In order to improve the effectiveness of predicting the course of measles in
adults based on the clarification of clinical and laboratory features and the diagnostic
significance of immunological changes, a comprehensive examination of 175 adult
measles patients who were treated at the Municipal Institution "Regional Infectious
Diseases Clinical Hospital" during 2017-2019 seasonality. Special studies included
the determination of IgM to the measles virus, IgG to the measles virus, the content
of IFN-γ, TNF-α in blood serum by the ELISA method on the basis of the Training
and Laboratory Center of Zaporizhzhia State Medical University.
New scientific data were
obtained regarding the diagnostic significance of immunological changes in
predicting the course of measles in adults. It has been proven that the content of
TNF-α is the highest in patients with a severe course (p<0.05) and in the
development of complications of measles in adults (p<0. 05). A higher level of TNFα of measles patients during the rash is associated with a severe course (gamma
coefficient 0.38, p=0.008), as well as the development of complications during
hospitalization (gamma 0.77, p=0.003) and in the dynamics after 10 days (gamma
0.56, p=0.005). The content of IFN-γ is higher (p<0.05) in patients with severe
(p<0.05) than with moderately severe course of measles (p<0.05), and in the
presence of complications it exceeds 19.3 times (p<0.05) the corresponding
indicator in patients without complications. A high level of INF-γ is associated with
the development of complications (gamma coefficient 0.46, p=0.0001). It has been
proven that under the conditions of INF-γ content in blood serum during
hospitalization > 1.82 pg/ml (AUC=0.682; p=0.011) the probability of developing
measles complications is significant, and at a level > 1.90 pg/ml (AUC= 0.643;
p=0.038) there is a high probability of developing complications from the organs of
the respiratory system.
Practitioners are
recommended to take into account the modern features of the course of measles in
adults, namely the development of complications in 72.6 %, the spectrum of which
is mainly represented by complications from the respiratory system (88.2 %), in
particular acute bronchitis (76.4 %) and community-acquired pneumonia (11.8 %),
as well as complications from the gastrointestinal tract (70.9 %), including hepatitis
(58.3 %) and enteritis (11.8 %).
It is recommended to determine IgG to the measles virus when adult patients
with measles are admitted to the hospital in order to select patients with a high risk
of developing a severe and complicated course of the disease. Under the conditions
of the content of these antibodies ≤ 21.56 opt. units. consider the risk of developing
a severe course of measles to be high, and under the conditions of the content ≤ 20.26
opt.od. consider a high risk of developing measles complications, including
community-acquired pneumonia, hepatitis, and enteritis.
It is proposed to determine the content of INF-γ in blood serum during
hospitalization of adult measles patients in order to select patients with a high risk
of developing complications. Under the conditions of the content of INF-γ at
hospitalization > 1.82 pg/ml, the risk of developing complications of measles is
considered high, and with a level > 1.90 pg/ml, the risk of developing complications
from the respiratory system is high.
