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Involvement of the central nervous system in acute, uncomplicated measles virus infection
Abstract:
A prospective study on acute, uncomplicated measles infection was carried out in 59 patients hospitalized for an ordinary measles infection. A clinical and serological diagnosis of an acute measles infection was made in all cases. Serial serum and cerebrospinal fluid (CSF) specimens were taken two to five times from each patient and tested for pleocytosis, albumin, and measles-specific antibodies. Pleocytosis was found in 18 patients (30%), usually shortly after the onset of rash. Nine patients had antibodies against measles virus in their CSF. Six of them seemed to have damage to the blood-brain barrier, but in two cases there was a very high serum antibody titer with a normal serum/CSF ratio. One patient had a local antibody production against measles virus in the central nervous system. Conventional electroencephalography (EEG) was recorded on 22 children, and a separate, quantitative EEG study with two to six consecutive recordings was also performed on a group of nine patients. Moderate or strong slowing of background EEG activity was found in 50% of the patients. In the consecutive recordings, the changes culminated a few days after the onset of rash. No correlation seemed to exist between the changes in the CSF and the age of the patient, on the one hand, and slowing of the EEG, on the other.
Insights
Measles infection can affect the central nervous system, with 30% of patients showing cerebrospinal fluid (CSF) changes and 50% exhibiting abnormal electroencephalogram (EEG) findings. These neurological alterations often occur shortly after rash onset.
Area of Science:
- Neurology
- Virology
- Immunology
Background:
- Measles is a highly contagious viral illness.
- Complications of measles can involve the central nervous system (CNS).
- Understanding the neurological impact of measles is crucial for patient management.
Purpose of the Study:
- To investigate the neurological manifestations of acute, uncomplicated measles infection.
- To assess changes in cerebrospinal fluid (CSF) and electroencephalogram (EEG) in measles patients.
- To determine the presence and extent of CNS involvement during measles.
Main Methods:
- Prospective study of 59 hospitalized patients with confirmed measles.
- Serial collection and analysis of serum and CSF for pleocytosis, albumin, and measles-specific antibodies.
- Electroencephalography (EEG) recordings, including conventional and quantitative assessments.
Main Results:
- Pleocytosis (30%) and measles antibodies in CSF (9/59) were detected, indicating CNS inflammation or infection.
- Evidence of blood-brain barrier damage was observed in some patients with CSF abnormalities.
- Abnormal EEG findings, including slowed background activity (50%), were common and peaked post-rash onset.
- No correlation was found between CSF changes, patient age, and EEG slowing.
Conclusions:
- Acute measles infection can lead to subclinical or overt central nervous system involvement.
- CSF and EEG abnormalities are relatively common in measles patients.
- Further research is needed to understand the long-term implications of these neurological findings.