Measles in adults: symptoms and treatment

Measles belongs to highly contagious (infectious) infectious diseases of viral etiology. Preschool children are most vulnerable to it. Therefore, measles are considered a group of so-called childhood infections. But it can be diagnosed and in an adult person, if he did not get sick in childhood. And this is associated with a high risk of a serious and complicated course of the disease.

Do adults often get measles: the urgency of the problem

Before the introduction of mass vaccine prophylaxis in the second half of the XIX century, measles belonged to highly infectious and at the same time dangerous infections. More than 90% of people transferred it to childhood. At the same time, the disease was characterized mainly by a moderate and severe course, and mortality sometimes reached 40%. The defeat of the adult population was atypical, this was noted mainly when introducing the pathogen into previously isolated population groups.

Introduction of mass immunization of children of the first years of life in the middle of the XX century led to a marked decrease in the incidence and mortality from measles. And in some countries, new cases have completely ceased to be diagnosed. According to medical statistics, in recent years on the territory of the Russian Federation, mainly sporadic small epidemic outbreaks of measles have been recorded.

At the same time, such vaccination of preschool children contributed to the fact that in the structure of the incidence of measles now 40-55% falls on adults. Some of them were not vaccinated in childhood, others have insufficient post-vaccination immunity. In 2014, there was an increase in the incidence of measles in the Russian Federation, then this indicator declined significantly. And in 2016, there were 0.12 cases per 10, 00 population, 42.7% of them being adults.

Etiology and pathogenesis

Measles is a disease of a viral nature, which affects mostly preschool children. In some cases, it develops in adults.

Measles is an anthroponic infection and is caused by RNA-containing Morbillivirus, which belongs to the family of paramyxoviruses. The causative agent is unstable in the environment, dying at room temperature after a few hours. It spreads from the sick person by airborne droplets, it can be transported over considerable distances through the air.

The most important moments of pathogenesis of measles include:

• The measles virus tropen to the cells of the respiratory, digestive and immune systems, with the first subclinical signs their lesions can be detected during an on-site examination during the incubation period.
• The entrance gate for the virus is the mucous membrane of the nasal cavity, mouth, laryngopharynx, and sometimes - conjunctiva. After a while at the site of the pathogen the epithelium is necrotized, which is clinically characterized by the appearance of pathognomonic spots for the disease.
• After overcoming the epithelial barrier, the pathogen first penetrates into the macrophage, lymphoid and reticular cells located near it. This provokes the growing hyperplasia of lymphomacrofagal elements with the formation of multiple infiltrates with the capture of submucosal and even underlying layers. Therefore, the first symptoms of measles appear before the rash and are caused by damage to the upper parts of the respiratory system, conjunctiva, pharynx.
• The reaction of the immune system in a person infected with measles is excessive, hyperergic. Viral antibodies provoke the development of allergic-like changes. And this is the cause of the development of infectious nest dermatitis with a characteristic measles rash. Sensitization also contributes to the aggravation of inflammation in the bronchopulmonary apparatus and the digestive tract, up to the formation of small necrotic foci.
• The measles virus can provoke general immunosuppression. This is often due to the weighting of the condition of the patient, because an inadequate immune response with a high probability of contributing to the attachment of secondary infectious complications.

All these features of pathogenesis cause a measurable clinical picture.

Features and stages of measles

Cory is characterized by the gradual occurrence of symptoms. And unlike many other infections, the first clinical signs of the disease can be detected already during the incubation period. As the "new" pathogenetic links "include" the change in symptoms, the risk of complications increases.

The main stages of the disease include:

1. The incubation period lasts from the moment of infection until the appearance of clearly outlined clinical symptoms. For measles, its duration is on average 1.5 weeks. Perhaps an elongation of up to 17 days, and in humans after an emergency specific prevention (introduction of measles immunoglobulin) - up to 3 weeks. During this period, the first symptoms appear, but most of them are not accompanied by obvious discomfort and are local in nature.
2. Prodromal period, or stage of catarrhal manifestations. Its duration is usually not more than 4 days. Signs of intoxication and inflammation of the tissues of the upper respiratory tract and conjunctiva are combined with the appearance of typical Belsky-Filatov-Koplik spots on the oral mucosa / oropharynx.
3. The period of rashes (exanthema) in combination with severe intoxication and a second wave of hyperthermia. The rash is infectious-allergic in nature and lasts for an average of 4 days.
4. Pigmentation period. Such resolution of rashes is typical of measles. Hyperpigmentation lasts for several weeks and then gradually disappears.

