Clinical features, pathogenesis, pathology, neuroimaging, clinical course and outcome of measles inclusion-body encephalitis: a systematic review of published case reports and case series.

Measles inclusion-body encephalitis (MIBE) is rare, with insights largely from case studies. We systematically analyzed subacute Sclerosing Panencephalitis (SSPE) cases in immunocompromised patients, identifying distinctive clinical and neuroimaging features. These findings could facilitate MIBE diagnosis without the need for brain biopsies. Our systematic review on MIBE and HIV-related SSPE adhered to PRISMA guidelines and was registered with PROSPERO. We searched multiple databases and followed a detailed inclusion process with independent reviews and quality assessment. Data on patient demographics, clinical features, and outcomes were compiled. A review of 39 studies on 49 MIBE patients and 8 reports on HIV-positive SSPE patients was conducted. Acute lymphoblastic leukemia, HIV, organ transplants, and malignancies were common precursors to MIBE. Perinatal HIV was prevalent among SSPE cases. Seizures were the primary symptom in MIBE, often drug-resistant and progressing to status epilepticus or epilepsia partialis continua, whereas periodic myoclonus was universal in SSPE. Neuroimaging showed distinct patterns for each group, and histopathology confirmed measles virus presence in 39% of MIBE cases. MIBE patients typically progressed to coma and death. In conclusion, MIBE and SSPE in HIV-infected patients present with distinct clinical pictures but identical brain pathological abnormalities.

Favorable outcomes of interferon-α and ribavirin treatment for a male with subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a slow virus infection associated with mutant measles virus (MeV). The long-term outcome of antiviral treatments remains to be determined. We herein present a Japanese boy who was diagnosed with SSPE at 10 years of age. Intraventricular infusions of interferon-α effectively prevented the progress of symptoms during 14 years of follow-up period. Flow-cytometric analysis demonstrated higher proportion of T helper 17 cells (Th17, 18.2%) than healthy controls (4.8-14.5%) despite the normal subpopulation of peripheral lymphocytes. These data suggest that a group of patients with SSPE may show favorable responses to intraventricular infusions of interferon-α.

Risk Factors for Different Grades of Lower Respiratory Tract Infections in Children Under Five Years Old with Measles: Based on Chest Radiography.

BACKGROUND: Although measles epidemic has been controlled effectively after measles vaccination being carried out, China is still the focus of measles epidemic. The lower respiratory tract infections (LRTIs) is the most common complication, and also the most common reason for the death of patients with measles. PURPOSE: To analyze what clinical factors could affect the grades of LRTIs in children under five years old with measles. METHODS: Patients' 13 clinical factors and chest radiography were analyzed retrospectively. Based on the chest radiography, the LRTIs were divided into 3 grades. The clinical factors and the grades of LRTIs were analyzed by ordered logistic regression analysis. RESULTS: There were 74 cases in grade 0, 77 cases in grade 1, and 36 cases in grade 2. After univariate logistic regression analysis, there were 5 clinical factors whose P value were no more than 0.1, including the children's course of disease before admission, co-infection other pathogens, vaccination, the first symptoms and gender. After ordinal logistic regression analysis, the difference in the course of disease before admission (OR = 1.134, 95% CI: 1.025 to 1.141), without vaccination (OR = 1.808, 95% CI: 1.065 to 3.065) and co-infected other pathogens other pathogens infections (OR = 1.618, 95% CI: 1.073 to 2.440) during different grades was statistically significant (P < 0.05). CONCLUSION: In our study, there were three clinical factors, including "with a long course of disease before admission", "without measles vaccination" and "with other pathogens infections", as the independent risk factors of the grades of LRTIs in children with measles.

Lung ultrasound in the diagnosis of radio-occult pneumonia in the returned traveller: a case of measles pneumonia.

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Measles pneumonitis.

Measles is an acute febrile illness, potentially fatal and highly contagious, which is transmitted through the respiratory mode. Fever combined with one of the following: cough, coryza, conjunctivitis are the first manifestations of the disease. Koplik's spots may also appear on the buccal mucosa providing an opportunity to set the diagnosis even before the emergence of rash. Rash typically appears 3-4 days after the onset of fever, initially on the face and behind the ears, and its appearance is associated with the peak of the symptoms. Measles affects multiple systems, including the respiratory system, with pneumonia being one of the most lethal complications. Management involves best supportive care, correction of dehydration and nutritional deficiencies, treatment of secondary bacterial infections and provision of vitamin A. Importantly, given that measles present with lifelong immunity following infection or vaccination, prevention through measles vaccination has a cardinal role for measles' elimination. Indeed, public education and vaccination led to an estimated 79% decrease in global measles deaths from 2000 to 2015. Nonetheless, the last two years have seen a measles outbreak in several countries, partially due to the anti-vaccination movement. This article aims to present two cases of measles in our hospital and highlight the pressing need for vaccination in order to eradicate a potentially fatal disease.

Pulmonary measles disease: old and new imaging tools.

