Angina in measles: causes, symptoms, diagnosis, treatment

Measles is an acute infectious disease, predominantly affecting children, characterized by general intoxication, increased body temperature, catarrhal inflammation of the mucous membrane of the upper respiratory tract and eyes, specific rashes on the mucous membrane of the oral cavity, and maculopapular rash on the skin.

Until the 18th century, measles was not distinguished as a separate nosological form from the general group of rash diseases and, probably, it was known since ancient times as a febrile condition characterized by special changes in the mucous membranes of the upper respiratory tract and skin, interpreted in the 9th century as one of the varieties of smallpox. Despite the fact that a fairly complete description of the clinical manifestations of measles existed since the second half of the 17th century, it was distinguished as an independent disease only in the 18th century by the Italian scientist Borsieri. In Russia, the word "measles" first appears in 1744. In Russia and in almost all European countries, the entire 19th century was marked by measles epidemics; measles was brought from Europe to America. Measles did not leave humanity in the 20th century, and there is every reason to believe that it will be an unwelcome guest in the 21st century.

Epidemiology. The source of the infectious agent is a person with measles. He is infectious to others in the last 1-2 days of the incubation period and in the first 3-4 days of the rash, by the 5th day after the rash appears, the patient becomes epidemically harmless. The infection is transmitted by airborne droplets during conversation, sneezing, coughing. Infection with the measles virus occurs not only through close contact with the patient, but also at a considerable distance, since the virus can penetrate into neighboring rooms and even other floors of buildings with the air flow. Transplacental transmission of the virus to the fetus is also possible, in which case the fetus is born with measles symptoms.

Immunity (active) in those who have had measles, as a rule, lasts for life. Post-vaccination immunity, also related to active, is stable and in intensity approaches natural. Children born to a mother whose blood contains antibodies to the measles virus, have an inherited unstable passive immunity, which after 3 months of life begins to decrease, and by 9 months disappears.

Cause and pathogenesis of sore throat in measles. The causative agent of measles is a filterable, RNA-containing paramyxovirus Polynosa morbillorum. In the environment, it quickly dies under the influence of sunlight, ultraviolet radiation, high temperature, formalin, ether, acetone. The entry points for the measles virus are the mucous membranes of the upper respiratory tract and eyes. Primary fixation and reproduction of the virus occur in the cells of the ciliated epithelium of the respiratory tract and in alveolocytes - epithelial cells lining the alveoli of the lung. In addition, during the incubation period, the virus is fixed in many other organs (CNS, gastrointestinal tract, lymphoid tissue, liver, spleen, bone marrow), where its reproduction continues, accompanied by the development of small inflammatory infiltrates with proliferation of reticular elements and the formation of multinucleated giant cells.

Pathological anatomy. Pathological changes in measles, excluding the skin rash, are concentrated mainly in the pharynx, larynx and underlying respiratory organs and are manifested by catarrhal inflammation of the mucous membrane of the conjunctiva, nose, nasopharynx and pharynx, which is one of the signs of the prodromal period. This catarrh subsequently, by the time the measles rash becomes pale, gradually disappears. In a more severe course of the disease, catarrhal phenomena are rather quickly complicated by superficial necrosis of the mucous membrane, most often in the larynx, especially in the area of the vocal folds. Here, measles necrosis has the appearance of a rough strip running across the larynx along the edge of the vocal folds and spreading along them by 1-5 mm, often going beyond them into the area of the gut glotidis. The process can spread upwards to the area of the entrance to the larynx and laryngopharynx and downwards to the upper part of the trachea. By the end of the prodromal period, which lasts from 3 to 5 days, transient punctate hemorrhages appear on the mucous membrane of the soft palate and, together with them, characteristic Velsky-Filatov-Koplik spots appear on the mucous membrane in the form of whitish, pointed papules, most often on the inside of the cheeks at the level of the upper molars. These spots are surrounded by a halo of hyperemia and can spread to the mucous membrane of the lips and gums. They represent epithelial cells that have undergone fatty degeneration.

Symptoms of sore throat with measles. The incubation period of measles is from 9 to 17 days, more often 10 days. In typical cases, three periods are distinguished during the course of the disease: catarrhal (initial, prodromal), the period of rash and the period of pigmentation. According to the severity of the disease, mild, moderate and severe forms of measles are distinguished.

In the most typical moderate form, the catarrhal period begins acutely with typical symptoms of a viral (flu) infection: runny nose, cough, conjunctivitis, signs of intoxication (an increase in body temperature to 38-39°C, headache, malaise, lethargy, loss of appetite, etc.). The cough is rough, barking, the voice is hoarse, croup syndrome may develop. These symptoms can simulate adenovirus infection, flu, or a common cold. However, when examining the patient's face with measles, attention is drawn to its puffiness, swelling of the eyelids and lips, unusually bright hyperemia of the conjunctiva, dilation and hyperemia of the scleral vessels, lacrimation, and photophobia. From the 2nd-3rd day, red spots (enanthema) are found on the mucous membrane, and small papules (0.5-1 mm in diameter) appear on the mucous membrane of the cheeks at the level of the premolars, and sometimes on the mucous membrane of the lips and conjunctiva; they are grayish-whitish in color, rise above the surface of the mucous membrane, and are firmly fused with the underlying tissue. These elements are a symptom specific to measles and, as noted above, are called Velsky-Filatov-Koplik spots. They persist for 2-4 days and disappear on the 1st, less often on the 2nd day of the rash period.

