Case Study: Diagnosis, Prognosis, and Treatment of Measles

This case study provides an in-depth analysis of a 60-year-old diabetic patient diagnosed with measles. It details the variances in diagnosis, including differentiation from conditions like rubella, roseola, and scarlet fever, and discusses the prognosis at various stages of the illness. The study outlines potential complications such as pneumonia, given the patient's pre-existing diabetes, and explores treatment options, emphasizing supportive care like rest, hydration, and fever management with acetaminophen. The report concludes by highlighting the importance of accurate diagnosis and appropriate care strategies for managing measles, especially in vulnerable populations.

PROJECT 4
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TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Variances of diagnosis.................................................................................................................4
Prognosis of the condition during possible level of condition differential diagnosis..................5
Treatment options for the condition and treatment plan for the client........................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Diagnosis refer as the process for examining the nature of the particular diseases and
differentiating it with the other possible diseases. Historically diagnosis was considered as the
primary guide for the prognosis and treatment and it is still considered as the main concept
within the clinical practices (Kavak and et.al 2022). Dermatological condition is related to the
skin problem where it involves the common skin rashes, sever infection, that generally caused by
the various things like heat, allergies, system disorder. Whereas some skin problem is genetic
that becomes vulnerable with time. It is important for the patient to consult with the doctors in
order to undertake medication for healthy life. Following report is based on the case study where
the client is suffering from Dermatological condition which is measles. Where the treatment for
the skin related problem involves the medications, ointments and dermatological creams that is
suggested by the doctor. Following report will cover the description about measles
dermatological condition, it also covers the variances of the diagnosis and prognosis about the
condition during the possible stages and also discuss the differential diagnosis. Further it will
illustrate the treatment criteria which is required for treating the client who is suffering from the
measles.
MAIN BODY
Case study overview
From the given case study, it has been identified that Client is having a characteristics of
the Dermatological condition which is measles. Client is of age 60 and also have history of
diabetes. Client is experiencing the symptoms like watery eyes, runny nose, high fever. In such it
is important for them to underwent treatment for treating measles.
Dermatological condition
Measles is the acute respiratory illness that cause high fever and red rashes over the skin,
it is the contagious viral illness that is characterised by the cough, red eyes, runny nose. It is
disastrous disease which is also termed as the Rubeola. Generally, its symptoms appear within 7
to 14 days where patient started experiencing symptoms like high fever, watery eyes, its rashes
often appear within 2 to 5 days just after the first indication (Passeron and et.al 2019). It is highly
contagious as when person having measles contact with others and meet with others they spread
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the virus in the air through breath, cough, sneeze. It is found that this infection lasts for the
several weeks. As such no specific treatment is found for the measles unlike the other bacterial
infection. There are common 3 c’s symptoms found in measles that are cough, coryza and
conjunctivitis.
Variances of diagnosis
It is found that almost 20 distinct genotypes have isolates in different part of the world,
there is only one type of serotype. Measles is the dangerous disease where the person transmits
the 90 percent virus. Pneumonia is one of the major complication of the measles, young children
are more expose to this disease (Ezhilarasan, 2021). Virus of measles is envelopes; ribonucleic
acid virus is found in it. Inhalation of the virus that consists of the droplets, then measles virus
enters in the cells of throat and after 5-7 days’ exposure to infection it transmits from blood to
other part of body and gives the vulnerable symptoms like red rashes, red and watery eyes.
Mostly people who have vitamin A deficiency, or have advanced HIV infection are at greater
risk to develop the symptoms of the severe measles. Different diagnosis of the measles involves
the rubella, roseola, Scarlet fever and adenoviral infections etc. Complication of this virus forms
the pneumonia and encephalitis that can be sever and lead to death. Measles virus if the negative
sense where the single stranded RNA virus links to Paramyxoviridae family. Nucleoprotein (N-
450) is suggested by WHO for the measles virus genotyping, as it gives the greater variable
nucleotides density among the small fragments (Stumpf Schneider and Ständer, 2018). The
molecular attribute of the virus strain is important for monitoring measles virus transmission and
the growth of the elimination factors. World health organisation have identified the 24 types of
the genotype of the measles virus generally there are four type of predominant measles virus that
is spreading worldwide that are D8, B3, H1 and D4.
According to the data it is found that in year 2017 Italy has experienced the measles
epidemic where the number of cases were 5408 and also recorded the deaths (Has and et.al
2020). In regards with the case study it is found that patient is already at their older age and
experiencing several changes in the body, client also have the history of diabetes, it is clear that
people who have the diabetes generally suffers from various diseases because of this they are
already at high risk to get any kind of infection. As compared with other people treatment
process for the diabetic patient is slow as their wounds cannot be healing within a time usually

