MEASLES

Measles - an acute infectious disease of viral etiology with airborne transmission mechanism, characterized by fever, catarrh of the mucous membranes of the eyes, nose, throat and upper respiratory tract, enanthema and maculopapular rash.

The causative agent is an RNA-containing paramyxovirus, which killed quickly by sunlight, ultraviolet radiation.

The source of the infectious agent is a person sick with measles. It is contagious to others with the last 1-2 days of the incubation period of up to 4 days after the rash appears. Transfer pathogen occurs through airborne droplets. The virus enters the air with drops of fluid from the upper respiratory tract of the patient while talking, coughing, sneezing. Infection occurs when a direct communication with the patient, and at a considerable distance from it, as the air current virus can penetrate into the adjacent rooms and even on the other floors. If a pregnant woman before the birth sick with measles, probably transplacental infection of the fetus. In this case, the unborn child has symptoms of measles. A third person infectious agent is not transferred; cases of transmission over household items due to the low resistance of the virus is very rare.

When skidding measles pathogen in certain areas, where it has not been for many years, and also in unvaccinated children get sick almost all the teams before without a history of measles, regardless of age. In large towns, where expressed migration, often ill children aged 1 - 7 years, in the age groups older than 7 years, the incidence decreases rapidly and after the age of 14 years there are only isolated cases of measles. For measles, as well as for all airborne infections, characterized by seasonality. The maximum number of cases recorded from December to May, the minimum - in August and September. Due to mass vaccination against measles incidence of it has fallen sharply.

The clinical picture. The incubation period ranges from 8 to 17 days when administered gamma globulin. Its duration can be increased to 21-28 days. In typical cases, the course of the disease distinguish 3 periods: the catarrhal (Beginner, prodromal) period, rash and pigmentation. Catarrhal period begins acutely: runny nose, cough , conjunctivitis , symptoms of intoxication (increase in body temperature to 38 - 39 ° C, headache , malaise, lethargy, loss of appetite, etc.). Cough is usually rough, barking, hoarse voice. It can develop croup syndrome. The face becomes puffy eyelids and lips swell. There hyperemia conjunctiva and sclera, lacrimation and photophobia . From 2 to 3-day red spots (enanthema) are found in the mucosa of the hard and soft palate. On small papules (diameter 0.5-1 mm) buccal mucosa at the level of small molars, and sometimes on the mucous membrane of the lips and the conjunctiva appear to have a grayish-white color, rise above the mucosal surface, surrounded by a rim of hyperemia. Papules do not merge with each other, firmly soldered to the underlying tissues (can not be removed with a spatula). These elements are a specific symptom of measles and are called spots Belsky -Filatova-Koplik. They saved 2 - 4 days and disappear on the first, at least the second day of the period of precipitation. After their disappearance the mucous membrane of the cheeks a few days remain congested and rough. Sometimes, in the catarrhal period on the skin found weakly expressed punctulate scarlatiniform or spotty rashes, and in some cases it can be urticarial. With the characteristic measles rash prodromal rash disappear. Catarrhal period usually lasts for 3 - 4 days.

rashes period begins with the 4-5 th day of the disease and usually lasts 3 days. Typical phasing rashes. The first elements of the rash occur behind the ears, on the back of the nose, then during the first day, it quickly spreads to the face, neck, partially in the upper part of the chest and back. On the 2nd day the rash covers the entire body, and on the third - the upper and lower limbs. The rash is usually abundant, bright, maculopapular, located on the intact skin. Sometimes it happens with a hemorrhagic component. Mostly solid field erythema formed. The body temperature of the first day of the rash is higher than in the catarrhal period (sometimes for 1 - 2 days before the rash temperature is slightly lowered, a new rise in its first day of rash onset temperature gives the character a double-humped curve). The temperature remains elevated for the entire period of the rash. Become more pronounced symptoms of upper respiratory tract, eyes, intoxication. There have been changes in the nervous, urinary, cardiovascular system, gastrointestinal tract and lungs. Often there are nosebleeds.

On the 4th (sometimes third) day from the beginning of a period of pigmentation lesions rash begins to fade, it becomes brown or light brown. Pigmentation occurs in the same sequence as the rash. Simultaneously regress catarrhal phenomena and reduced toxicity, in the absence of complications to normal temperature, usually politically falling in a short period of time or critical. The disappearance of the rash may be accompanied by small pityriasis peeling of the skin. Sometimes there is a period of pigmentation croup syndrome caused by the addition of a secondary infection. pigmentation period usually lasts 1 - 1.5 weeks.

In mild catarrhal measles period is shortened to 1-2 days, the symptoms of intoxication are mild or absent, the body temperature of low-grade, catarrhal phenomena minor spots Belsky-Filatova- Koplik can be scanty rash, rash phasing less clear.

Complications may occur at any period of measles. The most common laryngitis , tracheitis, bronchitis , pneumonia , pleurisy . In addition, measles may be complicated by otitis media, meningitis, encephalitis, enteritis, colitis.

Diagnosis is based on the evaluation of clinical and epidemiological data. The blood at the end of the incubation period and the beginning of the catarrhal observed moderate leukocytosis with neutrophilia and shift to the left, lymphopenia; in a period of eruptions - leukopenia , often with a relative neutrophilia. If in doubt in the diagnosis sometimes resort to specific diagnostic methods (determination of increase antiviral antibody titer in the dynamics using hemagglutination inhibition, complement fixation and neutralization).

The differential diagnosis in the catarrhal period carried with acute respiratory viral diseases. During rash differential diagnosis often carried out with rubella, scarlet fever, yersiniosis, medication dermatitis.

Treatment for most patients is carried out at home. Hospitalizations are subject to the children of the first 2 years of life, patients with severe measles complications, as well as patients from the closed child care centers, hostels (based on epidemiological indications). In addition, hospitalization is necessary if it is impossible to care for patients at home, in poor living conditions.

In catarrhal period and the period prescribed bed rest is rash. It is necessary to ensure good ventilation. They recommend drinking plenty of fluids (such as fruit juices, juice, tea). With increased body temperature of the patient is necessary to feed more often, small portions. Food should be easily digestible, dairy plant. It is very important for skin care (hygiene bath, washing, wet wiping), oral mucosa (drinking, especially after a meal, older children and adults - mouthwash after eating boiled water). Displaying instillation into the conjunctival sac of 10 to 20% of a solution on 1-2 drops 1-2 times a day sulfatsil sodium.

When painful cough to infants give Pertussin (0.5 - 1 teaspoon 3 times a day), older children and adults prescribed narcotic antitussives: glaucine hydrochloride (glauvent) libeksin, tusupreks etc. When complications treatment is carried out in. according to their nature. In these cases it is necessary to prescribe antibiotics in sufficient dose in the earliest possible time (even in cases of suspected occurrence of complications).

Prognosis is generally favorable. However, recovery is slow. Within 2 - 8 weeks or more at the convalescent asthenia may occur. Previous infection contribute to the exacerbation of chronic diseases, endocrine disorders sometimes occur.

Prevention. The main preventive measure is the active immunization with live attenuated measles vaccine children without a history of measles. Of great importance are the early detection and isolation of patients with measles. Disinfection in the centers due to the instability of the virus is not carried out; it is replaced by airing and wet cleaning. The group child care centers should be placed in accordance with their potential isolation and separation.