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Journal of Clinical Microbiology, March 2000, p. 987-991, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Serological and Virological Characterization of Clinically Diagnosed Cases of Measles in Suburban Khartoum

H. Sittana El Mubarak,1 Marco W. G. Van De Bildt,2 Omer A. Mustafa,1 Helma W. Vos,2 Maowia M. Mukhtar,1 Jan Groen,2 Ahmed M. El Hassan,1 Hubert G. M. Niesters,2 Salah A. Ibrahim,1 Edward E. Zijlstra,2,dagger T. Fabian Wild,3 Albert D. M. E. Osterhaus,2 and Rik L. De Swart2,*

Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan1; Institute of Virology/World Health Organization Global Reference Laboratory for Measles, Erasmus University Hospital Rotterdam, Rotterdam, The Netherlands2; and Unite INSERM 404 Immunity and Vaccination, Institut Pasteur de Lyon, Lyon, France3

Received 5 August 1999/Returned for modification 12 November 1999/Accepted 24 December 1999

Measles continues to be a major childhood disease in terms of global morbidity and mortality. In the main areas of its endemicity the only available means of diagnosis are based on clinical criteria: the presence of a maculopapular rash and fever accompanied by cough, coryza, and/or conjunctivitis. We have studied 38 clinically diagnosed cases of measles in Khartoum, Sudan, by means of serology, reverse transcriptase PCR (RT-PCR) on throat swabs and virus isolation from lymphocytes. On the basis of serology, 28 patients were diagnosed as having an acute measles virus (MV) infection, while in 10 cases the clinical symptoms proved to have other causes. It was shown that in cases with low serum immunoglobulin M (IgM) levels, an additional measurement of IgG or virus-neutralizing antibodies was necessary to discriminate between patients with an acute MV infection sampled during an early stage of the disease and patients who had experienced an MV infection in the more distant past. The serological laboratory diagnosis was validated by an MV-specific RT-PCR: for all confirmed measles cases tested a fragment of the correct size which hybridized with a third MV-specific primer could be amplified, while all serologically negative cases were also RT-PCR negative. MV could be isolated from 17 out of 23 of the serologically confirmed cases, demonstrating that virus isolation is less reliable as a diagnostic tool than serology or RT-PCR. This study stresses the urgent need for a rapid diagnostic field test for measles.

* Corresponding author. Mailing address: Institute of Virology, Erasmus University Hospital Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Phone: 31 10 408 8280. Fax: 31 10 408 9485. E-mail: deswart{at}viro.fgg.eur.nl.

dagger Present address: Department of Medicine, College of Medicine, Blantyre, Malawi.

Journal of Clinical Microbiology, March 2000, p. 987-991, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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