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Key Features

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Essentials of Diagnosis
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  • Exposure to measles 9–14 days previously

  • Prodrome (2–3 days) of fever, cough, conjunctivitis, and coryza

  • Koplik spots (few to many small white papules on a diffusely red base on the buccal mucosa) 1–2 days prior to and after onset of rash

  • Maculopapular rash spreading from the face and hairline to the trunk over 3 days and later becoming confluent

  • Leukopenia

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General Considerations
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  • One of the most contagious infectious diseases of childhood that presents as a febrile exanthema

  • Transmission is via respiratory droplets

  • Considered eliminated from the United States in 2000, frequent outbreaks have occurred recently (644 cases in 2014, and 176 cases in the first 2 months of 2015), mainly due to lower vaccine coverage, increasing vaccine hesitancy, and importation

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Clinical Findings

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  • After 2–3 days of a prodrome of sneezing, eyelid edema, tearing, copious coryza, photophobia, and harsh cough, high fever and lethargy become prominent

  • Koplik spots are white macular lesions on the buccal mucosa, typically opposite the lower molars

  • A discrete maculopapular rash begins when the respiratory symptoms and fever are maximal and spreads quickly from the face to the trunk, coalescing to a bright red

  • As rash spreads to the extremities, it fades turning coppery from the face and is completely gone within 6 days; fine desquamation may occur

  • Diarrhea can occur in young children and lead to hospitalization

  • Persistent fever and cough may signal pneumonia

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Diagnosis

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Laboratory Findings
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  • Lymphopenia is characteristic

  • Total leukocyte count may fall to 1500/μL

  • Diagnosis is usually made by detection of measles IgM antibody in serum drawn at least 3 days after the onset of rash, and may be made later by detection of a significant rise in IgG antibody

  • Direct detection of measles antigen by fluorescent antibody staining of nasopharyngeal cells is a useful rapid method.

  • Polymerase chain reaction testing of oropharyngeal secretions or urine is extremely sensitive and specific and can detect infection up to 5 days before symptoms

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Imaging
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  • Radiography

    • Chest films often show hyperinflation, perihilar infiltrates, or parenchymal patchy, fluffy densities

    • Secondary consolidation or effusion may be visible

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Treatment

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  • Therapy is supportive

    • Eye care

    • Cough relief (avoid opioid suppressants in infants)

    • Fever reduction (acetaminophen, lukewarm baths; avoid salicylates)

  • Vaccination prevents the disease in susceptible exposed individuals if given within 72 hours

  • Immunoglobulin (0.25 mL/kg intramuscularly; 0.5 mL/kg if immunocompromised) prevents or modifies measles if given within 6 days

  • Secondary bacterial infections should be treated promptly; antimicrobial prophylaxis is not indicated

  • Ribavirin is active in vitro and may be useful in infected immunocompromised children

  • In malnourished children, vitamin A supplementation should be given to avoid blindness and decrease mortality

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Outcome

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Complications
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  • Respiratory

    • Bacterial superinfection ...

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