Measles

Measles

No, this is not just an infection of children anymore - we are seeing measles more frequently in adults. This is usually in those with no history of primary vaccination.

Classic Measles: there is about a 14 day incubation period where the virus replicates and spreads via lymphatics and hematogenously. Initial symptoms include fever, coryza, conjunctivitis, cough, and general malaise. Koplik's spots may be seen as well - these are small, raised lesions in the buccal mucosa that are whitish or blue in colour (see photo below). These are pathognomonic for measles and can be visualized roughly 2 days prior to the classic rash.

The exanthem of measles typically starts on the face and moves to the trunk and extremities, sparing the hands. It is a blanchable maculopapular rash (see photo above). Patients may start to feel better a couple of days after the rash appears, and the rash typically will start to fade after 4ish days.

Diagnosis: can be confirmed with serology. Send off measles IgM - this should be positive a few days after the exanthem appears. Measles IgG will be detectable two weeks after the exanthem.

What to do? this is a very contagious virus, so patients with suspected measles should be in respiratory isolation and the Infection Control service should be contacted. Treatment revolves mostly around supportive care - fluids, antipyretics, and monitoring for/treating bacterial suprainfections like pneumonia or otitis media. Vitamin A is given to children with measles in countries where vitamin A deficiency is prevalent.

Links:

• A neat case and image of Koplik's spots can be found here.
• Check out the epidemiology of measles in North America here.
  

(Koplik's Spots in the buccal mucosa)