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The present study was carried out to find out the incidence of measles in under five children and its complications in four selected urban slums of inter-state border districts of West Bengal. 20 cluster sampling technique was followed and in each cluster 250 under five children were covered. Paramedical workers found out the children of the target age group who had the history of measles in past one year and Medical Officer confirmed the case following standard case definition. Incidence of measles was round to be 3.3% in Purulia, 5.5% in Bankura. 4.6% in Midnapur, 5.7% in Haldia-Tamluk and with an overall rate of 4.8%. Incidence was higher in 0-11 and 12-23 months age group and decreased with increasing age, but no sex difference in incidence of Measles was observed. Only 20% of cases were vaccinated with measles vaccine and 26% received Vitamin A in oil. Diarrhoea was the commonest complications followed by cough and cold, pneumonia and weight loss. The study highlighted the necessity of timely measles vaccine coverage, additional dose at a higher age and Vitamin A oil supplementation through IEC activities.
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PMID:An epidemiological study on incidence, symptoms and complications of measles in bordering districts of West Bengal. 1912 71

A 38-year-old female with a two-week history of amoxicillin use for fever, cough, and coryza presented with two days of erythematous chest macules. Despite discontinuation of the antibiotic, her rash continued; measles was diagnosed with IgM titers. Three weeks previously she had returned from China. She had received only one vaccination despite travel to this measles-endemic area. Vaccination and herd immunity have reduced the measles prevalence in America by more than 99%; travel, foreign adoption, and refusal of vaccination have, however, increased the risk.
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PMID:A re-emerging infection? 1920 10

Measles are a systemic infectious disease caused by a single stranded ribonucleic acid virus (measles virus) from the paramyxovirus family. Typically, the disease is characterized by a two-phase course. After an average incubation period of 8 to 11 days, initial symptoms such as fever, cough, coryza and conjunctivitis appear. Two thirds of the patients shows a white-marked enanthema on the buccal mucosa (Koplik's spots). After disappearance of these symptoms, a second increase of temperature and the typical measles exanthema, a brownish-red maculopapular rash, appear. Infection with measles virus induces transient immunodeficiency that favours the formation of several complications. Some of them, e. g. encephalitic diseases, are severe and associated with a high mortality. Measles are world-wide distributed and belong to the ten most frequent infectious diseases in some less developed countries. The disease is associated with a high mortality in some African and South-East Asian countries, in particular in children aged less than 12 months. Of particular note, measles are the most important cause of blindness in children in population with borderline vitamin A status. In Germany, the number of reported measles cases has been declined dramatically since the introduction of a vaccine more than four decades ago. However, regional outbreaks or small epidemics still occur. Because there is no specific antiviral treatment, therapy of measles is symptomatic and depends on the manifestation of the disease. The most important prevention strategy is immunization with a life-attenuated vaccine that can be applied as monovaccination or in combination with mumps and rubella virus (MMR vaccination) or mumps, rubella and varicella virus (MMRV vaccination).
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PMID:[Measles]. 1944 68

Butterfly rash is characterized by symmetrical erythema and erythematous papules and plaques grouped on the bilateral cheeks and nose, commonly found in lupus erythematosus. Measles is a highly contagious viral disease, characterized by high fever, cough, coryza, conjunctivitis, and Koplik spots, which precede generalized maculo-papular rashes. We report an adult case of measles, accompanied by butterfly rash. A 20-year-old woman came to our hospital with a butterfly rash-like eruption on the face, high fever, and arthralgia. The eruption had appeared on the nose and both cheeks three days before admission. The oral mucosa was not involved. On the basis of the three criteria for a diagnosis of lupus eruthematosus, we first made a tentative diagnosis of lupus eruthematosus and performed blood tests. However, anti-DNA antibodies, scl-70, anti-Ro and La, anti-Sm and rheumatoid factor were all negative. Two days after admission, a Koplik macule appeared along with multiple erythematous macules and papules that were scattered through the trunk. Laboratory tests were positive for anti-measles immunoglobulin M and G. Therefore, we reached a diagnosis of measles. Within a week, all of the clinical symptoms disappeared. Physicians should be aware that, in rare cases, measles may present with a butterfly-like rash.
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PMID:Letter: Adult measles with a butterfly rash-like appearance. 2023 73

Simultaneous occurrence of measles and chickenpox in a single individual is a rare event despite the fact that each of these infections alone is very common. The clinical presentation and molecular characterization of a dual infection caused by measles and Varicella-Zoster virus (VZV) in a 3-year female child is reported for the first time from India. The child presented with high fever, cough, cervical lymphadenopathy, and maculopapular rash followed by vesicular skin rash. The child was not immunized against measles and chickenpox. The viral nucleic acids extracted from the clinical specimen were subjected to PCR-Sequencing for confirmation of a dual infection with measles and VZV. The PCR and sequence analysis from the throat swab samples confirmed the coinfection of wild-type measles (genotype D4) and Varicella-Zoster virus (PstI(+) BglI(+)). The measles virus RNA and VZV DNA could be detected successfully from a single specimen of a throat swab. The case recovered uneventfully. Dual infection with measles and VZV does occur but may be underreported in the literature.
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PMID:Simultaneous infection of measles and varicella-zoster virus in a child in India. 2191 77

A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.
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PMID:Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation. 2242 49

To assess the beneficial effectof ribavirin on measles, a study was conducted among one group (group A) of measles patients who were randomly assigned and treated with ribavirin along with supportive management and anothergroup who were also randomly assigned and treated by supportive therapy only acted as controls (group B) between January 2006 and December 2009 at ID&BG Hospital, Kolkata. Both the groups included 50 patients each and all were confirmed by serum IgM antibody detection. The duration of fever along with constitutional symptoms like malaise, cough, coryza, conjunctivitis, lacrimation, rash, hospital staying and complications of both the groups were compared. The duration and severity of fever and constitutional symptoms like anorexia, malaise, conjunctivitis, cough, etc, and maculopapularrash were much less in group A than those of group B and there were no complications in group A whereas there were many complications in group B cases and the duration of hospital stay of patients in group B were much more than those of group A cases. These results suggest that the beneficial effect of ribavirin on measles is established and each and every measles patient should be treated by ribavirin along with standard symptomatic managemen irrespective of duration regarding illness.
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PMID:Effects of ribavirin on measles. 2248 Jan 2

The authors report a 6-year-old boy with fever, rash and cough. He was diagnosed with severe measles pneumonia and admitted to the paediatric intensive care unit with severe dyspnoea 8 days after symptom onset. He received intravenous antibiotics and high dose vitamin A. Three days later, he had recovered and was discharged home. He had not been vaccinated for measles, mumps and rubella according to the schedule. This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles in order to prevent complications.
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PMID:A 6-year-old boy with fever, rash and severe pneumonia. 2260 78

On February 7, 2012, the Maine Center for Disease Control and Prevention was notified of suspected measles infection in an unvaccinated woman aged 57 years. The patient went to her medical provider on January 30 after 3 days of headache and fever and 2 days of papular rash. The rash began on her neck and spread to her abdomen, legs, and back. Two days later she developed coryza and cough. The rash resolved by February 6. A serum specimen collected on January 31 demonstrated a high titer of measles immunoglobulin M (IgM) and was positive for measles immunoglobulin G (IgG) on testing at a reference laboratory.
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PMID:Notes from the field: false-positive measles test - Maine, February 2012. 2264 46

In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73% (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%. The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.
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PMID:Evaluation of an expanded case definition for vaccine-modified measles in a school outbreak in South Korea in 2010. 2299 8


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