Acute Disseminated Encephalomyelitis with Measles (original) (raw)
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Acute measles encephalitis in partially vaccinated adults
Background: The pathogenesis of acute measles encephalitis (AME) is poorly understood. Treatment with immunemodulators is based on theories that post-infectious autoimmune responses cause demyelination. The clinical course and immunological parameters of AME were examined during an outbreak in Vietnam.
Acute Disseminated Encephalomyelitis Preceding Measles Exanthema
Journal of Child Neurology, 2011
We report a case of acute disseminated encephalomyelitis preceding measles virus infection. Brain magnetic resonance imaging revealed signal intensity abnormalities in the basal ganglia and cortex consistent with acute disseminated encephalomyelitis. Fever and the first Koplik spots appeared 8 and 10 days later, respectively. This case supports the hypothesis that the immune-mediated demyelinating process may occur before the symptomatic phase of a viral infection. Therefore, children without history of infectious disorders should also have acute disseminated encephalomyelitis included in the differential considerations.
QJM : monthly journal of the Association of Physicians, 2015
Encephalitis is the most frequent neurological complication of measles virus infection. This review examines the pathophysiology of measles infection and the presentations, diagnosis and treatment of the four types of measles-induced encephalitis including primary measles encephalitis, acute post-measles encephalitis, measles inclusion body encephalitis and subacute sclerosing panencephalitis. The early symptoms of encephalitis may be non-specific and can be mistakenly attributed to a systemic infection leading to a delay in diagnosis. This review provides a summary of the symptoms that should cause health care workers to suspect measles-induced encephalitis.
Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA
Emerging Infectious Diseases, 2022
M easles is a highly contagious, vaccine-preventable, systemic viral disease caused by measles virus (MV), an enveloped, single-stranded, negativesense RNA virus in the genus Morbillivirus, family Paramyxoviridae. MV may cause persistent central nervous system (CNS) infections that result in fatal neurologic diseases, such as subacute sclerosing panencephalitis and measles inclusion body encephalitis. Live-attenuated MV-containing vaccines, such as measles-mumps-rubella (MMR), are administered in a 2-dose series and are estimated to be >95% effective in preventing clinical measles (1,2). Serious adverse events are relatively uncommon after MV vaccination; rare reports have documented measleslike illness, predominantly in immunocompromised children (2-5). To our knowledge, before the case we report, only 1 sequence-confirmed, postvaccination MV CNS infection had been reported (6). A previously healthy infant received dose 1 of the MMR ProQuad vaccine (Merck, https://www.merck. com) at her 1-year well-child visit. Over the following week, the patient experienced fevers, and acute myeloid leukemia was diagnosed. During induction chemotherapy, a diffuse morbilliform rash developed. A nasopharyngeal swab sample was positive for MV RNA by a laboratory-developed multiplex quantitative reverse transcription PCR (7). We detected all 3 genomic targets: the nucleoprotein, hemagglutinin, and large protein genes. In addition, the carboxyl-906 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 28, No. 4, April 2022 RESEARCH LETTERS We report a fatal case of vaccine-associated measles encephalitis in an immunocompromised child in California, USA. The infection was confirmed by whole-genome RNA sequencing of measles virus from brain tissue. We observed biased matrix-gene hypermutation consistent with persistent measles virus central nervous system infection.
Subacute measles encephalitis: A case of long term survival with followup MRI brain scans
Neurology Asia
Measles virus causes three distinct neurological syndromes: acute disseminated encephalomyelitis, subacute sclerosing panencephalitis and the rare subacute measles encephalitis, or inclusion body measles encephalitis. There is a current debate of whether subacute measles encephalitis is an opportunistic infection or a subacute infection caused by a mutated measles strain. There is also no report of long term MRI of survivor. We reported a young Chinese girl with a history of relapsed acute lymphoblastic leukaemia and subacute measles encephalitis confirmed by brain biopsy who survived. Serial magnetic resonance imaging of the brain showed cortical and basal ganglial involvement in the initial phase, and generalized cerebral atrophy in the subsequent scan four and a half years later. The patient recovered from subacute measles encephalitis with substantial neurological deficits with the cessation of maintenance chemotherapy without specific antiviral treatment. This suggested that reconstitution of host immunity was adequate in effecting the clearance of the virus, and supporting the hypothesis that subacute measles encephalitis is primarily an opportunistic infection.
