Critical measles in children

ABSTRACT

Measles is a highly contagious viral illness that remains a major vaccine-preventable cause of severe pediatric illness. It has re-emerged in the United States through recent outbreaks in under-immunized communities. Although most cases are self-limited, a significant portion of children develop critical illness requiring pediatric intensive care. Complications, including severe pneumonia, pediatric acute respiratory distress syndrome, acute encephalitis, shock, and secondary bacterial infection, are among the top reasons for PICU admission. Severe measles reflects both direct viral injury and immune dysregulation, which can increase susceptibility to superinfection and multiorgan dysfunction. Diagnosis relies on recognition of characteristic clinical features in the appropriate epidemiologic setting and is confirmed by reverse transcription polymerase chain reaction and serologic testing. Management is primarily supportive and heavily relies on early recognition of respiratory, neurologic, and hemodynamic compromise. It includes escalating respiratory support and lung-protective ventilation when indicated, vitamin A supplementation, nutritional support, and careful evaluation for complications and bacterial superinfection. Strict isolation and outbreak preparedness remain essential to prevent nosocomial transmission. This review summarizes the epidemiology, pathophysiology, diagnosis, complications, and pediatric critical care management of severe measles in children.

Keywords: Measles; children; pediatric intensive care unit; pediatric acute respiratory distress syndrome; encephalitis; pneumonia; vitamin A; respiratory failure