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Coinfection is common in measles-associated pneumonia
B P Quiambao1, S R Gatchalian, P Halonen
1Research Institute for Tropical Medicine, Alabang, Muntinlupa, Metro Manila, Philippines.
Background:
Measles continues to be a significant health problem in developing countries.
Objectives:
To describe the clinical features of measles-associated pneumonia (MAP) and to identify other pathogens involved.
Methods:
Measles diagnosis was ascertained either by the typical symptom complex or by a sensitive enzyme immunoassay for antibody among children < 5 years of age admitted to the hospital with pneumonia. Other pathogens were identified by blood culture, virus isolation or antigen detection from nasopharyngeal aspirate and antibody determination from serum.
Results:
Of 182 MAP cases 162 (89%) had clinically typical measles. Twenty patients had a diagnostic antibody finding with an atypical clinical presentation. Thirteen percent were younger than 9 months of age. The case fatality rate was 17%, with a significantly increased odds ratio (OR) for those with cyanosis [OR 4.6, 95% confidence interval (CI) 1.7 to 13], respiratory rate > or = 60/min (OR 3, 95% CI 1.3 to 7) or fulfilling criteria for very severe pneumonia (OR 5.3, 95% CI 2.3 to 12). Mixed infection was found in 53% of patients. Blood culture was positive in 10 patients, Streptococcus pneumoniae (N = 5) being the most common finding. Adenovirus (19%) and parainfluenza (25%) viruses were the most frequent other viruses. A dense infiltrate was seen significantly more often among measles patients with bacterial coinfection (87.5%) than those with other viruses (36%, P = 0.007) or no evidence of other infection (33%, P = 0.004).
Conclusion:
In MAP, coinfection with other microbes is common. Cyanosis and a respiratory rate of > or = 60/min predict a greater risk of dying.
Insights
Measles-associated pneumonia (MAP) is common in young children, with coinfections frequently identified. Cyanosis and rapid breathing indicate a higher risk of mortality in these measles cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Measles remains a significant global health issue, particularly in developing nations.
- Pneumonia is a leading complication of measles in children.
Purpose of the Study:
- To characterize the clinical presentation of measles-associated pneumonia (MAP).
- To identify co-infecting pathogens in children with MAP.
Main Methods:
- Diagnosis of MAP was confirmed via clinical symptoms or serological testing in children under 5.
- Cultures, viral isolation, and serology were used to detect other pathogens.
- Clinical data, including vital signs and radiographic findings, were analyzed.
Main Results:
- Of 182 MAP cases, 89% presented with typical measles symptoms.
- Coinfections were present in 53% of cases, with Streptococcus pneumoniae, adenovirus, and parainfluenza virus being common.
- Cyanosis, tachypnea (respiratory rate > or = 60/min), and very severe pneumonia criteria were associated with increased mortality.
Conclusions:
- Coinfection with other microorganisms is frequent in measles-associated pneumonia.
- Clinical indicators such as cyanosis and a high respiratory rate are critical predictors of mortality in MAP patients.