Measles: Case StudyHiro LandazuriKarla GonzalezJonathan Chen

Case

• An 18 yr old freshman complained of a cough, runny nose, and conjunctivitis. The physician in the campus health center noticed small white lesions inside the patient’s mouth. The next day, a confluent red rash covered his face and neck.

Overview

• Rubeola• Paramyxovirus -

Morbillivirus• Negative-sense

ssRNA• F (fusion) protein/H

(hemoagglutanin) protein

http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm

Overview

• Systemic infection– Respiratory transmission– Primary site of infection =

nasopharynx• Primary viremia (2-3 days

post exposure)• Secondary viremia (5-7 days

post exposure)

http://www.homehealth-uk.com/image_01/image/throatdiagram.gif

Physical Diagnosis

• The 3 C’s– Cough, coryza,

conjunctivitis• Koplik’s spots• MV rash

– Maculopapular• Macule – red lesion

flushing• Papule – raised red lesion

dermatlas.med.jhmi.edu

Koplik’s Spots

Conjunctivitis

MV rashhttp://en.wikipedia.org/wiki/Conjunctivitis

http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm

Laboratory Diagnosis

• Isolation of MV from clinical specimen

• Serodiagnosis

– IgM ab (ELISA)

– IgG ab• ELISA, HI, Indirect flourescent ab test,

microneutralization, plaque reduction neutralization, complement fixation

Complement Fixation AssayPositive Negative

http://web.indstate.edu/thcme/PSP/labtests/complementfix.htm

Treatment

• No treatment• Supportive Care Only

– Tylenol, Non-steroidal anti-inflammatory drugs like Advil, Aspirin, Motrin etc.

– Isolation– Vitamin K– Hydration– Post-exposure Prophylaxis

• Antibiotics for serious complications (rare)Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).

When was this patient contagious?

• Course of the infection– Incubation 7-14 days– Initial symptoms immediately following incubation:

cough, coryza, conjunctivitis, fever – Koplik’s spots 2-3 days after initial symptoms– Rash appears 4-5 days after the initial symptoms

• Infection communicable four days before his rash appeared to four days afterMayoClinic.com Tools for Healthier Lives, Measles, http://www.mayoclinic.com/print/measles/DS00331/DSECTION=all&METHOD=print (Oct. 29, 2007).

Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).

Why is this disease not common in the United States?

• the United States is a developed country– most children are immunized with MMR (Measles Mumps

Rubella) vaccination– required proof of MMR immunization

• the Measles Initiative is working on standard global immunization for measles

Several possible reasons for patient’s susceptibility to measles at 18 years of age.

• if the patient did not receive MMR vaccinations– allergic reaction to component of MMR

• recent studies have shown no direct correlation

– poor healthcare• undeveloped countries without required MMR

– linking of MMR and autism• studies lacked substantial scientific evidence

• if patient did receive MMR vaccinations– may not have developed immunity

• either way, patient was susceptible to measles and was exposed via– traveling– dorms/college campus