Measles (Rubeola): Clinical Significance Of Its Complications, Diagnosis, Treatment And Prevention
Pneumonia Complicates Measles
Complications Of Measles
These are common, though in the majority, the disease is self-limiting. Respiratory complications include croup, bronchitis, bronchiolitis and rarely, interstitial giant cell Pneumonia. These are more common in immunocompromised persons and malnourished children. The eye lesion may progress to corneal ulceration, keratitis and blindness. Myocarditis develops in 20% of cases and this cause transient ECG changes, but clinical this may remain silent. Acute abdominal pain may occur due to mesenteric lymphadenitis. In pregnant women, fetal loss may occur in 20%
Secondary bacterial pneumonia by staphylococcus, streptococcus, pneumococcus and H. influenza is common and may progress to lung abscess and empyema. Otitis media may develop commonly. Stomatitis may develop and progress to cancrum orits, especially in malnourished children. Quiescent tuberculous lesions may flare up or fresh tuberculous infection may develop.
Encephlomyelitis, another serious complication occurs in 1/1000 patients, usually occurring 4 to 7 days after the appearance of the eruption. It is characterized by high fever, headache, drowsiness and coma ending fatally in 10% of cases. Progressive encephalitis may develop in 1 to 6 month after measles in immunosuppressed children. Subacute slcerorising panencephalitis (SSPE) which is a late complication of measles is characterized by progressive dementia and motor weakness.
Measles Prevention: Administration Of Gamma Globulin 0.25 ml/Kg Within 5 Days Of Exposure
Diagnosis, Treatment And prophylaxis Of Measles
Laboratory investigations are essential in diagnosing atypical cases and also for differentiating measles from rubella. Leucopenia is frequent in the early stages. Leucocytosis occurs with secondary bacterial infection. Cerebrospinal fluid shows raised protein and lymphocytosis in encephalomyelitis. Demonstration of multinucleated giant cells in Giemsa stained smears of nasal secretions is a simple side room laboratory test. Virus antigen can be detected in the cells by immunofluoresence. Virus can be isoltated in human embryonic kidney and amnion cells.
Demonstration of rising antibody levels by complement fixation test, hemagglutination inhibition test and neutralization test in paired sera help to make serological diagnosis.
Differential diagnosis: Rubella has to be differentiated from measles. Rubella is a milder illness of short duration without significant respiratory complaints,. Infectious mononucleosis, toxoplasmosis, secondary syphilis, adenovirus and enterovirus infectious, scarlet fever and drug rashes have to be differentiated.
Treatment And Prevention
Treatment: There is no specific drug against the virus and therefore management is symptomatic. Bacterial infection has to be treated with antibiotics based on clinical and bacteriological findings. Children who continue to be ill after an attack of measles should be investigated for the presence of tuberculosis.
Prevention: Administration of gamma globulin 0.25 ml/Kg within 5 days of exposure effectively prevents or reduce the attack. Children below three years, pregnant women, immunocompromised persons and those who suffer from tuberculosis should be given gammaglobulin for passive immunization.
Live attenuated measles vaccine, prepared from Admonston B strains of measles virus is used for active immunization. Immunity lasts for a period of about 10 years. In general, children below the age 1 are not vaccinated. If they have to be vaccinated under special circunstances, a second dose should be given at the age of 15 to 18 months. The vaccine may be given alone or in combination with rubella and mumps vaccines. Vaccination is leukemia, lumphoma and immunocompromised patients.
© 2014 Funom Theophilus Makama