retinol-palmitate and Measles

Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles.. We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar.. Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/- 0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level less than 0.7 mumols per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/- 0.5 g per liter) were also low. As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01). Of the 12 children who died, 10 were among those given placebo (P = 0.05). For the group treated with vitamin A, the risk of death or a major complication during the hospital stay was half that of the control group (relative risk, 0.51; 95 percent confidence interval, 0.35 to 0.74).. Treatment with vitamin A reduces morbidity and mortality in measles, and all children with severe measles should be given vitamin A supplements, whether or not they are thought to have a nutritional deficiency.

Topics: Administration, Oral; Child, Preschool; Croup; Diarrhea; Diterpenes; Double-Blind Method; Female; Humans; Infant; Male; Measles; Pneumonia; Randomized Controlled Trials as Topic; Retinol-Binding Proteins; Retinyl Esters; Serum Albumin; Vitamin A

Post-measles corneal ulceration resembling keratomalacia is frequently seen in young children in northern Nigeria. The concentration of retinol in plasma has been found to be depressed more by measles than by malnutrition. In order to determine whether this could be due to a specific influence of measles on the uptake, storage and release of retinol by the liver or its subsequent transport in the plasma, retinyl ester was administered parenterally to assess its effect on the concentration of circulating holo retinol-binding protein. A water-miscible preparation of retinyl palmitate was administered by intramuscular injection to well- and malnourished children with and without acute measles. In all cases, the concentration of both retinol and retinol-binding protein rose appreciably with 24 h of administration of the vitamin preparation. Thus the failure of post-measles corneal lesions to respond to orally or parenterally administered vitamin A would not appear to be due to the inability of such vitamin A to increase the level of circulating retinal in the plasma of children with measles.

Topics: Child, Preschool; Corneal Ulcer; Diterpenes; Humans; Infant; Injections, Intramuscular; Measles; Nigeria; Nutrition Disorders; Retinol-Binding Proteins; Retinol-Binding Proteins, Plasma; Retinyl Esters; Vitamin A