Materiały źródłowe

• #1 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Measles is a highly contagious respiratory virus that causes febrile rash illness. […] Measles has been eliminated (no sustained circulation) in the United States for decades. However, there can still be measles cases, as it is easily imported by unvaccinated travelers and can spread in under-immunized communities. […] The incubation period is typically 1112 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 24 days later and usually lasts 56 days. Measles is infectious 4 days before and 4 days after rash onset. […] Prodromal: Fever, cough, coryza, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also appear 23 days after symptoms first appear. […] Rash: A maculopapular rash (rash of both flat and raised skin lesions) begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet. The spots may become joined together as they spread from the head to the body. Fever may spike to more than 104 F when rash appears.

• #2 Measles – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857

  Measles symptoms show up around 7 to 14 days after contact with the virus. […] Call your healthcare professional if you think you or your child may have been around measles. Also call if you or your child has a rash that looks like measles. […] Measles is treated by managing symptoms and preventing complications. […] If you think you or your child has measles, call your healthcare professional right away. Because measles spreads easily from about four days before to four days after the rash appears, people with measles should stay home and stay away from other people during this time.

• #3 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Measles is a highly contagious respiratory virus that causes febrile rash illness. […] Measles has been eliminated (no sustained circulation) in the United States for decades. However, there can still be measles cases, as it is easily imported by unvaccinated travelers and can spread in under-immunized communities. […] The incubation period is typically 1112 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 24 days later and usually lasts 56 days. Measles is infectious 4 days before and 4 days after rash onset. […] Prodromal: Fever, cough, coryza, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also appear 23 days after symptoms first appear. […] Rash: A maculopapular rash (rash of both flat and raised skin lesions) begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet. The spots may become joined together as they spread from the head to the body. Fever may spike to more than 104 F when rash appears.

• #4 Measles Clinical Information – MN Dept. of Health

  https://www.health.state.mn.us/diseases/measles/hcp/clinical.html

  Many U.S. health care providers have never seen a case of measles. Without proper laboratory testing, measles cannot be diagnosed. […] Providers should consider measles in patients who meet the clinical case definition. Since measles is uncommon, providers should ask the patient about known exposures or travel history (domestic or international) in the 30 days prior to symptom onset. […] If measles is suspected, follow the steps in Minimize Measles Transmission in Health Care Settings. […] The incubation period for measles averages 10-12 days from exposure to prodrome and 14 days (range 7-21) from exposure to rash onset. Measles is infectious from 4 days prior to 4 days after rash onset. There are no asymptomatic infectious carriers. Airborne transmission via aerosolized droplet nuclei is the primary route of transmission. Airborne precautions are recommended.

• #5 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Measles is a highly contagious respiratory virus that causes febrile rash illness. […] Measles has been eliminated (no sustained circulation) in the United States for decades. However, there can still be measles cases, as it is easily imported by unvaccinated travelers and can spread in under-immunized communities. […] The incubation period is typically 1112 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 24 days later and usually lasts 56 days. Measles is infectious 4 days before and 4 days after rash onset. […] Prodromal: Fever, cough, coryza, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also appear 23 days after symptoms first appear. […] Rash: A maculopapular rash (rash of both flat and raised skin lesions) begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet. The spots may become joined together as they spread from the head to the body. Fever may spike to more than 104 F when rash appears.

• #6

  https://www.healio.com/clinical-guidance/measles/diagnostic-tests-and-differential-diagnosis-presentation-and-diagnosis

  Unless pathognomonic signs are present or symptoms consistent with measles appear during a local outbreak, diagnosing measles based on clinical signs alone is challenging. Laboratory testing thus remains essential for an accurate diagnosis. […] When faced with a patient presenting with an acute febrile rash illness (i.e., a suspected case of measles), the two best confirmatory diagnostic options are: Serologic testing for measles immunoglobulin M (IgM) antibody; and Molecular testing for MeV RNA by polymerase chain reaction (PCR). […] Serologic testing for immunoglobulin M (IgM) is usually done by enzyme immunoassay on blood samples, which has a sensitivity of 83-89% and a specificity of 95-99%. However, in up to 20-25% of measles-infected patients will not have detectable levels of IgM antibodies within 72 hours after the onset of rash.

