Measles Disease

Measles Disease

Clinical Features 

History of contact is usually elicited.

The prodromal (catarrhal) stage: There is high fever, lassitude, cough, coryza and conjunctivitis. The cough is barking and harsh and more at night. Koplik's spots which are white specks on a red base on the buccal mucosa are present and tend to occur opposite the lower molars. These are pathognomonic of measles.
Maculopapular stage: At the onset of this stage, tamperature rises abruptly and reaches 40 to 40.5 C (104-105 F). The rash starts as faint macules on the face behind the ears and along the hairline. The rash spreads to the trunk and limbs. The general appearance (the measly look) is characteristic. The patient is red eyed, with puffy eyelids and thin nasal discharge- a misrable look. As it reaches the legs and feet on the second or third day it is beginning to fade on the face.

The rash disappears downwards in the same sequence as its appearance. As the rash fades there is desquamation and brownish discoloration which disappears within 7 to 10 days.

Hemorrhagic measles or black measles is a severe form in which rash is confluent, petechiae may be present or there may be extensive ecchymoses. Bleeding may occur from the mouth, nose or bowel and death may result even before the rash has appeared.

Diagnosis

• During prodromal stage, multinucleated giant cells can be demonstrated in smears of nasal mucosa.
• Virus can be isolated in tissue culture or rising antibody titre can be detected in serum.
• White blood cell count is low with relative lymphocytosis.
• Lumbar puncture when encephalitis complicates, shows an increase in protein, a small increase in lymphocytes and normal glucose.

Differential Diagnosis 

1. Roseola infantum (Exanthema subitum): In this condition as the rash appears fever subsides as against measles in which temperature rises with the appearance of rash, also there are no Koplik's spots.
2. Rubella, Echo and coxsackie infections: In these, rash is less than that of measles. Fever and severity of illness are also less. There are no Koplik's spots and lymphadenopathy may be prominent.
3. Scarlet Fever: The rash of scarlet fever is diffuse, finely papular with a coarse feel, most marked on the abdomen.
4. Meningococcemia may be accompanied by maculopapular rash but more commonly it is petechial with marked toxicity and hypotension but cough and conjunctivitis are usually absent.
5. Drug rash and serum sickness have history of ingestion or injection of offending drug and no accompanying cough.
6. Erythema infectiosum is characterized by erythematous eruption on the face followed after 1 day by a maculopapular eruption with a lacy pattern.