A 25-year-old man was admitted to the hospital in mid-June for malaise and shortness of breath of 1 day's duration. Three days before admission, he had developed sneezing and a runny and stuffy nose. Two days before admission, he developed a nonproductive cough, a headache behind his eyes, a fever, and red blotches on his face. One day before admission, the rash covered most of his face and had spread to his arms and trunk.
Upon questioning, he stated that he had no known tick exposure, that his mother had told him that he had measles as an infant, and that he had never received measles vaccine.
A. Why do you think the patient was asked about tick exposure'?
Physical examination of the patient revealed a temperature of l00°F, a relatively low total white blood cell count, labored breathing, a red face, and an erythcmatous maculopapular rash on his trunk, palms, and extremities. Examination of his mouth revealed several salt-grain~size, raised white spots on his buccal mucosa (the lining of his cheeks).
B. What disease is suggested by the combination of fever, rash, and white spots on the patient's buccal mucosa?
C. What pathogen causes this disease?
D. What are the white spots called?
E. What laboratory tests would confirm the diagnosis?