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Measles
From WikEM
Contents
Background
- Also known as Rubeola, which is not to be confused with German Measles (Rubella)
- Patients are contagious from about 4 days before to 4 days after onset of rash
Clinical Features
- Consider measles in a patient of any age who has an acute RASH and FEVER
- Incubation period - 10 days
- Prodrome of high fever, cough, coryza, and conjunctivitis (lasts ~3 days)
- Koplik's spots (appears day 2-3) - pathognomonic enanthem
- Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
- Rash (begins day 4 - lasts to day 7)
- Red, blotchy, and maculopapular; rapidly progresses to confluence
- Usually starts on the face (hairline and behind the ears)
- Rapidly spreads to the chest, back, and finally the legs and feet
- Rash resolves in order of appearance between days 7-9
- Obtain a history of measles immunization, contact with known outbreak, travel outside of the Americas, or contact with international travelers in recent weeks
Differential Diagnosis
Pediatric Rash
- Drug rash
- Erythema Infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-Schonlein Purpura (HSP)
- Herpangina
- Herpes simplex virus
- Infectious Mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella German measles)
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Strep pharyngitis
Evaluation
- Measles IgG and IgM
- Culture and PCR of nasopharyngeal swab
- Urine PCR
Management
- Alert local health department ASAP
- The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately
Isolation Precautions
- For suspected patients
- Mask the patient and isolate immediately in an airborne infection isolation room
- All personnel entering the room should use respiratory protection at least as effective as an N95 respirator
- If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room
- Do not use the room for at least 2 hours after the patient leaves.
Post-Exposure Prophylaxis (Non-Immune Contact)
- Immunocompetent:
- MMR Vaccine (within 72 hours of exposure)
- Immunocompromised, children <12 months, and others at high risk of complications:
- IM Immune globulin (up to 6 days after exposure)
- Consider checking with your local health authorities
Complications
- Severe illness can cause pneumonia, encephalitis, and death
