Complications of Measles Virus
المؤلف:
Baijayantimala Mishra
المصدر:
Textbook of Medical Virology
الجزء والصفحة:
2nd Edition , p181-182
2025-10-20
155
Measles associated complications are seen in about 30% of measles cases and more common in children below 5 years of age and adults more than 20 years. It presents either as severe measles infection or secondary bacterial infection.
Diarrhea, otitis media, pneumonia and encephalitis are amongst the common complications associated with measles. Diarrhea is the most common measles complication, reported in 8% of measles cases.
Immunocompromised individuals particularly with defective cellular immune response are prone for severe measles which manifest mainly as giant cell pneumonia (Hecht pneumonia) consisting of multinucleated giant cells in the lungs. These patients may present with or without rash.
Respiratory tract complications are amongst the most frequent complications due to measles. Otitis media and bronchopneumonia are the commonest complications. Otitis media is seen in majority of children with measles amounting to 7% of all complications. Pneumonia is seen in 6% of measles cases and the most common cause of measles related deaths. Besides measles associated giant cell pneumonia, pneumonia can occur due to secondary viral or bacterial infections. Most often the bacterial pneumonia is due to Streptococcus pneumoniae or Haemophilus influenzae.
Central nervous system (CNS) complica tions are rare but severe. It can occur primarily in three different manners (Fig. 1).
1. Acute disseminated encephalomyelitis (ADEM)
2. Measles inclusion body encephalitis (MIBE)
3. Subacute sclerosing encephalomyelitis (SSPE)
Fig1. Timing of neurologic complications of measles
Acute disseminated encephalomyelitis (ADEM): It is an acute demyelinating auto immune disease due to measles virus induced autoimmunity to myelin basic protein of brain. It is seen within days to weeks of acute measles. It occurs in 1 in 1000 measles cases. The disease is characterized by fever, seizure and other neurological deficits. Mortality rate reported is 10–20%. No measles virus antigen, RNA or measles specific antibody can be detected in brain or CSF.
Measles inclusion body encephalitis (MIBE): It occurs in individuals with impaired cellular immunity. Progressive measles virus replication in brain results in neurological deterioration and death. It occurs after months of acute measles infection.
Subacute sclerosing panencephalitis (SSPE): Slowly progressive disease, occurs after years (5–10 years) of acute measles. The disease is more common in children who had measles infection before 2 years of age. Manifestation is commonly seen in boys <20 years of age. It occurs in 1 in 10000 to 1 in 100,000 cases.
The disease process is thought to be due to host response to the mutated measles virions and occurs because of defective assembly and budding.
Disease is characterized by four phases:
• I: Progressive mental deterioration and memory defect often present as change in school performance
• II: Myoclonous, seizures
• III: Neurological deterioration
• IV: Optic atrophy, coma
Death occurs within months to years of onset.
Diagnosis of SSPE can be made by detection of high level of measles antibody in CSF. The CSF: serum ratio of hemagglutinating antibody of £1:68 by hemagglutination inhibition assay (HAI) is considered as significant.
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