A 4 Year Old Child Presents With Fever And Rash

A 4 year old female child is brought to a rural primary care clinic by her mother with the complains of a high grade fever for about a week followed by development of a rash that started on the head and face which has now spread to involve the entire body. Mother describes that the child has been very irritable, has no appetite and refusing to eat , has a runny nose and a hacking cough. The patient has been breathing faster than usual and shows no interest in playing with her toys.
Mother says that the child has never been vaccinated because of their cultural beliefs against vaccinations. The child has normal growth and development for her age.
On Examination Patient has a  fever of  102 F , a respiratory rate of 52 breaths per minute and a generalized maculopapular rash covering her entire body. The picture is shown as below;

What is the Diagnosis ?
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Measles

Case Discussion:

Measles which is also known as Rubeola is a highly contagious infectious disease caused by a virus. Unvaccinated children are at highest risk of getting infected.

Clinical Features: Patients have following signs and symptoms;

• Fever
• Dry cough
• Runny nose 
• Sore throat
• Inflamed eyes
• Koplik's spots : tiny red spots, with blue white centers that appear inside the mouth. ( they appear temporary and disappear early so are rarely seen )
• Generalized red maculopapular rash that begins several days after the fever and first starts on the back of the ear which then spreads to the head and neck before spreading to cover most of the body. The rash initially appears red which later turns into dark brown before disappearing in the similar pattern as it appeared from the head to the entire body.

Complications; Patients may get many complications which are very common like:

• Diarrhea.
• Pneumonia 
• Otitis media
• Encephalitis
• Corneal ulceration which may lead to scaring and blindness
• Severe malnutrition
• Vitamin A deficiency

Management:

Measles usually can get better with good home care if there are no associated complications. 

1. The child should be allowed to get plenty of rest and good fluid intake.

2. The child should be kept away from school and day care for at least 4 days after the rash first appeared to prevent the spread of infection.

3. Give Vitamin A supplements

4. Antipyretics like acetaminophen should be given to reduce and control the fever

5. Vaccination is recommended for prevention.

6. Immune serum globulin can be given to infants and immunocompromised patients to make the symptoms less severe and prevent complications. 

7. children with complications may need hospitalization as well as antibiotics for treating superimposed bacterial infections.