Measles In Children - How To Determine? First Symptoms, Treatment And Prevention

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Measles in children: symptoms, treatment and prevention

Measles is a viral disease that is transmitted by airborne droplets. Children of the first year of life are in a special risk group. At this age, the antibodies received by the child from the mother should circulate in their bodies. Normally, they will protect the baby's body from infection. However, in modern women, their own immunity is often weakened, so they either have no antibodies to measles at all, or very few of them. Accordingly, such protection will not be enough for the child. Children are vaccinated against measles only after a year.

An infection that has entered the body affects the respiratory tract, oropharynx, and the organs of vision. A rash appears on the patient's body, signs of severe intoxication are observed. An infected person poses a danger to other people, since he releases viruses in large quantities into the external environment. This happens during sneezing and coughing. The first symptoms of the disease appear 10 days after infection.

Content:

• The mechanism of development of measles in children
• Measles stages and symptoms
• Diagnostics
• Complications of measles
• Measles treatment in children
• Measles prevention

The mechanism of development of measles in children

The measles virus dies quickly in the external environment. He is afraid of high temperatures and ultraviolet rays. He is not afraid of frosts and antibiotics.

Infection occurs through close interaction with a sick person. In this case, infection will occur with a 95% probability. The patient becomes contagious after the first symptoms of the disease appear and 4 days after their manifestation. In the future, he will simply be a carrier of the virus, but he will not be able to infect other people.

The virus is quickly transmitted through the air, as it has excellent volatility. He is able to overcome several floors, passing corridors.

After birth and up to 6 months, the child has protection against measles in the form of maternal immunity. By one year, this immunity becomes weaker, or completely disappears. If a woman has not been vaccinated against measles, then she will not have immunity, so she will not be able to protect her child with antibodies. If a person is ill with measles, then his immunity remains throughout his life.

The average incubation period is 8-17 days. Less often, it stretches up to 3 weeks.

The disease passes through 3 stages: the prodromal period, the period of rashes and the period of pigmentation.

The prodromal period has an acute course. The body temperature rises to feverish levels, a cough, a runny nose appears, the eyes swell and turn red. The patient's appetite worsens, he cannot sleep normally. Vomiting, fainting, and seizures may occur.

The disease negatively affects the child's immune system, provokes an allergic reaction, disrupts the metabolism of vitamin and mineral substances. All this becomes a favorable environment for the development of microbial flora, which in the future can lead to serious complications.

In recent years, more and more women are refusing to administer measles vaccines to their children. Therefore, in Russia from time to time there are massive outbreaks of infection. Measles is a human disease, animals do not suffer from it and are not distributors.

More than 80% of all infected children were not vaccinated. Moreover, in 30% of them, the medical challenge was justified.

Measles stages and symptoms

The incubation period for measles lasts up to two weeks (from 8 to 13-17 days), with passive immunization with immunoglobulin, it can last up to four weeks. The disease can have a typical and atypical form of varying severity.

Catarrhal period. The disease begins acutely and is manifested by general malaise, accompanied by headache, loss of appetite, insomnia. In patients, the temperature rises to 40 ° C, and the symptoms of intoxication in adults are much more pronounced than in children. From the first day of the disease, patients are worried about a runny nose with profuse mucous discharge, a painful dry cough, in pediatrics, the cough often becomes barking, it may be accompanied by loss of voice and stenosis of the larynx. In parallel, conjunctivitis develops, which is accompanied by edema of the eyelids, redness, injection of the sclera and suppuration.

In the morning, patients may have sticky eyelids, photophobia is noted, children may experience puffiness of the face, redness and granularity of the pharyngeal mucosa and hyperemia of the oral cavity. In adults, catarrhal symptoms are not so significant, in this category of patients, lymph nodes are more often enlarged, breathing can become hard, dry wheezing in the lungs can be heard. In some cases, the pathology is accompanied by a mushy stool.

After three to five days, the patients feel a little better, their temperature drops, but after a day the catarrhal symptoms and intoxication intensify again. The body temperature again becomes high, and characteristic spots of Filatov-Koplik-Velsky are noted on the mucous membrane of the cheek:

The rash protrudes somewhat, the spots are white and tightly fixed, their edges are hyperemic, they resemble semolina. In children, the rash disappears after the appearance of exanthema; at an older age, similar spots remain on the first day after its appearance.

A little earlier the spots of Filatov-Koplik-Velsky or together with them on the mucous membrane of the soft and hard palate becomes noticeable measles enanthema, which looks like red spots with a pinhead of irregular shape. On the second day, the spots merge and become invisible against the general background of the reddened mucosa.

