CLINICAL PRESENTATIONS AND COMPLICATIONS OF SUSPECTED MEASLES IN HOSPITALIZED CHILDREN

We evaluated clinical presentations and complications retrospectively in 48 pediatric patients hospitalized for suspected measles during a measles epidemic in Chicago. Fifty-one percent were <15 months of age and 75% were <4 years of age. Measles, diagnosed in 44 patients, was culture-proved in 18. Presentations were not always classic. Respiratory complications, otitis media, hepatitis, preterm labor, keratitis and central nervous system involvement were reported. The presence of stomatitis and hypotension in some patients raised the differential diagnoses of Kawasaki disease and toxic shock syndrome. Six patients with stomatitis, admitted with a measles-like illness, fulfilled the Centers for Disease Control and Prevention criteria for Kawasaki disease. Three were diagnosed with Kawasaki disease and 3 with measles. In addition to serology and echocardiographic changes, the platelet count and the erythrocyte sedimentation rate may be useful in distinguishing between measles and Kawasaki disease. Two of 10 patients with hypotension met the Centers for Disease Control and Prevention criteria for toxic shock syndrome. The diagnosis of measles, solely on clinical grounds, may therefore not be as straightforward as is generally accepted.