The most common and dangerous meningitis is whooping cough and measles. Measles, rubella, whooping cough, chickenpox: etiology, routes of infection, pathogenesis, main morphological manifestations, complications, outcomes, significance
Measles
Measles is a highly contagious acute viral disease, transmitted by airborne droplets and manifested by increased body temperature, inflammation of the mucous membranes of the respiratory tract and conjunctiva, and a gradually appearing maculopapular rash.
ETIOLOGY
The causative agent of measles is an RNA virus from the paramyxovirus family. Measles virus - type species of the genus Morbillivirus(from lat. morbilli measles), contains a nucleocapsid and a lipoprotein shell. The antigenic structure is stable. All known strains belong to the same serological variant. The measles virus is unstable in the external environment, sensitive to insolation, high temperature and is quickly destroyed by disinfectants and detergents. After long passages on tissue media, attenuated non-pathogenic strains with high antigenic activity are obtained from some strains, which are used to obtain a vaccine against measles.
EPIDEMIOLOGY
The source of infection is a sick person who is contagious from the last 1-2 days of the incubation period until the 4th day from the moment the rash appears. The route of transmission of infection is airborne droplets. The virus enters the environment with droplets of mucus when the patient coughs, sneezes, or talks; can spread with air currents over long distances, penetrate into adjacent rooms and adjacent floors. Due to the low resistance of the measles virus, transmission of infection through objects and third parties is impossible. Susceptibility to measles can be considered universal (more than 95%).
and from the 5th day of the rash the patient is considered non-infectious. After the introduction of vaccination, the incidence of measles decreased significantly. Nowadays, measles often occurs in older children and adults. Cases of the disease in newborns and children in the first 3 months of life are observed extremely rarely. Children in this group have passive immunity (ATs received from the mother if she had measles or was vaccinated), which completely disappears after the 9th month of life. The peak incidence of measles occurs in the spring and summer months. The frequency of epidemic morbidity is 4-7 years. Immunity after measles is lifelong. Recurrent diseases occur extremely rarely, mainly after mitigated measles or in weakened children who had measles in early childhood.
PATHOGENESIS
The entry point for infection is the mucous membranes of the upper respiratory tract. Primary fixation and reproduction of the virus occurs in the epithelium of the upper respiratory tract and regional lymph nodes, and then the pathogen enters the bloodstream (on the 3-5th day of the incubation period). The pathogen disseminates hematogenously throughout the body, fixing itself in the reticuloendothelial system. The period of viremia is short, the number of viruses in the blood is small, they can be neutralized by the introduction of Ig, which is the basis for passive prevention of measles in children who have been in contact with patients. Reproduction of the virus in infected cells of the reticuloendothelial system leads to their death and the development of a second wave of viremia with secondary infection of the conjunctiva, mucous membranes of the respiratory tract and oral cavity. The circulation of the virus in the bloodstream and the developing protective reactions cause damage to the walls of blood vessels, swelling of tissues and necrotic changes in them.
The dynamics of the production of specific antibodies corresponds to the primary immune response: IgM appears in the early stages, followed by IgG, the level of which reaches a maximum by the 15th day from the moment of rash. It is extremely rare that the measles virus can persist for a long time in the brain tissue, which leads to the development of subacute sclerosing panencephalitis.
CLINICAL PICTURE
The incubation period lasts 9-17 days. In children who received Ig for prophylactic purposes, it may be extended to 21 days. The clinical picture of measles is characterized by successively replacing each other periods: catarrhal, rash period and pigmentation period.
Catarrhal period
The catarrhal period lasts 3-6 days. The patient's body temperature rises, catarrhal symptoms appear and increase: conjunctivitis with severe photophobia, runny nose, cough; well-being is disturbed. After 2-3 days, enanthema is detected on the mucous membrane of the soft palate. Soon, on the mucous membrane of the cheeks near the lower molars, less often on the gums, lips, and palate, characteristic Belsky-Filatov-Koplik spots appear (Fig. 22-1 on the inset) - grayish-white spots the size of a grain of sand, surrounded by a red corolla. By the end of the catarrhal period, body temperature decreases, but the manifestations of rhinitis and conjunctivitis intensify, and the cough becomes rough. The child's face has a characteristic appearance: puffy, the eyelids are swollen, photophobia and lacrimation are characteristic.
Period of rash
The period of rash begins with a repeated rise in body temperature (up to 38-40? C) and a deterioration in the general condition of the patient. During the entire period of the rash, lethargy and drowsiness persist; There may be abdominal pain, diarrhea; Photophobia, runny nose, and cough increase sharply. Belsky-Filatov-Koplik spots usually disappear 12 hours after the appearance of skin rashes, leaving behind roughness on the oral mucosa. Measles is characterized by a maculopapular rash, which is located on an unchanged skin background; individual elements of the rash merge with each other, forming larger spots of irregular shape; in severe cases, hemorrhages may also occur. A characteristic sign of measles is the staged nature of the rash. The rash first appears behind the ears and along the hairline, then spreads from top to bottom: on the first day it quickly covers the face and neck, on the 2nd day - the torso, on the 3rd-4th - the whole body, spreading to the proximal, and then distal parts of the arms and legs (Fig. 22-2 inset).
Elements of the rash begin to fade after 3 days. They become heterogeneous - bright maculopapular rashes predominate on the torso and limbs; on the face, the color of individual elements of the rash is less bright, brownish-cyanotic, then brown.
Pigmentation period
The period of pigmentation begins on the 3-4th day of the rash. Pigmentation appears in the same sequence as the rash. During this period, body temperature normalizes, catarrhal symptoms decrease and disappear, the rash acquires a brown tint and does not disappear when the skin is pressed and stretched. After 7-10 days, pityriasis-like peeling appears, the skin gradually clears.
CLASSIFICATION
When making a diagnosis, a classification based on the principles proposed by A.A. is used. Koltypin and M.G. Danilevich. The type, severity and characteristics of the course of measles are taken into account (Table 22-1).
Table 22-1.Classification of measles*
* According to Uchaikin V.F., 1998.
The typical form (prevalent in modern conditions) is characterized by a cyclical course with changing clinical periods and pronounced classical symptoms. Atypical forms develop in 5-7% of cases, proceed more easily, sometimes with the absence of individual symptoms or periods of illness. A special place is occupied by mitigated measles, which develops in the presence of antibodies to the measles virus (donor or maternal) in the blood. Sometimes this form occurs in children in the second half of life, but more often in persons who received Ig during the incubation period after contact with a measles patient, or if the disease was preceded by a plasma transfusion. With mitigated measles, the incubation period is extended to 21 days, the periods of illness are shortened, and immunity is unstable. All symptoms (temperature reaction, catarrhal symptoms, intensity of rashes) are mild, but the rash remains staged and turns into pigmentation.
The severity of measles is determined depending on the severity of the fever, rash, and duration of the disease.
COMPLICATIONS OF MEASLES
Complications of measles are distinguished by etiology, timing of occurrence and localization (Table 22-2).
Distinguishing signs of complications from the usual but pronounced symptoms of measles in the catarrhal and rash periods is sometimes difficult. This is especially true for early complications from the respiratory and digestive organs. During the period of pigmentation, complications include all emerging pathological conditions, even mild and short-term ones. The development of secondary complications is indicated by the lack of normalization of body temperature after the 3-4th day from the moment of the rash or a new rise in temperature.
