Mar 05, 2018
Characteristic symptoms of measles is fever, a typical rash on the skin and mucous membranes( exanthema and enanthema) and inflammatory phenomena from the mucous membranes of the respiratory tract and eyes. How to treat this disease with folk remedies. Etiology and epidemiology .The causative agent of measles belongs to the filtering viruses. Its epidemiological properties have been studied quite well. The source of infection in measles is only a sick person. Outside the body of the patient, the measles killer quickly dies. The possibility of transmission of measles through the healthy, who were in touch with the patients, and through things is practically not proven and probably does not exist. The measles virus is found in the patient's blood and in the mucous membranes of the oral cavity, nasopharynx, upper respiratory tract and conjunctiva of the eyes. The urine and feces of the patient are not contagious, as are the scales of the skin that peeled off during peeling. Thus, the transmission of the disease occurs directly from the patient to a healthy way of drip infection and contact. An infectious measles patient becomes in the prodromal period, 4 days before the onset of the rash, and remains dangerous for the surrounding 5 days for the rash, after which the convalescence loses its contagiousness. Infectivity of measles in the prodromal period, in which the disease often remains unrecognized, is very high. The patient continues to be on his feet, to communicate with others, he manages in most cases to infect all the children around him who were around him before the rash and the whole syndrome of the disease appeared.
The measles virus is extremely volatile. So, if the measles patient is in a separate room, but connected by a common corridor to other rooms, then the infection spreads easily throughout all these rooms. If a child who is in the ward of a hospital or in a dormitory in a children's institution becomes ill with measles, all children who live in the same room with a common corridor must be considered infected.
The second circumstance, which contributes to the rapid spread of measles, is the complete absence of natural immunity to it in individuals who have not previously had measles.
Most adults have an actively acquired immunity to measles. Immune to measles is also the majority of children under the age of 4 months due to passive immunity received from their mother. If the mother herself was not sick with measles and, therefore, does not have immunity to her, then her child can become ill with measles and in infancy.
The transferred measles leaves behind a persistent, lifelong immunity. Repeated diseases of measles are extremely rare.
In the Farrier Islands in 1846, out of 7,782 people had a measles incidence of 6,000. Only those old men who had been ill with it during the measles epidemic that had been on the islands in 1781 did not become ill. All other people who had contact with measles patients,without distinction of age, from small children to old people, measles became ill.
Pathogenesis and pathological anatomy. The entryway to the infection gateway for measles appears to be the upper respiratory tract.
The measles virus affects the most respiratory tract. From the side of the cardiovascular and central nervous system, measles are rarely observed acute toxic disorders, characteristic of the acute period of many infectious diseases, such as diphtheria, scarlet fever, typhus, influenza, etc. Hypertensive forms in measles are rare and almost never lead to death.
From the upper respiratory tract, there is catarrhal inflammation, and in more severe cases, inflammation with superficial necrosis of the mucosa. The consequence of this necrosis can be the formation of ulcers and the transition of the process to cartilage.
Inflammatory process already at the onset of the disease can pass to the bronchus and, bronchioles and lung tissue and often extends to the elastic-muscular wall and peribronchial tissue. This can lead, to the formation of peribronchitis, to bronchiectasis. The resulting bronchopneumonic foci easily undergo necrosis, which leads to the emergence of abscessed pneumonia and lung abscesses.
Severe lung injury and are the most common cause of measles death;they are observed in 70% of autopsies.
In addition to the respiratory tract, the mucosa of the large intestine( catarrhal colitis) is often affected by measles.
Measles lowers the resistance of the patient to pathogenic microorganisms( hypergia).It worsens the course of scarlet fever, diphtheria, dysentery and other acute infectious diseases and lowers the resistance to tuberculosis.
Clinic. The incubation period of measles lasts 8-12 days, and sometimes up to 21 days, stretching( in vaccinated according to Deqqvits) even up to 28 days. The disease begins gradually. After the incubation period begins prodromal period of measles: the child begins to sneeze, it has a coarse cough, runny nose, mucous or mucopurulent conjunctivitis, photophobia, hyperemia of the pharynx. Measles is not typical in this initial period;at this time it is easy to mix with the flu. The temperature in the prodromal period rises to 38-39 °.
