Fast Five Quiz: Measles Key Aspects

Michael Stuart Bronze, MD


November 25, 2020

To diagnose measles quickly enough to allow quarantine, contact tracing, vaccination of susceptible contacts, and other public health interventions, recognizing and diagnosing the disease clinically is important. Measles is readily recognizable by its clinical features. Laboratory testing to rule out measles is unlikely to be timely enough to help with measles control. Laboratory findings are important for confirmation, but the history and clinical features can make a reasonable clinical diagnosis or rule out measles well before laboratory test results are received.

The entire course of uncomplicated measles, from late prodrome to resolution of fever and rash, is 7-10 days. The first sign of measles is usually a high fever (often > 104 °F [40 °C]) that typically lasts 4-7 days. This prodromal phase is marked by malaise; fever; anorexia; and the classic triad of conjunctivitis, cough, and coryza (the "three Cs"). Other possible associated symptoms include photophobia, periorbital edema, and myalgias. The characteristic enanthem generally appears 2-4 days after the onset of the prodrome and lasts 3-5 days. Small spots (Koplik spots) can be seen inside the cheeks during this early stage.

The exanthem usually appears 1-2 days after the appearance of Koplik spots; mild pruritus may be associated. On average, the rash develops about 14 days after exposure, starting on the face and upper neck and spreading to the extremities. Immunocompromised patients may not develop a rash. Cough may be the final symptom to appear.

Read more about the presentation of measles.


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