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8. Viral diseases
Measles
M easles is a highly co ntagio us acute viral infectio n, transm itted by the airbo rne ro ute
(inhalatio n o f resp irato ry d ro p lets sp read by infected ind ivid uals). The d isease m ainly
affects child ren und er 5 y ears o f age and can be p revented by im m uniz atio n.
F o r m o re info rm atio n, refer to the M S F hand bo o k Management of a measles epidemic.
Clinical features
The average incubatio n p erio d is 1 0 d ay s.
Prodromal or catarrhal phase (2 to 4 d ay s)
– H igh fever (3 9 -4 0 °C ) with co ugh, co ry z a (nasal d ischarge) and / o r co njunctivitis ( red
and watery ey es).
– K o p lik ‟s sp o ts: tiny bluish-white sp o ts o n an ery them ato us base, fo und o n the
insid e
o f the cheek . This sign is sp ecific o f m easles infectio n, but m ay be absent at the tim e
o f exam inatio n. O bservatio n o f K o p lik 's sp o ts is no t required fo r d iagno sing
m easles.
Eruptive phase (4 to 6 d ay s)
– tOhennsapverreaagdes3d od awynswaarftdertoth ethoe fnasceet,onef csky m, trpuntko m(2 s: edruapy )t,ioabndoofmeryenthaenmd alotowuesr,linmo bns-
(p3 ruarinticd m4 acdualoy )p. ap ules, which blanch with p ressure. The rash begins o n the fo rehead
nd
rd th
–– TAhes rtahseh rfaadshesparroo ugnredstshees,5 p rdoadyroinmthealssaymme po trod emr tshastuibt aspid ep. eIanretdh e(fraobmsenthcee hoefad to
co m p licatio ns, the fever d isap p ears o nce the rash reaches the feet.
th
the feet). 8
Th e erup tive p h ase is fo llo w ed by sk in d esquam atio n d uring 1 to 2 w eek s, very
p ro no unced o n p igm ented sk in (the sk in d evelo p s a strip ed ap p earance).
In p ractice, a p atient p resenting with fever and ery them ato us m aculo p ap ular rash and
at least o ne o f the fo llo wing signs: co ugh o r co ry z a o r co njunctivitis, is a clinical case o f
m easles.
Complications
M o st m easles cases exp erience at least o ne co m p licatio n:
– R esp irato ry and E N T: p neum o nia, o titis m ed ia, lary ngo tracheo bro nchitis
– O cular: p urulent co njunctivitis, k eratitis, xero p hthalm ia (risk o f blind ness)
– G astro intestinal: d iarrho ea with o r witho ut d ehy d ratio n, benign o r severe sto m atitis
– N euro lo gical: febrile seiz ures; rarely , encep halitis
– A cute m alnutritio n, p ro vo k ed o r aggravated by m easles (p o st-m easles p erio d )
P neum o nia and d ehy d ratio n are the m o st co m m o n im m ed iate causes o f d eath.
189
Measles
M easles is a highly co ntagio us acute viral infectio n, transm itted by the airbo rne ro ute
(inhalatio n o f resp irato ry d ro p lets sp read by infected ind ivid uals). The d isease m ainly
affects child ren und er 5 y ears o f age and can be p revented by im m uniz atio n.
F o r m o re info rm atio n, refer to the M S F hand bo o k Management of a measles epidemic.
Clinical features
The average incubatio n p erio d is 1 0 d ay s.
Prodromal or catarrhal phase (2 to 4 d ay s)
– H igh fever (3 9 -4 0 °C ) with co ugh, co ry z a (nasal d ischarge) and / o r co njunctivitis ( red
and watery ey es).
– K o p lik ‟s sp o ts: tiny bluish-white sp o ts o n an ery them ato us base, fo und o n the
insid e
o f the cheek . This sign is sp ecific o f m easles infectio n, but m ay be absent at the tim e
o f exam inatio n. O bservatio n o f K o p lik 's sp o ts is no t required fo r d iagno sing
m easles.
Eruptive phase (4 to 6 d ay s)
– tOhennsapverreaagdes3d od awynswaarftdertoth ethoe fnasceet,onef csky m, trpuntko m(2 s: edruapy )t,ioabndoofmeryenthaenmd alotowuesr,linmo bns-
(p3 ruarinticd m4 acdualoy )p. ap ules, which blanch with p ressure. The rash begins o n the fo rehead
nd
rd th
–– TAhes rtahseh rfaadshesparroo ugnredstshees,5 p rdoadyroinmthealssaymme po trod emr tshastuibt aspid ep. eIanretdh e(fraobmsenthcee hoefad to
co m p licatio ns, the fever d isap p ears o nce the rash reaches the feet.
th
the feet). 8
Th e erup tive p h ase is fo llo w ed by sk in d esquam atio n d uring 1 to 2 w eek s, very
p ro no unced o n p igm ented sk in (the sk in d evelo p s a strip ed ap p earance).
In p ractice, a p atient p resenting with fever and ery them ato us m aculo p ap ular rash and
at least o ne o f the fo llo wing signs: co ugh o r co ry z a o r co njunctivitis, is a clinical case o f
m easles.
Complications
M o st m easles cases exp erience at least o ne co m p licatio n:
– R esp irato ry and E N T: p neum o nia, o titis m ed ia, lary ngo tracheo bro nchitis
– O cular: p urulent co njunctivitis, k eratitis, xero p hthalm ia (risk o f blind ness)
– G astro intestinal: d iarrho ea with o r witho ut d ehy d ratio n, benign o r severe sto m atitis
– N euro lo gical: febrile seiz ures; rarely , encep halitis
– A cute m alnutritio n, p ro vo k ed o r aggravated by m easles (p o st-m easles p erio d )
P neum o nia and d ehy d ratio n are the m o st co m m o n im m ed iate causes o f d eath.
189