Two days before the rash, and often within 4-5 days, there is a characteristic sign of measles - a symptom of Filatov-Koplik. This symptom was first described by the Russian scientist Filatov. It consists in the fact that on the mucous cheeks, against the molars, pink spots appear with a white dot in the center. The number of them increases, they are made larger, appear also on the mucosa of the upper and lower lips. Disappear these spots begin from the beginning of the rash. In the soft sky, the measles enanthema appears in the form of irregular bright spots, so that the pharynx appears "mottled" when viewed. On the 4th day of catarrhal phenomena, together with a high temperature, a significant deterioration in the general condition and increased conjunctivitis, runny nose and cough, there is a rash on the face, behind the ears;the next day the rash spreads to the trunk and upper limbs, and on the third day - to the lower extremities. The rash also gradually disappears: first on the face, then on the chest, and then on the limbs.
In the absence of complications, the temperature decreases simultaneously with paling rash, the general condition dramatically improves, the catarrhal phenomena decrease and disappear, the patient recovers.
The rash has the appearance of pink, slightly stained on the surface of the skin spots the size of lentils;in places it can be drained;-part of the skin between the elements of the rash have a normal color, which gives the skin of the measles patient a mottled appearance. The face is completely covered with a rash, than measles is significantly different from scarlet fever, in which there are free from the rash areas - nose and chin. The rash leaves a pigmentation after itself, and a week after the rash on the body appears a small otrebridnoe peeling;sometimes barely noticeable peeling occurs only on the trunk.
Skin lesions at the site of measles exanthema are expressed in inflammation and degeneration of the epidermis with cornification and scaly peeling of the epidermis. The duration of measles is of medium gravity 8-10 days.
From the side of white blood in the period of prodromal phenomena and rashes there is a leukopenia. When the process calms down, the blood comes to normal. If there is focal pneumonia and suppurative complications, neutrophilic leukocytosis is established.
Measles do not always flow typically, often it flows easily, in abortive form. The catarrh of the mucous with this form of measles is not pronounced, the rash and spots of Filatov-Koplik often appear simultaneously.
Abortive measles, which is usually observed in vaccinated children, occurs at a relatively low temperature, not exceeding 38 °.The disease stops in a few days. Complications with this form does not happen;sometimes measles, according to the description of Filatov, proceeds without rash.
Sometimes, mostly in the warm season, the measles epidemic is very easy. Occasionally there are toxic forms of measles with hemorrhages in the skin and mucous membranes, early collapse, meningeal phenomena.
Complications of .The most common complication of measles is pneumonia.
Measles groats. With a pronounced inflammation of the mucous membrane of the larynx and trachea in young children, stenosis can develop. Korevoi cereal appears in the prodromal period of measles or with a rash.
Symptoms of croup - barking cough, noisy and shortness of breath, zapping when inhaling pliable places of the chest;with increased stenosis - cyanosis, a serious condition.
A true diphtheria croup that can join measles usually appears in the pigmentation period and requires immediate serum treatment.
Mortality in measles usually depends on complications, mainly from pneumonia. Especially typical for measles is early pneumonia, which appears during the rash and is particularly difficult.
Complications of pneumonia can appear later - during blanching of the rash and pigmentation.
In pneumonia, it is often not possible to establish appropriate physical symptoms, although the essence of the complication is indicated by cyanosis, dyspnea, heart weakness. Sometimes pneumonia acquires a lingering course with a tendency to form abscessed pneumonia and bronchiectasises.
A common complication of measles is stomatitis. A severe form of stomatitis is noma - a gangrenous, deep ulcer on the inner surface of the cheek;fortunately, this complication is very rare. Very frequent and dangerous, especially for a small child, a complication is inflammation of the mucosa of the large intestine - colitis. The stool becomes liquid with an admixture of mucus, and sometimes blood, there are pains in the abdomen. Kolit can last very long and causes considerable exhaustion of the child. It should be remembered that diarrhea with an admixture of blood in measles can also be associated with dysentery.
A common complication of severe measles is otitis media( inflammation of the middle ear).
Coronitis otitis often has a catarrhal character and, in contrast to scarlet fever, rarely leads to mastoiditis( inflammation of the mastoid process).
Occasionally there are cases of congenital measles in a newborn, if the mother was ill with it immediately before childbirth.
There is a joint course of measles with other infectious diseases. Measles that have joined scarlet fever, diphtheria, dysentery and other acute infectious diseases, usually proceeds hard and worsen the course of the underlying disease.
Measles after measles should be carefully monitored.
Mortality in measles depends on age;at an older age it is 4-5%, rising to 30-40% in children under 2 years old.
Measles is an acute viral infection. The disease is a rash on the body of a child. Infection occurs by contact with a patient who secretes the virus when coughing, sneezing. The first manifestations of the disease begin on the 9th-10th day after infection.
