11/239. Measles inclusion-body encephalitis caused by the vaccine strain of measles virus. We report a case of measles inclusion-body encephalitis (MIBE) occurring in an apparently healthy 21-month-old boy 8.5 months after measles-mumps-rubella vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed histopathologic features consistent with MIBE, and measles antigens were detected by immunohistochemical staining. Electron microscopy revealed inclusions characteristic of paramyxovirus nucleocapsids within neurons, oligodendroglia, and astrocytes. The presence of measles virus in the brain tissue was confirmed by reverse transcription polymerase chain reaction. The nucleotide sequence in the nucleoprotein and fusion gene regions was identical to that of the Moraten and Schwarz vaccine strains; the fusion gene differed from known genotype A wild-type viruses. ( info) |
12/239. Lennox-Gastaut syndrome after a further attenuated live measles vaccination. We reported a 2-year-old boy with Lennox-Gastaut syndrome, of which the cause could be an adverse effect of further attenuated live (FL) measles vaccine. The pre- and peri-natal histories of the patient were uneventful, except that he was one of monozygotic twins. He had developed normally until 24 months of life, when tonic seizures began on postvaccination day 14 without a preceding episode of continuous fever or any neurologic symptoms. The tonic seizures and atypical absence have been intractable as to various antiepileptic drugs, while his twin brother has experienced no epileptic seizures. ( info) |
13/239. Atypical measles infections in leukaemic children on immunosuppressive treatment. One case of giant-cell pneumonia and two of encephalopathy, all due to measles infection in children in leukaemic remission on immunosuppressive treatment, were seen recently. The clinical syndromes were variable and atypical and the antibody responses unpredictable. Conventional doses of pooled immunoglobulin failed to protect the two children to whom it was given. Degeneration rather than inflammation seems to characterise the encephalopathy in immunosuppressed children infected with measles virus. ( info) |
14/239. Measles in a Dutch hospital introduced by an immuno-compromised infant from indonesia infected with a new virus genotype. A fatal measles case in an immunocompromised Indonesian child was associated with nosocomial transmission to health care workers. The virus isolated proved to represent a new genotype within clade G. ( info) |
15/239. Unusual encephalitic illnesses in a child with acute leukaemia in remission: possible role of measles virus and toxoplasma gondii. We report a girl who developed an encephalitic illness with visual loss after two years treatment for acute lymphoblastic leukaemia. The visual loss was found to be due to bilateral macular degeneration. She later developed radiological evidence of intracranial calcification and temporal lobe epilepsy. A second episode of encephalitis occurred when she had been off all antileukaemic treatment for three years and this left her with a right hemiparesis. Investigation suggested involvement with both measles virus and toxoplasma gondii as a cause for these illnesses. ( info) |
16/239. Acute transient pseudoatrophy of the brain accompanying measles infection. Two infants, age 1 year, with acute encephalopathy who showed transient pseudoatrophy of the brain were reported. They each had measles infection, followed by 'mild drowsiness'. Reversible brain atrophy has been observed in patients with undernutrition, dehydration, and overdoses of steroids and valproic acid. However, these manifestations were very mild and there was no history of drug administration in our patients. The cause of the transient brain pseudoatrophy was unknown. However, activation of glial cells accompanying the measles infection was thought to be one possibility to see high value of neopterin (51 pmol/l) in the cerebrospinal fluid in one case. Although 'mild drowsiness' is not a rare manifestation in patients with measles infection, it is probable that their 'mild drowsiness' is caused by acute encephalopathy like in our cases. Thus, we recommend that computed tomography scanning or magnetic resonance imaging is performed in patients showing 'mild drowsiness' during measles infection. ( info) |
17/239. Histopathological findings in the inner ear caused by measles. An otopathological analysis of three cases of viral labyrinthitis was performed. Six temporal bones cut in serial sections were available for this study. According to the degree of degenerative changes in various parts of the inner ear two types of morphologically distinct labyrinthitis after measles are presented: the first one with the port of entrance through the internal auditory meatus and characterized by, first and most significantly, changes in the spiral ganglion cells; and the second, as described previously by Lindsay, with the port of entrance of the virus in the inner ear through the stria vascularis, with degenerative changes in various structures within the endolymphatic duct. ( info) |
18/239. Infantile bilateral striatal necrosis following measles. A previously healthy 4-year-old boy presented with typical measles and demonstrated lesions confined to basal ganglia. The clinical symptoms were an abrupt onset, impaired consciousness and mutism, extrapyramidal signs and severe neurovegetative dysfunction. No modification of the cerebrospinal fluid was observed; laboratory tests were all normal with the exception of a positive serologic test for measles. Cranial magnetic resonance imaging showed abnormal signals in the striatum, affecting the putamen and the caudate nuclei bilaterally. Neurologic improvement occurred within 2 months, with regression of lesions on cranial imaging, suggesting that edema played an important role in the initial stage of the disease. ( info) |
| A healthy 13-year-old boy who had spent the first 4.5 years of his life in an orphanage in thailand before adoption by an American couple became ill with subacute sclerosing panencephalitis and died several months later. The boy had most likely contracted wild-type measles in thailand. Measles complications are a risk in international adoptions. ( info) |
| We present the unique case of a 2-year-old girl with congenital athyreosis who acquired primary measles virus infection at the age of 18 months, coincidentally with an Epstein-Barr virus infection. First neurologic symptoms of subacute sclerosing panencephalitis appeared 5 months later, and the girl died within 6 months after a rapid progressive illness. Factors possibly predisposing to this extraordinary disease course-primary measles virus infection at an early age and lack of evidence for immunodeficiency-are discussed. ( info) |