From the Guidelines
The main presenting symptoms of measles include 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 typically begins with a prodromal phase featuring the "three Cs" - cough, coryza (runny nose), and conjunctivitis - along with fever. Some key points about measles symptoms include:
- Small white spots called Koplik spots may appear inside the mouth 2-3 days before the rash emerges, as noted in 1.
- The hallmark measles rash typically appears after initial symptoms, beginning on the face and behind the ears before spreading downward to cover the body.
- Patients are most contagious from 4 days before to 4 days after the rash appears, as stated in 1 and also in 1.
- These symptoms result from the measles virus replicating in the respiratory tract before spreading throughout the body, triggering the immune response that causes the characteristic symptoms.
- Complications can include ear infections, pneumonia, and encephalitis, particularly in young children, immunocompromised individuals, and pregnant women, as mentioned in 1.
From the Research
Main Presenting Symptoms of Measles
The main presenting symptoms of measles in most people include:
- Fever, which is often the first symptom to appear 2, 3, 4, 5, 6
- Cough, coryza (runny nose), and conjunctivitis (red eye) 2, 3, 4, 5, 6
- Koplik's spots, which are small, white spots that appear on the buccal mucosa (the lining of the cheeks) 2, 4
- A characteristic erythematous, maculopapular rash, which typically appears 3-4 days after the onset of fever 2, 3, 4
Additional Symptoms
Additional symptoms of measles may include:
- Otitis media (middle ear infection) 3, 5
- Laryngotracheobronchitis (inflammation of the larynx, trachea, and bronchi) 3
- Pneumonitis (inflammation of the lungs) 2, 3, 5
- Stomatitis (inflammation of the mouth) 3
- Diarrhea 3
- Neurological complications, such as acute disseminated encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis 3, 5