Early ReportCrohn's disease after in-utero measles virus exposure
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.
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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
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Immunization in Europe
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2012, Vaccines: Sixth EditionMultifactorial etiology and pathogenic factors in inflammatory bowel disease
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