• #7 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Measles is a highly contagious respiratory virus that causes febrile rash illness. […] Measles has been eliminated (no sustained circulation) in the United States for decades. However, there can still be measles cases, as it is easily imported by unvaccinated travelers and can spread in under-immunized communities. […] The incubation period is typically 1112 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 24 days later and usually lasts 56 days. Measles is infectious 4 days before and 4 days after rash onset. […] Prodromal: Fever, cough, coryza, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also appear 23 days after symptoms first appear. […] Rash: A maculopapular rash (rash of both flat and raised skin lesions) begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet. The spots may become joined together as they spread from the head to the body. Fever may spike to more than 104 F when rash appears.

• #8 Measles | VisualDx

  https://www.visualdx.com/resources/public-health/measles/

  Encephalitis is a complication in about 1 in 1000 cases. […] Immunocompromised patients can also present with severe pneumonitis and without the classical viral prodrome. […] Subacute sclerosing panencephalitis (SSPE) is a delayed neurodegenerative disorder occurring approximately 10-11 years after acute infection. […] This complication is characterized by changes in personality, seizures, and coma and eventuates in death. […] Oral lesions called Koplik spots may develop 2-3 days after symptoms begin and prior to the generalized cutaneous eruption. […] This enanthem is considered pathognomonic for measles. […] The exanthem consists of erythematous macules and papules beginning at the forehead and behind the ears, eventually spreading in a cephalocaudal fashion down the neck, upper extremities, trunk, and lower extremities. […] Desquamation typically occurs after approximately 1 week. […] Variant: Atypical measles syndrome (in those receiving formalin-inactivated measles vaccine between 1963 and 1967 or in whom immunization has failed) will spread from the extremities inward.

• #9 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Measles is a highly contagious respiratory virus that causes febrile rash illness. […] Measles has been eliminated (no sustained circulation) in the United States for decades. However, there can still be measles cases, as it is easily imported by unvaccinated travelers and can spread in under-immunized communities. […] The incubation period is typically 1112 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 24 days later and usually lasts 56 days. Measles is infectious 4 days before and 4 days after rash onset. […] Prodromal: Fever, cough, coryza, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also appear 23 days after symptoms first appear. […] Rash: A maculopapular rash (rash of both flat and raised skin lesions) begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet. The spots may become joined together as they spread from the head to the body. Fever may spike to more than 104 F when rash appears.

• #10 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #11 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  Although the diagnosis of measles is usually determined from the classic clinical picture, laboratory identification and confirmation of the diagnosis are necessary for the purposes of public health and outbreak control. Laboratory confirmation is achieved by means of serologic testing for immunoglobulin G (IgG) and M (IgM) antibodies, isolation of the virus, and reverse-transcriptase polymerase chain reaction (RT-PCR) evaluation. […] A complete blood cell (CBC) count may reveal leukopenia with a relative lymphocytosis and thrombocytopenia. […] Consult public health or infectious disease specialists for recommendations and guidelines for diagnostic confirmation of cases and prophylaxis of susceptible contacts. […] Immediate reporting of any suspected case of measles to a local or state health department is imperative, as is obtaining serum for IgM antibody testing as soon as possible (ie, on or after the third day of rash).

• #12 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #13 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  The measles virus sandwich-capture IgM antibody assay, offered through many local health departments and through the CDC, is the quickest method of confirming acute measles. […] Because IgM may not be detectable during the first 2 days of rash, obtain blood for measles-specific IgM on the third day of the rash or on any subsequent day up to 1 month after onset to avoid a false-negative IgM result. […] Among persons with confirmed measles infection, the seropositivity rate for first samples is about 77% when collected within 72 hours; the rate rises to 100% when collected 4-11 days after rash onset. […] Although the measles serum IgM level remains positive 30-60 days after the illness in most individuals, the IgM titer may become undetectable in some subjects at 4 weeks after rash onset.

• #14 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  The measles virus sandwich-capture IgM antibody assay, offered through many local health departments and through the CDC, is the quickest method of confirming acute measles. […] Because IgM may not be detectable during the first 2 days of rash, obtain blood for measles-specific IgM on the third day of the rash or on any subsequent day up to 1 month after onset to avoid a false-negative IgM result. […] Among persons with confirmed measles infection, the seropositivity rate for first samples is about 77% when collected within 72 hours; the rate rises to 100% when collected 4-11 days after rash onset. […] Although the measles serum IgM level remains positive 30-60 days after the illness in most individuals, the IgM titer may become undetectable in some subjects at 4 weeks after rash onset.

