Measles

Question 1

Definition

Answer 1

Paramyxovirus, spread through respiratory secretions

• One of the most highly communicable diseases (>15 mins in direct contact is enough to transmit)
• Incubation = 7-18-days
• Infective period = 4 days before and 4 days after rash

Question 2

Signs and symptoms

Answer 2

Prodrome (2-4 days):
1. high fever (febrile convulsions)
2. malaise/ irritability
3. Conjunctivitis/coryza

o Maculopapular rash (face/neck -> hands/feet)

o Koplik spots (small white spots surrounded by red ring in mouth)

o Cough

o No lymphadenopathy

Question 3

Investigations

Answer 3

1st line = Measles antibodies (IgM and IgG) from Oral Fluid Test – OFT

2nd line = PCR of blood or saliva

Question 4

Management

Answer 4

Notify HPU, isolate for 4 days after development of rash

Rest and supportive treatment (fluids, antipyretics, rest)
* Children isolated in hospital

Immunise close contacts and encourage vaccination after acute episode
* Vitamin A is given in developping countries because due to deficiency measles follows a protracted course with severe complications

Safety net the complications:

Encephalitis (1 in 5,000) – after 1-2w:
* Headaches, lethargy
* Irritability -> seizures
* Coma = 15% death

SSPE (1 in 100,000) after 7 years
* Sub-acute Sclerosing Panencephalitis
* Measles dormant in the CNS
* S/S: dementia and death

Otitis media (most common complication)

Pneumonia (most common cause of death)

Keratoconjunctivitis

Question 5

Complications

Answer 5

Otitis media- MOST COMMON complication

Pneumonia- commonest cause of death

Encephalitis- occurs 1-2 weeks following onset of illness

Subacute sclerosing panencephalitis- VERY RARE à occurs 5-10 years after illness

Causes progressive brain damage and is fatal

Febrile convulsions

Keratoconjunctivitis, corneal ulceration

Diarrhoea

Increased incidence of appendicitis

Myocarditis

Corneal ulceration