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

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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

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### Vitals

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#### Temperature

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

#### Pulse

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

#### Respiratory Rate

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

### Skin

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#### Rash

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* 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]

* 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

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#### Conjunctivitis

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* 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]

* Conjunctivitis (pink eye) in a child with measles

### Throat

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#### Koplik's spots

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* 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]

* 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.

## References

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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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