The period of rash begins on the 5th day of illness and usually lasts 3 days. Measles rash is characterized by a spatial sequence of rash: first, the rash appears behind the ears, on the bridge of the nose, then within 24 hours it quickly spreads to the face, neck, partly to the upper chest and back. On the 2nd day, the rash covers the entire body, on the 3rd - the limbs. The rash is usually abundant, bright, maculopapular, located on unchanged skin. During the rash, the body temperature rises even more. Symptoms of damage to the upper respiratory tract, eyes become more pronounced, signs of intoxication increase. Catarrhal phenomena in the pharynx, superficial necrosis of the mucous membrane of the tonsils intensify, and opportunistic microorganisms are activated to deeper ones and the pathological process spreads.

The pigmentation period begins at the end of the 3rd - beginning of the 4th day from the beginning of the rash in the same sequence in which it began. At the same time, the severity of all local and general signs of measles infection decreases. The rash first fades, becomes brown or light brown. The pigmentation period lasts 1-2 weeks and may be accompanied by small bran-like peeling. It should be borne in mind that it is during the pigmentation period that croup syndrome may occur, caused by the addition of a secondary infection.

In mild forms of measles, the catarrhal period is shortened to 1-2 days, symptoms of intoxication are weakly expressed or absent, body temperature is subfebrile, catarrhal phenomena are insignificant, Velsky-Filatov-Koplik spots may be absent, the rash is scanty, pigmentation is not pronounced, quickly disappearing. In severe forms of measles, hyperthermic syndrome is observed (an increase in body temperature to 40 ° C and above, accompanied by a violation of the central nervous system, cardiovascular system and metabolism of varying severity).

In some cases, measles may have an atypical course. Thus, in infants with a complicated premorbid condition (dystrophy, rickets, etc.) and weakened older children, measles may proceed in a latent manner, however, despite the weak expression of the main symptoms of the disease, or even the absence of some of them, the general condition of the patient is severe, serious complications often occur (pneumonia, necrotic tonsillitis, false croup, etc.). Rarely occurring hemorrhagic measles with hemorrhages in the skin and mucous membranes of the nose, pharynx and larynx, hematuria, etc., proceeds extremely severely.

In children who have been in contact with a patient with measles and who were given y-globulin during the incubation period, the disease occurs in a weakened form with an extended incubation period and shortened subsequent periods of illness.

Complications of measles are quite common, especially in weakened children who have had some illness or suffer from chronic adenoiditis or tonsillitis, especially in decompensated forms. These complications include keratitis, otitis, meningitis, meningoencephalitis and encephalitis, enteritis, colitis.

Diagnosis with a typical clinical picture and correct collection of epidemiological anamnesis is not difficult. According to blood test data: at the end of the incubation period and the beginning of the catarrhal period - moderate leukocytosis with neutrophilia and a shift in the leukocyte formula to the left, lymphopenia; during the rash - leukopenia, often with relative neutrophilia. In doubtful cases, specific diagnostic methods are sometimes used (determination of the increase in the content of antiviral antibodies, complement fixation reaction, isolation of the measles virus from the blood and nasopharynx).

Differential diagnostics. In the catarrhal period, measles is differentiated from acute respiratory viral infections, in which the mucous membranes of the cheeks do not change, and the characteristic Filatov spots are absent. During the rash period, differential diagnostics are most often carried out with rubella, scarlet fever, drug allergy, yersiniosis (an infectious disease characterized by damage to the gastrointestinal tract, the causative agent is Yersinia enterocolitica - a gram-negative non-spore-forming rodent; the source of infection is mouse-like rodents, farm and domestic animals; factors of infection transmission are food products - meat, milk, vegetables, seeded with yersinia; characteristic syndromes are gastroenterocolitis, appendicitis, terminal ileitis, mesenteric lymphadenitis; with generalization of the process, the upper respiratory tract, liver, lungs, joints, meninges, eyes can be affected; in generalized forms - sepsis; treatment - antibiotics, symptomatic, detoxification, dehydration).

Treatment of sore throat during measles is carried out at home for most patients. Children under 2 years of age, patients with severe forms of measles, complications, as well as patients from closed children's institutions, hostels, boarding schools (but for epidemic indications) are subject to hospitalization. In the catarrhal period and the period of rashes - bed rest, a well-ventilated room, plenty of fluids (tea with lemon, fruit juices, preferably prepared ex tempore from fresh fruit, decoctions of dried fruit, rose hips, etc.), easily digestible dairy and vegetable food.

Great importance is attached to skin care (hygienic baths, washing with soap for children, wet rubbing with a solution of furacilin). For small children, diapers and pads are used, which are changed frequently. The skin in the groin area, between the buttocks, in the armpits after hygienic washing and wiping is lubricated with a thin layer of baby cream. Care of the mucous membranes of the oral cavity is extremely important, since it is aimed at preventing superinfection (vulgar tonsillitis, its purulent complications, prevention of false croup): children - plenty of fluids, adults after eating - rinsing the mouth and throat with warm boiled water.

It is recommended to instill 10-20% sodium sulfacyl solution into the conjunctival sac 1-2 drops 1-2 times a day and at night from the very beginning of the disease. In case of a painful cough, young children are given pertussin 1/2-1 dessert spoon 3 times a day; older children and adults are prescribed non-narcotic antitussive drugs (glauvent, libexin, tusuprex, etc.). In case of bacterial complications, antibiotics and sulfanilamide drugs are prescribed.

The prognosis for measles is generally favorable, but recovery is slow. For 2-8 weeks or more, depending on the severity of the disease, convalescents may experience asthenic syndrome, endocrine disorders, and exacerbations of existing chronic diseases. Fatal outcomes by the end of the 20th century were rare, mainly in older children with measles complicated by encephalitis.

Prevention. The main preventive measure is mass active immunization with a live attenuated measles vaccine of children who have not had measles. Due to the instability of the virus in the external environment, disinfection in the outbreak is not carried out and is limited to airing the room and wet cleaning.

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