What is the diagnosis and management of a patient presenting to the Emergency Department (ED) with suspected measles?

From the Guidelines

For a suspected measles case presenting to the Emergency Department, immediate isolation in a negative pressure room is essential to prevent further transmission. The patient should wear a mask, and healthcare providers should use airborne precautions including N95 respirators 1. Obtain a thorough history focusing on vaccination status, exposure to measles, and travel history. Look for the classic triad of symptoms: fever, cough/coryza/conjunctivitis, and rash. The rash typically begins on the face and spreads downward, appearing 3-5 days after initial symptoms.

Key Considerations

• Laboratory confirmation requires serum IgM antibody testing and RT-PCR from throat, nasal, or urine specimens.
• Notify public health authorities immediately as measles is a reportable disease, as emphasized by the Advisory Committee on Immunization Practices (ACIP) 1.
• Treatment is primarily supportive with antipyretics and hydration.
• Vitamin A supplementation (200,000 IU for adults, 100,000 IU for children 6-12 months, 50,000 IU for infants <6 months) is recommended, especially in malnourished patients.
• Post-exposure prophylaxis with MMR vaccine within 72 hours or immunoglobulin within 6 days may be indicated for exposed susceptible individuals, as outlined in the guidelines for immunization of health-care personnel 1. Measles is highly contagious through airborne transmission, with a significant infection rate among susceptible contacts, which necessitates rapid isolation and public health intervention to prevent outbreaks.

Prevention and Control

• The local or state health department should be contacted immediately when suspected cases of measles occur in a community 1.
• All reports of suspected measles cases should be investigated promptly to classify the case, identify the characteristics of the case and the source of exposure, and prevent further spread 1.
• Control activities should not be delayed pending the return of laboratory results from persons with suspected or probable cases 1.

From the Research

Presentation of Measles

• Measles is a highly contagious illness that classically presents with a rash, fever, cough, coryza, and conjunctivitis 2.
• Symptoms include fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis, although vaccinated individuals can have milder or even no symptoms 3.

Diagnosis of Measles

• Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M 2.
• Laboratory diagnosis relies largely on the detection of specific IgM antibodies in serum, dried blood spots, or oral fluid, or the detection of viral RNA in throat or nasopharyngeal swabs, urine, or oral fluid 3.

Management of Measles

• The management of measles is mainly supportive 2.
• Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhoea 3.
• Treatment may consist of the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin 2.
• Ribavirin and high-dose vitamin A might be a treatment option for life-threatening measles pneumonitis in adults 4.
• The early use of ribavirin and vitamin A shows significant improvements regarding morbimortality and should be systematic in severe cases 5.

Prevention of Measles Spread

• Special precautions are required by hospital workers to help prevent the spread of the virus, which include N-95 masks and patient isolation in an airborne infection isolation room 2.
• Disease control largely depends on prevention, and there is no specific antiviral therapy for the treatment of measles 3.

Complications of Measles

• Complications from measles are relatively common and can be associated with significant morbidity and mortality 2.
• Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea 3.
• Neurological complications are uncommon but serious, and can occur during or soon after the acute disease or months or even years later 3.