Table 22-2.Complications of measles*
According to Uchaikin V.F., 1998.
body temperature after its decrease, the appearance of symptoms of damage to the respiratory system, digestion, and nervous system. Regardless of the timing of development, complications of measles immediately include laryngitis, pneumonia, otitis media, and encephalitis.
DIAGNOSTICS
The diagnosis of measles is established based on a combination of epidemiological and clinical data:
Contact with a person with measles 9-17 days before the onset of catarrhal symptoms (with mitigated measles - 9-21 days);
The appearance of Belsky-Filatov-Koplik spots against the background of severe catarrhal phenomena and conjunctivitis;
A maculopapular rash that appears on the 3-4th day from the onset of the disease, accompanied by a second wave of fever and increased runny nose and cough;
The staged nature of the rash, pigmentation of the rash elements followed by pityriasis-like peeling.
DIFFERENTIAL DIAGNOSTICS
Diagnostic criteria vary during different periods of measles. In the catarrhal period, the only sign that allows one to reliably distinguish incipient measles from ARVI, primarily of adenoviral etiology, is the Belsky-Filatov-Koplik spot. During the period of rashes, it is necessary to carry out a differential diagnosis of measles with some infectious diseases accompanied by the appearance of a rash, as well as allergic exanthema (Table 22-3).
Table 22-3.Differential diagnostic signs of acute infectious diseases occurring with the appearance of a rash
Disease | Day of appearance rash | Type rash | Localization rash | Dynamics of rashes | Characteristic clinical syndromes |
Measles | 3-5th | Maculopapular | 1st day - face, 2nd - torso, 3rd - limbs | Stagedness, pigmentation, peeling | Fever, catarrhal symptoms, Velsky-Filatov-Koplik spots |
Rubella | 1st-2nd | Small-spotted | Face, extensor surfaces of limbs, back | Disappears without pigmentation | Enlargement of the occipital, postauricular and posterior cervical lymph nodes |
Enteroviral exanthema | 1st-3rd | Spotted | Face, torso; at the height of the fever or when it decreases | Disappears within a day | Fever, headache, weakness, vomiting, hyperemia of the upper half of the body |
Allergic exanthema | 1st | Polymorphic, itching; urticarial | No specific location | Disappears without pigmentation | Connection with errors in diet, prescription of medications |
TREATMENT
Treatment is usually carried out at home. Patients with severe disease or complications, as well as for epidemiological and social indications, are hospitalized. Bed rest is prescribed until body temperature normalizes. Food should be mechanically and thermally gentle. Drinking plenty of fluids is recommended. To prevent bacterial complications, careful care of the mucous membranes and skin is necessary. Drug therapy for uncomplicated measles is symptomatic: antipyretics (paracetamol), vitamins. For purulent conjunctivitis, instillation of a 20% sulfacetamide solution into the eyes is prescribed; for severe rhinitis, vasoconstrictor drops into the nose. Frequent obsessive coughs are relieved by prescribing cough medicines, herbal decoctions, butamirate, etc. If complications develop, treatment is carried out in accordance with their etiology, location and severity.
PREVENTION
The most effective measure to reduce the incidence of measles is to vaccinate at least 95% of the population. In Russia, active immunization against measles is carried out with a live attenuated vaccine prepared from the vaccine strain L-16 (Leningrad 16). The vaccine is administered in a dose of 0.5 ml subcutaneously (under the shoulder blade or in the shoulder area) or intramuscularly. Vaccination is carried out for all healthy children at the age of 12 months and again at 6 years. On the 6-15th day after vaccination (as a variant of the normal infectious process), a short-term increase in body temperature, catarrhal symptoms, and sometimes the appearance of a measles-like rash are possible. Regardless of the severity of the reaction to the vaccine, the child is safe for others. Combination drugs have been developed that also include vaccines against rubella and mumps.
General anti-epidemic measures include early identification and isolation of the source of infection, as well as measures among contacted persons.
Activities in the outbreak: isolation of sick people from the onset of the disease until the 5th day of rash; with the development of pneumonia - until the 10th day of illness; ventilation of the room in which the patient was located, thorough wet cleaning; emergency vaccination or passive immunization of contact children (who have not had measles and have not been vaccinated); Isolation of children who have not had measles and who have not received vaccination from the 8th to the 17th day from the moment of contact, and those who received Ig - until the 21st day.
For emergency vaccination in children's institutions after the introduction of measles, live measles vaccine is used. It is introduced first
5 days after contact for children who have not had measles, have not been vaccinated and have no contraindications to vaccination. Passive immunization (intramuscular injection of Ig in a dose of 1.5-3 ml no later than the 5th day after contact) is carried out for children who have been in contact with a patient with measles, who have not been vaccinated and who have contraindications to vaccination. The final decision as to which of the contact children is subject to passive immunization is possible after a serological examination - passive immunization is advisable only if the results of RPGA (RTGA) are negative, i.e. in the absence of specific antibodies in the blood.
FORECAST
In modern conditions, the prognosis is favorable. The prognosis worsens with the development of currently rare severe complications (encephalitis, stenosing laryngitis, bacterial pneumonia, etc.), especially in young children.
Rubella
Rubella is an acute viral disease that occurs in two forms, which have a significant difference in the mechanism of infection and clinical picture - acquired and congenital. Acquired rubella is characterized by airborne transmission of infection, moderate intoxication, small-spotted rash, and generalized lymphadenopathy. Congenital rubella is characterized by a transplacental route of transmission, a chronic course of the infectious process with the formation of various malformations in the fetus.
ETIOLOGY
The causative agent of rubella is an RNA virus from the genus Rubivirus families Togaviridae. The virus is tropic to epithelial, lymphoid, nervous and embryonic tissues, unstable in the external environment, and thermolabile. It exhibits a mild cytopathic effect and the ability to become chronically infected. Serologically of the same type, one serovar of the rubella virus is isolated
EPIDEMIOLOGY
The source of infection is a sick person or carrier. The patient is contagious during the last 2-3 days of the incubation period and during the first 7 days of the disease. Patients with congenital rubella pose an epidemic danger within a year after birth. The route of spread of acquired rubella is airborne,
congenital - transplacental. Less contagious than measles and chicken pox. Susceptibility to infection is high (80%).
Acquired rubella can be contracted at any age, with the exception of the first 6 months of life (due to the presence of natural passive immunity - AT, received from the mother). Children from 1 to 7 years old, organized in children's groups, are most often affected, since close and prolonged contact is necessary for infection. In families and hospitals, people who were in the same room or ward with the patient become ill with rubella. The rubella virus poses the greatest danger to pregnant women due to the possibility of its transplacental transmission to the fetus. The number of seronegative women of childbearing age currently amounts to 20% or more. In Russia, the incidence of rubella ranges from 200 to 800-1500 (during epidemic years) per 100,000 population. The incidence of rubella is far from being fully taken into account, which is due to the presence of asymptomatic and erased forms. The peak incidence occurs in the winter and spring months. The epidemic process of rubella is characterized by outbreaks and epidemics. The frequency of epidemic morbidity is 5-7 years. Following a rubella epidemic, 6-7 months later there is an increase in the incidence of congenital rubella. After an infection, lifelong immunity is developed.
