-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