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Measles encephalitis during immunosuppressive treatment for acute lymphoblastic leukaemia
I Hughes1, M E Jenney, R W Newton
1Department of Neurology, Royal Manchester Children's Hospital.
Abstract:
Between 1971 and 1989 measles encephalitis was identified in five children receiving chemotherapy for acute lymphoblastic leukaemia. Review of these and previously reported cases of measles encephalitis in immunosuppressed patients failed to identify any pathognomonic features in the history, the clinical presentation, or the results of electroencephalography or computed tomography. Detection of measles virus antigen in nasopharyngeal secretions or intrathecal synthesis of specific antibody was not possible in all instances. Early diagnosis by direct detection of viral antigen in the brain was confounded by difficulties in identifying areas of the brain suitable for biopsy. Increasing herd immunity to measles in the general population by vaccination is the only effective intervention against measles encephalitis in immunosuppressed children. Measles encephalitis must be remembered as a possible explanation of encephalopathy in the immunocompromised child: the benefits of early use of antiviral agents need to be evaluated.
Insights
Measles encephalitis in children with acute lymphoblastic leukemia is difficult to diagnose. Increasing measles herd immunity through vaccination is crucial for preventing this severe complication in immunocompromised children.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Onco-immunology
Background:
- Measles encephalitis poses a significant risk to immunocompromised children, particularly those undergoing chemotherapy for acute lymphoblastic leukemia (ALL).
- Understanding the diagnostic challenges and effective prevention strategies is critical for this vulnerable population.
Observation:
- Five cases of measles encephalitis in children with ALL were identified between 1971 and 1989.
- A review of these and prior cases revealed no pathognomonic features in clinical presentation, history, EEG, or CT scans.
- Detection of measles virus antigen or specific antibodies was inconsistent, complicating diagnosis.
Findings:
- Diagnosing measles encephalitis in immunosuppressed children is challenging due to the lack of specific clinical or diagnostic markers.
- Difficulties in brain biopsy targeting also hinder early etiological diagnosis.
- Measles virus detection in various samples proved unreliable in many instances.
Implications:
- Enhanced herd immunity via widespread measles vaccination is the primary preventive measure against measles encephalitis in immunocompromised children.
- Measles encephalitis should be considered in the differential diagnosis of encephalopathy in immunocompromised pediatric patients.
- Further research is needed to evaluate the potential benefits of early antiviral agent administration.