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December 19, 2012
Measles are the viral disease having infectious character and an acute current. Dl of an illness high temperature which can reach 40,5 °C, and also inflammatory process of mucous respiratory tracts and a mouth is characteristic. One more characteristic symptom of this illness is conjunctivitis and spotty and papular rash on skin.
The first descriptions of a disease of measles appeared still in the very ancient time. The illness is eurysynusic in the world and today, however it children, as a rule, have. Earlier measles were called also clumsy rubella, but now such designation is not used not to confuse this disease to a rubella. Most seriously this illness proceeds at the weakened children. Therefore till today in developing countries measles it becomes frequent the reason of children's death.
Measles are very infectious disease: as data of physicians testify, the susceptibility to a virus approaches 100%. As a rule, measles are diagnosed for children aged from 2 till 5 flyings. Much less often the disease affects adults who had no measles in the childhood. Newborn children have a so-called kolostralny immunity, the child gets which from mothers who earlier had measles. Such immunity protects the kid the first three months. After the person had measles, he creates durable immunity, and repeatedly the illness does not develop. However, similar cases nevertheless are documentary captured on a film and described by specialists.
As a rule, children have measles during the winter and spring period, and each 2-4 years increase in number of the diseased is observed. Today in the countries where mass vaccination is carried out, measles occur at adults and children seldom, or illness mini-epidemics take place.
Disease-producing factor is RNA-viruliferous families of paramyxoviruses. Out of a human body he very quickly perishes owing to influence of different external factors. Measles are transmitted between people in the airborne way. The sick person allocates a virus with slime when sneezes, coughs.
Thus, the source of an infection is the patient with measles of people. Infectious for other people it is from two last days of an incubation interval to fourth day of an illness with rash. Since fifth day of rashes, the patient is already considered noncontagious.
The infection gets to an organism through mucous membranes of upper respiratory tracts, and also sometimes as gate serve conjunctivas. During an incubation interval in an organism still there is rather small amount of viruses therefore they can be neutralized administration of protivokorevy immunoglobulin. Such measure of prevention practices that who contacted to patients with measles till 5 in the afternoon of an illness.
In a human body the virus affects generally upper parts of respiratory tracts, a conjunctiva, the digestive tract also slightly suffers.
Measles symptoms at the person begin to be shown after an incubation interval which proceeds about 1-2 weeks. Physicians classify measles, allocating a typiform of a disease of different severity, and also an atypical form of measles. Disease is subdivided into three stages which always pass consistently. These are three periods: catarral; rashes; reconvalescences.
The beginning of the catarral period at the patient always occurs sharply. The patient complains of manifestation of a febricula, a severe headache. It interrupts a sleep and appetite worsens. Body temperature increases, and, at a severe form of measles it can reach 40 °C.
At adult patients intoxication is shown is much more more expressed, than at children. In the first days of an illness at the person severe cold with mucous allocations which sometimes pass into mucopurulent is noted. The child or the adult patient are disturbed by constant dry cough. At children it becomes rough, at the same time the voice osiplost, stenotic breath is observed. Except this symptom of the child puffiness a century, conjunctivitis disturbs, pus is emitted. Sometimes thereof the phenomena in the morning the child wakes up with the stuck together centuries. The patient is strongly irritated by bright light.
Examining the sick child, doctors define existence of puffiness of the person, granularity on a back wall of a throat, a hyperemia of a mucous membrane of a stomatopharynx. At the same time at adult patients such symptoms of measles are softly expressed, but at the same time they observe a lymphadenopathy, there are dry rattles at lungs and rigid breath. Sometimes also short time is observed a kashitseobrazny chair.
In 3-5 days the health of the patient becomes a little better, fever decreases. But one day later intoxication of an organism and a catarral syndrome amplifies again, and body temperature indicators again considerably increase. At this particular time it is possible to find a cardinal clinical sign of measles – emergence of spots of Filatova-Koplika-Velskogo on a mucous membrane of cheeks near small molars. Sometimes such spots also appear on a mucous membrane of gums and lips. These are the white spots which are a little acting and at the same time surrounded with a thin border of a hyperemia. A little earlier or along with these spots on mucous the sky there is a clumsy enantema. These are the red spots having irregular shape. Their size is approximately equal to a pin head. In several days they merge with the general hyperemic mucosal surface.
At children duration of the catarral period makes 3-5 days, at adult patients it can reach 8 days.