PATHOGENESIS
The pathogenesis of acquired rubella has not been sufficiently studied due to the lack of an adequate model in laboratory animals. The virus enters the body through the upper respiratory tract, is adsorbed on the epithelium of the mucous membranes of the oropharynx and enters the bloodstream. Viremia leads to the introduction of the virus into the lymph nodes, where it replicates, and causes skin rashes. With the appearance of the rash, viremia ends, which coincides with the appearance of antibodies to the virus in the blood. Specific antibodies of the IgM class appear in the blood in the first days of the disease, reaching a peak by the 10-15th day, then their level gradually decreases, and they are replaced by antibodies of the IgG class, which determine final immunity.
The pathogenesis of congenital rubella has been somewhat better studied. When a pregnant woman is infected, the virus penetrates the placenta and affects the capillary endothelium, causing fetal hypoxia. The virus spreads through the fetus's body through the blood. Intrauterine infection is most dangerous in the early stages of development. The formation of developmental anomalies of various organs occurs as a result of the virus suppressing mitotic activity and slowing the growth of individual cell populations. The direct cytodestructive effect of the virus is also allowed, in particular in the lens of the eye and the cochlea of the inner ear. Critical
The periods of formation of defects during the intrauterine development of the fetus are considered to be: for the brain - 3-11 weeks, for the eyes and heart - 4-7 weeks, for the hearing organ - 7-12 weeks.
CLINICAL PICTURE
Acquired rubella
The incubation period lasts 14-24 days (18?3 days). In the last days of this period, the virus begins to be released from the nasopharynx. The prodromal period lasts 1-2 days and is characterized by a slight increase in body temperature and mild catarrhal symptoms. A small-spotted rash (Fig. 22-3 on the inset) on an unchanged skin background, not prone to merging, appears on the face within one day and quickly spreads to the torso and limbs. The rash is most pronounced on the face (cheeks), extensor surfaces of the limbs, back, and buttocks.
1-5 days before the rash, the occipital, posterior cervical, and parotid lymph nodes enlarge (up to 8-12 mm in diameter). In addition to rash and lymphadenopathy, there may be a short-term increase in body temperature up to 38? C, mild catarrhal symptoms, and enanthema. Elements of the rash disappear after 1-3 days without pigmentation or peeling. Then the size of the lymph nodes gradually decreases.Classification.
There is no generally accepted classification of acquired rubella. In clinical practice, when making a diagnosis, rubella is classified according to the principles adopted for the classification of other childhood infectious diseases. According to the type of clinical manifestations, rubella can be typical and atypical, and according to the degree of severity - mild, moderate and severe. Its course can be smooth or complicated. The typical (manifest) form includes rubella with the presence of a rash, and the atypical form includes erased and asymptomatic forms. In erased forms, the disease manifests itself only as enlarged lymph nodes at normal body temperature or short-term low-grade fever. In asymptomatic forms, there are no clinical manifestations of the disease. In most cases, rubella is mild, rarely - in the form of moderate severity. Severe forms of rubella with complications or the accumulation of secondary infections are observed extremely rarely - mainly in older children and adults.Complications.
With rubella, complications develop very rarely, usually in older children or adults. Typical complications of rubella are polyarthritis and encephalitis.
redness, sometimes swelling of the metacarpophalangeal and proximal interphalangeal joints of the fingers, less often of the knees and elbows.
Encephalitis, developing with a frequency of 1:5000, is the most serious complication of rubella. Almost all patients have impaired consciousness, sometimes generalized clonic-tonic convulsions and focal symptoms develop. Possible death.
Congenital rubella
In the case of rubella in a woman during the 1st to 8th week of pregnancy, the embryo and fetus develop a chronic course of the viral infection. This pathological process leads to severe damage to various organs and the formation of intrauterine developmental defects. There is a high probability of spontaneous abortion or the birth of a child with congenital rubella. After the first trimester of pregnancy, the rubella virus has a less harmful effect on the mature fetus. The classic manifestations of congenital rubella are cataracts, congenital heart disease and deafness. However, other malformations are also possible: microcephaly, hydrocephalus, retinopathy, glaucoma, skeletal defects, etc.
LABORATORY RESEARCH
A general blood test reveals lymphopenia, lymphocytosis, plasma cells, and a normal ESR value. The virological method of isolating the virus is technically complex; it is used for scientific purposes. Serological studies use RTGA or RPGA in paired sera. An increase in the AT titer in the second sample compared to the first by 4 times or more confirms the diagnosis.
DIAGNOSTICS
The diagnosis of rubella is established based on a combination of clinical data taking into account the epidemiological history.
Acquired rubella.
The onset of the disease is the appearance of a rash.
The rash is small-spotted, spreads throughout the body throughout the day, and disappears without a trace.
Enlargement of the occipital, parotid and posterior cervical lymph nodes.
Mild symptoms of intoxication and moderate short-term catarrhal symptoms.
Contact with a person sick with rubella no earlier than 2 weeks before the onset of the disease.
Congenital rubella.
Rubella contracted by the mother in the first trimester of pregnancy.
The presence of congenital malformations, primarily cataracts, heart defects and deafness.
Clinical manifestations of IUI in a newborn.
Laboratory methods are rarely used: when retrospective confirmation of rubella is necessary, confirmation of congenital rubella syndrome or epidemiological studies.
DIFFERENTIAL DIAGNOSTICS
Differential diagnosis for rubella is carried out with measles, enteroviral exanthema, allergic rash, scarlet fever, pseudotuberculosis, infectious mononucleosis (Table 22-4).
Table 22-4.Differential diagnosis of rubella
Disease | General symptoms | Differences in rubella |
Scarlet fever | Finely spotted rash that appears within a few hours | The rash is located on an unchanged skin background and spreads to the extensor surfaces of the limbs and back. There is no sore throat, peeling of the skin of the fingers |
Infectious mononucleosis | Enlarged posterior cervical lymph nodes. Possible finely spotted rash | Lymph nodes are enlarged to a lesser extent. There is no prolonged fever, sore throat, enlarged liver and spleen, changes in peripheral blood typical of mononucleosis |
Pseudotuberculosis | Enlarged cervical lymph nodes. Maculopapular rash | There is no severe fever, abdominal pain, or tonsillitis. The rash appears at the beginning of the disease, and not on the 3rd-4th day; the localization of the rash characteristic of pseudotuberculosis (symptoms of “hood”, “gloves and socks”) is not observed. |
TREATMENT
Treatment is symptomatic. PREVENTION
Immunization with a live attenuated rubella vaccine is included in the compulsory vaccination schedule. Combination drugs have been developed that also include vaccines against measles and mumps. Vaccination against rubella is carried out at the age of 12 months, the vaccine is administered in a dose of 0.5 ml subcutaneously or intramuscularly. Second
Vaccination is carried out at the age of 7 or 13 years (for girls) to protect against rubella in children who have not been vaccinated or who have not developed immunity during the first vaccination. Sometimes, from the 5th to the 12th day after vaccination, enlargement of the occipital and cervical lymph nodes and a short-term rash may occur, which is regarded as a specific reaction to the introduction of a live attenuated virus.
