Measles
Definition
A virus infection of the children caused by measles virus - RNA virus of the genus Morbillivirus: family Paramyxoviridae
Mode of Spread
by coughing and sneezing
Close personal contact / direct contact with secretions
Risk Factors
Immunodeficiency following HIV/AIDS
Immunosuppression following receipt of an organ/stem cell transplant, alkylating agents/steroid therapy/travel to an endemic area
Clinical Features
Four day fever
One of the three Cs : cough, coryza, conjunctivitis along with fever and rashes
Fever lasts for about one week
40°C / 104°F
Koplik's spots inside the mouth - pathognomonic
generalized red maculopapular rash that begins several days after the fever starts - lasts for 8 days
Itching +
resolves after 3 weeks
Complications
Diarrhoea
Pneumonia
Bronchitis
otitis media
Encephalitis
Corneal ulceration
Lab Investigations
Measles IgM antibodies
Isolation of measles virus RNA from respiratory specimens / saliva
Prevention
Immunization at 12 months of age - as part of a three part MMR vaccine (measles, mumps and rubella)
Treatment
No specific treatment
Only supportive treatment
Patients who become sicker may be developing medical complications. Some people will develop pneumonia as a consequence of infection with the measles virus. Other complications include ear infections, bronchitis (either viral bronchitis or secondary bacterial bronchitis), and brain inflammation. Brain inflammation from measles has a mortality rate of 15%. While there is no specific treatment for brain inflammation from measles, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen or paracetamol to reduce fever and pain and, if required, a fast-acting medication to dilate the airways for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye syndrome. Some research has shown aspirin may not be the only medication associated with Reye, and even antiemetics have been implicated. The link between aspirin use in children and Reye syndrome development is weak at best, if not actually nonexistent. Nevertheless, most health authorities still caution against the use of aspirin for any fevers in children under 16.
The use of vitamin A during treatment is recommended by the World Health Organization to decrease the risk of blindness. A systematic review of trials into its use found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years.
It is unclear if zinc supplementation in children with measles affects outcomes.
Prognosis
The majority of people survive measles, though in some cases, complications may occur. Possible consequences of measles virus infection include bronchitis, sensorineural hearing loss, and—in about 1 in 10,000 to 1 in 300,000 cases—panencephalitis, which is usually fatal. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles rash and begins with very high fever, severe headache, convulsions and altered mentation. A person with measles encephalitis may become comatose, and death or brain injury may occur.
