Angina with measles: causes, symptoms, diagnosis, treatment

Measles is an acute infectious disease predominantly of childhood, characterized by general intoxication, fever, catarrhal inflammation of the mucous membrane of the upper respiratory tract and eyes, specific eruptions on the oral mucosa, maculopapular rash on the skin.

Until the XVIII century. Measles were not isolated into a separate nosological form from the general group of fungal diseases and, probably, it was known from ancient times, as a feverish state, which is characterized by special changes in the mucous membranes of the upper respiratory tract and skin, which was interpreted in the 9th century. As one of varieties of smallpox. Despite the existence of the second half of the XVII century. A fairly complete description of the clinical manifestations of measles, it was isolated in an independent disease only in the XVIII century. Italian scientist Vorsieri. In Russia, the word "measles" is first encountered in 1744. In Russia and practically in all European countries the entire 19th century. Passed under the sign of measles epidemics; from Europe, measles was imported 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 causative agent of infection is a person with measles. It is contagious to others in the last I-2 days of the incubation period and in the first 3-4 days of rash, by the 5th day after the appearance of the rash the patient becomes epidemically not dangerous. Transmission of the infection occurs by airborne droplets during a conversation, sneezing, coughing. Infection with the measles virus occurs not only with close contact with the patient, but also at a considerable distance, because a virus with air current can penetrate into neighboring rooms and even to other floors of buildings. It is also possible to transplacental way of transmission of the virus to the fetus, in which the fetus is born with symptoms of measles.

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

The cause and pathogenesis of angina at measles. The measles activator is the filtering, RNA-containing paramyxovirus Polynosa morbillorum. In the environment, it quickly dies under the influence of sunlight, UV, high temperature, formalin, ether, acetone. The entrance gates for the measles virus are the mucous membranes of the upper respiratory tract and eyes. Primary fixation and multiplication of the virus occur in the cells of the ciliary 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 multiplication continues, accompanied by the development of small inflammatory infiltrates with proliferation of the reticular elements and the formation of multinucleated giant cells.

Pathological anatomy. Pathological changes in measles, with the exception of skin rash, concentrate mainly in the pharynx, larynx and underlying respiratory organs and manifest catarrhal inflammation of the mucous membrane of the conjunctiva, nose, nasopharynx and pharynx, which is one of the signs of a prodromal period. This catarrh in the future, by the time of blanching of the measles rash, gradually disappears. With a more severe course of the disease, catarrhal phenomena are quickly complicated by superficial necrosis of the mucous membrane, most often in the larynx, especially in the area of vocal folds. Here, measles necrosis has the appearance of a rough band running across the larynx along the edge of the vocal folds and propagating along them by 1-5 mm, often extending beyond them into the region of the glutidis guta. The process can spread upward to the area of the entrance to the larynx and the larynx and down to the upper part of the trachea. By the end of the prodromal period, which lasts from 3 to 5 days, transient point hemorrhages appear on the mucous membrane of the soft palate and along with them appear on the mucous membrane the characteristic spots of the Velsky-Filatov-Koplik in the form of whitish holly papules, most often from the inside of the cheeks on 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 are fatty degenerated epithelial cells.

Symptoms of angina at measles. The incubation period of measles is from 9 to 17 days, more often 10 days. In typical cases during the disease, three periods are distinguished: catarrhal (initial, prodromal), period of rash and period of pigmentation. The severity of the disease distinguishes between light, moderate and severe forms of measles.

In the most typical medium-severe form, the catarrhal period begins acutely with typical symptoms of a viral (influenza) infection: runny nose, cough, conjunctivitis, signs of intoxication (fever to 38-39 ° C, headache, malaise, lethargy, loss of appetite, etc.). . Cough rough, barking, voice hoarse, can develop a croup syndrome. These symptoms can simulate adenovirus infection, flu, an ordinary cold. However, when examining the patient's face with measles, attention is drawn to his puffiness, swelling of the eyelids and lips, unusually bright congestion hyperemia, enlargement and hyperemia of the vessels of sclera, lacrimation and photophobia. From the 2nd to the 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 small molars, and sometimes on the mucous membrane of the lips and conjunctiva. They have a grayish-whitish color, rise above the surface of the mucous membrane, are firmly welded to the underlying tissue. These elements are a symptom specific for measles and, as already noted above, are called the spots of Belsky - Filatov - Koplik. They persist for 2-4 days and disappear in the 1st, less often on the 2nd day of the rash period.

