Measles: An epidemic of upper airway obstruction SCOTT C. MANNING, MD, BROCK RIDENOUR, MD, ORVAL E. BROWN, MD. and JANET SQUIRES, MD. Dallas, Texas

Between October 1989 and August 1990, Dallas County experienced an ii-month epl· demlc 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 10· ryngotracheltis, but all patients were treated with breed-spectrum antibiotics to prevent possible progressionto 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 mustkeep In mind the possibilityof upper airway obstruction In a significant proportion of these patients. Early diagnosis on the basis of clinical signs and symptoms. endescopy, and radiographs Is the key to timely appropriate management. (OTOLARYNGOL HEAD NECK SURG 1991;105:415,)

With licensing of the first vaccine in 1963, the incidence of measles in the United States fell by 98%.1 The goal of eradication has not been achieved, however, and since 1983, measles has again been on the rise." The past 3 years, in particular, have witnessed a dramatic jump in numbers of major measles outbreaks with an associated rise in measles deaths.' The most severe outbreaks have occurred in inner city preschool populations, where measles immunization rates are often embarrassingly low." Children in these populations may become infected at a very young age and experience more severe manifestations of the disease, similar to measles outbreaks in developing countries.

From the Department of Otorhinolaryngology (Drs. Manning. Ridenour. and Brown) and Pediatrics

Measles: an epidemic of upper airway obstruction.

Between October 1989 and August 1990, Dallas County experienced an 11-month epidemic of measles. Of 995 cases of pediatric measles diagnosed in the ou...
562KB Sizes 0 Downloads 0 Views