Measles

Measles is an acute infectious disease characterized by inflammation of the mucous membranes of the respiratory tract, eyes, maculopapular rash, General intoxication.
Etiology. The causative agent of measles - virus that develops inside living cells. Outside of the body loses pathogenic properties and dies. Sensitive to drying and the action of sunlight.
Epidemiology. Measles hurts only the person who is the only source of infection. Patient measles contagious from the first day of illness (and possibly the last day incubation period) to 5-th day (inclusive) from the date of rash. In the presence of pneumonia gain popularity patient is extended for another 5 days. The patient is most contagious in the catarrhal period. The infection is transmitted by airborne droplets. Through a third party, food products, objects of measles is not transmitted. Due to the rapid destruction of the virus outside the body disinfection is not required. Enough after isolation of the patient is well ventilate the room.
Especially hard measles occurs in children of early age with poor physical developmentsuffering from anemia, rickets, exudative diathesis and other diseases.
Measles not hurt the children of the first three months of life. However newborn can get measles, if the mother measles was not sick. In the case of measles mother a few days before birth the child can be born measles or get sick of it in the first days after birth. Susceptibility to measles in children of 3-6 months. small. With a nine-month age susceptibility to measles increases. The highest morbidity among children under 5 years. After measles remains a life-long immunity (immunity).
Pathogenesis and pathological anatomy. Gateway infections are upper respiratory tract, where the virus enters the blood, where can be found already in the incubation period. When ingested, the virus causes catarrhal inflammation of respiratory organs, digestive tract, skin, affects the Central nervous system. When measles observed deep functional disorders in the body of the patient, provoking the hidden disease that severely limit resistance to secondary infections and contributing heavy coexistent diseases. Specific morphological changes caused by the measles virus, are giant cell transformation mesenchymal cells and epithelial cells, the development of early hematogenic interstitial pneumonia. When complication of inflammatory process can move on to the wall of the trachea, bronchi, peribronchial and lung tissue.
The clinical picture. In the clinical course of measles distinguish four periods: the incubation, catarrhal (prodrome), the period rash, period fading rash.
The incubation period for measles - up to 21 days, more often 9-11 days. In this period the disease does not occur.
Catarrhal period lasts 3-4 days. The temperature rises up to 38-40 degrees. Appear runny nose, dry cough, conjunctivitis, photophobia, tearing, symptom Velsky - Filatova - kaplica (Fig. 6). This symptom is expressed in the emergence on the lining of the cheeks against indigenous teeth, sometimes throughout the mucous membrane of the mouth of small white spots, like semolina (partial necrosis of the cells of the mucous membrane of the oral cavity). On soft and partly solid sky , there are small red spots (anathema; Fig. 7)that in 1-2 days merged with the General redness of the throat. There are sometimes vomiting and abdominal pain, simulating appendicitis.

measles
Fig. 1 and 4. Measles rash. Fig. 2. Symptom Bielsko - Filatova - kaplica with measles. Fig. 3. Enanthema in the prodromal period of measles.


The period rash begins at the end of 4 days from the appearance of maculopapular rash (Fig. 1 and 4) beginning on the forehead, ears, nose, cheeks, lips, and chin. On day 2, the rash spreads to the trunk, on the 3rd day on a limb. The rash can be a drain, large, irregular shapes, from pink to purple color. Symptom Bielsko - Filatova - kaplica disappears to the 2-th day of rash.
During the first two days of rash condition of the patient is severe: high temperature, and face pitch in, runny nose, cough, and sometimes purulent discharge from the eyes, the babies noted liquid stool. After 4 days, the rash fades in the same sequence in which they started rash - from top to bottom (the period of fading rash). On a rash remain dark spots that are kept about one week, and the physically impaired children up to 3 weeks.
The skin can be pityriasis peeling. At the end of the period rash temperature drops to normal, the child's condition improves.
Metilirovaniya (simplified) measles develops when administered to a child in the incubation period of gamma globulin. When motivirovannoe measles incubation period is extended to 21 days. There is a small temperature rise or she remains normal. Intoxication as a rule, does not happen.
Prodromal period is short. Catarrhal phenomena are poorly expressed, which leads to lower it gain popularity. Spot Velsky - Filatova - kaplica often absent. Rash in the form of rare scattered delicate pink papules. Pigmentation lasts no more than 2 days. After motivirovannoe measles remains a lifelong immunity. However, in infants undergoing motivirovannoe measles immunity is not enough racks.
Complications when measles is the leading cause of death. From uncomplicated measles patients do not die. Pneumoniacaused by the measles virus and layering of bacterial flora,is the most frequent and hard place complication in infants. Appears during the rash, and the physically impaired children can be found in the catarrhal period. Laryngitis may occur in the catarrhal period. Is manifested hoarseness, rough "barking" cough. End to the period of the rash. Laryngitis arising during rash, is difficult, long, wavy course, especially in infants. Sometimes laryngitis may cause obstruction of the passage of air through the larynx, requiring surgery.
Encephalitis occurs rarely differs severe, persistent lesions of the Central nervous system, often poor prognosis. Occurs more often in older children.
The diagnosis in a typical course is no problem. Should be distinguished spots Velsky - Filatova - kaplica from small the aft and elements of thrush. Measles should be differentiated from adenovirus and enteroviruses. When adenovirus infection is not observed symptom Velsky - Filatova - kaplica and landmark rash rash. Unlike measles, enteroviral infection (with crepadona rash) affects children of all ages, including the first three months of life, rash appears when the temperature drops, held 1-1,5 days, leaves no pigmentation. When the enterovirus infection no catarrhal phenomena, spots Velsky - Filatova - kaplica and phasing of rash rash. Measles with skarlatinopodobnym rash in the catarrhal period must be differentiated from scarlet fever.
Treatment. Of particular importance care and good hygienic conditions (light, clean, aired premise, fresh air). Care of mucous membranes of the mouth, eyes, hygienic bath.
Infants give breast milk, sour milk - yogurt, acidophilus. Children of older age, it is recommended semi-liquid food, drink plenty of water (tea, 5% glucose, fruit juices), and also vitamins a, C and groups Century With the development of complications shown intramuscularly antibiotics (penicillin, streptomycin, monomitsin) in the conventional age dosages.
Prevention. The isolation of patients is mandatory. Contact intramuscularly gamma globulin the rate of 0.2 ml per 1 kg of body weight. Gamma globulin is particularly effective in the first 5-6 days of the incubation period.
Children who recover from measles, and came into contact with patients, may be admitted to children's institutions in 17 days (unvaccinated), and during the passive immunization gamma-globulin - 21 days.