Measles

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There are three forms of encephalitis produced by measles virus. The most common form is a post-infectious encephalomyelitis characterized by the acute onset of headache, fever, stiff neck, seizures and focal deficit, usually within 14 days of rash. Mortality is about 10-20%,222 and survivors are often left with seizure disorders, impairment of cognitive function and deafness. Pathological changes are found mainly in white matter and are indistinguishable from the inflammatory demyelination seen in fatal cases of post-vaccinial encephalomyelitis due to rabies immunization or smallpox vaccination. Measles virus is not found in the brains of patients who die of measles post-infectious encephalo-myelitis.223

A less common form of encephalitis is subacute sclerosing panencephalitis (SSPE), a chronic progressive encephalitis that develops years after measles. Dementia, focal deficit and seizures, including myoclonic seizures, characterize the disease. Death usually occurs within a few years. Both gray and white matter are affected, and inclusion bodies, measles virus antigen and RNA as well as para-myxovirus nucleocapsids are abundant in brain. Measles virus vaccination has nearly eradicated both measles post-infectious encephalomyelitis and SSPE.

Finally, a rare form of subacute encephalitis produced by measles virus occurs in immunocom-promised individuals. About 50% of such patients have rash in association with severe, usually fatal encephalitis. Measles virus inclusions and viral antigen and RNA are present in brain. Surprisingly, this form of measles virus encephalitis has not emerged as a significant opportunistic virus encephalitis in AIDS patients.

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