Symptoms

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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