Skip to main content
SpringerLink
Log in

Measles Virus Infection and Subacute Sclerosing Panencephalitis

  • Chapter
  • First Online:
Viral Infections of the Human Nervous System

Part of the book series: Birkhäuser Advances in Infectious Diseases ((BAID))

Abstract

Measles virus can cause two acute neurological disorders: acute infectious encephalitis and postinfectious autoimmune encephalitis, each with a risk of about 1 in 1,000 measles cases. Two other rare neurological problems manifest after a latent period: subacute measles encephalitis occurring in immunocompromised individuals, and subacute sclerosing panencephalitis (SSPE) in immunocompetent hosts. SSPE develops 1–10 years after measles infection; it is usually progressive and fatal. Mental and behavioral changes, myoclonia, and ataxia are typical initial manifestations. The diagnosis is based on the demonstration of intrathecal anti-measles virus immunoglobulin G synthesis. Pathological examination of brain biopsy or autopsy material demonstrates inflammation, neuronal loss, gliosis, demyelination, and typically, inclusion bodies containing measles virus antigens or RNA. Treatment with inosiplex and interferons may induce temporary stabilization or remission in about 30–35 % of the cases. Immunization against measles virus and maintenance of immunization rates above 90 % in the population are of extreme importance for the prevention of these debilitating or fatal disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ADEM:

Acute disseminated encephalomyelitis

CSF:

Cerebrospinal fluid

EEG:

Electroencephalography

IL:

Interleukin

MRI:

Magnetic resonance imaging

MV:

Measles virus

SSPE:

Subacute sclerosing panencephalitis

References

  • Adels BR, Gajdusek C, Gibbs CJ Jr, Albrecht P, Rogers NG (1968) Attempts to transmit subacute sclerosing panencephalitis and isolate a measles virus related agent, with a study of the immune response in patients and experimental animals. Neurology 18:30–51

    Article  PubMed  CAS  Google Scholar 

  • Albertyn C, van der Plas H, Hardie D, Candy S, Tomoka T, Leepan EB, Heckmann JM (2011) Silent casualties from the measles outbreak in South Africa. S Afr Med J 101:313–314, 316–317

    PubMed  Google Scholar 

  • Anlar B, Yalaz K (2011) Prognosis in subacute sclerosing panencephalitis. Dev Med Child Neurol 53:965

    Article  PubMed  Google Scholar 

  • Anlar B, Saatçi I, Köse G, Yalaz K (1996) MRI findings in subacute sclerosing panencephalitis. Neurology 47:1278–1283

    Article  PubMed  CAS  Google Scholar 

  • Anlar B, Yalaz K, Oktem F, Köse G (1997) Long-term follow-up of patients with subacute sclerosing panencephalitis treated with intraventricular alpha-interferon. Neurology 48:526–528

    Article  PubMed  CAS  Google Scholar 

  • Anlar B, Köse G, Gürer Y, Altunbaşak S, Haspolat S, Okan M (2001a) Changing epidemiological features of subacute sclerosing panencephalitis. Infection 29:192–195

    Article  PubMed  CAS  Google Scholar 

  • Anlar B, Söylemezoğlu F, Aysun S, Köse G, Belen D, Yalaz K (2001b) Tissue inflammatory response in subacute sclerosing panencephalitis (SSPE). J Child Neurol 16:895–900

    Article  PubMed  CAS  Google Scholar 

  • Anlar B, Ayhan A, Hotta H, Itoh M, Engin D, Barun S, Köseoglu O (2002a) Measles virus RNA in tonsils of asymptomatic children. J Paediatr Child Health 38:424–425

    Article  PubMed  CAS  Google Scholar 

  • Anlar B, Pinar A, Yaşar Anlar F, Engin D, Ustaçelebi S, Kocagöz T, Us D, Akduman D, Yalaz K (2002b) Viral studies in the cerebrospinal fluid in subacute sclerosing panencephalitis. J Infect 44:176–180

    Article  PubMed  Google Scholar 

  • Anlar B, Aydin OF, Guven A, Sonmez FM, Kose G, Herguner O (2004) Retrospective evaluation of interferon-beta treatment in subacute sclerosing panencephalitis. Clin Ther 26:1890–1894

    Article  PubMed  CAS  Google Scholar 

  • Bakir TF (1989) Viral meningitis and encephalitis in Saudi Arabia. J Trop Pediatr 35:211–213

