RESUMEN
Parechovirus (HpEV) and Enterovirus (EV) infections in children mostly have a mild course but are particularly fearsome in newborns in whom they may cause aseptic meningitis, encephalitis, and myocarditis. Our study aimed to describe the clinical presentations and peculiarities of CNS infection by HpEV and EV in neonates. This is a single-center retrospective study at Istituto Gaslini, Genoa, Italy. Infants aged ≤ 30 days with a CSF RTq-PCR positive for EV or HpEV from January 1, 2022, to December 1, 2023, were enrolled. Each patient's record included demographic data, blood and CSF tests, brain MRI, therapies, length of stay, ICU admission, complications, and mortality. The two groups were compared to identify any differences and similarities. Twenty-five patients (15 EV and 10 HpEV) with a median age of 15 days were included. EV patients had a more frequent history of prematurity/neonatal respiratory distress syndrome (p = 0.021), more respiratory symptoms on admission (p = 0.012), and higher C-reactive protein (CRP) levels (p = 0.027), whereas ferritin values were significantly increased in HpEV patients (p = 0.001). Eight patients had a pathological brain MRI, equally distributed between the two groups. Three EV patients developed myocarditis and one HpEV necrotizing enterocolitis with HLH-like. No deaths occurred. Conclusion: EV and HpEV CNS infections are not easily distinguishable by clinical features. In both cases, brain MRI abnormalities are not uncommon, and a severe course of the disease is possible. Hyper-ferritinemia may represent an additional diagnostic clue for HpEV infection, and its monitoring is recommended to intercept HLH early and initiate immunomodulatory treatment. Larger studies are needed to confirm our findings. What is Known: ⢠Parechovirus and Enteroviruses are the most common viral pathogens responsible for sepsis and meningoencephalitis in neonates and young infants. ⢠The clinical course and distinguishing features of Parechovirus and Enterovirus central nervous system infections are not well described. What is New: ⢠Severe disease course, brain MRI abnormalities, and complications are not uncommon in newborns with Parechovirus and Enteroviruses central nervous system infections. ⢠Hyper-ferritinemia may represent an additional diagnostic clue for Parechovirus infection and its monitoring is recommended.
Asunto(s)
Infecciones por Enterovirus , Parechovirus , Infecciones por Picornaviridae , Humanos , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/epidemiología , Infecciones por Enterovirus/complicaciones , Masculino , Estudios Retrospectivos , Femenino , Parechovirus/aislamiento & purificación , Recién Nacido , Infecciones por Picornaviridae/diagnóstico , Infecciones por Picornaviridae/complicaciones , Infecciones por Picornaviridae/epidemiología , Enterovirus/aislamiento & purificación , Italia/epidemiología , Infecciones del Sistema Nervioso Central/virología , Infecciones del Sistema Nervioso Central/diagnóstico , Infecciones del Sistema Nervioso Central/epidemiología , Infecciones del Sistema Nervioso Central/líquido cefalorraquídeo , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Acute cerebellitis is a rare complication of pediatric infections. There are many reports that viral infections lead to neurological manifestations, including acute cerebellitis. METHODS: A retrospective chart review was conducted for pediatric patients diagnosed with enterovirus cerebellitis between 2000 and 2024. The methods involved reviewing clinical and radiological records and assessing the treatment methods. RESULTS: Case Report We present the case of a 4-year-old immunocompetent child who initially presented with acute encephalopathy followed by truncal ataxia, and eventually received a diagnosis of postinfectious cerebellitis. Enterovirus real-time polymerase chain reaction were positive in the nasopharyngeal swab. Therapeutic plasma exchange (TPE) was started due to neurological deterioration despite IVIG treatment. She improved significantly with TPE, and methylprednisolone treatment and was discharged in good health status. The patient is being followed up as neurologically normal. CONCLUSION: Acute cerebellitis associated with enterovirus is a rare pediatric disorder. Early diagnosis and treatment with TPE in this severe case is thought to be preventive for the potentially fatal complications.