After end of the catarral period it is replaced by the rash period. At this time on a body of the patient there is a bright spotty and papular dieback which gradually merges. Between spots sites of healthy skin are observed. In the first day of this period rash is watched ears, on the head under hair. A bit later, in the same day, it covers a face, a neck, upper part of a breast. For the second day rash passes to upper part of hands and a trunk. On third day the face begins to be cleaned, but at the same time rash develops standing and distal departments of hands.
In the course of diagnosis of an illness descending sequence of rash is considered as the most essential sign for differentiation of measles. More plentiful rash is characteristic of adult patients and if the illness proceeds very hard, then hemorrhagic elements can be shown.
In the second period of measles the catarral phenomena become more intensive: the severe cough and cold, constant dacryagogue, a photophobia is noted. Fever and intoxication are brightly expressed. If the patient is inspected during this period, then tracheobronchitis symptoms, and also moderate arterial hypotension and tachycardia are found in it.
In the third period — reconvalescence (or pigmentation) the condition of the patient becomes stabler. Body temperature returns to normal, the state improves, catarral manifestations disappear. Rash gradually turns pale, and, it occurs precisely in the same order, as well as its emergence. On site rashes remain spots of a light brown shade. Approximately in a week pigmentation completely disappears, but on its place skin can be shelled. Such phenomenon is generally noted on a face of the patient.
Meet as well other options of a course of measles if the atypical form of an illness takes place. At mitigirovannay measles which are shown at those people who received active or passive immunization against an illness or earlier were already ill it, an incubation interval more long. The course of an illness a lung, intoxication it is expressed a little, the catarral period is reduced. There are no spots of Filatova-Koplika-Velskogo also. Rash can be ascending or arise on all body at the same time.
One more atypical form of measles — abortal measles. Its beginning same, as well as at an illness typiform. But in 1-2 days after the beginning it is interrupted. Rash is noted only on a face and a trunk, temperature is increased only in day of emergence of rash.
There are also subclinical types of measles, but they can be diagnosed only during serological research of pair blood sera.
Complications of measles
Most often as complication of measles there is pneumonia. At children also false croup, sometimes stomatitis can be shown. At adults during pigmentation meningitis, an encephalomeningitis and a polyneuritis can develop. The most serious complication — clumsy encephalitis, but happens it very seldom.
Diagnosis of measles
At measles the diagnosis is established taking into account existence of the characteristic symptoms described above. One of determinal factors in the course of establishment of the diagnosis existence of recent contact of the patient with the person for which measles are diagnosed is considered.
In the course of diagnosis the general blood test at which in case of measles the lymphopenia and a neutropenia is defined is carried out. Also laboratory studying of smears of the secret taken from respiratory tracts is made. At establishment of the diagnosis it is also important to define a caption of the developed antibodies to a measles virus.
It is necessary to differentiate an illness from scarlet fever, rubellas, a pseudotuberculosis, dermatitis and other diseases of which an enanthesis is characteristic.
Treatment of measles
The sick child or the adult needs to be isolated, it is recommended to it to observe a bed rest. The room should be aired as often as possible, it is also important to make wet cleaning every day. The patient needs to drink a lot of liquid, the special diet at the same time is not required. Careful care of eyes and an oral cavity is important. For comfort of the patient it is protected from bright light.
The symptomatic treatment of measles practices: antitussives, vasoconstrictive drops in a nose, paracetamol at high temperature are applied. Also antihistaminic medicines are appointed. In eyes 20% sulfacetamide sodium solution are dug in.
If at the person pneumonia, other complications develops, then to him the course of antibiotics is appointed. As a preventive measure and in the course of treatment high doses of vitamin A, vitamin C are applied.
If at the patient the uncomplicated form of a disease takes place, then it is treated most often in house conditions. In a hospital patients at whom severe forms of measles and complication of an illness are noted stay. Also hospitalize patients according to epidemiological indications.
If encephalitis is diagnosed clumsy, to the patient high doses of Prednisolonum and antibacterial medicamentous agents are appointed.
Prevention of measles
As prevention to children vaccination is made. The special vaccine protecting from measles was made in 1966. The measles inoculation becomes to children at the age of 1 year and 6 years. To provide active immunoprevention, the live clumsy vaccine is applied. Today also complex vaccine which warns not only measles, but also parotitis, and also a rubella is actively applied. The measles inoculation is carried out by a live vaccine to the children who still did not have measles since age of 12-15 months. The revaccination is carried out similarly before the child is sent to school. Reaction to an inoculation at most of children is not noted.
Section: Infectious diseases