Clinical Manifestations and Pathology

The prodromal phase of measles disease typically includes symptoms and signs of fever, cough, coryza, and conjunctivitis. During this stage, small whitish specks on reddened areas of the mucosal lining of the mouth called Koplik's spots are diagnostic of measles. The prodromal period continues for 3 to 7 days until the characteristic blotchy reddish rash appears. This rash usually appears first on the head and then spreads down the body and outward to the limbs, lasting about 4 to 7 days. After its peak, in uncomplicated cases, all the symptoms and signs begin to recede and the rash fades in the same order it appeared.

Complications due to viral replication or secondary bacterial infection may occur, however, and result in middle-ear infections and pneumonia. Diarrhea may also complicate measles and, in the developing world, is one of the most important causes of measles-associated mortality. Neurological involvement may also occur, resulting in encephalitis during or soon after the acute illness or in the rare subacute sclerosing panencephalitis (SSPE) after a lengthy incubation period. Measles is uncommon during pregnancy, and the limited data available do not appear to demonstrate clearly any increased risk of fetal mortality or congenital malformations.

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