From the Guidelines
Koplik spots are a pathognomonic sign of measles, characterized by small, white or bluish-white lesions with a red base that appear on the inner lining of the cheeks during the early stages of measles infection. These spots are a key diagnostic feature of measles, as noted in a study on infectious diseases associated with organized sports and outbreak control published in Pediatrics in 2017 1. The study highlights the importance of recognizing Koplik spots, which appear during the prodrome of measles, along with other symptoms such as cough, coryza, and conjunctivitis with fever. Some key characteristics of Koplik spots include:
- They typically appear 1-2 days before the typical measles rash develops on the skin
- They may persist for 12-24 hours after the rash appears
- They resemble grains of salt or sand on a red background
- They occur due to the measles virus infecting and replicating in the epithelial cells of the oral mucosa, causing localized inflammation and necrosis. Recognition of Koplik spots is crucial for early diagnosis of measles, allowing for timely isolation of patients to prevent transmission, especially in unvaccinated individuals or those with vaccine failure, which can occur in up to 5% of people who have received a single dose of vaccine at 12 months or older 1.
From the Research
Definition and Diagnosis of Koplik Spots
- Koplik spots are considered a disease-specific sign for measles, although they can also appear in other viral infections, such as rubella 2.
- The sensitivity and specificity of Koplik spots as a diagnostic marker for measles were found to be 48 and 80%, respectively 2.
- The presence of Koplik spots was associated with confirmed measles, with a diagnostic odds ratio of 7.2 3.
Clinical Presentation and Association with Measles
- Koplik spots were observed in 23.7% of measles and measles-suspected cases in a national survey in Japan 2.
- The measles virus was detected in 28.2% of cases with Koplik spots, while the rubella virus was detected in 17.4% of cases 2.
- Other viruses, such as parvovirus and human herpesvirus type 6, were also detected in cases with Koplik spots 2.
- Koplik spots were found to be highly predictive of confirmed measles, with a positive predictive value of 80% 3.
Case Studies and Treatment
- A case study of a 33-year-old female with severe adult measles pneumonia found that combination therapy with steroid pulse, high-dose vitamin A, and gamma globulin was effective in treating the condition 4.
- Koplik spots were observed in the pharynx of the patient, along with other symptoms such as facial, trunk, and limb eruptions, and conjunctiva intrahemorrhage 4.
- A prospective case series found that dermatological manifestations of measles, including Koplik spots, were heterogeneous and not conclusive for diagnosis 5.