Case history 4

A 13 month old Hispanic male was brought to the emergency room by his mother for fever and cough. The family had arrived in Chicago 1 week ago from Mexico where they had previously resided. The child had fever to 39o C for two days, persistent cough, rhinorrhea and conjunctivitis. Today the mother had noted a red rash on the neck and behind the ears. There was no rash on the rest of the body. The child had received immunizations at 2, 4 and 6 months of age but none since then. The physician noted that the mouth was very red with white spots near the molars the size of coarse salt and made a diagnosis of measles. Over the next 1-2 days, the rash spread to involve the entire body and then all symptoms resolved over the next few days. A 4 month old cousin resided with the family.

Study questions

1. If the patient needed to be admitted, what isolation would be appropriate?

2. What is known about the pathogenesis of the infection? 

3. List the clinical signs that the physician focused on to make an accurate clinical diagnosis of measles. What test could be done to confirm the diagnosis?

4. Describe the vaccine that is available to prevent this infection. Why wasn=t this child vaccinated?

5. Are there any effective anti-viral agents that act against this virus? What is the appropriate treatment? Should any therapy be prescribed for the 4 month old cousin?

6. Are there any long term consequences associated with this viral infection?