- Clinical science
Measles (Rubeola) is a highly infectious disease that is caused by a paramyxovirus. There are two phases of disease: a catarrhal (prodromal) stage and an exanthem stage. The catarrhal stage is characterized by a fever with conjunctivitis, coryza, cough, and pathognomonic Koplik spots on the buccal mucosa. The sudden development of a high fever, malaise, and exanthem represents the next phase. The exanthem stage is typically characterized by an erythematous maculopapular rash that originates behind the ears and spreads to the rest of the body towards the feet. Infection is usually self-limiting and followed by lifelong immunity. Disease management includes vitamin A supplementation, symptomatic treatment, and possible post-exposure prophylaxis (PEP). Measles causes transient immunosuppression and may lead to serious complications such as encephalitis, otitis, or pneumonia. A rare but lethal late complication of measles is subacute sclerosing panencephalitis (SSPE), which may also affect immunocompetent individuals. Vaccination against measles (active immunization) is administered in association with the mumps and rubella (MMR) vaccine; the first dose is recommended between the ages of 12–15 months and the second dose between 4–6 years of age or at least 28 days after the first dose. The prognosis is good in uncomplicated cases; newborns and immunocompromised patients are more likely to suffer from severe complications.
- Distribution: Measles typically occurs in regions with low vaccination rates and in developing countries.
- Peak incidence: < 12 months of age
- Infectivity: ∼ 90%; highly contagious 5 days before and up to 4 days after the onset of exanthem.
Epidemiological data refers to the US, unless otherwise specified.
- Duration: ∼ 2 weeks after infection
Prodromal stage (catarrhal stage)
- Duration: lasts ∼ 4–7 days
- Duration: appears 1–2 days after enanthem and lasts ∼ 7 days
- High fever, malaise
- Generalized lymphadenopathy
Erythematous maculopapular, blanching, partially confluent exanthem
- Usually begin in the face, frequently behind the ears along the hairline
- Disseminates to the rest of the body towards the feet (palm and sole involvement is rare)
- Mild pruritus is possible
- The rash begins to fade after ∼ 5 days of onset; leaving a brown discoloration and desquamation in severely affected areas
- The cough; may persist for another week and it may be the last remaining symptom.
Measles should be suspected in a patient with typical clinical findings. Laboratory tests are always necessary to confirm the diagnosis.
- CBC: ↓ leukocytes, ↓ platelets
Identification of pathogen
- Direct virus detection via reverse-transcriptase polymerase chain reaction (RT-PCR) possible
- Viral culture
|Differential diagnoses of pediatric rashes||a||erythema infectiosum) (||exanthem subitum) (|| |
|Exanthem|| || || || |
|Other features|| |
As with all rashes, always consider drug reactions!
The differential diagnoses listed here are not exhaustive.
- Bacterial superinfection: otitis media, pneumonia, laryngotracheitis
- (Viral) giant-cell pneumonia
Acute encephalitis, often with permanent neurological deficits
- Frequency: ∼ 1:1000
- Develops within days of infection
- Acute disseminated encephalomyelitis may develop within weeks
Subacute sclerosing panencephalitis (SSPE): a lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection
Epidemiology: very rare
- Primarily affects males between 8 and 11 years old
- Usually develops at least 7 years after measles
- Three clinical stages
- Epidemiology: very rare
We list the most important complications. The selection is not exhaustive.
- Vaccine: : live, attenuated virus; in combination with the mumps and rubella (MMR) vaccine and possibly varicella (MMRV) vaccine
- Two vaccinations during childhood → see
- In adults born after 1957 with unknown immunization or incomplete status
- Indication: In negative or indeterminate serology
Active immunization ;:
- Immunocompetent patients after direct exposure
- Vulnerable, chronically ill, and immunocompromised patients
Further measures for individuals with contact
- Persons with close contact to infected individuals should avoid communal facilities.
- Not required for: immunization, postexposure prophylaxis, or following prior infection
Measles is a notifiable disease. Cases should be reported within 24 hours to the CDC or National Center for Immunization and Respiratory Diseases (NCIRD).