* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Measles and its cutaneous presentations
Meningococcal disease wikipedia , lookup
Trichinosis wikipedia , lookup
Neonatal infection wikipedia , lookup
Yellow fever wikipedia , lookup
Typhoid fever wikipedia , lookup
Onchocerciasis wikipedia , lookup
Ebola virus disease wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Whooping cough wikipedia , lookup
Herpes simplex virus wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Hospital-acquired infection wikipedia , lookup
West Nile fever wikipedia , lookup
Henipavirus wikipedia , lookup
Schistosomiasis wikipedia , lookup
Yellow fever in Buenos Aires wikipedia , lookup
Rocky Mountain spotted fever wikipedia , lookup
Hepatitis B wikipedia , lookup
Leptospirosis wikipedia , lookup
Orthohantavirus wikipedia , lookup
Marburg virus disease wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Journal of Pakistan Association of Dermatologists 2013;23 (3):253-255. Editorial Skin and measles Shehla Shaukat, Shahbaz Aman, Atif Hasnain Kazmi Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore Measles is an acute infectious disease of children, also known as rubeola, caused by paramyxovirus which is a single stranded enveloped RNA virus.1 According to WHO, it remains one of the leading causes of death among children globally, approximately 158000 people mostly children under the age of five died from measles in 2011.2 Recently, Pakistan witnessed measles epidemic particularly in the province of Sindh from January 2012 to February 2013, 19,048 suspected measles cases with 463 deaths of children were reported throughout the country. Most of these cases were reported during the last quarter of 2012.3 The total number of cases of measles reported from Punjab was 19,192 with 239 deaths during the last six months.4,5 Compared to previous years these are alarming figures which compels us as dermatologists to know more about the disease and its common and uncommon cutaneous presentations. The virus resides in the upper respiratory tract of an infected person. It can spread by droplet infection or by fomites which are infected by the secretions. Incubation period of measles is 7-14 days.6 In classical dermatological measles syndrome, the symptoms are initially nonspecific including Address for correspondence Dr. Shehla Shaukat Department of Dermatology, Unit I, King Edward Medical University/Mayo Hospital, Lahore E-mail: [email protected] fever, sore throat, cough, rhinorrhea, conjunctivitis and photophobia.6 During the initial two to three days the pathognomonic Koplik’s spots are also seen in the buccal mucosa.6 The typical maculopapular rash starts from behind the ears and along the hairline. It spreads in cephalocaudal pattern to involve the face, trunk and limbs over the next few days.6 The fever becomes high grade with temperature rising to 104ºF or 105ºF. The patients remain infectious from four days before the rash appears till the four days after the rash is there. The rash after a few days starts to fade away starting from the face sometimes leaving behind a staining pattern or hyperpigmentation.7 There can be an atypical or modified presentation of the disease. People who received killed measles vaccine or are exposed to wildtype virus can develop an atypical measles syndrome.8 The rash can be urticarial, purpuric or even vesicular. It starts from palms and soles then spreads to the trunk before fading. Koplik’s spots in these cases are absent.8 Atypical measles syndrome may also present with congested macules and papules starting on the extremities and back.9 The systemic features include fever, pleural effusions, pneumonia and swelling of extremities.9 In HIV positive patients there can be an atypical rash or no rash at all.9 Skin necrosis or even minute skin coloured papules can also be seen.9 In modified form of measles the symptoms are mild and last for a very short time.9 It develops 253 Journal of Pakistan Association of Dermatologists 2013;23 (3):253-255. in those persons who received immunoglobulins after exposure to measles or the those infants who were either non-immunized or had low immunity from their mothers.8 The complications of measles are more common in children under the age of five, or adults over the age of twenty. Complications include