Measles is an easily transmitted infectious disease caused by a virus that contains RNA (a paramyxovirus family).
The incubation period of infection lasts from 7 to 10 days. At this time, the person does not feel the deterioration of health. But at the same time it becomes contagious at the end of the first week, as well as during rashes.
The source of the disease is a sick person. The infection is transmitted by airborne droplets when talking, sneezing or coughing. The virus enters the respiratory tract with particles of mucus from a sick person. At the site of introduction, it causes symptoms of inflammation. At the same time, it penetrates the vascular bed and circulates through the body. After suffering the disease, a person develops a stable immunity.
How can you get infected?
The causative agent of the disease is an RNA-containing virus belonging to the genus Morbillivirus. Unstable in the environment, inactivated when exposed to direct sunlight, drying, heating to 50 ° C. The virus persists at room temperature for one to two days; when cooled to -20 ° C, the pathogen remains viable for several weeks.
The source and carrier of the infection is a sick person. Virus isolation into the environment begins in the last 1-2 days of the incubation period, the entire catarrhal stage, is completed within 4 days of the rash phase. Sometimes the time of contagiousness is delayed up to 10 days. The causative agent of measles is transmitted by airborne droplets through the aerosol mechanism. A sick person releases a virus when sneezing, coughing, or when breathing out normally.
People are very susceptible to the measles virus, after the disease has survived lifelong immunity. As a rule, children are ill in preschool age; in adults, the infection is rare and hard. The peak incidence is observed in the spring and winter. Due to a massive routine vaccination, the number of measles cases has dropped significantly.
Measles causative agent – what is known about the virus?
The measles virus is a single strand of RNA coiled up. It is surrounded by a shell (capsid) of proteins and lipids. And on top of this organism is covered with another protective sheath with outgrowths that look like thorns. The virus has a regular round shape and small size of 120-230 nm.
Properties of the measles virus:
- The hemagglutinating activity of the virus (glues the erythrocytes into flakes) helps lab technicians detect the measles virus in the blood.
- The hemolytic activity of the virus (causes destruction of red blood cells in the blood and is accompanied by the release of hemoglobin into the blood) is also used in laboratory diagnostics.
- The virus causes the formation of multicore giant cells. They appear as a result of the fusion of neighboring cells in the palatine tonsils, lymph nodes, respiratory tract mucosa. Their function is to produce new viruses.
- The measles pathogen increases capillary permeability. Through their wall comes the liquid component of the blood, which causes a runny nose, a wet cough, conjunctivitis, swelling on the surface areas of the skin.
- It affects mainly the epithelial cells of the upper respiratory tract, which is manifested in inflammation of the conjunctiva, throat, larynx, trachea. Measles of the nervous system are also affected by measles. This is associated with severe intoxication, sometimes convulsions and loss of consciousness, inflammation of the lining of the brain (meningitis). The intestinal mucosa also suffers, which causes indigestion.
- Protein particles of the virus envelope cause an allergic reaction that underlies most of the symptoms of the disease: Filatov-Koplik-Velsky spots on the mucous membrane of the cheeks and lips, a rash on the skin and the sky mucosa.
- Immunosuppression is attributed to the fact that the virus affects the lymphoid tissue and brain structures that are responsible for immune responses.
- The virus reduces the activity of macrophages, which are considered to be bacteria-eaters and provide protection against infections. In this regard, 30% of cases end with bacterial complications (pneumonia, otitis, encephalitis).
- The plethora of blood vessels and virus damage to their walls, causes hemorrhages in the skin and in the eyes.
- Penetrating the cell, the measles virus rearranges it in such a way that it becomes a factory for the production of new viruses. The cell produces helixes of RNA and protein casings for capsids.
- When the virus enters the environment, it dies pretty quickly. It is poorly tolerated by sunlight, UV radiation, high temperatures, and any acids and disinfectants. It dies itself after 2-3 hours, so disinfection with measles can be avoided.
