Rubeola (Red Measles)

– A highly contagious, acute viral disease characterized by Koplik’s spots and a spreading maculopapular rash.

Causes and Incidence

Rubeola is caused by a paramyxovirus and is spread by airborne droplets or direct contact with nasopharyngeal secretions. The disease is communicable from 4 days before the rash appears until the rash disappears. Before the advent of a vaccine in the 1960s, epidemics were seen every 2 or 3 years among small and school-age children in the United States. Now outbreaks occur primarily in previously immunized adolescents and adults and in unimmunized children. Infection confers lifelong immunity.

Disease Process

The virus invades the nasopharynx and the respiratory epithelium, incubates, and multiplies there for about 7 to 14 days. It spreads via the lymphatics, producing hyperplasia and viremia, which spreads by means of the leukocytes to the reticuloendothelial system. The reticuloendothelial cells necrose and set up a secondary viremia, which infects the respiratory mucosa and produces edema. Two to 4 days after the respiratory invasion, the virus travels to and invades the cells of the epidermis and oral epithelium, stimulating a cell-mediated response and producing Koplik’s spots, followed in 1 to 2 days by a skin rash. The rash lasts 4 to 7 days before fading.

Symptoms

Prodrome
Fever, coryza, hacking cough, conjunctivitis, photophobia, lymphadenopathy

Rash
Koplik’s spots on the buccal mucosa 2 to 4 days after prodrome onset; irregular maculopapular rash starts on face and neck and spreads to trunk and extremities

Post rash
Brownish desquamation

Potential Complications

Complications include secondary bacterial infections (e.g., otitis media or pneumonia); viral pneumonia; and encephalitis and delayed, subacute, sclerosing pan-encephalitis.

Diagnostic Tests

The diagnosis is made on the basis of the symptom pattern plus a positive culture of pharyngeal or conjunctival secretions or of blood or urine, plus a fourfold increase in specific antibodies.

Treatments

Surgery
None.

Drugs
Antipyretics for fever; active immunization for people over 15 months of age except those with compromised immune systems; passive immunization (immune globulin) for high-risk contacts; prophylactic antiinfective drugs in high-risk children; vitamin A supplementation is under study.

General
Bed rest in a quiet, darkened room during prodrome; isolation during prodrome and rash; skin care; tepid baths; monitoring for complications.