Measles

Measles - Acute
Rahul Soman, M. Pharm

 

Definition  

Infectious viral disease characterized by a generalized rash lasting 3 or more days, fever (38.3°C or higher), cough, coryza, and conjunctivitis

 

Medical History  

* Occupational Exposure

* Foreign travel history finding

* Overcrowded in house

* Nutritional disorder

* Nonspecific lung disease, chronic

* Finding of immune status

* Patient immunocompromised

* Vaccination failure

 

Findings  

* Stridor

* Abdominal pain - Acute

* Rash - Acute

* Arthralgia

* Conjunctivitis

* Cough

* Diarrhea - Acute

* Fever

* Increased heart rate

* Koplik spots

* Light intolerance

* Loss of appetite

* Lymphadenopathy - Acute

* Maculopapular eruption

* Myalgia

* Nasal discharge

* Pain in eye

* Pain in throat

* Splenomegaly

* Tachypnea

* Vomiting

 

Tests  

 

Suspected or known measles exposure  

* Measles antibody level: Measle-specific immunoglobulin M (IgM) serology is the standard rapid test for laboratory confirmation of measles .

 

Suspected or known measles  

* PCR test for measles: Reverse-transcriptase polymerase chain reaction analysis directly detects measles virus RNA .

 

Suspected or known measles  

* Complete blood count: Leukopenia, lymphocytosis, and anemia are possible in measles .

 

Differential Diagnosis  

* Scarlet fever

* Adverse reaction to drug - Acute

* Transfusion reaction due to serum protein reaction

* Erythema multiforme - Acute

* Disease due to Enterovirus

* Rocky Mountain spotted fever - Acute

* Rubella - Acute

* Roseolar erythema

* Erythema infectiosum - Acute

* Cytomegalovirus infection - Acute

* Leptospirosis

* Pityriasis rosea

 

Treatment  

 

Drug Therapy  

 

Fever  

 

ACETAMINOPHEN \

Adults: 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

ASPIRIN

Adults: 650 mg orally every 4 to 6 hours

Pediatrics: not to be used in children

 

Measles infection in children aged 6 months to 2 years hospitalized with complications; children older than 6 months not receiving vitamin A supplementation who are at risk of vitamin A deficiency  

 

VITAMIN A  

Pediatrics (6 months to 1 year): 100,000 International Units orally; if ophthalmologic evidence of vitamin A deficiency, repeat dose the next day and 4 weeks later

Pediatrics (?1 year): 200,000 International Units orally; if ophthalmologic evidence of vitamin A deficiency, repeat dose the next day and 4 weeks later

 

 

Patients with measles from developing countries with populations at risk of vitamin A deficiency  

 

VITAMIN A  

Pediatrics (<6 months): 50,000 International Units orally on 2 consecutive days and 1 additional dose at least 2 weeks later

Pediatrics (6 to 12 months): 100,000 International Units orally on 2 consecutive days and 1 additional dose at least 2 weeks later

Pediatrics (>12 months): 200,000 International Units orally on 2 consecutive days and 1 additional dose at least 2 weeks later

 

Postexposure measles prophylaxis  

 

MEASLES, MUMPS, AND RUBELLA VIRUS VACCINE, LIVE  

Adults: 0.5 mL subcutaneously

Pediatrics (>12 months): 0.5 mL subcutaneously

 

IMMUNE GLOBULIN  

Adults (immunocompetent): 0.25 mL/kg IM (maximum 15 mL)

Adults (immunocompromised): 0.5 mL/kg IM (maximum 15 mL)

Pediatrics (immunocompetent): 0.25 mL/kg IM (maximum 15 mL)

Pediatrics (immunocompromised): 0.5 mL/kg IM (maximum 15 mL)

 

Procedural Therapy  

 

Suspected or known measles  

* Isolation procedure: Respiratory isolation is important to prevent the spread of measles in the outpatient and inpatient setting .

 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

 

Determination of measles immune status  

* Measles antibody level: Most individuals with a detectable measle-specific antibody (titers of 4 or greater) are likely immune to the disease .