11/109. Clinical significance of the serum surfactant protein D and KL-6 levels in patients with measles complicated by interstitial pneumonia.To examine the value of surfactant protein D and KL-6 as markers for the diagnosis and the severity of interstitial pneumonia caused by measles infection, surfactant protein D, KL-6 and lactic acid dehydrogenase were measured serially in three patients with measles complicated by interstitial pneumonia as compared to ten measles infected patients without interstitial pneumonia. The serum surfactant protein D and KL-6 levels were higher in patients with measles and interstitial pneumonia as compared to those with measles without interstitial pneumonia. In patients with measles and interstitial pneumonia, the respiratory distress and the alveolar-arterial oxygen differences improved after steroid pulse therapy while the serum surfactant protein D level decreased dramatically under the cut-off level and earlier than the KL-6 level. On the contrary, the serum KL-6 level increased transiently and it took longer to decrease below the cut-off level as compared to the pattern observed for serum surfactant protein D. The serum lactic acid dehydrogenase level changes were between those of the surfactant protein D and KL-6 levels. CONCLUSION: Surfactant protein D and KL-6 are easily measured and useful markers for the diagnosis of interstitial pneumonia caused by measles infection. Early decrease of surfactant protein D contrasts with the transient increase of KL-6 levels after prednisolone pulse therapy.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/109. measles virus infection in the placenta of monozygotic twins.We report a case of monozygotic twins whose mother was infected with measles at 19 weeks' gestation. One of the twins died in utero at 32 weeks' gestation. The placenta of the stillbirth showed massive fibrin deposition, and some residual trophoblasts contained many inclusion bodies positive for measles virus antigen. Fetal organs and cells other than a few splenic lymphocytes showed no evidence of measles virus infection. The placenta of the surviving infant showed focal intervillous fibrin deposits, and only a few syncytiotrophoblasts were positive for measles virus antigen. At present, 7 months after the delivery, the surviving infant has not developed any sign of measles virus infection. Postpartum course of the mother has been uneventful, although high titers of serum anti-measles virus IgM persisted for 6 months after delivery. This case is informative in the following respects: the villous trophoblasts had diagnostic inclusion bodies and ultrastructural evidence of measles virus infection, the degree of viral involvement within the monochorionic placenta was uneven, both of the twins were virtually free from measles virus infection despite the marked involvement of the placenta, and measles virus infection had persisted in the monochorionic placenta for approximately 13 weeks.- - - - - - - - - - ranking = 4.5keywords = infection (Clic here for more details about this article) |
13/109. Giant cell pneumonia in a leukemic child in remission: a case report.Giant cell pneumonia is a rare and uncommon type of lung infection developing as a complication of measles, especially in immunocompromised patients, whether their immune systems are affected primarily or whether they have acquired immune defects. As well as being uncommon, it is also atypical because of absence of the characteristic rash and of absent or low antibody titers against measles in most of the cases. It is known that cellular immunity is more important than humoral immunity in the host response to measles, so hypogammaglobulinemic patients with normal cellular immunity usually recover uneventfully from measles and also have the characteristic rash. We report a case with giant cell pneumonia that was confirmed by postmortem histopathological examination. We especially want to point out that even in the absence of rash, with the clinical and radiological features of pneumonia, measles should be considered in a patient, whether in remission or not, receiving immunosuppressive treatment.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
14/109. Measles-related appendicitis.Owing to the characteristic Warthin-Finkeldey giant cells found in hyperplastic mucosa-associated lymphoid tissue, it has been emphasized that pathologists can make a diagnosis of measles from appendectomy specimens even in the prodromal stage before diagnostic rashes develop. However, to date, those reported cases of measles-related appendicitis have dealt with the histologic features of the prodromal stage and we found no reports in the English literature describing the histopathologic findings of appendicitis during the full-blown stage of measles. Here, we describe 2 cases of measles-related appendicitis that show contrasting histologic features according to stage, one discovered during the prodromal stage and the other occurring during the full-blown stage. This report describes heretofore unreported histopathologic findings of measles-related appendicitis observed during the full-blown stage of the infection and highlights histopathologic changes caused by replication of the virus in different compartments of the same organ during the course of infection.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
