clinical manifestations and complications of measles

1. MEASLES
Clinical manifestations and complication of measles
By: Brij Raghuwanshi

2.  The clinical course of measles can be divided in four clinical stages –
 Incubation
 prodromal stage
 catarrhal stage and
 post-measles stage of complications.

3.  The incubation ranges from 10-12 days.
 In the later part of incubation period, the child shows prodromal
symptoms which last for 2-4 days and consist of fever, malaise, coryza
and tracheobronchitis.
 At the end of prodromal phase, the child gets fever which may be high
grade.
 Koplik’s spots, which are pathognomonic sign of measles, are seen on
day 2-3 of fever. These are greyish white or bluish white dots with
reddish areola occasionally they are hemorrhagic. Mostly seen on
buccal mucosa opposite lower molars but may be seen all over the
buccal mucosa.

4.  Conjunctival congestion and photophobia is also classical of measles,
which occurs before Koplik’s spots appear.
 Temperature rise abruptly as rash appears and often reaches 40°C or
higher.

5.  Rash appears on 4th to 6th days of fever.
 It starts as faint erythematous maculopapular rash on upper lateral
aspect of neck and typically behind the ears and increasingly involve
face then spreading on to trunks and then to legs and arms over next 3
to 4 days. By the time rash appears on feet it starts disappearing from
face and fades down in same pattern. Temperature also suddenly
normalizes once rash starts fading and child suddenly looks well from
sick look.
 The severity of disease is directly related to the extent and confluence
of rash. In severe cases rash may become hemorrhagic.
 The rash fades in the next 3 to 4 days. As the rash disappears it leaves
behind the brawny desquamation and brownish discoloration
characteristic of post-measles state which disappears in 7-10 days.

6. COMPLICATIONS
 Measles can affect various systems in the body resulting in following
complications.
 Respiratory system – Postmeasles bronchopneumonia, empyema,
mediastinal and subcutaneous emphysema and flaring of pulmonary
tuberculosis.

7. COMPLICATIONS
 ENT – Otitis media
 Eye – Keratitis.
 CNS – Measles encephalitis and encephalopathy.
 Systemic – Acute malnutrition, secondary bacterial infections like
septicemia with Streptococcus, etc.
 Cancrum oris, stomatitis nomans at different sites.
 GIT – Diarrheal episodes are quite common after measles.

8. COMPLICATIONS
 SSPE – Subacute sclerosing pan encephalitis (SSPE) is a degenerative
disease of the brain caused by a persistent infection with measles virus.
It can manifest several years (usually 7 years) after measles infection.
 The patient develops progressive personality changes, developmental
retardation, myoclonic seizures and motor disability. Measles virus has
been isolated from the brain tissue of such patients. Their sera and CSF
show a high titer of measles specific antibodies.