Measles in children holds a special place among infectious infectious diseases. The symptoms of this acute infectious pathology in children are high fever, a characteristic measles rash, sore throat, cough, severe body intoxication. Any child or even an adult can get measles, and measles can occur with serious complications and is sometimes fatal. It is known that measles annually kills 150,000 people worldwide, mostly children under 10 years old. Therefore, any person, especially parents of small children, should know well what is measles.
- Causes of the disease
- How is measles transmitted
- Incubation period for measles
- How does measles manifest
- Measles, symptoms in childhood
- Clinical manifestations of measles in adults
- Atypical forms of measles
- Diagnostic Events
- Treatment of measles in children and adults
- Medication Treatment
- Measles: preventive measures
Causes of the disease
The source of infection in measles is a sick person. The virus is transmitted by airborne droplets and is extremely contagious. Prevention of measles in children is carried out in the form of routine vaccination in two stages. Formed immunity protects against measles or, in case of infection, helps to transfer the disease in a mild form and without complications.
The causative agent of measles belongs to paramyxoviruses. The paramyxovirus itself is unstable outside the body, quickly destroyed by exposure to ultraviolet rays, low humidity, but it remains at low (to -70 ° C) temperatures.
How is measles transmitted
Seasonal incidence of measles – from October to April – is associated with a crowd of people on the premises. Infection with children often occurs in kindergartens. Cases of infection through third parties are extremely rare due to the rapid destruction of the virus in the external environment.
The pathogen is transmitted by airborne droplets from a sick person to a healthy one. Especially dangerous is the release of the active virus to patients during the incubation period, when there are 3-4 days left before the onset of the rash and accurate diagnosis of the clinical picture of the disease is not possible.
A person suffering from measles is dangerous to others for 7-10 days. The measles virus is highly contagious, the percentage of transmission by close contact is almost 100% of cases in the absence of vaccination. The pathogen can also move by air, for example, through the stairwells, ventilation shafts in apartment buildings.
In recent decades, due to the introduction of vaccination into routine vaccinations, the incidence of children has decreased significantly, but the adult population still has a fairly high number of people who are not immune to paramyxovirus, which causes an increased number of adult patients and the occurrence of intrauterine infection of the fetus from measles mothers.
If a person has had measles, then he has a lasting immunity for the rest of his life, and with repeated infection the disease is unlikely. Cases of recurrent measles disease are usually associated with states of immune deficiency.
measles infection in children under two years of age is most common in the absence of the mother’s immunity to paramyxovirus, natural or produced after vaccination. Considering the risk of measles for infants, the paramyxovirus vaccine is on the recommended list of vaccines for women planning a pregnancy and not having specific immunity.
Incubation period for measles
The causative agent of measles penetrates the human body through the mucous membranes of the respiratory tract and organs of vision.
Three days after penetration, the paramyxovirus enters the bloodstream, spreads through the lymph nodes, settles in the spleen, where it actively reproduces in the bloodstream during the incubation period (7 to 17 days).
At the end of the measles incubation period, a new generation of paramicovirus spreads throughout the body, affecting the skin, conjunctiva, organs of the gastrointestinal tract, respiratory and nervous systems.
How does measles manifest
The clinical symptoms of measles in a child and in an adult are different due to the differences in physiological processes, the maturity of the body and the formation of immunity. Quite often in adults, the disease is more severe than in childhood.
Measles, symptoms in childhood
Measles in children manifests itself in different ways depending on the period of the disease. The initial period, characterized by catarrhal symptoms and signs of general intoxication, lasts from 3 to 5 days.