Considering the ease of the course of rubella, the contagiousness of the patient already in the catarrhal period and the instability of the pathogen in the external environment, quarantine in children's groups in the case of rubella is not imposed. The following measures are carried out at the source of infection: the patient is isolated in a separate room for 5 days from the moment the rash appears; children who have been in contact with the patient remain in the group, but are subject to daily examination for 21 days; in foci of rubella, pregnant women are isolated and observed for 21 days (serological tests are required in paired sera).
FORECAST
The prognosis for acquired rubella is favorable, but with the development of encephalitis, mortality can reach 20-40%. With congenital rubella, the prognosis is unfavorable, which is determined by a delay in physical development and the presence of congenital anomalies. Immunity after rubella is usually persistent and lifelong.
Parotitis
Mumps is an acute infectious viral disease that occurs with damage to the glandular organs (usually the salivary glands, especially the parotid glands, less often the pancreas, genitals, mammary glands, etc.), as well as the nervous system (meningitis, meningoencephalitis). Based on the fact that the clinical manifestations of mumps are not limited only to damage to the parotid salivary glands, it is more appropriate to call the disease a mumps infection.
ETIOLOGY
The causative agent is an RNA virus of the family Paramyxoviridae. The antigenic structure is stable; One serovar of mumps virus is known. The pathogen is stable in the external environment (at an air temperature of 18-20? C it persists for several days, and at low temperatures - up to several months), but is quickly inactivated when exposed to high temperatures and disinfectants.
EPIDEMIOLOGY
The source of infection is only a sick person (manifest, erased and asymptomatic form). The greatest epidemic danger is posed by patients with erased forms of the disease. The virus is released in the patient's saliva, starting from the last hours (possibly from the last 4-6 days) of the incubation period and during the first 9 days of illness. Maximum contagiousness is noted in the first 3-5 days; after the 9th day the patient is considered non-infectious. The route of transmission is airborne. The transmission factor is close contact. Contagiousness index - 70%. Susceptibility is about 85%. Children of preschool and primary school age are most often affected. With age, the number of cases of the disease decreases due to an increase in the layer of immune individuals. Cases of the disease among children of the first year of life are extremely rare due to the presence of specific antibodies received from the mother transplacentally and with milk. In persons over 40 years of age, mumps is rarely observed. Seasonality: the peak incidence occurs in the winter and spring months. The frequency of epidemic morbidity is 2-3 or 3-4 years.
The absence of catarrhal phenomena and reduced salivation make it impossible for the infection to spread to a distance of more than 2 m from the patient, so people from the immediate environment are mainly infected. This, as well as the presence of asymptomatic forms of the disease, also explains the relatively slow spread of infection during an epidemic outbreak (compared to influenza, measles and other droplet infections). It is possible to transmit the virus through toys and household items contaminated with saliva, but this route is not significant.
PATHOGENESIS
The mumps virus, entering the body through the mucous membrane of the nasal cavity, mouth, pharynx and conjunctiva, first circulates in the blood (primary viremia), then enters the glandular organs (salivary, gonads and pancreas), as well as the central nervous system, where multiplies and causes an inflammatory response. The greatest reproduction of the virus occurs in the salivary glands. Primary viremia is supported by the repeated release of the pathogen from the affected organs (secondary viremia), so clinical manifestations of damage to a particular organ can appear both in the first days of the disease and at a later date. The persistence of the virus lasts 5-7 days, then IgM class antibodies appear in the blood. Final immunity with accumulation of IgG class antibodies is formed after several weeks.
CLINICAL PICTURE
The incubation period lasts 11-21 days (average 18), but can be shortened to 9 or extended to 26 days. The disease can manifest as isolated damage to individual organs or various combinations of characteristic syndromes (mumps, submaxillitis, serous meningitis or meningoencephalitis, orchitis, pancreatitis), occurring simultaneously or sequentially. Most often, mumps affects the salivary glands (mumps, submaxillitis, sublinguitis).
Mumps begins acutely with a rise in body temperature to 38-39? C, general malaise and pain in the parotid region, when opening the mouth and chewing, and sometimes tinnitus is noted. One of the early signs of mumps is pain behind the earlobe. Already on the first day, a swelling of doughy consistency can be palpated in front of the auricle and behind the angle of the lower jaw, at first, as a rule, one-sided. On the mucous membrane of the cheek on the affected side, you can find an edematous and hyperemic outlet of the parotid salivary gland duct. With the sequential involvement of the second parotid, submandibular, sublingual glands and other organs, repeated rises in body temperature occur. During the height of the disease, the face of patients takes on a characteristic appearance, which is why the name “mumps” arose. Enlargement, swelling, tenderness of the parotid and/or submandibular glands (unilateral or bilateral) persists from 2 to 7 days, after which the pain subsides, the size of the enlarged gland begins to decrease and normalizes by the 8-10th day.
Submaxillitis develops in every fourth patient. In this case, the swelling with a doughy consistency is located in the submandibular region.
Sublinguitis, manifested by swelling under the tongue, develops extremely rarely.
Lesions of the pancreas (pancreatitis), gonads (orchitis, oophoritis), mammary gland (mastitis), as well as the central nervous system (serous meningitis, meningoencephalitis) are more often observed in combination with inflammation of the salivary glands (Table 22-5). Sometimes changes in the central nervous system or glandular organs come to the fore or occur in isolation.
CLASSIFICATION
The classification of mumps is presented in table. 22-6. There are typical and atypical forms of mumps. Criteria for the severity of typical forms: severity and duration
Table 22-5.Clinical manifestations of damage to the glandular organs and central nervous system in mumps
Localization. Predominant clinical syndrome, frequency | Clinical manifestations |
Genital organs (testes, ovaries, mammary glands): orchitis (in adolescents and men); 10-34% | Increase in body temperature to 38-39? C 1-2 weeks after the onset of the disease, headache. Pain in the groin radiating to the testicle. Enlargement, hardening, soreness of the testicle, hyperemia of the scrotum. Reverse dynamics of symptoms after 5-7 days. Signs of testicular atrophy after 1-2 months |
Pancreas: pancreatitis; 3-72% (including asymptomatic forms) | Increased body temperature on the 5-9th day of illness. Pain in the abdomen of a “girdling” nature. Positive Mayo-Robson symptom, etc. Increased amylase levels in the blood and urine. Reverse dynamics of symptoms after 10-12 days |
CNS (meninges, brain substance): serous meningitis (children from 3 to 9 years); 2-4% | Increased body temperature on the 7-10th day of illness. Headache, vomiting. Positive meningeal symptoms. High cytosis of lymphocytic nature in the cerebrospinal fluid. Reverse dynamics of symptoms after 3-5 days |
Table 22-6.Classification of mumps*
* According to Uchaikin V.F., 1998.
severity of fever and intoxication, the degree of damage to other glandular organs (orchitis, pancreatitis) and the nervous system (meningitis). Meningoencephalitis is an indicator of the particular severity of the pathological process. The erased form is characterized by mild symptoms, slight swelling of the parotid gland, and the absence or minimal involvement of other glandular organs. Temperature
the patient's body is normal or subfebrile. Diagnosis of the subclinical form of the disease is based only on the results of serological studies.
