High rates of hepatic involvement associated with new epidemic measles strains in Romania.
D8 genotype
cytolysis
hepatic involvement
hepatitis
measles
outbreak
Journal
Journal of medical virology
ISSN: 1096-9071
Titre abrégé: J Med Virol
Pays: United States
ID NLM: 7705876
Informations de publication
Date de publication:
Oct 2024
Oct 2024
Historique:
revised:
09
09
2024
received:
31
07
2024
accepted:
01
10
2024
medline:
13
10
2024
pubmed:
13
10
2024
entrez:
10
10
2024
Statut:
ppublish
Résumé
Similar to other European countries, a measles epidemic dominated by D8 genotype strains is ongoing since 2022 in our country. Recent reports of liver involvement associated with new measles virus (MeV) strains are scarce. The aim of the study was to compare the clinical characteristics between hospitalized patients with measles from the current epidemic and those from the previous outbreak and to analyze the risk factors associated with hepatic involvement. Data were collected retrospectively for all consecutive adult ( ≥18 years old) patients admitted between October 2022-April 2024 and January 2018-December 2019. A number of 228 patients from the current and 130 from the previous MeV epidemic were included. The main statistically significant differences were those regarding hepatic involvement (77.2% vs. 45.4%, p < 0.001) and significant hepatocellular injury (23.6% vs. 10.7%, p = 0.003). Compared to cases without liver involvement (123), patients with hepatocytolysis (235) had a higher prevalence of keratoconjunctivitis (42.5% vs. 28.4%, p = 0.01), thrombocytopenia (47.6% vs. 34.9%, p = 0.02), severe lymphopenia (51% vs. 35.7%, p = 0.007) and high fibrinogen levels (58.7% vs. 47.1%, p = 0.04). MeV strains from the 2022-2024 epidemic were the strongest predictors of hepatic involvement in the multivariable analysis (odds ratio = 4.3, 95% confidence interval: 2.5-7.4, p < 0.001). The mortality rate of patients with hepatocellular injury was 1.2%. The current measles epidemic is dominated by high rates of hepatic involvement compared to the previous outbreak. Although not associated with a significant mortality, the potential change in MeV hepatotropism could have important clinical implications and warrants further monitoring.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e70001Informations de copyright
© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.
Références
Donohue RC, Pfaller CK, Cattaneo R. Cyclical adaptation of measles virus quasispecies to epithelial and lymphocytic cells: to V, or not to V. PLoS Pathog. 2019;15(2):e1007605.
Stanescu A, Ruta SM, Cernescu C, Pistol A. Suboptimal MMR vaccination coverages—a constant challenge for measles elimination in Romania. Vaccines. 2024;12(1):107.
Lazar M, Pascu C, Roșca M, Stănescu A. Ongoing measles outbreaks in Romania, March 2023 to August 2023. Euro Surveill. 2023;28(35):2300423. doi:10.2807/1560-7917.ES.2023.28.35.2300423
Rector A, Bloemen M, Hoorelbeke B, Van Ranst M, Wollants E. Detection of measles virus genotype D8 in wastewater of Brussels capital region, Belgium, March 2024. medRxiv. Preprint posted online April 10, 2024. doi:10.1101/2024.04.08.24305478
Orosz L, Gáspár G, Rózsa Á, Rákos N, Sziveri S, Bosnyákovits T. Epidemiological situation of measles in Romania, Italy, and Hungary: on what threats should we focus nowadays? Acta Microbiol Immunol Hung. 2018;65(2):127‐134.
Lazar M, Stănescu A, Penedos AR, Pistol A. Characterisation of measles after the introduction of the combined measles‐mumps‐rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania. Euro Surveill. 2019;24(29):1900041. doi:10.2807/1560-7917.ES.2019.24.29.1900041
Satoh A, Kobayashi H, Yoshida T, et al. Clinicopathological study on liver dysfunction in measles. Intern Med. 1999;38(5):454‐457.
Dinh A, Fleuret V, Hanslik T. Liver involvement in adults with measles. Int J Infect Dis. 2013;17(12):e1243‐e1244.
Nobili V, Pietro S, Stefania P. Fulminant hepatic failure following measles. Pediatr Infect Dis J. 2007;26(8):766‐767.
Sternfeld T, Spöri‐Byrtus V, Riediger C, et al. Acute measles infection triggering an episode of liver transplant rejection. Int J Infect Dis. 2010;14(6):e528‐e530.
Hanna A. Brain tropism acquisition: the spatial dynamics and evolution of a measles virus collective infectious unit that drove lethal subacute sclerosing panencephalitis. npj Viruses. 2024;2(1):1.
Yousaf I, Hannon WW, Donohue RC, et al. Brain tropism acquisition: the spatial dynamics and evolution of a measles virus collective infectious unit that drove lethal subacute sclerosing panencephalitis. PLoS Pathog. 2023;19(12):e1011817.
Pițigoi D, Săndulescu O, Crăciun MD, et al. Measles in Romania—clinical and epidemiological characteristics of hospitalized measles cases during the first three years of the 2016‐ongoing epidemic. Virulence. 2020;11(1):686‐694.
Turaiche M, Feciche B, Gluhovschi A, et al. Biological profile and clinical features as determinants for prolonged hospitalization in adult patients with measles: a monocentric study in Western Romania. Pathogens. 2022;11(9):1018.
Zhong R, Yi F, Xiang F, et al. Hepatitis of unknown etiology in children: current evidence and association. World J Clin Cases. 2022;10(35):12837‐12843.
Schaefer TJ, John S. Acute hepatitis. St. Petersburg: StatPearls Publishing.
Tamboen I, Sinuhaji AB, Sutanto AH. Measles enteritis in infants and children. Paediatr Indones. 1991;31(7‐8):198‐204.
Minemura M. Liver involvement in systemic infection. World J Hepatol. 2014;6(9):632‐642.
de Swart RL. The pathogenesis of measles revisited. Pediatr Infect Dis J. 2008;27(10):S84‐S88.