History

Fact Explanation
Fever - usually resolves after the onset of the rash. But can be prolonged if the patient develops any complication of Measles Viraemia, viral dissemination and systemic inflammatory response. Prodromal symptoms.[1,2]
Malaise Viraemia, viral dissemination and systemic inflammatory response. Prodromal symptoms.[1,2]
Cough Viraemia, viral dissemination and systemic inflammatory response. Prodromal symptoms.[1,2]
Rhinorrhoea Viraemia, viral dissemination and systemic inflammatory response. Prodromal symptoms.[1]
Conjuctivitis Due to inflammatory response[2]
Rash; A non-pruritic erythematous maculo-papular rash This is the eruptive phase of measles. The rash usually begins in the face and then spreads to involve the rest of the body. The rash usually lasts one week and fades leaving behind a brownish discoloration. [2]
Gastrointestinal symptoms: nausea, vomiting, diarrhea Viraemia, viral dissemination and systemic inflammatory response.[3]
Exclude possible immunodeficiency e.g. Diabetes mellitus, HIV infection, Immunosuppressive therapy Risk of developing severe life threatening complications of measles, such as pneumonia or acute encephalitis.[4]
References
  1. KUMAR P, CLARK M. Clinical medicine, 8th Edition, London, Elsevier, 2012
  2. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  3. ORENSTEIN WA, PERRY RT, HALSEY NA. The clinical significance of Measles: A review, The journal of infectious diseases, Oxford Journals, 2004, Volume 189, (Issue supplement 1):S4 - S16. doi: 10.1086/377712
  4. SABELLA C. Measles: Not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123

Examination

Fact Explanation
Fever Viraemia and systemic inflammatory response. [1,2]
Koplik's spots - Whitish spots that occur on the buccal mucosa. they appear prior to occurrence of the rash and are pathognomonic of measles Inflammatory response. [2]
Rash - maculo-papular, generalized, non-pruritic Eruptive phase of the disease. [2]
Lymphadenopathy Due to systemic inflammatory response. [2]
Splenomegaly Due to systemic inflammatory response. [2]
Respiratory system - Pneumonia may complicate Due to primary complication of Measles or secondary bacterial infection. [3], [4]
Central nervous system - level of consciousness: drowsiness to coma Measles may be complicated by acute encephalitis. [3,4]
References
  1. KUMAR P, CLARK M, Clinical medicine, 8th Edition, London, Elsevier, 2012
  2. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill Companies Inc, 2012
  3. ORENSTEIN WA, PERRY RT, HALSEY NA. The clinical significance of Measles: A review, The journal of infectious diseases, Oxford journals, 2004, Volume 189, (Issue supplement 1):S4 - S16. doi: 10.1086/377712
  4. SABELLA C. Measles: Not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123

Differential Diagnoses

Fact Explanation
Kawasaki Disease Can present with fever, erythematous rash similar to measles. Patient can have conjunctival injection, lymphadenopathy. Patient is usually child under 5 years of age. [1,2]
Scarlet fever Patient presents with fever, erythematous generalized maculo-papular rash (that blanches on pressure). Usually affects children following erythrogenic-toxin producing Group A Streptococcal infection. [2,3]
Infectious Mononucleosis Fever, transient erythematous rash - usually after patient has been treated with an Amino-penicillin. Lymphadenopathy and splenomegaly can occur. High risk of splenic rupture. Palatal petechiae occurrence may help in differentiating. [2]
Drug eruption Due to drug allergy. [2]
References
  1. KUMAR P, CLARK M, Clinical medicine, 8th Edition, London, Elsevier, 2012
  2. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  3. BIESBROECK L, SIDBURY R. Viral exanthems: an update, Dermatol Ther. Pubmed. 2013 Nov;26(6):433-8. doi: 10.1111/dth.12107

Investigations - for Diagnosis

Fact Explanation
Immunofluorescent staining for measles antigen from respiratory secretions or throat swabs Specific diagnosis by demonstration of measles virus. [1]
Microscopic examanition of respiratory secretions for multinucleated giant cells Due to inflammatory response. [1]
Culture of measles virus in respiratory secretions or urine Virus present in respiratory secretions and in urine. [1]
Polymerase Chain Reaction (PCR) to demonstrate measles virus in respiratory secretions or urine Virus present in respiratory secretions and in urine. [1,2]
Enzyme Immunoassay (EIA) of blood for IgM and titres of IgG IgM present few days after onset of rash, IgG titre progressively rises after 1-2 weeks. [1,2,3]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. SABELLA C. Measles: Not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123
  3. KUMAR P, CLARK M, Clinical medicine, 8th Edition, London, Elsevier, 2012

