Measles complications — DTM&H MCQ

Correct answer: A — Pneumonia

The correct answer is A, pneumonia. Measles pneumonia (either primary viral pneumonitis or secondary bacterial superinfection, commonly with Streptococcus pneumoniae or Staphylococcus aureus) is the leading cause of measles-associated death worldwide, and this risk is dramatically amplified by malnutrition and vitamin A deficiency, both of which impair mucosal immunity and epithelial repair in the respiratory tract. Vitamin A is essential for maintaining respiratory and gut epithelial integrity and for normal immune function, so deficient children mount a poorer immune response to measles virus and are far more likely to develop severe, complicated lower respiratory tract disease. This is precisely why WHO recommends vitamin A supplementation for all children with measles in areas of deficiency, as it reduces the severity and mortality of measles-related pneumonia. The clinical picture here (malnourished child, vitamin A deficient, classic measles prodrome with Koplik spots) is the textbook high-risk scenario for fatal pneumonia rather than the rarer complications listed. Why the other options are wrong: B. Subacute sclerosing panencephalitis: This is a rare, delayed complication occurring years after acute infection, not an acute risk driven by malnutrition or vitamin A status. D. Arthritis: Arthritis is a recognised feature of rubella, not measles, and is not linked to nutritional status. C. Orchitis: Orchitis is a mumps complication; it is not a recognised feature of measles infection. E. Hepatitis: Hepatitis can occur with measles but is uncommon and not the major driver of mortality; it is not specifically potentiated by vitamin A deficiency in the way pneumonia is. Key point: In malnourished, vitamin A deficient children, measles kills predominantly through pneumonia, which is why WHO mandates vitamin A supplementation in measles management in such settings.

Reference: World Health Organization, Vitamin A supplementation in children with respiratory infections (ELENA), and WHO Measles factsheet on complications and vitamin A treatment recommendations, https://www.who.int/tools/elena/interventions/vitamina-pneumonia-children