Home Measles (Rubeola) BY: Mohammed H

ETIOLOGY SS RNA Species: Measles Virus, Family: Paramyxoviridae Genus: Morbillivirus Highly contagious The portal of entry is through the respiratory tract or conjunctivae following contact with air droplets.

CLINICAL MANIFESTATION Infectious: 3 days before and 4-6 days after onset of rash Incubation period 8-12 days Prodromal phase Exanthematous phase Recovery LIFELONG IMMUNITY Still cough Red maculopapular eruption Cepalocaudal progression With the onset of the rash, symptoms begin to subside but cough persists. The rash fades over 7 days cephalocaudally Mild fever 3Cs: Conjuctivitis, Cough and Coryza Koplik spots appear 1-4 days prior to the onset of the rash Symptoms increase in intensity for 2-4 days until the 1st day of the rash.

DIAGNOSIS Clinically WBC ↓ed, Lymphopenia CRP and ESR are normal Serology: IgM Ab, 4 fold ↑ in IgG Ab Viral culture Viral PCR

DIFFERENTIAL DIAGNOSIS Rubella Adenovirus, enterovirus infection, and Epstein-Barr virus infection. Mycoplasma pneumoniae and group A streptococcus may also produce rashes similar to that of measles. Kawasaki syndrome. Drug eruption.

COMPLICATIONS Acute otitis media Pneumonia Croup, tracheitis, and bronchiolitis Encephalitis and Subacute sclerosing panencephalitis (SSPE)

Vitamin A therapy is indicated for all patients with measles. TREATMENT Supportive Antiviral Antibiotic Vitamin A Vitamin A therapy is indicated for all patients with measles. administered once daily for 2 days at doses of: 200,000 IU for children ≥12 mo 100,000 IU for infants 6-11 mo 50,000 IU for infants younger than 6 mo.

Vaccination 12-15 mo and 4-6 yr PREVENTION Isolation Vaccination 12-15 mo and 4-6 yr Immunoglobulin is indicated for susceptible household contacts of measles patients, especially infants younger than 6 mo of age, pregnant women, and immunocompromised persons. 20,000,000/year 200.000 deaths (kids) USA 63/yr

REFERENCES https://emedicine.medscape.com/article/96622 0-clinical Nelson textbook of pediatrics, 20th edition, Page 1542. Chapter 246