Investigations - Fitness for Management

Fact Explanation
Chest X ray Measles may be complicated by pneumonia due to Measles virus or due to secondary bacterial pneumonia. [1,2,3]
Non contrast CT scan of Brain Measles encephalitis. [1,2]
Lumbar puncture Measles encephalitis. [1]
Electroencephalogram (EEG) Measles encephalitis. [2]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. ORENSTEIN WA, PERRY RT, HALSEY NA. The clinical significance of Measles: A review, The journal of infectious diseases, Oxford journals, 2004, Volume 189, (Issue supplement 1):S4 - S16. doi: 10.1086/377712
  3. SABELLA C. Measles: Not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123

Investigations - Followup

Fact Explanation
Enzyme Immunoassay IgG levels With resolution of acute illness, titer of IgG should reduce. [1,2,3]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. SABELLA C. Measles: not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123
  3. KUMAR P, CLARK M. Clinical medicine, 8th Edition, London, Elsevier, 2012

Investigations - Screening/Staging

Fact Explanation
White cell count Asses for Lymphopenia or Neutropenia. [1,2,3]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. SABELLA C. Measles: not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123
  3. KUMAR P, CLARK M. Clinical medicine, 8th Edition, London, Elsevier, 2012

Management - General Measures

Fact Explanation
Supportive care To Prevent further deterioration due to acute illness. [1,2,3,4]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. ORENSTEIN WA, PERRY RT, HALSEY NA. The clinical significance of Measles: A review, The journal of infectious diseases, Oxford journals, 2004, Volume 189, (Issue supplement 1):S4 - S16. doi: 10.1086/377712
  3. SABELLA C. Measles: not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123
  4. KUMAR P, CLARK M. Clinical medicine, 8th Edition, London, Elsevier, 2012

Management - Specific Treatments

Fact Explanation
Intra venous antibiotics For management of pneumonia or otitis media. [1,2,3]
Observation for increased intracranial pressure When complicated by measles Encephalitis. [1,2,3]
Vitamin A supplementation In severe measles. [4,5]
Ribavirin In immunocompromised patients. [1,2,3]
Measles vaccine - either separate or combined as Measles, Rubella or Measles, Mumps, Rubella To prevent acute measles infection, to prevent Sub-acute Sclerosing pan-encephalitis (usually in children under 2 years old who haven't been vaccinated) [4,6,8]
References
  1. LONGO DL, FAUCI AS , KASPER DL, HAUSER SL, JAMESON JL, LOSCALZO J. Harrison's principles of internal medicine, 18th Edition, United States of America, McGraw- Hill companies Inc, 2012
  2. SABELLA C. Measles: Not just a childhood rash, Cleveland clinic journal of medicine, Cleveland clinic, March 2010, volume 77 (3), 207-213. doi:10.3949/ccjm.77a.09123
  3. KUMAR P, CLARK M. Clinical medicine, 8th Edition, London, Elsevier, 2012
  4. ROSALES FJ. Vitamin A supplementation of vitamin A deficient Measles patients lowers the risk of Measles-related pneumonia in Zambian children, The journal of nutrition, The American society for nutritional sciences 2002, December 1, 2002 vol. 132 no. 12 3700-3703,
  5. SUDFELD CR, NAVAR AM, HALSEY NA. Effectiveness of measles vaccination and vitamin A treatment, International Journal of Epidemiology, Oxford Jounals, (2010) 39 (suppl 1): i48-i55. doi: 10.1093/ije/dyq021
  6. CUTTS FT, LESSLER J, METCALF CJE. Measles elimination, Expert Rev Vaccines. 2013;(12)8:917-932.
  7. TRICOU V, PAGONENDJI M, MANENGU C, MUTOMBO J, MABO RO, and GOUANDJIK-VASILACHEA I. Measles outbreak in northern central African republic 3 years after the last national immunization campaign, BMC Infectious Diseases 2013, 13:103. doi: 10.1186/1471-2334-13-103
  8. ORENSTEIN WA, PERRY RT, HALSEY NA. The clinical significance of Measles: A review, The journal of infectious diseases, Oxford journals, 2004, Volume 189, (Issue supplement 1):S4 - S16. doi: 10.1086/377712