Measles - Symptoms

The WHO has proposed a standard definition of a person with measles: “any person with a temperature of 38°C or higher, a maculopapular (not vesicular) rash and typical measles symptoms: cough, runny nose, conjunctivitis, or any other person in whom health workers suspect measles.”

Measles periods:

• incubation;
• prodromal (catarrhal);
• exanthema period (rash);
• pigmentation period.

The incubation period of measles lasts 9-11 days. With prophylactic administration of immunoglobulin, it can be extended to 15-21 days, less often - longer. Individual symptoms of measles are noted from the second half of the incubation period (weight loss of the patient, swelling of the lower eyelid, hyperemia of the conjunctiva, subfebrile temperature in the evenings, cough, slight runny nose).

Classification of measles

1. Reactive measles.

• By severity:
  • Light.
  • Medium-heavy.
  • Heavy.
• By type:
  • Typical.
  • Atypical:
    • hemorrhagic;
    • erased;
    • rudimentary.

2. Mitigated measles (weakened, in children who have undergone seroprophylaxis).
3. Measles in vaccinated children.

In the prodromal period of measles (lasting 2-4 days in children and 5-8 days in adults), measles symptoms resembling a respiratory infection are distinct: malaise, cough, runny nose with copious nasal discharge, conjunctivitis with lacrimation, fever (up to 40 °C) associated with the second wave of viremia. Shortly before the rash, Filatov-Belsky-Koplik spots appear (bluish-white, 1-2 mm in diameter, with a bright red border), located on the mucous membrane of the cheeks opposite the second molars. With the appearance of the rash, the spots fade and soon disappear. The mucous membrane of the cheeks and the surface of the lips are inflamed, the lips sometimes turn red. Sometimes, on the 2nd or 3rd day, a rash in the form of small spots appears on the patient’s face, torso and limbs, accompanied by itching (the so-called prodromal rash).

A characteristic red non-itchy maculopapular rash appears on the head along the hairline and behind the ears, spreading to the face, trunk and limbs, including the palms and feet, often becoming confluent: On the 1st day, the rash elements appear on the face and neck; on the 2nd day - on the trunk, arms and thighs; on the 3rd day, the rash affects the shins and feet, and begins to fade on the face. The rash elements are most densely located on the face, neck and upper body. The rash consists of small papules (about 2 mm), surrounded by an irregularly shaped spot more than 10 mm in diameter. The rash elements merge, forming complex figures with scalloped edges, but even with the densest rash, areas of completely normal skin color can be found. In some cases, hemorrhages (petechiae) can be seen against the background of measles exanthema. During the period of the rash, the condition of patients is most severe. On the 4th day, the rash begins to fade in the same order in which it appeared. Pigmentation persists for 1-2 weeks, bran-like peeling on the face and body - 5-7 days. The temperature normalizes on the 4-5th day from the onset of the rash. A longer fever indicates the development of complications.

The hemorrhagic form of the disease has pronounced symptoms of measles and intoxication, damage to the nervous system with impaired consciousness and acute cardiovascular failure. Multiple hemorrhages in the skin and mucous membranes, hematuria are characteristic; hemocolitis may develop.

Rudimentary measles is characterized by the fact that all the main symptoms of measles are weakly expressed, and sometimes absent.

Mitigated measles develops in children after the introduction of immunoglobulin or other preparations containing antibodies during the incubation period, as well as in infants who have not completely lost the antibodies received from the mother transplacentally. Measles occurs with mild symptoms of intoxication; the stages of the rash are shortened and disrupted.

There are three groups of complications of measles: from the respiratory system, the central nervous system and the gastrointestinal tract.

In some cases, the defeat of the respiratory tract mucosa by the virus leads to the development of laryngitis, laryngotracheitis, bronchitis, false croup, bronchiolitis. Severe laryngotracheitis (necrotic, ulcerative) occurs during the period of pigmentation due to the addition of secondary flora and is accompanied by aphonia.

The most severe complication is severe interstitial giant cell pneumonia, which develops more often in immunocompromised individuals; infiltrative changes are detected in the lungs, and multinucleated giant cells are found in the sputum. In developing countries, this is the leading cause of measles-related deaths, primarily among children under 2 years of age.

Otitis develops in 10% of children who have had measles.

Conjunctivitis is a mandatory manifestation of measles; less often, keratitis occurs, which can lead to blindness.

A severe complication of measles is damage to the central nervous system (encephalitis, meningoencephalitis). Signs of encephalitis are more often observed in adolescents and adults, appear a week after the manifestation of exanthema. The body temperature rises again, such symptoms of measles as drowsiness, lethargy, disturbances of consciousness, convulsions, amimia, nystagmus appear, abdominal reflexes disappear, the facial nerve is affected, paralysis of the limbs develops. In most cases, CNS damage is caused by an immune reaction to the myelin proteins of the virus, and not by its direct action. In patients with weakened immunity, encephalitis can progress and lead to death in 1-6 months. The incidence of measles encephalitis is 1 in 1000-2000 cases.

Subacute sclerosing panencephalitis is an extremely rare, slow-moving form of measles encephalitis. It is most common in children who have had measles before the age of two. It develops several years after the disease and usually leads to dementia and death within a few months. The disease is characterized by a very high titer of measles antibodies in the serum and cerebrospinal fluid.

Gastrointestinal complications - gastroenteritis, hepatitis, appendicitis, colitis, mesadenitis. Serum ALT and AST activity is often elevated, although jaundice may not be present.

Rare complications of measles include myocarditis, glomerulonephritis, and thrombocytopenic purpura. Measles can exacerbate tuberculosis, apparently due to suppression of cellular immunity.

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