The increase in symptoms of intoxication is often accompanied by dyspepsia. The catarrhal period usually resolves in five days, in adults it can last up to eight days.

The period of the rash replaces the catarrhal one, which is characterized by bright spots of papular exanthema, over time they merge and form figures, in the intervals of which you can notice areas of healthy skin. On the first day, the rash appears behind the ears, then covers the scalp and at the same time the face, neck and upper chest:

On the second day, the rash spreads to the trunk and upper arms; on the next day, elements of exanthema are noted on the legs and distal parts of the upper limbs, while on the face the rash becomes paler.

The descending sequence of rashes characteristic of measles is an essential differential diagnostic sign of the disease. In adult patients, the rash can be more pronounced than in children, usually it looks like large spots in the form of papules, which often merge with each other, with a more serious course of pathology, hemorrhagic elements may be observed.

During the period of rashes, catarrhal phenomena intensify, patients have a runny nose, cough, watery eyes, photophobia develops, fever and symptoms of intoxication become more pronounced. During a medical examination, patients have tracheobronchitis, which occurs with a moderate heartbeat and is accompanied by a drop in blood pressure.

The period of convalescence. During the period of convalescence, the general condition of patients becomes better, the body temperature returns to normal levels, the catarrhal symptoms subside. The elements of the rash become paler and over time pass in the order in which they previously appeared, acquiring the appearance of brown spots:

After five to seven days, there is no trace of pigmentation: it disappears, leaving behind a pityriasis skin peeling, mostly on the face. These symptoms are also of great importance in the diagnosis, although they serve as retrospective signs of the disease.

At this stage of the pathology, the activity of nonspecific and specific protective factors decreases in patients. The reactivity of their body comes to normal gradually, over several weeks or months, low resistance to various pathogens in patients who have recovered from measles is still preserved.

Measles is a serious viral disease. Its complications can be fatal. The death of a child does not happen because of measles itself, but because of the complications that it can provoke.

Video: Dr. Alexey Khukhrev, specialist in internal medicine "Measles - what is this disease and how is it dangerous?"

Diagnostics

Diagnosis of the disease is based on an assessment of its symptoms and laboratory diagnostics. The appearance of a patient with measles has characteristic features, including: swelling of the eyelids, swelling of the face, rash. It appears gradually, giving way to spots. The leukocyte count falls while the neutrophil count rises.

It is important to distinguish measles from allergy rashes. In the latter case, the rash will itch, and its appearance is preceded by contact with the allergen. Allergy symptoms will be controlled by taking antihistamines.

To confirm the diagnosis, the ELISA method is used, which in the early stages of measles development allows detecting antibodies to the virus in the blood. RTGA studies with measles antigen are also performed.

Measles must be differentiated from rubella, influenza, whooping cough, enterovirus infection, herpes, etc. Therefore, it is so important to pay attention to measles-specific symptoms, in particular, to Belsky-Filatov-Koplik spots, to swelling of the eyelids, to palate exanthema.

Complications of measles

In most cases, measles is benign, but in some cases it can cause a variety of complications. After the illness, croup, bronchitis, bronchiolitis, and in rare cases pneumonia may develop. Interstitial giant cell pneumonia occurs in children with systemic diseases and is accompanied by vivid respiratory symptoms; infiltrates and multinucleated giant cells can be observed in the lung tissue.

Such symptoms may not be accompanied by rashes typical of the disease. In some cases, uncomplicated measles can cause corneal ulcers, as well as keratitis and blindness.

In 20% of cases, patients with measles develop myocarditis with transient ECG changes without clinical symptoms of pathology.

Lymph node involvement can cause abdominal pain. Measles is often accompanied by hepatitis without pronounced clinical manifestations, which appears in the acute phase of the disease. The measles rubella transferred during pregnancy causes fetal death, and a teratogenic effect similar to rubella is not observed.

Recurrent bacterial pneumonia occurs due to streptococci, pneumococci, staphylococci, influenza sticks and can turn into empyema or lung abscess. In pediatrics, measles can be complicated by bacterial otitis media; in the tropics, the course of the disease can cause a pathology of bacterial genesis, which threatens the patient with a coma.

After three days or a couple of weeks, measles can be complicated by thrombocytopenia, the infection can cause the formation of purpura, bleeding in the mouth, in the intestines and urinary tract. The disease, in addition, contributes to the transient suppression of delayed hypersensitivity to tuberculin and contributes to the exacerbation of tuberculosis and the emergence of new cases of infection.

