CDA Essentials 2019 • Volume 6 • Issue 4

17 Issue 4 | 2019 | N ews and E vents MEASLES Spotting Signs of Infection in the Mouth Measles is a serious infectious disease with no antiviral treatment. It is transmitted through the air and is so contagious that it’s estimated to infect 90% of non- immune people who are exposed to someone with measles. It can cause encephalitis and pneumonitis and results in 1–3 deaths out of every 1,000 infections. A ccording to the Public Health Agency of Canada’s weekly Measles and Rubella Reports , 51 cases of measles have been reported in Canada in 2019, as of mid-May. These cases were reported in Quebec, British Columbia, the Northwest Territories, Ontario, Alberta and New Brunswick. Low vaccination rates are giving rise to measles outbreaks in countries around the world, including those with widespread vaccine availability and well-established public health infrastructure. An infected child or adult visiting your practice can incubate the virus and infect others nearby who are not immune. Signs and Symptoms of Measles Can Appear in theMouth Most parents and even some pediatricians and physicians have never seen or treated measles before, making it difficult for them to recognize signs and symptoms. This lack of familiarity also means parents and caregivers may underestimate the severity of the disease, are more likely to consider their child to be at low risk and may not appreciate how easy it is for measles outbreaks to occur. In some cases, early signs of measles infection can be seen orally, including Koplik spots, which can appear as bluish spots on the soft palate and oropharynx, and bright red spots on the buccal mucosa resembling grains of sand ( Figs. 1 and 2 ). Figure 1: Very small, bright red spots on the buccal mucosa, diagnosed as Koplik spots and indicating the onset of measles. Photo: Centers for Disease Control and Prevention - Public Health Image Library Figure 2: A 10-month-old girl presented with multiple 2–4 mm bluish-white Koplik spots on the buccal mucosa. She had been exposed to the measles virus two weeks before presentation and further testing confirmed the patient had measles. Photo: Xavier S, Forgie SED. Koplik spots revisited. CMAJ. 2015;187(8):600.