Acute Measles Encephalitis: Primary Encephalitis or Postinfectious Encephalomyelitis

Abstract

Measles remains an important vaccine-preventable disease, particularly in the developing countries. The disease at times is accompanied by numerous complications in the backdrop of malnutrition. Of these, the neurologic complications are the most devastating. The neurological involvement in measles encompasses at least four distinct conditions, namely, primary measles encephalitis (PME), acute postinfectious measles encephalomyelitis (APME), measles inclusion body encephalitis, and subacute sclerosing panencephalitis. The pathogenesis of PME or APME continues to be enigmatic with both immune mechanism and direct viral invasion being variously incriminated. We report a fatal case of measles encephalitis in a 3.5-year-old child, with a slow and indolent course over a 1-month period with laboratory evidence of acute measles infection without any demonstrable virus in the body fluid at the time of the encephalitis with typical magnetic resonance imaging features.

Keywords

measles - encephalitis - neurologic complications

• References

• 1 Mason WH. Measles. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier; 2011: 1069-1075
• 2 Buchanan R, Bonthius DJ. Measles virus and associated central nervous system sequelae. Semin Pediatr Neurol 2012; 19 (3) 107-114
• 3 Chowdhary J, Ashraf SM, Khajuria K. Measles with acute disseminated encephalomyelitis (ADEM). Indian Pediatr 2009; 46 (1) 72-74
• 4 Schneider-Schaulies J, Niewiesk S, Schneider-Schaulies S, ter Meulen V. Measles virus in the CNS: the role of viral and host factors for the establishment and maintenance of a persistent infection. J Neurovirol 1999; 5 (6) 613-622
• 5 Johnson RT, Griffin DE, Hirsch RL , et al. Measles encephalomyelitis—clinical and immunologic studies. N Engl J Med 1984; 310 (3) 137-141
• 6 Oglesbee M, Niewiesk S. Measles virus neurovirulence and host immunity. Future Virol 2011; 6 (1) 85-99
• 7 Lee KY, Cho WH, Kim SH, Kim HD, Kim IO. Acute encephalitis associated with measles: MRI features. Neuroradiology 2003; 45 (2) 100-106
• 8 Kim SJ, Kim JS, Lee DY. Neurologic outcome of acute measles encephalitis according to the MRI patterns. Pediatr Neurol 2003; 28 (4) 281-284