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Measles (Robeola)
D. Haider
Measles
Viral infections with exanthema, exanthema is widespread rash with fever.
1. The incubation period 7-14 days
2. High fever is the first sign last 4-7 days
3. Prodromal phase :fever ,anorexia and classical triad of conjunctivitis, cough and
coryza(3c),photophobia,periorbital edema and myalgia may occurred.
4. The characteristic enanthem generally appears 2-4 days after the onset of the prodrome
and last 3-5 days(koplik spots) can be seen inside the cheeks during the early stage.it is
pathognomonic but its absence does not exclude the diagnosis.it is defined as grains of
sound on a red base appeared on a buccal mucosa apposite the second molars .
5. The exanthema usually appears 1-2 days after the appearance of koplik spots,the rash is
maculopapular starting on face and upper neck and spreading to the extremities ,the entire
course of uncomplicated measles from late prodrome to resolution of fever and rash is 7-
14 days.
Complications
They are more common in adults especially pregnant, malnourished and immunocompromised
patients:
1. otitis media
2. bacterial pneumonia
3. Transient hepatitis
4. Encephalitis (0.1%)
Subacute sclerosing panencephalitis(sspe)which is rare complication and late occurred after
7 years.
Diagnosis
Is clinical and by detection of antibody (IgM) in serum or saliva or by PCR OR VIRAL
CULTURE.
• Death occurred from bacterial super infection as complication of measles :pneumonia,
diarrhea and gangrenous stomatitis or encephalitis.
Management:
1. supportive in uncomplicated
2. Immunoglobulin given to immunocompromised patients may attenuate the disease if
received within 6 days.
3. vitamin A
4. Antibiotic is reserved for bacterial infection.
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Prevention
MMR is lived attenuated vaccine that is contraindicated in immunocompromised
patients
If patient with TB it should be deferred until completion of anti TB therapy.
Measles give life long immunity.
Rubella (German Measles)
1. It spread by respiratory droplets.
2. Infectivity from up to 10 days before to two weeks after rash.
3. It usually sub clinical in adults.
Clinical features:
1. Fever
2. Maculopapular rash spreading from face.
3. Lymphadenopathy.
4. In adults especially women arthritis is relatively common ,this enter in differential
diagnosis of undifferentiated arthritis the most important of this is rheumatoid arthritis.
Congenital rubella
Laboratory confirmation is required if there has been contact with pregnant women because
rubella virus had the potential for trans placental transmission and severe congenital
malformations occurred, this is achieved by detection of igM against rubella in serum or by IgG
seroconversion, in the exposed pregnant absence of specific rubella igG confirm the potential
for congenital infection.
Congenital rubella is risk for diabetes mellitus.
Prevention
1. All children should be immunized as for measles by MMR.
2. All children of childbearing age should be tested for rubella and vaccinated if
seronegative.
Mubark A. Wilkins