Measles B05.99

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

1. infectious disease; flying infection; Measles; Morbilli; Morbilli (lat. diminutive form of "Morbus; Rosolia; Rougéole; Sarampion; was formerly used to distinguish measles from plague = "Morbus")

History
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ar-Razi (Rhazes), 900

Definition
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Severe, highly contagious (transmitted by droplet infection), notifiable(obligation to report by name in case of suspicion and manifest disease) infectious disease caused by an RNA virus (family of paramyxoviruses) with typical exanthema and enanthema.

Pathogen
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Measles virus (RNA virus of the paramyxovirus family. Transmission by droplet infection. Infectious during the catarrhal stage and in the first days of exanthema.

Occurrence/Epidemiology
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Worldwide, around 200,000 people contract measles every year (mainly in African countries). The prevalence is almost 100%. In Germany, local outbreaks with varying numbers of cases are repeatedly reported. According to the Robert Koch Institute, 2,464 cases were reported in Germany in 2015, 325 cases in 2016 and just over 900 cases in 2017.

Manifestation
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Mostly occurring in childhood.

Clinical features
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  • Stage-like course.
    • Incubation period: 8-10 days until prodromia, 14 days until exanthema
    • Catarrhal prodromal stage: severe generalized feeling of illness, fever up to 40 °C, rhinitis, conjunctivitis, photophobia, pharyngitis, tracheitis, generalized lymphadenopathy. On the 2nd to 3rd day coplik spots (white spots of the cheek mucosa opposite the molars), defibrillation with rapid temperature rise with simultaneous development of enanthema and exanthema.
    • Exanthematic stage: On the 3rd day of the disease, enanthema of the palate, tonsils, uvula. Large red, round or oval, initially pale and then dark red spots, also haemorrhagic; spots tend to confluence.
    • Craniocaudal course beginning first behind the ears, then on the neck and trunk, and finally on the extremities. Enlargement and confluence of the spots. After 3-4 days of temperature drop, fading of the exanthema in the mentioned order. Small lamellar white (bran-like) scaling of the affected skin areas.
  • Special forms of progression:
    • Abortive form: Morbilloid
    • Measles pemphigoid
    • Primary toxic measles: Foudroyanter course with somnolence, hyperpyrexia, bloody stools, circulation disorders, cramps and lethal outcome is possible.

Laboratory
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Prodromal stage: Leukocytosis. Exanthematic stage: leukopenia, neutropenia, thrombopenia, eosinopenia. A previously positive tuberculin test can become negative!

Diagnosis
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Clinical picture, titre increase by 2 levels in the haemagglutination inhibition test.

Differential diagnosis
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Complication(s)
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Industrialized countries: in 10-15% of cases bronchopneumonia, otitis media, measles croup. Rare: measles encephalitis, subacute sclerosing panencephalitis. Complications are due to virus-induced immunosuppression which persists for about 6 weeks.

The occurrence of TEN after measles vaccination has been described in the literature.

General therapy
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Isolation of patients for 4-5 days after the start of exanthema.

External therapy
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In the exanthematic stage drying external substances such as shaking mixtures or solutions with antiseptic additives, e.g. 2% Clioquinol-Lotio R050. If necessary, antiseptic mouth rinses with chlorhexidine (e.g. R045, Hexoral).

Internal therapy
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  • For children at risk or immunosuppressed, IVIG therapy, e.g. with gamma globulin (e.g. beriglobin 0.2-0.5 ml/kg bw i.m.), effective until the 3rd day after contact (between the 4th to 7th incubation day, possibly attenuated course of disease).
  • Otherwise symptomatic therapy: In the prodromal stage, bed rest in darkened rooms and, if necessary, antipyretic measures such as paracetamol (e.g. ben-u-ron juice or supplements) 15 mg/kg bw as ED, up to 50 mg/kg bw/day. expectorant measures such as acetylcysteine (e.g. ACC granules): infants 100 mg/day, children 200-400 mg/day, adults and adolescents 600 mg/day. Liquid and electrolyte supply.
  • In case of bacterial superinfection (e.g. skin, bronchopneumonia), if necessary, hospitalization and antibiotic treatment, initially with broad-spectrum antibiotics such as dicloxacillin (e.g. InfectoStaph), then after an antibiogram. Depending on the clinic, intensive medical care if necessary.
  • In case of laryngotracheitis with croup (danger of suffocation!) emergency admission to the clinic.

Prophylaxis
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Active immunization with weakened live vaccines towards the end of the 1st year of life. Repeat vaccination between the ages of 3 and 6.

Literature
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  1. Afzal MA (2000) Clinical safety issues of measles, mumps and rubella vaccines. Bull World Health Organ 78: 199-204
  2. Bellini WJ et al (2003) The challenges and strategies for laboratory diagnosis of measles in an international setting. J Infect Dis 187: S283-290
  3. Duke T et al (2003) Measles: not just another viral exanthem. Lancet 361: 763-773
  4. Hellenbrand W et al (2003) Progress towards measles elimination in Germany. J Infect Dis 187: S208-216
  5. Pereira FA et al (2007) Toxic epidermal necrolysis. J Am Acad Dermatol 56: 181-200
  6. RKI (2017) Epidemiological Bulletin. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2017/Ausgaben/16_17.pdf?__blob=publicationFile
  7. Spika JS et al (2003) Measles and rubella in the World Health Organization European region: diversity creates challenges. J Infect Dis 187: S191-197

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020