Measles - Causes, Symptoms, Treatment, and Prevention

What Is Measles?

Measles is caused by the measles virus. It is an RNA virus. The standard type is also called Rubeola. It is seen in early childhood. Measles is highly contagious and spreads through the droplets that are expelled during the prodromal stage. The prodromal stage indicates the beginning of the symptoms. The virus is shed in nasal secretion, blood, and urine. The other variant is German measles. It is also called rubella. Rubella has more minor symptoms than measles, but more concern should be given to pregnant women.

What Is the Incubation Period of Rubeola?

The incubation period is from ten to fourteen days. It remains infective five days before and after the appearance of rashes.

What Are the Symptoms of Rubeola?

The prodromal phase symptoms include fever, cough, conjunctivitis, malaise, and Koplik’s spots.

Koplik’s Spots: They are small, irregularly shaped, white spots surrounded by erythema in the buccal mucosa. They appear two days before the rashes appear. They have an appearance similar to table salt crystals. It can be seen on the mucosa of the buccal region, rectal, and vaginal mucosa.

Erythematous Patches: Brick red-colored, irregular maculopapular rash appears three to four days after the onset. It appears in the neck, trunk, and upper arms within 24 hours. In the next 24 hours, it spreads over the back, abdomen, and thighs. It then starts affecting the palms and soles at last. The rash lasts for four days, and it fades away. Hyperpigmentation remains in fair-skinned individuals.

What Is Atypical Measles?

It is a syndrome occurring in adults who received the inactivated measles vaccine. After vaccination, when they come in contact with the wild-type measles virus, atypical measles occurs. The patients might experience high fever without different prodromal symptoms. There might be a severe headache, abdominal pain, vomiting, and the rash first appear in the palms and soles. Later, these rashes progress in a centripetal direction. The maculopapular rash becomes vesicular and hemorrhagic. The vesicular type contains fluid-filled blisters. Koplik spots are uncommon.

What Happens When You Get Measles During Pregnancy?

Measles during pregnancy is not known to cause congenital abnormalities in the fetus. However, it may induce abortion or premature delivery and may cause severe complications in mothers. It is recommended that infants born to such mothers should be passively immunized with immunoglobulin at birth.

What Are the Complications of Rubeola?

• Postinfectious encephalomyelitis. This might induce vomiting, convulsions, coma, and neurological defects. This can occur in 0.1 % of cases.

• Guillain-Barre syndrome, cerebral thrombophlebitis, and hemiplegia are also known to be manifested.

• Subacute Sclerosing Panencephalitis (SSPE): It is a very late central nervous system complication. This can happen five to fifteen years after the infection. The measles virus acts as a slow virus to produce degenerative CNS disease. Subacute Sclerosing Panencephalitis primarily affects children and very rarely develops in adults. The clinical manifestations are personality changes, developmental retardation, dementia, myoclonic jerks, cerebellar ataxia, and various motor disabilities degrees. The CT scans and MRI scans reveal variable cortical atrophy and ventricular enlargement with focal or multifocal lesions in the brain’s white matter.

• Respiratory complications may be present. They include bronchiolitis, bronchopneumonia, pneumonia, and exacerbation of pulmonary tuberculosis.

• Otitis media. It is an inflammatory disorder affecting the middle ear. This might occur due to the sudden onset of infection. It may be accompanied by pain. Some people are prone to have multiple ears infection.

• Cervical adenitis is common.

• Conjunctivitis, keratitis, and retrobulbar neuritis might also occur.

• Diarrhea and protein-losing enteropathy can occur in malnourished children.

How Is Rubeola Diagnosed?

The doctor will recommend performing a blood test and tissue cultures. Clinical examination is also an important part of the diagnosis.

• Clinical methods mostly make the diagnosis.

• Detection of measles with specific IgM antibodies using a blood test.

• Isolation of viruses from the individual by tissue culture.

What Are the Treatment Options for Rubeola?

• Vaccination with the measles vaccine should be given within 72 hours of exposure. Newborn babies should not be given a vaccination for measles until they are twelve months of age. However, they will be receiving passive immunity from the mother’s breast milk.

• There is no specific antiviral therapy. Vitamin A supplementation might be given if it is needed.

• Medications such as Acetaminophen and Ibuprofen can be given to reduce fever. A humidifier can be given to ease the sore throat.

• Adequate intake of fluids is recommended.

• Nutrients should be taken in adequate amounts.

• Antimicrobials for secondary infection.

What Is Rubella?

Rubella is also known as German measles. Rubella is a systemic disease caused by a togavirus transmitted by inhalation of infective droplets. The incubation period is two to three weeks. The importance of rubella lies in its teratogenic effect on the fetus. Teratogenic effects determine the physiological changes in the fetus.

What Are the Clinical Features of Rubella?

• No symptoms are seen in children, but mild symptoms are seen in adults. The symptoms might be in the form of fever, malaise, and inflammation of the mucous membrane.

• Posterior cervical and postauricular lymphadenopathy might be seen five to seven days before the appearance of the rash.

• A fine maculopapular rash appears on the face and then spreads to the trunk and extremities occurs.

What Are the Complications of Rubella?

The complications of rubella are:

• Hepatitis.

• Encephalitis.

• Thrombocytopenia.

How Is Rubella Diagnosed?

• Detection of rubella IgM in serum or by IgG seroconversion.

• Isolation of viruses by culture techniques.

What Are the Treatment Options for Rubella?

• Treatment is symptomatic and supportive.

• All women of child-bearing age should be tested for rubella. They should get vaccinated if necessary.

• Prevention is better, so MMR must be given to all children.

What Is the Differential Diagnosis?

• Pharyngitis.

• Tonsillitis.

• Centrally coated tongue.

• Moderate generalized lymphadenopathy.

• Splenomegaly.

What Are the Preventive Measures for Rubella and Rubeola?

• MMR (measles, mumps, rubella) vaccine is given at the age of six months. The second dose is given at the age of four to six years. The measles vaccine is contraindicated in pregnancy. It is also contraindicated in patients with untreated tuberculosis, malignancy, organ transplant, and those with a weak immune system.

• Post-exposure Prophylaxis: Children should be vaccinated with MMR within 72 hours after exposure. Immunocompromised children, children with malignancy, and patients with AIDS should be given 0.5ml of immunoglobulin (maximum 15ml) intramuscular injection, irrespective of immunity status, six days after exposure.

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