Measles: Difference between revisions
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**Usually starts on the face (hairline and behind the ears) | **Usually starts on the face (hairline and behind the ears) | ||
**Rapidly spreads to the chest, back, and finally the legs and feet | **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 | *Obtain a history of measles immunization, contact with known outbreak, travel outside of the Americas, or contact with international travelers in recent weeks | ||
Revision as of 17:48, 18 February 2015
Background
- Also known as Rubeola, which is not to be confused with German Measles (Rubella)
- 10d incubation period
- 3d prodromal period
- Patients are contagious from about 4 days before to 4 days after onset of rash
Current Outbreaks
- 2015
- Large scale outbreak linked to DisneyLand, CA: children through teenagers affected, 70 known cases
Clinical Features
- Consider measles in a patient of any age who has an acute RASH and FEVER
- Typically begins with a prodrome of high fever, cough, coryza, and conjunctivitis
- 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)
Work Up
- Usually you need (check with your lab):
- Blood: 5-10 mL for measles IgG and IgM
- Use a red-top tube and spin down serum if possible
- Swabs: nasopharyngeal (or throat) for culture and PCR
- Use a viral culturette with viral transport media
- Urine: 50-100 mL of urine for PCR
- Use a sterile container
- Blood: 5-10 mL for measles IgG and IgM
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:
- Within 72 hours of exposure use MMR vaccine
- Immunocompromised, children <12 months, and others at high risk of complications:
- Consider checking with your local health authorities
- Up to 6 days after exposure use IM immune globulin
Complications
- Severe illness can include pneumonia, encephalitis, and death
See Also
Source
- 2/3/15 VEP HEALTH ADVISORY by Rob Wyman, MD