Measles

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

Koplik's Spots on Cheek

Koplik's Spots on Palate

Measle's Rash on Face

Measle's Rash on on Thorax

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)

Oral rashes and lesions

• Angioedema
• Aphthous stomatitis
• Herpes gingivostomatitis
• Herpes labialis
• Measles (Koplik's spots)
• Perioral dermatitis
• Oral thrush
• Steven Johnson syndrome
• Streptococcal pharyngitis
• Tongue diagnoses
• Vincent's angina

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

See Also

• Pediatric Rashes