    PubMed  CAS  Google Scholar 

  • Bellini WJ, Rota JS, Lowe LE, Katz RS, Dyken PR, Zaki SR, Shieh WJ, Rota PA (2005) Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized. J Infect Dis 192:1686–1693

    Article  PubMed  Google Scholar 

  • Bouteille M, Fontaine C, Vedrenne C, Delarue J (1965) Sur un cas d’encbphalite subaigue a inclusions. Etude anatomoclinique et ultrastructurale. Rev Neurol 113:454

    Google Scholar 

  • Cherian T, Joseph A, John TJ (1984) Low antibody response in infants with measles and children with subclinical measles virus infection. J Trop Med Hyg 87:27–31

    PubMed  CAS  Google Scholar 

  • Committee on Infectious Diseases; American Academy of Pediatrics (2011) Policy statement–recommended childhood and adolescent immunization schedules–United States, 2011. Pediatrics 127:387–388

    Article  Google Scholar 

  • Connolly JH, Haire M, Hadden DS (1971) Measles immunoglobulins in subacute sclerosing panencephalitis. Br Med J 1:23–25

    Article  PubMed  CAS  Google Scholar 

  • Dittmar S, Harms H, Runkler N, Maisner A, Kim KS, Schneider-Schaulies J (2008) Measles virus-induced block of transendothelial migration of T lymphocytes and infection-mediated virus spread across endothelial cell barriers. J Virol 82:11273–11282

    Article  PubMed  CAS  Google Scholar 

  • Dyken PR, Swift A, DuRant RH (1982) Long-term follow-up of patients with subacute sclerosing panencephalitis treated with inosiplex. Ann Neurol 11:359–363

    Article  PubMed  CAS  Google Scholar 

  • Erturk O, Karslıgil B, Cokar O, Yapıcı Z, Demirbilek V, Gurses C, Yalcinkaya C, Gokyigit A, Direskeneli GS, Yentur S, Onal E, Yılmaz G, Dervent A (2011) Challenges in diagnosing SSPE. Childs Nerv Syst 27:2041–2044

    Article  PubMed  Google Scholar 

  • European Centre for Disease Prevention and Control (ECDC). European monthly measles monitoring (EMMO) 2011. Stockholm. http://ecdc.europa.eu/en/publications/Publications/1109_European_monthly_measles_monitoring_August_2011.pdf.

  • Filia A, Tavilla A, Bella A, Magurano F, Ansaldi F, Chironna M, Nicoletti L, Palù G, Iannazzo S, Declich S, Rota MC (2011). Measles in Italy, July 2009 to September 2010. Euro Surveill 16: pii: 19925.

    Google Scholar 

  • Fukuyama Y, Nihei K, Matsumoto S, Ebina T, Kamoshita S, Sato T, Arima M, Yabuuchi H, Ueda S, Ohtahara S et al (1987) Clinical effects of MND-19 (Inosiplex) on subacute sclerosing panencephalitis–a multi-institutional collaborative study–The Inosiplex-SSPE Research Committee. Brain Dev 9:270–282

    Article  PubMed  CAS  Google Scholar 

  • Gadoth N, Kott E, Levin S, Hahn T (1989) The interferon system in subacute sclerosing panencephalitis and its response to isoprinosine. Brain Dev 11:308–312

    Article  PubMed  CAS  Google Scholar 

  • Gibbs FA, Gibbs EL, Spies HW, Carpenter PR (1964) Common types of childhood encephalitis: electroencephalographic and clinical relationships. Arch Neurol 10:1–11

    Article  PubMed  CAS  Google Scholar 

  • Gunaratne PS, Rajendran T, Tilakaratne S (2001) Neurological complications of measles. Ceylon Med J 46:48–50

    PubMed  CAS  Google Scholar 

  • Gürer YK, Kükner S, Sarica B (1996) Intravenous gamma-globulin treatment in a patient with subacute sclerosing panencephalitis. Pediatr Neurol 14:72–74

    Article  PubMed  Google Scholar 

  • Haddad FS, Risk WS (1980) Isoprinosine treatment in 18 patients with subacute sclerosing panencephalitis: a controlled study. Ann Neurol 7:185–188

    Article  PubMed  CAS  Google Scholar 

  • Hirayama T, Ikeda K, Hidaka T, Nagata R, Yoshii Y, Kawabe K, Iwasaki Y (2010) Unilateral measles-associated retrobulbar optic neuritis without encephalitis: a case report and literature review. Case Rep Neurol 2:128–132

