Measles - Causes, Symptoms and Treatment .MF .
Measles - an acute, highly contagious viral infection, which is found only in humans, transmitted by airborne droplets, causing generalized mucous oral cavity, oropharynx, respiratory tract and eyes, and is accompanied by spotty-papular rash on the skin (exanthema) and mucosal mouth(enanthema), with concomitant severe intoxication.
Already more than 2 thousand years the disease has terrorized the inhabitants of our planet.For the first time described a measles Arab physician Rhazes in the IX century, in XVIII - highlighted in an independent nosological form.In 1911, Anderson and Goldberger infectious nature of measles has been proved by infecting monkey filtrates of nasopharyngeal secretions from a patient.In 1919 Degkvittsem seroprevention measles by introducing human serum has been proposed, resulting in decreased mortality from this disease, bringing terror to the people of the world.In 1954, Enders and Peebles isolated measles virus.In 1967, a live measles vaccine (ZHKV) was established in Russia u
Measles virus - RNA virus, belongs to the family of paramyxoviruses and completely typical for this family - large size and irregular spherical shape, but unlike other members (parainfluenza and mumps) has neuraminidase (N)presumably it difficult penetration through the mucous membranes.Measles virus has hemagglutinating and hemolytic activity, ie bonding and causes the destruction of red blood cells, it causes pigmentation (skin discoloration) after a rash.And the main distinctive ability of measles virus is a life-long stay in the body, with the ability to cause a particular form of infection - infection is slow, namely SSPE.
maloustoychiv virus in the environment: inactivated at 56⁰S for an hour, when 37⁰S - for 2 hours killed 50% of the virus population.In sub-zero temperatures can be stored up to a year, with 12-5⁰S - persist for several days.At room temperature is active for 5 hours. It is sensitive to disinfectants, esters, UFI (divided into direct sunlight, fluorescent light), drying, acidic environment.
universal susceptibility to the virus, disease outbreaks are registered with different shift trend (from winter to spring and summer).High risk of disease is high among those who have been ill and was not vaccinated, especially dangerous adult neprivivochny contingent (unvaccinated older than 14), because they have the disease is the most difficult and fraught with a number of complications.When communicating with the patient, the risk of infection in non-immune contingent of 40% - in finding him 24 hours, 60% - 48 hrs, 80% - 72 hours.
After suffering a life-long disease is formed strong immunity, but recorded isolated cases reinfetsirovaniya.At vaccination, revaccination with subsequent immunity lasts for 20 years.
Causes of measles
Source - sick man with typical and atypical forms of measles.It is dangerous to others with ≈7 days after exposure, when begins prodromal period, ie the first catarrhal symptoms.Ways of transmission - airborne (sneezing, coughing, crying, talking).Infection occurs much more easily in organized groups of closed institutions (children's homes, gardens, etc.).
Symptoms of measles
incubation period - 9-17 days of absence of symptoms after infection.Once infection has occurred by the airborne virus is attached to the mucous membranes of the upper respiratory tract or the conjunctiva, if the patient has got the saliva was originally there.Once the virus penetrates into the submucosal layer and the regional lymph nodes - in this area is the primary replication of the virus (ie its reproduction).During this period, no symptoms, but increased lymph nodes, usually the neck.By the end of this period, the virus becomes so much that he breaks into the blood and there is a next time.
Prodrome lasts 3-5 days and is characterized by viremia (virus in the blood circulation), with the localization of the virus in the upper respiratory tract and other organs:
• catarrh of the upper respiratory tract (nose abundant mucous, rough / dry / compulsivecough with hoarseness)
• conjunctivitis (edema and hyperemia of the mucous membrane of the eyes, with serous discharge, vascular injection sclera, lacrimation and photophobia)
• fever (rise t⁰ to 38,5⁰S)
• intoxication (lethargy, irritability, decreased appetite,sleep disturbance)
• enanthema = stains Bielsko-Koplik Filatov - a spot in the form of semolina (small whitish, with redness around the edges), located on the mucosa of the cheeks around the molars, may also be on the mucosa of the lips and gums.They appear 2-3 days before the rash (or in other words, within 1-2 days after the onset of catarrhal manifestations) and, when there are lesions on the skin, these spots on the mucous disappear.
• Small spot reddish rash on the tongue, soft palate, and solid - they appear on the 2-3 day of illness and persist until the end of rashes.
period rash lasts 3 days, from the end of the prodromal period (2-3 days after the onset of rash on the mucous membranes), ie, against the background of bright symptoms when the concentration of virus in the blood, and it reaches a maximum internal organs: CNSskin, lungs, intestines, tonsils, bone marrow, spleen, liver - in which there is a secondary viral replication, followed by a secondary viremia, and is accompanied by an allergy-immunology restructuring with the following symptoms:
• strengthening of intoxication and fever
• strengthening symptomsthe upper respiratory tract (may develop bronchitis, with a change in cough character - it becomes more humid, there is expectoration)
• Speckled-papular rash with the following landmark:
on the 1st day of rash pale pink spots appear on verhnebokovyh areas of the neck, thenbehind the ears, then along the hair growth, and on the cheeks, near the ear, and within 24 hours the rash has covered the neck, arms and upper chest;while the rash becomes papular character.
to the 2nd day of the rash spreads to the back, abdomen, extremities.
