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Measles: an epidemic of upper airway obstruction
S C Manning1, B Ridenour, O E Brown
1Department of Otorhinolaryngology, University of Texas Southwestern Medical Center, Dallas 75235-9035.
Abstract:
Between October 1989 and August 1990, Dallas County experienced an 11-month epidemic of measles. Of 995 cases of pediatric measles diagnosed in the outpatient department of Children's Medical Center, 108 patients were admitted and 34 of these demonstrated significant upper airway obstruction at the time of admission. Airway problems ranged from mild inspiratory stridor with nasal flaring to frank obstruction and arrest in the emergency room, requiring intubation. Eight of the 34 airway patients were eventually diagnosed with bacterial tracheitis on the basis of endoscopic findings and culture results. The remaining patients had pictures more consistent with viral laryngotracheitis, but all patients were treated with broad-spectrum antibiotics to prevent possible progression to bacterial tracheitis. A total of nine patients overall required intubation for airway obstruction and all were successfully extubated. Large outbreaks of measles are becoming common again in populations of urban poor--largely unvaccinated children. The disease in these populations tends to occur at a younger age and may be more aggressive with more associated complications. Physicians must keep in mind the possibility of upper airway obstruction in a significant proportion of these patients. Early diagnosis on the basis of clinical signs and symptoms, endoscopy, and radiographs is the key to timely appropriate management.
Insights
Measles outbreaks in unvaccinated children can cause severe upper airway obstruction. Early diagnosis and management are crucial for preventing complications like bacterial tracheitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Measles outbreaks are re-emerging, particularly in unvaccinated urban poor populations.
- Pediatric measles cases can present with significant upper airway complications.
- Airway obstruction in pediatric measles requires prompt medical attention.
Purpose of the Study:
- To investigate the incidence and characteristics of upper airway obstruction in pediatric measles patients during an epidemic.
- To identify risk factors and clinical presentations associated with airway compromise in measles.
- To evaluate the diagnostic and management strategies for measles-related airway obstruction.
Main Methods:
- Retrospective review of 995 pediatric measles cases.
- Analysis of 108 admitted patients, focusing on 34 with upper airway obstruction.
- Clinical assessment, endoscopy, and microbiological cultures for diagnosis.
Main Results:
- 34 of 108 admitted pediatric measles patients had significant upper airway obstruction.
- Eight patients were diagnosed with bacterial tracheitis; others had viral laryngotracheitis.
- Nine patients required intubation for airway obstruction, all successfully extubated.
Conclusions:
- Pediatric measles, especially in unvaccinated populations, can lead to severe airway obstruction.
- Early recognition of clinical signs and prompt endoscopic evaluation are vital for managing airway compromise.
- Broad-spectrum antibiotics should be considered to prevent secondary bacterial infections like tracheitis.