    Article  PubMed  Google Scholar 

  • Horta-Barbosa L, Fuccillo DA, London WT, Jabbour JT, Zeman W, Sever JL (1969) Isolation of measles virus from brain cell cultures of two patients with subacute sclerosing panencephalitis. Proc Soc Exp Biol Med 132:272–277

    PubMed  CAS  Google Scholar 

  • Jones CE, Dyken PR, Huttenlocher PR, Jabbour JT, Maxwell K (1982) Inosiplex therapy in subacute sclerosing panencephalitis. A multicentre, non-randomised study in 98 patients. Lancet 1:1034–1037

    Article  PubMed  CAS  Google Scholar 

  • Katayama Y, Kohso K, Nishimura A, Tatsuno Y, Homma M, Hotta H (1998) Detection of measles virus mRNA from autopsied human tissues. J Clin Microbiol 36:299–301

    PubMed  CAS  Google Scholar 

  • Katz M, Rorke LB, Masland WS, Koprowski H, Tucker SH (1968) Transmission of an encephalitogenic agent from brains of patients with subacute sclerosing panencephalitis to ferrets. Preliminary report. N Engl J Med 279:793–798

    Article  PubMed  CAS  Google Scholar 

  • Kim SJ, Kim JS, Lee DY (2003) Neurologic outcome of acute measles encephalitis according to the MRI patterns. Pediatr Neurol 28:281–284

    Article  PubMed  Google Scholar 

  • Kühne Simmonds M, Brown DW, Jin L (2006) Measles viral load may reflect SSPE disease progression. Virol J 3:49

    Article  PubMed  Google Scholar 

  • Laboccetta AC, Tornay AS (1964) Measles encephalitis. Report of 61 cases. Am J Dis Child 107:247–255

    PubMed  CAS  Google Scholar 

  • Lee KY, Cho WH, Kim SH, Kim HD, Kim IO (2003) Acute encephalitis associated with measles: MRI features. Neuroradiology 45:100–106

    Article  PubMed  CAS  Google Scholar 

  • Lisse I, Samb B, Whittle H, Jensen H, Soumare M, Simondon F, Aaby P (1998) Acute and long-term changes in T-lymphocyte subsets in response to clinical and subclinical measles. A community study from rural Senegal. Scand J Infect Dis 30:17–21

    Article  PubMed  CAS  Google Scholar 

  • Luzi P, Leoncini L, Valassina M, Federico A, Palma L (1997) Chronic progressive leptomeningitis associated with measles virus. Lancet 350:338–339

    Article  PubMed  CAS  Google Scholar 

  • Maas S, Kawahara Y, Tamburro KM, Nishikura K (2006) A-to-I RNA Editing and Human Disease. RNA Biol 3:1–9

    Article  PubMed  CAS  Google Scholar 

  • Meyer E, Byers RK (1952) Measles encephalitis; a follow up study of sixteen patients. AMA Am J Dis Child 84:543–579

    PubMed  CAS  Google Scholar 

  • Miki K, Komase K, Mgone CS, Kawanishi R, Iijima M, Mgone JM, Asuo PG, Alpers MP, Takasu T, Mizutani T (2002) Molecular analysis of measles virus genome derived from SSPE and acute measles patients in Papua, New Guinea. J Med Virol 68:105–112

    Article  PubMed  CAS  Google Scholar 

  • Moss WJ, Griffin DE (2012) Measles. Lancet 2012 379:153–164

    Google Scholar 

  • Mustafa MM, Weitman SD, Winick NJ, Bellini WJ, Timmons CF, Siegel JD (1993) Subacute measles encephalitis in the young immunocompromised host: report of two cases diagnosed by polymerase chain reaction and treated with ribavirin and review of the literature. Clin Infect Dis 16:654–660

    Article  PubMed  CAS  Google Scholar 

  • Nakajima M, Sakuishi K, Fukuda S, Fujioka S, Hashida H (2008) Recovery from adult measles encephalitis immediately after early immunomodulation. Clin Infect Dis 47:148–149

    Article  PubMed  Google Scholar 

  • Nakayama T, Mori T, Yamaguchi S, Sonoda S, Asamura S, Yamashita R, Takeuchi Y, Urano T (1995) Detection of measles virus genome directly from clinical samples by reverse transcriptase-polymerase chain reaction and genetic variability. Virus Res 35:1–16

