding erythema
• Generalised macular papular rash which starts on face. Blotchy red rash
• The rash spreads to the rest of the body. Becomes brownish and blanches on pressure.
• General lymphadenopathy, Convulsions may be seen
• Patients remain infectious until 5 days after the rash appears

Complications

• Diarrhoeal illness, Rash (can be absent if immunocompromised)
• Bacterial Pneumonia in 5% (Giant cell pneumonitis in immunocompromised)
• Encephalitis 1 in 1000 normally
• Measles inclusion body encephalitis seen in immunocompromised - myoclonus, seizures
• Subacute sclerosing panencephalitis which is usually delayed up to 7 years 1 case per 100,000. Personality change, myoclonus, vegetative state
• Corneal ulceration leading to corneal scarring
• Otitis media, Myocarditis, Pericarditis
• Complications are usually more severe amongst adults who catch the virus
• Malnourished - cancrum oris, diarrhoea, pneumonia can be fatal
• Acute disseminated encephalomyelitis

More severe illness

• Pregnant - pneumonitis and hepatitis
• Vitamin A deficiency, Malnourished, Elderly
• Neonates (once maternal Ig cover has gone)

Investigations

• Fourfold rise in acute and paired sera for anti-measles IgM and IgG
• Serum or saliva Anti measles IgM or IgG

Prevention

• Prevention with 100% take up of MMR which contains live attenuated form
• Given to children at 13 months
• Human IG may be given post exposure to those without immunity

Management

• ABCDE and IV fluids
• Antibiotic treatment if there is real evidence of secondary bacterial infection.
• Secondary bacterial infection is very significant in increasing mortality.
• The disease gets more severe and more prolonged with age
• Consider post-exposure prophylaxis with human IgG or MMR in high-risk groups - take advice

Measles rash images

Koplik spots images