MEASLES – Rubeola, morbilli, English Measles

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ISSN-1059-6518

Volume 28 Number 1

By Frank Hubbell, DO

The reason for this article is simple: there is currently an outbreak of a highly contagious viral illness – measles. This epidemic has been going on for the past several months, with over 80 cases being reported in more than 14 states.

Measles Case Study:

You are with a local ambulance squad and are asked to transport a 4yo child to the local emergency department who reportedly has a fever, chills, cough, and lethargy.

Upon arrival at the home, you are presented with a child who appears sick. She has a rash on her face and neck, conjunctivitis, and a runny nose, is feverish, and has a cough. Mom states that her daughter has been sick for the past several days, but seems to be getting worse. She developed the rash overnight.

S: SUBJECTIVE:

4yo female, whose mom states has been sick for 4 days and is getting worse. She is c/o a sore throat, cough, runny nose, fever, and conjunctivitis.

O: OBJECTIVE:           

Vital Signs:

LOC:                        A & O x 3

RR & Effort:            20 and not labored

HR:                        96 and regular

BP:                        104/72

SCTM:            + for a rash on her face and neck, feverish, and moist

Physical Exam:

Skin is + for erythematous macules on her face and neck

Eyes + for erythematous conjunctiva with mucopurulent material on the lashes

Throat is + for erythema with whitish spots on the buccal mucosa next to the back molars

Lungs + for crackles; she has a wet cough with deep breathing

Heart – RRR without murmur

Abdomen is + for bowel sounds, soft, and non-tender

You can see images of Measles rash at the CDC website.

AMPLE HX:

A: NKDA

M: ibuprofen and Tylenol for the fever

P: none; mom denies any childhood immunizations

L: light dinner last night

E: home from school sick

A: ASSESSMENT

Viral exanthem – measles

P: PLAN

Rest, liquids, supportive care

Quarantine to minimize spread

Receive recommended childhood immunizations

MEASLES:

Measles is one of the leading causes of death in children worldwide.

Worldwide:             2013 – 145,700 deaths (down from millions prior to vaccinations)

USA:                         2014 – 644 cases reported in 27 states

2015 – so far, >80 cases in 14 states

It is caused by a virus: Paramyxovirus, Morbillivirus.

Transmission is via airborne/droplet-spread.

Incubation: 10 – 12 days

Signs and Symptoms of Measles:

Fever – lasts 4 – 7 days

Coryza (runny nose)

Cough

Conjunctivitis (red, goopy eyes)

Koplik’s spots – white spots on the buccal mucosa (short-lived) next to the back molars

Rash – starts on the face and neck, then speads to the trunk and extremities

4 D’s and 3 C’s ⇒ 4 Days with the 3 C’s – Cough, Coryza, and Conjunctivitis before the rash occurs.

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