Late complications - (a) Bronchiectasis. (b) Immuno-suppressive measles encephalopathy - 1-6 months after an attack of mild or atypical measles in chi

complication. Headache, confusion, coma and convulsions result from autoimmune demyelination. 6 Hepatitis - usually in young adults with severe disease. Frank jaundice may occur. May be giant cells in the liver. Spontaneous resolution. 7. Late complications - (a) Bronchiectasis. (b) Immuno-suppressive measles encephalopathy - 1-6 months after an attack of mild or atypical measles in children receiving cytotoxic drug therapy. Neurological damage is severe. (c) Subacute sclerosing panencephalitis (SSPE) -It occurs about 4-7 years after mild disease, evolves over a period of months or years, almost always ending fatally. Post-measles state - results from powerful immunosuppressive effect which alters immunity and the tissue-destructive effect of measles. Clinical features - Gradual deterioration into chronic illness (a) Growth retardation and diarrhoea - often with anorexia. May precipitate protein-energy-malnutrition. (b) Gingivo-stomatitis - with oral herpes, persistent pyrexia, worsening pneumonia, increasing hepatomegaly and encephalopathy. (c) Corneal ulcers mainly in malnourished children. (d) Other uncommon complications - Gangrene of tips of fingers and toes, cancrum oris, septicemia, candidosis, reactivation of pulmonary tuberculosis, possibly abortion or prematurity if infection occurs during pregnancy. Diagnosis -can be confirmed retrospectively with paired serology, salivary antibody detection is a non-invasive method of confirming the diagnosis. Differential Diagnosis - PRE EXANTHEMATOUS STAGE - Common cold, influenza, catarrhal stage of whooping cough. EXANTHEMATOUS STAGE -1. Rubella - No Koplik's spots, small shotty enlargement of suboccipital, posterior cervical and post-auricular lymphnodes; catarrhal symptoms and systemic disturbances slight. In measles mucous membrane is injected and dirty, in rubella it is pale and clean. 2. Drug eruption - especially that caused by ampicillin. Tends to persist longer and may have an urticarial element. Absence of catarrh and failure of rash to evolve from above downwards. 3. Serum rashes - Rash dense at site of injection, typical wheals. 4. Infectious mononucleosis - Fever, adenopathy, and sore throat. Maculopapular rash, splenomegaly. Atypical lymphocytes in blood smear. 5 Erythema infectiosum - Rash but usually no constitutional symptoms. Rash appears in three phases It begins with livid erythema of the cheeks (slapped cheeks), followed by maculopapular rash on extremities and trunk, and as the rash fades it has a lacy reticular appearance. 6. Roseola infantum (Exanthema subitum) - Acute viral disease of young children. 3 to 4 days of high fever. As fever falls by crisis, pink maculopapules appear on chest and trunk and fade in 1-3 days. 7. Erythema multiforme - Circular or irregular erythematous blotches usually occurring on backs of hands and forearms. Constitutional symptoms may be present. 8. Other exanthemas - (a) Coxsackie virus A. Hand-foot and mouth disease is the most specific syndrome. After a short prodroma of malaise, anorexia and fever, a vesicular exanthem develops involving buccal mucosa. A vesicular exanthem also appears on hands and feet in many patients. (b) Other viral infections - Adenovirus, parainfluenza virus, respiratory syncitial virus may occasionally be associated with macular or maculopapular rashes. 9. Paratyphoid - Sometimes profuse pinkish brown maculopapules. Longer prodromal illness, characteristic temperature chart, agglutination test