Viral hemorrhagic fevers: neurologic complications
Aug. 17, 2021
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This article includes discussion of central nervous system syndromes associated with measles infection, primary measles encephalitis, acute post-infectious measles encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis (SSPE). The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Measles, or rubella, is caused by a single stranded negative-sense RNA virus that belongs to the Morbillivirus genus of the Paramyxoviridae family (11) and is considered to be one of the most contagious infections known. Measles is typically spread via respiratory aerosol. Even in developed countries, mortality remains close to 3 in 1000 of those infected (44). Despite worldwide efforts of measles eradication and the availability of a preventive vaccine since the 1960s, outbreaks remain frequent. Measles has reemerged as a major public health problem in the last decade. Between January and August 2019, there have been over 1000 cases of measles confirmed in the United States alone. This is the highest number reported since measles were considered eliminated in 2000 (07).
Failure to vaccinate is the most common reason for the current increase in measles (07). Travel to countries where vaccination programs are lacking, waning immunity, and the lack of antibody production in 2% to 10% of the patients vaccinated also contribute to the reemergence observed in the past decade.
• Neurologic syndromes associated with measles include measles inclusion body encephalitis, acute post-infectious measles encephalomyelitis, primary measles encephalitis, and subacute sclerosing panencephalitis.
• Neurologic sequelae of measles are severe and, depending on the syndrome, may carry a substantial risk of disability and even death.
• Measles vaccination is highly effective in preventing primary infection. It does not cause autism.
Some of the first descriptions of measles infection are believed to belong to Chinese alchemist and philosopher, Kong Hu, circa 300 C.E. Several centuries later, in 910, an Iranian physician, Abu Bakr Mohammad Ibn Zakariya al-Razi, known simply as Rhazes, published a treatise on the diagnostic differentiation of measles and chickenpox.
When, therefore, you see these symptoms, or some of the worst of them (such as pain of the back, and the terrors of sleep, with the continued fever) then you may be assured that the eruption of one or the other of these diseases in the patient is nigh at hand; except that there is not in the measles so much pain of the back as in smallpox; nor in the smallpox so much anxiety and nausea as in measles, unless the smallpox be of a bad sort; and this shows that the measles came from a very bilious blood (24).
The first measles inoculation attempts in the Western world are ascribed to Francis Home, a Scottish physician, who, in 1757, demonstrated that measles was caused by an infectious agent by inoculating several groups of children with blood and nasal discharge from patients with measles (13).
The measles virus was first cultivated in kidney cell tissue by Thomas Peebles, a World War II bomber pilot turned pediatrician, who at that time was working with Enders, one of the most renowned virologists of the 20th century who invented the technique of viral tissue cultures, culminating in the creation of the polio vaccine and subsequently many others (14). Peebles isolated measles from an 11-year-old boy and used that strain to make the very first measles vaccine. The vaccine was approved in the United States in 1963 (02).
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