MEASLES: BACK FROM THE DEAD
As most of you might be unaware, a state of emergency has been declared in certain counties in the US after more than 30 cases of measles have been reported in the state of Washington.
Lets take this opportunity to learn more about measles, how to identify them, when to seek medical attention and how to prevent it from spreading.
DEFINITION
Measles is a highly communicable viral illness, characterized by a redish maculopapular rash that begins in the head and neck area and spreads towards the chest and trunk and then to the extremities. It maybe associated with cough, conjunctivitis and whitish spots in the oral cavity called Koplik spots.
Classic Triad: cough, coryza and conjunctivitis (3Cs)
ETIOLOGY
Morbillivirus (single stranded, negative sense RNA virus)
RISK FACTORS
– Lack of vaccination
– Contact with infected individuals
– Immunodeficiency
– Pregnancy
– Malnutrition
– Vitamin A deficiency
CLINICAL FEATURES
1. Fever may start 2-3 days prior to the rash, some cases may go upto 8 days
2. Maybe associated with cough, coryza (inflammation of the nasal mucousa) and conjunctivitis
3. Diarrhea, abdominal pain, headache and sore throat may also be present
4. On exam – grey white spots of 2-3 mm maybe seen in the buccal mucosa
4. Exanthematous maculopapular rash
DIAGNOSIS
1. IgM assay and measles RNA
2. Measles virus specific IgG
3. Viral cultures
4. CBC may show neutropenia
5. Chest XR if suspecting secondary pneumonia
TREATMENT
Is mostly supportive and conservative
– Immunosuppressed children, can be treated with Ribavirin
– Vitamin A for 2 days (Recommended by WHO)
– Antibiotics if secondary bacterial infection
– Immunoglobulin for high risk individuals for whom vaccination is inappropriate
VITAMIN A RECOMMENDATION
Children <6 months: 50,000 IU
Children 6-12 months: 100,000 IU
Children > 12 months: 200,000 IU
PREVENTION
Prevention is always better than cure and suffering
1. It is 100% preventable with proper vaccination (please, do not be an anti-vaxxer)
2. Proper hand-washing
References:
1. 5MinuteConsult: Rubeola (Accessed Jan 29 2019)
