When evaluating a patient for suspect measles, assess the following symptoms:
- Does the patient have a generalized, maculopapular rash? Typically, the rash will start on the face, move down the neck, trunk, arms, leg, and feet. It can appear on the palms of hands and soles of feet. Clinical presentation of rash usually occurs 3 to 5 days after symptoms begin.
- Does the patient have a temperature ≥101°F or 38.3°C? Fever should present prior to rash onset.
- Does the patient have cough, coryza, and conjunctivitis? The "three Cs" should present prior to rash onset.
- Does the patient have Koplik spots in their mouth?
A suspect case cannot be confirmed without correct labs. If a patient is clinically compatible with a measles infection, the following tests must be collected and ordered:
- Measles IgM - blood serum
- Measles IgG - blood serum
- Measles PCR through a nasopharyngeal or throat swab
Contact us to receive approval for PCR testing at the Utah State Public Health Laboratory. Measles serologies can be done at any private laboratory; ARUP offers serology testing with a quick turnaround time.
Other tests can also be helpful for ruling out measles, ideally a respiratory viral panel to consider differential diagnoses. When identifying alternative diagnoses, parvovirus IgM should be ordered, as well.
To help determine if measles testing is appropriate for a patient, also assess the following:
- Did the patient travel outside of the United States 21 days prior to symptom onset?
- Did the patient travel outside of Utah 21 days prior to symptom onset?
- Did the patient have contact with anyone else who traveled recently?
- Is the patient fully immunized with the MMR vaccine?
- Does the patient report any sick contacts who also have measles-like symptoms?
If you need immediate information while evaluating a patient, contact us at 385-468-4194 (Monday through Friday, 8:00am to 5:00pm) or 385-468-8888, option 7 (after hours).