Clinical Manifestations of Measles

Measles is a serious infection characterized by high fever, an enanthem, cough, coryza, conjunctivitis, and a prominent exanthem.

After an incubation period of 8–12 days, the prodromal phase begins with a mild fever followed by the onset of conjunctivitis with photophobia, coryza, a prominent cough and increasing fever.

The enanthem, Koplik spots, is the pathognomonic sign of measles and appears 1 to 4 days prior to the onset of the rash . They first appear as discrete red lesions with bluish white spots in the center on the inner aspects of the cheeks at the level of the premolars. They may spread to involve the lips, hard palate, and gingiva. They also may occur in conjunctival folds and in the vaginal mucosa. Koplik spots have been reported in 50–70% of measles cases but probably occur in the great majority.

Symptoms increase in intensity for 2–4 days until the 1st day of the rash.

The rash begins around the forehead (around the hairline), behind the ears, and on the upper neck as a red maculopapular eruption. It then spreads downward to the torso and extremities, reaching the palms and soles in up to 50% of cases. The exanthem frequently becomes confluent on the face and upper trunk

With the onset of the rash, symptoms begin to subside and the rash fades over about 7 days in the same progression as it evolved, often leaving a fine desquamation of skin in its wake.

Of the major symptoms of measles, the cough lasts the longest, often up to 10 days. In more severe cases, generalized lymphadenopathy may be present, with cervical and occipital lymph nodes especially prominent.