Emergency Department, University of Rome Sapienza, Rome, Italy; Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy.
Department of Public Health and Infectious Diseases, University of Pisa, Pisa, Italy; Department of Public Health and Infectious Diseases, Policlinico Casilino Hospital, Rome, Italy.
Infez Med. 2021 Jun 1;29(2):252-258.
Measles is a preventable disease still responsible for a number of outbreaks worldwide. Although most adults with measles recover uneventfully, measles-related complications may occur. However, as to whether every complicated case requires hospital management is still a point of debate. In this study we described the rate, clinical features and severity of measles complications in patients admitted to the ED of a tertiary-care teaching hospital during the outbreak that took place in 2017. Some insights into the impact on the health care system are reported as well. A retrospective cohort study was performed. Medical records of adults discharged from January to December 2017 with diagnosis of "measles" were collected and analyzed. Out of 58,579 of ED admissions, 162 measles cases were enrolled. Acute measles infection was laboratory confirmed in 71.6% and deemed as possible/probable in 24.0% of cases. Three percent of patients were immunocompromised while 1.2% of cases occurred in pregnant women. Of all complications reported (37%), hepatitis was the most frequent (29%) followed by pneumonia (10.4%), keratitis (3.8%), thrombocytopenia (3.8%) and otitis media (0.6%). No significant clinical and laboratory difference emerged between complicated and non-complicated cases besides antibiotic prescription (80.0% vs 66.3%; p=0.039). The course of the disease was mild, and no life-threatening measles-related complications or critical care support were reported. One out of three measles cases may experience at least one measles-related complication. However, the course of the disease seems to be rather benign in young adults, and the widespread use of the ED and hospitalization observed seem an inappropriate approach to the issue.
麻疹是一种可预防的疾病，仍在全球范围内导致多起暴发。虽然大多数成年麻疹患者都能顺利康复，但仍可能发生麻疹相关并发症。然而，是否每个复杂病例都需要住院治疗仍存在争议。在本研究中，我们描述了 2017 年暴发期间在一家三级教学医院急诊科就诊的麻疹患者的并发症发生率、临床特征和严重程度。此外，还报告了一些对医疗保健系统的影响。进行了一项回顾性队列研究。收集并分析了 2017 年 1 月至 12 月期间以“麻疹”诊断出院的成年患者的病历。在 58579 例急诊科就诊中，有 162 例麻疹病例入选。71.6%的急性麻疹感染通过实验室确认，24.0%的病例被认为是可能/疑似病例。3%的患者免疫功能低下，1.2%的病例发生在孕妇中。报告的所有并发症（37%）中，肝炎最常见（29%），其次是肺炎（10.4%）、角膜炎（3.8%）、血小板减少症（3.8%）和中耳炎（0.6%）。除抗生素处方外（80.0% vs 66.3%；p=0.039），复杂病例和非复杂病例之间无明显的临床和实验室差异。三分之一的麻疹病例可能至少经历一种麻疹相关并发症。然而，在年轻成年人中，疾病的过程似乎相当良性，广泛使用急诊科和住院治疗似乎是对该问题的不恰当处理方法。