15/109. Combined vaccination by measles and hepatitis b vaccines: a new cause of Gianotti-Crosti syndrome.An 11-month-old boy presented with Gianotti-Crosti syndrome. He had received measles and a third dose of hepatitis b vaccines 2 weeks before the onset of the eruption. There were no clinical symptoms of any viral infection at the presentation. Serological tests for common viral infections were negative. The combination of measles and hepatitis b vaccines was likely the relevant factor in the etiology.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
16/109. Early onset and rapidly progressive subacute sclerosing panencephalitis after congenital measles infection.We report an 18-month-old girl with rapidly progressive subacute sclerosing panencephalitis, whose non immunised mother had measles at the time of delivery. The patient presented with repetitive episodes of myoclonic jerks of the head and arms, followed by a drop of head and trunk with frequent falls. EEG, CSF studies and MRI confirmed the diagnosis. Despite therapy with isoprinosine and valproate, seizure activity continued and she became vegetative within 2 months, with severe spasticity and swallowing difficulties, and died at the age of 28 months. Early age of onset and rapid progression were most likely related to haematogenous in utero acquisition of the measles virus prior to delivery, as well as immaturity of neuronal and immune systems. CONCLUSION: this case emphasises the importance of a high measles vaccine coverage in the population in order to prevent the risk of disease in general and, in particular, gestational measles.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
17/109. Subacute measles encephalitis in an immunocompetent adult.subacute sclerosing panencephalitis (SSPE) and subacute measles encephalitis (SME) are both rare complications of measles virus infection. SSPE typically affects immunocompetent children, has an insidious onset and follows a steadily progressive course. SME mainly occurs in immunosuppressed children and has a rapidly progressive course. We describe a 43 year old immunocompetent man who presented with a rapidly progressive fatal encephalopathy. Histological examination of the brain showed a meningoencephalitis with inclusion bodies. Complement fixing antibody to measles virus was present in his serum and CSF. measles virus rna was found in the brain, spinal cord and eye, but not in the CSF. Analysis of the nucleoprotein gene isolated from this patient did not show similarity to SSPE strains of the measles virus. This patient demonstrates that subacute encephalitis secondary to measles virus infection can develop in an immunocompetent adult host.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
18/109. Bilateral anterior optic neuritis in adult measles infection without encephalomyelitis.PURPOSE: To describe anterior optic neuritis in adult measles infection.DESIGN: Interventional case report. methods: A 31-year-old woman presented with bilateral visual loss 6 days after the onset of maculopapular rash. Complete ophthalmic and neurologic examinations, radiologic studies, and lumbar puncture were performed. RESULTS: Visual acuities were counting fingers in both eyes, with bilateral optic disk hyperemia and swelling noted. neurologic examination was unremarkable, and computed tomography and magnetic resonance imaging of the brain were normal. The cerebrospinal fluid (CSF) was devoid of white cells, although measles immunoglobulin m (IgM) antibodies were detected in both CSF and serum. Intravenous corticosteroids were administered, and clinical findings resolved within 1 month. A fall in serum IgM and a rise in serum IgG titers were observed. CONCLUSIONS: Although rare, optic neuritis in the absence of encephalomyelitis may occur in measles. Whether treatment is effective is unknown.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
19/109. Proton magnetic resonance spectroscopy in a case of subacute sclerosing panencephalitis.subacute sclerosing panencephalitis is an encephalopathy caused by a persistent measles virus infection. We examined a 13-year-old girl with subacute sclerosing panencephalitis and performed a magnetic resonance spectroscopic study to evaluate the in vivo pathophysiologic abnormality. The results suggested the occurrence of inflammatory processes and glial proliferation prior to neuronal loss even in magnetic resonance imaging (MRI)-negative regions as well as in MRI-positive regions. The additional resonance peaks were also detected, but further studies should be performed to determine the precise pathophysiologic mechanisms. Novel in vivo modalities such as spectroscopy would be useful as a tool to measure responses to therapy.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
20/109. Encephalopathy following measles infection in children with chronic illness.Five patients with an unusual encephalopathy, possible secondary to measles virus infection, are described. Features common to these patients are: an existing chronic disease, neurologic deterioration 2 1/2 to 6 months after a measles infection, and death several weeks later. These events occurred when the chronic disease (e.g. leukemia or neuroblastoma) was in remission. That the measles virus was the causative agent is suggested only by finding in brain and extracranial tissues intracytoplasmic and intranuclear inclusions which contained measleslike particles. Additional clinical features seen in each of the five patients were: seizures, hypertension, and the inappropriate secretion of antidiuretic hormone.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
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