they suffered for the long time. Measles is caused from the Rubeola virus where it is from the
paramyxovirus family. Rubeola’s symptoms generally looks as the large flat red spots which
appear over the face at the hairline and also spread all over the face and downwards to neck side,
arms, legs. Where the small bumps is also found on the top of the large red spots, these spots
linked together as they are transmitted from head to all over the body parts. Rubeola is fatal for
the small children and the people who are not vaccinated also at the high risk to get the measles.
Roseola is the childhood disease which is generally caused from two strains of herpes virus,
where its common symptoms involves the high fever and red rashes over the neck and trunk.
Roseola is also knowns as the baby measles, it is rare in adults generally kids are at the high risk
of getting the Roseola virus (Grein and et.al 2019). Usually two types of measles is found that
are standard measles that also known as the red measles and hard measles which is due to the
rubeola virus. Other measles is German measles which is termed as the Rubella and it is
considers as the different illness that is by the Rubella virus and have the moderate infection that
the other standard measles. For its diagnosis blood and saliva test is the only method to confirm
its diagnosis. Its test involves the monitoring for the immunoglobulin M and Immunoglobulin G
antibody degree, with this it can be easily determined the current and past history of the measles.
There are no such specific medicines or drugs are found for the treatment of the measles as it is
viral disease and nonbacterial therefore antibiotics are ineffective in this case.
Prognosis of the condition during possible level of condition differential diagnosis
Prognosis refers to the prediction of the course about the disease also involves the
prognosis for the treatments and outcomes. As diagnosis comes before the prognosis. Every
aspect of the disease known as the differential diagnosis for an example acute Bronchitis that is
differential diagnosis for the evaluation of the cough even the final diagnosis is the common
cold. It is important for the healthcare provider to examine other illness as well before
proceeding with the diagnosis of the measles, it is generally because measles is fairly rare in
different part of the world (Griffin, Lin and Nelson, 2018). It is found that measles is fairly
simpler to diagnosis when checking the blood tests it is used for confirming of the disease. Other
illness which the healthcare provider rules out on the basis of how long patient is showing the
symptoms of the measles.
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Before the red rashes appears
During the few time before the measles rashes obtained, it also looks like that the patient
is having the respiratory virus that are flu and other respiratory syncytial virus that are commonly
responsible for the cold (Cattaneo and et.al 2019). After the two or three days Koplik spots
started to appear inside the mouth, they can also be mistaken as the Fordyce Spots which the
enlarged oil glands. But it is seen that fever in measles virus is higher than other viral disease,
that is also considered as the indication that patient does not have the viral infection. Measles can
also be mistaken or confused with the dengue fever before and after its symptoms appears, but it
can be identified through the blood test to confirm whether it is measles or not.
After the red rashes appears
When the rashes appear in the five days’ other illness which the healthcare service
provider requires to rule out that involves:
Other virus, where the rashes are found as initial symptoms: It encompasses the chickenpox,
roseola, other parvovirus that also considered as the fifth disease. Generally healthcare provider
simply rules out the other viruses just by examining the rashes as how it looks and also checks
the symptoms.
Scarlet fever and TSS (Toxic shock syndrome): Streptococcus infection also leads to rashes, but
scarlet fever can easily rule out from the other symptoms. TSS generally followed by low blood
pressure and also from kidney problems.
Reactions to the drugs: Rashes which is by the hypersensitivity to the specific drug also appears
similar as the measles rash, but healthcare provider can easily determine to test whether the
patient is exposed to any drugs or not (Singh and et.al 2019). In context with the case study it is
found that client is also exposed to some drug, but after blood test it is confirmed that he has
developed the measles, because of this red rash is appeared on his body.
Meningococcemia: It is the bacterial infection which is generally due to the similar type of the
bacteria which develops the meningitis, where it also has the same type of the symptoms like
measles that also involves the rashes all over the body. The only things that helps in determining
whether the person have measles or other type of bacterial virus is blood testing, through this
healthcare provider can easily found that person have the measles and proceeded with the
treatment.

