Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
Morbilli, 1. infectious disease.
- Highly contagious infectious disease caused by measles viruses
- The measles virus is an RNA virus approximately 140 nm in size, which belongs to the group of paramyxoviruses
- Mostly occurring in winter and spring
- In 1964, the introduction of live measles vaccination led to a significant decrease in incidence
- Most affected are children, adolescents and young adults
- Worldwide 158000 deaths per year
- Europe-wide there is 1 death per 3000 reported cases
- The measles virus has been eliminated in Scandinavia, Australia and in North and South America
- Transmission: droplet infection (speaking, coughing, sneezing)
- The risk of infection is mostly in the catarrhal stage or the early exanthema stage
- Incubation period: 10-14 days
- In the keratinocytes and in the upper dermis, there is the formation of giant cells, the Warthin-Finkeldey cells as a result of virus replication
- 4 days after incubation period appearance of exanthema
- Catarrhal prodromal stage:
- Reduced general condition, fever (up to 40°C), pharyngitis, tracheitis, dry cough, rhinitis, conjunctivitis and photophobia
- After 2-3 days, punctate white mucosal lesions (Koplik's spots) appear enorally in the region of the molars for 48 hours, which cannot be scraped off
- Enanthema: From the 3rd day, there are red spots in the area of the oral mucosa with a simultaneous drop in fever
- Exanthematic stage:
- Starting retroauricularly, spreading over neck and trunk, morbilliform, erythematous, partly confluent patches finally pass to extremities
- Simultaneously, the fever begins to rise again, after 3-4 days the body temperature is regressive
- Foudroyant, sometimes lethal cases occur, especially in adults who have not been vaccinated. These are characterised by somnolence, bloody stools, hyperpyrexia, convulsions and circulatory disorders
- BB (leukopenia)
- PCR from body fluids
- When neurological symptoms are present, a neurological consult is essential
- Liquor puncture in case of neurological abnormalities. Note: In acute sclerosing panencephlitis with poor prognosis, very high IgG titres are found in the CSF
- To perform a chest X-ray in case of pulmonary symptoms (streaky drawing)
- IgM antibodies can be detected by ELISA from day 3 of the exanthema stage. If there is a 4-fold increase (2 levels) in the titer after 2 weeks, measles infection can be assumed
- Bronchopneumonia (approx. 4-5%)
- Otitis media (approx. 4-5%)
- Measles croup
- Lupus vulgaris (cutaneous spread of tubercle bacilli)
- Masencephalitis (1:100,000)
- Subacute sclerosing panencephalitis (SSPE)
After a measles infection has already been passed, there is lifelong immunity.
- Cutts FT, Henao-Restrepo AM, Olivé JM. Measles elimination: progress and challenges. Vaccine 1999;17:S47-S52.
- 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.
- Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
- 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