Koplik Spots


Article Author:
Prachi Jain


Article Editor:
Manu Rathee


Editors In Chief:
David Wood
Andrew Wilt
Hajira Basit


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
10/17/2019 7:30:58 PM

Definition/Introduction

Koplik spots are the peculiar spots present on the buccal mucosa and are considered to be a diagnostic/pathognomic feature of measles/rubeola in the pre-eruptive stage. The term Koplik spot derives its name Dr. Henry Koplik of New York, who described them in 1896.

Issues of Concern

The appearance of Koplik spots in the mucosa is usually one day before the onset of rash. They appear as bluish-white spots, slightly raised with a diameter of approximately 2 to 3 mm on an erythematous base on the buccal mucosa opposite the first molar.[1][2] This characteristic appearance of Koplik spots is sometimes referred to as “grains of salt on a red background.” The bluish appearance is due to the collar of dilated veins around the submucosal gland duct, and the white portion is likely due to the destruction of cells of the glandular epithelium.[3] Occasionally, they may also appear in other areas such as the soft palate, conjunctival fold, and vaginal or intestinal mucosa and usually persist for 2 or 3 days.[2][4]

Reports indicate that Koplik spots appear in 60% to 70% of persons suffering from measles.[5] The height of the eruption takes place when the skin eruption appears and starts spreading. As the skin rash progresses, the spot on the mucosa loses its characteristic appearance and becomes discrete, resulting in a diffuse red background that has numerous bluish-white specks randomly scattered on its surface. Ultimately, after a few days, the mucosa reverts to its normal appearance.

Differential diagnosis: This includes Fordyce granules (lack a bright red background), aphthous ulcers (painful and are less numerous), and parvovirus B19 infection.

Clinical Significance

Measles is among the leading causes of morbidity and mortality worldwide during childhood, particularly in developing countriesIt is one of the most contagious diseases known that spreads through exposure to contaminated exposure or contact. The World Health Organisation has issued various vaccine strategies for the reduction of measles.[5] But there is decreased coverage in some countries due to economic and political issues, and safety concerns about vaccines; this has lead to a sharp increase in the case of measles in these countries. Thus, early detection is a must and is a key to limit its spread. Koplik spots have not only a diagnostic significance, but also they are essential in controlling the outbreak of measles. If measles is diagnosed early via identification of Koplik spots, measures can be taken to limit the spread before they reach maximum infectivity. Thus, early identification dramatically aids in controlling this highly infectious disease by permitting prompt management and control measures for measles.[6]

Nursing Actions and Interventions

The nurse should be aware of the early symptoms of measles such as Koplik spots, procedures to be done if the presence of measles is confirmed and should know how to handle the patient. She should have a thorough knowledge of the disease and should be able to physically examine the child for symptoms of measles and assess the family’s hygiene practices to prevent the spread of the disease. The ability of the nurses to quickly assess the child with Koplik spots may save lives by decreasing the spread of this highly communicable disease  (measles). Nurses should be aware of the current recommendations for vaccinations In a child suffering from measles, nurse intervention is necessary for proper skin care, eye care, and hydration. Also, some patients chose not to vaccinate their children. In such cases, nursing intervention is necessary as they can educate the parents on its consequences.


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Koplik Spots - Questions

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A 28-year-old male presented with a history of fever, conjunctivitis, dry cough, and dyspnea for the past seven days. He also complained that rashes appeared on his face the day before the presentation, which had now spread to his shoulders. On intraoral examination, small bluish-white spots on the buccal mucosa with a reddish background were noted. The patient is suffering from which of the following conditions?

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A 12-month-old girl is brought to the clinic by her parents with a one-day history of rash. The patient has been fully vaccinated and is otherwise in a healthy condition. Two weeks earlier, the patient was exposed to a confirmed case of measles. Physical examination reveals a red maculopapular rash on her face. Some lesions are discretely present on her trunk. Intraoral examination reveals numerous bluish-white spots on a red background opposite her molar buccal mucosa. The bluish appearance on the buccal mucosa is most likely due to which of the following factors?



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A 13-year-old male reported with his parents with fever and nonproductive cough for the past few days. He has a family history of eczema, and his vaccination history is unknown. On examination, his temperature was 39.5 C, pulse was 116/min, and a respiratory rate was 16/min. Physical examination revealed intense conjunctivitis and a macular rash on the trunk. On intraoral examination, bluish-white spots with reddish background were found on mucosa opposite the second molars. The whitish appearance on the buccal mucosa is due to which of the following factors?



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A 25-year-old female reported to the clinic with complaints of a sore throat, cough, fever, and chills for the past three days. On examination, her temperature was 39.5 C. Physical examination revealed a facial maculopapular rash and conjunctivitis. Intraoral examination revealed erythema on the pharynx and buccal mucosa with numerous bluish-white spots. Over the next three days, the rash extends over her trunk and extremities. The characteristic bluish-white spots in the condition affecting the patient can be seen on which of the following site?



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Koplik Spots - References

References

Tanaka M,Harada T, Koplik spots in measles. Postgraduate medical journal. 2019 Aug;     [PubMed]
Lefebvre N,Camuset G,Bui E,Christmann D,Hansmann Y, Koplik spots: a clinical sign with epidemiological implications for measles control. Dermatology (Basel, Switzerland). 2010;     [PubMed]
Brem J, Koplik spots for the record. An illustrated historical note. Clinical pediatrics. 1972 Mar;     [PubMed]
Suringa DW,Bank LJ,Ackerman AB, Role of measles virus in skin lesions and Koplik's spots. The New England journal of medicine. 1970 Nov 19;     [PubMed]
Conis E, Measles and the Modern History of Vaccination. Public health reports (Washington, D.C. : 1974). 2019 Mar/Apr;     [PubMed]
Provenzano S,Santangelo OE,Giordano D,Alagna E,Piazza D,Genovese D,Calamusa G,Firenze A, Predicting disease outbreaks: evaluating measles infection with Wikipedia Trends. Recenti progressi in medicina. 2019 Jun;     [PubMed]

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