• #15

  https://www.healio.com/clinical-guidance/measles/diagnostic-tests-and-differential-diagnosis-presentation-and-diagnosis

  Unless pathognomonic signs are present or symptoms consistent with measles appear during a local outbreak, diagnosing measles based on clinical signs alone is challenging. Laboratory testing thus remains essential for an accurate diagnosis. […] When faced with a patient presenting with an acute febrile rash illness (i.e., a suspected case of measles), the two best confirmatory diagnostic options are: Serologic testing for measles immunoglobulin M (IgM) antibody; and Molecular testing for MeV RNA by polymerase chain reaction (PCR). […] Serologic testing for immunoglobulin M (IgM) is usually done by enzyme immunoassay on blood samples, which has a sensitivity of 83-89% and a specificity of 95-99%. However, in up to 20-25% of measles-infected patients will not have detectable levels of IgM antibodies within 72 hours after the onset of rash.

• #16 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #17

  https://www.healio.com/clinical-guidance/measles/diagnostic-tests-and-differential-diagnosis-presentation-and-diagnosis

  Real time PCR-based methods, which detect MeV RNA with a sensitivity of 94% and a specificity of 99%, play an increasingly important role in confirming a tentative diagnosis of measles. […] Adequate samples for PCR-based detection include swabs (throat, nasal, or posterior nasopharyngeal), bronchial lavage samples and urine samples. […] While respiratory specimens are preferred, testing the urine increases the chance of establishing a diagnosis. […] Note that a positive result from any molecular or serologic test, including MeV isolation, can only be taken to indicate natural measles in the absence of vaccination for measles in the preceding 6-45 days, since measles vaccines contain live-attenuated MeV virus. Thus, a positive PCR result in the setting of mild measles-like illness may simply indicate recent vaccination.

• #18

  https://www.healio.com/clinical-guidance/measles/diagnostic-tests-and-differential-diagnosis-presentation-and-diagnosis

  Real time PCR-based methods, which detect MeV RNA with a sensitivity of 94% and a specificity of 99%, play an increasingly important role in confirming a tentative diagnosis of measles. […] Adequate samples for PCR-based detection include swabs (throat, nasal, or posterior nasopharyngeal), bronchial lavage samples and urine samples. […] While respiratory specimens are preferred, testing the urine increases the chance of establishing a diagnosis. […] Note that a positive result from any molecular or serologic test, including MeV isolation, can only be taken to indicate natural measles in the absence of vaccination for measles in the preceding 6-45 days, since measles vaccines contain live-attenuated MeV virus. Thus, a positive PCR result in the setting of mild measles-like illness may simply indicate recent vaccination.

• #19 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #20 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #21 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Measles-Diagnosis.aspx

  After an infection the IgM shows an immediate rise that persists for a month or two. This is diagnostic of measles. […] Measles virus contains a single stranded RNA in its core. These RNA strands may be detected in saliva and other samples for confirmation of diagnosis. […] Isolation of measles virus is not recommended as a routine method to diagnose measles. However, studies of these isolates help in molecular epidemiologic surveillance of measles and help in detecting the geographic origin of the virus and strains of the virus. […] Further tests include those with buccal scrapings. This includes gently scraping the cells of the inner linings of the cheeks. These cells are then placed over a slide and stained with special dyes called Leishman’s stain. Under the microscope giant cells are visible. […] Yet another method is to use special fluorescent dyes and with a process called immunofluorescence of a nasopharyngeal aspirate (NPA) the virus may be detected.

• #22 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  Patients with subacute sclerosing panencephalitis (SSPE) have unusually high titers of measles antibody in their serum and cerebrospinal fluid (CSF). […] The earliest confirmation of measles using IgG antibodies takes about 3 weeks from the onset of illness, a delay too long to permit implementation of effective control measures. […] Reverse-transcription polymerase chain reaction (PCR) evaluation is highly sensitive at visualizing measles virus RNA in blood, throat, nasopharyngeal, or urine specimens and, where available, can be used to rapidly confirm the diagnosis of measles. […] In immunocompromised patients, who may have poor antibody responses that preclude serologic confirmation of measles, isolation of the virus from infected tissue or identification of measles antigen by means of immunofluorescence may be the only feasible method of confirming the diagnosis.

