A 19-day old male who was born early (at 35 weeks’ gestation) died after being hospitalized for just over one  day with fever and breathlessness.

The reasons for his prematurity are not known. There is limited documentation of prenatal care, but his mother had oligohydramnios, or lack of amniotic fluid around the baby. Her membranes ruptured (her “water broke”) five weeks-early.  The baby was born via vaginal delivery, and foul-smelling fluid was noted at the time of birth, a sign of possible infection.  At delivery, he did not cry right away and required resuscitation and hospital admission

He was readmitted to the hospital just over 24 hours before his death, with breathlessness and fever for two days. He weighed just 1420g upon readmission. Clinical records show that he was lethargic, cyanotic or blue in color, had irregular breathing, a low heart rate, fever, and a distended abdomen despite severe wasting. Doctors started antibiotics and provided respiratory support. He did not improve, developed seizures, ultimately stopped breathing and did not respond to cardiopulmonary resuscitation. At the hospital his death was attributed to late-onset neonatal sepsis.

Determining the Cause

CHAMPS post-mortem blood and cerebrospinal fluid cultures were both positive for Proteus spp., a bacteria that causes infection.

Additional CHAMPS post-mortem testing unexpectedly found measles from 4 different sites throughout the baby’s tissues, blood, and cerebrospinal fluid. Pathologist examination of tissues confirmed that the baby had inflammation and viral pneumonia in the lungs with signs of measles, including syncytial giant cells and intranuclear inclusions. Pathologists tested for other viruses that cause these signs (like Respiratory Syncytial Virus, or RSV) and these tests were negative.

The CHAMPS team determined that this baby died from measles complicated by bacterial sepsis due to Proteus spp.