If the fever lasts two days after the onset of the rash or returns, you should immediately call the doctor again or take the child to the hospital. Complications can be serious and, unlike the measles itself, can be treated with modern means.
Differential diagnosis. Measles are mixed with scarlet fever and rubella.
The rash of measles covers the entire face, with scarlet fever the nose and chin are not covered with a rash;with scarlet fever the rash is solid, small-spotted, with measles stains rise above the skin, which acquires a mottled appearance;with scarlet fever, the rash appears one day after the onset of the disease, with measles on the 3-4th day;when measles, starting with the prodromal period, strong mucous catarrh is observed, with scarlet fever - dry mucous;With measles, there are no acute toxic effects, like scarlet fever, rarely vomiting.
When rubella rash resembles measles, but paler;there is no strongly pronounced catarrh of mucous membranes. The rash with rubella covers the entire body for one day, with measles it spreads within 3 days. With rubella during the rash the child's condition is good, the temperature rises slightly. Especially characteristic of rubella is the increase in the cervical and occipital lymph glands. Rashes in the form of small red dots may appear on the mucous cheeks.
In case of serum sickness, a measles-like rash and mild catarrhal phenomena are possible from the mucous membranes of the upper respiratory tract. The diagnosis is made on the basis of anamnesis( the introduction of serum 1-2 weeks before the rash, the appearance of the rash at the beginning of the injection of serum) and the further picture of the disease.
Erythemas of various origins and septic rashes can cause diagnostic errors.
In all cases, suspected of measles, it is necessary to carry out preventive measles vaccinations for children who have come into contact with the ill with measles.
Sometimes, measles can be taken early in smallpox or typhus.
Treatment. Treatment of uncomplicated measles is reduced to preventive and hygienic measures. The patient should be placed in a bright, well ventilated room and every 2-3 days to make him a warm bath. It is necessary 2-3 times a day to wash eyes with 2% solution of boric acid, to rinse the older children with the mouth, and to the youngest children to douche it with the same solution. When pneumonia, mustard wraps, mustard plasters, are recommended for older children at the beginning of pneumonia. With the onset of decay of cardiac activity, cardiac outputs are shown: Sol. Coffeini natrio-benzoici 1-2% teaspoonful 4-5 times a day;01. Camphorae 1 cm3 under the skin.
For early pneumonia with severe toxic effects, it is recommended to pour intravenously 20-25 cm3 of 40% glucose solution daily for 4-6 days. With sluggish current pneumonia diathermy and other thermal procedures are used, as well as hemotherapy - intramuscular injection of 5-10 cm3 of the mother's blood several times every 2-3 days. The most effective treatment of measles pneumonia penicillin or sulphidine. The daily dose of sulphidine 0.1-0.2 per 1 kg of weight( the first 2 days of sulphidine is given every 4 hours, in the following days the daily dose is gradually reduced).Penicillin is administered intramuscularly every 3 hours for 25 000-50 000 units. In colitis, sulfamide preparations can also be used.
It is important to eat the baby properly. Older children are recommended to give light, but nutritious food: cereals, jelly, broth, yolks and curdled milk, white bread;younger - milk with broths, jelly, porridge;breastmilk - it is mandatory breast milk. In all cases, it is necessary to give vitamin C( in the form of berry juice or ascorbic acid daily 2-3 times 0.25) and vitamin B1( 2-3 times a day to 0.005).
The measles virus belongs to the genus Morbillivirus, the family Paaamyxoviridae. All known strains of measles are represented by one antigenic variant. RNA of the virus is surrounded by a lipoprotein coat with an M-protein, in which hemagglutinin and F protein are embedded. F-protein causes the cytopathic effect characteristic of paramyxoviruses - the fusion of virus-infected cells into giant multinucleated cells - the symplasts.
Measles is a highly contagious, global anthropo- nous infection. The mechanism of transmission of the pathogen is airborne. After the disease, lifelong immunity to measles occurs. With the introduction of mass vaccination of children, the incidence of measles among adolescents and young people has increased, since immunodeficiency immunity to measles is not stable and lasting for all people.
Measles infection is characterized by acute course, fever, general intoxication, upper respiratory tract mucosa and conjunctivitis, a kind of rash. It affects mainly children and most often it is easy. However, in the world of measles, about 1.5 million children die each year in developing countries because of severe complications due to malnutrition. The measles virus has cytotrophy to the epithelium of the upper respiratory tract, the endothelium of the skin vessels, the lymphocytes, to the nerve cells. The most dangerous complications of two types: superinfection and lesion of CNS cells.