• #23 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #24 Measles (Rubeola) | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq162

  Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if they recently traveled internationally or were exposed to a person with a febrile rash illness. […] Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction (PCR) in a respiratory specimen are the most common methods for confirming measles infection. […] A positive real-time PCR test confirms the measles diagnosis. […] False-negative IgM results can also occur if the serum sample is obtained 3 days after rash presentation, (ie, prior to IgM antibody development). […] Obtain both a serum sample AND a throat swab or nasopharyngeal swab from patients suspected to have measles. […] The real-time PCR test has the greatest diagnostic sensitivity when samples are collected as soon as possible in a suspected measles patient.

• #25 Measles (Rubeola) | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq162

  Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if they recently traveled internationally or were exposed to a person with a febrile rash illness. […] Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction (PCR) in a respiratory specimen are the most common methods for confirming measles infection. […] A positive real-time PCR test confirms the measles diagnosis. […] False-negative IgM results can also occur if the serum sample is obtained 3 days after rash presentation, (ie, prior to IgM antibody development). […] Obtain both a serum sample AND a throat swab or nasopharyngeal swab from patients suspected to have measles. […] The real-time PCR test has the greatest diagnostic sensitivity when samples are collected as soon as possible in a suspected measles patient.

• #26 Measles (Rubeola) | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq162

  If the acute-phase measles antibody sample collected 3 days after rash onset is negative, and the patient has a negative (or not yet reported) result for measles real-time PCR, a second serum sample 3 to 10 days after symptom onset may be useful. […] Laboratory confirmation is essential for all sporadic measles cases and all outbreaks.

• #27 Measles – Wikipedia

  https://en.wikipedia.org/wiki/Measles

  Typically, clinical diagnosis begins with the onset of fever and malaise about 10 days after exposure to the measles virus, followed by the emergence of cough, coryza, and conjunctivitis that worsen in severity over 4 days of appearing. Observation of Koplik’s spots is also diagnostic. […] Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or detection of measles virus RNA from throat, nasal or urine specimen by using the reverse transcription polymerase chain reaction assay. This method is particularly useful to confirm cases when the IgM antibodies results are inconclusive. […] Positive contact with other people known to have measles adds evidence to the diagnosis.

• #28 Measles Differential Diagnoses

  https://emedicine.medscape.com/article/966220-differential

  The diagnosis of measles is usually determined from the classic clinical picture, including the classic triad of cough, coryza, and conjunctivitis; the pathognomonic Koplik spots; and the characteristic cephalocaudal progression of the morbilliform exanthem. […] It is worthwhile to be mindful of atypical measles, which has been described in individuals who were infected with wild measles virus several years after immunization with a killed measles vaccine (a vaccine used in the United States from 1963-1967). This syndrome tends to be more prolonged and severe than regular measles and is marked by a prolonged high fever, pneumonitis, and a rash that begins peripherally and may be urticarial, maculopapular, hemorrhagic, and/or vesicular. […] Diagnosis of measles with an IgM capture EIA: the optimal timing of specimen collection after rash onset.

• #29 Measles Differential Diagnoses

  https://emedicine.medscape.com/article/966220-differential

  The diagnosis of measles is usually determined from the classic clinical picture, including the classic triad of cough, coryza, and conjunctivitis; the pathognomonic Koplik spots; and the characteristic cephalocaudal progression of the morbilliform exanthem. […] It is worthwhile to be mindful of atypical measles, which has been described in individuals who were infected with wild measles virus several years after immunization with a killed measles vaccine (a vaccine used in the United States from 1963-1967). This syndrome tends to be more prolonged and severe than regular measles and is marked by a prolonged high fever, pneumonitis, and a rash that begins peripherally and may be urticarial, maculopapular, hemorrhagic, and/or vesicular. […] Diagnosis of measles with an IgM capture EIA: the optimal timing of specimen collection after rash onset.

