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Clinical features of measles in immunocompromised children
T Nakano1, Y Shimono, K Sugiyama
1Department of Pediatrics, Mie National Hospital, Japan.
Abstract:
Measles is often fatal for immunocompromised hosts. Protective immunity against measles has been studied but is still not completely understood. Recently, five cases of measles were encountered in immunocompromised children. Two of these were allogeneic bone marrow transplanted cases (one common variable immunodeficiency and one severe aplastic anemia) in remission, one Wilms' tumor case in remission, one hepatoblastoma case after cytotoxic therapy at disease onset and one exaggerating hemophagocytic syndrome case with suppressed natural killer cell activity. Clinical symptoms, laboratory findings and the immunologic backgrounds of these five patients were investigated. One of the patients, an 8 year old boy with hemophagocytic syndrome, died of giant cell pneumonia which was confirmed in the section of necropsy lung specimen. Two other patients who received allogeneic bone marrow transplants were not immune to measles, despite their own and their donors' immunizations. Their clinical symptoms were rather severe but both patients recovered and have remained seropositive for as long as 13 months. This fatality from measles is the first reported in a patient with hemophagocytic syndrome. Suppressed natural killer cell activity may be a poor prognostic factor. Also, secondary immunization failure for measles can occur in bone marrow transplanted patients with rather severe clinical symptoms.
Insights
Measles can be fatal for immunocompromised children, even after bone marrow transplants. This study highlights potential immunization failures and poor prognostic factors like suppressed natural killer cell activity.
Area of Science:
- Immunology
- Pediatrics
- Infectious Diseases
Background:
- Measles poses a significant risk to immunocompromised individuals, with protective immunity not fully elucidated.
- Understanding measles' impact on vulnerable populations is crucial for public health strategies.
Observation:
- Five immunocompromised children with measles were studied, including those with hemophagocytic syndrome and bone marrow transplants.
- One patient with hemophagocytic syndrome died from giant cell pneumonia, a novel measles-related fatality.
- Two bone marrow transplant recipients experienced severe measles despite prior immunizations, indicating potential secondary immunization failure.
Findings:
- Hemophagocytic syndrome with suppressed natural killer cell activity appears to be a poor prognostic indicator for measles.
- Allogeneic bone marrow transplant recipients may not achieve protective immunity against measles, even with donor immunization.
- Severe clinical symptoms and prolonged seropositivity were observed in transplant patients who recovered.
Implications:
- This research underscores the need for enhanced measles surveillance and potentially revised vaccination protocols in immunocompromised pediatric populations.
- Identifying prognostic factors like suppressed natural killer cell activity can guide clinical management and improve outcomes.
- The findings emphasize the risk of secondary immunization failure in bone marrow transplant recipients, necessitating further investigation into immune reconstitution and booster strategies.