DIAGNOSTICS AND DIFFERENTIAL DIAGNOSTICSDiagnosis of mumps in typical cases is not difficult.
Difficulties arise in variants of the disease that occur in the form of submaxillitis or without damage to the salivary glands (isolated pancreatitis, serous meningitis, etc.). Epidemiological anamnesis provides some assistance in diagnosing these forms - cases of the disease in the family, preschool institution, school. You can use serological diagnostic methods (RPGA, RTGA, ELISA), with the help of which the diagnosis can be confirmed retrospectively. Virological studies are labor-intensive, require specially equipped laboratory services, and therefore are not used in practical work.
TREATMENT
Treatment is usually carried out at home, patients are hospitalized for clinical (meningitis, meningoencephalitis, orchitis) and epidemiological indications.
Disease | General symptoms | There is no specific therapy. Bed rest is prescribed until body temperature normalizes. The diet is gentle (dairy-vegetable with a limitation of raw vegetables and fruits, fresh bread). Careful oral hygiene is required. Apply dry heat to the area of the affected glands. If necessary, use symptomatic drugs (antipyretics for hyperthermia, etc.). For meningitis, dehydration and detoxification therapy, vitamins, nootropic drugs are prescribed; in recent years, interferon drugs have been successfully used. For orchitis, glucocorticoids, ribonuclease, and wearing a suspensor are indicated (at least 2-3 weeks). In the treatment of severe cases of pancreatitis, anti-enzyme drugs, such as aprotinin, are widely used along with dietary measures. |
Differences in mumps | Purulent parotitis |
|
It occurs suddenly and not against the background of a bacterial infection. There is no fluctuation in the center of the inflamed gland. Neutrophilic leukocytosis in peripheral blood and increased ESR are not typical | Salivary stone disease | Enlargement and tenderness of the parotid gland |
Increased body temperature, no indication of recurrent enlargement of the parotid gland in the past | Cytomegalovirus infection | Enlargement of the parotid and submandibular glands |
The enlargement of the glands is initially unilateral, and not symmetrical, as with generalized cytomegalovirus infection. Pneumonia, swollen lymph nodes, hepatosplenomegaly are not typical | Sjögren's syndrome | Parotid gland enlargement |
No “sicca syndrome”, no joint pain and other signs of rheumatic diseases, no changes in blood tests (except for leukopenia) | Acute pancreatitis | Abdominal pain, increased amylase activity in the blood and urine |
Typically, the picture of pancreatitis develops in the 2nd week of illness with subsiding symptoms of mumps (submaxillitis) | Serous meningitis due to enterovirus infection | Meningeal syndrome, lymphocytic cytosis of cerebrospinal fluid |
in the form of a short-term increase in body temperature. Rarely, slight enlargement of the parotid gland occurs. It is extremely rare that complications may develop these days: an excessively pronounced general reaction (high body temperature, intoxication, abdominal pain), meningeal syndrome, which requires hospitalization of the child and the registration of an emergency notification to the Center for Sensitivity and Epidemiology. Final disinfection is not carried out at the source of the disease. It is enough to ventilate the room and carry out wet cleaning. Children under 10 years of age who have not had mumps are separated for 21 days from the moment of contact. Once the exact date of contact is established, children are not allowed into the organized group from the 11th to the 21st day.
FORECAST
The prognosis is generally favorable. Severe infection with systemic manifestations (meningitis, pancreatitis, orchitis) usually occurs in people over 15 years of age; in such cases, the disease does not always go away without a trace. For example, it is believed that 1/4 of all cases of male infertility are caused by mumps.
Chickenpox, rubella, measles, mumps, whooping cough... For some reason we are sure that you can only get sick with them in childhood. And we believe that even if this did not happen, at school we were certainly inoculated “from everything.” However, doctors advise not to rely on chance in this case. And go to the doctor, look through your children's medical record with him, if necessary, get tested and get vaccinated. It will take a little time, but will avoid serious problems. And here are the ones exactly.
Chickenpox (varicella)
“Infection with chickenpox occurs through airborne droplets,” says Dali Macharadze, MD, professor, immunologist at the SM-Doctor clinic. - And it occurs in adults with the same symptoms as in children. One of the main signs of the disease is an itchy rash, including on the mucous membranes.” People over 40 years of age with chickenpox may experience sharp pain in the intercostal space and the appearance of itchy papules in the chest area.
Incubation period: 11-21 days.
How dangerous. “Chicken pox is very difficult for adults to tolerate, with complications, and there is a risk of damage to nerve endings,” says Nona Hovsepyan, consultant physician at the INVITRO Independent Laboratory. “Moreover, even those who have already had it in childhood can become infected: there is no guarantee of stable and lifelong immunity.” Isolation and bed rest are important for the sick person. And, of course, under no circumstances should you scratch the wounds: the scars remain forever. Chickenpox is especially dangerous for pregnant women: it can lead to miscarriage or fetal malformations.
Rubella
An acute infectious disease, often disguised as a common cold: a slight headache, runny nose and cough. “The temperature (usually low) can disappear within a few days, and the disease is most often treated symptomatically: antipyretic and tonic drugs,” explains Dali Macharadze. - Rubella rash is pinpoint-like, most often on the neck, torso and thighs. Lymph nodes often become inflamed.”
Incubation period: 11-24 days.
How dangerous. “Infection of a pregnant woman is very dangerous (for the fetus), especially in the first trimester,” says Nona Hovsepyan. - If a person had rubella in childhood or was vaccinated, he received lasting immunity for life. Therefore, when planning a pregnancy, a woman needs to undergo examination and find out whether she has antibodies to this disease.” In addition, rubella suffered in adulthood threatens the development of arthritis.
Measles
“As a rule, children tolerate measles more easily; in adults, the symptoms are usually more pronounced and the condition is more severe,” explains Dr. Hovsepyan. In the first two days, a person suffers from fever (the temperature rises to 39-40°C), cough and runny nose, the mucous membranes become inflamed, and it is painful to look at the light. A rash also appears: in this case, it looks like small white dots, after which pigment spots remain for some time.
Incubation period: 9-14 days.
How dangerous. This disease has many varieties, each with its own consequences. The most common complications are otitis media, bronchitis, pneumonia, and in some cases meningoencephalitis (inflammation of the membranes of the brain). It is important for those around you to remember that the patient is contagious from the moment the temperature rises until the rash completely disappears.
Mumps (mumps)
According to WHO, 30% of the world's adult population is not immune to this disease. It is characterized by headaches, muscle and joint pain, and severe dry mouth. “In adults, as a rule, the temperature rises greatly and the salivary glands enlarge,” explains Professor Dali Macharadze. “Patients may complain of pain in the parotid area, worsening at night.” The face takes on a pear shape, the earlobe rises - for this reason the disease is called “mumps”. The fever (39-40 degrees) lasts no more than a week, and the swelling does not go away for about the same amount of time.
Incubation period: 11-23 days.
How dangerous. In adults, the nervous system often suffers, and this indicates the severity of the disease. “A serious complication of mumps can occur in men - this is inflammation of the testicles, which can lead to infertility,” says Nona Hovsepyan. “The severe inflammation of the salivary glands that mumps causes can lead to deafness.” The pancreas is often affected.
