Meningoencephalitis caused by Bovine alphaherpesvirus 5 in Pernambuco, Brazil / [Meningoencefalite causada pelo Bovine alphaherpesvirus 5 em Pernambuco, Brasil]

Objetivou-se descrever a ocorrência do Bovine alphaherpesvirus 5 (BoHV5) como causa de meningoencefalite não supurativa em bovinos do estado de Pernambuco, Brasil. Para tanto, 32 amostras de sistema nervoso embebidas em parafina foram obtidas de animais acometidos por doenças neurológicas atendidos na Clínica de Bovinos de Garanhuns da Universidade Federal Rural de Pernambuco (CBG-UFRPE), entre 2012 e 2016. As amostras foram analisadas quanto à presença do gene da glicoproteína C do BoHV5 por reação em cadeia da polimerase (PCR). Dois animais (6,25%) tiveram resultado positivo à PCR, e sua análise de sequenciamento indicou 100% de similaridade para o BoHV5. Os resultados histopatológicos desses dois animais revelaram lesões multifocais de meningoencefalite não supurativa associada à polioencefalomalácia, presença de corpúsculos de inclusão basofílicos, infiltração de células de Gitter e presença de manguitos perivasculares. A PCR se mostra uma importante ferramenta para diferenciação das infecções por BoHV5 de outras enfermidades neurológicas de bovinos, especialmente a raiva.(AU)

Determination of Etiology and Epidemiology of Viral Central Nervous System Infections by Quantitative Real-Time Polymerase Chain Reaction in Central India Population.

INTRODUCTION: Viral infections of the central nervous system (CNS) are the most common cause of hospital admission in worldwide and remain a challenging disease for diagnosis and treatment. The most common infectious agents associated with viral CNS infections are cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), Japanese encephalitis virus (JEV), Dengue virus (DENV),West Nile virus(WNV), and Chandipura virus(CHPV). The aim of the present work was to find the etiology of CNS viral infection in the Central India population by transcriptase PCR (RT-PCR) comparing real-time polymerase chain reaction (PCR) method [one-step and two-step reverse transcriptase (RT-PCR)] in cerebrospinal fluid (CSF) and blood samples of CNS viral infections patients. MATERIALS AND METHODS: One-step and two-step real-time PCR assays were evaluated in CSF and parallel blood samples from patients with viral CNS infections for detection of DNA and RNA viruses. A comparative analysis was also done between gDNA, gRNA, cDNA, and plasmid-based real-time PCR methods for an efficient quantitation of viral particles in clinical samples for determination of viral etiology. RESULT: On evaluation of 150 CSF and 50 parallel blood samples from suspected cases of viral CNS infections, a viral etiology was confirmed in 21 (14%) cases, including 3% for EBV, 1% of CMV, and 5% for VZV and JEV. The one-step RT-PCR has a higher detection limit for detection and quantitation of viral RNA in comparison to two-step RT-PCR. CONCLUSION: Our result reveals that VZV and JEV are the most usual cases of CNS viral infection in hospitalized patients in the Central India population and one-step RT-PCR shows higher viral load detection limits for quantitation of viral genome and more sensitivity in comparison to two-step RT-PCR.

Prevalence of progressive multifocal leukoencephalopathy (PML) in adults and children with systemic lupus erythematosus.

OBJECTIVE: To define the risk of progressive multifocal leukoencephalopathy (PML) in SLE. METHODS: This is a retrospective observational study to evaluate PML cases in patients with SLE admitted to two large academic hospitals. Using electronic medical record (EMR) data, International Classification of Diseases (ICD) codes identified PML cases among patients with SLE, rheumatoid arthritis (RA) (controls), had renal transplant and with HIV. Medication exposure was reviewed. RESULTS: A total of 5409 Columbia University Medical Center (CUMC) patients and 2046 Northwell Health patients were identified using one ICD code for SLE. Of 7455 patients, three had an ICD code for PML. On EMR review, however, PML was substantiated in only one fatal SLE case with significant immunosuppressant use and severe lymphopenia (<0.5 cells x 109/L); one patient was evaluated for PML but cerebrospinal fluid (CSF) was negative for JC virus and improved with treatment of central nervous system (CNS) lupus. EMR data were very limited for the third patient and diagnosis could not be confirmed. None of the 13 342 patients with RA ICD codes had PML. Of the 5409 patients with an SLE ICD code at CUMC, 212 also had a renal transplant ICD code, and 83 had concomitant HIV/AIDS. Based on inpatient pharmacy records of 5409 hospitalised patients at CUMC, 59.2% were treated with steroids, and 16.09% with immunosuppressants (7.76% mycophenolate, 3.42% cyclophosphamide, 2.88% azathioprine and 2.03% rituximab). No patients with paediatric SLE (pSLE) (n=538) had PML. The combined prevalence of PML in hospitalised patients with SLE at the two hospitals was 13-27/100 000 patients. CONCLUSION: Among 7455 adult patients with SLE ICD codes, there were two PML cases, with only one confirmed case associated with severe lymphopenia and immunosuppressants, corresponding to a prevalence of 13-27 per 100 000 patients. No PML cases in pSLE were found. A high index of suspicion in patients with SLE and CNS manifestations is required for the prompt diagnosis of PML.