Rocky mountain fever: This bacterial illness is transmitted from the ticks and have the same
symptoms like the measles. It is diagnosed from skin biopsy and from blood tests.
Infectious mononucleosis: Generally known as the mono, this viral illness also has the measles
like symptoms that includes red rashes, it is particularly obtain after in taking the specific
antibiotics. Blood test can be rule out to confirm the mononucleosis.
Treatment options for the condition and treatment plan for the client
As such no specific real treatment is found for the measles, but sometimes its vaccines can
be used after first three days exposing to the virus, its vaccine is MMR (measles, mumps and
rubella), it can be used for preventing the one from the disease. Healthcare professional advises
the patient to get more liquid and to take the acetaminophen (Tylenol) for the fever (Ayasoufi
and Pfaller, 2020). It is found that the people who have the measles often leads to develop the
other complications as Pneumonia, diarrhea which also creates the hospitalisation situation. As
for the client who also have the Diabetes is found that client has developed the pneumonia
complication and needed to hospitalised to prevent to expose to other bacterial virus. After the
laboratory tests, as blood and secretion from the nose is found that client is having measles and
also there are red rashes is appeared all over the face of client.
Therefore, for the client it is advisable to take the acetaminophen or other ibuprofen for the
pains and to get relieve from the fever. It is suggested that patient need to take rest and get
enough fluids, gargling with the salt water to relax the throat, and avoid lights that cause the
itchiness in the eyes. It is suggested that patient need to avoid the sugary drinks and caffeine in
their drinks. As no treatment is specifically identified it can be cured by making sure to take
proper diets and other things which is suggested by the healthcare provider, as no antibiotic is
working to prevent the measles, therefore in such it is important for the patient to protect
themselves from getting other infectious disease. It is recommended to the client to take sponge
bath with the lukewarm water as it will help in decreasing the discomfort that is generally caused
from the fever and also allowed to use the humidified that helps in cough and also relieves the
nasal congestion.
Client is having the diabetic problem but it is no case that he will get after symptoms because of
MMR vaccine. No evidences have been found which says that people with the diabetic is
vulnerable to the measles vaccine. Thus client is also allowed to take MMR vaccine as it helps
him to prevent from the measles. Generally, the incubation period for this disease is 8-12 days,
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where the incubation time between exposure to the measles disease and onset of the initial
symptoms (Morán-Santibañez and et.al 2018). It is recommended to patient to take rest at home
and avoid travelling and gathering as measles virus can easily transmitted through air, therefore
to remain at isolation is the best way to restricts its transmission. As the client is old and having
other health problem as well also their immune system is low, in such it is advisable to consider
such things after exposing to the virus.
Post exposure vaccination: It is identified that people who have no immunity to the measles are
suggested to take the vaccine within the 72 hours after exposing to the measles virus to prevent
its further symptoms. After this it still develops the measles symptoms then it usually a small or
moderate symptoms which generally lasts for the short duration of time (Pfaller and et.al 2020).
Immune serum globulin: Infants, and other people who have the weak immune system are at
higher risk, for that healthcare provider generally prescribes the protein injections which is also
known as the immune serum globulin. Therefore, for the client who has low immune system is
allowed to take this antibody in order to prevent measles and to make its symptoms less fatal.
CONCLUSION
From the above report it is concluded that dermatological conditions can lead to severe
consequences, for that it is essential to undertake the skin biopsy and other preventive measures
to protect from its after effects. Above have illustrated the discussion about the dermatological
conditions which the client has developed as discussed in the case study. It discussed the measles
virus which generally causes the high fever and other rashes, spots and watery eyes like
symptoms. Following have illustrated the range of discussion over the dermatological condition,
it also discussed the variances of the diagnosis which involves the variants of the measles that are
roseola, rubella. It also discussed how measles can be mistaken to different infections such as
scarlet fever, chicken pox etc. moving on further report have illustrated the prognosis of the
condition, where it highlighted the discussion over the differential of diagnosis, it discussed the
before and after appearance of the rashes and reactions to the drugs. It lastly concluded with the
description of the treatment and treatment plan for the client to prevent the further development
of measles.

REFERENCES
Books and journals
Ayasoufi, K. and Pfaller, C.K., 2020. Seek and hide: the manipulating interplay of measles virus
with the innate immune system. Current Opinion in Virology. 41. pp.18-30.
Cattaneo, R. and et.al 2019. Stronger together: multi-genome transmission of measles
virus. Virus research. 265. pp.74-79.
Ezhilarasan, D., 2021. Dapsone-induced hepatic complications: it’s time to think beyond
methemoglobinemia. Drug and chemical toxicology. 44(3). pp.330-333.
Grein, T.A. and et.al 2019. Aeration and shear stress are critical process parameters for the
production of oncolytic measles virus. Frontiers in bioengineering and biotechnology. 7.
p.78.
Griffin, D.E., Lin, W.H.W. and Nelson, A.N., 2018. Understanding the causes and consequences
of measles virus persistence. F1000Research. 7.
Has, C. and et.al 2020. Consensus reclassification of inherited epidermolysis bullosa and other
disorders with skin fragility. British Journal of Dermatology. 183(4). pp.614-627.
Kavak, A. and et.al 2022. Did dermatological hospital referrals and practice of dermatologists
change in between pre-covid and covid era? A short-term preliminary evaluation. Turkish
Journal of Dermatology. 16(2). p.57.
Morán-Santibañez, K. and et.al 2018. Virucidal and synergistic activity of polyphenol-rich
extracts of seaweeds against measles virus. Viruses. 10(9). p.465.
Passeron, T. and et.al 2019. Laser treatment of hyperpigmented lesions: position statement of the
European Society of Laser in Dermatology. Journal of the European Academy of
Dermatology and Venereology. 33(6). pp.987-1005.
Pfaller, C.K. and et.al 2020. The C protein is recruited to measles virus ribonucleocapsids by the
phosphoprotein. Journal of virology. 94(4). pp.e01733-19.
Singh, B.K. and et.al 2019. Measles virus ribonucleoprotein complexes rapidly spread across
well-differentiated primary human airway epithelial cells along F-actin rings. MBio.
10(6). pp.e02434-19.
Stumpf, A., Schneider, G. and Ständer, S., 2018. Psychosomatic and psychiatric disorders and
psychologic factors in pruritus. Clinics in Dermatology. 36(6). pp.704-708.
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