超越科氏斑：青少年和成人麻疹中作为新型黏膜疹的类阿弗他溃疡
Beyond Koplik spots: aphthous-like ulcers as a novel enanthem in adolescent and adult measles.
文献信息
| PMID | 42731628 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Baker Ninan Fenn |
| 作者单位 | Department of Infectious Diseases, Government Medical College, Kottayam, Kerala, India; Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India. Electronic address: fennbaker1@gmail.com. |
| 期刊 | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases |
| SCI 分区 | Q1 |
| IF | 8.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 麻疹在青少年和成人中重新出现，但其除科氏斑以外的口腔表现特征尚不明确。我们描述了该人群中确诊麻疹的口腔黏膜表现，重点关注类阿弗他溃疡，这是一种特征较少的麻疹黏膜疹。
方法： 在印度喀拉拉邦一家三级中心进行的前瞻性观察性队列研究（2024年6月至2026年6月）中，连续纳入年龄12岁及以上、患有急性发热和全身性皮疹的患者；报告了通过IgM ELISA和/或鼻咽RT-PCR确诊麻疹的患者。系统检查口腔；在可行的情况下获取溃疡基底拭子，并对一处溃疡进行活检。
结果： 在307例发热和皮疹患者中，31例确诊麻疹（中位年龄26岁；31例中30例接种过疫苗，其中22例仅接种过一剂婴儿期疫苗）。31例中有21例（67.7%）出现任何口腔黏膜表现。类阿弗他溃疡发生于31例中的11例（35.5%），持续于病程第3至第8天，并比科氏斑（31例中13例，41.9%）持续时间更长，后者与更早就诊相关（中位第4天对第6天，p=0.001）。在3例患者中获取的溃疡基底拭子，3例均为麻疹RT-PCR阳性，且单纯疱疹病毒1/2型、肠道病毒、巨细胞病毒、EB病毒和水痘-带状疱疹病毒均为阴性；活检显示非特异性阿弗他形态。
结论： 类阿弗他口腔溃疡是麻疹常见的黏膜疹，其持续时间超过科氏斑窗口期，值得积极识别并及时进行麻疹检测。
英文摘要
OBJECTIVES: Measles is re-emerging in adolescents and adults, yet its oral phenotype beyond Koplik spots is poorly characterised. We describe the oral mucosal manifestations of confirmed measles in this group, focusing on aphthous-like ulcers, a less characterised enanthem of measles.
METHODS: In a prospective observational cohort at a tertiary centre in Kerala, India (June 2024 to June 2026), patients aged 12 years or older with acute fever and generalised rash were enrolled consecutively; those with measles confirmed by IgM ELISA and/or nasopharyngeal RT-PCR are reported. The oral cavity was examined systematically; ulcer-base swabs were obtained where feasible and one ulcer was biopsied.
RESULTS: Of 307 patients with fever and rash, 31 had confirmed measles (median age 26 years; 30 of 31 vaccinated, 22 of them with a single infant dose). Any oral mucosal finding occurred in 21 of 31 (67.7%). Aphthous-like ulcers occurred in 11 of 31 (35.5%), spanned illness days 3 to 8, and outlasted Koplik spots (13 of 31, 41.9%), which were associated with earlier presentation (median day 4 versus 6, p=0.001). Ulcer-base swabs, obtained in three patients, were measles RT-PCR-positive in all three and negative for herpes simplex virus 1/2, enteroviruses, cytomegalovirus, Epstein-Barr virus and varicella-zoster virus; biopsy showed non-specific aphthous morphology.
CONCLUSIONS: Aphthous-like oral ulcers are a frequent enanthem of measles that outlasts the Koplik window and warrants active recognition and prompt measles testing.