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Kanaan D, Al-Khazali MN, Khalid IW, Abu-Ekteish F, Al-Sweedan S. An Unusual Complication of Measles Infection in a Pediatric Patient: A Case Report of Measles-Induced Hemophagocytic Lymphohistiocytosis (HLH) From Jordan. Cureus 2023; 15:e48144. [PMID: 38046741 PMCID: PMC10692959 DOI: 10.7759/cureus.48144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Measles is a highly contagious infection that leads to many serious complications. Despite the significant global effort to eradicate it, it still represents a major threat due to suboptimal vaccination coverage, especially after the coronavirus disease 2019 (COVID-19) pandemic that affected all routine childhood vaccinations. One of its fatal complications, which has been reported a few times in the literature, is hemophagocytic lymphohistiocytosis (HLH). We discuss a case of a 14-month-old unvaccinated female patient who developed measles-induced HLH and was treated with intravenous immunoglobulins (IVIG) and steroids; unfortunately, she developed multiorgan failure and passed away before chemotherapy could be initiated.
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Affiliation(s)
- Dana Kanaan
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Mohammad N Al-Khazali
- Department of Pediatrics, Princess Rahma Teaching Hospital, Jordanian Ministry of Health, Irbid, JOR
| | - Israa W Khalid
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Faisal Abu-Ekteish
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Suleimman Al-Sweedan
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
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Mohseni Afshar Z, Babazadeh A, Janbakhsh A, Afsharian M, Saleki K, Barary M, Ebrahimpour S. Vaccine-induced immune thrombotic thrombocytopenia after vaccination against Covid-19: A clinical dilemma for clinicians and patients. Rev Med Virol 2021; 32:e2273. [PMID: 34197678 PMCID: PMC8420499 DOI: 10.1002/rmv.2273] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (Covid-19) pandemic has had devastating effects on public health worldwide, but the deployment of vaccines for Covid-19 protection has helped control the spread of SARS Coronavirus 2 (SARS-CoV-2) infection where they are available. The common side effects reported following Covid-19 vaccination were mostly self-restricted local reactions that resolved quickly. Nevertheless, rare vaccine-induced immune thrombotic thrombocytopenia (VITT) cases have been reported in some people being vaccinated against Covid-19. This review summarizes the thromboembolic events after Covid-19 vaccination and discusses its molecular mechanism, incidence rate, clinical manifestations and differential diagnosis. Then, a step-by-step algorithm for diagnosing such events, along with a management plan, are presented. In conclusion, considering the likeliness of acquiring severe SARS-CoV-2 infection and its subsequent morbidity and mortality, the benefits of vaccination outweigh its risks. Hence, if not already initiated, all governments should begin an effective and fast public vaccination plan to overcome this pandemic.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mandana Afsharian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Fragkou PC, Thomas K, Sympardi S, Liatsos GD, Pirounaki M, Sambatakou H, Marantos T, Karofylakis E, Dourakis SP, Tsiodras S, Kavvatha D. Clinical characteristics and outcomes of measles outbreak in adults: A multicenter retrospective observational study of 93 hospitalized adults in Greece. J Clin Virol 2020; 131:104608. [PMID: 32877891 PMCID: PMC7448962 DOI: 10.1016/j.jcv.2020.104608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/03/2020] [Accepted: 08/21/2020] [Indexed: 12/23/2022]
Abstract
Measles is an unresolved issue for unvaccinated or incompletely vaccinated adults. Data for outcomes, complications and risk factors in adults are limited. Pneumonitis and hepatic involvement are the most frequent complications in adults. Older age, low lymphocyte count and male sex are associated with pneumonitis. Case fatality ratio in adults is low despite the high frequency of complications.
Objectives Measles outbreaks are increasingly reported among countries that were close-to-eliminate measles infection. There are few reports of clinical characteristics of measles in adults in the contemporary literature. In this study we aim to describe the clinical characteristics and complications of measles infection in hospitalized adults during the recent epidemic in Greece. Methods A multicentre observational retrospective study was conducted in three tertiary hospitals in Greece. All adult hospitalized patients (≥18 years old) with serologically confirmed and/or clinical features compatible with measles were included. Pediatric patients and patients with missing data were excluded. Results In total, 93 patients, 40 males (43 %) and 53 females (57 %), mostly young patients were included. Most of them (87 %) had no past medical history. Among women, 4 were pregnant. 56 (60.2 %) and 25 (26.9 %) patients reported either unknown or incomplete vaccination for measles. Ribavirin was administered in 8 (8.6 %) patients. Pneumonitis and hepatic involvement were the most common complications, occurring in 43 (46.2 %) and 75 (80.6 %) patients respectively. Pneumonitis was significantly associated with male sex, older age, lower lymphocyte counts and higher C-reactive protein (CRP) on admission. One pregnant woman suffered spontaneous fetal miscarriage and one patient died due to acute respiratory distress syndrome (ARDS) and high-risk pulmonary embolism. Conclusion Considerable proportions of incompletely vaccinated or unvaccinated adults have led to the re-emergence of measles in countries with reported close-to-elimination rates. Pneumonitis is a major complication among adults with measles. More studies are imperative in order to explore the role of immune paresis in measles.
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Affiliation(s)
- Paraskevi C Fragkou
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
| | - Konstantinos Thomas
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
| | - Styliani Sympardi
- 1stDepartment of Internal Medicine, Thriasio General Hospital, Elefsis, 19600, Greece.
| | - George D Liatsos
- 2ndDepartment of Internal Medicine and Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, 11527, Greece.
| | - Maria Pirounaki
- 2ndDepartment of Internal Medicine and Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, 11527, Greece.
| | - Helen Sambatakou
- 2ndDepartment of Internal Medicine and Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, 11527, Greece.
| | - Theodoros Marantos
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
| | - Emmanouil Karofylakis
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
| | - Spyridon P Dourakis
- 2ndDepartment of Internal Medicine and Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, 11527, Greece.
| | - Sotirios Tsiodras
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
| | - Dimitra Kavvatha
- 4thDepartment of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, 12462, Greece.
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