[A Seven-Year Evaluation of Viral Central Nervous System Infections]. / Viral Etkenlere Bagli Santral Sinir Sistemi Enfeksiyonlarinin Yedi Yillik Degerlendirmesi.

Identification of viral agents causing central nervous system (CNS) infections increased by the application of nucleic acid tests. In this study, the results of polymerase chain reaction (PCR) for viral agents were evaluated in cerebrospinal fluid (CSF) samples taken from patients with CNS infection. CSF samples taken from 1185 patients between 2010 and 2017 were tested for the presence of Herpes simplex virus (HSV) type 1 and 2, Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus ve enterovirus by PCR in Dokuz Eylul University Hospital. Tests were performed according to the clinicians' orders and results were evaluated retrospectively. The number of tests performed were 1038 for HSV, 882 for adenovirus, 865 for enterovirus, 496 for VZV, 100 for EBV and 92 for CMV. Commercial tests were used for EBV, CMV (Artus QS-RGQ Kits, Qiagen, Germany) and enterovirus (GeneXpert, Cepheid, USA) while the other viruses (HSV, VZV, adenovirus) were tested by in-house real-time PCR assays. Ninety-one CSF (7.7%) samples were positive. The mean age was 13 (<1 to 76 years) while median was seven. The most frequently detected pathogens were enterovirus (63/91, 69%) and HSV-1 (14/91,15%). The number of patients positive for adenovirus, VZV, EBV and CMV were five, four, three and two, respectively. In one patient, both enterovirus (Ct: 29.5) and EBV (Ct: 38.53) were positive. The number of positive samples were increased in summer months. Enterovirus RNA positive patients (n= 60/63, 95.2%) were ≤ 18 years old while 29% were younger than one year of age. Enterovirus positive samples peaked in 2012 and 2014 and detected mainly in summer (60.3%) and autumn (20.6%) months. VZV was mostly detected in patients greater than 65 years of age. Mean Ct of the positive reactions was 31.87 ± 3.5 (22.88-40.32). The lowest and the highest Ct values were detected in HSV-1 assay. The mean Ct value of enterovirus assay (30.4; 25.7-35.9) was lower than the other pathogens' values. In the seven-year period, 7.7% of the1185 patients' CSF samples were positive for viral nucleic acids. As expected, enteroviruses were the most common pathogens in children and detected mainly in summer-autumn period. Syndromic approach in CNS infections could increase the viral pathogen detection.

Acute flaccid myelitis and enterovirus D68: lessons from the past and present.

Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus.Conclusion: This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease. What is Known: • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68. What is New: • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians. • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.

Viral infections of the central nervous system in Africa.

Viral infections are a major cause of human central nervous system infection, and may be associated with significant mortality, and long-term sequelae. In Africa, the lack of effective therapies, limited diagnostic and human resource facilities are especially in dire need. Most viruses that affect the central nervous system are opportunistic or accidental pathogens. Some of these viruses were initially considered harmless, however they have now evolved to penetrate the nervous system efficiently and exploit neuronal cell biology thus resulting in severe illness. A number of potentially lethal neurotropic viruses have been discovered in Africa and over the course of time shown their ability to spread wider afield involving other continents leaving a devastating impact in their trail. In this review we discuss key viruses involved in central nervous system disease and of major public health concern with respect to Africa. These arise from the families of Flaviviridae, Filoviridae, Retroviridae, Bunyaviridae, Rhabdoviridae and Herpesviridae. In terms of the number of cases affected by these viruses, HIV (Retroviridae) tops the list for morbidity, mortality and long term disability, while the Rift Valley Fever virus (Bunyaviridae) is at the bottom of the list. The most deadly are the Ebola and Marburg viruses (Filoviridae). This review describes their epidemiology and key neurological manifestations as regards the central nervous system such as meningoencephalitis and Guillain-Barré syndrome. The potential pathogenic mechanisms adopted by these viruses are debated and research perspectives suggested.

