Measles Prodrome and Clinical evolution E Fever (mild to moderate) E Cough E Coryza E Conjunctivitis E Fever spikes as high as 105ºF Koplik’s spots Koplik’s Spots E E Viral enanthem of measles Rash E Erythematous, maculopapular rash which begins on typically starting 1-2 days before the face (often at hairline and behind ears) then spreads to neck/ the rash. Appearance is similar to “grains of salt on a wet background” upper trunk and then to lower trunk and extremities. Evolution and may become less visible as the of rash 1-3 days. Palms and soles rarely involved. maculopapular rash develops. Rash INCUBATION PERIOD Fever, STARTS on face (hairline & cough/coryza/conjunctivitis behind ears), spreads to trunk, Average 8-12 days from exposure to onset (sensitivity to light) and then to thighs/ feet of prodrome symptoms 0 (average interval between exposure to onset rash 14 day [range 7-21 days]) -4 -3 -2 -1 1234

NOT INFECTIOUS higher fever (103°-104°) during this period rash fades in same sequence it appears INFECTIOUS 4 days before rash and 4 days after rash Not Measles

Rubella Varicella cervical lymphadenopathy. Highly variable but (Aka German Measles) (Aka Chickenpox) Rash E often maculopapular with Clinical manifestations E Clinical manifestations E Generally mild illness with low- Mild prodrome of fever and malaise multiforme-like lesions and grade fever, malaise, and lymph- may occur one to two days before may resemble scarlet fever. adenopathy (commonly post- rash. Possible low-grade fever. Rash often associated with painful edema hands and feet. auricular and sub-occipital). Rash E Itchy vesicular rash and p NO Koplik’s spots, coryza, photophobia, or cough. Rash E Resembles measles scabs appear in crops at several but the rash is milder, more stages of maturity. evanescent, rose-pink, fine and separate spots, p NO Koplik’s spots, coryza, photophobia, or cough. Roseola discrete. Infantum p NO Koplik’s spots, coryza, photophobia, or cough. Fifth Disease (Often due to HHV-6) (Aka Erythema Infectiosum Clinical manifestations E Scarlet Fever or Parvovirus B19) Sudden onset of high fever lasting 3-5 days. As rash devel- (Associated with Clinical manifestations E Streptococcal pharyngitis, Usually nonspecific but can ops may also have malaise, palpebral conjunctivitis, aka ‘scarlatina’) include fever, runny nose, runny nose, vomiting, diarrhea or lymphadenopathy As fever subsides, a rash begins on neck and Clinical manifestations E and headache Rash E trunk and spreads to extremities. Rose-pink, small Fever, pharyngitis, malaise, chills, Rash E Generally occurs after the respiratory headache and cervical lymphade- symptoms and typically starts on face with a solid and separate spots, discreet, on chest and abdomen. nopathy. bright eruption on the face (“slapped cheek”). Within p NO Koplik’s spots. Enanthem E Streptococcal phar- a few days, a 2nd stage rash may occur on trunk and yngitis and strawberry tongue extremities and is initially erythematous and later Other Rash E Erythema rash that becomes lace-like and/or reticular. Several other entities can cause a rash and should blanches with pressure with small p NO Koplik’s spots, coryza, conjunctivitis, be considered in the differential such as meningo- (1-2 mm) papular elevations photophobia, or cough. coccemia, enteroviruses, mononucleosis syndrome resulting in a ‘sandpaper’ quality of the skin. Rash and drug reaction. generally starts in armpits and groin and expands to Kawasaki measles symptoms must cover the trunk, followed by extremities. The rash is (Aka mucocutaneous lymph Members with be immediately masked and roomed in most marked in skin folds of the inguinal, axiallary, node syndrome) an isolation or negative pressure room. antecubital. Linear petechial marks may be seen E Clinical manifestations Consider testing for individuals with classic (Pastia’s line) {see figure] Desquamation usually Illness often begins with fever measles symptoms,Courtesy ofregardless Northern of vaccination follows. which may be high and spiking lasting several days. history, asCalifornia well as contacts Kaiser. of measles cases p NO Koplik’s spots, coryza, conjunctivitis, Often with conjunctivitis, dry cracked lips, a red with symptoms of varying severity, regard- photophobia, or cough. “strawberry” tongue, erythema of oropharynx and less of vaccine history. If suspected, contact Infection Prevention at x26130 or x22123 2 or Infectious Diseases on call.