Onset of illness was acute; fever is high and rash is widespread. Exam is performed in isolation. Your Dx?
Your nurse tells you the child is quite sick, advises wearing mask and gown and puts the patient in a room meant for isolation in the clinic.
The 3-year-old is a regular in your practice; her mother has refused to have her vaccinated so she has not had any immunizations.
Pertinent history: No immunizations; multiple well-child check-ups-parental refusal of immunization at each. No significant illnesses until the last 4-5 days.
Acute onset of illness 4-5 days ago; fever of 102o â 104oF; no known sick exposures; cough, coryza, congestion.
3- year-old with macular reddish-brown lesions began on head 3-4 days ago, spread downward; many have become confluent.
Rash appeared on child's head ~2 days after fever was noted, then spread down the back and chest and then to the extremities; macular, reddish-brown without petechiae.
of unvaccinated 3-year-old with fever cough, coryza, and conjunctivitis: roseola, rubella, rubeola, erythema infectiosum, a herpes hominus virus.
Acute viral respiratory illness; prodrome fever may be as high as 105FPathognomonic exanthema (Koplik spots) followed by maculopapular rash.
Measles virus declared eliminated in 2000; small local outbreaks continue, mostly in areas where immunization rates are low.
Vitamin A supplementation is recommended by the
World Health Organization
and by the
American Academy of Pediatrics.
Some readers may be familiar with the situation encountered in this case, including the symptoms recounted and the sight of the child whose examination was confined to an isolation room.Take note of the symptom constellation as as well as the images; you may see more of this type of illness, but the hope is you won't. (Resources below; view case slides first)Â Â Â Â Â Resources American Academy of Dermatology. Viral Exanthems: Medical Student Core Curriculum in Dermatology. Presentation updated March 2011.American Academy of Pediatrics. Measles. Pickering LK, ed. Red Book: Report of the Committee on Infectious Disease. Elk Grove, Ill: AAP; 2012. 441-52.CDC. Measles (Rubeola) for healthcare professionals. Accessed October 7, 2016.Kutty P, Rota J, Bellini W, et al. Measles. In: VPD Surveillance Manual, 6th Edition, 2013. Chapter 7-1:Â Â a