05 August, 2008


Photo) Measles virus infect and affect the morphology of cells in culture.
----Linda Stannard, Department of Medical Microbiology, University of Cape Town
Case presentation( 4 year old boy)

Clinical course of Measles(4-year-old boy):

Days 2; fever with cough and runny nose.
----------Antibiotics and anti-cough drugs were prescribed.
late of Days 3; Koplik's spot appeared in buccal mucosa.
Days 4: many Koplik's spot
---------late of Days 4; maculopapular rash began from face.
Days 5; skin rash spread to upper limb and trunk,
----------descending to lower parts.
----------WBC 7,000(39% Lym, 9% Mon, 45% Seg, 7% Band),
----------CRP 0.43mg/dl.
Days 6; peak of skin rash.
Days 8; fever fall down.
----------WBC 5,900(Atypical cell 36%, Lym44%, Mon2%,
-----------Band5%, Seg9%, Eos4%)
Days 9; no fever. skin pigmentation began.

Photo: Measles's rash

Koplik's spots: tiny white spot in buccal mucosa, look-like" thrush"
----------After high fever lasting 3-4 days with dry cough ,
----------sometimes croup and blear eye, Koplik's spot appear
----------on buccal mucosa( may also conjunctivae or rectum).
------------Within 1-2 day, the red maculopapular rash begins
----------behind the ears and spread to the face. the rash spreads
----------down the body, taking 2-3 days to progress to the lower
----------limb. About the time the rash appears on the chest, the
----------dry cough moistens, and occasionally fine crackles may
----------be heard in the lung(measles bronchitis).

Etiology: Measles virus (RNA virus, paramyxovirus family)
Incubation period: 8-12 days
Transmission route:
------------direct contact with patient, via coughing and sneezing.
------------Patient can be transmitted virus from 4 days prior to
------------the onset of rash to 4 days after the onset of disease.
-----------    Virus can stay in the air up to 75minutes after a known
-------------case of measles has left the room.

1) Otitis media
2) Broncho-pneumonia: often infant and toddler, bacterial
3) febrile convulsion: infant and toddlers
4) Laryngo-tracheo-bronchitis:
5) Meningo(-encephalo-)myelitis: appear in convalescent stage
6) Encephalitis: appear 4-5 days after the onset of rash.
7) SSPE: very rare
8) kelatitis: in vitamin-A deficiency countries.

Any questions: write to Keiji Hagiwara MD,