Last January 8th, Private Practice aired its season 2 episode 11, called Contamination where Oceanside Wellness is put under quarantine when one of Cooper’s patients contracts the measles. Naomi pressures Addison into working with her rival, Wyatt, on a fertility case; meanwhile Dell fights for sole custody of his daughter, and Violet and Pete considers taking their friends-with-benefits relationship to the next level.
But what is the measles?
Measles is a disease caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include fever, cough, runny nose, red eyes and a generalized, maculopapular, erythematous rash.
Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it. The incubation period usually lasts for 4–12 days (during which there are, by definition, no symptoms). Infected people remain contagious from the appearance of the first symptoms until 3–5 days after the rash appears.
‘German measles’ is an unrelated condition caused by the rubella virus.
The classical symptoms of measles include a four day fever, the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40° Celsius (104° Fahrenheit). Koplik’s spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to “stain”, changing colour from red to dark brown, before disappearing.
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs. Observation of Koplik’s spots is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. However, in the rare case of a secondary vaccine failure, other external symptoms may be present, including nausea, headaches, or a feeling of slight dizziness when turning one’s head to the left. In these cases serological confirmation may be made by showing IgG antibody rises by enzyme immunoassay or complement fixation. In children, where phlebotomy is inappropriate, saliva can be collected for salivary measles specific IgA test. Adults are recommended to seek medical help right away.
Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen, saliva, or mucus can cause you to get it.
There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.
Some patients will develop pneumonia as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the Warthin-Finkeldey cell, is a multinucleated giant with eosinophilic cytoplasmic and nuclear inclusions.
The measles is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects and replicates in the lymphatic system, urinary tract, conjunctivae, blood vessels and central nervous system of its new host. The role of epithelial cells is uncertain, but the virus must infect them to spread to a new individual.
Patients with the measles should be placed on droplet precautions.
Humans are the only known natural hosts of measles, although the virus can infect some non-human primate species.
The Episode raised the issue about vaccines and the importance of being vaccinated.