Measles - semiology and a clinical course Measles — the acute infectious disease characterised by an inflammation of mucous membranes of respiratory

Measles - semiology and a clinical course

Measles — the acute infectious disease characterised by an inflammation of mucous membranes of respiratory ways, eyes, is spotty-papuleznoj a rash, the general intoxication.
Aetiology.
The measles activator — a virus which develops in live cages. Out of a human body quickly loses the pathogenic properties and perishes. It is sensitive to drying and action of solar beams.
Эпидемиология.
With measles the person who is a unique source of an infection is ill only. Sick measles it is infectious from first day of illness (probably, and from last day the incubatory period) till 5th day (inclusive) from the moment высыпания. In the presence of a pneumonia infectivity of the patient is extended for 5 days. The patient is most infectious in катаральном the period. The infection is transferred by an air-drop way. Through the third party, foodstuff, subjects the measles are not transferred. In connection with fast destruction of a virus out of a disinfection organism it is not required. Enough the ambassador of isolation of the patient it is good to air a premise.
Especially hard the measles proceed at children of early age with the bad physical development, suffering an anaemia, a rickets, экссудативным a diathesis, etc. diseases.
With measles children of first three months of a life are not ill. However the newborn can be ill with measles if mother measles was not ill. In case of disease by measles of mother some days before sorts the child can be born sick of measles or be ill with it in the first days after a birth. The susceptibility to measles at children is insignificant 3—6 months. From nine-monthly age the susceptibility to measles increases. The highest disease among children till 5 years. After the transferred measles there is a lifelong immunity (immunity).
Патогенез and pathological anatomy. Entrance collars of an infection are the top respiratory ways, whence a virus gets into blood where it is found out already in the incubatory period. At hit in an organism the virus causes катаральное an inflammation of respiratory organs, a digestive path, a skin, influences the central nervous system. At measles deep functional infringements in an organism of the patient, the provoking latent diseases sharply reducing stability to influence of a secondary infection and promoting a heavy current of accompanying diseases are observed. The specific morphological changes caused by action of a virus of measles, consist in гигантоклеточном transformation мезенхимальных and эпителиальных cages, development early гематогенной интерстициальной a pneumonia. At occurrence of complications inflammatory process can pass to walls of a trachea, bronchial tubes, перибронхиальную and a pulmonary fabric.
Clinical picture.
In a clinical current of measles distinguish four periods: incubatory, катаральный (продромальный), the period высыпания, the period of fading of a rash.
The incubatory period at measles — to 21 days, more often 9—11 days. In this period disease can be shown by nothing.
The kataralnyj period proceeds 3—4 days. The temperature ° raises till 38-40. There is a cold, dry cough, конъюнктивит, a photophobia, слезотечение, a symptom Velsky — Filatova — Koplika. This symptom is expressed in occurrence on a mucous membrane of cheeks against molars, sometimes on all mucous membrane of an oral cavity of the small white specks similar to semolina (partial омертвение cages of a mucous membrane of an oral cavity). On soft and partially on a hard palate there are small red specks (энантема) which in 1—2 days merge with the general redness of a pharynx. Vomiting and the belly-aches feigning an appendicitis are sometimes observed.
The period высыпания begins by the end of 4 days with occurrence is spotty-papuleznoj rashes, in the beginning on a forehead, behind ears, on a nose, cheeks, lips, a chin. For 2nd day the rash extends on a trunk, for 3rd day — on finiteness. The rash can be drain, large, wrong outlines, from pink to crimson colour. The symptom Velsky — Filatova — Koplika disappears by 2 day высыпания.
Within first two days высыпания a condition of the patient heavy, a heat, the person bloated, the cold, cough, sometimes purulent allocation from eyes, at chest children is marked a liquid chair. In 4 days the rash turns pale in that sequence in what began высыпание — from top to down (the period of fading of a rash). On a rash place there are dark pigmentary stains which keep about one week, and at physically weakened children till 3 weeks.
On a skin can be отрубевидное a peeling. In the end of the period высыпания the temperature decreases to norm, the condition of the child improves.
Митигированная (facilitated) measles, develop at introduction to the child in the incubatory period of gamma globulin. At митигированной reproach the incubatory period about 21 days are extended. Small lifting of temperature is observed or it remains normal. Intoxications, as a rule, do not happen.
The prodromalnyj period short. The kataralnye phenomena are poorly expressed that causes its smaller infectivity. Stains Velsky — Filatova — Koplika often are absent. A rash in the form of seldom scattered gentle pink папул. Pigmentation keeps no more than 2 days. After митигированной to measles there is a lifelong immunity. However the chest children who have transferred митигированную a measles, immunity have not enough racks.
Complications at measles are a death principal cause. Patients do not die of not complicated measles. A pneumonia caused by influence of a virus of measles and stratification of bacterial flora, — the most frequent and hard proceeding complication at children of chest age. Appears during the period высыпания, and in physically weakened children can be found out already in катаральном the period. The laryngitis can arise in катаральном the period. It is shown by hoarseness, rough "barking" cough. Comes to an end by the period высыпания. The laryngitis arising during the period высыпания, differs a heavy, long, wavy current, especially at children of chest age. The laryngitis can sometimes cause difficulty of passage of air through a throat, demanding surgical intervention.
Энцефалит it is observed seldom, differs the heavy current, proof defeat of the central nervous system, quite often bad forecast. Arises more often at children of advanced age.
The diagnosis at a typical current does not represent difficulties. It is necessary to distinguish stains Velsky — Filatova — Koplika from small афт and elements of the milkwoman.
The measles should be differentiated with аденовирусной and энтеровирусной infections. At аденовирусной infections it is not observed a symptom Velsky — Filatova — Koplika and этапного высыпания rashes. Unlike measles, энтеровирусная the infection (with кореподобной a rash) amazes children of all age, including. And first three months of a life, the rash appears at temperature recession, keeps 1 — 1/2 day, does not leave pigmentation. At энтеровирусной infections are absent катаральные the phenomena, stains Velsky — Filatova — Koplika, and also этапность высыпания rashes. The measles with скарлатиноподобной a rash in катаральном the period are necessary for differentiating from a scarlet fever.