8/4/2019 Pbl Violet Measles-1

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Violet has cough, fever, runny nose, watery eyes, blotchy red rash that spreads from

face to trunk and upper extremities.

Her lymph nodes are normal and she does not have a sore throat.

Differential DX: Common causes of the fever, rash, conjunctivitis triad:

Rubella = Distinctive lymphadenopathy, called “mild measles”, NO COUGH 

Kawasaki’s disease aka mucocutaneous lymph nodes = associated with cervical

lymphadenopathy

Infectious mononucleosis – characterized by sore throat, lymphadenopathy,

maculopapular rash uncommon

Roseola – Fever precedes rash

Scarlet fever – usually associated with strep pharyngitis. NO SORE THROAT

Rocky Mountain Spotted Fever – Wrong region, no tick bites, Rash is PETECHIAL,

PAPULAR

Drug Reaction – no drugs

Measles

Pertinent negatives = Absence of lymphadenopathy, Absence of sore throat.

This allows us to eliminate Rubella (DISTINCTIVE LYMPHADENOPATHY, No cough),

Kawasaki (No lymphadenopathy), Mono (No lymphadenopathy, no sore throat, rashis rare), Scarlet fever (No sore throat)

That leaves us with Roseola, Rocky Mountain Fever, Measles.

With Roseola, rash tends to follow fever. With Rocky Mountain Fever there should

be history of tick bite (may not be unreasonable considering she’s homeless, but her

rash doesn’t sound like it’s petechial or popular).

 About Measles:

-  highly contagious. Spreads through nasopharyngeal secretions by air ordirect contact.

Life cycle: the virus multiplies in respiratory mucous membranes and in

conjunctival membranes before entering the blood to infect leukocytes. Once it has

infiltrated leukocytes it begins to multiply greatly before disseminating throughout 

the body. After dissemination occurs, the immune response mounts and symptoms

begin.

8/4/2019 Pbl Violet Measles-1

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The life cycle explains why we don’t see signs of measles until 10 days after

infection.

PRODROMAL PHASE is characterized by:

-  Fever and malaise followed by cough and conjunctivitis.

These symptoms worsen over the course of about 4 days.

-  Koplik’s spots = small bluish white spots surrounded by erythema mouth

usually develop a day or two before the rash. WE DID NOT SEE THESE BUT

o  Koplik’s spots tend to fade with the onset of rash. 

The characteristic rash starts a few days after the fever or ~2 weeks after infection.

The rash is erythematous macules that start behind the ears at the hairline. It 

progresses down the face, trunk, and arms and moves onto legs and feet within a

couple days. It fades slowly away in the order in which it appeared 3-4 days after

onset (show picture).

Diagnosis:

Usually diagnosed based on symptoms. Blood test for Measles virus specific IgM or

IgG is confirmatory. Antibodies for the virus are also detectable within 1-3 days of 

rash onset.

Treatment:

Usually given supportive measures like hydration unless secondary bacterial

infection is detected.

WHO recommends doses of Vitamin A for 2 days after infection.

Why was she hospitalized??Probably for post measles encephalitis. Occurs in 1/1000. It’s characterized by

fever, seizures, neurologic abnormalities. It’s also probably a good idea considering

Measles fatalities in refugee camps and among displaced populations (like her) are

as high as 20-30%.

Prognosis: She will most likely recover and and have a a long term protective

immunity against reinfection.

Prophylaxis: In immunocompetent persons, administration of 

immunoglobulin within 72 h of exposure usually prevents measles virus infection and almost always prevents clinical measles.

Administered up to 6 days after exposure, immunoglobulin will stillprevent or modify the disease. Prophylaxis with immunoglobulin is

recommended for susceptible household and nosocomial contacts whoare at risk of developing severe measles, particularly children