THE DIFFERENTIAL DIAGNOSIS OF MEASLES pends on the isolation of measles virus from’ throat washings, blood, or urine by inoculation of various types of tissue culture with materials obtained during the first five days of illness. Increase in specific antibody may be detected as early as the first or second day of the rash by the complement fixation test. The antibody is also demonstrable by neutralization and hemagglutination-inhibition procedures. A presumptive diagnosis may be made if giant cells are detected in stained smears of nasal exudate in the pre-eruptive period.
Prognosis. Fatalities are almost always the result of secondary streptococcal or pneumococcal pneumonia, occurring principally in children below the age of five who become infected after the dissipation of passive neonatal immunity. Mortality in underdeveloped countries maybe 250 times that observed in the United States or northern Europe. Case fatality rates are also high in elderly and tuberculous patients. Congestive cardiac failure is a common cause of death in patients, over 50 years old. The incidence of otitis media and pneumonia may be lowered by the prophylactic use of penicillin or a tetracycline early in the illness.
There is no specific treatment for measles. Symptomatic Therapy. In the absence of complications, bed rest is the essence of treatment 2717 this usually benign, self-limited disease. Codeine sulfate (0.015 to 0.06 grain) is useful in the amelioration of headache and myalgia and is effective in the management of cough. Aspirin (0.3 to 0.6 gram) may be employed for its analgesic and antipyretic actions. A GUIDE TO THE DIFFERENTIAL DIAGNOSIS OF MEASLES Diet should be unrestricted. Bright light is not an ocular hazard, but photophobia may require darkening of the patient’s room. Antimicrobial Prophylaxis.
The course of present; test available i+ present and severe uncomplicated measles is not influenced by anti-microbial therapy. In common practice, the incidence of serious bacterial infections is not sufficient to justify the routine prophylactic use of antimicrobials. Certain special circumstances may warrant full therapeutic dosage with penicillin or the tetracyclines in anticipation of the potentially fatal sequelae of pneumococcal or beta-hemolytic streptococcal infections. If careful observation of the patient is possible, rational therapy is based on the prompt recognition and etiologic definition of complications, followed by the initiation of the appropriate antimicrobial drug in the proper dosage.
Prevention. In children over five, less subject to complications, the goal of prophylaxis is attenuation of the in-fection sufficient to lessen symptoms but not the development of effective immunity. Vaccination. Highly effective vaccines are now available for the prevention of measles. Most are derived from the Edmonston strain of measles virus isolated in the laboratory of Dr. John Enders. This strain, although it proved very effective in early trials as a live virus vaccine, produced febrile and other reactions (attenuated measles) with such high frequency that it is now usually administered concomitantly with measles immune globulin (injected at a different site).