Measles

Summary

Measles is a paramyxovirus that can present with a variety of symptoms. Prodromal symptoms include the 4 C’s of measles - a cough, coryza, conjunctivitis, and Koplik Spots, which are blue-grey spots visible on the oral mucosa. Measles is transmitted via respiratory droplets or contact and is highly contagious. A few days after onset, patients usually experience a downward-spreading maculopapular rash. In some rare cases, patients experience acute encephalitis. Late stage complications include the feared SSPE or Subacute Sclerosing Panencephalitis, which is usually fatal To treat a severe measles infection, vitamin A supplements are used and have been proven to reduce morbidity and mortality in malnourished children. Finally, prophylaxis for measles include the live-attenuated MMR vaccine, which is administered in children between 12-15 months of age.

Key Points

• Measles virus
  • Transmission
    • Respiratory droplets or contact
    • Highly contagious
  • Presentation: Measles
    • Prodromal fever with cough, coryza (runny nose), conjunctivitis
      • 4 Cs of measles: cough, coryza, conjunctivitis, “Coplik” spots
    • Koplik spots
      • Bright red spots with blue white center on buccal mucosa
    • Followed 1-2 days later by maculopapular rash
      • Starts at head/neck and spreads downwards
    • Possible sequelae
      • SSPE (subacute sclerosing panencephalitis)
        • Occurs years after initial infection and apparent recovery
        • personality changes, dementia, autonomic dysfunction, death
        • High titers of measles antibodies in serum and CSF
      • Acute Encephalitis (1:1000)
        • Symptoms occur within a few days of rash
      • Acute Cerebellitis (post-viral cerebellar ataxia)
        • Occurs 2-3 weeks after infection with cerebellar symptoms (ataxia, nystagmus)
      • Giant cell pneumonia
        • rare except in immunosuppressed
      • Pneumonia
        • Most common cause of measles-associated death in kids
  • Diagnosis
    • Biopsy of lymph nodes shows Warthin-Finkeldey giant cells (fused lymphocytes) in background of paracortical hyperplasia
    • Acute rise in anti-measles IgM, IgG, or RT-PCR used to confirm diagnosis
  • Treatment
    • Vitamin A → reduces morbidity and mortality, esp. In malnourished children
  • Prophylaxis
    • MMR (Measles, Mumps, Rubella) vaccine - live attenuated
      • Administered at 12-15 months of age