• #30 Diagnosing Measles in the Post-Elimination Era

  https://asm.org/articles/2019/june/diagnosing-measles-in-the-post-elimination-era

  The 3 main components of the laboratory diagnosis of measles are: Serum IgM testing, Viral culture, Reverse-transcription PCR (RT-PCR). […] The most common method for measles IgM testing is a capture enzyme immunoassay (EIA), although indirect EIAs may also be used. […] The combination of IgM and RT-PCR is usually sufficient to establish or rule out a diagnosis of measles. […] The diagnosis of measles is particularly challenging in previously infected or vaccinated individuals. […] An IgG avidity assay can be useful in distinguishing between these two groups: IgG avidity will be low in a person with PVF recently infected with measles, whereas it will be high in a person with SVF. […] Unfortunately, the usual tests for diagnosis of acute measles have limitations in reinfection cases: viral shedding may be reduced, decreasing the likelihood of successfully detecting virus by PCR or culture, IgM results may be falsely negative, and the clinical manifestations often diverge from the classic measles presentation.

• #31 Measles – Rubeola | Choose the Right Test

  https://arupconsult.com/content/measles-virus

  Measles is a highly communicable respiratory disease characterized by symptoms such as fever, malaise, cough, conjunctivitis, coryza, Koplik spots, and a maculopapular rash that radiates downward from the head. […] When measles is suspected, serology and molecular detection are used for diagnosis. […] According to the CDCs case definition for measles, a positive laboratory result in either an existing or epidemiologically linked case is required to confirm a measles diagnosis. […] Measles infection in vaccinated individuals is typically milder, and immunoglobulin M (IgM) antibodies may be low or undetectable. […] The CDC currently recommends the use of molecular detection, in addition to immunoglobulin M (IgM) serology, to improve diagnostic accuracy. […] Molecular tests designed to specifically detect the vaccine strain of measles virus have been developed to help clinicians assess a patients risk.

• #32 Measles – Rubeola | Choose the Right Test

  https://arupconsult.com/content/measles-virus

  Measles is a highly communicable respiratory disease characterized by symptoms such as fever, malaise, cough, conjunctivitis, coryza, Koplik spots, and a maculopapular rash that radiates downward from the head. […] When measles is suspected, serology and molecular detection are used for diagnosis. […] According to the CDCs case definition for measles, a positive laboratory result in either an existing or epidemiologically linked case is required to confirm a measles diagnosis. […] Measles infection in vaccinated individuals is typically milder, and immunoglobulin M (IgM) antibodies may be low or undetectable. […] The CDC currently recommends the use of molecular detection, in addition to immunoglobulin M (IgM) serology, to improve diagnostic accuracy. […] Molecular tests designed to specifically detect the vaccine strain of measles virus have been developed to help clinicians assess a patients risk.

• #33 Measles | VisualDx

  https://www.visualdx.com/resources/public-health/measles/

  Encephalitis is a complication in about 1 in 1000 cases. […] Immunocompromised patients can also present with severe pneumonitis and without the classical viral prodrome. […] Subacute sclerosing panencephalitis (SSPE) is a delayed neurodegenerative disorder occurring approximately 10-11 years after acute infection. […] This complication is characterized by changes in personality, seizures, and coma and eventuates in death. […] Oral lesions called Koplik spots may develop 2-3 days after symptoms begin and prior to the generalized cutaneous eruption. […] This enanthem is considered pathognomonic for measles. […] The exanthem consists of erythematous macules and papules beginning at the forehead and behind the ears, eventually spreading in a cephalocaudal fashion down the neck, upper extremities, trunk, and lower extremities. […] Desquamation typically occurs after approximately 1 week. […] Variant: Atypical measles syndrome (in those receiving formalin-inactivated measles vaccine between 1963 and 1967 or in whom immunization has failed) will spread from the extremities inward.

• #34 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  Patients with subacute sclerosing panencephalitis (SSPE) have unusually high titers of measles antibody in their serum and cerebrospinal fluid (CSF). […] The earliest confirmation of measles using IgG antibodies takes about 3 weeks from the onset of illness, a delay too long to permit implementation of effective control measures. […] Reverse-transcription polymerase chain reaction (PCR) evaluation is highly sensitive at visualizing measles virus RNA in blood, throat, nasopharyngeal, or urine specimens and, where available, can be used to rapidly confirm the diagnosis of measles. […] In immunocompromised patients, who may have poor antibody responses that preclude serologic confirmation of measles, isolation of the virus from infected tissue or identification of measles antigen by means of immunofluorescence may be the only feasible method of confirming the diagnosis.

