Wong R D, Goetz M B
Department of Medicine, UCLA/San Fernando Valley Program, Los Angeles County/Olive View Medical Center, Sylmar.
Am J Med. 1993 Oct;95(4):377-83. doi: 10.1016/0002-9343(93)90306-a.
Description of the epidemiology, morbidity, and mortality of hospitalized adults with typical measles.
Retrospective case analysis of 33 adults who required acute care for complications of measles in a public hospital in Los Angeles, California. The diagnosis of measles was established on standard clinical or serologic grounds.
Of 68 patients (age greater than 14) with signs and symptoms of measles who presented for medical care, 33 (19 males and 14 females) required hospitalization; 18 were natives of the United States. The patient age was 26.1 +/- 7.3 (mean +/- SD) years; four patients, all natives of the U.S., were born before 1957. The duration of hospitalization was 6.8 +/- 8.8 days for all patients and 13.4 +/- 14.2 days for the nine patients who required intensive care unit (ICU) care. Six of the ICU patients required mechanical ventilation for 11.0 +/- 15.0 days; two deaths occurred among these patients. During the course of their illness, 7 of 25 (28%), 11 of 28 (39%), 6 of 28 (21%), and 5 of 16 patients (31%) had peak lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and creatine kinase values, respectively, that were greater than 5 times the upper limit of normal. Fifteen of 28 patients (54%) developed total serum calcium levels less than or equal to 2.0 mmol/L. Ten cases were serologically confirmed; 23 cases were diagnosed as probable measles on clinical grounds. There were no significant demographic, clinical, or laboratory differences between patients with confirmed and probable measles. No patients had characteristic manifestations of atypical measles. The sole immunocompromised patient died.
Measles in adults may result in severe, life-threatening complications that utilize substantial medical resources. Physicians need to appreciate the clinical presentations and manifestations of severe measles in adults and to provide measles vaccine to nonimmune adults during community-wide outbreaks.
描述患典型麻疹的住院成人的流行病学、发病率及死亡率。
对加利福尼亚州洛杉矶一家公立医院33例因麻疹并发症需接受急性治疗的成人进行回顾性病例分析。麻疹诊断依据标准临床或血清学标准确定。
68例出现麻疹体征和症状前来就医的患者（年龄大于14岁）中，33例（19例男性和14例女性）需住院治疗；18例为美国本土居民。患者年龄为26.1±7.3（均值±标准差）岁；4例患者（均为美国本土居民）出生于l957年以前。所有患者的住院时间为6.8±8.8天，9例需重症监护病房（ICU）治疗的患者住院时间为13.4±14.2天。6例ICU患者需要机械通气11.0±15.0天；这些患者中有2例死亡。在患病过程中，25例患者中的7例（28%）、28例患者中的11例（39%）、28例患者中的6例（21%）以及16例患者中的5例（31%）的乳酸脱氢酶、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶及肌酸激酶峰值分别高于正常上限的5倍。28例患者中有15例（54%）血清总钙水平降至2.0 mmol/L及以下。10例经血清学确诊；23例根据临床情况诊断为可能的麻疹。确诊麻疹患者与可能患麻疹患者在人口统计学、临床或实验室检查方面无显著差异。无患者出现非典型麻疹的特征性表现。唯一的免疫功能低下患者死亡。
成人麻疹可能导致严重的、危及生命的并发症，消耗大量医疗资源。医生需要了解成人严重麻疹的临床表现，并在社区范围内爆发疫情期间为未免疫的成人接种麻疹疫苗。