[Central Neurological Diagnosis in Patients Infected with HIV in the Infectious Diseases Unit of University Hospital of Casablanca, Morocco]. / Manifestations neurologiques centrales chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mm3. Infection with severe immunosuppression was progressive multifocal leucoencephalitis, cryptococcal meningitis, and primary cerebral lymphoma. Lethality was 39%. In the department of infectious diseases of the UHC, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the detection and management of these patients.

L'objectif de ce travail est d'étudier l'épidémiologie des manifestations neurologiques centrales (MNC) des patients vivant avec le VIH (PvVIH) suivis dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca entre janvier 2005 et mai 2015. La source des données était le logiciel Nadis. Trois cent quatre-vingt-sept patients ont été hospitalisés pour une MNC sur 3 496 PvVIH, soit une prévalence de 11 %. Le sex-ratio (H/F) était de 1,27. L'âge moyen des patients était de 39 ans (± 7). L'atteinte neurologique était révélatrice de l'infection à VIH dans 266 cas (69 %). Les troubles neurologiques étaient dominés par les céphalées (70 %), le syndrome neurologique focal (35 %) et le syndrome méningé (35 %). Les étiologies étaient dominées par la méningoencéphalite tuberculeuse (37 %), la toxoplasmose cérébrale (30 %) et la cryptococcose neuroméningée (CNM) (20 %). La médiane des lymphocytes T CD4 était de 184 cellules/mm3. Les atteintes survenues en cas d'immunodépression sévère étaient la leucoencéphalite multifocale progressive, la CNM et le lymphome cérébral primitif. Le taux de létalité global était de 39 %. Dans le service des maladies infectieuses du CHU prenant en charge les PvVIH, la tuberculose est la première étiologie des MNC au cours de l'infection au VIH. Une collaboration conjointe du programme national de lutte contre la tuberculose et de celui de lutte contre le sida a été mise en place pour améliorer le dépistage et la prise en charge de ces patients.

Situación epidemiológica de las meningoencefalitis / Epidemiological situation of meningoencephalitis

La meningoencefalitis son enfermedades endemoepidémicas de distribución universal, generalmente graves, que requieren un rápido tratamiento por la velocidad de su evolución y la posibilidad de secuelas o muerte. La meningitis de etiología infecciosa es una patología de notificación obligatoria, inmediata y universal, lo que permite conocer su incidencia, distribución etaria, ubicación geográfica, estacionalidad, características de su evolución, entre otras variables, para orientar las estrategias de prevención y control. Se analizan los casos de meningitis desde la SE 1 a la 37 del 2016, (17 de Septiembre) provenientes de la notificación a través del Sistema Nacional de Vigilancia Sanitaria, y la situación epidemiológica en la Ciudad de Buenos Aires

Coronavirus Infections in the Central Nervous System and Respiratory Tract Show Distinct Features in Hospitalized Children.

BACKGROUND/AIMS: Coronavirus (CoV) infections induce respiratory tract illnesses and central nervous system (CNS) diseases. We aimed to explore the cytokine expression profiles in hospitalized children with CoV-CNS and CoV-respiratory tract infections. METHODS: A total of 183 and 236 hospitalized children with acute encephalitis-like syndrome and respiratory tract infection, respectively, were screened for anti-CoV IgM antibodies. The expression profiles of multiple cytokines were determined in CoV-positive patients. RESULTS: Anti-CoV IgM antibodies were detected in 22/183 (12.02%) and 26/236 (11.02%) patients with acute encephalitis-like syndrome and respiratory tract infection, respectively. Cytokine analysis revealed that the level of serum granulocyte colony-stimulating factor (G-CSF) was significantly higher in both CoV-CNS and CoV-respiratory tract infection compared with healthy controls. Additionally, the serum level of granulocyte macrophage colony-stimulating factor (GM-CSF) was significantly higher in CoV-CNS infection than in CoV-respiratory tract infection. In patients with CoV-CNS infection, the levels of IL-6, IL-8, MCP-1, and GM-CSF were significantly higher in their cerebrospinal fluid samples than in matched serum samples. CONCLUSION: To the best of our knowledge, this is the first report showing a high incidence of CoV infection in hospitalized children, especially with CNS illness. The characteristic cytokine expression profiles in CoV infection indicate the importance of host immune response in disease progression.

Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea.

BACKGROUND: Viral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection. METHODS: We performed a prospective study of Papua New Guinean children hospitalized with signs and symptoms of CNS infection. CSF samples from 300 children without proven bacterial/fungal meningitis were analyzed for human herpes viruses (HHV), picornaviruses, influenza, adenoviruses, flaviviruses and bacteria. RESULTS: Fifty-five children (18%) had viral (42), bacterial (20) or both viral and bacterial (7) nucleic acids (NA) identified in their CSF. Human herpes viruses accounted for 91% of all viruses found. The identification of viral or bacterial NA was not associated with any characteristic clinical features. By contrast, malaria was associated with increased identification of viral and bacterial NA and with impaired consciousness, multiple convulsions and age. Malaria was also inversely associated with an adverse outcome. Amongst children with HHV infection, those with HHV-6 and -7 were younger, were more likely have impaired consciousness and had a higher proportion of adverse outcomes than children with CMV. Dengue and enteroviral infections were infrequent. Adenoviral and influenza infections were not identified. CONCLUSION: Infections with HHV-6, HHV-7, dengue and enterovirus have the potential to cause serious CNS disease in young PNG children. However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.

Epstein-Barr virus (EBV) load in cerebrospinal fluid and peripheral blood of patients with EBV-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation.

BACKGROUND: To evaluate the diagnostic and prognostic utility of monitoring the Epstein-Barr virus (EBV) load in the cerebrospinal fluid (CSF) and peripheral blood for the patients with EBV-associated central nervous system (CNS) diseases after allogeneic hematopoietic stem cell transplantation (allo-HSCT), 172 patients undergoing allo-HSCT were enrolled in the study. METHODS: The EBV DNA levels of blood were monitored regularly in recipients of transplants for 3 years post transplantation. The EBV DNA levels of CSF were monitored in patients with EBV-associated CNS diseases before the treatment and at different points following the treatment. RESULTS: Post-transplant EBV-associated diseases developed in 27 patients, including 12 patients with EBV-associated CNS diseases. The 3-year cumulative incidences of EBV-associated diseases and EBV-associated CNS diseases were 19.5 ± 3.5% and 8.6 ± 2.4%, respectively. Patients with EBV-associated diseases showed higher loads of EBV DNA in their blood compared with patients with EBV DNA-emia. No difference was seen between the EBV DNA levels of blood in patients with CNS involvement and patients without CNS involvement. The EBV DNA loads of blood increased 3-14 days before the clinical manifestations of EBV-associated diseases emerged. The EBV DNA loads of CSF were higher than that of blood in patients with EBV-associated CNS diseases. In 12 patients with EBV-associated CNS diseases, EBV DNA levels were declining in both blood and CSF with the control of diseases, and the EBV DNA loads of CSF decreased faster than that of blood in 5 patients who responded to treatment, and the EBV DNA levels of CSF increased in 5 patients who were unresponsive to treatment. On multivariate analysis, the use of anti-thymocyte globulin and intensified conditioning regimens were independent risk factors for EBV-associated diseases and EBV-associated CNS diseases. CONCLUSIONS: EBV-associated CNS diseases are not rare after allo-HSCT. The EBV DNA loads of CSF could act as an important indicator, but the EBV DNA loads of blood could not, for the diagnosis, prognosis, and therapeutic evaluation of EBV-associated CNS diseases.

Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study.