In adults, measles have the same pattern of unfolding symptoms. But their severity is usually much greater, and the likelihood of complications is higher. The incubation period in adults is short, the signs of intoxication are acute and bright. The rash is abundant, draining, with concomitant expressed lymphadenitis, the spots of the Belsky-Filatova-Koplik are multiple and do not pass for a long time. But catarrhal phenomena in uncomplicated course of the disease may be mild.

Features of measles rash

Rash is the most characteristic sign of measles, and it is her appearance that allows you to correctly establish a diagnosis. After all, the symptoms of the incubation and prodromal periods are nonspecific and are associated with intoxication and infectious-inflammatory response of tissues at the site of the virus. And the typical spots of the Belsky-Filatov-Koplik on the mucous membrane of the cheeks often remain without due attention.

The features of measles rash include:

• The rash is patchy-papular and does not lead to a disruption of the integrity of the epidermis. It has a fairly uniform bright pink or rich red color. Sometimes, with severe measles, there are also individual petechial rashes and even intradermal hemorrhages with a diameter exceeding 3 mm.
• Nodular elements of the rash have a size of about 2 mm and are located on the background of unchanged skin.
• With abundant rash, there is a tendency to merge some of its elements, while the skin looks swollen.
• The first elements of the rash initially appear in the behind-eye area and on the face. In the subsequent there is a fairly rapid spread of it from top to bottom, with damage to the entire surface of the body.

Korevye rashes are kept for an average of 4 days, after which their fading begins. Elements pale, in their place appears neobylnoe peeling and hyperpigmentation.

Possible complications

Measles can cause neuritis of the auditory nerve, which is manifested by hearing disorders.

Adults tend to have a complicated course of measles, which can manifest already at the catarrhal stage. This is what constitutes the main danger in infecting people of adulthood.

Possible complications of measles include:

• The defeat of ENT organs with the development of sinusitis, otitis media, tonsillitis, laryngitis. The addition of a secondary bacterial infection causes a severe course and a purulent-necrotic nature of the inflammation.
• Tracheobronchitis.
• Korevoi meningoencephalitis with severe cerebral disorders, focal neurological symptoms, violations of higher cortical functions.
• Neuritis of the auditory and optic nerves.
• Viral-bacterial conjunctivitis.
• The defeat of the heart and parenchymal organs with the development of hepatitis, glomerulonephritis, myocarditis.
• Enterocolitis.

Accession of complications is the main reason for hospitalizations of adults with measles. In some cases, their long-term consequences are unrecoverable and lead to persistent disability.

Principles of treatment

Etiotropic treatment (aimed at targeted destruction of the pathogen) with measles is not. Therefore, the intended therapy is symptomatic or intended to eliminate the development of complications.

Treatment of measles in adults may include the use of drugs from different groups:

• Antipyretics. The non-steroidal anti-inflammatory drugs used also somewhat reduce the severity of inflammatory reactions and intoxication. But they can not prevent the development of complications or shorten the duration of the disease.
• Antiviral drugs. There is currently no specialized anti-measurable drug, antiviral drugs means are designed to somehow contain the speed of replication and the assembly of virus particles.
• Localized vasculature. Allow to facilitate nasal breathing, promote improvement of sanation of paranasal sinuses and auditory tubes.
• Antihistamines for some relief of itching with rashes and a reduction in discomfort during catarrhal phenomena.
• Local remedies with anti-inflammatory and nonspecific antimicrobial action to improve the condition of the mucous membrane of the oropharynx.
• Means for washing and sanitizing the eyes with conjunctivitis.

Antibacterial agents for measles are shown only when a secondary bacterial infection is attached to the development of complications. According to the doctor's decision, local and systemic drugs can be used. In the lesion of tracheobronchial tree and lungs, additionally, muculitis and expectorants are usually prescribed. In general, the treatment of measles complications is carried out according to the treatment regimens of the corresponding diseases.

Measles does not belong to dangerous infections. But the development of this disease in adults requires special attention and often leads to hospitalization, which is explained by the rather high probability of developing severe and not always reversible complications.

A health-saving channel, a specialist speaks of measles in adults: