Measles - Revision history

Rossdonaldson1: /* Background */

2024-12-11T17:17:00Z

Background

← Older revision		Revision as of 17:17, 11 December 2024
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	==Background==		==Background==
			{{Skin anatomy background images}}
	*Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]])		*Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]])
	*Patients are contagious from about 4 days before to 4 days after onset of rash		*Patients are contagious from about 4 days before to 4 days after onset of rash

SMReel: /* Management */

2022-10-04T15:57:42Z

Management

← Older revision		Revision as of 15:57, 4 October 2022
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	==Management==		==Management==
	*Supportive care		*Supportive care
	*Vitamin A should be considered for patients ages 6 mo - 2 yrs who are hospitalized, or those who are immunocompromised <ref~~>Sara~~ Bode~~; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542~~/~~aap.ppcqr.396150</ref~~>		*Vitamin A should be considered for patients ages 6 mo - 2 yrs who are hospitalized, or those who are immunocompromised <ref name="Bode"/>

	===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===		===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===

SMReel: /* Clinical Features */

2022-10-04T15:57:00Z

Clinical Features

← Older revision		Revision as of 15:57, 4 October 2022
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	**Usually starts on the face (hairline and behind the ears)		**Usually starts on the face (hairline and behind the ears)
	**Rapidly spreads to the chest, back, and finally the legs and feet		**Rapidly spreads to the chest, back, and finally the legs and feet
	**Rash quickly becomes confluent, produces a characteristic morbilliform rash <ref~~>Sara~~ Bode~~; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542~~/~~aap.ppcqr.396150</ref~~>		**Rash quickly becomes confluent, produces a characteristic morbilliform rash <ref name="Bode"/>
	**Rash resolves in order of appearance between days 7-9		**Rash resolves in order of appearance between days 7-9

SMReel: /* Risk factors */

2022-10-04T15:56:32Z

Risk factors

← Older revision		Revision as of 15:56, 4 October 2022
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	===Risk factors===		===Risk factors===
	*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.		*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
	* Highly contagious, transmitted via respiratory droplets or by airborne transmission <ref>Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>		* Highly contagious, transmitted via respiratory droplets or by airborne transmission <ref name="Bode">Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>
	*Confirmed measles cases in community.		*Confirmed measles cases in community.
	*Never immunized with measles vaccine and born in 1957 or later.		*Never immunized with measles vaccine and born in 1957 or later.

SMReel: /* Management */

2022-10-04T15:46:20Z

Management

← Older revision		Revision as of 15:46, 4 October 2022
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	==Management==		==Management==
	*Supportive care		*Supportive care
			*Vitamin A should be considered for patients ages 6 mo - 2 yrs who are hospitalized, or those who are immunocompromised <ref>Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>

	===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===		===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===

SMReel: /* Clinical Features */

2022-10-04T15:28:03Z

Clinical Features

← Older revision		Revision as of 15:28, 4 October 2022
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	*Prodrome of high [[fever]], [[cough]], coryza, and [[conjunctivitis]] (lasts ~3 days)		*Prodrome of high [[fever]], [[cough]], coryza, and [[conjunctivitis]] (lasts ~3 days)
	*Koplik's spots (appears day 2-3) - pathognomonic enanthem		*Koplik's spots (appears day 2-3) - pathognomonic enanthem
	**Tiny ~~red spots (base) with~~ bluish-white ~~centers~~ on the mucosa of the cheek or palate		**Tiny bluish-white spots on an erythematous base, cluster on the mucosa of the cheek or palate
	*[[Rash]] (begins day 4 - lasts to day 7)		*[[Rash]] (begins day 4 - lasts to day 7)
	**Red, blotchy, and maculopapular; rapidly progresses to confluence		**Red, blotchy, and maculopapular; rapidly progresses to confluence
	**Usually starts on the face (hairline and behind the ears)		**Usually starts on the face (hairline and behind the ears)
	**Rapidly spreads to the chest, back, and finally the legs and feet		**Rapidly spreads to the chest, back, and finally the legs and feet
			**Rash quickly becomes confluent, produces a characteristic morbilliform rash <ref>Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>
	**Rash resolves in order of appearance between days 7-9		**Rash resolves in order of appearance between days 7-9