|Hyperthermia||Increased body temperature – a protective reaction of the body|
|Psychomotor agitation, worsening of sleep, hyper-reaction to stimuli, moodiness||Consequence of paramyxovirus penetration into the cortex and other brain regions|
|Rhinitis (runny nose), with clear mucous discharge, sore throat, redness and swelling of the mucous membranes||The virus damages the capillaries of the upper respiratory tract, the nasal mucosa is activated and produces a protective protein. This process is accompanied by signs of irritation of the throat and nose. Puffiness of the mucous membranes of the respiratory tract can develop up to laryngospasm.|
|Cough||The inflammatory process in the airways extends to the vocal cords. Typical measles symptoms develop – hoarseness, hoarseness and characteristic “barking” cough|
|Conjunctivitis photophobia||Swelling of the inner lining of the eyelids contributes to the multiplication of pathogenic bacteria, the inflammatory process contributes to the start of the reaction of irritation to bright light|
|Puffiness, puffiness of face||These signs of measles are caused by inflammatory processes in the cervical lymph nodes provoked by the paramyxovirus. They are accompanied by swelling, stagnation of blood and lymph in the blood vessels of the head.|
|Korevaya enanthema||It forms on the 2-4 day of the disease on the mucous membrane of the soft palate in the form of red spots up to half a centimeter in diameter. After 24-48 hours, it merges with the general hyperemia of the mucous throat|
|Velskiy-Filatov-Koplik Spots||These characteristic spots appear on day 3-5 on the mucous membrane of the cheeks in the area of the chewing teeth in the form of small white spots with a red border due to the death of part of the mucous in the paramyxovirus reproduction foci.|
|Gastrointestinal symptoms||Abdominal pain, refusal to eat, increased stool, nausea, vomiting as a result of intestinal mucous membranes.|
The catarrhal period of measles is replaced by a period of characteristic measles eruptions on the skin. Rash appears 3-4 days after the onset of the disease, primarily on the front of the head. Next, the rash spreads to the neck, upper body and gradually covers the entire body, including the limbs.
measles eruptions are called maculopapular exanthema, manifested in the form of pink nodules of irregular shape towering above the skin. Papules are surrounded by red spots, increasing in size, prone to merge with each other. During this period, general intoxication is manifested by headache and fever. Also, when exanthema is observed increased cough and runny nose. The duration of this period is 4-5 days, after which the rash turns pale, changes color, is reduced in size. The patient’s condition improves, the virus is contagious.
The next period of measles is accompanied by a process of convalescence (skin pigmentation).
|Change the color of the rash||After five days after the onset of exanthema, melanin deposits cause a symptom of “dirty skin”, a light brown spot at the site of papular nodes.|
|Epidermis Peeling||Dead cells of the horny epithelium disappear from the eruption sites|
|General improvement in well-being||Normalization of body temperature, decrease in the severity of catarrhal phenomena due to the production of measles antibodies by the body|
This period lasts from 7 to 10 days and, in the absence of complications, ends with recovery.
Clinical manifestations of measles in adults
The clinical picture of measles in adults has the same periods as in childhood illness. However, the symptoms are more pronounced, the disease is more severe, the likelihood of complications is higher. Symptoms include tachycardia (more than 100 beats per minute), a decrease in blood pressure, a rash accompanied by subcutaneous hemorrhages caused by damage to the capillaries.
Atypical forms of measles
Allocate a typical clinical picture of measles with preservation of all symptoms and adherence to the periodicity of development, and atypical forms:
- aggravated form.
Mitiated or weakened form of measles is typical for patients who have undergone preventive procedures in the incubation period (administration of immunoglobulin, steroid hormones, blood transfusions, plasma from donors with immunity, etc.). In this case, the incubation period can be extended to 21 days. Symptoms of mitigated measles are not clearly expressed or erased. Body temperature may remain within the normal range or rise to subfebrile indices, the period of eruptions is shortened, the exanthema is pale, not large, there are no lesions on the mucous membranes. The disease proceeds quickly, without complications.
The abortive form of measles begins the same way as a typical measles infection, but after 2-3 days the clinical signs of the disease disappear. Hyperthermia occurs on the first day, after which the temperature returns to normal. The rash is present mainly on the facial part and trunk.
Blurred form is typical for patients with immune protection against paramyxovirus injection of measles vaccine. The symptoms of measles are not pronounced, the course is fast, without complications, the patient’s condition is satisfactory.
Asymptomatic form is characterized by the absence of specific symptoms, determined only by laboratory analysis of blood for immunoglobulins.
A form with aggravated symptoms is rare. Accompanied by severe intoxication of the body, hemorrhagic syndrome, is more common in adults.
The pronounced clinical picture of measles infection in most cases allows the diagnosis to be established after visual inspection of the patient. However, at the beginning of the disease, in case of mild or atypical course, as well as the accession of another infection, differentiation with diseases such as scarlet fever, rubella, and infectious erythema is necessary, also accompanied by rashes of a similar nature and type.
