Measles in children

Measles in children is an acute infectious disease with an increase in body temperature, intoxication, catarrh of the upper respiratory tract and mucous membranes of the eyes, as well as a maculopapular rash.

ICD-10 code

• 805.0 Measles complicated by encephalitis (post-measles encephalitis).
• 805.1 Measles complicated by meningitis (post-measles meningitis).
• 805.2 Measles complicated by pneumonia (post-measles pneumonia).
• 805.3 Measles complicated by otitis media (post-measles otitis media).
• 805.4 Measles with intestinal complications.
• 805.8 Measles with other complications (measles mumps and measles keratoconjunctivitis).
• 805.9 Measles without complications.

Epidemiology

Measles was the most common infection in the world before vaccination and was found everywhere. Increases in incidence every 2 years are explained by the accumulation of a sufficient number of people susceptible to measles. Measles incidence was observed all year round with an increase in autumn, winter and spring.

The source of infection is only a sick person. The patient is most contagious during the catarrhal period and on the first day of the rash. From the 3rd day of the rash, contagiousness decreases sharply, and after the 4th day the patient is considered non-contagious.

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Causes of measles

The causative agent is a large virus with a diameter of 120-250 nm, belongs to the Paramyxoviridae family, genus Morbillivirus.

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

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Pathogenesis of measles

The entry point for the virus is the mucous membranes of the upper respiratory tract. There are indications that the conjunctiva of the eye may also be an entry point for infection.

The virus penetrates the submucosa and lymphatic tract 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. During these days, the virus is present in large quantities in the discharge of the mucous membranes of the upper respiratory tract. From the 3rd day of the rash, the excretion of the virus decreases sharply and is not detected in the blood. Virus-neutralizing antibodies begin to predominate in the blood.

Symptoms of measles

The incubation period is on average 8-10 days, but can extend up 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, three periods are distinguished: catarrhal (prodromal), rashes and pigmentation.

The onset of the disease (catarrhal period) is manifested by an increase in body temperature to 38.5-39 "C, the appearance of catarrh of the upper respiratory tract and conjunctivitis. Photophobia, conjunctival hyperemia, swelling of the eyelids, scleritis are noted, then purulent discharge appears. Often at the onset of the disease, loose stools and abdominal pain are noted. In more severe cases, symptoms of general intoxication are sharply expressed from the first days of the disease, there may be convulsions and clouding of consciousness.

The catarrhal period of measles lasts 3-4 days, sometimes extending to 5 or even 7 days. This period of measles is pathognomonic for specific changes on the mucous membrane of the cheeks near the molars, less often on the mucous membrane of the lips and gums in the form of grayish-whitish dots the size of a poppy seed, surrounded by a red rim. The mucous membrane becomes loose, rough, hyperemic, and dull. This symptom is known as Filatov-Koplik spots. They appear 1-3 days before the rash, which helps to establish the diagnosis of measles before the rash appears and differentiate catarrhal phenomena in the prodrome from catarrh of the upper respiratory tract of another etiology.

Classification of measles

A distinction is made between typical and atypical measles.

• Typical measles has all the symptoms of this disease. According to its severity, typical measles is divided into mild, moderate and severe.
• Atypical measles includes cases in which the main symptoms of the disease are erased, blurred, or some of them are absent. The duration of individual periods of measles may be changed - shortening of the period of rash, absence of the catarrhal period, violation of the stages of rash.
• The erased, or very mild, form of measles is called mitigated. It is observed in children who received immunoglobulin at the beginning of the incubation period. Mitigated measles usually occurs with normal or slightly elevated body temperature, Filatov-Koplik spots are absent. The rash is pale, small, not abundant (sometimes only a few elements), the stages of the rash are disrupted. Catarrhal phenomena are very weakly expressed or completely absent. Complications with mitigated measles are not observed. The erased form of measles is often noted in children of the first half of life due to the fact that they develop the disease against the background of residual passive immunity received from the mother.
• Atypical cases also include cases of measles with extremely pronounced symptoms (hypertoxic, hemorrhagic, malignant). They are observed very rarely. Measles in those vaccinated with a live measles vaccine, in whose blood antibodies have not formed, proceeds typically and retains all its characteristic clinical manifestations. If measles develops with a low content of antibodies in the blood serum, its clinical manifestations are erased.

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Diagnosis of measles

The diagnosis of typical measles does not present any particular difficulties.

In cases where there are difficulties, serological examination of the patient using ELISA provides significant assistance in establishing the diagnosis. The detection of specific IgM undoubtedly confirms the diagnosis of measles.

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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 subject to hospitalization. Children from closed children's institutions and children under 1 year of age are subject to mandatory hospitalization.

The main attention should be directed to the creation of good sanitary and hygienic conditions and proper care of the patient. Fresh air and proper nutrition are necessary. The patient with measles should be hospitalized in a Meltzer box, which should not be darkened.

Preventing measles

Those who fall ill are isolated for at least 4 days from the onset of the rash, and if complicated by pneumonia, for at least 10 days.

Information about the sick person and those who have been in contact with the sick person is passed on to the relevant children's institutions. Children who have not had measles and who have had contact with a patient with measles are not allowed into children's institutions (nurseries, kindergartens and the first two grades of school) for 17 days from the moment of contact, and for those who have received immunoglobulin for prophylactic purposes, the period of isolation is extended to 21 days. The first 7 days from the beginning of contact, the child can attend the child's institution, since the incubation period for measles is never shorter than 7 days, their isolation begins on the 8th day after contact. Children who have had measles, as well as those vaccinated with a live measles vaccine, and adults are not separated.