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MEASLES (RUBEOLA)
DEFINITION
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Measles is a communicable disease
manifesting with fever , cough ,
coryza , lacrimation and koplik spots
in the pre – eruptive phase and a
maculopapular rash starting at 4th or
5th day of the illness.
Coryza : profuse discharge from the
mucous membrane of the nose
koplik spot : small, white spots (often
on a reddened background) that
occur on the inside of the cheeks
early in the course of measles.
Koplik spots
Coryza
ECOLOGICAL TRIAD
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Agent: Measles( paramyxovirus ,RNA virus)
Age: children (6months -3 years)
Measles tend to be very serious in malnourished
children, mortality is 400 times higher.
Both sexes are affected
Immunity : one attack of measles gives immunity for life.
 Infants acquire immunity transplacentally from mothers
who have had measles or measles immunization. This
immunity is usually completed for the first 4–6 months of
life.
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Reservoir : - Man is only the reservoir of infection.
ENVIRONMENT
Incidence is higher in spring and winter
 Incidence is higher in densely populated
urban areas
Natural history
 Reservoir is a case of measles
 Source of infection: nasopharyngeal
secretions, lacrimal secretion, urine
 Infectious period: 4 days before, and 5 days
after the onset of rash
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MODE OF TRANSMISSION
Directly from person to person by droplet
infection, droplet nuclei
 Other modes –fomites, airborne
Incubation period: 8 – 12 days
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PATHOGENESIS
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Virus infects by invasive of respiratory tract .
After entering the viral particles infects the respiratory epithelium and
local multiplication leads to primary viremia ( day 2 – 3 ) and
subsequently spread to the reticuloendothelial system.
Cells of reticuloendothelial system necrose , causing secondary
viremia ( day 5 – 7 ) which is responsible for systemic symptoms.
Multinucleated gaint cells can be demonstrated in both epidermis and
oral epithelium by 7 – 11 days
Two types of gaint cell are seen :  Warthin – Finkeledy cells of reticuloendothelial system
 Epithelium gaint cells of respiratory tract
During infection , CD4T and CD8 cells are activated and
participate in clearance of virus and development of rash.
During recovery,level of interleukin 4 is elevated
IL-4: protein that stimulates the immune system to develop mast cells,
resting T-cells, and activated B-cells.
CLINICAL FEATURES
A.
Prodromal :
- onset is acute with moderate elevation
of temperature , cough , running of nose ,
sneezing , redness of eyes and excessive
lacrimation
- on second or third day : koplik spots
appear on the inner side of the cheek,
opposite to the second molars .
- Koplik spots increase in number for 2 to
3 days and disappear by the end of
second day of the rash
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Koplik’s spot:
Eruptive phase :
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With the appearance of rash on the 4th day the fever
tends to rise again
Early rash is erythematous and blanches on pressure (
blotchy )
First appears behind the ears , near the hair line on the
forehead , face and neck and spread to trunk ,
extremities , palms and soles within 3 days.
The rash now appears brownish , and does not fade on
pressure.
Rash start disappearing after 4 to 5 days in the same
order in which it appeared
Fever and rash lasts for about a week in uncomplicated
cases
May complain anorexia , malasie , generalised
lymphadenopathy
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Maculo-papular rash:
DIAGNOSIS
Clinical diagnosis:
 Laboratory diagnosis:
 Blood count – leucocytosis in early stages
followed by increased lymphocytes
 Sputum or urine culture
 Serological tests
Complement fixation test
Haemagglutination test
 Enzyme-linked immunosorbent assay (ELISA)
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Differential diagnosis
Rubella : rash is pink , maculopapular and
discrete
 Infectious mononucleosis : rash is associated
with generalised lymphadenopathy and
hepatosplenomegaly
 Meningococcemia : rash appears within 24
hours. Fever , vomiting , irritability and
possibly stiff neck are present
 Drug rash : H / o drugs administration
 Sunburn
 Roseola infantum : - faint pink maculopapular
rash.
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Treatment :
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It is a self limiting disease unless it is
complicated
Symptomatic and supportive
Body and oral hygiene are attended to
Parents are encouraged to give bath to the child
and mouth is washed and teeth are brushed
daily
Adequate amount of fluids orally
Fever (paracetamol and hydrotherapy )
Severe cough ( saline nebulization )
Vitamin A decrease the severity , complication
rate and mortality. Dose : 2 lac units , orally
children older than one year of age for 2
consecutive days.
PREVENTION AND CONTROL
Control measures
 Isolation
 Bed rest
 Supportive Tx- vit. A ,
 Immunization of contacts within 2 days of
exposure
 Preventive measures
 Active immunization(9 months,
0.5cc,IM/SC,deltoid)
 Passive immunization (Human gamma
globuline0.25ml/kg IM within 5 days of exposure)
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VACCINES
Dose and schedule:
0.5ml – S/C – 9months
 Adverse reactions:
Measles like illness, febrile convulsion, toxic
shock syndrome, transient thrombocytopenia
 Contraindications: acute illness, untreated
malignant diseases, immunodeficiency,
pregnancy, received any live vaccine within 3
weeks
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COMPLICATIONS
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Respiratory tract :
 otitis
media , cervical lymphadenopathy ,
laryngitis , laryngotracheitis , interstitial
pneumonia ,bronchopneumonia
Encephalitis
 Digestive system :
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 Persistent
diarrhea , appendicitis ( lymphoid
tissue blocking the lumen of appendix ) ,
hepatitis , ileocolitis
Malnutrition : PEM
Others : acute glomerulonephritis ,
disseminated intravascular coagulation .