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Late morphologic consequences of measles: a lethal and debilitating lung disease among the poor
Insights
Measles can lead to severe pneumonia and bronchiectasis in children, especially when complicated by adenovirus or herpesvirus infections. These infections, exacerbated by immune suppression and poor nutrition, are key causes of childhood lung damage.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Measles is a significant cause of childhood pneumonia and death, particularly in impoverished populations.
- Measles immunization program effectiveness influences the incidence of measles-related pneumonia.
- Bronchiectasis is a serious pulmonary complication that can arise after measles infection.
Purpose of the Study:
- To investigate the causal link between measles and bronchiectasis in children.
- To identify the specific factors contributing to severe lung pathology following measles.
- To explore the role of superinfecting viruses and bacteria in measles-related pulmonary morbidity.
Main Methods:
- Retrospective analysis of 20 out of 57 pediatric bronchiectasis cases for measles association.
- Histopathological examination of lung tissue from 21 children who died following measles.
- Correlation of observed lung necrosis with intercurrent viral (adenovirus, herpesvirus) and bacterial infections.
Main Results:
- A strong causal relationship between measles and bronchiectasis was identified in 20 of 57 cases.
- Severe necrosis of bronchi and bronchioles was observed in children with measles complicated by adenovirus and herpesvirus infections.
- Bacterial infections resulted in less severe necrosis compared to viral superinfections.
Conclusions:
- Intercurrent adenovirus and herpesvirus infections post-measles are primary triggers for childhood follicular bronchiectasis.
- Transient immune suppression from measles and malnutrition likely exacerbates these superinfections.
- Understanding these mechanisms is crucial for preventing severe pulmonary sequelae in children affected by measles.
Abstract:
Pneumonia that occurs within 28 days of the onset of measles rash is a common cause of severe pulmonary morbidity and/or death among poor children. The prevalence of such pneumonia can be related to the effectiveness of measles immunization programs. For 20 of 57 new cases of bronchiectasis in children undergoing bronchography, a strong causal relationship to measles was found. The lungs of 21 unselected children who died in the wake of measles were examined. Severe necrosis of bronchi and bronchioles was found in those children who had developed intercurrent adenovirus and herpesvirus infections. Bacterial suppuration produced a less severe necrosis. It is suggested that intercurrent adenovirus and herpesvirus infections that occur following measles are the most important initiating causes of follicular bronchiectasis in childhood. The severity of these supervening infections may be mediated by the transient immune suppression that occurs as a consequence of both measles and inadequate nutrition.