Acute measles encephalitis of the delayed type in an immunosuppressed child
Brain and Development, 1989
The measles virus (MY) may cause three major CNS syndromes: acute measles encephalitis, subacute sclerosing panencephalitis and acute measles encephalitis of the delayed type (AMED) [1, 2]. The last condition has been reported to occur in immunosuppressed children [3-16] and adults [17, 18], and in patients without obvious evidence of immunosuppression [19-22]. A prominent clinical feature in AMED patients is epilepsia partialis continua (EPC) [11, 18, 19, 22]. The neuroradiological features are not often reported, but they are frequently normal [8,15, 18]. We report here a case, in an immunosuppressed child, in which AMED and EPC were associated with bilateral lucency of the putamen. CASE REPORT was admitted to the Pediatric Department of Verona University in May, 1984, at the age of 6 years, with an abdominal mass. A large left suprarenal neuroblastoma, with skeletal metastases-stage IVwas
Medicine, 2013
France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction. The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25thY75th interquartile range EIQR^, 27.2Y34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9Y18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women. Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications. Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated. Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised. On follow-up, 1 patient had severe chronic respiratory failure related to lung fibrosis, and 2 patients had mild lower limb paraparesis along with bladder dysfunction, both of which were ascribable to measlesinduced encephalitis and myelitis. Among the 5 pregnant patients, the course of measles infection was uneventful, albeit 1 patient underwent emergent cesarean delivery because of fetal growth restriction. Measles is a disease with protean and potentially deceptive clinical manifestations, especially in the immunocompromised patient. Measlesassociated pneumonitis and its complications, and less commonly postinfectious encephalomyelitis, are the main source of morbidity and mortality. In contrast with the usually benign course of the disease in immunocompetent patients, measles occurring in immunocompromised patients gives rise to lethal complications including ARDS, with or without bacterial superinfection. Other patients potentially at high risk for severe measles are young adults and pregnant women. Measles pneumonitis may predispose to air leak disease in patients using mechanical ventilation. To date, vaccination remains the most potent tool to control measles infection. (Medicine 2013;92: 257Y272) Abbreviations: ADEM = acute disseminated encephalomyelitis; ARDS = acute respiratory distress syndrome, CAP = communityacquired pneumonia, CDC = Centers for Disease Control and Prevention, CFU = colony-forming units, chest CT = thoracic computed tomography, CK = creatinine kinase, CNS = central nervous system, CSF = cerebral spinal fluid, ECMO = extracorporeal membrane oxygenation, EEG = electroencephalogram, FLAIR = fluidattenuated inversion recovery, HIV = human immunodeficiency virus, ICU = intensive care unit, IgG = immunoglobulin G, IgM = immunoglobulin M, IQR = interquartile range, IVIG = intravenous immunoglobulin, MIBE = measles inclusion body encephalitis, MRI = magnetic resonance imaging, MSSA = methicillinsensitive Staphylococcus aureus, MV = measles virus, NO = inhaled nitric oxide, NSAID = nonsteroidal antiinflammatory drug, PIE = postinfectious encephalitis and/or myelitis, RT-PCR = reverse transcription polymerase chain reaction, SAPS II = Simplified Acute Physiology Score, VAP = ventilator-associated pneumonia, WHO = World Health Organization.
Subacute measles encephalitis: a case of long term survival with follow-up MR brain scans
Measles virus causes three distinct neurological syndromes: acute disseminated encephalomyelitis, subacute sclerosing panencephalitis and the rare subacute measles encephalitis, or inclusion body measles encephalitis. There is a current debate of whether subacute measles encephalitis is an opportunistic infection or a subacute infection caused by a mutated measles strain. There is also no report of long term MRI of survivor. We reported a young Chinese girl with a history of relapsed acute lymphoblastic leukaemia and subacute measles encephalitis confirmed by brain biopsy who survived. Serial magnetic resonance imaging of the brain showed cortical and basal ganglial involvement in the initial phase, and generalized cerebral atrophy in the subsequent scan four and a half years later. The patient recovered from subacute measles encephalitis with substantial neurological deficits with the cessation of maintenance chemotherapy without specific antiviral treatment. This suggested that reconstitution of host immunity was adequate in effecting the clearance of the virus, and supporting the hypothesis that subacute measles encephalitis is primarily an opportunistic infection.
Post-vaccinal acute disseminated encephalomyelitis: a case report
Marmara Medical Journal, 1992
Acute disseminated encephalomyelitis (ADEM) may occur following viral exanthemata or following vaccination. The disorder represents an allergic phenomenon which appears to result from delayed hypersensitivity to myelin basic proteins. On the other hand, circulating immune complexes are postulated to cause vascular injury. In this study we report computerized tomography (CT) findings in a case of ADEM due to Semple type vaccination.