Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

956 Measles

■Dry, nonproductive cough

■Pleuritic chest pain

■2–3 days after onset

➣rash appears first on distal extremities and progresses in cepha-

lad direction

➣rash most pronounced on wrists/ankles

➣rash may be maculopapular, vesicular, petechial, and/or pruritic

■respiratory symptoms; dyspnea, rales

■hepatosplenomegaly

■marked hyperesthesia

■numbness, paresthesia

tests

Nonspecific

■leukopenia

Specific

■most utilized test if measles-specific IgM – usually detectable 3–4

days after onset of rash, no longer detectable 30–60 days after onset

■Measles can be isolated from the nasopharynx, conjunctiva, and/or

urine during acute phase

■Atypical measles; high titers

■SSPE: very high titers IgG in serum and CSF

Special Hosts

■immunocompromised individuals are more susceptible to compli-

cations of measles and have a higher fatality rate

differential diagnosis

n/a

management

Report all cases of measles to the local health department.

specific therapy

■no specific antiviral available

■consider vitamin A supplement in special circumstances

follow-up

n/a

complications and prognosis

Complications

■otitis media: 5–15%