Measles (Rubeola) (cont.)
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What are the symptoms of measles?
The typical case of measles actually starts with a fever, runny nose, hacking cough, and red eyes. After
two to four days of these symptoms, the patient may develop spots within the mouth called Koplik's spots. These spots look like little grains of white sand surrounded by a red ring and are usually found inside the cheek toward the back of the mouth (opposite the
first and second upper molars).
The skin rash (also known as an exanthem or exanthema) appears three to five days after the onset of the
initial symptoms (fever, cough, runny nose, and red eyes). The rash is a flat to slightly raised (maculopapular) red rash that usually last
five to six days. It begins at the hairline and then progresses to the face and upper neck. Over the next
two to three days, the rash progresses downward to cover the entire body, including the hands and feet. The rash has mostly distinct lesions, but some may overlap (become confluent). Initially, these lesions will turn white when you press on them (blanch). After
three to four days, they no longer will blanch. As the rash begins to fade, there will often be a fine flaking of the skin (desquamation). The rash fades in the same order that it appears.
The fever that occurs with measles is called a stepwise fever. The patient starts with a mild fever that progressively gets higher. Fevers often reach temperatures greater than 103 F (39.4 C).
Although not as common as other symptoms, some patients may have a sore throat.
What complications are seen with measles?
Approximately 30% of cases of measles have an associated complication. These complications include diarrhea (8%), ear infections (7%), pneumonia (6%), blindness (1%), acute brain inflammation (encephalitis) (0.1%), and persistent brain inflammation (subacute sclerosing panencephalitis) (0.0001%).
Blindness associated with measles is due to a combination of poor nutrition (specifically
vitamin A deficiency) and the measles infection. Prevention is the most effective treatment. In third world countries, post-measles blindness is the leading cause of blindness, with up to 60,000 cases occurring annually.
Acute encephalitis, although rare, is extremely dangerous and results in death in approximately 15% of patients who develop it. When it occurs, acute encephalitis generally starts
six days after onset of the rash. Symptoms can include fever, headache, vomiting, stiff neck, drowsiness, seizures, and coma.
Subacute sclerosing panencephalitis (SSP) is an extremely rare degenerative condition of the brain and spinal cord (central nervous system). It is believed to be caused by a chronic infection of the central nervous system with the measles virus. Typically, symptoms start years after the patient had measles (average
seven years, range one month to 27 years). The patient has a slow and progressive loss of brain function, seizures, and eventually death results. There is no known treatment for SSP.
Most deaths from measles are due to pneumonia in children and encephalitis in adults. There are approximately 2.2 deaths per 1,000 people who get the measles. The people most likely to have complications (including death) are those who are malnourished or who have weakened immune systems (for
example, people with AIDS or other conditions that weaken the immune system).
What is atypical measles?
Atypical measles occurs in people who received the killed measles vaccine (KMV; only used from 1963 until 1967) and who are exposed to wild-type measles virus. The KMV unfortunately sensitizes the patient to the measles virus but does not offer any protection. The disease is characterized by fever, pleural effusions, pneumonia, and swelling of the extremities. The rash of atypical measles is different from measles in that it may have an urticarial component (hives) and usually appears first on the ankles and wrists.
It is recommended by the U.S. Centers for Disease Control and Prevention (CDC) that people who may have received the KMV should receive revaccination with the live measles vaccine.
The virus can be isolated in tissue culture in the lab. Blood
(serologic) tests are also available.
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| Picture Koplik spots. Source: CDC |
Next: What is modified measles? »
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