Measles (Rubeola)- Symptoms, Causes, Diagnosis and Treatment

Introduction - Measles (Rubeola)

Measles or Rubeola is viral infection. It is highly contagious infectious disease caused by measles virus. it’s serious for small children but is easily preventable by a vaccine.

Measles is caused by the measles virus, a single-stranded, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae.

The family Paramyxoviridae consists of 3 genera-

1. Paramyxovirus - parainfluenza viruses and mumps virus

2. Pneumovirus - respiratory syncytial virus (causes infections of the lungs and respiratory tract)

3. Morbillivirus - which includes the measles virus

Epidemiological Triad

Agent - Measles is caused by RNA paramyxovirus. This virus is present in secretions of nose, throat and respiratory tract of a case of measles.

Host - In developing country measles occurs in infancy or childhood (between 6 months and 3 years of age) because of poor environmental conditions.

In develop countries, measles occurs in over 5 years age.

Measles occurs in severe form in malnourished children. The cause of low socio- economic condition.

Environmental factor - it occurs in winter because people over crowd indoors and also seen in spring.

 

Mode of Transmission

 

Portal of entry  - Respiratory tract, conjunctiva also might act.

 

1. Measles is an airborne disease which spreads easily from one person to the another through the airborne droplets, coughs and sneezes of an infected child or people.

2. Droplet nuclei

3. Droplet infection

4. Transmitted by person to person contact, close personal contact or direct contact with mouth or infected nasal or throat secretions.

 

Usually 7 to 14 days (range of 7 to 18 days)

Measles symptoms appear 7 to 14 days after contact with the virus and onset include high fever, cough, runny nose, and watery eyes. Measles rash appears 3 to 5 days after the appear first symptoms.

 In case of injection of measles vaccines, 14 days to appearance rash.

 

Measles Pathophysiology

 

1. Measles virus is transmitted via the respiratory route, oropharynx, or conjunctiva

2. Measles virus proliferates locally in respiratory mucosa and spread to lymph nodes during the first 2-3 days after infection

3. Replicates in the nasopharynx and regional lymph nodes within 2 to 4 days after exposure.

4. Primary viremia occurs

5. Hyperplasia (enlargement) of lymphoid tissue usually occur

6. Koplik spots in buccal mucosa appear

7.  Further replication result secondary viremia occurs in 5-7  days after infection  later is spread to nearby tissues.

8. Continues to spread, spreading to more lung tissue, as well as other organs such as intestines and the brain

9. Disseminate (spread) measles virus throughout the body

 

Clinical Symptoms of Measles

 

 

1. High fever (may more than 104°F)

2. Cough

3. Runny nose (coryza)

4. Red, watery eyes (conjunctivitis), inflamed eyes

5. Sore throat, fever

6. Red, blotchy (spot or mark) skin rash

7. White spots inside the mouth

 

The incubation period from exposure to prodrome (early stage of symptoms indicating the onset of a disease or illness) is 7 to 10 days, with the onset of rash within 14 to 18 days. Symptoms typically begin 10–14 days after exposure.

 

 

In measles, three stages of disease are-

 

1. Prodromal stage-  Fever, coryza, sneezing, nasal discharge, cough, redness of eye, lacrimation, vomiting, diarrhoea, koplik’s spot ((small, bluish-white spot with a red background on the inside of the cheek).

 

2.  Eruptive stage- Dusky red, Red, blotchy (spot or mark) skin rash

 

3. Post measles stages- Weight loss, weakness, growth retardation, reactivation of pulmonary tuberculosis, nutritional and metabolic effects.

 

First symptoms show: 7 – 14 days after a measles infection

 

The first sign of measles is usually a high fever, which begins about 7 to 14 days after exposure to the virus includes high fever cough, runny nose (coryza), and red, watery eyes (conjunctivitis).

 

Koplik spots: 2-3 days after symptoms begin

 

Tiny white spots (Koplik spots) may appear inside the mouth 2 to 3 days after symptoms begin.

 

Measles rash: 3-5 days after symptoms begin

 

3 to 5 days after symptoms begin, a rash erupts. It usually begins as flat red spots that appear on the face upper neck, trunk, arms, legs, and feet and then fades.

Small raised bumps may also appear on the flat red spots. These spots may become joined together and they spread from the head to the rest of the body.

When the rash appears, a person’s may get fever more than 104° F.

 

The rash occurs 14 days after contact to the virus (within a range of 7 to 18 days).

 

Get information about Mumps and know the signs and symptoms of Mumps.

 

 

Laboratory Diagnosis

 

1. Testing for Measles IgM antibodies

2. Isolation of Measles virus from clinical samples

3. Detection of measles virus RNA by RT-PCR (reverse - transcriptase polymerase chain reaction) from clinical specimens.

 

 

Who is at Risk?

 

1. Unvaccinated young children are at highest risk of measles

2. Unvaccinated pregnant women are also at risk

3. Any person who has not been vaccinated or was vaccinated but did not develop immunity (non-immune person) can become infected 

 

 

Treatment of Measles

 

There is No specific antiviral treatment exists for measles virus infection.

But can take some measures to protect individuals who have been exposed to the virus to get severe complications from measles.

1. Adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution, prevent lost through diarrhoea or vomiting.

2. Prescribed Antibiotics to treat eye infections, ear infections, and pneumonia.

3. Good nutrition

 

 

Post-exposure vaccination

 

Non- immunized individual, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to provide protection against the disease.

 

 

Prevention of Measles

 

1. Active Immunization Vaccine

 

Measles can be prevented by active immunization, live attenuated (weakened) vaccine with MMR vaccine. The vaccine protects against three diseases- measles, mumps, and rubella or MMR-V Vaccine.

Measles vaccine can be combine with mumps and rubella (live attenuated vaccines) to have MMR (Measles, mumps and rubella vaccine).

 

Immunization                 Dose               Route                    Age

Live attenuated              0.5ml           Subcutaneous      12-15  months

 

2. Passive immunization by Immuno- globulins

 

Administration of immune-globulins early in incubation period can also prevent the disease.

 

 

Note- Measles vaccines should not be given in pregnancy and acute illness.

 

 

Medications for Measles

 

1. Antipyretic – Given Acetaminophen

2. Antibiotics-  If a bacterial infection, such as pneumonia or an ear infection, eye infection develops, child has measles

3. Vitamin A -Children with low levels of vitamin A are more suspect to have a more severe case of measles.

 

 

Prevention of Measles

 

1. Isolation - individual having measles should be isolated for 7 days after the onset of rash.

2. Early Diagnosis

3. Immunization

 

Complications of Measles

 

1. Measles associated diarrhoea

2. Pneumonia

3. Otitis media

4. Febrile convulsions

5. Encephalitis

6. Laryngotracheobronchitis (inflammation of the larynx, trachea, and bronchi)

7. Corneal ulceration (leading to corneal scarring).

8. Subacute sclerosing panencephalitis -  inflammation of the brain (encephalitis), may develop due to reactivation of the measles virus.