1/239. SSPE following neonatal measles infection. The authors report a case of subacute sclerosing panencephalitis in a child who had measles during the neonatal period. At 3 years, 6 months of age, over a period of a few weeks, the patient lost the ability to sit unaided as a result of progressive truncal ataxia, without apparent cognitive changes, simulating acute cerebellar ataxia. His symptoms improved in 1 month, and he was able to walk again with support, but mental alteration and periodic mild head nodding on awakening followed. His illness was diagnosed as subacute sclerosing panencephalitis on the basis of the elevated titers of measles antibodies in the cerebrospinal fluid. Measles infection before 1 year of age is a risk factor of subacute sclerosing panencephalitis, but reports about patients with neonatal measles infection are rare. Immaturity of the brain at the time of measles infection may not only be a risk factor but may also influence the clinical course of the disease. ( info) |
2/239. Subacute measles encephalitis in a young man immunosuppressed for ankylosing spondylitis. Subacute measles encephalitis occurred 1 month after measles onset in a 26-year-old hiv-negative man undergoing immunosuppressive treatment for ankylosing spondylitis. He had seizures, a decline in mental status, and progressive impairment of consciousness, with a fatal outcome. Despite severely deficient cellular immunity, the elevated antimeasles antibody titers and CSF findings indicated that humoral immunity was not impaired. Histologic, electron microscopic, and immunocytochemical studies revealed the typical intranuclear inclusions of paramyxovirus nucleocapsids, and measles virus antigen in neurons and oligodendrocytes. ( info) |
3/239. Acute measles encephalitis of the delayed type. An acute measles encephalitis with epilepsia partialis continua occurred three months after measles in a previously healthy child with no detectable immunological defect. Levels of measles antibodies in serum and cerebrospinal fluid were high, and tubular inclusions of the type seen in subacute sclerosing panencephalitis were found in nerve cell nuclei. A communicating high-pressure hydrocephalus developed in the later stage of the disease. This case demonstrates that measles encephalitis of the delayed type should systematically be considered in children with acute encephalitis. ( info) |
| The patient is a 10-year-old male who experienced somnolence and incomplete quadriplegia after headache and vomiting, without exanthema, for 3 days. The clinical course and magnetic resonance imaging findings of the brain and spinal cord were compatible with acute disseminated encephalomyelitis. The serologic examination revealed that the patient had rubeola because titers of IgM and IgG antibody to measles virus measured by enzyme immunoassay were 0.91 and 40 (cutoff = 0.80 and 2), respectively, at 5 weeks after the onset, the IgM titer had become negative (0.56), and the IgG titer had decreased to 17.7 at 13 weeks after the onset. Because the patient had received a measles-mumps-rubella vaccine at 12 months of age, the acute disseminated encephalomyelitis was thought to be attributed to the modified measles resulting from measles vaccine failure. ( info) |
5/239. Isolation of measles virus from a naturally-immune, asymptomatically re-infected individual. BACKGROUND: The changing epidemiology of measles with mild measles cases increasingly being recognised in previously-vaccinated individuals, suggests that more asymptomatic or subclinical cases might be occurring. Although this has been clearly documented in previously-vaccinated individuals, the frequency of these asymptomatic infections in individuals previously naturally-infected with measles is not known. Also, it is not known whether these asymptomatic or mildly-infected individuals who do not display the full range of clinical signs of measles are capable of transmitting the virus to other susceptible persons. OBJECTIVES: To demonstrate the isolation of measles virus (MV) from previously, naturally-immune individuals asymptomatically infected with measles while in close contact with acutely infected family members and to document the secondary immune responses (SIR) associated with asymptomatic measles infection. STUDY DESIGN: Throat swab and urine specimens from five acute measles cases and their family contacts, taken within 5 days of onset of rash in each acute case, were used to isolate MV by tissue culture. Positive tissue culture results were confirmed by indirect immunofluorescence (IF) staining. Measles specific antibodies (IgG and IgM), IgG urea avidity and measles-neutralising antibodies were measured in the one family (index family) where an asymptomatic measles infection of a contact was demonstrated. RESULTS: The acutely infected patient in the index family (T1/96) had a measles-neutralising antibody titre of < 1:10, measles IgG urea avidity of 24% and MV was isolated and confirmed by IF from urine and throat swab specimens. T1/96 represents acute measles infection after primary vaccine failure because he had a clear history of being vaccinated against measles as a child. MV was also successfully isolated from throat swab and urine specimens from the other four acute cases and from the urine but not the throat swab of an asymptomatically infected family contact in the index family (mother, T2/96). T2/96 had a history of natural measles infection as a child approximately 50 years ago. In addition to detectable MV in urine this contact also had a SIR with a rise in measles specific neutralising antibody titre. No virus was isolated from the other contact in the index family (father, T3/96) or from the contacts of the other four acute cases examined. CONCLUSIONS: This is the first report of a confirmed asymptomatic MV infection, by MV isolation and IF testing and a concurrent SIR, in a previously naturally-immune contact of an acute case. The importance of these findings to the epidemiology and control of MV as well as the diagnostic value of MV urine isolation and IF confirmation for mild or asymptomatic cases must be examined further. ( info) |
