BACKGROUND Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. METHODS In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1-6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. RESULTS This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. CONCLUSION The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik's spot can be added to this combination, albeit with a slight reduction of sensitivity value.

中文翻译：

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在有限资源环境下评估儿童麻疹病毒感染的临床特征以进行诊断。

背景技术麻疹是发达国家和发达国家中反复出现的健康问题。世界卫生组织（WHO）推荐抗麻疹免疫球蛋白M（Ig M）作为检测病毒的标准方法；然而，许多地区仍然无法进行抗麻疹IgM血清学检测。因此，麻疹的诊断需要典型的临床特征。本研究的目的是评估色素沉着过度皮疹和其他临床特征作为麻疹的诊断工具，特别是在爆发环境中。方法在这项观察性诊断研究中，纳入标准如下：年龄在6至144个月之间，发热，斑丘疹持续3天或以上，并伴有咳嗽、鼻炎或结膜炎。除了那些有 2 周或更长时间皮质类固醇使用史和免疫功能低下状况的人之外，那些有麻疹疫苗接种史（1-6 周）的人也被排除在外。样本取自印度尼西亚泗水的 Soetomo 博士综合学术医院。我们评估了此类临床特征的敏感性、特异性、阳性预测值和阴性预测值。使用 Kappa 和 Mc Nemar 测试验证色素沉着过度皮疹。抗麻疹 Ig M 被认为是金标准。结果 这项研究聚集了 82 名参与者。所有受试者的临床表现包括发热、咳嗽、鼻炎、结膜炎、科普利克斑和斑丘疹（随着病程转变为色素沉着过度皮疹）。大多数斑丘疹皮疹都是色素沉着过度（89%）。发热、斑丘疹和色素沉着过度皮疹组合的敏感性、特异性、阳性预测值和阴性预测值分别为 90.7%、28.6%、93.2% 和 22.2%。Mc Nemar 和 Kappa 检验显示 p 值分别为 0.774 和 0.119。结论 发热、斑丘疹和色素沉着过度皮疹的组合可以作为麻疹暴发环境中麻疹感染的筛查工具，然后可以通过抗麻疹 Ig M 进行确诊。咳嗽、鼻炎和科普利克斑可以添加到麻疹爆发中。这种组合，尽管灵敏度值略有降低。