Appendix in prodromal and early measles.

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Appendix in prodromal and early measles. Appendix in prodromal and early measles. (A) Appendix in a prodromal case (case 2). The first (from the left) image shows an intact cerium ammonium molybdate (CAM)-stained crypt epithelium. The inset in the second (MV) image is an H&E-stained image with an MGC. The third (H&E-stained) image shows MGCs (arrows) in the lamina propria. The fourth image shows CD20+ B cells in the lamina propria, MALT, and epithelium. (B) Appendix of early case 3. The first images shows a surface epithelium with macrophages within the epithelium and at the luminal epithelial surface (H&E staining). The second image shows a punctate staining pattern of MV antigen in cells at the epithelial luminal surface. The third image shows CD68+ staining at the luminal surface of the epithelium, CD68+ cells in the lamina propria, and one unidentified CD68-negative cell in the epithelium. CD11c+ cells are mainly confined to the lamina propria. CD150+ cells are observed within the epithelium and lamina propria, whereas CD3-positive and CD20-positive cells are primarily located in the lamina propria. (C) Appendix of early case 3. All images show MV (green), CAM 5.2 (red), and nuclei (DAPI, blue). MV positivity is seen at the luminal epithelial surface and above the epithelial basement membrane (arrow). In the first image (left), showing an intraepithelial MV+ cell, a CAM 5.2+ focus is seen with many nuclei, possibly representing an infected MGC (arrow). MV positivity is seen at the luminal epithelial surface in the leftmost three images (arrow). In image 4 and, at higher magnification, image 5, MV infection is shown in a CAM 5.2+ cell traversing the epithelium. Original magnifications: panel A, ×25 (H&E), ×100 (H&E) (MV) (inset, ×250), ×250 (H&E), and ×100 (CD20); panel B, ×400 (MV, CD68; H&E), ×500 (CD150, CD11c), ×250 CD3, and ×100 CD20. In panel C, all images are ×400, except the first and fourth images, which are ×200. Ingrid V. Allen et al. mSphere 2018; doi:10.1128/mSphere.00570-17