SMReel: /* Risk factors */

2022-10-04T15:24:29Z

Risk factors

← Older revision		Revision as of 15:24, 4 October 2022
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	===Risk factors===		===Risk factors===
	*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.		*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
			* Highly contagious, transmitted via respiratory droplets or by airborne transmission <ref>Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>
	*Confirmed measles cases in community.		*Confirmed measles cases in community.
	*Never immunized with measles vaccine and born in 1957 or later.		*Never immunized with measles vaccine and born in 1957 or later.

Rossdonaldson1: /* Differential Diagnosis */

2022-08-17T20:06:13Z

Differential Diagnosis

← Older revision		Revision as of 20:06, 17 August 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Peds Rash DDX}}		{{Peds Rash DDX}}

	{{DDX oral rashes and lesions}}		{{DDX oral rashes and lesions}}
			{{Maculopapular rash DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 20:04, 7 June 2022

2022-06-07T20:04:15Z

← Older revision		Revision as of 20:04, 7 June 2022
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	==Background==		==Background==
			*Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]])
			*Patients are contagious from about 4 days before to 4 days after onset of rash

			===Risk factors===
			*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
			*Confirmed measles cases in community.
			*Never immunized with measles vaccine and born in 1957 or later.

			==Clinical Features==
	[[File:Koplik's Spots on Cheek.jpg\|thumb\|Koplik's Spots on Cheek]]		[[File:Koplik's Spots on Cheek.jpg\|thumb\|Koplik's Spots on Cheek]]
	[[File:Koplik's Spots on Palate.jpg\|thumb\|Koplik's Spots on Palate]]		[[File:Koplik's Spots on Palate.jpg\|thumb\|Koplik's Spots on Palate]]
	[[File:Measle's Rash on Face.jpg\|thumb\|Measle's Rash on Face]]		[[File:Measle's Rash on Face.jpg\|thumb\|Measle's Rash on Face]]
	[[File:Measle's Rash on on Thorax.jpg\|thumb\|Measle's Rash on on Thorax]]		[[File:Measle's Rash on on Thorax.jpg\|thumb\|Measle's Rash on on Thorax]]
	*Also known as Rubeola, which is not to be confused with German Measles ([[Rubella]])
	*Patients are contagious from about 4 days before to 4 days after onset of rash

	~~==Clinical Features==~~
	*Consider measles in a patient of any age who has an acute RASH and FEVER		*Consider measles in a patient of any age who has an acute RASH and FEVER
	*Risk factors
	**In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
	**Confirmed measles cases in your community.
	**Never immunized with measles vaccine and born in 1957 or later.
	*Incubation period - 10 days		*Incubation period - 10 days
	*Prodrome of high [[fever]], [[cough]], coryza, and [[conjunctivitis]] (lasts ~3 days)		*Prodrome of high [[fever]], [[cough]], coryza, and [[conjunctivitis]] (lasts ~3 days)