Whooping cough
The main symptom of whooping cough is a cough. When examining patients with a prolonged cough, 20-26% of them, according to statistics, are diagnosed with pertussis infection. “Adults tolerate whooping cough more easily than children,” says professor and immunologist Dali Macharadze. “But the cough can persist for up to two months, and there is also a risk of relapse.” Whooping cough is characterized by a gradual increase in symptoms, so adults often confuse it with ordinary bronchitis or a cold.
Incubation period: 5-14 days.
How dangerous. “After whooping cough, adults can develop pneumonia,” says Nona Hovsepyan. “And there is no guarantee that a person, even having coped with this disease in childhood, will not suffer from it again at a later age.” Many adults do not seek help for whooping cough (and severe cough in general). This leads to a number of complications, for example, long-term bronchitis, which in turn can cause hernias and hemorrhages.
Parents dream of their children growing up healthy. Of course, it is unlikely that you will be able to protect yourself from all misfortunes, but you can avoid encountering the most dangerous diseases.
We will talk about old, but far from good diseases, which many have heard about - mothers, fathers, grandparents.
Sometimes it seems that a typical “childhood” disease will be mild, but this is a big misconception. The insidiousness of many ailments is that they cause serious complications that can lead to disability or death.
Elena Tikhonovskaya, chief physician of Moscow clinic No. 36, talks about infections that are much worse and more dangerous than they seem.
Polio
The infection most often occurs in children under the age of five and transmitted by airborne droplets or fecal-oral route. The virus multiplies in the intestines, is absorbed and enters the nervous system, affecting it.
About 30-40% of children who suffer from polio become disabled.
The natural susceptibility of humans to the polio virus is not very high: out of 200 people in contact with the virus, one will get sick. But he will get sick.
Body temperature rises to 38 degrees, headache, vomiting, severe weakness throughout the body, especially weakness and tension in the muscles of the neck and back and difficulty swallowing. After the child has been ill for 2-3 weeks, all symptoms disappear.
Very important! At the time of infection and illness, a person is the main source of this virus - he releases it into the external environment.
Before the invention of the vaccine, polio was a real scourge in many countries. American President Franklin Roosevelt suffered from polio and used a wheelchair. According to statistics, from 1950 to 1955, 50 (!) thousand people suffered from this disease, and this is a very high rate of infection.
Currently, according to WHO, from 10 to 20 million people suffer from the consequences of polio.
Although at the moment this infection is considered defeated - provided that the entire vaccination plan is completed. Infants are vaccinated first with an inactivated vaccine (with a dead virus) - an injection is given. Then - live (drops in the mouth). When vaccinated with a live vaccine, the person is a carrier of the polio virus. That is, if one child in a family is not vaccinated, and the second has been vaccinated against polio, the chance of infecting an unvaccinated person is very high.
Complications
1. Flaccid paralysis, a sign of which is weakness in the limbs. The child stops running, jumping and moving independently. This is a kind of “red flag” and an important clinical symptom for any doctor or paramedic.
The earlier treatment occurs, the higher the chances of preserving intact neurons in the child’s central nervous system. This is definitely the case when you can’t sit and wait for the problem to go away on its own.
2. Paralysis of the respiratory muscles. It is no secret that our breathing is connected with the fact that signals from the brain go to the spinal cord. This impulse travels along the neuron to the muscles, due to which the chest expands and the person inhales. When the nerve fibers are damaged and there is no impulse due to paralysis, the child stops breathing. And this situation, unfortunately, is not temporary: if treatment is not started in a timely manner, the child will be on respiratory support for the rest of his life - that is, breathing with the help of a breathing apparatus.
This complication occurs in 5-10%, which means that out of 100 sick children, 10 can have such severe consequences. 
Measles
Another dangerous causative agent of childhood diseases, the incidence statistics here are disappointing: out of 100 children who do not have immunity against measles, all will get sick - susceptibility to the virus is 100%.
Measles is transmitted by airborne droplets: The virus is quite light and volatile, so it is quickly transmitted with air currents over long distances.
The infection enters through the upper respiratory tract and also affects the central nervous system. The so-called prodromal period lasts from 8 to 10 days (the time from the moment of infection until the manifestation of active symptoms), and at this moment the person is the source of the spread of the virus.
At first, measles is very similar to ARVI: the disease begins with high fever, headache and cough. Very typical - eye damage, lacrimation, conjunctivitis may develop. But then a rash appears. Pink spots cover the patient's body from top to bottom, starting from the head.
No matter how “funny” measles may seem, this disease is.
Before the invention of the vaccine, the mortality rate was quite high - up to 3%. Vaccination is carried out with a very weakened virus, and gives the child immunity against this disease. The risk of re-infection is very small - up to 1%.
What is the insidiousness of this disease?
The measles virus greatly reduces immunity and destroys vitamins A and C in the body - reliable defenders of our health. And against the background of this infection, a bacterial one quite often joins. And together, viral and bacterial infections give a clinical picture that is very difficult to treat in a child. 
Whooping cough
An extremely common childhood infection that is transmitted by airborne droplets. The worst thing is that even a newborn can get sick.
The causative agent of this disease is whooping cough, and this microbe quite easily penetrates the body when communicating with a patient. At the same time, the microbe does not spread over a distance of more than three meters.
The main symptom of whooping cough is a paroxysmal cough.
It is difficult to treat and difficult to correct, which is why whooping cough is scary precisely because of its manifestations. And even after successfully suppressing germs, a person may still have a reflex cough.
In addition to a growing cough, symptoms such as a slight runny nose and fever are identified - the disease is disguised as a common ARVI. With such symptoms, children can remain quite mobile and, in contact with others, infect them with infection.
The first thing to do when a child gets sick is to limit contact with other people and carry out antibacterial therapy strictly as prescribed by the doctor.
Children must be given antitussives so that attacks do not reach the point we described above. Allergens, dust, strong odors, cold air and physical activity - everything that can provoke a cough must be excluded. The drier the air, the thicker the sputum, and it should foam and come out, that is, the air should be humidified. We should also not forget that another infection may accompany this disease.
The development of whooping cough can be prevented by routine vaccination, which will give the child immunity to this disease.
What is the insidiousness of this disease?
The worst thing is a spasmodic cough, when the child literally suffocates. This cough has many variations: it can occur with whistling, with vomiting, etc.
It is almost impossible to avoid diseases in childhood. The little man's immunity is still developing and cannot protect him from all infections. However, preventive measures should not be neglected: they can indeed reduce the risk of developing many diseases.
Are modern preventive measures effective in the fight against viruses and bacteria?
Infectious diseases are caused by viruses and bacteria. The treatment of bacterial and viral infections is fundamentally different, but the methods of disease prevention are common to all.
- Vaccination. When vaccinated, a weakened or dead strain of the pathogen is introduced. The purpose of vaccination is to “teach” the child’s immune system to recognize and neutralize this particular virus or bacterium. After vaccination, antibodies are formed that will instantly react if the same pathogen enters the body again and quickly destroy it. Some vaccinations are given once, others are given several times according to a specific schedule, and vaccination against variable (mutating) viruses, in particular the influenza virus, must be carried out annually. Vaccination is the most reliable way to protect against many dangerous diseases; it was the spread of vaccinations that allowed us to practically defeat smallpox, tuberculosis and polio, which were very widespread before mandatory vaccination.