Asunto(s)
Infecciones por Enterovirus , Intercambio Plasmático , Humanos , Intercambio Plasmático/métodos , Preescolar , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/terapia , Femenino , Enfermedades Cerebelosas/terapia , Enfermedades Cerebelosas/etiología , Metilprednisolona/uso terapéutico , Enfermedad Aguda , Enterovirus/aislamiento & purificaciónRESUMEN
Keshan disease (KD) is a type of endemic cardiomyopathy with an unknown cause. It is primarily found in areas in China with low selenium levels, from northeast to southwest. The nutritional biogeochemical etiology hypothesis suggests that selenium deficiency is a major factor in KD development. Selenium is important in removing free radicals and protecting cells and tissues from peroxide-induced damage. Thus, low environmental selenium may affect the selenium level within the human body, and selenium level differences are commonly observed between healthy people in KD and nonKD areas. From the 1970s to the 1990s, China successfully reduced KD incidence in endemic KD areas through a selenium supplementation program. After years of implementing prevention and control measures, the selenium level of the population in the KD areas has gradually increased, and the prevalence of KD in China has remained low and stable in recent years. Currently, the pathogenesis of KD remains vague, and the effect of selenium supplementation on the prognosis of KD still needs further study. This paper comprehensively reviews selenium deficiency and its connection to KD. Thus, this study aims to offer novel ideas and directions to effectively prevent and treat KD in light of the current situation.
Asunto(s)
Cardiomiopatías , Infecciones por Enterovirus , Desnutrición , Selenio , Humanos , Selenio/análisis , Cardiomiopatías/epidemiología , Cardiomiopatías/etiología , Cardiomiopatías/prevención & control , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/epidemiología , Infecciones por Enterovirus/prevención & control , China/epidemiologíaRESUMEN
Background and Objectives: the principal purpose of this literature review is to cluster adults with hematological malignancies after treatment or on maintenance with obinutuzumab who experienced disseminated EV infection to understand clinical characteristics and outcome of this rare condition in these patients. We report the first clinical case of a male affected by follicular lymphoma treated with immune-chemotherapy including obinutuzumab who was affected by disseminated EV infection with cardiovascular involvement. Materials and Methods: this narrative review summarizes all the research about disseminated EV infection in immunosuppressed adult patients treated with obinutuzumab from January 2000 to January 2024 using the Scale for the Assessment of Narrative Review Articles (SANRA) flow-chart. We performed a descriptive statistic using the standard statistical measures for quantitative data. Results: we included six studies, five case reports, and one case report with literature analysis. We collected a total of seven patients, all female, with disseminated EV infection. The most common signs and clinical presentations of EV infection were fever and encephalitis symptoms (N = 6, 85.7%), followed by hepatitis/acute liver failure (N = 5, 71.4%). Conclusions: onco-hematological patients who receive immune-chemotherapy with a combination of treatments which depress adaptative immunity, which includes the antiCD20 obinutuzumab, could be at higher risk of disseminated EV infection, including CNS and cardiac involvement.
Asunto(s)
Infecciones por Enterovirus , Linfoma Folicular , Adulto , Humanos , Masculino , Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/tratamiento farmacológico , Linfoma Folicular/complicaciones , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/patologíaRESUMEN
Small animal models play an important role in investigating and revealing the molecular determinants and mechanisms underlying neuro-virulence of enterovirus A71 (EV-A71). In our previous study, we successfully developed two mouse cell-line replication competent EV-A71 strains (EV71:TLLm and EV71:TLLmv) which were capable of inducing neuro-invasion in BALB/c mice. The more virulent EV71:TLLmv exhibited ability to induce acute encephalomyelitis accompanied by neurogenic pulmonary oedema. EV71:TLLcho virus strain was generated from EV71:TLLm by a series of passages in CHO-K1 cells. EV71:TLLcho demonstrated a broader range of infectivity across various mammalian cell lines and exhibited complete cytopathic effects (CPE) within 48 hours post-inoculation in comparison to EV71:TLLm or EV71:TLLmv. EV71:TLLcho consistently yielded higher levels of viral replication at all time points examined. In comparison to EV71:TLLm, EV71:TLLcho consistently induced more severe disease and increased mortality in one-week old BALB/c mice. However, unlike mice challenged with EV71:TLLmv, none of the mice challenged with EV71:TLLcho progressed to severe acute encephalomyelitis and developed neurogenic pulmonary oedema.
