Measles physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Vidit Bhargava, M.B.B.S [2]

Overview

Measles is a condition, that is best diagnosed clinically based on a constellation of signs and symptoms. Fever, rash and conjunctivitis are 3 major physical findings that must be looked out for, while making the diagnosis of measles.[1][2]

Physical Examination

Vitals

Temperature

  • A high fever is always present, it could be as high as 105°F.

Pulse

Respiratory Rate

Skin

Rash

  • Three to five days after the start of symptoms, a red or reddish-brown itchy rash appears.
  • The rash usually begins on a person’s face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet.
  • It also regresses in the same manner as it appeared in about 5-7 days.
  • The rash is blanching, maculopapular in nature to begin with but may coalesce later to become plaques and patches.
  • When the rash appears, a person’s fever may spike to more than 104°F.
  • Shown below are images depicting the characteristic rash of measles.

Images obtained from the Public Health Image Library[3]

Eyes

Conjunctivitis

  • Conjuntivitis, also known as pink eye, is one of the 3 'C' 's in the classical 3 'C' presentation of measles (other 2 being cough and coryza).
  • Shown below is an image illustrating pink eye in a child with measles:

Images obtained from the Public Health Image Library[3]

Throat

Koplik's spots

  • Koplik's spots are tiny white spots with erythematous base and bluish-white centers found inside the mouth at the base of second molars.
  • These appear usually 2-3 days after initial prodrome and may or may not persist until the rash disappears.
  • Although they are pathognomic, Koplik's spots are not present in all the cases.
  • Its absence does not exclude the diagnosis of measles.

Images obtained from the Public Health Image Library[3]

References

  1. "CDC Measles".
  2. "WHO GUIDELINES FOR EPIDEMIC PREPAREDNESS AND RESPONSE TO MEASLES OUTBREAKS".
  3. 3.0 3.1 3.2 "Public Health Image Library (PHIL)".

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