Late morphologic consequences of measles: a lethal and debilitating lung disease among the poor.

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.

Increased susceptibility to herpes simplex virus infections in children with acute measles.

Children with measles treated either in hospital or as outpatients were examined for clinical or laboratory evidence of oropharyngeal herpes simplex virus (HSV) infection. HSV was isolated from 43% of the hospitalized children and 37% of the outpatient children and an additional 9% of the hospitalized group had lesions without the virus being isolated. The incidence of both HSV isolation and clinical lesions in infected children was significantly greater in children hospitalized for measles than in a control group of children hospitalized for tuberculosis. Data from the outpatient group strongly suggest that malnourished children with measles are particularly susceptible to HSV infection. The immunosuppressed state of the children with acute measles was demonstrated by impaired lymphocyte transformation responses to phytohemagglutinin and the inability of their serum to support normal transformation responses by lymphocytes from normal individuals. However the extent of this immunosuppression was unrelated to the susceptibility of the children to HSV infection.

Subacute sclerosing panencephalitis (SSPE) in southern Africa. Recent additions to the SSPE Registry.

Subacute sclerosing panencephalitis can no longer be regarded as a rare disease in all parts of southern Africa. Information derived from a third postal survey added to that from our own experience in Cape Town has brought to light 116 cases; 61 of the patients came from the Cape Province, 40 from the Transvaal and the remaining 15 from the other regions. This unequal distribution and the high prevalence in the Coloured community are important factors in any attempt to understand the epidemiology and the pathogenesis of this serious complication of measles.

Atypical presentation of subacute sclerosing panencephalitis in 3 patients.

Experience with some of our patients suggests that the diagnosis of subacute sclerosing panencephalitis (SSPE) may be made early and confirmed by the demonstration of high levels of measles complement-fixing antibodies in the cerebrospinal fluid (CSF) and serum, in the absence of classic clinical, electroencephalographic or brain biopsy support for the diagnosis. It is not known when the measles-specific antibodies first appear in the CSF, but these 3 atypical cases suggest that they were present in high titre early in the disease.

Subacute sclerosing panencephalitis SSPE in southern Africa. Recent additions to the SSPE Registry

Subacute sclerosing panencephalitis can no longer be regarded as a rare disease in all parts of southern Africa. Information derived from a third postal survey added to that from our own experience in Cape Town has brought to light 116 cases; 61 of the patients came from the Cape Province; 40 from the Transvaal and the remaining 15 from the other regions. This unequal distribution and the high prevalence in the Coloured community are important factors in any attempt to understand the epidemiology and the pathogenesis of this serious complication of measles

Serum complement concentrations, nutritional status and the outcome of measles and measles pneumonia.

A prospective study of children with measles has shown a significant association between malnutrition and a poor prognosis. Levels of a number of complement components bore no relationship to the severity of the disease or to its prognosis. Some of the children with acute measles had depressed serum concentrations of factor D, Clq or C3, but complement deficiency does not appear to be implicated in the heightened susceptibility to secondary bacterial and viral infection so commonly found after acute measles.

Rubella infection and other factors associated with congenital cataracts in Cape Town.

An analysis of 56 patients with congenital cataracts was made to determine which factors played a role in the causation of these lenticular defects in Cape Town. There is good evidence that 16% of the defects were caused by intra-uterine rubella virus infection and that a further 30% were hereditary in origin.

Rubella--a reappraisal.

Rubella infection is reviewed and new information about congenital infection, possible sources of infection in pregnant women and the optimum ages and population groups for rubella vaccination is considered. Investigations required to confirm a suspected and possibly 'silent' infection during pregnancy are outlined.

The epidemiology of rubella in Cape Town.

This preliminary study indicates that a high proportion of adult females in Cape Town are immune to rubella, and that, unlike the situation in the UK, natural rubella infections are common before 4 years of age. At least 10 children with the congenital rubella syndrome have been seen in the Cape Town group of teaching hospitals in a 5 1/2-year period since October 1971. Continuous serological surveillance is essential in order to implement the most effective programme of immunization in any particular area and also to be able to determine whether the vaccine is successfully preventing the birth of children with congenital rubella infection.

Register of cases of subacute sclerosing panencephalitis (SSPE) in Southern Africa.

An analysis of cases of subacute sclerosing panencephalitis (SSPE) in Southern Africa to the end of 1976 is presented. In the 2 years since the last report in 1975, 15 new cases have been added to the register. Seven patients from the Cape Province were investigated in Groote Schuur and Red Cross War Memorial Children's Hospitals in Cape Town and a recent postal survey revealed 6 cases in the Transvaal and 1 each from South West Africa and Rhodesia. This analysis indicates that the high incidence and temporal clustering of cases in the Cape Province is continuing, and that the relatively constant annual number of cases in the Transvaal and the apparent absence of the disease in Natal and the Orange Free State are being maintained.

Km (1) [Inv (1)] typing of saliva and semen.

Km(1) [formerly called Inv(1)] typing of 115 matched serum and saliva samples and of 31 matched serum and semen samples is reported. The use of freezing and thawing to reduce the viscosity of the saliva, which would otherwise cause non-specific aggregation of the red cells used in the test, is described. Problems of antiserum selection and of semen and saliva samples which do not respond to the freezing and thawing treatment are discussed.

Virus peneumonia following measles: a virological and histological study of autopsy material.

Adenovirus, measles virus and herpesvirus were found to be responsible for the serious non-bacterial bronchiolar and interstitial necrosis in post-measles pneumonia in underprivlieged non-White children less than 4 years of age in Cape Town. Secondary bacterial bronchopneumonia, possibly antibiotically suppressed, proved to be less important in accounting for the extensive lung damage in 18 fatal cases that were examined virologically and histologically.