Measles in children
The content of the article:
- Causes and risk factors
- Forms of the disease
- Measles symptoms in children
- Diagnostics
- Measles treatment in children
- Possible complications and consequences
- Forecast
- Prevention
Measles in children is a highly contagious anthroponous acute infectious disease with airborne transmission. It is accompanied by severe intoxication syndrome, fever, catarrh of the upper respiratory tract and eyes, a characteristic rash.
Source: sq.com.ua
Measles is one of the most common infectious diseases; children of preschool and school age are most susceptible to it in the autumn-winter and spring periods. Before the advent of mass mandatory vaccination in the world, up to 130 million people fell ill with measles annually, of which 7% died, a new rise in incidence was recorded every two years. Currently, the incidence has decreased 60-80 times. Nevertheless, measles in young children remains one of the main causes of death: about 45 million children fall ill every year, of which more than a million die.
Susceptibility to the disease appears in children after six months. Before this period, children whose mothers in the past had measles or were vaccinated do not get sick with it, since the child's body is protected by the mother's antibodies.
Causes and risk factors
The causative agent of measles is the RNA-containing virus Polinosa morbillarum of the paramyxovirus family, which has hemolytic, hemagglutinating and symplast-forming activity.
The source of infection is a sick person. The virus spreads with the secretion of the nasopharynx or conjunctiva through the aerosol mechanism by airborne droplets, through the mucous membranes of the conjunctiva of the eyes and upper respiratory tract during coughing, sneezing, or talking. The route of transmission of measles from a pregnant woman to a fetus is also possible. It is practically impossible to transmit the virus by contact (through objects that have gotten droplets of saliva) due to the extremely low resistance of the virus in the external environment, as well as to the action of physical and chemical factors.
The susceptibility to measles is very high. When in contact with a patient with measles, almost all people who have not been sick before and have not been vaccinated get sick.
Forms of the disease
Measles can take on a typical and atypical course. Typical measles has all the symptoms associated with the disease and is classified by severity as mild, moderate, and severe. The severity of the disease is determined by the degree of damage to the respiratory system, the severity of intoxication and the nature of the rash.
Mild measles has the following symptoms:
- mild catarrhal symptoms;
- moderate intoxication;
- low temperature;
- scanty, no tendency to merge, rash;
- satisfactory general condition.
The moderate form is accompanied by:
- significant catarrhal symptoms;
- severe intoxication;
- profuse, bright rash;
- fever;
- puffiness of the face;
- vomiting;
- impaired consciousness.
The severe form is manifested by the following symptoms:
- damage to the respiratory system;
- pronounced intoxication;
- cyanotic rash;
- temperature rise to 40 ° C and above;
- loss of consciousness, convulsions.
Atypical measles in children also has several forms:
- abortive - differs in the typical onset of the disease, but after a few days the symptoms subside. Fever occurs only on the first day of the rash. The rash that appears only spreads to the face and chest, quickly regresses. Weakly pigmented areas remain at the site of the rash;
- hemorrhagic - is expressed by nosebleeds, hematuria, bloody stools, massive hemorrhages in the mucous membranes of the eyes, mouth, throat, internal organs. The rash has a bluish tinge. This clinical form is more often observed in children with hemorrhagic diathesis and vascular wall inferiority, has a high risk of death;
- hypertoxic - proceeds overly acutely, with progressive symptoms of severe intoxication, impaired brain function, cardiac insufficiency;
- erased (weakened) - characterized by mild catarrhal symptoms, violation of the stages of rashes. The rash is pale, scanty, unstable, often in the form of discrete elements.
Erased measles in children treated with measles immunoglobulin is called mitigated. The incubation period in this case, as a rule, is delayed until the 21st day.
Measles symptoms in children
The presence and severity of measles symptoms in children depends on the period of illness. In typical measles, four successive stages are distinguished:
- Incubation period.
- Catarrhal (prodromal period).
- Exanthematous (period of rashes).
- Resolution stage (period of appearance of pigmentation).
The incubation period for measles in children lasts an average of 9-17 days. At the beginning, the virus multiplies in the cells of the ciliated epithelium and alveolocytes of the upper respiratory tract, in the submucosa of the nasopharynx. The virus infects the lymphoid system and blood vessels, then enters the general bloodstream and spreads to almost all organs and tissues.
The duration of the catarrhal period in children is 3-5 days. The following symptoms appear:
- headache;
- lethargy, decreased appetite;
- sharp rise in temperature up to 39 ° С;
- the appearance of a runny nose with profuse serous, and then mucopurulent discharge from the nose;
- sneezing, dry obsessive cough;
- vomiting, heartburn, belching;
- hyperemia of the pharynx, granularity of the posterior pharyngeal wall;
- hoarseness of voice;
- conjunctivitis (accompanied by intense swelling of the eyelids) with purulent exudate;
- photophobia, blepharospasm;
- puffiness of the face, eyelids;
- the appearance of a characteristic rash on the skin and mucous membrane of the mouth near the molars (spots of Velsky - Filatov - Koplik and measles enanthem).
Source: likar.info
The spots of Velsky - Filatov - Koplik represent separately located grayish-white small papules surrounded by a rim of hyperemia. They begin 1–3 days before the onset of the rash period and disappear with the appearance of the typical measles rash.
