Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Measles 955

■Transmission mainly by aerosolized droplets of respiratory secre-

tions, direct contact of respiratory secretions

■Contagious 1–2 days before onset symptoms (3–5 day before rash, 0

to 4 day after rash appears)

■Highly contagious

■Incubation period 8–12 days

■Disease mildest in children, more severe in very young and adults

■Malnourished individuals have a high rate of complications (vitamin

A deficiency increases severity).

■Peak incidence winter/spring

■Vaccine has dramatically reduced cases, >99% reduction since intro-

duction of vaccine

■Disease most severe in infants and adults, milder in children

Signs & Symptoms

■URI prodrome 2–4 days, then

■fever (peaks 2–3 days of rash)

■cough – often severe and very “troublesome”

■coryza

■characteristic erythematous maculopapular rash (immunocompe-

tent host may not have characteristic rash)

➣first appears behind ears and forehead hairline

➣spreads in centrifugal pattern from head to feet

➣rash can become confluent, later may desquamate

■pathognomonic enanthem (Koplik spots); bluish-white specks upon

a bright red mucosal surface usually involving the buccal and lower

labial mucous membranes. Initially few in number, which then

progress to high numbers.

Modified Measles

■occurs in partially immune individuals

■clinically similar to measles as above but milder

■Koplik spots may not be present

■Exanthem follows progression of regular measles but usually no con-

fluence

Atypical Measles

■Occurs in previously immunized persons

■Fever

■Headache

■Abdominal pain

■Myalgia