BACKGROUND: Fever with reduced consciousness is an important cause of hospital admission of children in sub-Saharan Africa, with high mortality. Cerebral malaria, diagnosed when acute Plasmodium falciparum infection and coma are recorded with no other apparent reason, is one important cause. We investigated whether viruses could also be an important cause of CNS infection in such patients, and examined the relative contribution of viral pathogens and malaria parasitaemia. METHODS: We did a prospective cohort study in Blantyre, Malawi. From March 1, 2002, to Aug 31, 2004, we enrolled children aged between 2 months and 15 years who were admitted to hospital with suspected non-bacterial CNS infections. Children with a cerebrospinal fluid (CSF) white cell count of less than 1000 cells per µL and negative bacterial microscopy and culture were deemed to have suspected viral CNS infection. Blood was examined for asexual forms of P falciparum. PCR was done on CSF or on post-mortem brain biopsy specimens to detect 15 viruses known to cause CNS infection. FINDINGS: Full outcome data were available for 513 children with suspected viral CNS infection, of whom 94 (18%) died. 163 children (32%) had P falciparum parasitaemia, of whom 34 (21%) died. At least one virus was detected in the CNS in 133 children (26%), of whom 43 (33%) died. 12 different viruses were detected; adenovirus was the most common, affecting 42 children; mumps, human herpes virus 6, rabies, cytomegalovirus, herpes simplex virus 1, and enterovirus were also important. 45 (9%) of the 513 children had both parasitaemia and viral infection, including 27 (35%) of 78 diagnosed clinically with cerebral malaria. Children with dual infection were more likely to have seizures than were those with parasitaemia alone, viral infection only, or neither (p<0·0001). 17 (38%) of the 45 children with dual infection died, compared with 26 (30%) of 88 with viral infection only, 17 (14%) of 118 with parasitaemia only, and 34 (13%) of 262 with neither (p<0·0001). Logistic regression showed children with a viral CNS infection had a significantly higher mortality than did those who did not have a viral CNS infection (p=0·001). INTERPRETATION: Viral CNS infections are an important cause of hospital admission and death in children in Malawi, including in children whose coma might be attributed solely to cerebral malaria. Interaction between viral infection and parasitaemia could increase disease severity. FUNDING: Wellcome Trust, US National Institutes of Health, and UK Medical Research Council.

Prevalencia de infección por citomegalovirus en pacientes pediátricos con afecciones neurológicas en el estado Zulia, Venezuela (2007-2008) / Prevalence of cytomegalovirus infection in pediatric patients with neurological disorders in Zulia state, Venezuela (2007-2008)

El objetivo de este estudio fue determinar la prevalencia de citomegalovirus en pacientes pediátricos con afecciones neurológicas, provenientes del Estado Zulia, Venezuela durante el período 2007-2008. Se recolectaron 186 muestras pareadas de líquido cefalorraquídeo (LCR) y suero, de pacientes entre 1 mes y 14 años de edad, que presentaron sintomatología clínica sugestiva de afectación del SNC y cuyo estudio bacteriológico convencional de LCR resultó negativo. Se determinó la relación albúmina LCR/suero a fin de descartar contaminación y a los pares óptimos se les determinó por la técnica de ELISA anticuerpos IgM e IgG en suero e IgG en LCR anti-CMV. Del total de muestras recolectadas 40,86% (76/186) resultaron óptimas para el análisis. De los 76 casos analizados, el 2,6% (2/76) de las muestras de suero resultaron positivas para IgM; 93,4% (71/76) fueron seropositivas a IgG mientras que el 31,6% (24/76) de las muestras de LCR presentaron anticuerpos IgG. En cuanto a los parámetros citoquímicos del LCR, se observaron valores de glucosa aumentados en el 58,3% (p<0,05) de los pacientes con CMV que presentaron meningoencefalitis. En los pacientes con meningitis que presentaron positividad de anticuerpos IgG anti-CMV en el LCR se observó un aumento significativo (p<0,01) en las proteínas del LCR. Se evidencia que una proporción de los pacientes pediátricos con afecciones neurológicas presentaron infección aguda por CMV, lo que demuestra una participación importante de este agente en pacientes del estado Zulia, Venezuela para el período en estudio.

The aim of this study was to determine the prevalence of cytomegalovirus (CMV) in pediatric patients with neurological disorders from Zulia State, Venezuela, during the period 2007-2008. Samples of cerebrospinal fluid (CSF) and serum were obtained from 186 patients with neurological symptoms and bacteriological negative CSF. The albumin CSF/serum content was determined to rule out contamination of CSF and optimal pairs were determined by ELISA of IgM and IgG anti-CMV antibodies in serum and IgG in CSF. Only 40.86% (76/186) of patients were optimal for this study. Serum samples positive for IgM antibodies (2/76; 2.6%) and IgG antibodies (71/76; 93.4%) were obtained. CSF IgG antibodies were observed in 24/76 patients (31.6%). Increased values of glucose in CSF (p<0.05) were observed in 58.3% of CMV patients with meningoencephalitis. In addition, increased CSF protein concentration (p<0.01) was observed in CSF anti-CMV antibodies positive patients with meningitis. This study shows high prevalence of acute CMV infection in pediatric patients with neurological affections suggesting an important role of this virus in this pathology during the studied period.

