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Lecture notes, cheat sheets
Infectious diseases. Measles. Rubella. Etiology, pathogenesis, clinical picture, diagnosis, treatment (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 4. Measles. Rubella. Etiology, pathogenesis, clinic, diagnosis, treatment 1. Measles Measles is an acute viral disease with airborne transmission, characterized by cyclical course, fever, intoxication, catarrh of the respiratory tract and membranes of the eyes, maculopapular rash on the skin. Etiology. The causative agent from the family of paramyxoviruses is quickly inactivated in the external environment. The virus contains RNA, has an irregular shape. Unstable in the external environment, quickly dies under the influence of high temperatures, ultraviolet radiation, ether, and drying. It remains active for a long time at low temperatures and is not sensitive to antibiotics. Epidemiology. The source of infection is a person with measles. Virus carrying in measles has not been established. The patient is contagious in the last 2 days of the incubation period, the entire catarrhal period and in the first 4 days after the onset of the rash. The infection is transmitted by airborne droplets. After a reactive measles infection, persistent, lifelong immunity is developed. Pathogenesis. At the end of the incubation period and up to the 3rd day of the rash period, the virus is contained in the blood (viremia). There is a systemic lesion of the lymphoid tissue and the reticuloendothelial system with the formation of giant multinuclear structures. The virus infects the mucous membranes of the respiratory tract and causes perivascular inflammation of the upper layers of the skin, which is manifested by a rash. The role of allergic mechanisms has been proven. Possible persistence of the measles virus in the body after suffering measles with the development of subacute sclerosing panencephalitis, which has a progressive course and ends in death. Clinic. The following periods of illness are distinguished: 1) incubation (hidden) - 9-17 days. If the child was given immunoglobulin (or blood products) before or after exposure to a measles case, the incubation period may be extended to 21 days; 2) catarrhal (initial, prodromal) period - 3-4 days; 3) period of rash - 3-4 days; 4) pigmentation period - 7-14 days. The catarrhal (initial) period lasting 3-4 days is characterized by an increase in body temperature to febrile numbers, general intoxication, severe catarrhal inflammation of the upper respiratory tract and conjunctiva. Discharge from the nose is profuse, serous in nature, then a dry, sharp, obsessive cough appears. There are hyperemia of the conjunctiva, photophobia, lacrimation, swelling of the eyelids. A pathognomonic symptom that occurs 1-2 days before the rash is Belsky-Filatov-Koplik spots: small grayish-whitish dots appear on the mucous membrane of the cheeks near small molars (less often lips and gums), surrounded by a red corolla, the size of a poppy seed . They do not merge, they cannot be removed with a spatula, as they are small areas of necrotic epithelium. This symptom lasts 2-3 days. On the 4-5th day of illness, with a new rise in temperature, a rash appears, a period of rash begins, which lasts 3 days and is characterized by stages: at first, the rash is found on the face, neck, upper chest, then on the trunk and on the 3rd day - on limbs. The elements of the rash are large, bright maculopapular, non-pruritic, accompanied by a deterioration in the general condition of the patient, can merge with each other and, after fading, leave spotty pigmentation in the same order as they appeared. The rash lasts 1-1,5 weeks and ends with a small pityriasis peeling. During the period of pigmentation, body temperature normalizes, health improves, catarrhal phenomena gradually disappear. Measles occurs in mild, moderate and severe forms. In seroprophylactic individuals, mitigated (weakened) measles is observed, characterized by the rudimentary nature of all symptoms. The most common complications are laryngitis, which may be accompanied by stenosis of the larynx - an early croup associated with the action of the measles virus, and a late croup with a more severe and prolonged course; pneumonia associated, like late croup, with a secondary bacterial infection and especially frequent in young children; stomatitis, otitis, blepharitis, keratitis. A very rare and dangerous complication is measles encephalitis, meningoencephalitis. Measles in adults is more severe than in children. Symptoms of intoxication, fever, catarrhal manifestations are more pronounced. Diagnosis is based on anamnesis, clinical and laboratory data. In the blood test - leukopenia, eosinopenia, monocytopenia. A serological examination (RTGA) helps in accurate recognition. For early diagnosis, the method of enzyme-linked immunosorbent assay is used, with the help of which anti-measles antibodies of the IG M class are detected in the blood of a patient in the acute period of the disease, which indicates an acute measles infection, and class antibodies. IG G indicate a previous illness (vaccination). A differential diagnosis is made with acute respiratory infections, rubella (in which there is no catarrhal period, the rash appears immediately on the first day of illness and quickly spreads to the entire trunk and limbs, is located mainly on the extensor surfaces, is smaller, does not leave pigmentation, does not tend to merge, also typically an increase in the occipital and posterior cervical lymph nodes), allergic and drug rashes. Treatment. Specific treatment has not been developed. The therapy is based on bed rest until the temperature normalizes and body hygiene. Patients are hospitalized in cases of severe forms of the disease, the presence of complications, and children under 1 year of age are also hospitalized. Posyndromic