Measles: symptoms

WHO has proposed a standard definition of measles: "anyone with a temperature of 38 ° C or higher, spotty-papular (not vesicular) rash, and typical symptoms of measles: cough, runny nose, conjunctivitis, or any other person whose medical workers suspect measles."

Measles periods:

• incubation;
• prodromal (catarrhal);
• period of exanthema (eruption);
• period of pigmentation.

The incubation period of measles lasts 9-11 days. With the prophylactic administration of immunoglobulin, it can extend to 15-21 days, more rarely - longer. Some symptoms of measles are noted from the second half of the incubation period (weight loss, puffiness of the lower eyelid, hyperemia conjunctiva, subfebrile condition in the evenings, cough, small rhinitis).

Classification of measles

1. Reactive measles.

• By gravity:
  • Light.
  • The middle-aged.
  • Heavy.
• Type:
  • Typical.
  • Atypical:
    • hemorrhagic;
    • stupid;
    • rudimentary.

2. Mitigated measles (weakened, in children exposed to seroprevention).
3. Measles in vaccinated children.

In the prodromal period of measles (duration 2-4 days in children and 5-8 days in adults), measles symptoms resembling respiratory infections are: malaise, cough, runny nose with copious discharge from the nose, conjunctivitis with lacrimation, fever (up to 40 ° C) , associated with the second wave of viremia. Shortly before the rash, there are spots of Filatova-Belsky-Koplik (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 cheek and lips are inflamed, lips sometimes turn red. Sometimes on the face, trunk and extremities of the patient on the 2-3 rd day there is a rash in the form of small specks, accompanied by itching (the so-called prodromal rash).

A characteristic red non-spitting patchy-papular rash appears on the head along the line of hair growth and behind the ears, extends to the face, trunk and limbs, including on the palms and feet, often becoming draining: In the 1st day, the elements of the rash appear on the face, neck ; on the 2nd day - on the trunk, arms and thighs; on the 3rd day the rash seizes the lower leg and foot, and on the face begins to turn pale. The densest elements of the rash are located on the face, neck and upper body. The rash consists of small papules (about 2 mm), surrounded by an irregularly shaped patch with a diameter of more than 10 mm. Elements of the rash merge, forming complex shapes with scalloped edges, but even with the thickest rash, you can find areas of perfectly normal skin color. In some cases, against a background of measles exanthema, hemorrhages (petechiae) can be noted. During the period of rash, the condition of the patients is the most severe. On the 4th day the rash begins to fade in the same order in which it appeared. Pigmentation is preserved for 1-2 weeks, otrierevidnoe peeling on the face and trunk - 5-7 days. The temperature is normalized on the 4th-5th day from the onset of the rash. A longer-term fever indicates the development of complications.

The hemorrhagic form of the disease has pronounced symptoms of measles and intoxication, the defeat of the nervous system with a disorder of consciousness and acute cardiovascular insufficiency. Characterized by multiple hemorrhages in the skin and mucous membranes, hematuria; possibly development of hemocolitics.

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

Mitigated measles develops in children after the introduction of an immunoglobulin or other drugs containing antibodies in 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; shortens and breaks the stage of rashes.

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

The defeat of the mucous membrane of the respiratory tract in a number of cases leads to the development of laryngitis, laryngotracheitis, bronchitis, false croup, bronchiolitis. Severe laryngotracheitis (necrotic, ulcerative) occurs during pigmentation in connection with the attachment of secondary flora and is accompanied by aphonia.

The most severe complication is interstitial giant cell pneumonia of severe course, develops more often in individuals with immunodeficiencies; In the lungs, infiltrative changes are revealed, multicore giant cells are found in the sputum. In developing countries, this is the main cause of deaths associated with measles, mainly among children under 2 years of age.

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

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

Severe complication of measles - the defeat of 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 measles symptoms appear as: drowsiness, blocking, frustration of consciousness, convulsions, amyema, nystagmus, abdominal reflexes disappear, the facial nerve is affected, limb paralysis develops. In most cases, CNS lesions are caused by an immune response to the myelin proteins of the virus, and not by its direct action. In patients with impaired 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-flowing form of measles encephalitis. It is more common in children who have suffered measles before the age of two. Develops a few years after the disease and usually in a few months leads to dementia and death. The disease is characterized by a very high titre of anticorrosive antibodies in the serum and spinal fluid.

Gastrointestinal complications - gastroenteritis, hepatitis, appendicitis, colitis, mesadenitis. Serum often increases the activity of ALT and ACT, although jaundice may not be present.

Among the rare complications of measles are myocarditis, glomerulonephritis. Thrombocytopenic purpura. Measles can lead to an exacerbation of tuberculosis, apparently because of the inhibition of cellular immunity.

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