diarrhea, otitis media, bronchitis, pneumonia, corneal ulcerations and scarring, encephalitis, subacute sclerosing panencephalitis, thrombocytopenia or even death.10 The mortality rate reported by WHO is 10% in underdeveloped nations where there are high rates of malnutrition and poor health care. In immunocompromised patients the fatality rate is approximately 30%.2 Women infected while pregnant may end up with miscarriage or preterm delivery. Risk factors for severe measles and its complications include malnutrition, underlying immunodeficiency, pregnancy and vitamin A deficiency.10 Diagnosis is made clinically, as well as, by laboratory investigations including detection of IgM antibodies or culture of virus. IgA antibodies can be tested from the saliva of the patients in whom phlebotomy is difficult.11 The differential diagnoses are numerous including dengue fever, drug eruptions, enteroviral infections, fifth disease, rubella, Kawasaki disease, Rocky Mountain spotted fever, roseola and toxic shock syndrome.11 of exposure to the virus.7 The complications are treated by supportive care which includes antipyretics, treatment of dehydration, adequate nutrition and antibiotics for eye, ear infections and pneumonia. Two doses of vitamin A supplements are given to children in developing countries for prevention of eye damage and blindness.11 Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.11 Prevention of measles is possible by vaccination. First dose of measles vaccine is given at nine months of age while second dose with triple combination vaccine called MMR (measles, mumps and rubella) at fifteen months and booster dose at four to five years in developing countries. In developed countries two doses at fifteen to eighteen months and then at four to six years of age are given.11 Side effects of the vaccine are rare, with fever and pain at the injection site being the most common. The vaccine is less effective in HIV-infected infants than in general population. People who recover from measles remain immune from this disease for the rest of their lives. It is time for us to play our role in creating awareness about cutaneous manifestations of this viral infection among general public and practitioners for early referral to tertiary care hospitals for its management. References There is no specific antiviral treatment for measles. Nonimmunized people, including infants, may be given measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. The symptoms are usually milder and transient even if the person develops measles. Pregnant women, infants and immunodeficient people should receive immunoglobulins within six days 1. 2. 3. Tod B, Carrara H, Levin M, Todd G. Dermatological manifestations of measles infection in hospitalized paediatric patients observed in the 2009-2011 Western Cape epidemic. S Afr Med J. 2012;102;356-9. World Health Organization. Measles. Fact sheet No. 286. Available from: URL: www.who.int/mediacentre/factsheets/fs286/ Report on measles outbreak in Pakistan (vol1) wafaqi mohtasib (ombudsman)’s 254 Journal of Pakistan Association of Dermatologists 2013;23 (3):253-255. 4. 5. 6. 7. secretariat Islamabad. Available at: URL: 202.83.164.28/wafaqimoh/userfiles1/file/Me asles%20Report.pdf 89 new cases of measles reported in a day. Available at: URL: www.dailytimes.com.pk/24-6-2013pg13-6 Galpin R. Fighting Pakistan's measles epidemic. Available at: URL: www.bbcnews.com/30-52013. Morrison LK, Ahmed A, Madkan V et al. Exanthematous viral diseases. In: Goldsmith LA, Katz SI, Gilchrest BA et al. editors. Dermatology in General Medicine, 8th edn. New York: McGraw-Hill; 2012. P. 2337-67. Centers for disease control and prevention. www.cdc.gov/vaccines/pubs/pinkbook/meas .html 8. Pang M, Xu JY, Li P et al. Clinical analysis of 51 cases of atypical measles syndrome characterized by fever and multiple lung lesions. Zhonghua Jie He He Hu Xi Za Zhi (Chinese). 2008;31:731-5. 9. Permar SR, Griffin DE, Letvin NL. Immune containment and consequences of measles virus infection in healthy and immunocompromised individuals. Clin Vaccine Immunol. 2006;13:437-43. 10. URL: en.wikipedia.org/wiki/Measles 11. Mancini AJ, Shani-Adir A. Other viral diseases. In: Bolognia JL, Jorrizo JL, Rapini R eds. Dermatology, 3rd edn. UK: Elsevier Saunders; 2012. p. 1345-62. 255