A 4-year-old child presents with a prodrome of high-grade fever for 3 days followed by appearance of a morbilliform rash starting from behind the ears and spreading downward. Koplik's spots are noted on the buccal mucosa. Which of the following complications is the LEADING CAUSE OF DEATH in measles in developing countries?

• A Subacute sclerosing panencephalitis (SSPE) occurring years after the acute illness
• B Secondary bacterial pneumonia due to Streptococcus pneumoniae or Staphylococcus aureus ✓
• C Measles encephalitis occurring 1–2 weeks after rash onset
• D Myocarditis causing acute cardiac failure during the exanthem phase

Explanation

Secondary bacterial pneumonia is the leading cause of measles mortality in developing countries, particularly in malnourished children. Measles-induced immunosuppression (due to lymphopenia and impaired macrophage function) predisposes to S. pneumoniae, S. aureus, H. influenzae, and gram-negative bacterial superinfection of the respiratory tract. SSPE is a rare, late complication (years later). Measles encephalitis (~1 in 1000 cases) is a serious but less frequent cause of death. Myocarditis is uncommon.

Reference: Ghai Essential Pediatrics, 10th ed.

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