Measles - Causes, symptoms and treatment. MF.

Measles is an acute, highly contagious viral infection, occurring only in humans, transmitted by airborne droplets, causing generalized damage to the oral mucosa, oropharynx, respiratory tract and eyes and accompanied by a spotty-papular rash on the skin( exanthema) and mucous membranes( enanthema), with concomitant severe intoxication.

For more than 2 thousand years this disease has been terrorizing the inhabitants of our planet. For the first time measles was described by Arab physician Razes in the IX century, in the XVIII - it was allocated to an independent nosological form. In 1911, Anderson and Goldberger proved the infectious nature of measles, by infecting the monkey with nasopharyngeal secretions from the patient. In 1919, Degqvitz proposed seroprofilaktika measles by introducing human serum, resulting in a decrease in mortality from this disease, horrifying people around the world. In 1954, Enders and Peebles isolated the measles virus. In 1967 in Russia, under the guidance of Smorodintsev, live measles vaccine( HCV) was created, which is still used in the mandatory routine vaccination program. In 1969, a group of scientists proved the infectious measles nature with a severe progressive disease PSPE( subacute sclerosing panencephalitis).

Measles virus

Measles virus - RNA containing a virus, belongs to the family of paramyxoviruses and is completely typical for this family - large size and irregular spherical shape, but unlike other representatives( parainfluenza and parotitis) does not have neuronididase( N), presumably this makes it difficultpenetration through the mucous membranes. The measles virus has haemagglutinating and hemolyzing activity, ie it causes gluten and destruction of red blood cells, this causes pigmentation( discoloration) after rash. And the main distinguishing ability of the measles virus is a lifetime stay in the body, with the ability to cause a special form of the infectious process - a slow infection, namely, the PSE.

The virus is less stable in the environment: it is inactivated at 56 ° C for an hour, at 37 ° C - within 50 hours 50% of the virus population perishes. At subzero temperatures can persist for up to a year, at 12-5 ° C - persists for several days. At room temperature it is active for 5 hours. It is sensitive to disinfectants, ethers, UVI( including direct sunlight, daylight), drying, acidic environment.

Susceptibility to the virus is universal, outbreaks are recorded with a different shifting tendency( from winter, to spring-summer period).The high risk of morbidity is high among those who were not sick and were not vaccinated, the adult non-vaccinating contingent is especially dangerous( ungrafted older than 14), because they have the most severe disease and are fraught with a number of complications. When communicating with a patient, the risk of infection in an unimmunized contingent is 40% - when you are with him 24 hours, 60% - 48 hours, 80% - 72 hours.

After the transferred disease, life-long stable immunity is formed, but individual cases of reinfection are recorded. When vaccinated, followed by revaccination, immunity persists for 20 years.

Causes of infection with measles

The source is a sick person with typical and atypical forms of measles. It is dangerous for others from ≈7 days after contact, when the prodromal period begins, ie the first catarrhal manifestations. Ways of transmission of the virus - airborne( when sneezing, coughing, screaming, talking).Infection occurs much easier in organized groups of closed institutions( orphanages, gardens, etc.).

Symptoms of measles

The incubation period of is 9-17 days after symptoms of infection. After the infection has occurred by an aerogenic route, the virus is attached to the mucous membranes of the upper respiratory tract, or on the conjunctiva, if the saliva of the patient first got there. After, the virus penetrates into the submucosal layer and regional lymph nodes - in these places, the primary replication of the virus( ie, its reproduction) takes place. In this period there are no symptoms, but lymph nodes, often cervical, increase. By the end of this period, the virus becomes so much that it breaks into the blood and the next period appears.

The prodromal period of lasts 3-5 days and is characterized by viremia( circulation of the virus in the blood), with the localization of the virus in the upper respiratory tract and other organs:

• catarrh of the upper respiratory tract( nasal mucous membranes, rough / dry / obtrusive cough with hoarseness)
• conjunctivitis( edema and hyperemia of the eye mucosa, with serous discharge, injection of vessels of sclera, lacrimation and photophobia)
• fevert⁰ up to 38.5⁰С)
• intoxication( lethargy, irritability, decreased appetite, sleep disturbance)
• Enanthema = Belsky-Filatova-Koplik spots are spots in the form of semolina( small whitish, with red at the edges), located on the mucous membraneshineto near the molars, can also be on the mucous lips and gums. They appear 2-3 days before the appearance of rashes( or in other words 1-2 days after the onset of catarrhal manifestations) and, when rashes appear on the skin, these specks on the mucosa disappear.

Filmatov-koplik spots

• Small point reddish rashes on the tongue, soft and hard palate - they appear on day 2-3 of the disease and remain until the end of the rash.

The period of rashes of lasts 3 days, begins at the end of the prodromal period( 2-3 days after the appearance of the rash on the mucous membranes), ie against the background of bright symptoms, when the concentration of the virus in the blood is maximal and it reaches the internal organs: CNS, skin, lungs, intestines, tonsils, bone marrow, spleen, liver - in them there is a secondary multiplication of the virus followed by secondary viremia, and is accompanied by this allergic-immunological restructuring with the following symptoms:

• increased intoxication and fever
• amplified(possible development of bronchitis, with a change in the character of the cough - it becomes more humid, sputum is observed)
• Spotted-papular rash with the following stage:
On the 1st day of the rash, pale pink spots appear on the upper lateral areasneck, then behind the ears, then along the hair growth and on the cheeks, closer to the auricle and within 24 hours the neck, arms and upper chest are covered with a rash;while the rash gets papular.
By the 2nd day, the rash spreads to the back, abdomen, limbs.
On the 3rd day the rash appears on the feet, but begins to fade on the face, leaving temporary pigmentation after itself( due to the destroyed red blood cells in the skin thickness) with a slight flaking. At the same time, the edges of the merged rashes are not even, as "gnawed" or radiant.