Complications of measles from the central nervous system

One out of a thousand patients has encephalomyelitis with severe clinical symptoms, with the first manifestations occurring about five days or more after the first rash. The complication is accompanied by severe fever, headache, insomnia, and coma. In some cases, patients show signs of focal lesions of the spinal cord or brain.

Measles encephalomyelitis in 10% of cases causes death, in addition, there are also signs of persistent complications from the central nervous system: the disease can cause mental disorders, epilepsy and paralysis.

The uncomplicated course of the disease causes changes in the electroencephalogram in half of the patients, while other symptoms of CNS damage may be absent. Children who contract measles against the background of malignant diseases of the lymphatic system and are treated with drugs that suppress the immune system may develop progressive encephalitis, which can cause death of patients six months after the first symptoms of measles appear.

In rare cases, neurological complications occur: transverse or ascending myelitis. Rarely enough, the disease is accompanied by subacute sclerosing panencephalitis.

Measles treatment in children

If the disease is mild, then you just need to monitor the patient's hygiene. He should be in a warm room that is regularly ventilated. Bathing is important. The eyes are washed with a solution of boric acid with a concentration of 2%, the mouth is rinsed.

With pneumonia, the patient is shown intravenous administration of drugs to relieve intoxication and antibiotics of the penicillin group. If it is not possible to use penicillins, then they are replaced with cephalosporins or macrolides.

The child needs to eat properly and fully. Dishes should be light. Broths, cereals, jelly, bread are suitable. If the child is small, then he is given ascorbic acid and milk.

The child should not be forced to eat by force. At high body temperature, there is no appetite, which is normal. It is enough to make sure that the baby drinks water. If you load the body with food, it will lead to additional stress on the liver, kidneys and the gastrointestinal tract as a whole.

It is equally important to keep the oral cavity clean. In order not to provoke eye irritation, you should dim the light, make it less bright. The room should not be cool. When the cough has passed, you can take the child for a walk. He no longer needs isolation.

If the child has not yet fallen ill, but had contact with the sick, what to do?

1. Get vaccinated urgently (if less than 72 hours have passed since contact, quarantine is not required);

2. If more than 72 hours have passed since the moment of contact, but less than 6 days, use normal human immunoglobulin, which is sold in Russia under the names Octagam, Pentaglobin, Gamimun

If the child does get sick, then you should understand that there is no special treatment for measles. You can only take extra vitamin A to reduce the risk of complications. After the rash appears, measles resolves in 4-6 days.

Measles prevention

Measles prevention is achieved by developing active and passive immunity. For these purposes, an immunoglobulin or a vaccine containing a live attenuated virus can be used.

Passive measles prevention

For passive prevention of measles, immunoglobulin is used, it must be administered to a person who has been in contact with a patient with measles, no later than 72 hours. The drug contains an active protein fraction that is released from donor plasma. The form of the vaccine is 1.5 ml ampoules containing one dose of the active substance, or 3 ml ampoules containing two doses. The package contains 10 ampoules. The immunoglobulin is stored in the refrigerator, the shelf life of the drug is two years.

Active prevention of measles

Currently, Russia has achieved a fairly high level of coverage of the population with measles vaccination, this concerns the primary and secondary vaccination. The country has created real prerequisites for the elimination of the pathogen according to the terms recommended by WHO.

The fact that measles today is more common in adolescents and adults was a consequence of the incomplete coverage of children at one year of age in previous years (about 85% of babies had previously received the vaccine), as well as the fact that only children with low antibodies were re-vaccinated based on testing results.

The age shift is also caused by the loss of immunity with age in some patients. It is also known that the real figures on the incidence of measles exceed the official statistics by about five times.

The first vaccine for children who have not had measles is given at 12–15 months, and re-vaccination is carried out at 6 years of age. Thus, children who have not been vaccinated for any reason, as well as children with low immunity to the disease that formed after the first vaccination, receive protection before school.

The measles vaccine is compatible with the mumps, rubella and hepatitis B vaccine. The injection is given in different parts of the body and requires the use of different syringes. Most often, in practice, two injections are carried out, putting two vaccines at intervals of 30 days. If it is necessary to put the Mantoux reaction, it is done at the same time or six months after the measles vaccination, since the vaccination process contributes to the low sensitivity of the skin to tuberculin, which leads to a false-negative result.

If all recommendations for vaccination are followed, immunity is developed in almost 100% of vaccinated children of the second year of life after 21 or 28 days. Immunity lasts 25 years and only in a small number of people fades over time.

The vaccine is administered subcutaneously or intramuscularly in the area of the scapula or shoulder. In order to prevent a decrease in the effectiveness of the drug, contact of the contents of the ampoule with ether, alcohol and detergent is not allowed.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.