Rubeola, also known as the measles or morbilli, is an acute, highly contagious paramyxovirus infection that may be one of the most common and most serious of all communicable childhood diseases. Use of the vaccine has reduced the occurrence of measles during childhood; as a result, measles is becoming more prevalent in adolescents and adults. (See Administering measles vaccine.) In the United States, the prognosis is usually excellent; however, measles is a major cause of death in children in underdeveloped countries.
Measles is spread by direct contact or by contaminated airborne respiratory drop-lets. The portal of entry is the upper respiratory tract. In temperate zones, incidence is highest in late winter and early spring. Before the availability of measles vaccine, epidemics occurred every 2 to 5 years in large urban areas.
Incubation is from 8 to 14 days. Initial symptoms begin and greatest communicability occurs during the prodromal phase, about 11 days after exposure to the virus. This phase lasts from 4 to 5 days; signs and symptoms include fever, photophobia, malaise, anorexia, conjunctivitis, coryza, hoarseness, and hacking cough.
At the end of the prodrome, Koplik's spots, the hallmark of the disease, appear. These spots look like tiny, bluish white specks surrounded by a red halo. They appear on the oral mucosa opposite the molars and occasionally bleed. About 5 days after Koplik's spots appear, temperature rises sharply, spots slough off, and a slightly pruritic rash appears. This characteristic rash starts as faint macules behind the ears and on the neck and cheeks. The macules become papular and erythematous, rapidly spreading over the entire face, neck, eyelids, arms, chest, back, abdomen, and thighs. When the rash reaches the feet (2 to 3 days later), it begins to fade in the same sequence that it appeared, leaving a brownish discoloration that disappears in 7 to 10 days. (See Incubation and duration of common rash-producing infections, page 232.)
The disease climax occurs 2 to 3 days after the rash appears and is marked by a fever of 103° to 105° F (39.4° to 40.6° C), severe cough, puffy red eyes, and rhinorrhea. About 5 days after the rash appears, other symptoms disappear and communicability ends. Symptoms are usually mild in patients with partial immunity (conferred by administration of gamma globulin) or infants with transplacental antibodies. More severe symptoms and complications are more likely to develop in young infants, adolescents, adults, and patients who are immunocompromised than in young children.
Atypical measles may appear in patients who received the killed measles vaccine. These patients are acutely ill with a fever and maculopapular rash that's most obvious in the arms and legs or with pulmonary involvement and no skin lesions.
Severe infection may lead to secondary bacterial infection and to autoimmune reaction or organ invasion by the virus, resulting in otitis media, pneumonia, and encephalitis. Subacute sclerosing panencephalitis, a rare and invariably fatal complication, may develop several years after measles but it's less common in patients who have received the measles vaccine.
Diagnosis rests on distinctive clinical features, especially the pathognomonic Koplik's spots. Mild measles may resemble rubella, roseola infantum, enterovirus infection, toxoplasmosis, and drug eruptions; laboratory tests are required for a differential diagnosis. If necessary, measles virus may be isolated from the blood, nasopharyngeal secretions, and urine during the febrile period. Serum antibodies appear within 3 days after onset of the rash and reach peak titers 2 to 4 weeks later.
Treatment for measles requires bed rest, relief of symptoms, and droplet isolation throughout the communicable period. Vaporizers and a warm environment help reduce respiratory irritation, and antipyretics can reduce fever. Cough preparations and antibiotics are generally ineffective. I.V. ribavirin has reduced the severity of illness in adults. Therapy must also combat complications.
❑Teach the patient's parents supportive measures, and stress the need for isolation, plenty of rest, and increased fluid intake. Advise them to cope with photophobia by darkening the room or providing sunglasses and to reduce fever with antipyretics and tepid sponge baths.
❑Warn the patient's parents to watch for and report the early signs and symptoms of complications, such as encephalitis, otitis media, and pneumonia.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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