In apparent measles infection

• A subclinical form of measles may occur in individuals

with passively acquired antibody , such as infants and
recipients of blood products .
• In such a case , rash may be indistinct , brief , or some
times entirely absent .
• In some children who have received vaccine , when
exposed to measles , may have a rash but few other
symptoms .
• Children with in apparent or subclinical measles do not
transmit measles virus and disease to other contacts .
 Diagnosis
• Diagnosis is primarily clinical .
• During the prodromal stage , multinucleated giant
cells can be demonstrated in smears of nasal mucosa
.
• Virus can be isolated in tissue culture or antibody
titer can be detected in serum .
• White blood cell count is low with relative
lymphocytosis .
• Lumber puncture in encephalitis shows an increase
in protein and small increase in lymphocytes
 Differential diagnosis
• Typical measles is unlikely to be confused with other illnesses ,
especially if koplik spots are observed
• Roseola infantum (exanthem subitum ) in this when rash appears fever
subsides as against measles in which temperature also rises with the
appearances of rash .
• Rubella , Echo and Coxsackie infections . In these rash is less striking
than that of measles , fever and severity of illness is also less . There
are no koplik spots and lymphadenopathy may be prominent
• Scarlet fever . The rash of scarlet fever is diffuse ,finely papular with a
sandpaper feel most marked on the abdomen .
• Meningococcemia . It may be accompanied by maculopapular rash but
more commonly it is petechial with marked toxicity and hypotention
but cough and conjunctivitis are usually absent
 Drug rash
• There is a history of ingestion of offending drug or injection
and there is no accompanied cough .
• Erythema infectiosum . It is charaterized by erythematous
eruption on the face followed after 1 day by a
maculopapular eruption with lacy pattern .
• Infectious mononucleosis .
• Kawasaki disease . Kawasaki syndrome can cause many of
the same findings as measles but there are no kpolik spots
and severe prodromal cough , the characteristic
thrombocytosis of kawasaki syndrome is absent in measles
.
 Comlication
• Respiratory system : Otitis media and pneumonia may occur . Pneumonia is the most
common cause of death in measles .
• Encephalitis : it occur in 1:1000 cases with coma , convulsions and bizarre behavior 3
—8 days after the onset of rash . Diagnosis is confirmed by CSF pleocytosis , raised
protein and normal glucose content .
• Hemorrhagic ( black ) measles : in fulminant measles hemorrhage may occur in to
GIT , mucous membrane and CNS . Fever and toxicity is pronounced .
• Thromobocytopenia . May occur with bleeding in to the rash .
• GIT complication : post measles gastroenteritis is common , often with a fatal
outcome . Noma or gangrene of mouth may occur .
• Eye : Corneal ulceration , conjunctivitis and optic nerve damage may occur rarely .
• Heart : myocarditis and cardiac failure occur occasionally .
• Miscellaneous : measles leads to immunosuppresion and may cause flaring up of
quiescent tuberculosis or pyogenic infections . Anergy to tuberculin is frequent .
Nephrosis , eczema and asthma may abate after measles infection . Extreme
marasmus and kwashiorkor may develop after measles .
 Management
• Treatment is mainly supportive .
• Good nursing care is essential .
• There is no specific antiviral therapy .
• Antipyretic (paracetamol or ibuprofen ) for high fever , relief of
cough , maintenance of clear nasal passages , sedatives , bed rest
and adequate fluid intake are essential .
• Humidification of the room may relieve the irritating cough by
making the room comfortably warm .
• Bacterial super infections should be treated with antimicrobial
therapy .
• Complications should be treated accordingly .
• Gamma globulin and steroid are of limited value .