Measles: Case

Study
Hiro Landazuri
Karla Gonzalez
Jonathan Chen
 Case

• An 18 yr old freshman complained of a

cough, runny nose, and conjunctivitis. The
physician in the campus health center
noticed small white lesions inside the
patient’s mouth. The next day, a confluent
red rash covered his face and neck.
 Overview

• Rubeola
• Paramyxovirus -
Morbillivirus
• Negative-sense
ssRNA
• F (fusion) protein/H
(hemoagglutanin)
protein

http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm
 Overview
• Systemic infection
– Respiratory transmission
– Primary site of infection =
nasopharynx
• Primary viremia (2-3 days
post exposure)
• Secondary viremia (5-7 days
post exposure)

http://www.homehealth-uk.com/image_01/image/throatdiagram.gif
 Physical Diagnosis

• The 3 C’s
– Cough, coryza,
conjunctivitis
• Koplik’s spots
• MV rash
– Maculopapular
• Macule – red lesion
flushing
• Papule – raised red lesion

dermatlas.med.jhmi.edu
 Conjunctivitis
Koplik’s Spots

http://en.wikipedia.org/wiki/Conjunctivitis

MV rash

http://www.cdc.gov/vaccines/vpd-
vac/measles/photos.htm
 Laboratory Diagnosis
• Isolation of MV from clinical specimen
• Serodiagnosis
– IgM ab (ELISA)
– IgG ab
• ELISA, HI, Indirect flourescent ab test,
microneutralization, plaque reduction
neutralization, complement fixation
Complement Fixation Assay
Positive Negative

http://web.indstate.edu/thcme/PSP/labtests/complementfix.htm
 Treatment
• No treatment
• Supportive Care Only
– Tylenol, Non-steroidal anti-inflammatory drugs
like Advil, Aspirin, Motrin etc.
– Isolation
– Vitamin K
– Hydration
– Post-exposure Prophylaxis
• Antibiotics for serious complications (rare)
Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).
When was this patient contagious?

• Course of the infection

– Incubation 7-14 days
– Initial symptoms immediately following incubation:
cough, coryza, conjunctivitis, fever
– Koplik’s spots 2-3 days after initial symptoms
– Rash appears 4-5 days after the initial symptoms
• Infection communicable four days before his
rash appeared to four days after
MayoClinic.com Tools for Healthier Lives, Measles, http://www.mayoclinic.com/print/measles/DS00331/DSECTION=all&METHOD=print (Oct. 29,
2007).

Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).
Why is this disease not common in the
United States?

• the United States is a developed country

– most children are immunized with MMR (Measles Mumps
Rubella) vaccination
– required proof of MMR immunization
• the Measles Initiative is working on standard global
immunization for measles
 Several possible reasons for patient’s
susceptibility to measles at 18 years of age.
• if the patient did not receive MMR vaccinations
– allergic reaction to component of MMR
• recent studies have shown no direct correlation
– poor healthcare
• undeveloped countries without required MMR
– linking of MMR and autism
• studies lacked substantial scientific evidence
• if patient did receive MMR vaccinations
– may not have developed immunity
• either way, patient was susceptible to measles and was
exposed via
– traveling
– dorms/college campus