• #35

  https://www.healio.com/clinical-guidance/measles/diagnostic-tests-and-differential-diagnosis-presentation-and-diagnosis

  Real time PCR-based methods, which detect MeV RNA with a sensitivity of 94% and a specificity of 99%, play an increasingly important role in confirming a tentative diagnosis of measles. […] Adequate samples for PCR-based detection include swabs (throat, nasal, or posterior nasopharyngeal), bronchial lavage samples and urine samples. […] While respiratory specimens are preferred, testing the urine increases the chance of establishing a diagnosis. […] Note that a positive result from any molecular or serologic test, including MeV isolation, can only be taken to indicate natural measles in the absence of vaccination for measles in the preceding 6-45 days, since measles vaccines contain live-attenuated MeV virus. Thus, a positive PCR result in the setting of mild measles-like illness may simply indicate recent vaccination.

• #36 Measles – Rubeola | Choose the Right Test

  https://arupconsult.com/content/measles-virus

  Measles is a highly communicable respiratory disease characterized by symptoms such as fever, malaise, cough, conjunctivitis, coryza, Koplik spots, and a maculopapular rash that radiates downward from the head. […] When measles is suspected, serology and molecular detection are used for diagnosis. […] According to the CDCs case definition for measles, a positive laboratory result in either an existing or epidemiologically linked case is required to confirm a measles diagnosis. […] Measles infection in vaccinated individuals is typically milder, and immunoglobulin M (IgM) antibodies may be low or undetectable. […] The CDC currently recommends the use of molecular detection, in addition to immunoglobulin M (IgM) serology, to improve diagnostic accuracy. […] Molecular tests designed to specifically detect the vaccine strain of measles virus have been developed to help clinicians assess a patients risk.

• #37

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3165981/

  To evaluate the performance of a newly developed point-of-care test (POCT) for the detection of measles-specific IgM antibodies in serum and oral fluid specimens and to assess if measles virus nucleic acid could be recovered from used POCT strips. […] The POCT has the sensitivity and specificity required of a field-based test for measles diagnosis. However, its role in global measles control programmes requires further evaluation. […] Laboratory confirmation of cases of measles is a vital aspect of surveillance at all stages of control programmes because clinical diagnosis is unreliable. The mainstay of laboratory confirmation is the detection of measles-specific immunoglobulin M (IgM) antibodies in serum samples. […] Point-of-care tests (POCTs) are increasingly used for the rapid diagnosis of infections.

• #38

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3165981/

  In this study, the POCT showed good sensitivity, specificity and positive and negative predictive values (88%) and is therefore suitable for field use. […] An added advantage of the POCT, apart from its ability to detect measles-specific IgM, is that the test strip is an excellent matrix for capturing viral nucleic acid from oral fluid samples and preserving it for up to 5 weeks at ambient temperature.

• #39

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3165981/

  In this study, the POCT showed good sensitivity, specificity and positive and negative predictive values (88%) and is therefore suitable for field use. […] An added advantage of the POCT, apart from its ability to detect measles-specific IgM, is that the test strip is an excellent matrix for capturing viral nucleic acid from oral fluid samples and preserving it for up to 5 weeks at ambient temperature.

• #40 Measles Workup: Approach Considerations, Antibody Assays, Viral Culture

  https://emedicine.medscape.com/article/966220-workup

  Although the diagnosis of measles is usually determined from the classic clinical picture, laboratory identification and confirmation of the diagnosis are necessary for the purposes of public health and outbreak control. Laboratory confirmation is achieved by means of serologic testing for immunoglobulin G (IgG) and M (IgM) antibodies, isolation of the virus, and reverse-transcriptase polymerase chain reaction (RT-PCR) evaluation. […] A complete blood cell (CBC) count may reveal leukopenia with a relative lymphocytosis and thrombocytopenia. […] Consult public health or infectious disease specialists for recommendations and guidelines for diagnostic confirmation of cases and prophylaxis of susceptible contacts. […] Immediate reporting of any suspected case of measles to a local or state health department is imperative, as is obtaining serum for IgM antibody testing as soon as possible (ie, on or after the third day of rash).