In 2000, mass vaccination of Russians against hepatitis B began. Over 16 years, the incidence of this dangerous disease has decreased from 62 thousand cases per year to less than 1 thousand.
- Strengthening the immune system. Often, modern children are introduced to an unhealthy lifestyle from an early age. Outdoor games are being replaced by computer games; parents often pamper their children with unhealthy food or, due to lack of time, feed them semi-finished foods, wrap their children up, even if it is not very cold outside. All this leads to a weakening of the body's defenses.
If you want to strengthen your child's immunity, you should take a comprehensive approach. The diet should contain a minimum amount of semi-finished products; it is better to use natural products. Keep track of the balance of proteins, fats and carbohydrates. Include vegetables and fruits, cereals, dairy products, whole grain bread in your menu more often, and limit your consumption of sweets. If necessary, you can give your child vitamins, but the feasibility of such measures should be discussed with your pediatrician. - Hygiene. Many diseases are transmitted through household means, and it is extremely important to explain to your child the basic rules of hygiene. The child should not use someone else’s comb, toothbrush, washcloth, dishes, toys, clothes, bedding and towels. You should wash your hands not only before eating, but as often as possible, especially when in public places. Of course, it is not easy to control the implementation of these rules, but they should be instilled in the child from early childhood.
Prevention of viral diseases in children
ARVI and influenza
The influenza virus is variable, so even vaccination does not provide long-term immunity. However, the flu vaccine is the only reliable method of prevention. Vaccinations should be performed annually, starting at 6 months. Until this point, prevention consists of vaccinating all adults in contact with the baby.
Measles
An extremely contagious infection. It is transmitted from person to person by airborne droplets. Even with short-term contact with a patient, the risk of infection is about 40%. Prevention of measles consists primarily of vaccination. The first vaccination with LCV (live measles vaccine) is given at 12 months, the second at 6 years. There is another method - the administration of Y-globulin within 3 days after the child’s contact with a person with measles. A widely used vaccine contains weakened strains of three dangerous viral infections - rubella, measles and mumps.
Rubella
It is transmitted by airborne droplets or from mother to child during pregnancy. Congenital rubella is especially dangerous - it is often accompanied by serious pathologies of the fetus. Vaccination against rubella is carried out for the first time at 12–14 months, then it is repeated at 6 years. Usually we are talking about the “triple vaccine” that we talked about earlier.
Mumps (mumps)
Despite the funny name, mumps is a serious disease that affects the glands (submandibular, parotid and others). Children aged 3–6 years are most often infected with mumps; the disease is rare in infants and adults. It is distinguished from other viruses by its resistance to the external environment - it can exist for a long time outside the human body, so infection is possible both through airborne droplets and through household contact. Vaccination against mumps - LPV (live mumps vaccine) - is carried out at 12 months and at 6 years as part of the “triple vaccine”. If the child was previously given immunoglobulin as a preventive measure, vaccination should be postponed - in this case the doctor will prescribe the date.
Chickenpox
Chicken pox, or, as it is more often called, chickenpox, is highly contagious - very short contact is enough for infection. Despite the fact that this virus does not live long in the external environment and dies under the influence of disinfectants, as well as low and high temperatures, it is able to travel through the air over significant distances, so that sometimes direct contact is not even required for infection.
There are vaccines against chickenpox - vaccination is carried out at 2 years of age, if there are no contraindications for it.
Prevention of bacterial infections
acute respiratory infections
By acute respiratory infections we mean all acute respiratory diseases in general, but in conversation they often call bacterial respiratory infections so as not to confuse them with viral ones. There are no specific vaccinations against bacteria that cause acute respiratory infections, so prevention of acute respiratory infections should include comprehensive measures to strengthen the immune system - taking children's vitamin preparations, a healthy diet with plenty of natural products, and physical activity. It is important to dress your baby correctly - not to wrap him up too much so that he does not sweat, but also to make sure that he does not freeze if it is cold outside. Cold itself does not cause a cold, but with hypothermia, local immunity is reduced due to vasospasm. Following the rules of hygiene also helps protect against acute respiratory infections - teach your child to wash their hands several times a day, since the infection often enters the body this way.
Scarlet fever
This is a dangerous disease, which is accompanied by swelling of the tonsils, rash, high fever, it has many complications, it can even lead to disability. Scarlet fever is transmitted by airborne droplets and household routes, is highly contagious and most often affects preschool children. There is no special prevention against scarlet fever, so all the methods described above for strengthening the immune system can be used as protective measures.
Whooping cough
The causative agent of whooping cough is a gram-negative hemolytic bacillus. This bacterium does not survive in the external environment, so infection occurs only through close contact, through household or airborne droplets. There is a vaccine against whooping cough, but in order for vaccination to be effective, vaccinations must be done strictly on schedule - at 3 months, 4.5 months, 6 months and 18 months.
Prevention is a method of combating infectious diseases, the effectiveness of which has been tested for centuries. Keep this in mind when deciding whether to vaccinate your child or when your child starts asking you questions about the need to wash their hands before eating and after using the toilet.
Measles- an acute, highly contagious infectious disease of children, characterized by catarrhal inflammation of the mucous membranes of the upper respiratory tract, conjunctiva and maculopapular rash of the skin. Children under 3 years of age and adults rarely get measles.
Etiology and pathogenesis. The causative agent of measles is an RNA-containing virus, a myxovirus, 150 nm in size, cultivated in human and monkey tissue culture, where typical giant cells develop, which are found in the patient’s throat secretions, upper respiratory tract, blood and urine.
PP: by airborne droplets. The virus enters the upper respiratory tract and the conjunctiva of the eyes. In the epithelium of the mucous membranes, the virus causes dystrophic changes and penetrates into the blood, which is accompanied by short-term viremia, the consequence of which is the spread of the virus into the lymphoid tissue, causing immune restructuring in it. Viremia becomes more pronounced and prolonged, and a rash appears. With the end of the skin rash, the virus disappears from the body. The duration of the disease is 2-3 weeks. Measles virus has the ability to reduce the barrier function of the epithelium and phagocytic activity. This state of anergy dramatically increases the susceptibility of patients to secondary infection or exacerbation of an existing chronic process, such as tuberculosis.
Macro: Catarrhal inflammation develops in the mucous membrane of the pharynx, trachea, bronchi, and conjunctiva. The mucous membrane is swollen, congested, mucus secretion is sharply increased. In severe cases, necrosis may occur, the mucous membrane becomes dull, grayish-yellow in color, and small lumps are visible on its surface. Swelling and necrosis of the mucous membrane of the larynx can cause a reflex spasm of its muscles with the development of asphyxia - false croup.
Micro: in the mucous membranes, hyperemia, edema, vacuolar degeneration of the epithelium, up to its necrosis and desquamation, increased mucus production by the mucous glands and slight lymphohistiocytic infiltration are observed.
Enanthema is determined on the mucous membrane of the cheeks corresponding to the small lower molars in the form of whitish spots called Bielshovsky-Filatov-Koplik spots.
Exanthema in the form of a large-spotted papular rash appears on the skin, first behind the ears, on the face, neck, torso, then on the extensor surfaces of the extremities.