    Article  PubMed  CAS  Google Scholar 

  • Naniche D, Varior-Krishnan G, Cervoni F, Wild TF, Rossi B, Rabourdin-Combe C, Gerlier D (1993) Human membrane cofactor protein (CD46) acts as a cellular receptor for measles virus. J Virol 67:6025–6032

    PubMed  CAS  Google Scholar 

  • Öktem F, Nester MJ, Anlar B (1997) Mental assessment in subacute sclerosing panencephalitis: Hacettepe Cognitive Short Assessment Scale. J Child Neurol 12:398–402

    Article  PubMed  Google Scholar 

  • Ölmez A, Yilmaz D, Tan H, Duman O, Güngör S, Okuyaz C, Anlar B (2007) Cerebrospinal fluid pressures in subacute sclerosing panencephalitis. Brain Dev 29:409–412

    Article  PubMed  Google Scholar 

  • Otaki M, Jiang DP, Sasayama M, Nagano-Fujii M, Hotta H (2007) Generation of recombinant adenovirus expressing siRNA against the L mRNA of measles virus and subacute sclerosing panencephalitis virus. Microbiol Immunol 51:985–991

    PubMed  CAS  Google Scholar 

  • Paunio M, Hedman K, Davidkin I, Valle M, Heinonen OP, Leinikki P, Salmi A, Peltola H (2000) Secondary measles vaccine failures identified by measurement of IgG avidity: high occurrence among teenagers vaccinated at a young age. Epidemiol Infect 124:263–271

    Article  PubMed  CAS  Google Scholar 

  • Pipo-Deveza JR, Kusuhara K, Silao CL, Lukban MB, Salonga AM, Sanchez BC, Kira R, Takemoto M, Ishizaki Y, Yukaya N, Kusuhara K, Kira R, Torisu H, Ihara K, Sakai Y, Sanefuji M, Pipo-Deveza JR, Silao CL, Sanchez BC, Lukban MB, Salonga AM, Hara T (2010) PD1 as a common candidate susceptibility gene of subacute sclerosing panencephalitis. Hum Genet 127:411–419

    Article  PubMed  Google Scholar 

  • Piskin AK, Akpinar P, Muftuoglu S, Anlar B (2007) Signaling lymphocyte activating molecule (SLAM) expression in subacute sclerosing panencephalitis. Brain Dev 29:439–442

    Article  PubMed  Google Scholar 

  • Plaza JA, Nuovo GJ (2005) Histologic and molecular correlates of fatal measles infection in children. Diagn Mol Pathol 14:97–102

    Article  PubMed  CAS  Google Scholar 

  • Prasad SR, Shaikh NJ, Verma S, Banerjee K (1995) IgG & IgM antibodies against measles virus in unvaccinated infants from Pune: evidence for subclinical infections. Indian J Med Res 101:1–5

    PubMed  CAS  Google Scholar 

  • Prashanth LK, Taly AB, Sinha S, Ravi V (2007) Subacute sclerosing panencephalitis (SSPE): an insight into the diagnostic errors from a tertiary care university hospital. J Child Neurol 22:683–688

    Article  PubMed  CAS  Google Scholar 

  • Reuter D, Schneider-Schaulies J (2010) Measles virus infection of the CNS: human disease, animal models, and approaches to therapy. Med Microbiol Immunol 199:261–271

    Article  PubMed  CAS  Google Scholar 

  • Robertson WC Jr, Clark DB, Markesbery WR (1980) Review of 38 cases of subacute sclerosing panencephalitis: effect of amantadine on the natural course of the disease. Ann Neurol 8:422–425

    Article  PubMed  Google Scholar 

  • Sever AE, Rainey JJ, Zell ER, Hennessey K, Uzicanin A, Castillo-Solórzano C, Dietz V (2011) Measles elimination in the Americas: a comparison between countries with a one-dose and two-dose routine vaccination schedule. J Infect Dis 204(Suppl 2):S748–755

    Article  PubMed  Google Scholar 

  • Shu M, Liu Q, Wang J, Ao R, Yang C, Fang G, Wan C, Guo W (2011) Measles vaccine adverse events reported in the mass vaccination campaign of Sichuan province, China from 2007 to 2008. Vaccine 29:3507–3510

    Article  PubMed  Google Scholar 

  • Srivastava SP, Nema HV (1963) Optic neuritis in measles. Brit J Ophthal 47:180–181

    Article  PubMed  CAS  Google Scholar 

  • Stanescu A, Janta D, Lupulescu E, Necula G, Lazar M, Molnar G, Pistol A (2011) Ongoing measles outbreak in Romania, 2011. Euro Surveill 16: pii:19932.