• #41 Measles (Rubeola) | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq162

  If the acute-phase measles antibody sample collected 3 days after rash onset is negative, and the patient has a negative (or not yet reported) result for measles real-time PCR, a second serum sample 3 to 10 days after symptom onset may be useful. […] Laboratory confirmation is essential for all sporadic measles cases and all outbreaks.

• #42 Diagnostic algorithm for the confirmation of cases of measles and rubella in Mexico

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016-38132019000500492

  Timeliness and quality in the taking and submission of samples, until the reception in the laboratory, are determinant to the reliability of the result. […] The InDRE and the RNLSP have the technical and professional resources to establish a reliable and timely diagnosis and to support the actions of disease prevention and control.

• #43 Measles Clinical Diagnosis Fact Sheet | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/hcp/communication-resources/clinical-diagnosis-fact-sheet.html

  Most common complications: Diarrhea and otitis media. […] Most severe complications: Pneumonia, encephalitis, and death. Patients may require hospitalization. Children younger than 5, adults older than 20, pregnant women, and immunocompromised persons are at most risk of serious complications. […] Immediately mask and isolate the patient in a room with a closed door (negative pressure room if available). Follow standard and airborne precautions. […] Evaluate the patient and order measles confirmatory testing (collect a throat or nasopharyngeal swab for RT-PCR and serum for IgM measles testing). […] Immediately report this suspected case to your local and/or state health department.

• #44 Measles | ACEP | ACEP

  https://www.acep.org/by-medical-focus/infectious-diseases/infectious-diseases/measles

  Patients who present with possible measles should have a PCR test performed, and if immunosuppressed, they may be a candidate for immunoglobulin. […] Due to the high infectivity of this virus, potential measles patients must be immediately isolated and should not spend time in a general waiting area. […] Rapid triage and movement of a suspected measles case to a designated isolation room or isolation area is essential. […] Adhering to Standard and Airborne Precautions for patients with known or suspected measles. […] Evaluate the patient and order measles confirmatory testing (collect a throat or nasopharyngeal swab for RT-PCR and serum for IgM measles testing).

• #45 Laboratory Testing for Measles | Measles (Rubeola) | CDC

  https://www.cdc.gov/measles/php/laboratories/index.html

  CDC recommends the collection and submission of samples for all suspected measles cases. […] Nasopharyngeal or throat swabs are preferred over urine specimens. […] Detection of specific IgM antibodies in a serum specimens collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. […] Detection of measles RNA in a clinical specimen can provide laboratory confirmation of infection. […] CDC recommends that either a nasopharyngeal swab, throat swab, or urine specimen as well as a blood specimen be collected from all patients with clinical features compatible with measles. […] Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash.

• #46 Measles (Rubeola) | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq162

  Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if they recently traveled internationally or were exposed to a person with a febrile rash illness. […] Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction (PCR) in a respiratory specimen are the most common methods for confirming measles infection. […] A positive real-time PCR test confirms the measles diagnosis. […] False-negative IgM results can also occur if the serum sample is obtained 3 days after rash presentation, (ie, prior to IgM antibody development). […] Obtain both a serum sample AND a throat swab or nasopharyngeal swab from patients suspected to have measles. […] The real-time PCR test has the greatest diagnostic sensitivity when samples are collected as soon as possible in a suspected measles patient.

• #47 Diagnosing Measles in the Post-Elimination Era

  https://asm.org/articles/2019/june/diagnosing-measles-in-the-post-elimination-era

  The 3 main components of the laboratory diagnosis of measles are: Serum IgM testing, Viral culture, Reverse-transcription PCR (RT-PCR). […] The most common method for measles IgM testing is a capture enzyme immunoassay (EIA), although indirect EIAs may also be used. […] The combination of IgM and RT-PCR is usually sufficient to establish or rule out a diagnosis of measles. […] The diagnosis of measles is particularly challenging in previously infected or vaccinated individuals. […] An IgG avidity assay can be useful in distinguishing between these two groups: IgG avidity will be low in a person with PVF recently infected with measles, whereas it will be high in a person with SVF. […] Unfortunately, the usual tests for diagnosis of acute measles have limitations in reinfection cases: viral shedding may be reduced, decreasing the likelihood of successfully detecting virus by PCR or culture, IgM results may be falsely negative, and the clinical manifestations often diverge from the classic measles presentation.

