Acute renal failure with neurological involvement in adults associated with measles virus isolation

Renal Abnormalities Caused by Canine Distemper Virus Infection in Terminal Patients

The aim of this study was to analyze the glomerular and tubular alterations in dogs with terminal distemper through light microscopy, immunofluorescence, and electron microscopy. Thirteen animals with a molecular diagnosis of distemper and neurological signs were selected. As a control group, 10 clinically healthy animals with no manifestations or signs of disease and with negative tests for Ehrlichia sp., Anaplasma sp., and Babesia sp. were included in this study. Renal tissue was evaluated by light microscopy, topochemistry for DNA/chromatin, and video image analysis to detect the nuclear phenotypes of the renal tubular epithelial cells (RTECs), immunofluorescence, and transmission electron microscopy. Results showed that dogs with distemper exhibited anemia, hypergammaglobulinemia, and proteinuria. Creatinine in the distemper group was lower compared to the control group (p = 0.0026), but there was no significant difference in relation to urea (p = 0.9876). Although this alteration may be due to the smaller muscle mass observed in animals with distemper, it probably is not of clinical importance. Glomerular and tubular lesions were confirmed by light microscopy in 84.6% of these animals. Additional findings in the animals with distemper included deposition of different classes of immunoglobulins, particularly IgM in 92.3% of the cases, fibrinogen deposition in 69.2% of the cases as assessed by immunofluorescence, alterations in the nuclear phenotypes of the RTEC characterized by condensation of chromatin, loss of DNA and reduction in the nuclear shape, and the presence of subendothelial and mesangial electron-dense deposits. These findings confirm the existence of renal alterations related to terminal distemper.

Inpatient morbidity and mortality of measles in the United States

Background

Measles is an extremely contagious, vaccine-preventable infection that was officially declared eradicated in the US in 2000. However, measles outbreaks are increasingly occurring in the US. Measles cases have considerable morbidity requiring hospitalization, yet little is known about hospitalization and complications from measles in recent years.

Objectives

To analyze the frequency, predictors, costs and other outcomes of hospitalization for measles in the US.

Methods

The 2002–2016 Nationwide Inpatient Sample, containing a 20% sample of US hospitalizations (n = 96,568,625), was analyzed. Measles and comorbidities were defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) or ICD-10-CM codes. Multivariable survey logistic regression and linear regression models controlling for sociodemographic demographic factors were constructed to understand associations with organ-specific complications, and cost of care and length of stay, respectively.

Results

Overall, 1,018 measles hospitalizations occurred in 2002–2016, and hospitalizations increased over time. In multivariable logistic regression models, measles was associated with higher odds of gastrointestinal, hematologic, infectious, neurologic, ophthalmologic, pulmonary, and renal complications, with the strongest association observed with encephalitis (39.84 [16.51–96.12], P<0.0001). Increased length of stay (LOS) and similar cost of care (mean [95% CI]; 4.8 [4.4–5.4]; $7,438 [$6,446-$8,582]) were observed versus (vs.) all other admissions (4.5 [4.4–4.5]; P<0.01; $7,854 [$7,774-$7,935], P>0.05). There were 34 deaths in hospitalized measles patients; inpatient mortality was numerically higher in those with vs. without measles (proportion ± SEM: 3.3±1.2% vs. 2.3±0.01%, P = 0.333).

Limitations

Lack of outpatient or prescription data.

Conclusions

Measles continues to pose a substantial and preventable health care burden, with serious complications, hospitalization and inpatient mortality. Further studies are needed to improve the prevention and management of measles.

Mapping the evolutionary trajectories of morbilliviruses: what, where and whither

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Morbilliviruses are important human and animal pathogens.

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Measles virus is the prototype and is the most infectious human pathogen on earth.

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Live attenuated vaccines have been used to control the infections.

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Rinderpest virus is the second virus to be eradicated from earth.

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New morbilliviruses have been identified in cats and vampire bats.

