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, with Koplik spots appearing during the prodrome, as described in the most recent and highest quality study 1. The prodromal phase is characterized by a combination of symptoms, including cough, coryza, and conjunctivitis, along with fever, which can last for several days.
- Key features of the prodrome include:
- Cough
- Coryza
- Conjunctivitis
- Fever Koplik spots, which are considered pathognomonic for measles, appear during the prodrome, typically 1-2 days before the onset of the rash.
- The characteristic rash of measles is maculopapular or morbilliform in nature, beginning on the face and spreading downward to cover the trunk and extremities over the course of several days. The rash initially appears as discrete lesions that become confluent, especially on the face and upper body, and fades in the same order it appeared.
- Patients with measles are contagious from 4 days before the onset of the rash to 4 days after the rash appears, as noted in the study 1. Complications of measles can include otitis media, pneumonia, encephalitis, and subacute sclerosing panencephalitis, highlighting the importance of prompt recognition and management of the disease, as well as prevention through vaccination, as discussed in the context of measles outbreaks and vaccine failure 1.
From the Research
Typical Presentations of Measles (Rubeola)
The typical presentations of measles (rubeola) include:
- A prodrome of high fever, cough, coryza, and conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots 2, 3, 4
- A characteristic erythematous, maculopapular rash that classically begins on the face and becomes more confluent as it spreads cephalocaudally 3, 4, 5
- Fever, runny nose, cough, and pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash 4
- A two-phase course, with initial symptoms such as fever, cough, coryza, and conjunctivitis, followed by a second increase of temperature and the typical measles exanthema, a brownish-red maculopapular rash 2
Key Symptoms
Key symptoms of measles include:
- Fever 2, 3, 4, 6, 5
- Cough 2, 3, 4, 6, 5
- Coryza (runny nose) 2, 3, 4, 6, 5
- Conjunctivitis 2, 3, 4, 6, 5
- Koplik spots (pathognomonic enanthem) 2, 3, 4
- Maculopapular rash 2, 3, 4, 6, 5
Complications
Complications of measles can occur in 10% to 40% of patients and may include: