Measles in children

Measles in children - an acute infectious disease with fever, intoxication, catarrh of the upper respiratory tract and mucous membranes of the eyes, as well as a spotty-papular rash.

ICD-10 code

• 805.0 Measles, complicated by encephalitis (post-cutaneous encephalitis).
• 805.1 Measles, complicated by meningitis (post-cutaneous meningitis).
• 805.2 Measles, complicated by pneumonia (post-fatal pneumonia).
• 805.3 Measles, complicated by middle otitis media (post-root otitis media).
• 805.4 Measles with intestinal complications.
• 805.8 Measles with other complications (measles mumps and measles keratocon junctivitis).
• 805.9 Measles without complications.

Epidemiology

Measles in the pre-vaccination period was the most common infection in the world and was found everywhere. The incidence of morbidity every 2 years is explained by the accumulation of a sufficient number of people susceptible to measles. The incidence of measles was observed all year round with a rise in autumn, winter and spring.

The source of infection is only a sick person. The most infectious patient in the catarrhal period and the first day of the appearance of the rash. From the third day of rashes, the contagiosity decreases sharply, and after the 4th day the patient is considered to be non-contagious.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of measles

Pathogen - a large virus with a diameter of 120-250 nm, belongs to the family Paramyxoviridae, the genus Morbillivirus.

Unlike other paramyxoviruses, measles virus does not contain neuraminidase. The virus has haemagglutinating, hemolytic and symplast-forming activity.

[11], [12], [13], [14], [15], [16], [17], [18]

Pathogenesis of measles

The entrance gates for the virus are the mucous membranes of the upper respiratory tract. There are indications that the conjunctiva of the eye can also be the gateway to infection.

The virus penetrates the submucosa and the lymphatic pathways of the upper respiratory tract, where its primary reproduction occurs, then enters the blood, where it can be detected from the first days of the incubation period. The maximum concentration of the virus in the blood is observed at the end of the prodromal period and on the 1st day of the rash. These days the virus is present in large quantities and in the mucosal membranes of the upper respiratory tract. From the 3rd day of the rash the secretion of the virus decreases sharply and it is not detected in the blood. Viral neutralizing antibodies begin to predominate in the blood.

Symptoms of measles

The incubation period averages 8-10 days, may extend to 17 days.

In children who received immunoglobulin for prophylactic purposes, the incubation period is extended to 21 days. In the clinical picture of measles, there are three periods: catarrhal (prodromal), rashes and pigmentation.

The onset of the disease (catarrhal period) is manifested by an increase in the body temperature to 38.5-39 ° C, the appearance of catarrh of the upper respiratory tract and conjunctivitis.They are noted for photophobia, conjunctival hyperemia, eyelid edema, scleritis, then there is a purulent discharge.Often at the beginning of the illness, liquid stool , pain in the abdomen.In more severe cases, from the first days of the disease the symptoms of general intoxication are sharply expressed, there may be convulsions and confusion of consciousness.

Catarrhal period of measles lasts 3-4 days, sometimes prolongs to 5 and even up to 7 days. For this period, measles pathognomonic peculiar changes on the mucosa of the cheeks in the molars, less often on the mucous membrane of the lips and gums in the form of grayish-whitish points the size of the poppy seed, surrounded by a red halo. The mucous membrane becomes loose, rough, hyperemic, dull. This symptom is known as the spots of Filatov-Koplik. They appear 1-3 days before the rash, which helps to establish a diagnosis of measles before the onset of rash and differentiate catarrhal phenomena in a prolonged catarrh of the upper respiratory tract of another etiology.

Classification of measles

There are typical and atypical measles.

• With typical measles, there are all the symptoms of this disease. By severity, typical measles are divided into mild, moderate and severe.
• Atypical measles include cases in which the main symptoms of the disease are erased, smeared or some of them are absent. The duration of the individual periods of measles can be changed - the shortening of the period of the rash, the absence of a catarrhal period, the violation of the stage of precipitation.
• Scraped, or very light, form of measles is called mitigirovannoy. It is observed in children who received immunoglobulin at the beginning of the incubation period. Mitigated measles occurs usually at normal or slightly elevated body temperature, there are no Filatov-Koplik patches. The rash is pale, shallow, ungrowth (sometimes only a few elements), the stage of the rash is disturbed. Catarrhal manifestations are very weak or completely absent. Complications with mitigated measles are not observed. A measly form of measles is often noted in children of the first half of life due to the fact that they develop a disease against the background of residual passive immunity received from the mother.
• Atypical cases include measles with extremely pronounced symptoms (hypertoxic, hemorrhagic, malignant) They are observed very rarely. Measles in vaccinated live measles vaccine, in the blood of which no antibodies were formed, occurs typically and retains all its characteristic clinical manifestations. If measles develops with a small amount of antibodies in the blood serum, its clinical manifestations are erased.

[19], [20], [21], [22], [23], [24], [25], [26], [27]

Diagnosis of measles

The diagnosis of typical measles is not particularly difficult.

In cases of difficulty, serological examination of the patient with the help of ELISA is of considerable help in establishing the diagnosis. Detection of specific IgM, unquestionably, confirms the diagnosis of measles.

[28], [29], [30], [31], [32], [33], [34], [35], [36]

Treatment of measles

Patients with measles are usually treated at home. Only children with severe measles, with complications or patients whose home conditions do not allow for appropriate care are eligible for hospitalization. Children from closed children's institutions and children under the age of 1 year are subject to mandatory hospitalization.

The focus should be on creating good hygienic conditions and proper care for the sick. Fresh air and proper nutrition are needed. To hospitalize a patient with measles is needed in the miller's box, which should not be obscured.

Prevention of measles

Illnesses are isolated for a period of at least 4 days from the onset of the rash, with complication with pneumonia - at least 10 days.

Information about the person who has been ill and who has been in contact with the patient is transferred to the appropriate children's institutions. Children who did not have measles and who had contact with sick measles are not admitted to children's institutions (nurseries, kindergartens and the first two classes of the school) within 17 days from the time of contact, and for those who received immunoglobulin for a preventive purpose, they extend the dissolution period to 21 days. The child can visit the children's institution for the first 7 days from the beginning of the contact, since the incubation period for measles does not occur shorter than 7 days, their dissociation begins on the 8th day after contact. Children who had been ill with measles, as well as those vaccinated with living measles vaccine and adults are not separated.