Morbilliviruses are pathogens of humans and other animals. Live attenuated morbillivirus vaccines have been used to end endemic transmission of measles virus (MV) in many parts of the developed world and to eradicate rinderpest virus. Entry is mediated by two different receptors which govern virus lymphotropism and epitheliotropism. Morbillivirus transmissibility is unparalleled and MV represents the most infectious human pathogen on earth. Their evolutionary origins remain obscure and their potential for adaption to new hosts is poorly understood. It has been suggested that MV could be eradicated. Therefore it is imperative to dissect barriers which restrict cross species infections. This is important as ecological studies identify novel morbilliviruses in a vast number of small mammals and carnivorous predators.

The Reemergence of Measles

Measles, or rubeola, is a highly infectious, acute viral illness of childhood that is considered eliminated in the USA but has reemerged in the past few years. Globally, an estimated 20 million cases of measles continue to occur, and it remains a leading cause of death among young children. It is rare in the USA and other first world countries, but numerous outbreaks have occurred in the USA recently, due to a combination of factors including poor vaccine coverage and importation of cases among travelers returning from endemic areas. The diagnosis of measles is usually made clinically, when an individual presents with a constellation of symptoms including cough, coryza, conjunctivitis, high fever, and an erythematous maculopapular rash in a cephalocaudal distribution. Complications are common and include otitis media, pneumonia, encephalitis, and rarely death. A measles vaccine is available in two doses and provides excellent protection against the disease. Despite this, vaccination coverage, especially among young adults, remains poor. Given its resurgence in the USA and other countries, interventions are urgently needed to address low vaccination rates and vaccine hesitancy. Measles awareness should also be a priority among young clinicians, who may have never seen a case or are not familiar with the disease.

Prevalence of measles, mumps, rubella, and varicella susceptibility among health science students in a University in India

BACKGROUND

Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertaken to determine the prevalence of susceptibility of HSS to these infections.

METHODS

Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost(®)).

RESULTS

The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively.

CONCLUSION

HSS susceptible to measles, mumps, rubella, and/or varicella are at risk of acquiring these diseases during their training period. In addition, they may be a potential source for nosocomial transmission posing a risk to immunocompromised patients. Hence, in the Indian setting, HSS should be immunized against measles, mumps, rubella, and varicella at the time of joining the medical school.

The clinical significance of measles: a review

Forty years after effective vaccines were licensed, measles continues to cause death and severe disease in children worldwide. Complications from measles can occur in almost every organ system. Pneumonia, croup, and encephalitis are common causes of death; encephalitis is the most common cause of long-term sequelae. Measles remains a common cause of blindness in developing countries. Complication rates are higher in those <5 and >20 years old, although croup and otitis media are more common in those <2 years old and encephalitis in older children and adults. Complication rates are increased by immune deficiency disorders, malnutrition, vitamin A deficiency, intense exposures to measles, and lack of previous measles vaccination. Case-fatality rates have decreased with improvements in socioeconomic status in many countries but remain high in developing countries.

Molecular techniques should not now replace cell culture in diagnostic virology laboratories

The value of molecular techniques for virology is not in dispute; the issue debated here is whether or not to abandon virus isolation altogether. Modern clinical virology relies on rapid virus detection for timely infection control and antiviral therapy. The role of virus isolation, inevitably a slower process as it involves replication in cell cultures, is most significant in providing epidemiological data, in the diagnosis of new or unexpected infection, and in yielding infectious virus for further study. Examples include identification of enterovirus serotypes in outbreaks, diagnosis of atypical virus infections, and provision of virus isolates for phenotypic antiviral susceptibility assays. Many viruses can be detected after overnight culture using the centrifugation-enhanced (shell vial) technique. In contrast to this established track record, the commercial development of molecular assays has been concentrated on blood-borne viruses, and standardisation of procedures for other viruses is lacking. Accreditation of molecular techniques is just beginning, and few external quality assurance schemes are available yet. In my view, it is premature to abandon routine virus isolation, although as molecular diagnosis expands, the facilities for cell culture and isolation work may become more centralised to retain expertise and to provide the range and quality of service required.