Significance of Koplik spots in the Early Clinical Diagnosis of Measles in Children in Resource-Limited Settings, Lahj, Yemen

Background Measles is a highly contagious vaccine preventable viral disease with high morbidity and mortality worldwide. Measles is characterized by high fever, systemic rash, respiratory and conjunctival symptoms. Early clinical diagnosis and control are crucial. Koplik spots on the buccal mucosa is a disease specific pathognomonic sign of measles and appears before fulfillment of the WHO clinical diagnosis. The objective of this study is to assess the significance of Koplik spots in early clinical diagnosis of measles. Patients and Methods A prospective observational study which was conducted at Alamal outpatient Clinic at Lahj Governorate, Yemen, from March 2023 to March 2024. A total of 81 patients between age 7 months - 144 months who did not fulfill the WHO clinical diagnosis of measles were selected, presented with symptoms and signs of pre-eruptive stage of measles and all of them had positive Koplik spots and no skin rash. Data were collected in pre-designed questionnaire by direct interview with the parents about socio-demographic and clinical features. buccal cavity examination was done for all cases and photos for Koplik spots were picked up by telephone digital camera with strict adherence to patient's anonymity . The day of detection of Koplik spots was registered and all cases were followed for the appearance of skin rash. Both descriptive and inferential statistics were used for data analysis. Results In this study which comprised 81 patients, there was a slight preponderance of males 44 (54%). The Median age was 36 months with range between 7 - 144 months, of whom 79% were ≤ 60 months. All patients developed skin rash after detection of Koplik spots. The mean time of detection of Koplik’s spots and appearance of skin rash calculated from onset of fever were 4±1.18 Days (Mean ±SD), 95% CI:(3.75- 4.26) and 5.7±1.03 Days (Mean ± SD) ,95% CI: (5.48 - 5.92) respectively. The Median interval between detection of Koplik spots and appearance of skin rash was 2 Days with minimum and maximum interval of 1 and 4 days respectively. Conclusion Detection of Koplik spots in measles outbreak may be considered as a potential early warning sign that may contribute in early detection and control of measles and can be useful adjunct to the WHO standard clinical definition of measles in Resource-Limited Settings as in Yemen. We recommend routine buccal examination in measles outbreak taking into consideration training of health personnel on how to recognize and check for Koplik's spots.