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Patient Case: Measles

Patient Case: Measles

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A 5-year-old boy has been brought to the pediatric clinic by his parents with a high fever, cough, runny nose, and red eyes for the past four days. His parents report that he was previously healthy but has not received any vaccinations due to concerns about side effects. Over the past day, they noticed a red, blotchy rash that started on his face and spread downward to his chest, back, and limbs.

On examination, the child is irritable and febrile (39.5°C/103.1°F). He has conjunctivitis, nasal discharge, and a dry cough. Small white spots on a red base (Koplik spots) are visible on his buccal mucosa. His skin shows a widespread, non-itchy maculopapular rash that started on the forehead and is now covering most of his body.

Given the classic clinical presentation, a diagnosis of measles (rubeola) is made. The child is isolated to prevent spread, and supportive care with hydration, fever management, and vitamin A supplementation is initiated. The parents are educated on the importance of routine childhood vaccination to prevent complications and future outbreaks.

Questions
  1. Which clinical feature is most characteristic of measles?
    A) Vesicular rash that appears in crops
    B) Red maculopapular rash that starts on the face and spreads downward
    C) Target-like lesions on the palms and soles
    D) Painful pustular rash with central necrosis
  2. What is the significance of Koplik spots in measles?
    A) They confirm an alternative diagnosis of scarlet fever
    B) They appear in the late stage of the disease when the rash resolves
    C) They are a pathognomonic sign of measles, appearing before the rash
    D) They indicate a secondary bacterial infection
  3. Which of the following is the most effective way to prevent measles?
    A) Frequent handwashing
    B) Avoiding crowded places
    C) Measles, mumps, and rubella (MMR) vaccination
    D) Long-term antibiotic prophylaxis
  4. Which of the following is a potential complication of measles?
    A) Postherpetic neuralgia
    B) Subacute sclerosing panencephalitis (SSPE)
    C) Guillain-Barré syndrome
    D) Rheumatic heart disease
Reveal answers

Answers

  1. Answer: B) Red maculopapular rash that starts on the face and spreads downward
    • Measles presents with a characteristic red, maculopapular rash that begins on the face and progresses downward. In contrast, a vesicular rash that appears in crops (A) is seen in varicella (chickenpox), target-like lesions (C) suggest erythema multiforme, and painful pustular rashes (D) are seen in bacterial infections like cutaneous anthrax.
  2. Answer: C) They are a pathognomonic sign of measles, appearing before the rash
    • Koplik spots are small white spots on a red base that appear on the buccal mucosa 1-2 days before the measles rash. They help confirm measles before the rash appears, unlike scarlet fever (A), which is associated with a "strawberry tongue." Koplik spots do not appear in the late stages (B), nor do they indicate bacterial infection (D).
  3. Answer: C) Measles, mumps, and rubella (MMR) vaccination
    • The MMR vaccine is the most effective way to prevent measles, providing lifelong immunity in most individuals. Handwashing (A) and avoiding crowds (B) can reduce transmission but are not as effective as vaccination. Antibiotics (D) do not prevent viral infections like measles.
  4. Answer: B) Subacute sclerosing panencephalitis (SSPE)
    • SSPE is a rare but fatal long-term complication of measles, occurring years after the initial infection. Postherpetic neuralgia (A) is a complication of herpes zoster, Guillain-Barré syndrome (C) is linked to viral infections like influenza and Campylobacter infection, and rheumatic heart disease (D) is a sequela of untreated streptococcal infections.

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