The pathology of Measles viral Pneumonia with special reference to Malnutrition

Abstract

The mortality from measles is high in Tropical Countries. Since different strains of measles virus have not been shown to occur, the high mortality cannot be explained on the presence of a more virulent strain of measles virus in these countries. The explanation must, therefore, be looked for in the host himself and his environments. Recovery from measles infection requires mainly cell mediated inmune reactions as it has been repo¬rted that children with the Bruton type of aganmaglobu¬linaenia recover normally from measles infection. The observations reported in the literature suggest that the high mortality from measles infection in Africa and other Tropical Countries is related to malnutrition. The mechanism by which this is brought about has not been explained before. It has also been reported that children with Kwashiorkor may show a negative Heaf in the presence of active tuberculosis and that they have a depressed response to B'.C .G. vaccination. These are two other responses requiring mainly cell mediated immune reactions. In the last twelve years or• so much has been learnt concerning the function of the thyrilus and the effects of its removal mainly in neonatal animals. The observations reported in this thesis suggest that malnutrition operates by producing a variable degree of atrophy of the lYmphoreticular tissues. 585 paediatric autopsies which were done in the years 1967 and 1968 have been reviewed to pick up lung sections with a histopathological evidence of viral pneumonia. The incidence of "giant cell pneumonia" probably measles pneumonia has been worked out and its association with malnutrition pointed out. In part two a prospective study of children who came to autopsy following measles infection or with other respiratory complaints was made. Ten cases are reported and the histopathology of measles giant cell pneumonia described. In part three a prospective study of the lynphoreticular system in fourteen children who died following acute trauma and fourteen children with kwashiorkor or marasmus is reported. The significance of the lesions found in the lynphoreticular system in malnourished children and their relation to measles infection and its mortality is discussed. There is a high mortality from measles infection in Ugandan children as seen in New Mulago Hospital, Kampala, Uganda. Chilc1ren with kwashiorkor or marasmus often die with giant cell pneumonia following measles infection and may show no measles skin rash. There is a histopathological evidence of lesions in the lyrjphoreticular system in children with kwashiorkor or marasmus which may explain a depression in the Cell mediated immune responses and a high mortality from measles infection.