BACKGROUND: Measles virus can cause lower respiratory tract infection, so that chest radiography is necessary to investigate lung involvement in patients with respiratory distress. PURPOSE: To assess measles pneumonia imaging during the measles outbreak occurred in 2016-2017 in Italy. MATERIAL AND METHODS: We retrospectively observed adult patients with a serological diagnosis of measles, who underwent chest-X rays for suspected pneumonia. If a normal radiography resulted, the patient underwent unenhanced CT. A CT post processing software package was used for an additional quantitative lung and airway involvement analysis . RESULTS: Among 290 patients affected by measles, 150 underwent chest-X ray. Traditional imaging allowed the pneumonia diagnosis in 114 patients (76%). The most frequent abnormality at chest X-rays was bronchial wall thickening, observed in 88.5% of the cases; radiological findings are faint in the 25% of the cases (29/114 patients). In nine subjects with a normal chest X-ray, unenhanced CT with a quantitative analysis was performed, and depicted features consistent with constrictive bronchiolitis. CONCLUSION: Measles may produce bronchiolitis and pneumonia. In the cases in which involvement of pulmonary parenchyma is not sufficient to result in radiological abnormalities, CT used with a dedicated postprocessing software package, provides an accurate lungs and airways analysis, also determining the percentage of lung involvement.

Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Presentation with predominant extrapyramidal features is uncommon. We describe a case of SSPE presenting with extensive rigidity with highly elevated CPK values, mimicking neuroleptic malignant syndrome (NMS) which was most probably due to central dopaminergic blockade induced by the disease process. To our knowledge, this is the first case of SSPE presenting with a NMS-like syndrome.

Severe measles pneumonia in adults with respiratory failure: role of ribavirin and high-dose vitamin A.

Although measles is usually considered a benign viral disease of childhood, adults may be affected at any age and may experience severe respiratory or neurologic consequences. We present three adult cases (one of whom was pregnant) admitted to our University Hospital who were diagnosed to have measles and who had uncommon clinical features such as hepatitis and hyponatremia. All patients were markedly hypoxic; one required mechanical ventilation. Two patients received therapy with intravenous ribavirin and all patients received high-dose vitamin A for 3 days. Therapy with intravenous ribavirin and vitamin A were well tolerated by our patients except one patient who developed acute renal failure and were associated with reversal of respiratory compromise. Life-threatening measles pneumonitis in adults may be more common than previously appreciated, regardless of the patient's immune status, and ribavirin and high-dose vitamin A might be a treatment option.

Early detection of encephalitis with (18)F-FDG PET/CT.

Encephalitis is a relatively rare condition for which making an accurate diagnosis can be challenging. In fact, clinical features are not specific and structural imaging can be normal in a considerable number of cases. However, an early diagnosis is important as many forms of treatment are effective if started promptly. Even though recent guidelines do not recommend (18)F-FDG PET/CT for patients with suspected encephalitis, the case presented suggests that (18)F-FDG PET/CT may play a relevant role for the early diagnosis of this clinical condition.

Viral pneumonias in adults: radiologic and pathologic findings.

Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.

Measles pneumonitis.

STUDY OBJECTIVE: To investigate the finding of increased alveolar-arterial (A-a) gradient in adult patients with measles who have normal results on both pulmonary auscultation and chest radiography. DESIGN: Retrospective, descriptive case series. SETTING: An urban county teaching hospital in southern California. PARTICIPANTS: Consecutive adult patients with the clinical diagnosis of measles seen in the emergency department. METHODS: Patients were considered to have pneumonitis if they had any of the following: ED diagnosis of pneumonia; an A-a gradient of more than 30 mm Hg; one or more infiltrates on chest radiograph. RESULTS: Seventy-five patients, including 44 men and 31 women (median age, 25 years; 25% to 75% interquartile range [IQR], 20 to 28 years) were seen during the 36-month study period. Forty-three patients (57%; 95% confidence interval [CI], 45% to 69%) had pneumonitis, with a median A-a gradient of 42 mm Hg (IQR, 34 to 48 mm Hg). Twenty-seven of the 43 patients with pneumonitis (63%; CI, 48% to 77%) had both normal pulmonary auscultation findings and normal chest radiographs; this represented 36% of the study population (CI, 25% to 50%). Thirty-eight of the 43 patients with pneumonitis were admitted; one patient was later intubated after respiratory failure developed. Two of the 5 patients with pneumonitis who were sent home were admitted the following day for worsening symptoms. All 75 patients eventually did well. CONCLUSION: A significant percentage of adult patients with measles presenting to an ED with both normal pulmonary auscultation and normal chest radiographs have increased A-a gradients. These patients warrant close follow-up and perhaps hospital admission.

[Clinical features of measles pneumonia in adults: usefulness of computed tomography].

The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases with serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be a useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course.

[Roentgenologic findings in chronic bronchopulmonary diseases in children]. / Röntgenologische Befunde bei chronischen broncho-pulmonalen Erkrankungen im Kindesalter.

X-ray findings in chronic bronchopulmonary diseases in children are presented on the basis of observations made during the last 20 years. Six groups of diseases can be differentiated according to signs and clinical course: Pneumonias with delayed healing, chronic relapsing infiltrations, mucoviscidosis, chronic pleuropneumonia with abscess formation, chronic interstitial processes and chronic infiltrations with bronchiectasis. The typical phenomena and possibilities of differential diagnosis are discussed.

Nodular residua of atypical measles pneumonia.

Atypical measles pneumonia should be considered an explanation for nodular pulmonary lesions in older children and young adults. The disorder can develop in children immunized with inactivated measles virus vaccine who are then exposed to natural measles virus. Individuals given the vaccine when it was used (1961--1968) are now at risk to develop atypical measles pneumonia. This pneumonia may have a lobar or diffuse bronchopneumonia pattern. Three cases of this disorder are described. In one case, radiography showed calcification in the nodules 6 years after the pneumonia. Complicated and possibly hazardous workups can be avoided by awareness of this disease.