[Infection of the central nervous system by Epstein-Barr virus: clinical manifestations and prognosis]. / Infección del sistema nervioso central por el virus de Epstein-Barr: manifestaciones clínicas y pronóstico.

INTRODUCTION: The role of Epstein-Barr virus (EBV) in central nervous system (CNS) infections is not fully resolved. We wanted to describe the clinical manifestations of patients with EBV infection in cerebrospinal fluid. PATIENTS AND METHODS: We reviewed the clinical records of all adult patients EBV PCR-positive in cerebrospinal fluid, without lymphoproliferative disease, during 2004 to 2020. RESULTS: We identified 27 patients, 22 (81.5%) were men, and median age was 54 years. Twenty-three (82.1%) patients were immunosuppressed, 16 HIV-positive. In 15 (55.6%) patients coinfection with another microorganism was diagnosed and in 12 (44.4%) patients it was detected as the only pathogen. Of the 12 patients, three (25%) was immunocompetent patients, one had Guillain Barre syndrome (GBS), another had disseminated multiphasic encephalitis, and another had lymphocytic meningitis; 9 (75%) immunosuppressed, 7 HIV-positive, 4 had encephalitis that resolved without sequelae and 4 had encephalopathy, two HIH-positive had moderate cognitive impairment as a sequela. CONCLUSIONS: In our study, EBV produced encephalitis, meningitis, polyradiculomyelitis and GBS, mainly in immunosuppressed patients. In more than half of the cases, it is associated with other pathogens where the role of EBV is unclear. In immunocompetent patient, the infection can be serious and leave sequelae and in HIV-positive patients with encephalopatic involvement without encephalitis, the neurological damage could be greater, so we consider it of interest to carry out studies to evaluate the prognosis as well as the role of antivirals in the evolucion of these clinical pictures.

TITLE: Infección del sistema nervioso central por el virus de Epstein-Barr: manifestaciones clínicas y pronóstico.Introducción. El papel del virus de Epstein-Barr (VEB) en las infecciones del sistema nervioso central no siempre está claro. Nuestro objetivo fue describir las manifestaciones clínicas y la evolución de los pacientes con detección del VEB en el líquido cefalorraquídeo (LCR). Pacientes y métodos. Se revisaron las historias clínicas de todos los pacientes adultos con detección del VEB en el LCR por reacción en cadena de la polimerasa diagnosticados desde 2004 hasta 2020 sin enfermedad linfoproliferativa. Resultados. Se diagnosticó a 27 pacientes, 22 (81,5%) hombres, con una mediana de 54 años; 23 (82,1%) pacientes eran inmunodeprimidos, 16 positivos para el virus de la inmunodeficiencia humana (VIH). En 15 (55,6%) pacientes, el VEB se detectó en coinfección con otro microorganismo, y en 12, como único patógeno. De los 12 pacientes, tres (25%) eran inmunocompetentes, uno presentó un síndrome de Guillain-Barré, otro una encefalitis diseminada multifásica y otro una meningitis linfocitaria; y nueve (75%) inmunodeprimidos, de los que cuatro presentaron encefalitis que se resolvieron sin secuelas, y cuatro encefalopatía, dos de ellos positivos para el VIH, que presentaron secuelas (deterioro cognitivo moderado). Conclusiones. En nuestro estudio, el VEB produjo cuadros de encefalitis, meningitis, polirradiculomielitis y SGB, principalmente en inmunodeprimidos. En más de la mitad de los casos se asocia a otros patógenos, en donde el papel del VEB no está claro. En inmunocompetentes, las infecciones pueden ser graves y dejar secuelas, y en pacientes con VIH con encefalopatía sin encefalitis, el daño neurológico podría ser mayor, por lo que consideramos de interés realizar estudios que evalúen el pronóstico y el papel de los antivirales en la evolución de estos cuadros clínicos.

CMV viral load in bronchoalveolar lavage for diagnosis of pneumonia in allogeneic hematopoietic stem cell transplantation.

The objective of this report is to analyze the value of CMV viral load (VL) in bronchoalveolar lavage (BAL) in recipients of allogeneic hematopoietic stem cell transplantation (AHSCT) and to analyze the concordance between CMV quantification in plasma and BAL samples. Fifty-six patients were included; in 16 (28.6%) patients with symptoms of lung disease a BAL sample was collected, 7 (43.7%) patients had a VL >150 copies/mL (six had probable CMV pneumonia). Patients with CMV pneumonia were female (100%), of median age 53.5 years, and the median time from transplantion to onset of symptoms was 67.5 days. Pneumonia was early in three cases (incidence 5.4%). Median BAL VL was 53 250 copies/mL and plasma VL was 538 copies/mL (in one patient, the plasma VL was negative). Three (50.0%) patients had an improvement in the first week of treatment, and plasma VL became negative; the other 3 (50.0%) patients died with a CMV pneumonia refractory to treatment. Therefore, any value of CMV VL in BAL, especially if it is greater than plasma, with compatible signs or symptoms, should be considered suggestive of CMV pneumonia in recipients of AHSCT and they should receive specific treatment.

[Epidemiology and clinical study of Bordetella pertussis in Gran Canaria Island, Spain, in the period 2003-2007]. / Estudio clínico-epidemiológico de la infección por Bordetella pertussis en la isla de Gran Canaria en el período 2003-2007.

OBJECTIVE: To describe the epidemiological and clinical pattern of a Bordetella pertussis infection (whooping cough) among hospitalised infants in a paediatric hospital in Gran Canaria island (Spain). METHODS: A retrospective review of the patient hospital records was performed considering only those with a microbiological diagnosis of pertussis by polymerase chain reaction (PCR) for the period September 2003-September 2007. RESULTS: Forty nine patients were identified, of which 47 were < 6 months of age. The annual incidence of hospitalisation was estimated between 103.9 and 204.5 cases per 100,000 infants < 12 months old. Household members were the potential source of infection in at least 65.3 % of the cases. Clinical data were obtained from 47 patients. Complications occurred in 23.4 % of the patients (11 infants), three of them died (6.4 %). Viral coinfections occurred in 33.3 % of the infants diagnosed with pertussis. CONCLUSIONS: Pertussis presents a high complication rate among infants < 6 months old. Pertussis must be considered in the differential diagnosis of infants < 6 months old who present with severe pneumonia. Immunization strategies in the adult population must be reviewed and updated in order to attain higher protection of the more vulnerable paediatric population.