• #48 Diagnosing Measles in the Post-Elimination Era

  https://asm.org/articles/2019/june/diagnosing-measles-in-the-post-elimination-era

  The 3 main components of the laboratory diagnosis of measles are: Serum IgM testing, Viral culture, Reverse-transcription PCR (RT-PCR). […] The most common method for measles IgM testing is a capture enzyme immunoassay (EIA), although indirect EIAs may also be used. […] The combination of IgM and RT-PCR is usually sufficient to establish or rule out a diagnosis of measles. […] The diagnosis of measles is particularly challenging in previously infected or vaccinated individuals. […] An IgG avidity assay can be useful in distinguishing between these two groups: IgG avidity will be low in a person with PVF recently infected with measles, whereas it will be high in a person with SVF. […] Unfortunately, the usual tests for diagnosis of acute measles have limitations in reinfection cases: viral shedding may be reduced, decreasing the likelihood of successfully detecting virus by PCR or culture, IgM results may be falsely negative, and the clinical manifestations often diverge from the classic measles presentation.

• #49 Diagnosing Measles in the Post-Elimination Era

  https://asm.org/articles/2019/june/diagnosing-measles-in-the-post-elimination-era

  For most of human history, the diagnosis of measles was made on clinical grounds: a doctor or parent could recognize the disease, also known as rubeola, simply by observing a miserable-appearing child who, after a few days of high fever, runny nose, cough, and conjunctivitis, developed a blanching, morbilliform rash on the face that subsequently spread over the rest of the body. […] Scientists were, however, interested in finding a way to identify and propagate measles in the laboratory, in part because this capacity would be essential in the development of a vaccine. […] The accurate identification of measles cases is critical for outbreak control, however. Measles is one of the most contagious infectious diseases in existence, so the prompt institution of appropriate infection control and post-exposure prophylaxis measures are critical in preventing its spread to vulnerable populations, including infants too young to have been vaccinated and immunocompromised individuals.

• #50 Use of Measles and Rubella Rapid Diagnostic Tests to Improve Case Detection and Targeting of Vaccinations

  https://www.mdpi.com/2076-393X/12/8/823

  Accurate and timely surveillance data incorporating laboratory testing results for both measles and rubella can also help monitor the quality of routine immunization services. […] Laboratory-based enzyme immunoassay (EIA) testing of sera for measles and rubella immunoglobulin M (IgM) antibodies is currently the mainstay of testing for both diseases. […] Over recent years, quantitative real-time reverse-transcriptase polymerase chain reaction (qRT-PCR) has been used increasingly to complement IgM detection for case confirmation. […] The World Health Organization (WHO) Global Measles and Rubella Laboratory Network (GMRLN), a network of over 700 laboratories operating in 191 countries, has played a key role in supporting laboratory testing worldwide, including evaluating commercially available measles and rubella EIA test kits.

• #51 Measles Clinical Information – MN Dept. of Health

  https://www.health.state.mn.us/diseases/measles/hcp/clinical.html

  Many U.S. health care providers have never seen a case of measles. Without proper laboratory testing, measles cannot be diagnosed. […] Providers should consider measles in patients who meet the clinical case definition. Since measles is uncommon, providers should ask the patient about known exposures or travel history (domestic or international) in the 30 days prior to symptom onset. […] If measles is suspected, follow the steps in Minimize Measles Transmission in Health Care Settings. […] The incubation period for measles averages 10-12 days from exposure to prodrome and 14 days (range 7-21) from exposure to rash onset. Measles is infectious from 4 days prior to 4 days after rash onset. There are no asymptomatic infectious carriers. Airborne transmission via aerosolized droplet nuclei is the primary route of transmission. Airborne precautions are recommended.

• #52 Diagnosing Measles in the Post-Elimination Era

  https://asm.org/articles/2019/june/diagnosing-measles-in-the-post-elimination-era

  Once a disease of primarily historical interest in the United States, measles now represents a growing re-emerging threat both in the U.S. and throughout the world. The clinical microbiology laboratory has a critical role in assisting clinicians, infection preventionists, and epidemiologists in controlling the spread of this highly contagious and potentially lethal infection.

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