{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:57:22Z","timestamp":1784055442534,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023\u20132024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized. Methods: This study retrospectively analyzed the medical records of adults treated for laboratory-confirmed measles at a Bucharest hospital between July 2023 and July 2024. Data from specialist eye examinations were used to compare patients with keratitis against those with other ocular issues. Results: A total of 250 adult patients were included. Of the 88 patients referred for ophthalmologic examination, 93.2% showed ocular lesions. Keratitis was the primary form, identified in 64.6% of these cases. Patients with keratitis had blood markers indicating a more activated inflammatory profile (higher neutrophile-to-lymphocytes ratio). Pneumonia and respiratory failure were not associated with ocular lesion status; inflammatory markers were more strongly linked to respiratory failure than to ocular involvement. Conclusions: Ocular lesions were highly prevalent in hospitalized adult measles cases during the 2023\u20132024 Romanian epidemic wave, and keratitis was common. Ocular involvement correlated with mucosal disease expression and systemic inflammatory activation. Systematic ophthalmologic assessment should be considered during measles epidemic peaks to improve early identification of clinically relevant ocular complications.<\/jats:p>","DOI":"10.3390\/clinpract16010004","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T02:07:58Z","timestamp":1766714878000},"page":"4","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patterns of Ocular Involvement and Associated Factors in Adult Measles: A Retrospective Study from a Romanian Tertiary Hospital"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9772-2482","authenticated-orcid":false,"given":"Drago\u0219 \u0218tefan","family":"Laz\u0103r","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9379-432X","authenticated-orcid":false,"given":"Adina-Alexandra","family":"Nanu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilie-Andrei","family":"Condurache","sequence":"additional","affiliation":[{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nica","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrinel","family":"Tudosie","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Alexandra","family":"Malciolu-Nica","sequence":"additional","affiliation":[{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Ioana","family":"Grigore","sequence":"additional","affiliation":[{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3994-5020","authenticated-orcid":false,"given":"George Sebastian","family":"Gherlan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6316-0333","authenticated-orcid":false,"given":"Corneliu Petru","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6482-3386","authenticated-orcid":false,"given":"Simin Aysel","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babes\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1016\/S0140-6736(17)31463-0","article-title":"Measles","volume":"390","author":"Moss","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1016\/S1473-3099(17)30307-9","article-title":"The basic reproduction number (R0) of measles: A systematic review","volume":"17","author":"Guerra","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e944436","DOI":"10.12659\/MSM.944436","article-title":"A Review of the Resurgence of Measles, a Vaccine-Preventable Disease, as Current Concerns Contrast with Past Hopes for Measles Elimination","volume":"30","author":"Parums","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_4","unstructured":"World Health Organization (WHO) (2025, September 13). Measles\u2014Fact Sheet. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/measles."},{"key":"ref_5","unstructured":"Medscape (2025, September 13). Measles Clinical Presentation. Available online: https:\/\/emedicine.medscape.com\/article\/966220-clinical."},{"key":"ref_6","unstructured":"(2025, September 13). Merck Manual Professional Edition. Measles. Available online: https:\/\/www.merckmanuals.com\/professional\/pediatrics\/common-viral-infections-in-infants-and-children\/measles."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16049","DOI":"10.1038\/nrdp.2016.49","article-title":"Measles","volume":"2","author":"Rota","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1086\/377712","article-title":"The clinical significance of measles: A review","volume":"189","author":"Perry","year":"2004","journal-title":"J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Laksono, B.M., de Vries, R.D., McQuaid, S., Duprex, W.P., and de Swart, R.L. (2016). Measles Virus Host Invasion and Pathogenesis. Viruses, 8.","DOI":"10.3390\/v8080210"},{"key":"ref_10","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, September 13). History of Measles, Available online: https:\/\/www.cdc.gov\/measles\/about\/history.html."},{"key":"ref_11","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, September 13). Epidemiology and Prevention of Vaccine-Preventable Diseases: The Pink Book. Chapter 13\u2014Measles, Available online: https:\/\/www.cdc.gov\/pinkbook\/hcp\/table-of-contents\/chapter-13-measles.html."},{"key":"ref_12","unstructured":"World Health Organization (WHO) (2017). Measles Vaccines: WHO Position Paper\u2014April 2017. Wkly. Epidemiol. Rec., 92, 205\u2013227. Available online: https:\/\/www.who.int\/publications\/i\/item\/who-wer9217-205-227."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1900041","DOI":"10.2807\/1560-7917.ES.2019.24.29.1900041","article-title":"Characterisation of measles after the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania","volume":"24","author":"Lazar","year":"2019","journal-title":"Euro Surveill."},{"key":"ref_14","unstructured":"ECDC (2025, September 13). Communicable Disease Threats Report, Week 34 (16\u201322 August 2020); European Centre for Disease Prevention and Control: Stockholm, Sweden, 2020. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/communicable-disease-threats-report-22-aug-2020.pdf."},{"key":"ref_15","unstructured":"Ministerul S\u0103n\u0103t\u0103\u021bii (2025, September 13). Ordin nr. 4128\/2023 Privind Declararea Epidemiei de Rujeol\u0103. Available online: https:\/\/legislatie.just.ro\/Public\/DetaliiDocument\/276996."},{"key":"ref_16","unstructured":"UNICEF Rom\u00e2nia (2025, September 13). Press Release: Regiunea European\u0103 Raporteaz\u0103 cel Mai Mare Num\u0103r de Cazuri de Rujeol\u0103 din Ultimii 25 de Ani\u2014UNICEF, OMS\/Europa. Available online: https:\/\/www.unicef.org\/romania\/ro\/comunicate-de-pres\u0103\/regiunea-european\u0103-raporteaz\u0103-cel-mai-mare-num\u0103r-de-cazuri-de-rujeol\u0103-din."},{"key":"ref_17","unstructured":"World Health Organization Regional Office for Europe (WHO Europe) (2024). Measles and Rubella Surveillance Data: Epidemiological Update for the WHO European Region, 2023\u20132024, World Health Organization. Available online: https:\/\/immunizationdata.who.int\/dashboard\/regions\/european-region."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Stanescu, A., Ruta, S.M., Cernescu, C., and Pistol, A. (2024). Suboptimal MMR Vaccination Coverages\u2014A Constant Challenge for Measles Elimination in Romania. Vaccines, 12.","DOI":"10.3390\/vaccines12010107"},{"key":"ref_19","unstructured":"World Bank (2025, November 10). Measles Immunization Coverage (% of Children Ages 12\u201323 Months). Available online: https:\/\/openknowledge.worldbank.org\/handle\/10986\/39728."},{"key":"ref_20","first-page":"392","article-title":"Ocular manifestations of measles in adults: About three cases","volume":"43","author":"Sana","year":"2020","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1071\/HC20013","article-title":"Rubeola keratitis emergence during a recent measles outbreak in New Zealand","volume":"12","author":"Ong","year":"2020","journal-title":"J. Prim. Health Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"B\u00eerlu\u021biu, V., and B\u00eerlu\u021biu, R.-M. (2024). Measles\u2014Clinical and Biological Manifestations in Adult Patients, Including a Focus on the Hepatic Involvement. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185535"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/1\/4\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T02:49:46Z","timestamp":1766717386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/1\/4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,25]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["clinpract16010004"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16010004","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,25]]}}}