Measles

Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

Morbilli, first infectious disease.

  • Highly contagious infectious disease caused by measles viruses.
  • The measles virus is an approximately 140 nm RNA virus which belongs to the group of paramyxoviruses.

  • Especially occurring in winter and spring.
  • 1964 saw the introduction of live measles vaccination, which led to a significant decline in incidence.
  • Children, adolescents and young adults are particularly affected.
  • Worldwide 1580,000 deaths per year.
  • Throughout Europe, there are 1 death per 3,000 reported illnesses.
  • The measles virus has been eliminated in Scandinavia, Australia and North and South America.

  • Transmission: droplet infection (speaking, coughing, sneezing).
  • The risk of infection usually exists in the catarrhal stage or in the early exanthema stage.
  • Incubation period: 10-14 days.
  • In the keratinocytes and in the upper dermis giant cells, the Warthin-Finkeldey cells, are formed as a result of virus replication.

  • 4 days after incubation period occurrence of an exanthema.

 

  • Catarrhal prodromal stage:
  • Reduced general condition, fever (up to 40°C), pharyngitis, tracheitis, dry cough, rhinitis, conjunctivitis and photophobia.
  • After 2-3 days for 48 hours enoral pointlike, white mucous membrane changes (Koplik spots), which are not scratchable, occur in the area of the molar teeth.

 

  • Enanthema: From the 3rd day, red spots appear in the area of the oral mucosa with a simultaneous drop in fever.

 

  • Exanthematic stage
  • Starting retroauricularly, spreading over neck and trunk, morbilliform, erythematous, partially confluent spots finally pass to the extremities.
  • At the same time the fever starts to rise again, after 3-4 days the body temperature regresses.
  • Especially in adults who are not vaccinated, there are foudroyant, sometimes lethal cases. These are characterized by somnolence, bloody stools, hyperpyrexia, cramps and circulatory disorders.

  • Clinic.
  • Blood Count (Leukopenia).
  • PCR from body fluids.
  • In case of neurological symptoms, a neurological consil is essential.
  • CSF puncture for neurological abnormalities. Note: In acute sclerosing panencephlitis with infaust prognosis, very high IgG titres are found in the cerebrospinal fluid.
  • Thoracic x-ray in case of pulmonary symptoms (striped drawing).
  • ELISA can be used to detect IgM antibodies from day 3 of the exanthema stage. In case of a 4-fold increase (2 steps) of the titre after 2 weeks, a measles infection can be assumed.

  • Bronchopneumonia (approx. 4-5%)
  • Otitis media (approx. 4-5%)
  • Measles croup
  • Lupus vulgaris (cutaneous scattering of tubercle bacteria)
  • Measles encephalitis (1:100,000)
  • Subacute sclerosing panencephalitis (SSPE)

After a measles infection has already occurred, a lifelong immunity exists.

  1. Cutts FT, Henao-Restrepo AM, Olivé JM. Measles elimination: progress and challenges. Vaccine 1999;17:S47-S52.
  2. Davidkin I, Valle M, Peltola H, et al. Etiology of Measles‐ and Rubella‐like Illnesses in Measles, Mumps, and Rubella–Vaccinated Children. The Journal of Infectious Diseases 1998;178:1567-70.
  3. Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
  4. Bundesamt für Gesundheit - Masern. (2016). Bag.admin.ch. Retrieved 10 May 2016, from http://www.bag.admin.ch/themen/medizin/00682/00684/01087/index.html?lang=de