An 8 year old boy is taken to a pediatrician because of behavioral changes, mild intellectual deterioration, and "laziness." Over the next several months the boy develops increasing clumsiness and periodic, involuntary, jerky movements every 3 to 6 seconds. Visual deterioration is apparent upon visual field testing, and optic atrophy is evident on funduscopic examination. Cerebrospinal fluid studies do not show significant pleocytosis, but oligoclonal bands of IgG are present on CSF electrophoresis. The electroencephalogram shows periodic discharges that are synchronous with the periods of myoclonus. Computed tomography (CT) of the head shows low-density white matter lesions and cerebral atrophy. At the age of 10, the boy dies. Prior infection with which of the following agents was probably related to the patient's condition?
The rare disease illustrated is subacute sclerosing panencephalitis (SSPE), which typically presents as in the question stem. SSPE appears to be due to a combination of persistent, possibly abnormal measles virus and to autoimmune damage caused by antibodies directed against the virus. Many patients developing SSPE have had measles at 2 years of age or younger; there is typically a six-year interval between measles infection and symptom development. A small propoion of cases have followed vaccination with live measles virus. Unfounately, no effective therapy has been developed, although some experimental work with drugs such as isoprinosine shows some promise. Postinfectious encephalomyelitis, rather than SSPE, can follow mumps or varicella. Latent infection with the varicella virus causes shingles (herpes zoster). Papillomaviruses are associated with was. They do not usually infect the brain. Poliovirus causes gastrointestinal disturbances, viremia, and paralysis. Ref: Ray C.G., Ryan K.J. (2010). Chapter 10. Mumps Virus, Measles, Rubella, and Other Childhood Exanthems. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
Measles virus
Mumps virus
Papillomavirus
Poliovirus