MEASLES

MEASLES VIRUS
• single-stranded, lipid-enveloped RNA virus
• family Paramyxoviridae
• genus Morbillivirus.
6 MAJOR STRUCTURAL PROTEINS OF MEASLES VIRUS

2 most important in terms of induction of immunity

hemagglutinin (H) protein
fusion (F) protein
• neutralizing antibodies are directed against the H protein, and
antibodies to the F protein limit proliferation of the virus during
infection.
PATHOGENESIS
 INCUBATION
• measles virus migrates to regional lymph nodes.
• A primary viremia ensues that disseminates the virus to the
reticuloendothelial system.
• A secondary viremia spreads virus to body surfaces.
PRODROMAL ILLNESS
• Begins after the secondary viremia and is associated with epithelial
necrosis and giant cell formation in body tissues.
• Cells are killed by cell-to-cell plasma membrane fusion associated with viral
replication that occurs in many body tissues, including cells of the central
nervous system.
• Virus shedding begins
• With onset of the rash, antibody production begins, and viral replication
and symptoms begin to subside.
• Measles virus also infects CD4+ T cells, resulting in suppression of the Th1
immune response and a multitude of other immunosuppressive effects.
• Measles virus is transmitted by respiratory droplets.
• Three cell-surface receptors have been identified for the
virus:
 CD46 (A COMPLEMENTREGULATORY PROTEIN THAT
INACTIVATES C3 CONVERTASES)
 expressed on all nucleated cells
 SIGNALING LYMPHOCYTIC ACTIVATION MOLECULE (SLAM,
A MOLECULE INVOLVED IN T-CELL ACTIVATION)
 expressed on cells of the immune system
 NECTIN 4 (ADHERENS JUNCTION PROTEIN)
 expressed on epithelial cells
• measles virus attaches to specific cell receptors to infect host cells.

• initial targets for measles virus are alveolar macrophages, dendritic cells, and
lymphocytes.
• The cell receptor used appears to be the signaling lymphocyte activating
molecule or more properly CD150.
• mechanism of infection of respiratory tissues: attachment to the PVRL4 receptor
(Nectin4) that is expressed on cells in the trachea, oral mucosa, nasopharynx,
and lungs.
• These 2 receptors, CD150 and PVRL4, account for the lymphotropic and
epitheliotropic nature of natural measles virus infection, and along with the
prolonged immunosuppressive effects of measles, suggest that it is more
characteristic of human immunodeficiency virus infection than a respiratory
illness.
• initially multiplies within the respiratory tract then spreads to local
lymphoid tissues.
• Replication of the virus in lymphatic tissue is followed by viremia and
systemic dissemination to many tissues, including the conjunctiva, skin,
respiratory tract, urinary tract, small blood vessels, lymphatic system, and
CNS.
• Most children develop T-cell–mediated immunity to measles virus that
helps control the viral infection and produces the measles rash.
• in malnourished children with poor medical care, measles virus may cause
croup, pneumonia, diarrhea and protein-losing enteropathy, keratitis
leading to scarring and blindness, encephalitis, and hemorrhagic rashes
(“black measles”).