MEASLES (RUBEOLA)
Sabah Mohsin Al-Maamuri MD
FICPS
Essentials of diagnosis & typical features: Koplik spots are white macular lesions on the buccal
mucosa, typically opposite the lower molars. These
Exposure to measles 9–14 days previously. are almost pathognomonic for measles, although
Prodrome of fever, cough, conjunctivitis, they may be absent.
and coryza.
Koplik spots (few to many small white A discrete maculopapular rash begins when the
papules on a diffusely red base on the respiratory symptoms are maximal and spreads
buccal mucosa) 1–2 days prior to and after quickly over the face and trunk, coalescing to a
onset of rash. bright red. As it involves the extremities, it fades
Maculopapular rash spreading down from from the face and is completely gone within 6 days;
the face and hairline to the trunk over 3 fine desquamation may occur.
days and later becoming confluent.
Fever peaks when the rash appears and usually falls
Leukopenia.
2–3 days thereafter.
General Considerations:
Laboratory findings:
This childhood exanthem is "rarely" seen in the Lymphopenia is characteristic. Total leukocyte
developed countries because of vaccination. counts may fall to 1500/µL.
The attack rate in susceptible individuals is An experienced cytologist may see multinucleated
extremely high; spread is respiratory. giant cells in oral mucosal scrapings and in nasal
secretions, but the diagnosis is usually made by
Morbidity and mortality rates in the developing detection of measles IgM antibody in serum drawn
world are substantial because of underlying at least 3 days after the onset of rash or later by
malnutrition and secondary infections. detection of a significant rise in antibody. Direct
Because humans are the sole reservoir of measles, detection of measles antigen by fluorescent
there is the potential to eliminate this disease antibody staining of nasopharyngeal cells is a useful
worldwide. rapid method.
Imaging:
Chest x-rays often show hyperinflation, perihilar
Clinical Findings: infiltrates, or parenchymal patchy, fluffy densities.
Secondary consolidation or effusion may be visible.
A history of contact with a suspected case may be
absent because airborne spread is efficient and
patients are contagious during the prodrome. Complications & Sequelae:
Contact with an imported case may not be
recognized.
In temperate climates, epidemic measles is a A. Respiratory complications
winter-spring disease. Many suspected cases are These occur in up to 15% of patients. Bacterial
misdiagnoses of other viral infections. superinfections of lung, middle ear, sinus, and
cervical nodes are most common. Fever that
Symptoms and signs: persists after the third or fourth day of rash
High fever and lethargy are prominent. suggests such a complication, as does leukocytosis.
Bronchospasm, severe croup, and progressive viral
Sneezing, eyelid edema, tearing, copious coryza,
pneumonia or bronchiolitis (in infants) also occur.
photophobia, and harsh cough ensue and worsen.
Immunosuppressed patients are at much greater
Page 1 of 2
Sabah Mohsin Al-Maamuri MD
FICPS
Essentials of diagnosis & typical features: Koplik spots are white macular lesions on the buccal
mucosa, typically opposite the lower molars. These
Exposure to measles 9–14 days previously. are almost pathognomonic for measles, although
Prodrome of fever, cough, conjunctivitis, they may be absent.
and coryza.
Koplik spots (few to many small white A discrete maculopapular rash begins when the
papules on a diffusely red base on the respiratory symptoms are maximal and spreads
buccal mucosa) 1–2 days prior to and after quickly over the face and trunk, coalescing to a
onset of rash. bright red. As it involves the extremities, it fades
Maculopapular rash spreading down from from the face and is completely gone within 6 days;
the face and hairline to the trunk over 3 fine desquamation may occur.
days and later becoming confluent.
Fever peaks when the rash appears and usually falls
Leukopenia.
2–3 days thereafter.
General Considerations:
Laboratory findings:
This childhood exanthem is "rarely" seen in the Lymphopenia is characteristic. Total leukocyte
developed countries because of vaccination. counts may fall to 1500/µL.
The attack rate in susceptible individuals is An experienced cytologist may see multinucleated
extremely high; spread is respiratory. giant cells in oral mucosal scrapings and in nasal
secretions, but the diagnosis is usually made by
Morbidity and mortality rates in the developing detection of measles IgM antibody in serum drawn
world are substantial because of underlying at least 3 days after the onset of rash or later by
malnutrition and secondary infections. detection of a significant rise in antibody. Direct
Because humans are the sole reservoir of measles, detection of measles antigen by fluorescent
there is the potential to eliminate this disease antibody staining of nasopharyngeal cells is a useful
worldwide. rapid method.
Imaging:
Chest x-rays often show hyperinflation, perihilar
Clinical Findings: infiltrates, or parenchymal patchy, fluffy densities.
Secondary consolidation or effusion may be visible.
A history of contact with a suspected case may be
absent because airborne spread is efficient and
patients are contagious during the prodrome. Complications & Sequelae:
Contact with an imported case may not be
recognized.
In temperate climates, epidemic measles is a A. Respiratory complications
winter-spring disease. Many suspected cases are These occur in up to 15% of patients. Bacterial
misdiagnoses of other viral infections. superinfections of lung, middle ear, sinus, and
cervical nodes are most common. Fever that
Symptoms and signs: persists after the third or fourth day of rash
High fever and lethargy are prominent. suggests such a complication, as does leukocytosis.
Bronchospasm, severe croup, and progressive viral
Sneezing, eyelid edema, tearing, copious coryza,
pneumonia or bronchiolitis (in infants) also occur.
photophobia, and harsh cough ensue and worsen.
Immunosuppressed patients are at much greater
Page 1 of 2