6/239. Corticosteroid rescue in late paediatric acute respiratory distress syndrome. Late acute respiratory distress syndrome (ARDS) is associated with a mortality of more than 80%. Recent reports in adults have shown improved survival in late ARDS treated with prolonged course of steroids, however little data are available in children concerning its safety and efficacy. We report the successful treatment of a child dying from refractory late ARDS using a prolonged course of high-dose methylprednisolone instituted after 12 days of advanced mechanical ventilation. Progressive improvement was seen from days 3, 7, 10 and 14 after treatment with improvement in PaO2/fraction of inspired oxygen (FiO2) ratios, lung injury score and chest radiographical score. Treatment was complicated by a fungal urinary tract infection that was easily controlled. There were no major metabolic side effects. Steroid therapy can be considered in the treatment of children with refractory late ARDS but larger prospective studies are needed to define indications, timing, dosing and safety of this mode of treatment in children. ( info) |
7/239. What is the cause of a rash after measles-mumps-rubella vaccination? Surveillance and laboratory confirmation of measles will increase in importance as australia implements enhanced measles control. We describe a 17-month-old child with fever and rash after measles-mumps-rubella vaccination. Detection of vaccine-strain measles virus in his urine by polymerase chain reaction confirmed the diagnosis of a vaccine reaction rather than wild-type measles. We propose that measles virus should be sought and identified as vaccine or wild-type virus when the relationship between vaccination and measles-like illness is uncertain. ( info) |
8/239. Acute renal failure with neurological involvement in adults associated with measles virus isolation. BACKGROUND: Three people with clinical manifestations of acute renal failure with neurological involvement of unknown cause were admitted to a hospital in Mumbai, india. We describe clinical presentations and investigations of the cause. methods: We analysed case reports and laboratory findings for the patients (age 37-43 years, two men, one woman) that were provided by the clinicians in charge. serum and cerebrospinal fluid were tested for viral cause by IgM ELISA to Japanese encephalitis, west nile fever, dengue, and measles. Samples were inoculated in vero-cell culture for virus isolation. The virus isolates were confirmed with indirect immunofluoresence with antimeasles immune sera and mouse monoclonal antibodies to measles HA and F proteins and with neutralisation tests using antimeasles immune sera. FINDINGS: Clinical features were fever, vomiting, oliguria or anuria, bilateral facial weakness, impaired hearing, blindness, proximal and distal areflexic limb paralysis, and respiratory paralysis. No patient had a macropapular rash. blood urea nitrogen (4.64-27.8 mmol/L) and creatinine (601.1-1105.0 micromol/L) were high, and cerebrospinal fluid contained high concentrations of proteins and pleocytosis. kidney biopsy samples in two patients showed severe interstitial nephritis. IgM antibodies to measles were found in blood and cerebrospinal fluid. Vero-cell cultures from serum and cerebrospinal fluid of one patient and cerebrospinal fluid of two patients, showed cytopathic effects characteristic of measles. INTERPRETATION: Unusual manifestations of acute renal failure with neurological involvement associated with measles virus in adults presenting without rash was confirmed. Our findings may affect the development of measles-elimination programmes. ( info) |
9/239. A 4-year-old with pica, progressive incoordination, and decreased responsiveness. This article reports a typical case of subacute sclerosing panencephalitis (SSPE). The patient contracted measles as an infant during the 1989 to 1991 united states measles epidemic. At 4 1/2 years of age, he developed behavioral changes and quickly progressed through the typical clinical stages of SSPE. His EEG was characteristic. serum and CSF measles immunoglobulin g were markedly elevated. He remains alive but is vegetative. To our knowledge, this is the first case of SSPE stemming from the 1989 to 1991 measles epidemic. Because infants--the group at highest risk to develop SSPE--were most severely affected by this measles outbreak, other cases of SSPE stemming from this epidemic may occur. ( info) |
10/239. Subacute encephalopathy in a 5-year-old boy. A 5-year-old boy presented with an acute ataxia and altered mental status. Although he initially recovered from these symptoms, he presented a second time with myoclonus and seizures and rapidly became vegetative. cerebrospinal fluid studies, magnetic resonance imaging, and brain biopsy all confirmed the presence of subacute sclerosing panencephalitis. Despite courses of therapy with cimetidine, amantadine, ribavirin, and inosine, no clinical improvement has been seen. Clinicians need to be alert to the possibility of subacute sclerosing panencephalitis even in the vaccinated child in the appropriate clinical setting. ( info) |