The period of rash starts from the 5th day of the illness and lasts usually 3 days. For measles rash is characteristic of the spatial sequence of rashes: first the rash appears behind the ears, on the back of the nose, then within 1 day quickly spreads to the face, neck, partially to the upper part of the chest and back. On the 2nd day the rash covers the entire body, on the third - the limbs. The rash is usually plentiful, bright, spotty-papular, located on unchanged skin. During the rash, the body temperature rises even more. The symptoms of upper respiratory tract infection, of the eyes become more pronounced, the signs of intoxication become worse. The catarrhal phenomena in the pharynx, the phenomena of superficial necrosis of the mucous membrane of the tonsils, and the activation of opportunistic microorganisms to deeper and spread of the pathological process intensify.

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

With a mild form of measles, the catarrhal period is shortened to 1-2 days, the symptoms of intoxication are weak or absent, the body temperature is subfebrile, the catarrhal phenomena are minor, the Belsky-Filatov-Koplik stains may be absent, the rash is meager, the pigmentation is not pronounced, rapidly disappearing. In severe forms of measles, there is hyperthermia syndrome (an increase in body temperature up to 40 ° C and higher, accompanied by a violation of the central nervous system, cardiovascular system and metabolism of varying severity).

In some cases, there is an atypical course of measles. For example, in infants with a burdened premorbid condition (dystrophy, rickets, etc.) and weakened older children, measles can be erased, however, despite the mild severity of the underlying symptoms of the disease, or even the absence of part of them, the general condition of the patient is severe, often there are serious complications (pneumonia, necrotic sore throats, false cereals, etc.). Very rarely occurs hemorrhagic measles with hemorrhages in the skin and mucous membranes of the nose, pharynx and larynx, hematuria, etc.

In children who were in contact with sick measles, who were injected with y-globulin in the incubation period, the disease proceeds in a weakened form with an extended incubation period and shortened subsequent periods of the disease.

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

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

Differential diagnostics. In the catarrhal period measles differentiate from acute respiratory viral infections, in which the mucous membranes of the cheeks do not change, the characteristic spots of Filatov are absent. In the period of rash, differential diagnosis is most often performed with rubella, scarlet fever, drug allergy, iersiniosis (an infectious disease characterized by a gastrointestinal lesion, a causative agent - Yersinia enterocolitica - a gram-negative spore-forming rod, the source of infection is mouse rodents, agricultural and domestic animals, products - meat, milk, vegetables, disseminated by Yersinia, characteristic syndromes - gastroenterocolitis, appendicitis, terminal ileitis, mesenteric th lymphadenitis, during the generalization of the process, the upper respiratory tract, liver, lungs, joints, meninges, eyes, generalized forms - sepsis, treatment - antibiotics, symptomatic, detoxification, dehydration) may be affected.

Treatment of angina in the measles of most patients is carried out at home. Hospitalization is required for children of the first 2 years of life, patients with severe measles, complications, as well as patients from closed children's institutions, dormitories, boarding schools (but with epidemic indications). In the catarrhal period and the period of rashes - bed rest, well-ventilated room, plentiful drink (tea with lemon, fruit juices, preferably cooked ex tempore from fresh fruits, decoctions of dried fruits, rose hips, etc.), easily digestible milk and vegetable food.

Great importance is attached to skin care (hygienic baths, washing with soap for children, wet wiping with furatsilin solution). Young children use diapers and pads, which often change. The skin in the inguinal areas, between the buttocks, in the axillary areas after hygienic washing and rubbing is smeared 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, purulent complications, prevention of false croup): children - plentiful drink, adults after eating - rinsing the mouth and throats with warm boiled water.

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

The prognosis for measles is usually favorable, however, recovery is slow. Within 2-8 weeks or more, depending on the severity of the disease, convalescents may have asthenic syndrome, endocrine disorders, exacerbations of existing chronic diseases. Deaths by the end of the XX century. Were rare, mainly in older children with measles complicated by encephalitis.

Prevention. The main preventive measure is the massive active immunization of live weakened measles vaccine in children who did not have measles. In view of the instability of the virus in the external environment, disinfection in the outbreak is not carried out and is limited only to airing the room and its wet cleaning.

[1], [2], [3], [4], [5]