Dataset Information

Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France.

ABSTRACT: We report a fatal case of measles inclusion-body encephalitis occurring in a woman from Romania with AIDS. After an extensive but unsuccessful diagnostic evaluation, a pan-pathogen shotgun metagenomic approach revealed a measles virus infection. We identified no mutations previously associated with neurovirulence.

SUBMITTER: Rodriguez C

PROVIDER: S-EPMC7454109 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France.

Rodriguez Christophe C Gouilh Meriadeg Ar MA Weiss Nicolas N Stroer Sébastian S Mokhtari Karima K Seilhean Danielle D Mathon Bertrand B Demontant Vanessa V N'Debi Melissa M Gricourt Guillaume G Woerther Paul-Louis PL Pawlotsky Jean-Michel JM Stefic Karl K Marlet Julien J Dequin Pierre-François PF Guillon Antoine A Pourcher Valérie V Boutolleau David D Vabret Astrid A Burrel Sonia S

Emerging infectious diseases 20200901 9

We report a fatal case of measles inclusion-body encephalitis occurring in a woman from Romania with AIDS. After an extensive but unsuccessful diagnostic evaluation, a pan-pathogen shotgun metagenomic approach revealed a measles virus infection. We identified no mutations previously associated with neurovirulence. ...[more]

PMID: 32818389

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Project description:BackgroundThe pathogenesis of acute measles encephalitis (AME) is poorly understood. Treatment with immune-modulators is based on theories that post-infectious autoimmune responses cause demyelination. The clinical course and immunological parameters of AME were examined during an outbreak in Vietnam.Methods and findingsFifteen measles IgM-positive patients with confusion or Glasgow Coma Scale (GCS) score below 13, and thirteen with uncomplicated measles were enrolled from 2008-2010. Standardized clinical exams were performed and blood collected for lymphocyte and measles- and auto-antibody analysis. The median age of AME patients was 21 years, similar to controls. Eleven reported receiving measles vaccination when aged one year. Confusion developed a median of 4 days after rash. Six patients had GCS <8 and four required mechanical ventilation. CSF showed pleocytosis (64%) and proteinorrhachia (71%) but measles virus RNA was not detected. MRI revealed bilateral lesions in the cerebellum and brain stem in some patients. Most received dexamethasone +/- IVIG within 4 days of admission but symptoms persisted for ?3 weeks in five. The concentration of voltage gated calcium channel-complex-reactive antibodies was 900 pM in one patient, and declined to 609 pM ? 3 months later. Measles-reactive IgG antibody avidity was high in AME patients born after vaccine coverage exceeded 50% (? 25 years earlier). AME patients had low CD4 (218/µl, p?=?0.029) and CD8 (200/µl, p?=?0.012) T-cell counts compared to controls.ConclusionYoung adults presenting with AME in Vietnam reported a history of one prior measles immunization, and those aged <25 years had high measles-reactive IgG avidity indicative of prior vaccination. This suggests that one-dose measles immunization is not sufficient to prevent AME in young adults and reinforces the importance of maintaining high coverage with a two-dose measles immunization schedule. Treatment with corticosteroids and IVIG is common practice, and should be assessed in randomized clinical trials.

Dataset Information

Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France.

Publications

Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France.

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