The source of infection is a sick person. He becomes infectious already in the last 2 days of the incubation period, when there are still no signs of the disease. The virus is excreted from the body before the 4th day of the rash. That is, a person remains dangerous to others for 7-10 days. The measles virus is transmitted through the air by airborne droplets, with drops of saliva and mucus, when coughing and talking.
In the clinical picture of the disease there are 4 stages:
- The incubation period is 7–10 days.
- Catarrhal period 2–7 days.
- Stage rashes 3 days.
- The pigmentation period is 4–5 days.
The recovery period is delayed for 2–3 weeks. Patients still have weakness and lethargy, lack of appetite.
When measles occurs in adults, the clinical picture is the same as in children, but the symptoms are more pronounced. The main manifestations of this infection are:
- increase in body temperature (fever) to 38-40 ° C;
- decreased appetite;
- hard breathing;
- inflammation of the upper respiratory tract;
- hacking dry cough;
- large red or pink spots on the sky (measles enanthema);
- rash and pigmentation on the skin;
- disturbance of consciousness (delirium, fainting, etc.);
- peeling, skin pigmentation;
- intestinal dysfunction.
Difference in measles in adults from measles in children
Any childhood infection in adults is much more difficult than in children and measles is no exception. In addition to the general similarity of measles symptoms, in adults the symptoms have distinctive features:
- Body temperature is very high 40C-40.5C
- The sharp deterioration of health, a person instantly requires bed rest
- The rash is very intense, covers the whole body, the staging of the rash persists as it does in children
- In adults, measles is severe, most often with laryngitis, bronchitis, and sometimes complicated by pneumonia and meningoencephalitis.
- Slower recovery and recovery than children
- Measles in adults in most cases requires hospitalization of the patient, when, as children, they are most often treated at home.
Measles in adults: symptoms
Measles (see photo) has a rather interesting picture of symptoms, due to which the diagnosis of the disease in adults does not take much time and often does not require a differential analysis, excluding other respiratory infections.
Depending on the prevalence of certain symptoms, the following periods of illness are distinguished:
- Incubation period. After the virus has entered the body, for 1–2 weeks a person does not feel any manifestations of the disease. Sometimes the incubation period can take up to three weeks, which is associated with the peculiarities of the immune system in a particular person. It is worth recalling that, despite this, the person carrying the virus becomes infectious to all people susceptible to the measles virus.
- Catarrhal period (initial). Measles are commonly associated with characteristic skin rashes. But the first symptoms of the disease, appearing after the incubation period expires, are simple manifestations of the common cold: significant fever, cough, runny nose, asthenic syndrome. At this point, you can suspect you have a cold or acute respiratory viral infection, but the characteristic signs in the form of rashes on the skin will make the correct diagnosis.
- Outdoor manifestations. From the second day of the onset of symptoms, a person appears reddening of the mucous membrane of the eyes (conjunctivitis), rashes on the cheeks in the form of small white spots, with a characteristic red border (see photo). The main dermatological manifestations begin on the 5th day of the initial period of the disease, and are red spots that merge into one large spot covering the skin of the face, neck, torso, arms and legs. During this period, the temperature can rise again to the maximum for the whole course of the disease mark – up to 40.5 degrees.
- Stage of convalescence. Starting from the fifth day after the appearance of a red rash, the disease regresses and the person begins to recover. The temperature gradually decreases to a normal level, the rash peels off. It is worth remembering that skin manifestations may disappear slowly over a period of two weeks, while during this period of the disease a person is no longer infectious.
In adults, measles has the same pattern of symptom development. But their severity is usually much higher, and the likelihood of complications is higher. The incubation period in adults is short, the signs of intoxication are acute and bright. The rash is profuse, confluent, with concomitant marked lymphadenitis, the spots of Belsky-Filatov-Koplik are multiple and have not passed for a long time. But catarrhal phenomena with uncomplicated course of the disease may be mild.
The manifestation of pathology may be typical or atypical. By atypical include:
- Worn out form. In this case, the disease passes in a very mild form, without expressed specific clinical manifestations. Patients note a slight increase in body temperature, cold symptoms (sore throat, cough, weakness). Sometimes the erased form of the disease occurs after a vaccine against measles or the introduction of gamma globulin.
