MEASLESClinical manifestations and complication of measles

By: Brij Raghuwanshi

The clinical course of measles can be divided in four clinical stages –

Incubation prodromal stage catarrhal stage and post-measles stage of complications.

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.

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.

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.

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.

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.

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.

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