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ULY CLINIC

25 Septemba 2025, 02:02:44

Koplik’s spots

Koplik’s spots are small red macules with bluish-white centers found on the buccal and lingual mucosa, typically near the first and second molars. They are an early and pathognomonic sign of measles (rubeola), appearing 1–2 days before the characteristic skin rash.

Pathophysiology

Measles virus infects epithelial cells of the oral mucosa, leading to localized inflammation and necrosis.
The combination of vascular dilation (red base) and epithelial necrosis (white center) produces the classic blue-white specks on a red background.
Koplik’s spots reflect early viral replication before systemic spread triggers the exanthem rash.

Examination Technique

Patient positioning: Have the patient seated or lying down comfortably.
Oral inspection: Ask the patient to open the mouth widely.
Mucosal examination: Use a tongue depressor and good lighting to inspect the buccal and lingual mucosa, especially opposite the first and second molars.
Observation: Look for tiny, irregular red spots with central bluish-white specks.
Documentation: Record location, number, and size of spots; note the timing relative to other symptoms (fever, cough, conjunctivitis).

Clinical Features

Feature	Manifestation
Lesion appearance	Small red macules with bluish-white centers
Location	Buccal and lingual mucosa, usually opposite molars
Timing	1–2 days before measles rash (exanthem)
Associated prodrome	Fever, cough, coryza, conjunctivitis
Disease progression	Exanthem erupts 1–2 days after spots appear

Differential Diagnosis

Condition	Key Feature	Notes
Measles (Rubeola)	Koplik’s spots + prodrome + rash	Pathognomonic sign of early measles
Rubella	Rash without Koplik’s spots	Milder prodrome; oral lesions usually absent
Scarlet fever	Strawberry tongue, not bluish-white spots	Caused by Group A Streptococcus
Herpangina / Coxsackie virus	Vesicles on posterior oropharynx	Painful, ulcerative; different distribution
Aphthous ulcers	Single or multiple ulcers	White base, red halo; not widespread opposite molars

Pediatric considerations

Most commonly observed in children aged 6 months to 5 years.
Often precedes the classic measles rash, serving as a crucial early diagnostic clue.
Careful oral inspection is essential, as young children may not verbalize discomfort.

Geriatric considerations

Rare in adults due to prior immunity or vaccination.
When present, the oral lesions are similar but may be less conspicuous.

Limitations

Spots are transient and may be missed if inspection is delayed.
Requires good lighting and careful oral inspection.
Can be overlooked in uncooperative or very young patients.

Patient counseling

Explain that Koplik’s spots are an early sign of measles.
Advise on isolation to prevent transmission.
Supportive care includes hydration, fever control, and monitoring for complications.
Emphasize vaccination for at-risk contacts if not immune.

Conclusion

Koplik’s spots (Koplik’s sign) are a pathognomonic early oral manifestation of measles, appearing before the characteristic rash. Early recognition allows for timely diagnosis, isolation, and supportive management, helping prevent further transmission and complications.

References

Perry RT, Halsey NA. The Clinical Significance of Measles. N Engl J Med. 2004;351:1391–1401.
Cherry JD, et al. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia: Elsevier; 2019.
Heymann DL. Control of Communicable Diseases Manual. 20th ed. Washington, DC: APHA; 2015.
Moss WJ, Griffin DE. Measles. Lancet. 2012;379:153–164.