A Retrospective Analysis Of Clinical Features Of Children With Measles Complicated With Severe Pneumonia

Objective: To learn more about the clinical features of children with measles complicated with severe pneumonia, in order to help doctors to make the right clinical decision.Methods: We make a retrospective analysis of the 75 patients who were hospitalized in Affiliated Hospital of Chongqing Medical University from January 2010 to December 2015, at the same time, they were diagnosed with measles complicated with severe pneumonia. We collected the clinic data of the patients, divided the patients into two groups according to the prognosis, and we used logistic regression to analyze the prognostic factors.Results:(1) General situation: the ratio of male to female was 2.75:1, and the ratio of urban and rural areas closed to 1:1, the median age was 7 months, infants accounted for 78.7%(59/75), toddler accounted for 16.0%(12/75), preschool children accounted for 5.3%(4/75). The unvaccinated accounted for 92%(69/75), 66.7%(50/75) of them had underlying diseases, anemia and congenital heart disease were common.(2) Clinical manifestations: the average days of onset to develop severe pneumonia was 6.75 ± 3.03 days. According to the proportion of occurrence: pulmonary rales(92.0%, 69 / 75), respiratory failure(82.7% 62/75), moderate fever(50.7%, 38/75), ARDS(21.3% 16/75),cardiac insufficiency(8.0%, 6 / 75), gastrointestinal tract damage(2.7% 2/75).(3) Laboratory examination: The proportion of occurrence: electrolyte disorder(66.7%, 50/75), CRP > 8mg / L(58.7%, 44/75),WBC> 10 x 109 / L(57.3%, 43 / 75), coagulation abnormalities(38.1%, 16 / 42), liver function damage(25.3% 19/75),myocardial damage and,(21.3% 16/75), WBC < 4 x 109 / L(10.7%, 8/75) and renal function damage(4.0%, 3/75).(4) Etiology: the sputum culture positive rate of 62.7%(47/75), a total of 55 strains of bacteria were detected, gram negative bacteria accounted for 78.2%(43/55), gram positive strains accounted for 21.8%(12/55). The top five strains were Klebsiella pneumoniae, Haemophilus parainfluenzae, Streptococcus pneumoniae, Acinetobacter baumannii,Enterobacter cloacae. Various types of bacteria were sensitive to piperacillin/tazobactam, cefepime, meropenem, imipenem/cilastatin. The positive rate of virus detection was 18.7%(14/75), the most common virus were the parainfluenza viru 3, respiratory syncytial virus, adenovirus. Mixed infection accounted for 32%(24/75).(5) Image: the chest imaging of all the patients developed different degrees of pneumonia, 13.3%(10 / 75) appear lung air leak, and pleural effusion accounted for proportion 4.0%(3/75).(6)Hospitalization situation: the median days of hospitalization was 14 days, the ICU admission accounted for 60%(45/75), 49.3%(37/75) underwent mechanical ventilation, the average ventilation time was 8.62 ±7.46 days. Treatment with vitamin A accounted for 85.3%(64/75), the use of intravenous glucocorticoid accounted for 41.3%(31/75), the use of IVIG accounted for 81.3%(61/75), the use of PS accounted for 5.3%(4/75). 81.3%(61/75) had a good prognosis, 18.7%(14/75) of them had a poor prognosis.(7) prognostic risk factors: We made a single factor analysis of all the clinic data, only complicated with ARDS, the gastrointestinal tract damage, CRP > 8mg / L, coagulation abnormalities, ICU admission, mechanical ventilation were statistically significant(P < 0.05). After multiple factors logistic regression analysis, it was found that multiple organ dysfunction was an independent risk factor affecting the prognosis, and its OR value was 7.704, 95% confidence interval was 2.156-27.521.Conclusions: The patients of measles complicated with severe pneumonia, the males were more than females(2.75:1), the main objects were infants, many of them were unvaccinated,many children had underlying diseases, they usually underwent severe respiratory symptoms, prone to develop ARDS, pulmonary air leak and respiratory failure, and they were easy to develop multiple organ dysfunction. Sputum bacteria detection rate was high, gram negative bacteria were the main pathogens, various types of bacteria were sensitive to piperacillin/tazobactam, cefepime, meropenem, imipenem/cilastatin.and antibiotic resistance rate was high, multi-species pathogen mixed infection was very common.