What are the treatment options for adults experiencing measles symptoms?

Treatment of Measles in Adults

Treatment for adults with measles is primarily supportive care, with vitamin A supplementation recommended for severe cases, while ensuring proper isolation to prevent transmission.

Clinical Presentation of Measles in Adults

Measles presents with characteristic symptoms that typically develop in stages:

• Prodromal phase (2-4 days):

  • High fever (often >101°F/38.3°C)
  • The "3 Cs": cough, coryza (runny nose), and conjunctivitis (red eyes)
  • Malaise and fatigue
  • Koplik spots (pathognomonic white spots on buccal mucosa) may appear 1-2 days before rash 1

• Exanthematous (rash) phase:

  • Erythematous, maculopapular rash beginning on the face
  • Rash spreads cephalocaudally (head to toe) over 3-4 days
  • Becomes more confluent as it spreads 1
  • May be milder or atypical in previously vaccinated individuals 2

Diagnostic Confirmation

Laboratory confirmation is essential and can be achieved through:

• Measles-specific IgM antibody testing (serum)
• Four-fold increase in measles-specific IgG between acute and convalescent sera
• Viral isolation in culture
• Detection of measles virus RNA by RT-PCR 1, 3

Treatment Approach for Adults with Measles

1. Supportive Care (Primary Treatment)

• Rest and adequate hydration
• Antipyretics for fever management (acetaminophen or ibuprofen)
• Humidified air for cough and respiratory symptoms
• Monitoring for complications 2

2. Vitamin A Supplementation

• While primarily recommended for children in developing countries, vitamin A should be considered for adults with severe measles
• Particularly important for those with:
  • Evidence of vitamin A deficiency
  • Immunocompromised status
  • Severe symptoms or complications 4

3. Management of Complications

Complications occur in 10-40% of patients 1, with higher rates in adults over 20 years old 4:

• Respiratory complications:

  • Pneumonia (bacterial superinfection): Treat with appropriate antibiotics
  • Laryngotracheobronchitis: May require airway management

• Neurological complications:

  • Acute disseminated encephalomyelitis (ADEM)
  • Measles inclusion body encephalitis
  • Subacute sclerosing panencephalitis (SSPE, rare late complication)
  • These require specialized neurological care 2

• Other complications:

  • Otitis media
  • Diarrhea (may require rehydration therapy)
  • Stomatitis 2

4. Special Populations

• Pregnant women:

  • Higher risk of complications
  • Increased risk of premature labor and low birth weight infants
  • Require close monitoring 5

• Immunocompromised patients:

  • Higher risk of severe disease and complications
  • May benefit from IVIG (intravenous immunoglobulin) 3

• Unvaccinated exposed individuals:

  • MMR vaccine within 72 hours of exposure may provide some protection
  • IVIG may be considered for high-risk exposed individuals who cannot receive the vaccine 3

Infection Control Measures

Critical to prevent transmission:

• Airborne precautions (N-95 respirator masks)
• Patient isolation in airborne infection isolation room
• Maintain isolation until 4 days after rash onset in normal hosts (longer in immunocompromised)
• Report cases to local public health authorities 3

Prevention

Prevention remains the most effective strategy:

• Adults born in 1957 or later who lack evidence of immunity should receive MMR vaccination
• A second dose is recommended for adults at higher risk, including:
  • Healthcare workers
  • International travelers
  • Students in postsecondary educational institutions
  • Those in outbreak settings 5

Common Pitfalls in Management

1. Failure to recognize measles early: The prodromal symptoms can mimic other viral illnesses, delaying diagnosis and appropriate isolation measures.

2. Inadequate infection control: Measles is highly contagious and requires strict airborne precautions, not just droplet precautions.

3. Missing complications: Vigilant monitoring for complications is essential, as they can develop rapidly and affect multiple organ systems.

4. Inappropriate antibiotic use: Antibiotics should be reserved for confirmed bacterial superinfections, not used prophylactically.

5. Neglecting post-exposure prophylaxis: Exposed susceptible individuals should be assessed for post-exposure prophylaxis with vaccine or immunoglobulin.

Remember that measles can be particularly severe in adults, with higher rates of hospitalization and complications compared to children. Early recognition, supportive care, and proper isolation remain the cornerstones of management.