symptomatic drug therapy is carried out. With complications of a bacterial nature - antibiotic therapy. Treatment of complications is carried out according to the general rules. Forecast. Deaths from measles are extremely rare. They are mainly found in measles encephalitis. Prevention. Vaccination is required for all children from 15-18 months of age. For this purpose, live measles vaccine Leningrad-16 is used. The diluted vaccine is administered once subcutaneously to weakened children without age restrictions, as well as to those under 3 years of age. Children under 3 years of age who have had contact with patients with measles are given prophylactic immunoglobulin in the amount of 3 ml. People with measles are isolated until at least 5 days after the onset of the rash. Children who have been in contact with patients and have not been actively immunized are subject to separation from the 8th to the 17th day. Children who have undergone passive immunization are separated until the 21st day from the moment of possible infection. Disinfection is not carried out. 2. Rubella Rubella is an acute viral disease with an airborne transmission, characterized by a short-term febrile state, a spotted rash and swelling of the posterior cervical and occipital lymph nodes. Etiology. The virus contains RNA, has a spherical shape, is unstable in the external environment, quickly dies under the influence of high temperatures, ultraviolet radiation and ether, and remains active for a long time when frozen. Epidemiology. The route of distribution is airborne with a primary lesion of children from 1 to 9 years old. There is a winter-spring peak of incidence. Sources of infection - a sick person or a virus shedder. An infectious patient is 7 days before the rash appears and 5-7 days after it appears. Innate immunity to rubella is present in children of the first six months of life, then it decreases. After the transferred rubella, a stable, lifelong immunity is developed. Clinic. The incubation period is 11-21 days, sometimes extended to 23 days. The prodromal period is unstable and lasts from several hours to one day; the appearance of enanthema in the form of small spots on the mucous membrane of the soft and hard palate against the background of hyperemia of the mucous arches and the posterior pharyngeal wall is also characteristic. During this period, enlarged posterior cervical, occipital and other lymph nodes appear. Simultaneously with a slight increase in temperature, a rash appears on the skin of the whole body, the duration of the rash is 2-4 days, the elements appear first on the face and spread to all skin integuments in the first day. The rash is small-spotted, soft, pink, plentiful, with even outlines, does not itch, and is mainly localized on the extensor surfaces of the limbs, on the back, lower back, buttocks. The elements of the rash do not tend to merge and disappear after 2-3 days, leaving no pigmentation. The state of health of the patient, as a rule, is almost not disturbed. A constant sign should be considered polyadenitis. Complications of postnatal infection are very rare (arthropathies, encephalitis). Intrauterine infection of the embryo leads to its death or the development of chronic rubella infection with damage to various organs and the formation of intrauterine malformations (microcephaly, hydrocephalus, deafness, cataracts, heart defects, etc.). Intrauterine infection after the end of organogenesis leads to the development of photopathy (anemia, thrombocytopenic purpura, hepatitis, bone lesions, etc.). In these children, the virus persists for a long time. Diagnosis is made on the basis of complaints, anamnesis, clinical and laboratory data. For early diagnosis, the ELISA method is used, where there is a detection in the blood of a patient in the acute period of the disease of anti-measles antibodies of the IG M class, which indicates an acute rubella infection, and IG G class antibodies indicate a previous disease (vaccination). The diagnosis of congenital rubella can be confirmed by the detection of viral antigens in biopsy specimens of tissues, blood, and cerebrospinal fluid. Differential diagnosis is carried out with measles, scarlet fever, enterovirus infection, allergic rash. Unlike measles, with rubella, in most cases there is no catarrhal period, Belsky-Filatov-Koplik spots, pronounced staging of the rash; the rash is paler, does not tend to coalesce, and leaves no pigmentation or scaling. An accurate diagnosis is assisted by a serological examination (RTGA). Treatment is carried out on an outpatient basis, patients with severe course, with complications from the central nervous system, or patients according to epidemiological indications are subject to hospitalization. Assign symptomatic treatment, vitamin therapy. The prognosis is favorable. Prevention. Isolation of the patient - at least 7 days from the onset of the disease (appearance of a rash). Contact isolation - for the period from the 11th to the 21st day from the moment of contact. It is necessary to protect pregnant women who have not had rubella from contact with patients for a period of at least 3 weeks. In case of contact of a pregnant woman with a patient with rubella, it is recommended to introduce hyperimmune gamma globulin (up to 20 ml). A woman's illness with rubella in the first 3 months of pregnancy is considered an indication for termination. A method has been developed for active immunization with a live rubella vaccine in children aged 12-15 years, and revaccination is carried out at the age of 6 years and girls at 13 years of age. Author: Gavrilova N.V. << Back: Whooping cough. Etiology, pathogenesis, clinic, diagnosis, treatment >> Forward: Chicken pox. Herpetic infection. Etiology, epidemiology, pathogenesis, clinic, treatment (Chicken pox. Herpetic infection)
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