When inflammatory changes subside, the growing normal epithelium causes rejection of incorrectly keratinized and necrotic foci, which is accompanied by focal (pityriasis-like) peeling. In the lymph nodes, spleen, lymphoepithelial organs of the digestive tract, proliferation with plasmatization of B-dependent zones and an increase in follicle proliferation centers are observed. Giant multinucleated macrophages are found in the tonsils, appendix and lymph nodes.
In uncomplicated measles, miliary and submiliary foci of proliferation of lymphoid, histiocytic and plasma cells are formed in the interalveolar septa of the lungs. It is possible to develop interstitial pneumonia, in which bizarre giant cells form in the walls of the alveoli - giant cell measles pneumonia. However, the etiological connection of such pneumonia only with the measles virus has not yet been proven.
Complications . Among the complications, the central place is occupied by lesions of the bronchi and lungs associated with the addition of a secondary viral and bacterial infection.
With modern treatment methods, such pulmonary complications are extremely rare. The wet gangrene of the soft tissues of the face, noma, which was previously observed in complicated measles, also disappeared.
The death of patients with measles is associated with pulmonary complications, as well as asphyxia with false croup.
Chicken pox-an acute infectious disease of children, characterized by a macular-vesicular rash on the skin and mucous membranes. Children predominantly of preschool and early school age are affected.
Etiology and pathogenesis . The causative agent is a DNA virus belonging to the group of herpes viruses (poxvirus). Elementary bodies (Arago bodies) have a coccus-like appearance, size 160-120 nm. The varicella zoster virus is identical to the causative agent of herpes zoster because cross-contamination and immunization occur. The source of infection is a sick person, transmission is carried out by airborne droplets. In rare cases, transplacental transmission occurs with the development of late fetopathy or congenital chickenpox.
The virus enters the respiratory tract, penetrates the bloodstream, where it multiplies during the incubation period. Due to ectodermotropy, the virus is concentrated in the epidermis of the skin, as well as in the epithelium of the mucous membranes.
Macro: skin changes begin with the appearance of reddish, slightly raised itchy spots, in the center of which a vesicle with transparent contents quickly forms. When the vesicle dries out, its center sinks and becomes covered with a brownish or blackish crust. Vesicles are located mainly on the trunk and scalp; on the face and limbs their number is scanty.
Micro: the process of formation of skin vesicles begins with balloon degeneration of the spinous layer of the epidermis, and the appearance of giant multinucleated cells is also observed here.
The death of the epidermis leads to the formation of small cavities, which, merging, form vesicles filled with serous fluid. The bottom of the vesicle is represented by the germinal layer of the epidermis, the roof is represented by the elevated stratum corneum. Swelling and moderate hyperemia are observed in the dermis. Erosion of the mucous membranes is a defect of the epithelium, the connective tissue of the mucous and submucosal membranes is swollen, the vessels are congested, and lymphohistiocytic infiltrates can be observed. In chickenpox with generalized lesions of internal organs, foci of necrosis and erosion are observed in the lungs, liver, kidneys, spleen, pancreas, adrenal glands, and in the mucous membrane of the digestive, respiratory and genitourinary tracts.
Complications are represented by secondary infection of skin rashes, most often with staphylococcus. Young children can easily develop staphylococcal sepsis.
The fatal outcome depends on associated staphylococcal sepsis or, in rare cases, on generalized lesions of internal organs.
Whooping cough- an acute infectious disease of children, characterized by damage to the respiratory tract with the development of typical attacks of spasmodic cough. The disease is rarely observed in adults.
Etiology and pathogenesis. Infection occurs by airborne droplets. The entry point for infection is the mucous membrane of the upper respiratory tract, where the microbe multiplies. The decay products of the pathogen (endotoxin) cause irritation of the nerve receptors of the larynx, impulses appear that go to the central nervous system and lead to the formation of a persistent focus of irritation in it. “Respiratory tract neurosis” develops, which is clinically manifested by successive jerky exhalations, followed by convulsive deep inhalations, repeated many times and ending with the discharge of viscous sputum or vomiting. Attacks of spasmodic cough cause stagnation in the superior vena cava system, increasing circulatory disorders of central origin, and lead to hypoxia. Whooping cough in infants is especially severe; they do not have spastic coughing attacks; their equivalent is attacks of apnea with loss of consciousness and asphyxia.
Pathological anatomy . During an attack, the face is puffy, acrocyanosis, hemorrhages on the conjunctiva, facial skin, oral mucosa, pleural leaves and pericardium are noted.
The mucous membrane of the respiratory tract is congested and covered with mucus. The lungs are emphysematously swollen, under the pleura there are air bubbles running in a chain - interstitial emphysema. In rare cases, spontaneous pneumothorax develops. On the section, the lungs are full of blood, with receding areas of atelectasis.
Microscopically in the mucous membrane of the larynx, trachea, bronchi - phenomena of serous catarrh: vacuolization of the epithelium, increased secretion of mucus, plethora, edema, moderate lymphohistiocytic infiltration.
In the brain, swelling, plethora, small extravasations are observed, and rarely, extensive hemorrhages in the membranes and brain tissue. Circulatory changes are especially pronounced in the reticular formation and the nuclei of the vagus nerve of the medulla oblongata. They lead to the death of neurons.
Complications depend on the addition of a secondary infection. In this case, panbronchitis and peribronchial pneumonia develop, similar to that of measles.
Death is now rare, mainly in infants from asphyxia, pneumonia, and in rare cases from spontaneous pneumothorax.
Rubella- anthroponotic viral infection with generalized lymphadenopathy and small-spotted exanthema.
Etiology: The causative agent is an RNA genomic virus of the Rubivirus genus of the Togaviridae family. It exhibits teratogenic activity.
The reservoir and source of infection is a person with a clinically pronounced or erased form of rubella. The patient releases the virus into the external environment 1 week before the rash appears and for 5-7 days after the rash appears. The route of transmission is airborne. There is a vertical route of transmission (transplacental transmission of the virus), especially in the first 3 months of pregnancy.
Pathogenesis: Infection occurs through the mucous membranes of the upper respiratory tract, infection through the skin is possible. Following this, the virus penetrates the regional lymph nodes, where it reproduces and accumulates, which is accompanied by the development of lymphadenopathy. Subsequent viremia with hematogenous dissemination throughout the body occurs during the incubation period. The pathogen, having a tropism for the epithelium of the skin and lymphatic tissue, settles on the epithelium of the skin and in the lymph nodes. Viremia usually ends with the appearance of exanthema. The rash elements are round or oval pink or red small spots with smooth edges. They are located on unchanged skin and do not rise above its surface. In adults, the rashes tend to merge; in children they rarely merge. Sometimes the appearance of a rash is preceded by itchy skin. First (but not always), elements of the rash appear on the face and neck, behind the ears and on the scalp. Virus-neutralizing antibodies are already detected in the blood of patients at this time; subsequently, their concentration increases, and the developing immune reactions lead to the elimination of the pathogen from the body and recovery. After an illness, antibodies remain for life, which ensures the stability of post-infectious immunity.
When rubella develops in pregnant women during the period of viremia, the pathogen with the blood of the pregnant woman easily overcomes the placental barrier and infects the fetus. Greg's triad: blindness, deafness, heart defects.