MEASLES

(RUBEOLA)
Measles (rubeola) is caused by a single-
stranded RNA paramyxovirus with one
antigenic type.

Humans are the only natural host.

Measles virus infects the upper respiratory

tract and regional lymph nodes and is spread
systemically during a brief, low-titer primary
viremia.

A secondary viremia occurs within 5 to 7 days

when virus-infected monocytes spread the
virus to the respiratory tract, skin, and other
organs.
 Clinical Manifestations
Measles infection is divided into 4
phases:
incubation,
prodromal (catarrhal),
exanthematous (rash),
recovery.

The incubation period is

8 to 12 days (exposure - onset of symptoms)
14 days (exposure - onset of rash)
 .Clinical
Manifestations

The manifestations of prodromal period :

cough, coryza, conjunctivitis, and
Koplik spots
Stimson line

The rash phase often is accompanied by high

fever (40C to 40.5C ).
The macular rash begins on the head (often above the
hairline) and spreads over most of the body in 24 hours
in a descending fashion.
The severity of the illness is related to the extent of the
rash.
It may be petechial or hemorrhagic (black measles).
 .Clinical
Manifestations

Cervical lymphadenitis,
splenomegaly, and mesenteric
lymphadenopathy with
abdominal pain may be noted.

Otitis media, pneumonia, and

diarrhea are more common in
infants
 Laboratory Studies
Routine laboratory findings are
nonspecific and do not aid in diagnosis.
Leukopenia is characteristic.

Measles virus can be cultivated in

human or monkey cells, but culture is
not generally available.

Serologic testing for IgM antibodies is

used to confirm the clinical diagnosis.
 DIFFERENTIAL DIAGNOSIS

The rash must be differentiated from

rubella, roseola, enteroviral or adenoviral infection,
infectious mononucleosis, toxoplasmosis,
meningococcemia, scarlet fever, rickettsial disease,
Kawasaki syndrome, serum sickness, and drug rash.

The constellation of fever, rash, cough, and

conjunctivitis is diagnostic for measles.
Koplik spots are pathognomonic, but are not
always present at the time the rash is most
pronounced
 Treatment
There is no specific therapy for measles.
Routine supportive care includes
maintaining adequate hydration and
antipyretics.
Photophobia is intensified by strong light,
which should be avoided.
High-dose vitamin A supplementation
improves the outcome.
 Complications
Measles is often complicated by otitis
media.
Measles virus may cause
interstitial pneumonia
Myocarditis and mesenteric lymphadenitis
Encephalomyelitis
Subacute sclerosing panencephalitis
 Prognosis
Deaths most frequently result from
bronchopneumonia or encephalitis,
with much higher risk among persons
with underlying malignancy or HIV
infection.
 Prevention
Live measles vaccine prevents
infection and is recommended.