- Hemorrhagic form. The disease is accompanied by multiple hemorrhages on the skin, urine and stools mixed with blood. Due to the hemorrhagic form, death is often the result of a large loss of blood. With timely hospitalization and proper treatment, the prognosis is favorable.
- Hypertoxic. This form is observed with increased intoxication of the body. The hypertoxic form is manifested by a very high stagnant temperature (40 ° C and above), symptoms of meningoencephalitis, cardiac and respiratory failure (shortness of breath, tachycardia, lowering blood pressure, cyanosis of the lips and skin).
Features of the rash
A rash is the most characteristic sign of measles, and it is precisely its appearance that allows the diagnosis to be correctly made. After all, the symptoms of the incubation and prodromal periods are not specific and are associated with intoxication and an infectious-inflammatory tissue reaction at the site of the virus introduction. And the typical spots of Belsky-Filatov-Koplik on the mucous membrane of the cheeks often remain without proper attention.
Features of measles rash include:
- The rash is spotty-papular in nature and does not violate the integrity of the epidermis. It has a fairly uniform hot pink or deep red color. Sometimes, in severe cases of measles, individual petechial rashes and even intracutaneous hemorrhages with a diameter of over 3 mm also appear.
- Nodular elements of rash have a size of about 2 mm and are located on the background of unchanged skin.
- With abundant rash there is a tendency to merge its individual elements, while the skin looks swollen.
- The first elements of the rash initially appear in the ear region and on the face. Subsequently, its rather rapid spread from top to bottom occurs, with damage to the entire surface of the body.
Measles eruptions last for an average of 4 days, after which their extinction begins. The elements turn pale, in their place there is a slight peeling and hyperpigmentation.
Diagnostics is primarily based on:
- carefully collecting the patient’s history
- characteristic rash and spreading through the body (the beginning of the process from the head),
- the duration of the period of rash (in most cases, 3 days).
To confirm the diagnosis, the following laboratory tests are performed:
In the early stages of the disease, you can donate blood from a vein and determine immunoglobulin M (IgM, early antibodies) for the measles virus. Detection of this type of antibody indicates the initial stage of infection with the measles virus. The body has already begun to fight the disease.
When infected with measles, there is an increase in IgM titer (antibodies) to the measles virus four or more times. A blood test is performed when clinical signs appear and after 2-3 weeks, this is a reliable criterion for measles infection.
Late antibodies to the measles virus (immunoglobulin G, IgG) do not need to be determined during diagnosis, since they are formed both after vaccination and after the disease. The production of G-immunoglobulins occurs 1-2 months after suffering a measles infection. If a person has never been vaccinated against measles, then their appearance suggests that he once suffered measles. The presence of IgG protects a person from reinfection.
Complications of measles in adults
During measles patients, immunity is greatly reduced. This contributes to the secondary infection with other pathogenic microorganisms that easily penetrate into a weakened organism. The following complications may also occur:
- Various diseases of ENT organs, such as otitis, sinusitis, laryngitis, stomatitis, angina. Some patients may develop breathing disorders.
- When the secondary infection often affects the organs of the respiratory system, developing bronchitis, pneumonia.
- The most dangerous complications are secondary lesions of the central nervous system. Patients can develop myelitis, encephalitis, multiple sclerosis. Inflammation of the brain is accompanied by severe headaches, convulsions, impaired vital functions of the body and often leads to death.
- In some cases, an increased load on the liver can lead to hepatitis.
- With a secondary infection affecting the organs of the gastrointestinal tract, diarrhea and enterocolitis may begin.
- Pyelonephritis can develop due to the penetration of a bacterial infection into the organs of the urogenital system.
- Bleeding due to lesions of blood vessels can be extremely dangerous, leading to a critical reduction in blood pressure, anemia, a decrease in the number of platelets.
Measles during pregnancy
The measles virus is especially dangerous for pregnant women. Therefore, every expectant mother needs to know some important points:
- Transferred in the first trimester of pregnancy measles can cause fetal malformations and may be the basis for the decision on forced abortion.