Bacterial or viral-bacterial infections most often join measles in children of the first year, leaking in the form of otitis, pneumonia, enterocolitis, staphylo- and streptoderma. They are caused by the immunotropic nature of the measles pathogen and subsequent immunodeficiency.
Viral infection of the central nervous system is less common and manifests itself in the form of encephalomyelitis( usually after 8 years) or subacute sclerosing panencephalitis( PSP).
CAP is a slow measles infection, which usually develops during intrauterine infection from the mother in the early stages of fetal development. As a result, the primary lesion of CNS cells with the abortive cycle of reproduction in them of a defective virus occurs. The assembly of a full-fledged virion does not occur, since in brain cells there are no conditions for the synthesis of the M-protein shell. Cells are gradually destroyed due to the accumulation in them of a huge number of viral ribonucleoproteins.
If a mother becomes infected at the end of pregnancy, the child is usually either born with clinical signs of measles, or they manifest later. Congenital measles proceeds, as a rule, in severe form.
Clinical diagnosis of measles usually does not cause significant difficulties, since the characteristic symptoms of the disease - measles rash, Filatov-Koplik patches and other signs appear already in the early stages of the disease.
Laboratory confirmation of measles infection is relevant in the following cases:
- atypical or complicated course of measles;
- group outbreak in organized collectives of adolescents( Cadet, Suvorov schools and other similar educational institutions), among servicemen;
- investigation of the cause of death of the fetus, newborn, adult.
Laboratory methods are also used to study collective post-vaccination immunity or in assessing the epidemiological effectiveness of new vaccines. Immunological monitoring methods based on the detection of different classes of antibodies to measles virus are used.
All laboratory methods for measles diagnosis can be divided into 4 groups.
Express methods of antigen detection in cells( early diagnosis) or antibodies in the blood( from the 2nd week of the disease).The antigen is detected by immunofluorescence microscopy of the cells of the nasopharyngeal discharge or skin cells taken by scraping the elements of the rash. In this case, fluorochrome-labeled measles IgG is used. An additional confirmation of the infection can be the detection of multinucleated cells in the nasopharyngeal discharge or smears-prints after stained by Romanovsky-Giemsa or Pavlovsky. Antibodies are determined in ELISA using appropriate test systems.
Virological method has the goal of isolating and identifying the measles virus. The material for the study is nasopharyngeal flushing and blood in the prodromal period or not later than the first day after the appearance of the rash. Clinical samples are examined immediately or stored in a frozen state at -70 ° C.Infected with the measles virus-sensitive cells of the human embryonic kidney, L-41, Vero, human amnion( FL cells).After 3-4 days in the cell culture, giant multinucleate cells and syncytia with virus inclusions in the cytoplasm are found. The identification of the virus is usually carried out with the help of IF, RTGA and PH in tissue culture. With IF, smears are treated with measles gamma globulin, labeled fluorochrome.
Serological method for detecting antibodies to the measles pathogen. At present, the most widely used test is ELISA and even more simple RNGA.For the formulation of RNGA, a lyophilized diagnosticogicum is used on the basis of lamb erythrocytes, antigen-sensitized measles virus. At the same time, classical methods of PH, RSK, and RTGA have not lost their significance. To establish the neutralization reaction of the virus, the patient's blood serum antibodies use cell cultures of Hep-1, Hep-2, KV and the measles virus strain adapted to these cultures. When staging the RTGA, the most reliable results are obtained by the use of monkey erythrocytes( 0.5% suspension).Specific IgM antibodies appear in 95% of patients one week after the rash and persist up to 2 months. The increase in the antibody titer in paired sera 4 and more times is a clear diagnostic criterion. For more distant retrospective measles serodiagnosis, as well as for evaluating the immunoepidemiological effectiveness of vaccination, specific IgG antibodies to the measles virus that appear later but which persist for a long time( years) are determined.
Molecular assays of detect RNA virus or specific RNA fragments in clinical samples. A method of molecular hybridization( MMG) or polymerase chain reaction( PCR) with specific primers is used. It is advisable to use them when other tests proved to be ineffective, for example, when examining a sectional material in which the virus could not be detected due to improper storage( without deep freezing).
Of all the methods listed above, in practical diagnostic laboratories, serodiagnostic methods( ELISA, RNGA), and, more rarely, express methods for detection of viral antigens in clinical samples( IF) are usually used. The remaining methods are available only to specialized laboratories in which there are expensive cell cultures, monkey erythrocytes, primers for PCR, necessary reagents, equipment and trained personnel.
