By Gary M. White, MD
Measles is a highly contagious viral infection caused by an RNA paramyxovirus and spread via the respiratory route. A vaccine is currently administrated at 12 months of age in the US and thus, cases in the US result from vaccine failure, age less than 12 months, or failure to vaccinate the child.
It has been recently noted that infection with measles makes one more likely to die of other infectious diseases for up to 3 years. Measles infection, in essence, causes the body to "forget" some of the immunity it has developed against other diseases. It is thus all the more important to receive the measles vaccine.
The incubation period is 10-14 days. The patient then develops a fever, malaise and a cough. S/he may show the typical buccal mucosal Koplik spots which are small, white spots, often on a reddened background, that occur on the inside of the cheeks early in the course of measles. Three to seven days later, the typical maculopapular (morbilliform) eruption appears. Bacterial superinfection is the main complication although acute or subacute encephalitis may occur.
In the US in 2014, cases of measles hit a 20 year high. The measles vaccine became available in 1963 and eliminated "homegrown" outbreaks. Still, various parents refuse to have their children vaccinated for religious, philosophical, or personal reasons. Recent outbreaks in the US occur in clusters of unvaccinated groups exposed to travelers bringing the virus in from other countries, most notably the Philippines.
Viral RNA detection from nasopharyngeal swabs or blood/urine is available. Measles serology, e.g., from CDC, in the acute phase can show IgM positive and IgG negative. RPR should be negative. Drug rash and viral exanthems should be considered (e.g., Epstein-Barr and Parvovirus-B19). A skin biopsy may be helpful in uncertain cases.
The disease usually runs its course over 2 weeks time. The patient should be treated symptomatically and monitored for any complications. Serum IgG may be given to immune compromised patients who are exposed.
Pneumonia is the most common and may be fatal. Other potential complications include giant-cell pneumonitis and encephalitis.
Measles may present atypically or in a severe form in HIV-positive patients, and may occur in those patients previously immunized.
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