Measles - Symptoms and Treatment
What is measles?
Measles is an acute anthroponous (the main carrier of the virus is a patient with measles) viral disease, accompanied by the appearance of intoxication-febrile symptoms, the defeat of the airway syndrome (upper respiratory tract), as well as the appearance of a specific rash on the mucous membranes of the oral cavity and skin.
Measles belongs to the classic DKI (childhood droplet infections), therefore, in adults, the disease is less frequently recorded. However, in older patients, measles is more severe and more often accompanied by the development of severe complications.
Attention! Measles vaccine does not guarantee protection against the disease.
Measles after vaccination is recorded in seventy percent of vaccinated people. This is due to the fact that the measles vaccine supports intense immunity for ten to fifteen years, in the future there is a significant decrease in measles immunity.
Therefore, the maximum number of cases of measles (among those vaccinated) is observed among high school students, students, recruits in the army, etc.
In this regard, many parents find out why they need measles vaccination for children?
For reference. The measles vaccine reduces the risk of developing serious complications of the disease. Vaccinated patients, as a rule, carry the disease in an erased form.
The measles code for ICD10 is B05. Additionally, after the main one, the qualifying code is indicated:
0 - for measles complicated by encephalitis (B05.0);
1- for measles complicated by meningitis;
2- for a disease complicated by pneumonia;
3- for measles, accompanied by the development of otitis media;
4- for measles with the development of intestinal complications;
8- for a disease accompanied by the development of other specified complications (measles keratitis);
9- for uncomplicated measles.
Causative agent of measles
The measles causative agent belongs to the paramyxovirus families. In the environment, measles viruses are rapidly destroyed, so infection occurs directly by contact with an infected person (viruses are found in saliva, sputum, etc.).
For reference. On clothes, toys, dishes, etc. viruses are rapidly inactivated. Therefore, the contact-household mechanism of transmission of the virus practically does not affect the spread of measles.
At low temperatures, the pathogen is longer able to persist in the environment.
Measles virus can spread over long distances. With a stream of air, dust particles containing a virus can move into neighboring rooms, onto stairwells, etc.
Attention. The maximum susceptibility to measles is observed in children from one to five years. Children under three months old born from a vaccinated or measles-infected mother do not get sick.
In unvaccinated and not measles-infected, a high level of susceptibility to the virus lasts a lifetime. Such patients can get measles after fleeting contact with patients at any age.
The maximum incidence of measles is recorded in winter and spring, and the minimum in autumn.
After measles, a stable, lifelong immune resistance is formed.
The incubation period for measles viruses is from 9 to 17 days.
For reference. Isolation of the virus into the environment (the patient’s infectious period) begins two days before the end of the incubation period and continues until the fourth day after the appearance of rashes.
Pathogenesis of the development of the disease
The entry gates for infection are the mucous membranes lining the respiratory tract. Cell reproduction occurs in the cells of the respiratory epithelium and regional lymph nodes.
After the third day of the incubation period, the first wave of viremia begins (measles viruses enter the bloodstream). At this stage, a small number of measles viruses penetrate the blood, so they can be neutralized by specific immunoglobulins (postexposure prophylaxis).
In the future, the amount of virus in the tissues increases and on the 1st day of the appearance of rashes, a massive release of the pathogen into the blood is noted.
For reference. A measles rash is a consequence of a perivascular inflammatory process in the upper layers of the dermis. An important role in the development of measles rash is also played by the allergic component of inflammation.
Measles virus is highly tropic to tissues of the skin epithelium, ophthalmic conjunctiva, mucosa lining the oral cavity and respiratory tract.
In severe measles, the virus can enter the GM tissue (brain) with the development of measles encephalitis or subacute sclerosing panencephalitis.
For reference. With a pronounced inflammatory process in the mucosa of the respiratory tract, necrotic damage to epithelial cells is possible. In this case, the development of severe bacterial complications is noted (due to the activation of the secondary bacterial flora).
Measles is also characterized by the development of temporary secondary immunodeficiency, leading to the appearance of frequent bacterial infections. Secondary immunodeficiency may persist for several months after infection.