ClaireLewis at 01:12, 15 September 2019

2019-09-15T01:12:18Z

← Older revision		Revision as of 01:12, 15 September 2019
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	==Clinical Features==		==Clinical Features==
	*Consider measles in a patient of any age who has an acute RASH and FEVER		*Consider measles in a patient of any age who has an acute RASH and FEVER
			*Risk factors
			**In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
			**Confirmed measles cases in your community.
			**Never immunized with measles vaccine and born in 1957 or later.
	*Incubation period - 10 days		*Incubation period - 10 days
	*Prodrome of high [[fever]], cough, coryza, and [[conjunctivitis]] (lasts ~3 days)		*Prodrome of high [[fever]], [[cough]], coryza, and [[conjunctivitis]] (lasts ~3 days)
	*Koplik's spots (appears day 2-3) - pathognomonic enanthem		*Koplik's spots (appears day 2-3) - pathognomonic enanthem
	**Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate		**Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
	*Rash (begins day 4 - lasts to day 7)		*[[Rash]] (begins day 4 - lasts to day 7)
	**Red, blotchy, and maculopapular; rapidly progresses to confluence		**Red, blotchy, and maculopapular; rapidly progresses to confluence
	**Usually starts on the face (hairline and behind the ears)		**Usually starts on the face (hairline and behind the ears)
	**Rapidly spreads to the chest, back, and finally the legs and feet		**Rapidly spreads to the chest, back, and finally the legs and feet
	**Rash resolves in order of appearance between days 7-9		**Rash resolves in order of appearance between days 7-9
	*~~Obtain a history~~ of measles ~~immunization~~, ~~contact with known outbreak, travel outside~~ of the ~~Americas, or contact with international travelers in recent weeks~~
			===Complications===
			*Secondary infection
			**Measles virus can directly infect T cells, leading to systemic immune suppression and secondary infections
			*Gastrointestinal
			**[[Diarrhea]] is the most common complication
			** Others: gingivostomatitis, [[gastroenteritis]], [[hepatitis]], mesenteric lymphadenitis, and [[appendicitis]]
			*Pulmonary
			**Pneumonia is the most common cause of measles-associated death in children
			*Neurologic
			**[[Encephalitis]]
			**Acute disseminated encephalomyelitis
			***Demyelinating disease thought to be a postinfectious autoimmune response
			**Subacute sclerosing panencephalitis
			***A fatal, progressive degenerative disease of the CNS that usually occurs 7 to 10 years after natural measles virus infection

	==Differential Diagnosis==		==Differential Diagnosis==
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	Providers should consider measles in patients with FEVER AND a descending RASH in a person with a history of travel or contact with someone who has travelled outside North America <u>whether or not the patient has had 2 doses of MMR or prior measles disease</u>. However, persons without a history of travel or exposure to a traveler, are unlikely to have measles in the absence of confirmed measles cases in your community.		Providers should consider measles in patients with FEVER AND a descending RASH in a person with a history of travel or contact with someone who has travelled outside North America <u>whether or not the patient has had 2 doses of MMR or prior measles disease</u>. However, persons without a history of travel or exposure to a traveler, are unlikely to have measles in the absence of confirmed measles cases in your community.

	~~Symptoms plus risk factors should make providers suspect measles:~~		==Management==
	~~#Symptoms~~		*Supportive care
	~~#*Fever, including subjective fever.~~
	~~#*Rash that starts on the head and descends.~~
	~~#*Usually 1 or 2 of the “3 Cs” – cough, coryza and conjunctivitis.~~
	~~#Risk factors~~
	#*In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.
	~~#*Confirmed measles cases in your community.~~
	#*~~Never immunized with measles vaccine and born in 1957 or later.~~

	~~==Management==~~
	===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===		===Suspected Active Measles Case<ref name="CA Advisory 4-2019">California Department of Public Health Health Advisory: Measles Clinical Guidance: Identification and Testing of Suspect Measles Cases. April 3, 2019</ref>===
	#Isolate patient immediately (see below)		#Isolate patient immediately (see below)
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	*Discuss with public health		*Discuss with public health
	**Patients may be admitted with isolation to prevent public health spread vs. discharged with home isolation precautions		**Patients may be admitted with isolation to prevent public health spread vs. discharged with home isolation precautions

	~~==Complications==~~

	* Secondary infection
	** Measles virus can directly infect T cells, leading to systemic immune suppression and secondary infections
	*Gastrointestinal
	**Diarrhea is the most common complication
	** Others: gingivostomatitis, gastroenteritis, hepatitis, mesenteric lymphadenitis, and appendicitis
	*Pulmonary
	** Pneumonia is the most common cause of measles-associated death in children
	*Neurologic
	**[[Encephalitis]]
	**Acute disseminated encephalomyelitis
	*** Demyelinating disease thought to be a postinfectious autoimmune response
	** Subacute sclerosing panencephalitis
	*** A fatal, progressive degenerative disease of the CNS that usually occurs 7 to 10 years after natural measles virus infection

	==See Also==		==See Also==