pediatrics
Measles
Symptoms and Signs of Measles
After a 7- to 14-day incubation period, measles begins with a prodrome of fever, coryza, hacking cough, and tarsal conjunctivitis. Koplik spots (which resemble grains of white sand surrounded by red areolae) are pathognomonic. These spots appear during the prodrome before the onset of rash, usually on the oral mucosa opposite the 1st and 2nd upper molars. They may be extensive, producing diffuse mottled erythema of the oral mucosa. Sore throat develops. The rash appears 3 to 5 days after symptom onset, usually 1 to 2 days after Koplik spots appear. It begins on the face in front of and below the ears and on the side of the neck as irregular macules, soon mixed with papules. Within 24 to 48 hours, lesions spread to the trunk and extremities (including the palms and soles) as they begin to fade on the face. Petechiae or ecchymoses may occur with in severe cases. During peak disease severity, a patient’s temperature may exceed 40°C, with periorbital edema, conjunctivitis, photophobia, a hacking cough, extensive rash, prostration, and mild itching. Constitutional symptoms and signs parallel the severity of the eruption. In 3 to 5 days, the fever decreases, the patient feels more comfortable, and the rash fades rapidly, leaving a coppery brown discoloration followed by desquamation. Patients who are immunocompromised may not have a rash and can develop severe, progressive giant cell pneumonia. Complications of measles include Bacterial superinfection, including pneumonia Acute thrombocytopenic purpura Encephalitis Transient hepatitis Subacute sclerosing panencephalitis Bacterial superinfectionsinclude pneumonia, laryngotracheobronchitis, and otitis media. Measles transiently suppresses delayed hypersensitivity, which can worsen active tuberculosis and temporarily prevent reaction to tuberculin and histoplasmin antigens in skin tests. Bacterial superinfection is suggested by pertinent focal signs or a relapse of fever, leukocytosis, or prostration. Overview of Pneumonia None Acute thrombocytopenic purpuramay occur after infection resolves and cause a mild, self-limited bleeding tendency; occasionally, bleeding is severe. Encephalitis None Transient hepatitisand diarrhea may occur during an acute infection. Subacute Sclerosing Panencephalitis (SSPE) None Atypical measles syndrome is a complication that occurred in people vaccinated with the original killed-virus measles vaccines, which were used in the United States from 1963 to 1967 and until the early 1970s in some other countries ( Complications references ). These older vaccines altered disease expression in some patients who were incompletely protected and subsequently infected with wild-type measles. Measles manifestations developed more suddenly, and significant pulmonary involvement was more common. Confirmed cases have been extremely rare since the 1980s. Atypical measles is of note mainly because patients who received a measles vaccine during that time period may report a history of both measles vaccination and measles infection. 1.Centers for Disease Control and Prevention (CDC): Measles: For Healthcare Providers. Accessed March 13, 2023. 2.CDC: Measles prevention.MMWR Suppl38(9):1–18, 1989. 