    Google Scholar 

  • Tatsuo H, Ono N, Tanaka K, Yanagi Y (2000) SLAM (CDw150) is a cellular receptor for measles virus. Nature 406:893–897

    Article  PubMed  CAS  Google Scholar 

  • Thurner B, Spangenberg P, Kleines M, Blaum M, Scheithauer S, Häusler M (2007) Continuous intrathecal interferon alpha application in subacute sclerosing panencephalitis. Pediatr Infect Dis J 26:863

    PubMed  Google Scholar 

  • Tomiyasu K, Ishiyama M, Kato K, Komura M, Ohnuma E, Inamasu J, Takahashi T (2009) Bilateral retrobulbar optic neuritis, Guillain-Barré syndrome and asymptomatic central white matter lesions following adult measles infection. Intern Med 48:377–381

    Article  PubMed  Google Scholar 

  • Tomoda A, Nomura K, Shiraishi S, Hamada A, Ohmura T, Hosoya M, Miike T, Sawaishi Y, Kimura H, Takashima H, Tohda Y, Mori K, Kato Z, Fukushima A, Nishio H, Nezu A, Nihei K (2003) Trial of intraventricular ribavirin therapy for subacute sclerosing panencephalitis in Japan. Brain Dev 25:514–517

    Article  PubMed  Google Scholar 

  • Torisu H, Hara T (2006) Analysis of MxA, IL-4, and IRF-1 genes in Filipino patients with subacute sclerosing panencephalitis. Neuropediatrics 37:222–228

    Article  PubMed  Google Scholar 

  • Torisu H, Kusuhara K, Kira R, Bassuny WM, Sakai Y, Sanefuji M, Takemoto M, Hara T (2004) Functional MxA promoter polymorphism associated with subacute sclerosing panencephalitis. Neurology 62:457–460

    Article  PubMed  CAS  Google Scholar 

  • Tyler HR (1957) Neurological complications of rubeola (measles). Medicine (Baltimore) 36:147–167

    Article  CAS  Google Scholar 

  • Valassina M, Meacci F, Valensin PE, Cusi MG (2000) Detection of neurotropic viruses circulating in Tuscany: the incisive role of Toscana virus. J Med Virol 60:86–90

    Article  PubMed  CAS  Google Scholar 

  • Watanabe A, Yoneda M, Ikeda F, Terao-Muto Y, Sato H, Kai C (2010) CD147/EMMPRIN acts as a functional entry receptor for measles virus on epithelial cells. J Virol 84:4183–93

    Article  PubMed  CAS  Google Scholar 

  • Yalaz K, Anlar B, Oktem F, Aysun S, Ustacelebi S, Gurcay O, Gucuyener K, Renda Y (1992) Intraventricular interferon and oral inosiplex in the treatment of subacute sclerosing panencephalitis. Neurology 42:488–491

    Article  PubMed  CAS  Google Scholar 

  • Yilmaz V, Demirbilek V, Gürses C, Yentür SP, Uysal S, Yapici Z, Yilmaz G, Muncey A, Cokar O, Onal E, Gökyiğit A, Saruhan-Direskeneli G (2007) Interleukin (IL)-12, IL-2, interferon-gamma gene polymorphisms in subacute sclerosing panencephalitis patients. J Neurovirol 13:410–415

    Article  PubMed  CAS  Google Scholar 

  • Yüksel D, Sonmez PA, Yilmaz D, Senbil N, Gurer Y (2011) Ocular findings in subacute sclerosing panencephalitis. Ocul Immunol Inflamm 19:135–138

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey

    Banu Anlar & Kalbiye Yalaz

Authors
  1. Banu Anlar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kalbiye Yalaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Banu Anlar .

Editor information

Editors and Affiliations

  1. , Health Sciences Centre, University of Manitoba, Sherbrook Street 820, Winnipeg, R3A 1R9, Manitoba, Canada

    Alan C. Jackson

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Basel

About this chapter

Cite this chapter

Anlar, B., Yalaz, K. (2013). Measles Virus Infection and Subacute Sclerosing Panencephalitis. In: Jackson, A. (eds) Viral Infections of the Human Nervous System. Birkhäuser Advances in Infectious Diseases. Springer, Basel. https://doi.org/10.1007/978-3-0348-0425-7_1

Download citation

Publish with us

Policies and ethics

Search

Navigation