A viral infection that's serious for small children but is easily preventable by a vaccine. The disease spreads through the air by respiratory droplets produced from coughing or sneezing. Measles symptoms don't appear until 10 to 14 days after exposure. They include cough, runny nose, inflamed eyes, sore throat, fever and a red, blotchy skin rash. There's no treatment to get rid of an established measles infection, but over-the-counter fever reducers or vitamin A may help with symptoms.

1. MEASLES

2. Etiology
• Pathogen: Morbillivirus = RNA virus of the Paramyxoviridae family
• Route of transmission: direct contact with or inhalation of virus-containing droplets.
Spreads 4 days before and 5 days after the rash.
• The disease is highly contagious. SAR= 90%
• More common in developing countries
• More common in children 5-10 years

3. Clinical features
Incubation period∼ 2 weeks after infection
Prodromal stage (catarrhal stage)
o Duration: lasts ∼ 4–7 days
o Coryza, Cough, and Conjunctivitis (the “3 Cs”) , Fever
o Koplik spots - Koplik spots, considered as pathognomonic of measles, appear opposite the
lower second molars on the buccal mucosa on the second or third day of the illness as gray or
white lesions resembling grains of sand with surrounding erythema.
Exanthema stage- As natural antibody develops, the maculopapular rash appears, spreading from the
face to the extremities
o Duration: appears 1–2 days after enanthema and lasts ∼ 7 days
o High fever, malaise
o Generalized lymphadenopathy
o Erythematous maculopapular, blanching, partially confluent exanthem. Usually begin in
the face, frequently behind the ears along the hairline.Disseminates to the rest of the body
towards the feet. The rash begins to fade after ∼ 5 days of onset; leaving a brown discoloration
and desquamation in severely affected areas
Recovery stage -The cough may persist for another week and it may be the last remaining symptom.

5. Complications
• Bacterial superinfection: otitis media, pneumonia, laryngotracheitis
• Gastroenteritis
• (Viral) giant-cell pneumonia, Bronchopneumonia, activation of tuberculosis
• Acute encephalitis
• Acute disseminated encephalomyelitis may develop within weeks
• Subacute sclerosing panencephalitis (SSPE): a lethal,
generalized, demyelinating inflammation of the brain caused by persistent measles
virus infection

6. Investigations
• Clinical evaluation
• Serology – IgM antibody( becomes positive only after appearance of rash)
• Gold standard: detection of Measles-specific IgM
• IgG antibodies
• Isolation of virus in human embryonic or monkey kidney cells
• During prodromal stage giant cells can be demonstrated in nasal mucosa smears.
Cytopathic changes seen after 5-10 days – multinucleated giant cells and intranuclear
inclusion bodies.
• CBC: ↓ leukocytes, ↓ platelets
• Identification of pathogen
• Direct virus detection via reverse-transcriptase polymerase chain reaction possible

7. Treatment
• No specific antiviral treatment
• Only supportive
• Antipyretic drugs for fever
• Bed rest and adequate fluid administration
• Management of complications
• Administration of Vitamin A ( reduces morbidity and mortality)
❑ 100,000 IU oral single dose for 6M – 1Yr
❑ 200,000 IU oral single dose for >1yr
❑If ophthalmic complications its given for 4 weeks
Corticosteroids are of little value
Prophylaxis - MMR vaccine