On the 3rd day of rash on the feet, but begins to pale in the face, leaving a temporary pigmentation behind (because of the destroyed red blood cells in the skin) with a slight peeling.In this case, the edges fused rash is not smooth, as "izgryzannye" or radiant.
rash typical for measles
measles virus after secondary viremia is localized in the epidermal cells of the skin, for it looms immunocompetent lymphocytes - between them there is a conflict, which explains the appearance of rash maculopapular nature (papules - vesiclesresulting from inflammatory exudation, ie effusion due to vascular injury in which there is a violation of the permeability).
peeling due to inflammatory processes that lead to the destruction of cells in the epidermis (ie, loss of communication between the cells).The stronger eruptions, the stronger the symptoms of intoxication.
period pigmentation - lasts 1-1.5 weeks.At the site of lesions found brown spots, presence of peeling on the location of lesions.This period is characterized by:
• temperature reduction and disappearance of intoxication
• disappearance of symptoms of upper respiratory tract
• possible complications (since the measles virus has inhibitory effect on T-lymphocytes, act as line protection, so the virus affects the unimpededtarget cell bodies to which it has an affinity)
1. Virological method - abjection of the curve or nasopharyngeal 3 days prior to the onset of symptoms and for 1 day of the rash.
2. Serological methods - aimed at the detection of antibodies to the virus and its antigenic components.
• HI (hemagglutination inhibition reaction) - first bled into catarrhal period or during the first 3 days after the rash appears, and re-bled after 14 days - the results are compared and looking at an increase in antibody titer.
• EIA (enzyme immunoassay) - Detection of IgM specific immunoglobulins (indicate acute Measles process) and G (indicate disease moved early and keep the immune system).
should not rely solely on the objective evaluation and diagnosis only pas nature catarrhal symptoms and rash, because "mask measles" can be covered: rubella, chickenpox, pseudotuberculosis, CMV (cytomegalovirus), enterovirus infection and other - similar diseasesabout 25. But finding spots Bielsko-Koplik Filatov makes the diagnosis certain.
Treatment of measles
Specific treatment is not developed, so it should be comprehensive, with a personal touch in the choice of the drug, taking into account the age and severity of the current process.
• Bed rest for 3 days from the moment of normalization
temperature • Gentle vitaminized diet (with a focus on vitamin A, but must be dosed vitamin doctor, because it is easy to get and get an overdose of non-infectious jaundice)
• Etiotropic treatment -shirokospektornyh use of antivirals (izoprinozin, arbidol);immunomodulators (interferon viferon);immunostimulants (tsikloferon);immunoglobulins are used in severe cases intravenously (immunovenin, pentaglobin);
• Symptomatic treatment:
- when konnktivitah (0.25% levomitsitinovye drops 20% sulfacetamide)
- with catarrhal symptoms of the respiratory tract (expectorants, mucolytics, anti-aerosols)
- at a fever (antipyretics, analgesics, NSAIDS -non-steroidal anti-inflammatory)
- rinse mouth with a solution of chlorhexidine Rotokanom, chamomile extract.
Complications of measles
may occur as a result of secondary bacterial microflora and / or development immunodifetsitnogo state due to the overwhelming effect of the virus on the immune system.
• The respiratory system or the upper respiratory tract: laryngitis with possible stenosis of the larynx, nasopharyngitis, bronchitis, pneumonia, pleurisy, otitis, tonsillitis, sinusitis.
• GI: enterocolitis dysfunction by
bowel • central nervous system (most dangerous, often life-threatening complications): encephalitis, meningoencephalitis, myelitis, SSPE.
used to reduce the incidence of nonspecific and specific prevention.Non-specific measures - isolation of patients from the beginning of the prodromal manifestations of up to 5 days after the rash appears, possibly up to 10 days in the presence of complications in the respiratory tract.Contact persons are isolated up to 21 days.But people who have had past measles or been vaccinated are not subject to quarantine and preventive measures among them shall not apply.
Specific activities: active prevention: vaccination ZHKV (vaccine "Ruvaks" or MMR) at 12 months and then 6 years.Or passive - introduction of Y-globulin within 3-5 days from possible contact and at least 3 ml to prevent disease.
Consultation of measles:
Q: Is it dangerous to the disease measles, arose immediately after vaccination?
answer is no, because there is vaccination with attenuated (ie not dangerous) strains.
Question: Do I need to feed the baby if he does not want to eat when they are sick?
Answer: if the child is breastfed, but now with the introduction of complementary foods, it is necessary to conduct a "rejuvenation" of the diet, ie to remove the lures for a while (at least for the period of intoxication) and feed on demand.Almost the same thing applies to adults - to feed only on request and only light food, but give plenty of drink for detoxification.Food intake is fraught with aggravation against the will of intoxication, because in the background there is a temperature of inactivation of the enzyme systems of the digestive tract and the food will not be absorbed and starts to turn into toxic products.
therapists Shabanova I.E