measles /mē″zəlz/ [ME, meseles, skin spots] , an acute, highly contagious viral disease involving the respiratory tract and characterized by a spreading maculopapular cutaneous rash. It occurs primarily in young children who have not been immunized and in teenagers or young adults who are inadequately immunized. Measles is caused by a paramyxovirus and is transmitted by direct contact with droplets spread from the nose, throat, and mouth of infected people, usually in the prodromal stage of the disease. Indirect transmission by uninfected people or contaminated articles is unusual. Diagnosis is confirmed by the identification of Koplik’s spots on the buccal mucosa and by serological examination. Also called morbilli, rubeola. See also roseola infantum, rubella. ▪ OBSERVATIONS: An incubation period of 7 to 14 days is followed by the prodromal stage, characterized by fever, malaise, coryza, cough, conjunctivitis, photophobia, anorexia, and the pathognomonic Koplik’s spots, which appear 1 to 2 days before onset of the rash. Pharyngitis and inflammation of the laryngeal and tracheobronchial mucosa develop, the temperature may rise to 103° F or 104° F (39.4° C to 40° C), and there is marked granulocytic leukopenia. The papules of the rash first appear as irregular brownish pink spots around the hairline, the ears, and the neck, then spread rapidly within 24 to 48 hours to the trunk and extremities, becoming red, maculopapular, and dense and giving a blotchy appearance. Within 3 to 5 days the fever subsides and the lesions flatten, turn a brownish color, and begin to fade, causing a fine desquamation, especially over heavily affected areas. ▪ INTERVENTIONS: Routine treatment consists of bed rest, antipyretics, appropriate antimicrobials to control secondary bacterial infection, and, when necessary, application of calamine lotion, corn starch solution, oatmeal, baking soda, or cool water to relieve itching. Preventive measures include active immunization with measles virus vaccine after the infant is 1 year of age. A booster is recommended at 4 to 6 years of age. Passive immunization with immune serum globulin is recommended for unvaccinated individuals exposed to the disease. One attack of the disease confers lifelong immunity. ▪ PATIENT CARE CONSIDERATIONS: Rest, isolation, and quiet activity are recommended as long as fever and rash persist. Acetaminophen, fluids, cool sponge baths, nose drops, and cough medication may be necessary to counteract fever and respiratory symptoms. Bright sunlight may be irritating to the eyes. Special attention is given to the care and cleansing of the eyes and skin, especially in cases of severe papular eruption. An important nursing function is instruction of the parents in the proper home care of the child, because most cases are not serious enough to require hospitalization. The disease is usually benign, and mortality is rare. Complications sometimes occur. The most common are otitis media, pneumonia, bronchiolitis, obstructive laryngitis, laryngotracheitis, and occasionally encephalitis and appendicitis. Rarely, but most gravely, the virus causes subacute sclerosing panencephalitis several years after the acute attack of measles has occurred.
