Clinical cases of measles in pregnant women
DOI:
https://doi.org/10.14739/2310-1237.2020.2.212815Keywords:
measles in pregnant women, clinic, complicationsAbstract
The aim of the work is to analyze the clinical course of measles in hospitalized pregnant women for the period of 2017–2019 years.
Materials and methods. The clinical course of measles was analyzed in 4 pregnant patients with this disease aged from 19 to 30 years, who were hospitalized in the Regional Infectious Clinical Hospital during 2017–2019 years. The diagnosis of measles was established according to the WHO criteria (2013). All pregnant women with measles had epidemiological history of contact with measles patients and in all cases diagnosis of measles was confirmed by detection measles IgM in the Zaporizhzhia Regional Laboratory Center of the Ministry of Health of Ukraine.
Results. It was found that in all pregnant women who were included in the study, measles developed in the third trimester of pregnancy, one patient was pregnant with twins. The development of measles was accompanied by the appearance of typical clinical symptoms with formation of moderate (n = 2) and severe (n = 2) course. One pregnant woman had never been vaccinated against measles during her lifetime; other three patients had no documented evidence of previous measles vaccination.
Most of the pregnant women (3 out of 4) had complications of measles from respiratory system: acute bronchitis (n = 1), acute bronchitis with pulmonary edema and respiratory failure of I–II degree (n = 1), community-acquired lower lobe right-sided pneumonia, left lung atelectasis, respiratory failure of III degree (n = 1).
Only in one 26-year-old pregnant measles had moderate course without complications. In two pregnant women development of complications needed treatment in the intensive care unit. In 30-year-old pregnant woman with twins with gestational age of 27–28 weeks from the first day of the rash, complications like measles enteritis appeared, and from the second day of the rash there were signs of acute respiratory failure due to development of pulmonary edema. On the background of complex medical treatment with use of oxygen therapy, patient recovered, pregnancy progressed without complications.
However, in one unvaccinated 25-year-old woman, who had not been vaccinated with measles, severe course of the disease was accompanied not only by the development of complications, but also had adverse effects on pregnancy. In this patient, measles was complicated by community-acquired right-sided pneumonia of group IV, left lung atelectasis, acute respiratory failure degree III, toxic-hypoxic encephalopathy and brain edema, which required mechanical ventilation. In addition, chronic hepatitis C was first diagnosed. Against this background, there was premature birth within 30 weeks.
Conclusions. According to analysis of four observations we can determine that measles in pregnancy has both moderate and severe course, but development of complications from respiratory system was recorded in the majority of patients (3 out of 4 patients). In severe cases of measles in pregnant women treatment in the intensive care unit was required due to development of pulmonary edema on the background of acute bronchitis in combination with measles enteritis (n = 1), community-acquired right-sided pneumonia in combination with left lung atelectasis (n = 1). The above clinical observation demonstrates the development of a very severe complicated course of measles in previously unvaccinated 25-year-old pregnant, which led to premature birth in the gestation period of 30 weeks.
References
Zadorozhna, V. I., Marychev, I. L., Protsap, O. I. & Bryzhata, S. I. (2019). Epidemichna sytuatsiia po zakhvoriuvanosti na kir v Ukraini u 2017-2018 r.r. [Epidemic situation of measles incidence in Ukraine in 2017-2018]. Infectious diseases of modern times: etiology, epidemiology, diagnosis, treatment, prevention, biological safety. Materials of Scientific and Practical Conference (pp. 76-79). Kyiv. [in Ukrainian].
Kramarov, S. O., Yevtushenko, V. V., Kovalyukh, I. Yu., Kaminska, T. M., & Golovach, O. V. (2018). Klinichna kartyna koru v ditei, hospitalizovanykh pid chas spalakhu 2017-2018 rr. [Clinical features of measles in children hospitalized during 2017-2018 outbreak]. Aktualna infektolohiia - Actual infectology, 6(5), 55-60. [in Ukrainian]. https://doi.org/10.22141/2312-413х.6.5.2018.146773
Rota, P. A., Brown, K., Mankertz, A., Santibanez, S., Shulga, S., Muller, C. P., … Featherstone, D. (2011). Global distribution of measles genotypes and measles molecular epidemiology. Journal of Infectious Diseases, 204(Suppl. 1). https://doi.org/10.1093/infdis/jir118
Werber, D., Hoffmann, A., Santibanez, S., Mankertz, A., & Sagebiel, D. (2017). Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015. Eurosurveillance, 22(34), 6-13, Article 30599. https://doi.org/10.2807/1560-7917.es.2017.22.34.30599
Grammens, T., Schirvel, C., Leenen, S., Shodu, N., Hutse, V., da Costa, E. M., & Sabbe, M. (2017). Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. Eurosurveillance, 22(17), 5-9, Article 30524. https://doi.org/10.2807/1560-7917.es.2017.22.17.30524
Pavlenova, O. Yu., Ushenina, L. A., Ryabokon, E. V., Mashko, O. P., Furik, E. A., Ushenina, N. S., Savelyev, V. G., Onishchenko, T. E., & Firyulina, O. M. (2013). Osoblyvosti zmin pokaznykiv funktsionalnoho stanu vehetatyvnoi nervovoi systemy u khvorykh na kir [Peculiarities of changes of autonomic nervous system functional state in patients with measles]. Zaporozhye Medical Journal, (2), 39-41. [in Ukrainian].
