MEASLES

An acute, highly communicable viral infection characterized by a generalised skin rash, fever, and inflammation of mucous membranes. Measles is a notifiable disease. Measles virus is caused by a virus. The measles virus a single-stranded, lipid-enveloped RNA virus in the family Paramyxoviridae and genus Morbillivirus

Cause

  • Measles virus spreads by droplet infection and direct contact: through the respiratory tract or conjuctivae following contact with aerosals Virus remains viable after 1 hour in airdroplet.

Stages of measles

  1. Incubation phase.
  2. Prodromal phase.
  3. Exanthematous phase
  4. Recovery

Clinical features

  • Catarrhal stage: high fever, Koplik’s spots (diagnostic) runny nose, barking cough, conjunctivitis
  • Misery, anorexia, vomiting, diarrhoea
  • Later: generalised maculopapular skin rash followed by desquamation after few days

Complications

  • Secondary bacterial respiratory tract infection, e.g. bronchopneumonia, otitis media
  • Severe acute malnutrition especially following diarrhoea
  • Cancrum oris (from mouth sepsis)
  • Corneal ulceration and panophthalmitis – can lead to blindness
  • Demyelinating encephalitis
  • Thrombocytopaenic purpura

Differential diagnosis

  • German measles (Rubella)
  • Other viral diseases causing skin rash

Investigations

  • Clinical diagnosis is sufficient though virus isolation is possible

Management (symptomatic)

  • Isolate patients (at home or health centre)
  • Paracetamol prn for fever
  • Apply tetracycline eye ointment 1% every 12 hours for 5 days
  • Increase fluid and nutritional intake (high risk of malnutrition and dehydration)
  • Give 3 doses of vitamin A: first dose at diagnosis, 2nd dose the next day and 3rd dose on day 14
    • Child <6 months: 50,000 IU
    • Child 6-12 months: 100,000 IU
    • Child >12 months: 200,000 IU
  • Monitor for and treat secondary bacterial infections with appropriate antibiotics immediately
  • Refer to hospital in case of complications

In HIV positive patients, Ribavirin is recommended.

Prevention

  • Measles vaccination (see chapter 18)
  • Avoid contact between infected and uninfected persons
  • Educate the public against the common local myths e.g. stopping to feed meat and fish to measles patients.

Referres:
1: Uganda Clinical Guidelines 2016.
2: Nelson textbook of Paediatrics 19th Edition.