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.

Physical Examination

Vitals

Temperature

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

Pulse

• Tachycardia may be present, specially with the onset of fever.

Respiratory Rate

• Tachypnea may be present, specially in patients complicated with pneumonia.

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

• 
  Image showing measles rash on day 3.
• 
  Image showing characteristic day 4 appearance of measles rash.
• 
  Typical appearance of rash on day 3, measles.
• 
  Face of child with measles.
• 
  Characteristic red blotchy pattern on his buttocks during 3rd day of the rash.

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

• 
  Conjunctivitis (pink eye) in a child with measles

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

• 
  Image showing bluish-grey spots on an erythematous base known as Koplik's spots
• 
  Image showing Koplik's spots opposite the base of second molars.