Viral infection of central nervous system in children: one year prospective study.

Viral infection of central nervous system (CNS) is a common problem worldwide, especially in children. The clinical manifestations of viral CNS infection are the most important clues for diagnosis and treatment. The 1-year prospective study to explore the prevalence, clinical manifestations, and laboratory findings of viral CNS infection in children, including human herpes virus (HHV) type 1, 2, 3, 4, 5, 6A, 6B, 7, enterovirus B, mumps virus, measles virus, Japanese encephalitis virus, JC virus, BK polyomavirus, Nipha virus and influenza virus (H1N1, H3N2) were performed. Total of 71 children suspected CNS infection, aged between 2 days to 12.9 years were enrolled from May 2009 to April 2010. Total 4 children with non CNS infection, 5 bacterial meningitis, 2 tuberculous meningitis CNS infection were excluded. The HHV2 (50.0%) was the most common viral CNS infection. Other viral CNS infection included HHV1 (11.60%), VZV (6.7%), HHV6 (3.3%), HHV7 (3.3%), enterovirus B (1.67%) and H3N2 (1.67%). Diarrhea, irritability and CSF pleocytosis may helpful for differentiation between subtype of viral CNS infection.

Cerebrospinal fluid shunt infection: risk factors and long-term follow-up.

INTRODUCTION: Shunt infection (SI) is an enduring problem in pediatric neurosurgery. Its occurrence is variable in the different series that were published, according to the definition retained. In addition, long-term data, which could help to evaluate the incidence of delayed SI, as well as the developmental outcome after SI, are scarce in the literature. MATERIALS AND METHODS: We reviewed retrospectively children shunted for hydrocephalus during the last 20 years to evaluate the incidence of SI, including late SI, the risk factors and sources of contamination, and the late outcome after SI. RESULTS: We treated 1,173 patients who were followed-up for a mean duration of 7.0 years. During that period, 158 patients presented with a total number of 190 episodes of infection, 19 of which occurred more than 1 year after surgery. The infection rates per patient and per procedure were 13.6 and 5.9%, respectively. Age below 4 months at shunt insertion [odds ratio (OR)=1.81], antenatal diagnosis (OR=2.23), myelomeningocele (OR=2.14), and post-hemorrhagic hydrocephalus (OR=1.98) were significantly correlated with SI. SI was mostly due to intraoperative contamination; however, delayed SI was mostly caused by blood-borne contamination and abdominal sepsis. The mortality related to SI was 10.1%; the Glasgow Outcome Score, as well as schooling, was significantly and independently affected by SI. CONCLUSION: Long-term follow-up of shunted children is necessary to evaluate the real incidence of SI and the functional outcome after SI.

Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of ganciclovir therapy in neonates with congenital cytomegalovirus (CMV) disease. STUDY DESIGN: Neonates with symptomatic CMV disease involving the central nervous system were randomly assigned to receive 6 weeks of intravenous ganciclovir versus no treatment. The primary end point was improved brainstem-evoked response (BSER) between baseline and 6-month follow-up (or, for patients with normal baseline hearing, normal BSER at both time points). RESULTS: From 1991 to 1999, 100 patients were enrolled. Of these, 42 patients had both a baseline and 6-month follow-up BSER audiometric examination and thus were evaluable for the primary end point. Twenty-one (84%) of 25 ganciclovir recipients had improved hearing or maintained normal hearing between baseline and 6 months versus 10 (59%) of 17 control patients (P=.06). None (0%) of 25 ganciclovir recipients had worsening in hearing between baseline and 6 months versus 7 (41%) of 17 control patients (P<.01). A total of 43 patients had a BSER at both baseline and at 1 year or beyond. Five (21%) of 24 ganciclovir recipients had worsening of hearing between baseline and > or =1 year versus 13 (68%) of 19 control patients (P<.01). A total of 89 patients had absolute neutrophil counts determined during the course of the study; 29 (63%) of 46 ganciclovir-treated patients had grade 3 or 4 neutropenia during treatment versus 9 (21%) of 43 control patients (P<.01). CONCLUSIONS: Ganciclovir therapy begun in the neonatal period in symptomatically infected infants with CMV infection involving the central nervous system prevents hearing deterioration at 6 months and may prevent hearing deterioration at > or =1 year. Almost two thirds of treated infants have significant neutropenia during therapy.