For mass planned specific prevention of children, starting at the age of 12 months, trivaccine containing living vaccine strains of measles, mumps and rubella viruses is used. In Russia it is allowed to use the vaccine M-M-R, null,( morbilli-mumps-rubella), in which the strain of measles virus Endersy Edmonston was used. Domestic live measles vaccine on the basis of strain L-6 was created in the 1960s under the guidance of Academician AA Smorodintsev by the NIIEM them. L. Pasteur in Leningrad. It has been applied since 1963. Children born from "seronegative" mothers are recommended to be vaccinated earlier - from 8 months.
For emergency prevention of measles in the outbreaks of epidemic outbreaks, parenteral administration of donor measles gamma globulin is used.
During a period of illness associated with fever, the child almost completely loses his appetite. Usually he only drinks, and he needs to give a drink more often. The mouth should be gently cleared three times a day. It used to be that you need to keep the baby in the dark to protect your eyes. But now it is known that the eyes are not in danger. If the light causes inconvenience to the child, you can darken the room. It should be warm, so that the child does not freeze. Two days after the recession, the child's temperature is usually released from the bed. It can be released into the street and allowed to play with other children one week after the onset of the rash, if the cough and other symptoms have completely disappeared.
Prevention. Moments burdening the course of measles are poor hygienic conditions and a predisposition to respiratory disease. The task is to prevent measles at an early age and in the room of a sick child in good hygienic conditions.
You should not allow a person with a cold or sore throat to go to a child who has a measles, that the bacteria of these diseases cause complications. Usually measles are ill only once.
Uncomplicated measles proceeds favorably and at home. It is not recommended to place measles patients, especially small children, in general hospital wards because of the possibility of complications from the respiratory tract and the introduction of another infection in close contact of sick children. If in the ward of measles patients one or more of them develop pneumonia, then all other children in this ward are at risk of the same complication. It is necessary to isolate a measles patient either in an individual box or in a small ward for 2-3 beds, and patients with uncomplicated measles should not be placed with patients with pulmonary complications. Patients with measles are hospitalized only from closed children's institutions or in the presence of severe complications requiring hospital treatment, or in poor hygienic home conditions( dampness, smoke, the presence of coughing patients in the room, etc.).In all other cases, measles patients are left at home, and they follow the rules of individual care( separate dishes, toys, etc.) and measures to prevent contact with children who are not ill with measles within 5 days from the moment of rash and from 10 days if the patient has pneumonia. Disinfect the room and the things of the measles patient is not necessary;enough routine cleaning and ventilation of the premises. A current disinfection of phlegm, nasopharyngeal mucus is necessary. Children who did not have measles, but who had contact with measles patients, are not admitted to kindergarten and kindergartens for 28 days, counting from the day of separation from the sick. In the case of adult schoolchildren, as well as young children, who have already contracted measles, quarantine is not applied.
Measles disease can prevent or weaken the disease code if injecting gamma globulin in time. It is good to take measures against measles between the ages of three and four, because during this period the complications are most common and serious. Tired or sick older children are also injected with gamma globulin. Contact your doctor immediately to discuss the question of injection while it may still work. The protective effect of gamma globulin persists for several weeks. There is no need to prevent measles in a healthy older child in other cases, because it is likely to become infected at other times, but sometimes it is helpful to ease the course of the disease with gamma globulin.
Measles are diagnosed on the basis of bright typical clinical manifestations and serological studies.
Treatment of patients, as a rule, is carried out in a hospital. The only exception is the mild form of measles. It is prescribed bed rest, vitaminized diet, plentiful drink. The toilet of the eyes and oral cavity is carried out with special disinfectants. From medicamentous means are shown expectorant and antipyretic drugs, in case of complications, antibiotics.
Prognosis with appropriate treatment is normal.
Prophylaxis is the routine vaccination. Also, the detection of foci of infections and contact.
Measles causative agent( morbilla) - is classified as a class of RNA viruses. Children of preschool age are more likely to get measles. However, those who are not infected with measles remain highly susceptible to it throughout their lives and can get sick at any age. For the express diagnosis of measles use the detection of Ar in the cells of the nasopharyngeal or skin( from the elements of the rash) by the method of immunofluorescence microscopy( the reaction is used with fluorochrome-labeled measles IgG).An additional confirmation of the infection can be the detection of multinucleated cells in the nasopharyngeal discharge or smears-prints after stained by Romanovsky-Giemsa or Pavlovsky. Detection of AT to the measles pathogen is carried out in the inhibition of hemagglutination inhibition( RTGA), RSK, RPGA and ELISA.