Elsevier

The Lancet

Volume 348, Issue 9026, 24 August 1996, Pages 515-517
The Lancet

Early Report
Crohn's disease after in-utero measles virus exposure

https://doi.org/10.1016/S0140-6736(96)04429-7Get rights and content

Summary

Background

An epidemiological association between Crohn's disease and measles virus exposure in early life has been suggested in case-control studies.

Methods

To determine absolute risk estimates for in-utero measles virus exposure and Crohn's disease, maternity charts for all 25 000 deliveries at University Hospital, Uppsala, between 1940–49 were reviewed: four cases of measles infection in the mother during pregnancy were identified. The children and two of their mothers were interviewed and case records reviewed. Three offspring had undergone multiple intestinal resections; tissue from these cases were examined by routine histology, and for measles-virus nucleoprotein antigen by immunohistochemistry and immunogold electronmicroscopy.

Findings

Three of the four children had Crohn's disease. In each the disease was preceded by recurrent, antibiotic-resistant pneumonia. They had extensive ileal and colonic disease; two patients required intravenous feeding. The only offspring to have had measles as a child did not develop Crohn's disease. Measles virus antigen was detected in foci of granulomatous and lymphocytic inflammation in all children with Crohn's disease.

Interpretation

The data indicate that exposure of mothers to measles virus in utero is a risk factor for Crohn's disease in their children. Exposure at this time may lead to persistent infection, or modify the response to infection in later life, leading to persistence of measles virus.

Introduction

Measles virus has been implicated in the aetiology of Crohn's disease in epidemiological1, 2 and immunological studies3 as well as analysis by affected tissues for virus morphology and antigens.” Early exposure to measles virus may be associated with an increased risk of Crohn's disease,1 and live-attenuated measles vaccination has also been implicated.2 Although an association between Crohn's disease and early exposure to measles has been suggested by case-control studies, absolute risk estimates for exposure to measles in utero are lacking.

Section snippets

Patients and methods

Maternity charts for all 25 000 deliveries at the University Hospital, Uppsala, Sweden, between 1940 and 1949, were reviewed to identify all cases of measles infection in the mother during pregnancy; four such cases were found. The choice of this period was stimulated by the detection of two such cases in a previous study.7 Contact was established with the offspring and permission obtained for access to their medical records. They were interviewed about illnesses from childhood onwards, with

Case one

Measles was diagnosed in the mother at the beginning of her third trimester by her General Practitioner. She had no previous history of measles infection and had a typical rash. Delivery took place at term and was uneventful. The offspring, a boy, had never had measles. At the age of 20 years he developed severe pneumonia that did not respond to antibiotics. Whilst in hospital for treatment of his pneumonia, he had diarrhoea and weight loss for which no cause was identified. Later the same

Discussion

The shared features of these cases: maternal measles infection during pregnancy and previous antibiotic-resistant pneumonia; extensive aggressive intestinal disease; and evidence of persistent measles virus infection of the intestine-support an aetiological role for early measles-virus exposure. The detection of measles virus antigen in these cases, of an identical pattern to that described previously,4, 5, 6 suggests persistent infection after exposure in utero.

Diagnoses of maternal measles

References (13)

There are more references available in the full text version of this article.

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