Measles enanthema - pinkish-red spots of irregular shape that appear 1-2 days before the rash on the mucous membrane of the soft and hard palate. Sometimes in the catarrhal period, a small-dotted or spotty rash appears on the skin, giving way to a typical measles rash.
At the end of the prodromal period, the maximum concentration of the measles virus occurs in the patient's body.
The period of rashes begins on the 4th-5th day of the disease, characterized by an increase in symptoms of the inflammatory process and intoxication:
- the appearance of a small maculopapular rash against the background of unchanged skin;
- swollen lymph nodes;
- severe headaches;
- new high temperature rise;
- nausea, vomiting;
- decrease in the amount of urine separated;
- deterioration of the cardiovascular system;
- delirious confusion, delirium.
On the first day, elements of the rash appear behind the ears, on the back of the nose, on the scalp. The rash spreads quickly to the face and neck. On the second day, the rash covers the upper chest and back, the upper arms. On the third day - legs and lower arms. A measles rash can cover the entire surface of the body; in severe cases, continuous fields of erythema and small hemorrhages form on the skin. The appearance of a rash is due to the formation of large immune complexes, which are formed as a result of the interaction of antigen viruses with antibodies. With an uncomplicated course of the disease, on the 3-4th day after the onset of the rash, a period of pigmentation begins, the duration of which is 7-10 days. Its signs:
- the general condition of the child is normalized;
- body temperature decreases slightly;
- catarrhal phenomena gradually disappear;
- the rash turns pale, becomes brown.
The elements of the rash begin to fade in the same order as they appeared, leaving behind them pityriasis and pigmentation.
On the fifth day after the onset of the rash, the child ceases to be contagious and can attend child care facilities. After measles, persistent immunity develops, repeated diseases are extremely rare and occur only in people with severe immunodeficiency.
Diagnostics
Diagnosis of measles infection is straightforward in the typical course of the disease. An important criterion for making a diagnosis is the characteristic clinical signs of measles in a child, as well as the epidemic situation in the area of residence.
Laboratory diagnostics includes the isolation of the measles virus (virological studies are rarely used due to their complexity), the detection of the RNA virus (polymerase chain reaction), and the detection of specific antibodies. The material for research is nasopharyngeal washings, nasopharyngeal and oropharyngeal swabs, blood, urine. A blood test in the prodromal period shows a picture characteristic of a viral infection: moderate leukocytosis, leukopenia during the rash, increased erythrocyte sedimentation rate, plasmacytosis.
If it is difficult to establish an accurate diagnosis, antibodies to the virus are detected (serological study). To detect virus-specific IgM and IgG antibodies, they use mainly the ELISA method.
Measles treatment in children
In mild cases, measles in children is treated at home. The room must be ventilated and humidified. A sick child is provided with bed rest, abundant drink, light regime (dim lighting), hygienic care of mucous membranes and skin, and medical nutrition. Several times a day you need to rinse your eyes, rinse your mouth with a solution of soda. If necessary, you need to free the nasal cavities from mucus and crusts with cotton swabs moistened with petroleum jelly, lubricate chapped lips with a moisturizer.
Source: gstatic.com
Drug therapy is symptomatic. In the acute period of the disease, antipyretics, vasoconstrictor drops, expectorants, glucocorticoid hormones, antihistamines (antiallergic) drugs are prescribed. For complications associated with the addition of a secondary infection - antibiotics, with psychomotor agitation - sedatives and nootropics. In case of hyperkinesis - anticonvulsants.
In case of a high risk of complications, the patient is hospitalized.
After recovery, it is necessary to provide the child with a sparing regimen, balanced nutrition, and regular exposure to the fresh air. Children of school age should reduce physical and intellectual stress until they are fully recovered.
Possible complications and consequences
Severe atypical forms of measles in children can cause complications from different systems:
- respiratory (pneumonia, bronchitis, laryngitis, pleurisy);
- genitourinary (pyelonephritis, cystitis);
- digestive tract (stomatitis, enteritis, colitis);
- central nervous system (encephalitis, meningitis, meningoencephalitis, panencephalitis, polyneuritis);
- other organs and systems (otitis media, pyoderma, conjunctivitis, blindness).
Forecast
In most cases, the disease proceeds favorably, the rashes are resolved without leaving defects on the skin, the infectious process ends with complete recovery and the formation of stable immunity.
Prevention
The main activity for the prevention of measles in children is routine immunization with a live vaccine. As a rule, a combined vaccine is used, which includes weakened pathogens of measles, rubella and mumps (MMR vaccine - measles, rubella, mumps). Previously not sick children are vaccinated against measles at 12–15 months of age, again at 6 years of age. Giving the vaccine to susceptible children can cause a vaccine reaction lasting several days.
Children with measles are isolated for 4-10 days after the rash. Those children who have been in contact with a patient with measles are not allowed in child care facilities for 17 days from the date of contact. If children received immunoglobulin as a prophylaxis - up to 21 days from the date of contact.
Source: saroblnews.ru
Emergency prevention of measles in children is carried out using immunoglobulin prepared from donor blood. The introduction of immunoglobulin is performed for children who are contraindicated for vaccination with a live vaccine. Vaccination, carried out in the early stages of the incubation period in the focus of infection, stops the spread of measles and has no contraindications.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
