Diagnostic value of specific antibody synthesis in brain of patients with neuroinfections

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Material and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups. Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn't depend on concentration of specific Ab in serum and CSF and wasn't followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusions: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

Epstein-barr virus-associated encephalitis in a case-series of more than 40 patients.

OBJECTIVE: Introduction: Epstein-Barr virus (EBV) infection can present with neurologic manifestations including encephalitis, aseptic meningitis, Guillain-Barre syndrome, and many others. Most reported cases have been in children. Little is known about EBV encephalitis in adults. The aim: To describe the clinical presentations, investigational findings, management and outcome of adult patients with EBV encephalitis. PATIENTS AND METHODS: Materials and methods: This report conducted a retrospective review of all cases of EBV-associated encephalitis compiled in the Kyiv's referral hospital from January 2016 to December 2017. RESULTS: Review: Out of 226 adult patients hospitalized with acute encephalitis during the study period, 48 (21.2%) were identified as having evidence of EBV-infection: convincing EBV serology and/or positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) in patients that had no bacterial cause of encephalitis. EBV monoinfection was registered in 24 (50%) patients. Mixed herpesvirus infection with one to four viruses in addition to EBV was detected in the rest. The most common symptoms were fever, confusion, headache, focal neurological deficits, vestibulo-ataxic disorders. CSF cytosis, content of protein and glucose were close to normal. Magnetic resonance imaging (MRI) showed focal (28/58.3%) and diffuse (15/31.3%) changes of the brain parenchymal. All patients got antiviral medication: ganciclovir, valganciclovir or valaciclovir, as a rule. Outcome: 26 (54%) patients recovered without any disabling sequela, 21 (44%) patients with remaining preservations were transferred to a convalescence facility. One patient, which condition worsened against the background of the therapy, were moved to an intensive care unit. No patient died. CONCLUSION: Conclusions: CNS infection with EBV only and as a mixed infection is common in Ukraine. Presentation of EBV-infection is non-specific, both as MR imaging, sometimes reminding of HSV-1 infection. Prognosis of the disease is favorable.

Identification of human herpesvirus 7 in the cerebrospinal fluid of adult ukrainian with relapsing-remitting multiple sclerosis. A case study.

OBJECTIVE: Introduction: In this study, we investigated the possible involvement of Human herpesvirus 7 in multiple sclerosis. The aim: To contribute to clarifying the controversy on the association between Human Herpesviruses 7 (HHV-7) and multiple sclerosis (MS) studying patient with relapsing-remitting MS (RRMS). PATIENTS AND METHODS: Case study: Young female admitted to adult tertiary referral, infectious diseases hospital, Kyiv, Ukraine, with signs of a focal neurological deficit. Meningeal symptoms were not detected. The preadmission illness lasted some years. Clinical diagnosis was relapsing-remitting multiple sclerosis (RRMS). On admission, general condition was of moderate severity. She has a mild fever, confusion, speech and coordination disorders, dizziness, worsening of memory, inability to walk (inferior paraparesis). Focal lesions were detected on MRI scan. The spinal fluid contained oligoclonal IgG-chains and HHV-7 DNA. After two weeks of intensive antiviral treatment, the patient's condition improved significantly,the function of the lower limbs recovered almost completely, and she was discharged home. CONCLUSION: Conclusion: Here we present a comprehensive clinical, radiological and virological analysis of the HHV-7-associated case of multiple sclerosis.