Signs & Symptoms
Typical Measles
- Prodrome begins w/ fever followed by conjunctivitis w/ photophobia, coryza, cough; cough usually lasts for 10 days
- Koplik spots found on the inner aspects of the cheeks at the level of the premolars, may also spread in the labial mucosa, hard & soft palate & gingiva
- Appear as punctate bluish white spots on an erythematous base
- Pathognomonic for measles
- Erythematous maculopapular rash initially appears around the forehead or posterior occipital area, spreads downward & outward
- Begins at the peak of resp symptoms, about 2-3 days after emergence of Koplik spots
- May become confluent on the face & upper trunk
- Rash diminishes in the same progression as it appeared, followed by fine desquamation
- Generalized lymphadenopathy esp prominent in the cervical & occipital areas
- Gastrointestinal symptoms may occur eg diarrhea, loss of appetite, vomiting, abdominal pain
Atypical Measles
- Occurs in patients who received inactivated or killed measles vaccine
- Characterized by fever, pneumonia, pleural effusions & edema
- Rash may be maculopapular, petechial, urticarial, purpuric or vesicular & it appears initially on the wrists or ankles
Black Measles or Severe Hemorrhagic Measles
- High-grade fever
- Seizures
- Changes in mental status
Modified Measles
- An attenuated form of measles that may occur in patients who were previously given immunoglobulin (Ig) as post exposure prophylaxis to measles
- Signs & symptoms are milder than those of typical measles
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Diagnosis
- Diagnosis is based on clinical findings in the absence of measles outbreak
Lab Exam
- CBC may reveal leukopenia & lymphopenia, absolute neutropenia may also occur
- Serologic tests may be used to confirm the diagnosis
- A single elevated IgM level is indicative of recent infection; IgM antibody appears in 75% of cases w/in 3 days after emergence of rashes, increases up to 100% after 7 days, & remains detectable for about 1-2 mth
- A 4-fold rise in IgG levels in acute & convalescent specimens may also be used; 1st specimen is drawn soon after the onset of rash, 2nd specimen is taken 10-30 days later
Complications
- Croup, tracheitis, bronchiolitis, acute otitis media, pneumonia
- Acute encephalitis
- May present w/ fever, headache, changes in sensorium; usually occur 2-6 days after the appearance of rash
- Subacute sclerosing panencephalitis
- Incubation period of 7-10 yr
- Result from persistent CNS infection; more likely to develop in males
- Presents w/ gradual deterioration in intellectual & behavioral function
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