Measles (Rubeola/Morbilli)
Definition of Measles:
-
an acute, contagious and
exanthematous disease that usually affects children which are susceptible to
URTI.
Etiologic Agent: Filtrable virus that belongs to genus
Morbilivirus of the family paramyxoviridae.
- rapidly inactivated by heat, ultraviolet light, and
extreme degrees of acidity and alkalinity.
Incubation
Period of Measles
·
10 to 12
days
·
Single
attack conveys a lifelong immunity.
Period of Communicability: usually lasts about 9 to 10 days,
from the beginning of the prodromal symptoms to the fading of the rash.
·
The disease
is communicable 4 days before and 5 days after the appearance of rashes.
·
The disease
is most communicable during the height of rash.
Sources of Infection:
·
patient’s blood
·
Secretions from the eyes,
nose and throat.
Mode of
Transmission of Measles
1. Through direct contact with the droplets spread through
coughing & sneezing
2. Indirect contact (articles or fomites freshly
contaminated with respiratory secretions of infected patients.
Pathognomonic
Sign of Measles
Koplik’s spots - inflammatory lesions of the buccal
mucous glands with superficial necrosis.
2. They appear on the mucosa of the inner cheek opposite to
the second molars, or near the junction of the gum and the inner cheek.
3. They usually appear 1 to 2 days before the measles rash.
Clinical
Manifestations of Measles (3 Stages)
1. Pre-eruptive stage
a. fever
b. catarrhal symptoms (rhinitis, conjunctivitis,
photophobia, coryza)
c. respiratory symptoms start from common colds to
persistent coughing
d. enanthema sign (Koplik’s spot)
2. Eruptive stage
a. the rash is usually seen late on the 4th day.
b. maculo-papular rash appears first on either the cheeks,
bridge of the nose, along the hairline, at the temple or at the earlobe.
c. the rash is fully developed by the end of the second day
and all symptoms are at their maximum at this time.
d. High grade fever comes on and off.
e. Anorexia and irritability.
f. Abdominal tympanism, pruritus, lethargy
g. The throat is red and often extremely sore.
h. As fever subsides, coughing may diminish, but more often
it hangs on for a week or two, become looser and less metallic.
3. Stage of Convalescence
a. rashes fade away in the manner as they erupted.
b. fever subsides as eruption disappears.
c. when the rashes fade, desquamation begins.
d. symptoms subside and appetite is restored.
Diagnostic
Procedures of Measles
·
Nose and
throat swab
·
Urinalysis
·
Blood exams
(CBC, leukopenia, leukocytosis)
·
Complement
fixation or hemogglutinin test
Modalities
of Treatment of Measles
·
Anti-viral drugs
(Isoprenosine)
·
Antibiotics
if with complication
·
Supportive
therapy (oxygen inhalation, IV fluids)
Unfavorable
Signals of Measles
1. Violent onset with high grade fever
2. Fading eruption with rising fever
3. Hemorrhagic or black measles
4. Persistence of fever for 10 days or more
5. Slight eruptions accompanied by severe symptoms,
especially those of encephalitis.
Nursing
Management of Measles
1. Isolation of the patient is necessary (the room must be quiet,
well ventilated, and must have subdued light)
2. Control the patient’s high temperature with warm or tepid
sponges.
3. Skin care is utmost.
4. Provide oral and nasal hygiene.
5. Care of the eyes. The patient is sensitive to light. Keep
eyes free of secretions.
Preventive
Measures of Measles
Immunization with:
·
Anti-measles
at the age of 9 months, as single dose
·
Mumps,
measles, rubella (MMR) vaccine to be given at 15 months, 2nd dose at 11
to 12 years.
·
Measles
vaccine should not be given to pregnant women or to persons with active
tuberculosis, leukemia, lymphoma or depressed immune system.
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