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Published on: April 7, 2021
Measles-induced respiratory distress, air-leak and ARDS
Insights
Measles in young infants can cause severe respiratory distress, including acute respiratory distress syndrome (ARDS) and air leaks, leading to high fatality rates. Early pediatric intensive care unit (PICU) referral is crucial for managing measles-induced respiratory failure in infants.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- Measles poses a significant risk of mortality and long-term complications in young infants requiring respiratory support.
- Acute respiratory distress syndrome (ARDS) and spontaneous air leaks represent severe, high-fatality clinical presentations in early childhood, even in developed nations.
Observation:
- A clinical series review identified measles cases presenting with ARDS/spontaneous air-leak and interstitial pneumonia or bronchiolitis-like pictures.
- One infant required aggressive ventilatory and hemodynamic support, receiving nebulized iloprost and intravenous pentoxifylline during the hypoxemic phase.
- Four additional cases required non-invasive respiratory support; all were imported cases without malnutrition or chronic diseases.
Findings:
- Measles can manifest with diverse respiratory symptoms, from interstitial pneumonia to bronchiolitis-like presentations.
- Critically ill infants with measles-induced respiratory failure are susceptible to rapid deterioration.
- Pharmacological interventions like iloprost and pentoxifylline in ARDS require further investigation.
Implications:
- Early respiratory assessment and prompt pediatric intensive care unit (PICU) referral are vital for infants with measles-induced respiratory failure.
- The varied clinical presentations of measles respiratory illness necessitate heightened awareness among healthcare providers.
- Infants from immigrant families may constitute a high-risk group requiring targeted surveillance and care due to measles exposure.
Abstract:
Young infants with measles requiring respiratory support have a significant risk for death and long-term complications. Even in developed countries, the occurrence of spontaneous air-leaks and acute respiratory distress syndrome (ARDS) still represent the most severe clinical presentation in early childhood, with a high fatality rate. A clinical series review from a tertiary university paediatric intensive care unit (PICU) was undertaken. During the 2006-2007 outbreak in Rome, Italy, a young infant presented with ARDS/spontaneous air-leak and needed aggressive ventilatory management and haemodynamic support. Both nebulised iloprost and intravenous pentoxifylline were administered during the acute hypoxaemic phase; the role of this pharmacologic approach in critically ill patients is still under debate. We observed four further cases of respiratory impairment requiring a non-invasive approach. Clinical-radiological findings ranged from interstitial pneumonia to bronchiolitis-like pictures. All patients were imported cases, representing an important epidemiological factor and future medical issue, though they were not malnourished nor affected by chronic diseases. We conclude that early respiratory assessment and timely PICU referral is of mainstem importance in the youngest infants with measles-induced respiratory failure. The protean nature of clinical presentation and the possibility of rapid respiratory deterioration should be highlighted, and infants from immigrant families may represent a susceptible high-risk group.
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