Rash typical for measles

The measles virus after secondary viremia is localized in the epidermal cells of the skin, immunocompetent lymphocytes approach it - a conflict arises between them, which explains the appearance of rashes of a spotty-papular character( papules - vesicles formed as a result of inflammatory exudation, t.e effusion due to damage to the vessels in which permeability is violated).

Peeling is caused by inflammatory processes that lead to the destruction of epidermal cells( ie, disruption of communication between cells).The stronger the rash, the stronger the symptoms of intoxication.

Pigmentation period - lasts 1-1,5 weeks. At the site of the rash, spots of brown are found, the presence of peeling on the site of rashes. This period characterizes:

• temperature decrease and disappearance of intoxication
• disappearance of symptoms from the upper respiratory tract
• possible development of complications( because measles virus has a suppressive effect on T-lymphocytes acting as a line of defense, so the virus unchecked cellstarget organs to which it has an affinity)

Diagnosis of measles

1. Virological method - isolation of the pathogen from the curvature or nasopharynx 3 days before the onset of symptoms and on the 1st day of the rash.
2. Serological methods - aimed at detecting antibodies to the virus and its antigenic components.

• RTGA( hemagglutination inhibition) - first take blood in the catarrhal period or in the first 3 days after the onset of the rash, and re-take the blood after 14 days - the results are compared and look at the growth of the antibody titer.

• ELISA( enzyme immunoassay) - detection of specific immunoglobulins IgM( indicate acute measles) and G( indicate early disease and surviving immunity).

Do not rely solely on an objective evaluation and only make a diagnosis of the nature of catarrhal manifestations and rashes, because "measles mask" can be covered: rubella, chicken pox, pseudotuberculosis, CMVI( cytomegalovirus infection), enterovirus infection and others - similar diseases25. But the detection of the Belsky-Filatov-Koplik spots makes the diagnosis indisputable.

Treatment of measles

Specific treatment has not been developed, so it should be comprehensive, with an individual approach to the choice of the drug, taking into account the age and severity of the current process.

• Bed rest for 3 days after the temperature normalization

• Gentle vitaminized diet( with emphasis on vitamin A, but the vitamin should be dosed by the doctor, as it is easy to get an overdose of it and get non-infectious jaundice)

• Etiotropic treatment - the use of wide-spectrum antiviralpreparations( isoprinosine, arbidol);immunomodulators( interferon, viferon);immunostimulants( tsikloferon);In severe cases, immunoglobulins are administered intravenously( immunovinin, pentaglobin);

• Symptomatic treatment:
- with conjunctivitis( 0.25% levomycitin drops, 20% albicide)
- with catarrhal symptoms on the part of the respiratory tract( expectorants, mucolytics, anti-inflammatory aerosols)
- with fever( antipyretic, analgesics, NSAIDs - nonsteroidalanti-inflammatory)
- rinsing the mouth with chlorhexidine solution, rotocaine, infusion of chamomile.

Complications of measles

May occur as a result of attachment of secondary bacterial microflora and / or development of immunodifficiency due to the overwhelming effect of the virus on the immune system.
• On the part of the respiratory system or ENT organs: laryngitis with possible stenosis of the larynx, nasopharyngitis, tracheobronchitis, pneumonia, pleurisy, otitis, tonsillitis, sinusitis.
• Gastrointestinal tract: enterocolitis with bowel dysfunction
• CNS( the most dangerous, often deadly complications): encephalitis, meningoencephalitis, myelitis, SSPE.

Measles prophylaxis

Nonspecific and specific prophylaxis is used to reduce the incidence of measles. Nonspecific measures - isolation of patients from the onset of prodromal manifestations to 5 days after the onset of the rash, possibly up to 10 days in the presence of complications from the respiratory tract. Contact persons are isolated until 21 days. But people who have experienced measles or vaccinated quarantine in the past are not eligible and preventive measures among them do not apply.

Specific activities: active prophylaxis: vaccination of the SCF( vaccine "Ruvax" or MMR) at the age of 12 months, and then at 6 years. Or passive - the introduction of Y-globulin no later than 3-5 days from a possible contact and, at least 3 ml to prevent the disease.

Consultation of a doctor on measles:

Question: Is measles disease that occurs immediately after vaccination?
Answer: no, because grafting occurs attenuated( ie not dangerous) strains.

Question: Do I need to feed a child if he does not want to eat during illness?
Answer: if the child is breastfed, but already with the introduction of lures, then it is necessary to "rejuvenate" the diet, that is, remove the lures for a while( at least for the period of intoxication) and feed on demand. Almost the same applies to adults - to feed only at will and only light food, but at the same time give abundant drink for detoxification therapy. Food intake in addition to the will is fraught with the aggravation of intoxication, because against the background of the temperature there is an inactivation of enzymatic systems of the digestive tract and food will not be absorbed and will start to turn into toxic products.

Doctor therapist Shabanova IE