- The only means of preventing measles is vaccination against it, which must be done before conception.
- There are currently no specific drugs for the measles virus; therefore, the treatment of an ill future mother is carried out under the supervision of a gynecologist with symptomatic means and by creating optimal conditions for fighting the infection.
In pregnant women, measles is just like any other person.
Pregnant women with measles, the doctor prescribes bed rest, heavy drinking, hygiene of the mucous membranes and skin, symptomatic drugs. Paracetamol is an antipyretic and analgesic agent approved during pregnancy. When complications prescribe antibiotics. The treatment is carried out under the close supervision of a gynecologist and an infectious disease specialist.
Despite the fact that treatment of measles in pregnant women is reduced to symptomatic, the infection is dangerous consequences. One of the complications is measles pneumonia, which can lead to the death of both the baby and the expectant mother.
In the early stages of pregnancy, the disease leads to a wide variety of fetal developmental defects; damage to the central nervous system is especially dangerous. Unfortunately, before the birth it is impossible to conclude how affected the baby’s brain is. The decision to terminate the pregnancy, if the measles was postponed in the early stages, the doctors take in each case individually. With measles, the risk of the harmful effects of the virus on the baby is still lower than with rubella, when abortion or artificial labor is an absolute indication.
In the last trimester, measles infection is fraught with the birth of a child with a congenital measles infection, which pediatricians successfully treat, but there is a risk that the baby may not suffer. It is not possible to find out whether the infection was transmitted to the baby before birth. In some cases, measles infection during pregnancy can threaten preterm labor, spontaneous abortion, or fetal death.
A woman planning a pregnancy is recommended to donate blood for measles antibodies. Their presence in the blood indicates the protection of the body against infection.
How to treat measles?
To date, no drugs have been developed for the specific treatment of measles, therefore the treatment of the disease is symptomatic.
If measles is mild, the patient does not need hospitalization. He is shown bed rest, plentiful drinking, restriction of the light regime,
Nonsteroidal anti-inflammatory drugs in pills and powders are used to reduce the temperature, reduce headaches and symptoms of general intoxication: aspirin, nimesulide, paracetamol, ibuprofen, coldrex, nimesil, as well as antihistamines.
The phenomena of conjunctivitis are removed by instillation of levomycetinum drops, sodium sulfacyla (see eye drops from conjunctivitis), eye wash with furatsilin, black tea, baking soda.
To reduce the itching of the skin, it is washed with a solution of a special powder – Delaskine. For disinfection of the oral cavity use a strong infusion of chamomile, oak bark, eucalyptus, chlorhexidine (see how and what to gargle with angina). If measles occurs with complications and bacterial flora is added, antibiotics are prescribed.
Subcutaneous administration in the early stages of the disease of measles immunoglobulin significantly alleviates the patient’s condition. In severe measles, hospitalization is necessary. In a hospital, patients are given detoxification, anticonvulsant, and anti-inflammatory therapy.
Passive prevention of infection is carried out by the introduction of immunoglobulin. The drug is obtained from the plasma of donors. Immunoglobulin is administered for 72 hours after contact with measles.
The most effective prevention of measles in adults is a vaccine. As part of routine vaccination according to the national calendar, vaccinations are given free of charge to persons under 35 years of age. For older people vaccination fee. But after contact with the patient, all people vaccinated for free.
Vaccine against measles, rubella, chicken pox and parotitis is used for immunization. Vaccination is carried out in 2 stages. Interval between injections 3 months. In Russia, the domestic monovaccine Ruvax or the American polyvaccine Priorix is used. Vaccine strains are prepared in a chicken embryo culture. Therefore, vaccination is contraindicated for people who are allergic to chicken protein or vaccine components. A measles vaccine protects a person for 20 years or more.
Doctors sometimes ask the question, is it possible to get measles after vaccination? Yes, adult measles can develop after vaccination. However, this can happen if only one vaccination was given. Under the scheme, measles vaccination involves a second injection after 3 months. Resistant immunity is developed only after the second vaccination.