Ileocolitis Associated With Measles (Rubeola)

Abstract

A case of fatal measles is reported in a five-year-old boy with diarrhea. At necropsy, an ileocolitis whose histopathology suggested not only a viral etiology, but more specifically incriminated rubeola virus, was present.The Persian physician, Rhazes, in 860 AD is reputed to have been the first to have noted the occurence of diarrhea in patients with measles.1,2 In nutritionally compromised areas of the world, acute diarrhea, especially in children less than 5 years of age, is a common manifestation of measles.2,3 Anatomical lesions associated with this clinical finding have been limited to the description of giant cells (Warthin-Finkeldey cells) marginal to lymphoid tissues in Peyer's patches of the ileum or in the lamina propria of the colon and/or appendix during the preeruptive phase of the disease4-7 or of intestinal lymphoid hyperplasia.8The purpose of this communique is to describe a case in which diarrhea was the presenting manifestation of measles infection and could be related at necropsy to an ileocolitis of probable viral etiology. Report of a CaseThis was the first W. A. Shand's Teaching Hospital admission of a 5-year-old white boy. Five days prior to admission, the child had had the onset of a macular rash which became confluent and which was diagnosed as measles by a physician. Two days later, he developed severe diarrhea with 10 to 20 stools per day. Shortly before admission the child became cyanotic and collapsed. On arrival at the emergency room, he was pronounced dead. The necropsy was performed within four hours after death. Postmortem FindingsGross.-There was a dull, purple maculo-confluent rash over the major portion of the body. The skin was in¬ elastic, and the eyes were sunken. The esophagus was normal. The mu¬ cosa of the stomach showed normal rugae and appeared intact. In the duodenum, there were several acute superficial erosions. The mucosa of the jejunum appeared normal. In the distal ileum, the mucosa became ede¬ matous and had a granular appear¬ ance. The plicae pattern was effaced in regions of severe edema. In some areas the mucosa had a purplish ap¬ pearance and contained numerous minute petechial hemorrhages. The entire colon was congested with loss of the normal mucosal folds. The mu¬ cosa was finely dimpled, suggestive of minute ulcérations. Petechial hem¬ orrhages were prominent. These changes were most marked in the distal portion of the colon. Several areas of hemorrhage and overt ulcér¬ ation with gray-white surface ex¬ údate were also identified. The ap-

Measles virus-induced immune suppression in the cotton rat (Sigmodon hispidus) model depends on viral glycoproteins

“…Measles virus (MV) infection is still among the primary causes of infant death in the third world. The acute infection with fever and rash is often complicated by respiratory symptoms (32) such as laryngotracheitis and pneumonia, diarrhea (25), and postinfectious encephalitis (16). During infection, a marked immune suppression is observed which leads to a high incidence of bacterial and parasitic superinfections with often lethal outcome (see reference 9 for a review).…”

Detection of IgG Antibodies Specific for Measles Virus by Enzyme-Linked Immunosorbent Assay (ELISA)

“…Nevertheless, in spite of the impressive decrease in the number of reported cases, local outbreaks continue to occur and, with them, the numerous complications associated with measles -pneumonia, otitis media, encepha litis and subacute sclerosing panencephalitis (SSPE) -are still frequent [5][6][7][8], Therefore, it is important to have highly sensitive methods to detect accurately the level of specific anti bodies to measles in sera and cerebrospinal fluid (CSF) of patients.…”

Age-specific measles mortality during the late 19th–early 20th centuries

“…Measles can cause tremendous mortality rates across all ages when it first contacts an isolated population as was seen in Pacific Islands such as Fiji in 1875 and Rotuma in 1911 [13, 14]. Besides making the entire community from infants to the elderly ill simultaneously leaving few healthy persons to provide nursing care, first-contact epidemics had particularly pernicious symptoms such as subacute ileocolitis and pneumonia which sometimes resulted in up to one-fifth of the population dying during the epidemic [15–17]. As most of these epidemics occurred prior to the arrival of medically trained observers, there have been only a few detailed epidemiological studies of first-contact measles epidemics [18].…”