Babies A to Z

MEASLES

Measles (technically called morbilli or rubeola and historically called first disease) is a highly contagious Morbilli virus infection that is contagious from five days before the rash appears until it disappears. The incubation period is 10 to 14 days. It was originally a disease of cattle that was only passed to humans after these animals were domesticated many thousands of years ago.

It starts with the cold-like symptoms of a snuffly nose, cough and red eyes. A rash develops about four days later, starting in the mouth where tiny white spots appear on the lining of the cheeks. Dark red blotches then develop on the face and gradually spread across the body, remaining for a week or more before gradually fading. Other symptoms include a high fever and eye discomfort with bright lights. The patient often starts to feel better once the rash has reached its maximum spread.

The diagnosis can be confirmed by blood tests if necessary, and previous exposure to the measles virus or vaccine can also be confirmed by specific antibody blood tests.

There is no specific treatment. Rest, paracetamol and medication are used to relieve the cold symptoms, and vitamin A supplements appear to reduce the severity of an attack. Children must be excluded from school for at least four days after the appearance of the rash.

Measles may be prevented by a vaccination, which is usually given at one and four years of age in combination with the mumps and rubella (German measles) vaccine, and with widespread vaccination, it is becoming a rare infection in developed countries, and may be totally eradicated by 2020.

Complications include encephalitis (a serious brain infection), pneumonia, ear infections and damage, and possibly the increased risk of developing multiple sclerosis later in life. Immediately after an attack patients are susceptible to other infections, and a significant number will develop tonsillitis, ear and lymph node infections.

The prognosis is usually very good, but significant complications occur in one in every 200 cases, and death occurs in one in every 5000 cases in developed countries, while in third-world countries one in ten children or adults who catch measles will die.

See also GERMAN MEASLES; ROSEOLA INFANTUM; VIRUS

MEASLES, BABY

See ROSEOLA INFANTUM

MEASLES, GERMAN

See GERMAN MEASLES

MENINGITIS

Meningitis is a viral (aseptic) or bacterial (septic) infection of the meninges, membranes that wrap all the way around the brain and spinal cord, and act to contain the cerebrospinal fluid in which the brain is supported.

The diagnosis of both types of meningitis is confirmed by taking a sample of cerebrospinal fluid from the lower end of the spine (which is an extension of the brain) and examining it under a microscope for the presence of certain cells and it can be cultured to find the responsible bacteria. Blood tests also show abnormalities.

VIRAL MENINGITIS

Viral (aseptic) meningitis is a relatively benign condition that may be caught by close contact with someone who has a viral infection, or it may be a complication of diseases such as mumps, glandular fever and Herpes. It causes a fever, headache, nausea and vomiting, tiredness and sometimes muscle weakness or paralysis, and neck stiffness may be present. No specific treatment or prevention available, but bed rest, good nursing, paracetamol, and sometimes medication for vomiting are prescribed. It is rare for there to be any after-effects and patients usually recover in one or two weeks.

BACTERIAL MENINGITIS

Bacterial (septic) meningitis is caught from people who are carriers of the bacteria, but the victims are usually weak, ill, under stress or have their ability to resist infection reduced in some way. The most common forms of bacterial meningitis is caused by Haemophilus influenzae B (HiB), while the most serious is meningococcal meningitis (caused by Neisseria meningitidis). It is a much more serious condition, with the severity and symptoms varying depending upon which type of bacteria is responsible. Common symptoms include severe headaches, vomiting, confusion, high fevers, patients become delirious, unconscious and may convulse. Neck stiffness is quite obvious, and patients may lie with their neck constantly extended as though they are looking up. Meningococcal meningitis is accompanied by a bruise-like rash on the skin and inside the mouth. Complications include permanent deafness in one or both ears, damage to different parts of the brain, heart or kidney damage, arthritis and the excess production of cerebrospinal fluid which can put pressure on the brain (hydrocephalus). The worst complication is intravascular coagulation, which involves the blood clotting within the arteries and blocking them.

The treatment of bacterial meningitis involves antibiotics in high doses, usually by injection or a continuous drip into a vein, and patients always require hospitalisation. Patients can deteriorate very rapidly and most deaths occur within the first 24 hours. The overall mortality rate is about 20%, although it is higher in children and with the Meningococcal form. Both common causes of bacterial meningitis can be prevented by a vaccine. The HiB vaccine is routine in childhood, but the meningococcal vaccine is an optional extra childhood vaccine or may be given during epidemics to close contacts of victims. Other forms of bacterial and viral meningitis cannot be prevented.