Moyseyeva, A. V., Zadorozhna, V. I., Demchyshyna, I. V., & Novyk, L. V. (2010). Monitorynh populiatsiinoho imunitetu proty koru naselennia Ukrainy [Monitoring of population’s immunity is against measles of population in Ukraine]. Infektsiini khvoroby, (3), 5-13. [in Ukrainian]. https://doi.org/10.11603/1681-2727.2010.3.671
Usachova, O. V., Silina, Ye. A., Pakholchuk, T. N., Konakova, O. V., Dralova, O. A., Puhir, V. P., Firyulina, O. M., & Zelenukhina, E. V. (2019). Kir – kerovana infektsiia! Deiaki epidemiolohichni paradyhmy koru u Zaporizkii oblasti [Measles – controlled infection! Some epidemiological paradigm of measles in Zaporizhzhia region]. Sovremennaya Pediatriya, (1), 13-18. [in Ukrainian]. https://doi.org/10.15574/SP.2019.97.13
Timchenko, V. N., Kaplina, T. A., Bulina, O. V., Leonicheva, O. A., Khakizimana, Zh. K., & Timofeeva, E. V. (2017). Aktual'nye problemy korevoi infektsii [Actual problems of measles infection]. Pediatriya, 8(3), 120-129. [in Russian]. https://doi.org/10.17816/PED83120-129
Demenina, N. K., & Ishchenko, H. I. (2018). Vplyv infektsii koru na vahitnist ta metody profilaktyky (ohliad literatury) [Influence of measles on pregnancy and prevention methods (a literature review)]. Perinatologiya i pediatriya, (1), 80-83. [in Ukrainian]. https://doi.org/10.15574/PP.2018.73.83
Trykhlib, V. I., Shchur, A. B., Hrushkevych, V. V., Hryshyn, O. S., Pavlovska, M. O., Musiienko, T. I., Muzyka, H. A., Ralets, N. V., Dudar, D. M., & Kozachenko, L. V. (2018). Osoblyvosti klinichnykh proiaviv ta perebihu koru [Features of clinical manifestations and course of measles]. Aktualna infektolohiia, 6(3), 36-47. [in Ukrainian]. https://doi.org/10.22141/2312-413x.6.3.2018.136647
Yasunaga, H., Shi, Y. J., Takeuchi, M., Horiguchi, H., Hashimoto, H., Matsuda, S., & Ohe, K. (2010). Measles-related Hospitalizations and Complications in Japan, 2007-2008. Internal Medicine, 49(18), 1965-1970. https://doi.org/10.2169/internalmedicine.49.3843
World Health Organization. (2012). Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region. Geneva: WHO.
Hnatyuk V. V., & Pokrovska T. V. (2015). Uskladnennia koru v ditei i doroslykh [Complications of measles in children and adults]. Bukovynskyi medychnyi visnyk, 19(2), 48-51. [in Ukrainian].
Shostakovych-Koretsraya, L. R., Mavrutenkov, V. V., Cherhinets, A. V., Budayeva, I. V., Yakunina, O. M., & Chykarenko, Z. A. (2013). Kir (lektsiia, prodovzhennia) [Measles (lecture, continued)]. Medychni perspektyvy, 18(3), 4-15. [in Ukrainian].
Nozdracheva, A. V., Semenenko, T. A., Mardanly, S. G., & Rotanov, S. V. (2017). Otsenka napryazhennosti gumoral'nogo immuniteta k kori i krasnukhe u beremennykh zhenshchin v Moskve [Evaluation of intensity of humoral immunity to measles and rubella in pregnant women in Moscow]. Zhurnal mikrobiologii, (3), 91-98. [in Russian].
Casalegno, J. S., Huissoud, C., Rudigoz, R., Massardier, J., Gaucherand, P., & Mekki, Y. (2014). Measles in pregnancy in Lyon France, 2011. International Journal of Gynecology & Obstetrics, 126(3), 248-251. https://doi.org/10.1016/j.ijgo.2014.03.021
Ali, A. A., Abdelhameed, O., & Abdallah, T. M. (2014). Case-fatality rate associated with measles during pregnancy in Kassala, eastern Sudan. International Journal of Gynecology & Obstetrics, 124(3), 261-262. https://doi.org/10.1016/j.ijgo.2013.09.015
Ogbuanu, I. U., Zeko, S., Chu, S. Y., Muroua, C., Gerber, S., De Wee, R., Kretsinger, K., Wannemuehler, K., Gerndt, K., Allies, M., Sandhu, H. S., & Goodson, J. L. (2014). Maternal, Fetal, and Neonatal Outcomes Associated With Measles During Pregnancy: Namibia, 2009-2010. Clinical Infectious Diseases, 58(8), 1086-1092. https://doi.org/10.1093/cid/ciu037
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
