Measles typically begins with a high fever and the 3 Cs: cough, coryza (rhinitis), and conjunctivitis. An enanthem of punctate white papules on the buccal mucosa behind the first and second molars, called Koplik spots, appears prior to the start of the rash. The exanthem begins days after the prodrome in a cephalocaudal fashion, with the head first, then the trunk, and then the extremities. (See Figure 2.) The infectivity of disease occurs from 4 days prior to the onset of the rash to the fourth day of the rash.29,30
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Complications associated with measles include immune suppression due to loss of delayed-type hypersensitivity activation, which leads to secondary bacterial infections such as otitis media and pneumonia.4,30,31 Mortality is typically due to pneumonia and encephalitis. Otitis media is the most common complication, occurring in 1 out of every 10 children infected with measles. Blindness due to corneal infection, perforation, and scarring is another common complication in those with vitamin A deficiency.
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