See also HAEMOPHILUS INFLUENZAE B INFECTION; LISTERIOSIS; MENINGOCOCCAL MENINGITIS

MENINGOCOCCAL MENINGITIS

Meningococcal meningitis is an uncommon, serious bacterial infection of the meninges (membranes around the brain) and blood stream (septicaemia). Sporadic outbreaks occur worldwide, usually in winter, but up to 40% of the population carry the responsible bacteria in their nose and throat without any symptoms. Infection is more common in closed communities such as military camps and boarding schools. It affects about one person in every 100,000 every year.

The infection is caused by the bacteria Neisseria meningitidis, which occur in 5 common strains (forms), and several dozen uncommon strains. The C strain is the most serious, while strains M, W and Y are probably next in severity, but this varies between patients. It is spread by prolonged close contact with a person who has the disease by inhaling their sputum or phlegm in coughs and sneezes.

Symptoms include a high fever, severe headache, vomiting, neck and back stiffness, limb pains, confusion, convulsions and a rapidly spreading bruise like rash that starts on the arms and legs. The rash does not go white with pressure under a glass slide, a symptom that is critical in differentiating Meningococcal infections from other rashes, although there are some other infective rashes that do the same thing. In terminal stages the patient becomes delirious, and goes into a coma. Rarely, abscesses may form in the brain, and pneumonia may develop.

Cultures of blood and/or spinal fluid from the lower back can confirm the presence of the responsible bacteria, then penicillin, or more potent antibiotics, are given by injection as soon as the diagnosis is suspected. The patient should be admitted to hospital for confirmation of the diagnosis, and continuation of antibiotics given through a drip into a vein. Life support in an intensive care unit may be necessary. The infection may be rapidly progressive causing death within hours, but overall 80 to 90% of all cases survive, with only 5% of survivors developing longterm consequences such as epilepsy.

Two vaccines are available. One is against strain C only, but lasts long-term, the other prevents four strains of the bacteria, but lasts for only two years. The former can be given to infants, and is now part of most routine vaccination schedules. This form of meningitis is particularly common in the Sahel region of Africa (South of the Sahara Desert) and travellers to this region should consider vaccination.

See also MENINGITIS

MENINGOMYELOCELE

A meningomyelocele (myelomeningocele) is a congenital defect of the vertebrae and spinal cord that affects about 2 in every 1000 babies, and results in a protuberant sac on the back that contains cerebrospinal fluid, meninges and spinal nerve tissue. The affected vertebrae lack their normal bony arch across the back of the spinal cord. There is usually some degree of disruption to the nerve supply of the organs and structures below the level of the meningomyelocele, and there may be other abnormalities of leg development.

Immediate surgical repair by experienced neurosurgeons is required in order to preserve as much nerve function as possible. Hydrocephalus, bowel and bladder incoordination, meningitis and other infections may be complicating factors.

See SPINA BIFIDA

The expected ages to achieve certain activities in children are shown in the following table and diagram. Some variations from these milestones should be expected.

See also CHILDHOOD; SPEECH DELAYED; TALKING; TOILET TRAINING

MMR

MMR is an abbreviation used in medical records for the measles, mumps and rubella vaccine, a routine vaccination of children.

See also MEASLES; MUMPS; RUBELLA

MUMPS

In the 19th. Century, mumps was believed to be “a specific morbid miasma, generated during peculiar conditions of the atmosphere.” We now know that it is a viral infection of the salivary glands in the neck caused by a paramyxovirus, and it usually occurs in childhood. The responsible virus spreads in microscopic droplets of fluid that come from the nose and mouth with every breath. The incubation period is two to three weeks, and the patient is infectious from one or two days before the symptoms appear until all the swelling of the glands has disappeared. An attack usually gives lifelong immunity.

The symptoms may include fever, swollen tender salivary glands just under and behind the jaw, headache, and a general feeling of illness. Sometimes one side of the neck is involved, and not the other, then the other side may swell up several days after the first side has subsided. Patients often experience additional pain in the gland if spicy or highly flavoured food is eaten, or even smelled. It may be a significant disease, particularly in adults, when inflammation of the brain, testicles (mumps orchitis) and ovaries may occur. The kidneys, heart and thyroid gland may also be damaged, and very rarely, death may occur. Mumps orchitis may result in permanent damage to the testicles and infertility, particularly in adults.

Treatment involves rest, with aspirin or paracetamol and/or codeine for the pain and fever, but if complications occur, further medical advice should be sought. Recovery is usually uneventful after an eight to twelve day course. Exclusion from school is mandatory for the course of the disease.

A vaccine is available that gives lifelong protection, and is usually given combined with those against measles and German measles (rubella) at twelve months and five years of age. The mumps vaccine was first introduced in 1980.

MYXOVIRUS

Myxoviruses are the class of virus that are responsible for infections such as croup, common cold and some forms of influenza. The paramyxovirus is a subclass that causes mumps, Hendra virus and Nipah virus infections. See also INFLUENZA; MUMPS; RESPIRATORY SYNCITIAL VIRUS; VIRUS