Virological and serological methods are used in laboratory diagnostics.
In the case of the virological method, nasopharyngeal washes, discharge from the eyes, and urine of a patient with measles become the material of study. The determination of the presence of paramyxovirus in biological materials using immunofluorescence, phase-contrast and fluorescence microscopy. When the serological method resorted to studies of the reaction of agglutination, binding of complement, etc. The analysis is performed twice: at the onset of the disease and after two weeks. An increase in antibody titer 4 times or more serves as a diagnostic criterion for measles.
With the help of modern methods of examination (in particular, enzyme immunoassay) it is possible to isolate the presence of specific antibodies in the blood, allowing to judge the acute form of the disease or earlier contact with the pathogen. For such a diagnosis, a blood test for the content of immunoglobulins is performed. The presence of a pronounced infection process is indicated by the presence of immunoglobulins M (IgM) in an amount of 0.18 IU / ml. The analysis is carried out from 3 days after the onset of the disease.
Additional studies are not aimed at diagnosis, but allow to clarify the nature of the development process and the likelihood of complications. Most often, urinalysis is prescribed to monitor and correct therapy. If pulmonary inflammation is suspected as a complication of the disease, they are diagnosed with an x-ray of the chest.
Treatment of measles in children and adults
Specific treatment aimed at combating it with the paramyxovirus does not yet exist. Treatment is based on reducing the severity of symptoms, preventing or relieving complications.
Observance of bed sparing regimen for 7-10 days from the onset of the disease and the milk-vegetable diet is of prime importance. The diet excludes spicy, fatty, fried foods, dishes that irritate the gastrointestinal mucosa.
It is important to treat the patient with measles is to observe the drinking regime in view of the possible dehydration of the body due to fever, rapid stool, diarrhea. If necessary, resort to the use of electrolyte solutions.
The prescription of vitamins is specific: it is known that the disease is significantly more tolerated in patients with vitamin A deficiency. Thus, prescribing a single drug or multivitamins is part of therapy for measles infection.
Symptomatic therapy depends on the symptoms associated with the disease: it is the clinical manifestations that determine the choice of drugs. In conjunctivitis, the conjunctiva is washed with saline, chamomile decoction, warm boiled water, 2% sodium bicarbonate solution (baking soda). If conjunctivitis is bacterial in nature and there is a purulent discharge, antibacterial eye drops are prescribed.
To alleviate the condition in case of pronounced rhinitis, local-acting vasoconstrictor drugs and nasal passages are used. Dry, frequent, exhausting cough requires the appointment of antitussive drugs. At high rates of body temperature or a tendency to convulsive reactions on the background of hyperthermia, resort to antipyretic drugs.
In some cases, therapy is shown, aimed at strengthening the body’s defenses. If a child has severe intoxication, or the disease occurs in a weakened adult patient, then this is an indication for inpatient treatment with human immunoglobulin to increase the effectiveness of the patient’s overall immunity. In case of severe allergic reaction, symptoms of intoxication, edema, it is possible to use antihistamines (Suprastin, Fenistil, Zyrtec, etc.).
In the absence of complications and joined infection, antibiotic therapy is not indicated. If symptoms of bacterial infection are present, antibiotics from the group of penicillins, cephalosporins, macrolides are prescribed. Therapy of complications is carried out in stationary conditions. Drugs are selected depending on which organ is involved in the pathological process. You can stay in different departments, including in the intensive care unit and intensive care, if you need to treat such complications of measles as meningitis, encephalitis and pneumonia.
Measles: preventive measures
Measles is dangerous with severe complications: measles pneumonia, meningitis, encephalitis, obstructive bronchitis, laryngostenosis and others. Contrary to the frequent opinion, measles is not limited to temperature and skin rashes, but can have a long severe course with a pronounced effect on various internal organs, and require a long period of rehabilitation. Complications can provoke disability or result in death.
To prevent infection in small children, vaccinations are given. Vaccination is carried out at the age of 1 year and 6 years. After it, the immunity is maintained for a long time, but not always for life. Therefore, revaccination is shown in adulthood when post-vaccination immunity is lost.
In case of contact with a sick person, a preventive measure that allows to significantly ease the course of the disease and prevent the development of complications, is an urgent vaccination of an unvaccinated child or adult with a “live” monovalent vaccine against paramyxovirus.