Measles: Difference between revisions
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==Background== | ==Background== | ||
*Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]]) | *Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]]) | ||
*Patients are contagious from about 4 days before to 4 days after onset of rash | *Patients are contagious from about 4 days before to 4 days after onset of rash | ||
[[File:Koplik's Spots on Cheek.jpg|thumb|Koplik's Spots on Cheek]] | [[File:Koplik's Spots on Cheek.jpg|thumb|Koplik's Spots on Cheek]] | ||
[[File:Koplik's Spots on Palate.jpg|thumb|Koplik's Spots on Palate]] | [[File:Koplik's Spots on Palate.jpg|thumb|Koplik's Spots on Palate]] | ||
[[File:Measle's Rash on Face.jpg|thumb|Measle's Rash on Face]] | [[File:Measle's Rash on Face.jpg|thumb|Measle's Rash on Face]] | ||
[[File:Measle's Rash on on Thorax.jpg|thumb|Measle's Rash on on Thorax]] | [[File:Measle's Rash on on Thorax.jpg|thumb|Measle's Rash on on Thorax]] | ||
==Clinical Features== | |||
*Consider measles in a patient of any age who has an acute RASH and FEVER | *Consider measles in a patient of any age who has an acute RASH and FEVER | ||
* | *Incubation period - 10 days | ||
*Koplik's spots (appears day 2-3) | *Prodrome of high [[fever]], cough, coryza, and [[conjunctivitis]] (lasts ~3 days) | ||
*Koplik's spots (appears day 2-3) - pathognomonic enanthem | |||
**Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate | **Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate | ||
*Rash (begins day 4 - lasts to day 7) | *Rash (begins day 4 - lasts to day 7) | ||
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{{Peds Rash DDX}} | {{Peds Rash DDX}} | ||
== | ==Diagnostic Evaluation== | ||
* | *Measles IgG and IgM | ||
*Culture and PCR of nasopharyngeal swab | |||
* | *Urine PCR | ||
==Management== | ==Management== | ||
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===[[Isolation precautions|Isolation Precautions]]=== | ===[[Isolation precautions|Isolation Precautions]]=== | ||
*For suspected patients | *For suspected patients | ||
** | **Mask the patient and isolate immediately in an airborne infection isolation room | ||
**All personnel entering the room should use respiratory protection at least as effective as an N95 respirator | **All personnel entering the room should use respiratory protection at least as effective as an N95 respirator | ||
**If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room | **If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room | ||
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===Post-Exposure Prophylaxis (Non-Immune Contact)=== | ===Post-Exposure Prophylaxis (Non-Immune Contact)=== | ||
*Immunocompetent: | *Immunocompetent: | ||
** | **MMR Vaccine (within 72 hours of exposure) | ||
*Immunocompromised, children <12 months, and others at high risk of complications: | *Immunocompromised, children <12 months, and others at high risk of complications: | ||
**IM Immune globulin (up to 6 days after exposure) | |||
**Consider checking with your local health authorities | **Consider checking with your local health authorities | ||
==Complications== | ==Complications== | ||
*Severe illness can | *Severe illness can cause [[pneumonia]], [[encephalitis]], and death | ||
==See Also== | ==See Also== | ||
*[[Pediatric Rashes]] | *[[Pediatric Rashes]] | ||
== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Derm]] | [[Category:Derm]] | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 08:09, 7 September 2015
Background
- Also known as Rubeola, which is not to be confused with German Measles (Rubella)
- Patients are contagious from about 4 days before to 4 days after onset of rash
Clinical Features
- Consider measles in a patient of any age who has an acute RASH and FEVER
- Incubation period - 10 days
- Prodrome of high fever, cough, coryza, and conjunctivitis (lasts ~3 days)
- Koplik's spots (appears day 2-3) - pathognomonic enanthem
- Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
- Rash (begins day 4 - lasts to day 7)
- Red, blotchy, and maculopapular; rapidly progresses to confluence
- Usually starts on the face (hairline and behind the ears)
- Rapidly spreads to the chest, back, and finally the legs and feet
- Rash resolves in order of appearance between days 7-9
- Obtain a history of measles immunization, contact with known outbreak, travel outside of the Americas, or contact with international travelers in recent weeks
Differential Diagnosis
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Diagnostic Evaluation
- Measles IgG and IgM
- Culture and PCR of nasopharyngeal swab
- Urine PCR
Management
- Alert local health department ASAP
- The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately
Isolation Precautions
- For suspected patients
- Mask the patient and isolate immediately in an airborne infection isolation room
- All personnel entering the room should use respiratory protection at least as effective as an N95 respirator
- If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room
- Do not use the room for at least 2 hours after the patient leaves.
Post-Exposure Prophylaxis (Non-Immune Contact)
- Immunocompetent:
- MMR Vaccine (within 72 hours of exposure)
- Immunocompromised, children <12 months, and others at high risk of complications:
- IM Immune globulin (up to 6 days after exposure)
- Consider checking with your local health authorities
Complications
- Severe illness can cause pneumonia, encephalitis, and death