Complications of Measles Can Affect Every Organ System

Measles can infect every organ system and lead to a wide range of complications not commonly associated with the disease, such as hepatitis, appendicitis and viral meningitis, a recent study confirmed.

The study, published in BMJ Case Reports, highlights 3 cases at Mater Dei Hospital in Msida, Malta, in 2019.

“One major take-home message from our case report regarding complications of measles is that the disease is vaccine preventable and the importance to promote vaccination globally,” Thelma Xerri, MD, of Mater Dei Hospital, Malta told Contagion^®.

Measles suppresses the immune system, making every organ system vulnerable to complications, including pneumonia, febrile seizures, conjunctivitis, postinfectious encephalomyelitis (PIE), and subacute sclerosing panencephalitis (SSPE). Almost a third of all reported cases of measles are associated with one or more complications, with outcomes that can include blindness, permanent neurological damage leading to a vegetative state, and death.

The recent study examined 3 cases of measles: a 29-year-old Maltese man with measles complicated with hepatitis, an 18-year-old British woman diagnosed with measles appendicitis, and a 42-year-old man with viral meningitis secondary to measles infection.

“All 3 cases presented with a varying symptomatology, which is common in other viral infections such as hepatitis, syphilis, rubella, infectious mononucleosis and HIV,” Xerri told Contagion^®. “Thus, we want clinicians to have a high index of suspicion for measles in patients with similar presentations and to go through the patient's vaccination history. Patients should also be followed up regularly for any signs of deterioration or complications. Measles is often thought of as a harmless childhood illness when in fact it can have serious complications such as found in our case series.”

In the first case, the man had intermittent fever associated with chills, nausea and vomiting. He developed a rash over his face, trunk and lower limbs and tenderness in his abdomen. The patient, who had only received 1 dose of the MMR vaccine in childhood, was diagnosed with measles complicated with hepatitis and recovered after 3 weeks of treatment including intravenous fluids.

In the second case, the woman, who had never received the MMR vaccine, had a rash over her trunk, face and limbs, complained of a prominent dry cough, myalgias and tenderness in the right iliac fossa. She was diagnosed with measles appendicitis and improved with supportive care and broad-spectrum antibiotics.

In the third case, the man was diagnosed with measles by a general practitioner before going to the hospital with blurring vision associated with conjunctival discharge, occipital headaches, light sensitivity and neck stiffness. After a lumbar puncture, he was diagnosed with viral meningitis secondary to measles and improved with supportive care.

Measles caused about 110,000 deaths worldwide in 2017, despite the availability of a safe and cost-effective vaccine to prevent the disease, according to the study. Large outbreaks in European countries that previously had eliminated the disease have been attributed to declining vaccination rates, mostly due to misinformation leading people to falsely believe that the MMR vaccine can cause autism, the study noted.

“Next steps include the setting up of global frameworks to promote and implement the two-dose vaccination is required to promote herd immunity worldwide,” Xerri told Contagion^®.

During last year’s outbreak, the United States saw the greatest number of measles cases since achieving elimination status, leading the CDC to warn that the country could lose its elimination status.

Quelling vaccine misinformation has proven to be challenging. A recent survey of US adults found that social media use and mistrust of medical experts were associated with belief in false information about vaccines. Common false beliefs included that vaccines contain toxins, vaccines can be delayed without risk, gaining immunity through contracting the disease is safer than vaccination, and vaccines cause autism and remained stable despite an increase in news coverage related to the 2019 measles outbreak.