-IBIS-1.5.0-
tx
cutaneous system
rubeola
diagnoses

definition and etiology

definition:
an extremely contagious acute viral disease recognized by buccal eruption (Koplik's spots), fever, cough, conjunctivitis, nasal discharge, and a diffuse maculopapular skin rash; also called "measles" and "nine-day measles".

etiology:
The disease is spread through exposure to nasopharyngeal secretions by direct contact or through the air. In the U.S., the disease is now mainly seen in teenagers and young adults. Rubeola is contagious 2-4 days before the rash appears and continues to be communicable throughout the entire acute phase. There is no carrier state, and one episode of measles normally confers lifelong immunity. Atypical measles syndrome is seen in those patients who had been previously vaccinated with the original vaccination of killed virus (which is no longer available). Apparently the inactivated viral vaccinations did not prevent wild measle virus attacks, and markedly changed the disease presentation.

signs and symptoms

signs and symptoms: incubation period is 7-14 days; prodrome includes:
• malaise
• fever: up to 105° F
• coryza
• conjunctivitis: with increased lacrimation, photophobia, and edema
• cough: hacking
• Koplik's spots precede the rash; pathognomonic for measles; typically appear on the buccal mucosa by the 1st and 2nd upper molars; may be gray to blue-white and look like little grains of sand; are enclosed by an area of inflammation
• mild pharyngitis

• rash: appears 1-2 days after Koplik's spots; begins around the ears, hairline, face and on the side of the neck, then spreads down the torso (by 24-48 hours), possibly to the extremities by which time the facial eruption begins to disappear; initially brownish-pink then becomes red, maculopapular; disease severity parallels the extent of the rash

• in 3-5 days, the fever falls and the rash begins to fade, leaving a brown discoloration of the skin and fine granular desquamation

atypical measles syndrome:
• abrupt onset of marked fever, headache, abdominal pain, cough
• rash develops within 1-2 days: usually begins on the extremities; is purpuric, maculopapular, vesicular or urticarial
• pneumonia is common

lab findings:
• multinucleated giant cells in the coryza, pharyngeal and buccal mucosa, and even in the urinary sediment
• white cells increased at onset, then leukopenia with relative lymphocytosis
• mild thrombocytopenia in early stages
• (+) viral serologic tests

course and prognosis

Unless complications arise, the disease is typically benign and recovery is unremarkable.

Complications include: otitis media, pharyngitis, croup, bronchiolitis, pneumonia, secondary bacterial infection, acute thrombocytopenic purpura, colic and catarrhal appendicitis. Encephalitis, and subacute sclerosing panencephalitis (SSPE) can occur in rare cases and are extremely dangerous.

differential diagnosis

• rubella
• scarlet fever
• drug reactions
• serum sickness
• roseola infantum
• infectious mononucleosis
• adenovirus infection
• echovirus infection
• coxsackie virus infection


footnotes