The disease can occur in typical and atypical forms (in mitigated, abortive, erased, asymptomatic, hypertoxic, hemorrhagic forms of the disease). Measles with a typical course is divided by periods.
virus incubation (duration from 7 to 19 days);
catarrhal manifestations (lasts from three to four days);
rash (measles rash occurs on the 4th day of illness, rash lasts three to four days);
residual pigmentation (hyperpigmentation at the site of rashes and desquamation persists for seven to fourteen days).
By the presence of complications, a smooth (uncomplicated) and complicated course of the infectious process is distinguished.
Measles - Symptoms in Children
In the period of catarrhal manifestations, measles symptoms are similar to symptoms of acute respiratory viral infections or influenza.
Patients complain of severe weakness, lethargy, lethargy, adynamia, drowsiness, nausea, lack of appetite, fever, chills, muscle and joint pain, eye pain, conjunctival hyperemia, lacrimation, nasal congestion, sneezing, coughing.
Cough with measles is dry, sometimes barking.
For reference. The mucosa of the posterior pharyngeal wall is hyperemic, loose. Specific rashes (Filatov-Belsky spots) can be noted on the mucous membrane of the cheeks.
In severe measles, stenosis and laryngeal edema may develop.
Against the background of intoxication symptoms, a decrease in blood pressure (blood pressure), muffled heart sounds, tachycardia, and the appearance of arrhythmia are characteristic.
On electrocardiography, signs of myocardial dystrophic changes are recorded.
From the side of the kidneys, the development of secondary nephropathy is possible, manifested by the appearance of protein and cylinders in the urine, a decrease in the volume of urination.
Eye damage is manifested by symptoms of measles conjunctivitis. Characteristic appearance:
pain in the eyes;
purulent discharge from the eyes;
puffiness of the eyelids;
A measles rash is papular-spotted. Rashes do not itch.
Attention. A distinctive feature of measles rash is the phasing of its appearance. Rashes spread from top to bottom for three days. First, the skin of the face and neck is affected, then the skin of the body, etc.
Elements of the rash (small papules surrounded by a corolla of inflammatory hyperemia) are confluent. Areas of thick rash alternate with areas of normal skin.
With massive rashes, small hemorrhages may appear on the skin.
The appearance of puffiness, swelling of the face is also characteristic. The lips are dry, sometimes cracks and crusts can be noted on them.
The condition of patients during the rash is most severe. There is severe weakness, lethargy, and fever.
Attention. Normalization of body temperature occurs on the fourth or fifth day from the beginning of the rash. With a longer preservation of the fever, the development of complications due to the activation of the secondary bacterial flora (otitis, sinusitis, pneumonia, etc.) should be suspected.
The patient's condition normalizes during the disappearance of the rash and the appearance of hyperpigmentation. Rashes disappear in the same order as they appeared (from top to bottom).
In their place, hyperpigmented spots remain due to the accumulation of hemosiderin.
The appearance of pigmentation is usually observed on the third day after the appearance of rashes. In some cases, pigmentation spots may be accompanied by the appearance of peeling.
For reference. Symptoms of hemorrhagic measles are manifested by severe intoxication symptoms, neurological symptoms (convulsions, impaired consciousness), damage to the heart and blood vessels (acute cardiovascular failure). The appearance of multiple hemorrhages on the skin and mucous membranes is also characteristic.
In some cases, the development of hemocolitis and hematuria is noted.
In patients with rudimentary forms of measles, blurry, erased symptoms are observed. In some cases, rashes can be single or completely absent. With erased forms of the disease, catarrhal manifestations of the disease come to the fore.
With asymptomatic measles, the symptoms of the disease may be completely absent.
Mitigated measles in adults and children is noted when specific immunoglobulins are administered to the patient during the incubation period of the measles virus. In this case, the incubation period can be extended until the 21st day, and the symptoms of the disease will be erased.
Intoxication symptoms are mild, rashes are not plentiful. It should be noted that in patients with mitigated measles, the phasing of the appearance of a rash specific to this disease is impaired.
Measles - Symptoms in Adults
The main symptoms of measles in adults do not differ from the symptoms of the disease in children.
