Measles: symptoms and treatment in children

Despite massive vaccination, measles continues to lead among the causes of death of children on the globe. It is a kind of "children's plague", affecting mainly children of preschool age.

Measles is an acute viral disease that is caused by the RNA virus of the family of paramyxoviruses, the genus of morbilliviruses. Absolutely unstable in the external environment, it is sensitive enough to the influence of ultraviolet rays and usual disinfectants. A feature of measles is a high contagiosity, which is almost 100%. This suggests that if a child does not have measles and is not vaccinated, the risk of getting sick is 100%, especially considering one more feature of the virus: in order to get infected, 10 meters is enough.

The child is infected with measles from the patient, which is the most contagious in the catarrhal period (3 to 5 days before the onset of the rash) and up to 4 days of rashes. If the patient has complications (pneumonia, meningitis), then he presents infectious danger to 10 days. The disease spreads by airborne droplets. Infants up to 6 months of immunity from the mother, provided breastfeeding.

Classification of measles

The following forms of measles are distinguished:

• typical;
• atypical (asymptomatic);
• mitigated (weakened).

With the flow:

• smooth;
• with specific complications (encephalitis, laryngotracheitis, pneumonia);
• nonspecific complications (secondary bacterial infection).

Clinical manifestations of measles

The following stages of the disease pass through measles:

• incubation period, which can be from 8 to 17 days;
• prodromal period, which lasts for 3-5 days;
• period of rashes, which lasts for 3-4 days;
• period of pigmentation - 10 days;
• the period of convalescence - can last up to two months.

Prodromal period.For this period is characterized by the presence of catarrhal syndrome - the virus penetrates the patient through the conjunctiva of the eyelids and the upper respiratory tract. The child complains of photophobia, eyelids are swollen, hyperemic, sclera injected. Increases intoxication, body temperature rises to febrile digits, there is hoarseness of voice and an obsessive cough, all over the mucous membrane of the oral The cavities identify specific spots of the Belsky-Filatova-Koplik (a papule of a grayish-white color the size of a poppy seed, surrounded by a corona of hyperemia). The child is troubled by a runny nose, cough, face swollen and puffy.

The period of rashes.In this period, a rash, papular with a diameter of a couple of millimeters, appears, which can erupt. The rash appears first behind the ears, on the nose, during the first day it covers the face, neck and upper body. On the second day it spreads on the entire body, and on the third day - on the hands and feet. The period of rashes is combined with febrile temperature.

The measles virus multiplies not only in the cells of the epithelium, but also in immune cells, which leads to a pronounced decrease in immunity, allergy and a disruption in the metabolism of vitamins. The consequence of these processes is a large number of complications and attachment of secondary bacterial flora.

Pigmentation period.In the period of pigmentation, the temperature normalizes, cough regresses and appetite appears. The rash is replaced by pigmentation and peeling, which disappear in the same order as the rash appeared. The patient's condition improves significantly. From the fifth day of the rash the patient does not present an infectious danger. Completely the skin will be cleared in two weeks, and clinical recovery in the absence of complications comes on the 10th day.

Period of convalescence.This is the longest period, since measles are not so terrible in itself, as are its complications. The measles virus leads to immunodeficiency, which requires several months to recover. In connection with this, the medical officer from vaccinations is valid for one month.

Complications of measles in children

Complications of measles can be either primary, associated directly with the virus itself and its effect on the epithelium and the immune system, and secondary - when the bacterial flora joins.

Primary complications include laryngitis, tracheitis, bronchitis, pneumonia, enterocolitis that occur at the peak of the disease. But meningoencephalitis and encephalitis occur 5 days after the onset of the rash. They are characterized by a very severe course and a large number of deaths.

Secondary bacterial complications can be either early or late. They can manifest in the form of laryngitis, bronchitis, pneumonia, otitis, angina. Pneumonia is very often severe with abscess, it is possible to form pneumothorax. Purulent meningitis always signals the generalization of the infection and occurs against the background of unsanitary otitis and sinusitis.

Mitigated measles is more common in newborns and infants. The clinical course of it is erased, the periods of the disease are shorter and not so pronounced. Body temperature can be subfebrile, the catarrhal syndrome is not pronounced sharply, the rash is shallow and there is no tendency to merge, the period of pigmentation is short. Despite the lighter course, the disease is severe, as complications occur very early.

In addition to the aforementioned complications, the medicine describes the development of subacute sclerosing panencephalitis, which develops through 4-8 years after the transmitted measles in children with immunodeficiency, who were infected with the virus in utero or at the age of 2 years. This terrible complication always ends in a fatal outcome, and the duration of the disease itself does not exceed 3 years.

Laboratory diagnostics

Confirm the diagnosis of measles by examining the patient's blood.

In the clinical analysis of blood, there will be leukopenia, lymphocytosis. Evidence of the attachment of the secondary bacterial flora will be the appearance of leukocytosis with a shift of the leukocyte formula to the left.

In typical cases, the diagnosis of measles is determined on the basis of symptoms. In controversial cases, it is possible to conduct serological methods of investigation - RSK, RTGA, RIF. In favor of a positive diagnosis is the increase in antibody titer 4 and more times in paired sera.

In the presence of pneumonia, radiography of chest organs and sputum culture on the flora and sensitivity to antibiotics are performed. With the development of meningoencephalitis, a lumbar puncture is performed.

Measles can be masked for other diseases, so it must be differentiated with the following nosologies:

• hives;
• rubella;
• meningococcal infection;
• enterovirus infection;
• ARVI;
• Stevens-Johnson syndrome.

Therapeutic tactics

If measles proceeds without complications, then the treatment is carried out at home. Recommended bed rest for 10 days, darkened room. Gentle diet for appetite, plentiful warm drink. It is necessary to carry out frequent washing of the mouth, nose, eyes with warm boiled water, as well as frequent airing and wet cleaning of the room where the patient is.

It is necessary to prescribe vitamins A and C, antibiotics only in the presence of bacterial infection and in infants.

Children under the age of 2 must be hospitalized, as well as with complications and concomitant diseases.

As already mentioned above, this "childhood infection" is not so terrible in itself, as its grave consequences. In connection with this health, a routine vaccination against measles, which is carried out at the age of the year, and a booster at 6 years of age have been developed. WHO planned to "defeat" measles by 2012, but due to anti-vaccination propaganda and population migration, outbreaks of this infection are periodically noted. In Russia, the measles incidence is relatively low, as vaccination is controlled at the state level, which can not be said about developing countries.

School of Dr. Komarovsky on the topic "Measles":