1. Measles: Case Study Hiro Landazuri Karla Gonzalez Jonathan Chen

2. Case An 18 yr old freshman complained of a cough, runny nose, and conjunctivitis. The physician in the campus health center noticed small white lesions inside the patient’s mouth. The next day, a confluent red rash covered his face and neck.

3. Overview Rubeola Paramyxovirus - Morbillivirus Negative-sense ssRNA F (fusion) protein/H (hemoagglutanin) protein http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm

4. Overview Systemic infection –Respiratory transmission –Primary site of infection = nasopharynx Primary viremia (2-3 days post exposure) Secondary viremia (5-7 days post exposure) http://www.homehealth-uk.com/image_01/image/throatdiagram.gif

5. Physical Diagnosis The 3 C’s –Cough, coryza, conjunctivitis Koplik’s spots MV rash –Maculopapular Macule – red lesion flushing Papule – raised red lesion dermatlas.med.jhmi.edu

6. Koplik’s Spots Conjunctivitis MV rash http://en.wikipedia.org/wiki/Conjunctivitis http ://www.cdc.gov/vaccines/vpd- vac/measles/photos.htm

7. Laboratory Diagnosis Isolation of MV from clinical specimen Serodiagnosis –IgM ab (ELISA) –IgG ab ELISA, HI, Indirect flourescent ab test, microneutralization, plaque reduction neutralization, complement fixation

8. Complement Fixation Assay PositiveNegative http://web.indstate.edu/thcme/PSP/labtests/complementfix.htm

9. Treatment No treatment Supportive Care Only –Tylenol, Non-steroidal anti-inflammatory drugs like Advil, Aspirin, Motrin etc. –Isolation –Vitamin K –Hydration –Post-exposure Prophylaxis Antibiotics for serious complications (rare) Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).http://www.emedicine.com/derm/topic259.htm

10. When was this patient contagious? Course of the infection –Incubation 7-14 days –Initial symptoms immediately following incubation: cough, coryza, conjunctivitis, fever –Koplik’s spots 2-3 days after initial symptoms –Rash appears 4-5 days after the initial symptoms Infection communicable four days before his rash appeared to four days after MayoClinic.com Tools for Healthier Lives, Measles, http://www.mayoclinic.com/print/measles/DS00331/DSECTION=all&METHOD=print (Oct. 29, 2007).http://www.mayoclinic.com/print/measles/DS00331/DSECTION=all&METHOD=print Melissa Burnett, MD, Measles, Rubeola, EMedicine from WebMD, http://www.emedicine.com/derm/topic259.htm (Oct. 29, 2007).http://www.emedicine.com/derm/topic259.htm

11. Why is this disease not common in the United States? the United States is a developed country –most children are immunized with MMR (Measles Mumps Rubella) vaccination –required proof of MMR immunization the Measles Initiative is working on standard global immunization for measles

12. Several possible reasons for patient’s susceptibility to measles at 18 years of age. if the patient did not receive MMR vaccinations –allergic reaction to component of MMR recent studies have shown no direct correlation –poor healthcare undeveloped countries without required MMR –linking of MMR and autism studies lacked substantial scientific evidence if patient did receive MMR vaccinations –may not have developed immunity either way, patient was susceptible to measles and was exposed via –traveling –dorms/college campus