Clinical Features of Measles Virus
المؤلف:
Baijayantimala Mishra
المصدر:
Textbook of Medical Virology
الجزء والصفحة:
2nd Edition , p181
2025-10-20
116
Classical measles: Disease manifestation starts after 10 days of exposure. Prodromal symptoms begin with fever followed by cough, coryza and conjunctivitis (typically, at least 1 of 3Cs: Cough, Coryza and Conjunctivitis).
Appearance of Koplik’s spots occurs after 2 days of prodromal symptoms and 2 days before the onset of rash. To start with, it appears first behind the lower molar then affects the entire buccal mucosa. Koplik’s spots are bluish white papular lesions, about 1 mm in diameter, with white center and surrounded by an erythematous base. These are considered pathognomonic of measles.
Rash in measles is characteristic in nature. It starts 3–4 days after the onset of fever. The prodromal symptoms are maximum at the time of onset of rash. These are maculopapular, start from behind the ear, hair line, face and neck. Then spreads to trunk and extremities. Rash persists for 3–4 days and then begins to fade in the same manner as it appears. Overall an uncomplicated measles resolves within a week.
As the rash occurs due to cellular response and is represented by perivascular lymphocytic infiltration, the manifestation of rash is delayed or absent in children with impaired T cell immunity with high disease severity.
Modified measles: It occurs in partially immune children, with residual maternal antibodies or in individuals who have received immune globulin as postexposure prophylaxis.
The disease is characterized by:
• Prolonged incubation period
• Mild prodrome, and sparse, discrete rash of short duration and mild illness.
Atypical measles: Observed in individuals who were vaccinated with killed measles vaccine and were subsequently exposed to natural measles virus infection within years.
• It has been mostly observed in individuals who received killed measles vaccine during the period of 1963–1967 in US.
• It occurs due to abnormally intense cellular immune response due to sensitization to measles virus antigen by the killed measles vaccine which do not provide protection.
• Lack of production of antibody to fusion protein (F) allowing the virus to spread from cell-to-cell in presence of neutralizing Ab.
• Manifest with maculopapular or petechial rash, but may presents with hemorrhagic, urticarial, vesicular or combination. Unlike classical measles, rash first appears on wrist or ankle.
– High fever
– Interstitial pulmonary infiltrates, edema of extremities.
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