However, in adults, bacterial complications, severe neurological and cardiovascular complications more often develop, the intestines, biliary system, etc. are affected.
Complications of Measles
Complications of this disease can develop in any period of the infectious process. They can be specific and non-specific.
For reference. Specific measles complications are due to the toxic effects of the virus on the body. The development of non-specific complications is associated with the activation of the secondary bacterial flora (streptococcus, staphylococcus, enterococcus).
Complications of measles can occur in the form of:
keratitis (in severe cases, measles keratitis can lead to complete blindness);
pneumonia (the main cause of measles death among children under two years of age is the development of giant cell interstitial pneumonia);
An extremely rare complication of measles can be arthritis (most often, recorded in adults).
Symptoms of the development of measles encephalitis (in adults this complication is recorded much more often than in children) is the appearance of repeated fever, the progression of intoxication symptoms, the appearance of tremor of the extremities, convulsive syndrome, facial ammity, nystagmus, fainting, paralysis of the extremities, etc.
In patients with weak immunity, immunodeficiency conditions or concomitant severe somatic pathologies, the progression of encephalitis leads to death within six months after the onset of the disease.
For reference. Children who have had measles under the age of two years may develop subacute measles sclerosing panencephalitis. This complication refers to extremely rare and dangerous complications of measles.
Symptoms of the disease develop a few years after measles. Within a few months, dementia develops and death occurs.
Diagnosis of the disease is based on data on the epidemic situation (measles mainly proceeds in the form of outbreaks), an anamnesis of the disease (contact with a patient with measles) and clinical symptoms (conjunctivitis, catarrhal symptoms, stage-specific rashes, etc.).
Additionally, a general analysis of blood and urine, a passive hemagglutination reaction (RPHA), a complement fixation reaction (CSC) and an enzyme-linked immunosorbent assay (ELISA) are performed.
The most sensitive analysis is the determination of measles IgM by ELISA.
If suspected of developing measles encephalitis, spinal puncture is performed.
Also, according to indications, it is recommended that electrocardiography, chest x-ray, examination by an ENT doctor, etc.
For reference. Differential diagnosis of measles is performed with rubella, scarlet fever, chickenpox, acute respiratory viral infections and influenza (at the stage of catarrhal manifestations) and allergic reactions.
Measles - treatment
With a mild illness, patients can be treated at home. Mandatory hospitalization are subject to:
patients with immunodeficiencies and severe concomitant pathologies;
severe and moderate course of the disease;
women bearing a child;
kids up to two years old.
During the period of the fever, the patient is shown bed rest. Nutrition should be gentle and easily digestible, but at the same time enriched with vitamins.
Etiotropic (specific) treatment of measles has not been developed.
Patients are shown rinses of the oral cavity and throat with solutions of chamomile, oak bark, calamus, sage, calendula, nitrofural.
Attention. An important stage of treatment is the appointment of vitamin A. Retinol reduces the likelihood of complications, severe damage to the eyes and nervous system, and also reduces the risk of death.
For the teeatment of measles conjunctivitis, drops with sulfacetamide are indicated.
Additionally, antitussive drugs are prescribed (with an obsessive cough), NSAIDs (paracetamol, nimesulide, etc.), antihistamines (according to indications).
For reference. When bacterial complications are added, antibacterial agents are prescribed.
According to indications, physiotherapeutic treatment (massage, respiratory gymnastics, inhalation, etc.) can be additionally prescribed.
Measles - Prevention
Measles prevention are:
routine vaccination (measles is one of the controlled infections against which the vaccine has been developed);
limiting contact with the patient;
the introduction of specific immunoglobulins (after contact with the patient).
Measles - what vaccine is being performed
The measles vaccine is administered comprehensively as a part of CPC (measles, mumps, rubella).
The most commonly used Belgian vaccine is Priorix.
French Ruvax measles vaccine or Russian measles vaccine can also be used.
Measles vaccine - when done
For reference. Routine vaccination is indicated for children without measles. The vaccine is administered twice. The first vaccination of CPC is carried out at twelve months, the second at six years.
Before the vaccine is administered, the child should be examined by a pediatrician for any contraindications to vaccination (both temporary and absolute).