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Rubeola

Measles, also known as rubeola, is a disease caused by a virus of the genus Morbillivirus. more...

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Reports of measles go back to at least 700, however, the first scientific description of the disease and its distinction from smallpox is attributed to the Muslim physician Ibn Razi (Rhazes) 860-932 who published a book entitled "Smallpox and Measles" (in Arabic: Kitab fi al-jadari wa-al-hasbah). In 1954, the virus causing the disease was isolated, and licensed vaccines to prevent the disease became available in 1963.

Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious - 90% of people without immunity sharing a house with an infected person will catch it. Airborne precautions should be taken for all suspected cases of measles.

The incubation period usually lasts for 10-12 days (during which there are no symptoms).

Infected people remain contagious from the appearance of the first symptoms until 3-5 days after the rash appears.

Symptoms

The classical symptoms of measles include a fever for at least three days duration, and the three C's - cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40 degrees Celsius (105 Fahrenheit). Koplik's spots seen inside the mouth are pathognomic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.

The rash in measles is classically described as a generalised, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body. The measles rash also classically "stains" by changing colour to dark brown from red before disappearing later. The rash can be itchy.

Diagnosis

A detailed history should be taken including course of the disease so far, vaccination history, contact history, and travel history.

Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs above. Observation of Koplik's spots is also diagnostic of measles.

Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens.

Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis.

Treatment

There is no specific treatment for uncomplicated measles. Patients with uncomplicated measles will recover with rest and supportive treatment.

Complications

Complications with measles are relatively common, ranging from relatively common and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis). Complications are usually more severe amongst adults who catch the virus.

Read more at Wikipedia.org


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Rubeola during pregnancy - measles - Tips from Other Journals
From American Family Physician, 4/1/92

Rubeola (measles) has again become a concern in the United States, with cases being reported from many parts of the country. Los Angeles County has had an epidemic of measles since 1987, with cases occurring predominantly in nonimmunized Hispanic preschool children. When measles occurs in adults, the rate of complications, particularly pneumonia, may be high. Studies have shown that pneumonia develops in up to 50 percent of adults with measles and that one-third of these cases may be due to secondary bacterial infection. During pregnancy, pneumonia of any etiology is associated with onset of preterm labor and delivery. Stein and colleagues report three cases of pneumonia that occurred in pregnant women with measles during the current Los Angeles epidemic.

All three of the women presented in labor with signs and symptoms of severe respiratory illness. The classic history of malaise and upper respiratory symptoms preceding the development of a rash was present in each case. In addition, all had evidence of secondary bacterial pneumonia. In one patient, who was at 37 weeks of gestation, labor was allowed to proceed and a healthy infant was delivered. The other patients presented at 25 and 27 weeks' gestation, respectively. In the second case, preterm labor was successfully controlled initially, but the patient left the hospital against medical advice and subsequently delivered a stillborn infant at 32 weeks' gestation. In the third case, preterm labor recurred after three days of treatment and a healthy infant was delivered at approximately 35 weeks of gestation.

Epidemiologic data have not proved that rubeola is a teratogen, although the disease has been associated with increased rates of spontaneous abortion and perinatal mortality. The authors recommend that pregnant women with suspected measles should be evaluated for preterm labor, volume depletion, hypoxemia and bacterial pneumonia, as well as other less common complications, such as encephalitis. Because of the high infectivity of measles, patients suspected of having measles should be isolated and should not use common waiting rooms. Women who are susceptible to measles should be immunized during the puerperium and should avoid conception for three months after immunization. (Obstetrics and Gynecology, November 1991, vol. 78, p. 925.)

COPYRIGHT 1992 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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