From the Guidelines
Measles typically presents with a prodrome of cough, coryza, and conjunctivitis with fever, followed by a maculopapular or morbilliform rash that begins on the face and spreads downward to the trunk and out to the extremities, as described in the most recent and highest quality study 1. The illness begins with a prodromal phase featuring high fever, cough, coryza (runny nose), and conjunctivitis (red, watery eyes) - collectively known as the "3 Cs."
- Koplik spots, small white spots with bluish-white centers on a red background inside the mouth, appear during the prodrome and are considered pathognomonic for measles 1.
- The hallmark maculopapular rash develops after symptom onset, beginning on the face and behind the ears before spreading downward to the trunk and extremities.
- The rash typically lasts several days and may be accompanied by high fever. Other common symptoms include:
- Malaise
- Anorexia
- Diarrhea
- Generalized lymphadenopathy Complications can include:
- Otitis media
- Pneumonia
- Encephalitis
- Subacute sclerosing panencephalitis (SSPE) Treatment is primarily supportive with rest, fluids, antipyretics, and vitamin A supplementation (especially in malnourished children) 1. Measles is highly contagious through respiratory droplets, with patients being infectious from 4 days before to 4 days after rash onset, as noted in the most recent study 1.
From the Research
Typical Presentations of Measles
The typical presentations of measles include:
- Fever
- Maculopapular rash
- At least one of cough, coryza, or conjunctivitis 2, 3
- Symptoms can be milder or even absent in vaccinated individuals 2
Complications of Measles
Measles can lead to various complications, including:
- Otitis media
- Laryngotracheobronchitis
- Pneumonia
- Stomatitis
- Diarrhea 2, 3
- Neurological complications, such as acute disseminated encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis, can occur during or after the acute disease 2
Laboratory Diagnosis
Laboratory diagnosis of measles relies on the detection of specific IgM antibodies in serum, dried blood spots, or oral fluid, or the detection of viral RNA in throat or nasopharyngeal swabs, urine, or oral fluid 2
Patient Management
Patient management mainly involves supportive therapy, such as: