Measles

Measles is an acute viral disease with an airborne transmission mechanism characterized by fever, inoxication, catarrh of the respiratory tract and maculopapular rash.

Etiology, pathogenesis. The causative agent from the family of paramyxoviruses is rapidly inactivated in the external environment. At the end of the incubation and up to the 3rd day of the rash period, the virus is contained in the blood (viremia). There is a systemic lesion of lymphoid tissue and reticuloendothelial system with the formation of giant multinuclear structures. The virus affects the mucous membranes of the respiratory tract and causes nested perivascular inflammation of the upper layers of the skin, which is manifested by a rash. The role of allergic mechanisms is proved. The possibility of persistence of measles virus in the body after the transmitted measles with the development of subacute sclerosing panencephalitis, which has a progressive course and ends with death, has been established.

Symptoms, course. The incubation period is 9-10 days, sometimes it is extended to 17 days. The catarrhal (initial) period is characterized by an increase in body temperature, general intoxication, pronounced catarrh of the upper respiratory tract (runny nose, cough). The pathognomonic symptom arising 1-2 days before the rash is Belsky-Filatov-Koplik spots: small whitish papules appear on the mucous membrane of cheeks, rarely lips and gums, not merging with each other. This symptom lasts 2-3 days. On the 3-5th day of the disease, with a new fever, there is a rash, the rash starts, which lasts 3 days and is characterized by a gradual: first the rash is found on the face, neck, upper chest, then on the trunk and on the third day Extremities. Elements of the rash are maculopapules that merge with each other and, after extinction, leave spotted pigmentation and small pancreatic peeling. During the rash, catarrhal symptoms and intoxication symptoms increase; In the blood there is leukopenia with relative neutrophilia and eosinophilia.

Duration of the disease is 7-9 days. In the period of convalescence, asthenia and a decrease in the body's resistance to various pathogenic agents are noted. Measles proceeds in mild, moderate and severe forms. In persons receiving seroprofilaktu, mitigirovanaya (weakened) measles is observed, characterized by the rudimentary nature of all symptoms. Among complications, laryngitis is most common, which can be accompanied by stenosis of the larynx - early croup associated with the action of measles virus, and late croup with a more severe and prolonged course; Pneumonia, associated, like late cereals, with secondary bacterial infection and especially frequent in young children; Stomatitis, otitis, bleafaritis, keratitis. Very rare and dangerous complication is measles encephalitis, meningoencephalitis.

In typical cases, the diagnosis can be established already in the catarrhal period. Serologic examination (RTGA) helps to accurately identify. Differentiate follows from ARI, rubella, allergic and medicinal eruptions.

Treatment. Specific therapies have not been developed. The basis of treatment - bed rest, hygienic maintenance of the patient, symptomatic means. With complications of bacterial nature - antibiotics. Treatment of pneumonia, croup, encephalitis is carried out according to general rules. Hospitalization of patients is carried out on clinical (severe forms, complications) and epidemiological indications.

Forecast. The deaths of measles are very rare and are observed mainly in measles encephalitis.

Prevention. Active immunization of all children from 15-18 months. A live attuned L-16 vaccine is used. Vaccination is carried out once by subcutaneous injection of 0.5 ml diluted vaccine. When contacting a measles patient with non-primate children under 3 years of age (as well as weakened children without age restrictions) 3 ml of immunoglobulin are administered for the prevention. The patient is isolated from the measles no less than up to the 5th day after the rash. Children. Who were in contact with the patient and who had not previously been actively immunized, are to be disconnected from the 8th to the 17th day, and passively immunized - until the 21st day from the date of the alleged infection. Disinfection is not carried out.