Measles (notifiable)

Related Subjects: |Herpes Varicella-Zoster (Shingles) Infection |Chickenpox Varicella Infection |Varicella Cerebral Vasculopathy |Herpes Viruses |Herpes Zoster Ophthalmicus (HZO) Shingles |MonkeyPox |Mumps |Measles |Rubella (German Measles) |Epstein-Barr Virus infection

🔍 Look for Koplik's spots - tiny white lesions on a red background (like grains of salt). They are pathognomonic for measles. ⚰️ Fatality rates vary: - ~1 per 1000 in otherwise healthy people in developed countries 🌍. - Up to 10% in underdeveloped nations with malnutrition/poor healthcare 🍚. - ~30% in immunocompromised patients (very high risk) ⚠️.

ℹ️ About

• 📈 Epidemics occur every 2–3 years.
• ⏳ Incubation: 8–14 days.
• 💉 Vaccination + herd immunity = key prevention.

🦠 Virology

• RNA paramyxovirus → highly infectious.
• Spread by aerosols 😷.
• 👶 Neonates (up to 6 months) protected by maternal IgG.

⚰️ Mortality Rates

• Developing countries & immunocompromised: up to 25%.
• Developed countries: ~0.1% (1 per 1000).

🌍 Epidemiology

• 📑 Notifiable disease in the UK.
• One attack → lifelong immunity 🛡️.

🩸 Measles Rash

🔍 Koplik Spots in Oral Cavity

🩺 Clinical

• Fever 🌡️ ≥3 days + “4 Ks”: Cough, Coryza 🤧, Conjunctivitis 👀, Koplik’s spots.
• Maculopapular rash: starts on face → spreads downwards. Blotchy, red, blanching → brownish later.
• General lymphadenopathy, seizures/convulsions possible.
• Infectious until 5 days after rash appears ⚠️.

⚠️ Complications

• 💩 Diarrhoea, pneumonia (bacterial 5%, giant cell in immunocompromised).
• 🧠 Encephalitis: 1 in 1000; inclusion-body encephalitis (immunocompromised); SSPE (1 in 100,000, delayed 7 years).
• 👁️ Corneal ulceration/scarring → blindness.
• 👂 Otitis media, ❤️ Myocarditis, Pericarditis.
• More severe in adults 🚶‍♂️.
• In malnourished: cancrum oris, fatal diarrhoea/pneumonia.
• Acute disseminated encephalomyelitis (ADEM).

🚨 More Severe Illness

• Pregnancy 🤰: pneumonitis, hepatitis.
• Vitamin A deficiency, malnutrition 🍚, elderly 👵.
• Neonates once maternal Ig wanes 👶.

🔎 Investigations

• 📊 Fourfold rise in acute/paired sera for IgM/IgG.
• 💉 Serum/saliva measles IgM or IgG.

🛡️ Prevention

• MMR (live attenuated): 13 months + preschool booster 💉.
• Herd immunity essential (95%+ coverage).
• Human immunoglobulin can be given post-exposure in high-risk patients.

💊 Management

• ABCDE, IV fluids 💧.
• Antibiotics if proven secondary bacterial infection 🦠.
• Vitamin A supplementation in children (reduces mortality).
• Severity increases with age ⏳.
• Consider post-exposure prophylaxis (IgG or MMR) in high-risk groups after specialist advice.

📷 Useful Links

• Measles rash images
• Koplik spots images