CURRENT Essentials of Critical Care.pdf

272 Current Essentials of Critical Care■■■Rubeola (Measles)Essentials of Diagnosis• Acute epidemic disease with marked upper respiratory symptomsand widespread erythematous maculopapular rash• Incubation period 7–14 days, followed by high fever, cough,coryza, conjunctivitis with photophobia• Discrete erythematous macules and thin papules appear on day3–5, first on forehead and behind ears, coalescing and spreadingto trunk and extremities• Koplik spots usually appear on buccal mucosa 1–2 days beforeexanthema• Complications: secondary bacterial infection, otitis media, pneumonia,viral myocarditis, liver function abnormalities, andthrombocytopeniaDifferential Diagnosis• Cutaneous drug reactions• Other viral exanthemsTreatment• Supportive care• No proven antiviral therapy exists for rubeola• Aerosolized ribavirin, intravenous immunoglobulin (IGIV), andinterferon may be useful for treatment of measles pneumonitisor encephalitis• Respiratory isolation precautions■ PearlThe clinical presentation of rubeola in the immunocompromised patientsis atypical, with 30–40% having no rash.ReferenceDuke T, Mgone CS Measles: not just another viral exanthem. Lancet2003;361:763. [PMID: 12620751]