The primary clinical characteristics are fever, cold aversion, cough, sore throat, runny nose, red eyes, oral mucosal spots (Coriolis spots) and skin rash [1]. The incidence rate of adult measles has been increasing for many years. Some causes caused immune failure in measles vaccine inoculation or inoculation after childhood, and the cause of adult secondary immune deficiency, such as [2], caused an increase in incidence of measles in adults. [3] Clinical studies believe that there is no communication between adult measles and children's measles. Therefore, to deal with the adult population, we should improve the clinical familiarity and be careful of the occurrence of hairy measles. In order to prevent clinical misdiagnosis and mistreatment, this paper reviews the literature and summarizes the characteristics and treatment strategies of adult measles.
Fever with rash, beware of the occurrence of hairy measles
1、 Pathogenic characteristics
To sum up, adult measles patients include primary measles, secondary measles and secondary measles sequelae. According to the summary of the large number of cases, compared with childhood measles, adult measles is not typical and has many complications. The incidence rate of influenza and missing vaccine is high, with the following characteristics: [2, 3]:
1. In the early stage of onset, the symptoms of fever and poisoning lasted for a long time, and the gastrointestinal symptoms were more prominent than the respiratory symptoms: fatigue, loss of appetite, muscle soreness, hub pain, nausea, vomiting, etc;
2. Koplic plaques can not be found in some cases;
3. Compared with children's measles easily merged pneumonia, most adult measles patients are easily complicated with liver damage. And it is easier to present rare complications in infants such as leukocyte depletion, urinary tract infection and keratitis. Severe patients may be combined with laryngitis and myocarditis, and adults may also see occult onset subacute sclerosing panencephalitis (SSPE), which is a fatal degenerative disease of central nervous system caused by chronic continuous transmission of defective measles virus. SSPE should belong to the field of secondary measles sequelae;
4. Atypical cases (such as hemorrhagic measles, herpetic measles, irregular measles, etc.) and measles antibody IgM negative cases may be more than infants;
5. The misdiagnosis rate of measles in pregnant women is high and harmful. The severity of the disease varies. Measles in pregnant women can cause adverse effects on mothers and fetuses. It was reported that 54% were hospitalized due to primary measles, pneumonia and other respiratory complications. The infection in the early stage of pregnancy can cause stillbirth, and the infection in the later stage can cause natural abortion or stillbirth and premature birth. The infection in the late stage of pregnancy can transmit the virus to the fetus through the placenta to produce neonatal measles;
6. Measles again: it is reported in the literature that the adult onset is less, the number of years is 12.5-27 years old, with an average of 16.1 years old. The severity of the disease mainly depends on the level of serum anti measles virus antibody IgG [2];
7. Adult measles is more common in people with influenza and without measles vaccine.
2、 Diagnostic guidance
1. Diagnostic scale of adult measles
Clinically suspected measles, measles virus was evacuated from the secretion or blood of the nasopharyngeal department in the laboratory, or measles virus nucleic acid was detected. Or measles LGM antibody was found in serum without measles attenuated live vaccine within one month; The measles IgG antibody titer in the serum of patients in the recovery phase is 4 times or more higher than that in the acute phase, or the antibody in the acute phase is negative and the antibody in the recovery phase is positive [4].
2. Diagnostic scale of measles antibody negative cases:
It presents measles like symptoms, but measles antibody IgM is negative. It needs to unite medical history data. It may be window infection, which needs comprehensive evaluation. Measles IgM antibody negative cases should be retested on schedule to avoid missed detection or diagnosis.
3、 Treatment strategy
It is the same as the principle of diagnosis and treatment of childhood measles. It focuses on the treatment of complications, reward and punishment.
1. Pay attention to discontinuation: discontinuation period until 5 days after rash. Patients with complications delayed the severance period to 10 days after rash. Yi Yueer group, who is close to the patient and has not been vaccinated against measles, should be quarantined for 21 days [4]. Emergency vaccination of measles attenuated live vaccine can be tested for the Yi Yue group that is not ill around the patient. For the Yi Yue group that is close to the patient, middle-aged, young, frail or with contraindications to measles attenuated live vaccine vaccination, it can be injected with human hepatitis C (plasma or fetal disc) globular egg white preparation containing high measles antibody for passive immunization [4].
2. The prevention and control of adult measles focuses on taking care of nurses, symptomatic treatment and preventing complications.
(1) Key points of nursing care: individualized whole process nursing care should be given. Cluster care nurses have been a hot topic for the growth of care nurses in recent years [5]. Cluster care nurse was first proposed by the American Institute for health promotion (IHI). It integrates evidence-based medicine and contemporary care nurses. Its goal is to assist medical staff to provide patients with optimized medical care, nurse services and nurse care outcomes.
(2) Symptomatic treatment, reward and punishment: high fever intervention and the application of traditional Chinese medicine to clear away heat, detoxify and relieve skin rash.
(3) Treatment of complications: on the basis of comprehensive treatment, ① add liver protecting drugs (reduced glutathione or glycyrrhizin, etc.) when liver function is infringed; ② Myocarditis: add vitamin C, fructose sodium diphosphate and other treatment, and those who intend to decline will intervene as soon as possible; If there is recurrent failure, it shall be rewarded and punished according to shock; ③ In case of encephalitis, reward and punishment shall be handled according to the general practice of viral encephalitis; ④ Laryngitis: strive to fight infection. In severe cases, glucocorticoids are given to alleviate vocal cord edema and prevent obstruction. When laryngeal obstruction is merged, ask the Department of facial features for consultation in real time, and tracheotomy or endotracheal intubation are given in real time. ⑤ SSPE: there are no useful treatment essentials, mainly supportive therapy and symptomatic treatment.
