SEVERE MEASLES IN IMMUNOCOMPROMISED PATIENTS
SEVERE MEASLES IN IMMUNOCOMPROMISED PATIENTS
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DOI：
10.1001/jama.267.9.1237
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发表时间：
1992-03-04
影响因子：
120.7
通讯作者：
MCCARTHY, CA
中科院分区：
文献类型：
--
作者：
KAPLAN, LJ;DAUM, RS;MCCARTHY, CA
目的：描述免疫功能低下者麻疹的严重程度。数据。-1989 年 9 月至 1990 年 12 月期间入住两个学术医疗中心的患者以及 1963 年至 1991 年 MEDLINE 获得的英语参考文献。参考书目用于识别 1963 年之前的报告。研究选择。-我们确定了 9 名免疫功能低下的麻疹患者。进一步的分析基于来自两项肿瘤患者麻疹队列研究的 35 名患者和 24 份报告的人类免疫缺陷病毒 (HIV) 感染患者麻疹病例。数据提取。-临床数据来自我们治疗的 9 名患者。有关麻疹并发症、皮疹的存在、预防性免疫球蛋白的使用和治疗措施的信息均从文献中提取。数据综合。-在我们的 9 名患者中，8 名出现严重并发症，2 名死亡。两名患者没有出现皮疹。将我们的患者与文献中的患者结合起来，大约 80% 发生严重并发症。肿瘤患者的重症麻疹病死率约为 70%，艾滋病毒感染者的病死率约为 40%。约 30% 的患者不出现皮疹。由于患者人数较少，无法评估预防或治疗措施的效果。然而，我们观察到给予利巴韦林后快速退热。接种疫苗的 HIV 感染患者的死亡率低于之前未接种疫苗的患者 (P = .06)。结论：麻疹是免疫功能低下患者的一种严重疾病，并且经常不出现皮疹。虽然治疗是支持性的，但利巴韦林需要进一步研究。麻疹疫苗可能对艾滋病毒感染者有效。应重新评估肿瘤患者的疫苗接种。
Objectives.-To describe the severity of measles in immunocompromised. hosts and to assess preventive and therapeutic modalities.Data.-Patients admitted to two academic medical centers between September 1989 and December 1990 and English language references obtained by MEDLINE from 1963 to 1991. Bibliographies were used to identify reports prior to 1963.Study Selection.-We identified nine immunocompromised patients with measles. Further analysis was based on 35 patients from two cohort studies of measles in oncology patients and 24 reported cases of measles in human immunodeficiency virus (HIV)-infected patients.Data Extraction.-Clinical data are presented from the nine patients we treated. Information concerning measles complications, presence of rash, use of prophylactic immunoglobulin, and therapeutic measures was extracted from the literature.Data Synthesis.-Of our nine patients, eight developed severe complications and two died. Two patients had no rash. In combining our patients with those from the literature, severe complications occurred in about 80%. The case fatality rate for severe measles was about 70% for oncology patients and about 40% for HIV-infected patients. Rash was absent in about 30%. The efficacy of prophylactic or therapeutic measures could not be assessed due to the small number of patients. However, we observed a rapid defervescence following administration of ribavirin. Vaccinated, HIV-infected patients had a lower mortality rate than those not previously vaccinated (P = .06).Conclusions.-Measles is a severe illness in immunocompromised patients, and the absence of rash is frequent. While treatment is supportive, ribavirin requires further study. Measles vaccine may be efficacious in HIV-infected patients. Vaccination of oncology patients should be reassessed.