eMedicine Specialties > Dermatology > Viral Infections

Measles, Rubeola: Differential Diagnoses & Workup

Author: Melissa Burnett, MD, Attending Physician, Clinical Instructor in Dermatology, Harvard Medical School, Department of Dermatology and Pediatric Dermatology, Cambridge Health Alliance and Massachusetts General Hospital
Coauthor(s): Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Contributor Information and Disclosures

Updated: May 18, 2007

Differential Diagnoses

Drug Eruptions
Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Kawasaki Disease
Rubella
Syphilis

Other Problems to Be Considered

Exanthems usually associated with systemic lymphadenopathy
Brucellosis
Cytomegalovirus
Gianotti-Crosti syndrome
HIV (primary)
Mononucleosis + ampicillin or allopurinol
Kawasaki disease
Rubella (German measles)
Syphilis (congenital, secondary)
Toxoplasmosis
Anticonvulsant hypersensitivity syndrome

Exanthems usually not associated with systemic lymphadenopathy
Drug reaction
Measles
Enterovirus, echovirus, coxsackievirus
Infectious hepatitis
Rat bite fever (Spirillum minus)

Workup

Laboratory Studies

  • The diagnosis of measles is made on a clinical basis and historically does not require a diagnostic workup. Given the rarity of measles in the United States, laboratory confirmation of the disease should be sought. Contact your local public health department and the CDC for any suspected cases of measles.
    • The CDC recommends that a sample of the patient's serum be obtained for measles IgM antibody testing. Although commercial antibody tests are available, any positive results obtained from these tests must be confirmed by the IgM enzyme immunoassay (EIA-IgM) developed by the CDC. This assay has been thoroughly evaluated and is both highly sensitive and highly specific for anti–measles IgM antibodies. The CDC EIA-IgM is the reference test for measles in North America and South America.
    • Other methods of detecting measles infection have also been developed. A radioimmunoassay technique that detects anti–measles IgM antibodies in oral fluids has been used in the United Kingdom. The CDC is currently trying to develop a similar EIA that can detect IgM antibodies in oral fluids rather than requiring blood samples. In addition to simply detecting measles infection, the particular strain of the measles virus can be identified by genotyping the viral RNA to determine its origin.

Histologic Findings

Skin biopsy of the fully evolved exanthem of measles is not specific, but the findings can be suggestive of the diagnosis. The histologic findings include psoriasiform epidermal hyperplasia, spongiosis, parakeratosis, and occasional dyskeratotic keratinocytes. Multinucleated keratinocytes (Warthin-Finkeldey giant cells) may be seen. A superficial, perivascular lymphocytic infiltrate associated with variable erythrocyte extravasation is present in the dermis. Multinucleated lymphoid cells containing intranuclear and cytoplasmic inclusions may be observed.

More on Measles, Rubeola

Overview: Measles, Rubeola
Differential Diagnoses & Workup: Measles, Rubeola
Treatment & Medication: Measles, Rubeola
Follow-up: Measles, Rubeola
References
[ CLOSE WINDOW ]

References

  1. Karp CL, Wysocka M, Wahl LM, Ahearn JM, Cuomo PJ, Sherry B, et al. Mechanism of suppression of cell-mediated immunity by measles virus. Science. Jul 12 1996;273(5272):228-31. [Medline].

  2. Fugier-Vivier I, Servet-Delprat C, Rivailler P, Rissoan MC, Liu YJ, Rabourdin-Combe C. Measles virus suppresses cell-mediated immunity by interfering with the survival and functions of dendritic and T cells. J Exp Med. Sep 15 1997;186(6):813-23. [Medline].

  3. Centers for Disease Control and Prevention. Epidemiology of measles--United States, 1998. MMWR Morb Mortal Wkly Rep. Sep 3 1999;48(34):749-53. [Medline]. [Full Text].

  4. Borrow P, Oldstone MB. Measles virus-mononuclear cell interactions. Curr Top Microbiol Immunol. 1995;191:85-100. [Medline].

  5. Centers for Disease Control and Prevention. Advances in global measles control and elimination: summary of the 1997 international meeting. MMWR Recomm Rep. Jul 24 1998;47(RR-11):1-23. [Medline]. [Full Text].

  6. Clements CJ, Cutts FT. The epidemiology of measles: thirty years of vaccination. Curr Top Microbiol Immunol. 1995;191:13-33. [Medline].

  7. Dörig RE, Marcil A, Chopra A, Richardson CD. The human CD46 molecule is a receptor for measles virus (Edmonston strain). Cell. Oct 22 1993;75(2):295-305. [Medline].

  8. Feigen RD, Cherry JD, eds. Prevention of infectious diseases. In: Textbook of Pediatric Infectious Diseases. 4th ed. Philadelphia, Pa: WB Saunders; 1998:2742-44.

  9. Feigen RD, Cherry JD, eds. Measles. In: Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders; 1992:1595.

  10. Griffin DE. Immune responses during measles virus infection. Curr Top Microbiol Immunol. 1995;191:117-34. [Medline].

  11. Habif TP. Exanthems and drug eruptions. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. Philadelphia, Pa: Mosby; 1996:409-12.

  12. Horikami SM, Moyer SA. Structure, transcription, and replication of measles virus. Curr Top Microbiol Immunol. 1995;191:35-50. [Medline].

  13. Katz M. Clinical spectrum of measles. Curr Top Microbiol Immunol. 1995;191:1-12. [Medline].

  14. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. Nov 7 2002;347(19):1477-82. [Medline].

  15. Manchester M, Liszewski MK, Atkinson JP, Oldstone MB. Multiple isoforms of CD46 (membrane cofactor protein) serve as receptors for measles virus. Proc Natl Acad Sci U S A. Mar 15 1994;91(6):2161-5. [Medline].

  16. Naniche D, Varior-Krishnan G, Cervoni F, Wild TF, Rossi B, Rabourdin-Combe C, et al. Human membrane cofactor protein (CD46) acts as a cellular receptor for measles virus. J Virol. Oct 1993;67(10):6025-32. [Medline].

  17. Norrby E. The paradigms of measles vaccinology. Curr Top Microbiol Immunol. 1995;191:167-80. [Medline].

  18. Rima BK, Earle JA, Baczko K, Rota PA, Bellini WJ. Measles virus strain variations. Curr Top Microbiol Immunol. 1995;191:65-83. [Medline].

  19. Smith S. Two more cases of measles are confirmed. Boston Globe. June 15, 2006.

  20. Tatsuo H, Ono N, Tanaka K, Yanagi Y. SLAM (CDw150) is a cellular receptor for measles virus. Nature. Aug 24 2000;406(6798):893-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

rubeola, morbilli, rubeola measles

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Melissa Burnett, MD, Attending Physician, Clinical Instructor in Dermatology, Harvard Medical School, Department of Dermatology and Pediatric Dermatology, Cambridge Health Alliance and Massachusetts General Hospital
Melissa Burnett, MD is a member of the following medical societies: American Academy of Dermatology and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

James W Patterson, MD, Director of Dermatopathology, Professor of Pathology and Dermatology, Departments of Pathology and Dermatology, University of Virginia Medical Center
James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association, American Society of Dermatopathology, Medical Society of Virginia, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, European Academy of Dermatology and Venereology, International Society of Dermatology, Massachusetts Medical Society, New York Academy of Sciences, Phi Beta Kappa, Society for Investigative Dermatology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.