Asunto(s)
Modelos Animales de Enfermedad , Enterovirus Humano A , Infecciones por Enterovirus , Ratones Endogámicos BALB C , Edema Pulmonar , Animales , Edema Pulmonar/virología , Edema Pulmonar/patología , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/virología , Ratones , Replicación Viral , HumanosAsunto(s)
Infecciones por Enterovirus , Meningitis , Parechovirus , Infecciones por Picornaviridae , Lactante , Humanos , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/diagnóstico , Hospitalización , Infecciones por Picornaviridae/complicaciones , Infecciones por Picornaviridae/diagnósticoRESUMEN
RATIONALE: Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported. PATIENT CONCERNS: The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest. DIAGNOSES: Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71. INTERVENTIONS: The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO. OUTCOMES: The patient achieved a favorable outcomes. LESSONS: Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
Asunto(s)
Terapia de Reemplazo Renal Continuo , Infecciones por Enterovirus , Enterovirus , Oxigenación por Membrana Extracorpórea , Enfermedad de Boca, Mano y Pie , Humanos , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/terapia , Enfermedad de Boca, Mano y Pie/complicaciones , Enfermedad de Boca, Mano y Pie/terapia , Antígenos ViralesRESUMEN
Enterovirus A71 (EV-A71) is the main pathogen causing hand, foot and mouth disease (HFMD) in children and occasionally associated with neurological diseases such as aseptic meningitis, brainstem encephalitis (BE) and acute flaccid paralysis. We report here that cellular pseudokinase tribbles 3 (TRIB3) facilitates the infection of EV-A71 via dual mechanisms. In one hand, TRIB3 maintains the metabolic stability of scavenger receptor class B member 2 (SCARB2), the bona fide receptor of EV-A71, to enhance the infectious entry and spreading of the virus. On the other hand, TRIB3 facilitates the replication of EV-A71 RNA in a SCARB2-independent manner. The critical role of TRIB3 in EV-A71 infection and pathogenesis was further demonstrated in vivo in mice. In comparison to wild-type C57BL/6 mice, EV-A71 infection in TRIB3 knockdown mice (Trib3+/-) resulted in significantly lower viral loads in muscular tissues and reduced lethality and severity of clinical scores and tissue pathology. In addition, TRIB3 also promoted the replication of coxsackievirus B3 (CVB3) and coxsackievirus A16 (CVA16) in vitro. In conclusion, our results suggest that TRIB3 is one of key host cellular proteins required for the infection and pathogenesis of EV-A71 and some other human enteroviruses and may thus be a potential therapeutic target for combating the infection of those viruses.
Asunto(s)
Enterovirus Humano A , Infecciones por Enterovirus , Enterovirus , Enfermedad de Boca, Mano y Pie , Animales , Niño , Humanos , Ratones , Enterovirus/genética , Enterovirus Humano A/genética , Infecciones por Enterovirus/complicaciones , Enfermedad de Boca, Mano y Pie/complicaciones , Ratones Endogámicos C57BLRESUMEN
This paper presents a unique case of double meningitis with enterovirus and reactivated varicella-zoster virus without shingles in an immunocompetent male teenager, a case that offers many important medical lessons, all "gravitating" around physiopathological reasoning of any clinical case in general.
Asunto(s)
Infecciones por Enterovirus , Herpesvirus Humano 3 , Humanos , Masculino , Adolescente , Herpesvirus Humano 3/aislamiento & purificación , Infecciones por Enterovirus/virología , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/complicaciones , Enterovirus/aislamiento & purificación , Enterovirus/genética , Meningitis Viral/diagnóstico , Meningitis Viral/virología , Infección por el Virus de la Varicela-Zóster/complicaciones , Infección por el Virus de la Varicela-Zóster/diagnóstico , Infección por el Virus de la Varicela-Zóster/virologíaAsunto(s)
Encefalomielitis Aguda Diseminada , Infecciones por Enterovirus , Femenino , Humanos , Masculino , Encefalomielitis Aguda Diseminada/etiología , Encefalomielitis Aguda Diseminada/diagnóstico por imagen , Infecciones por Enterovirus/complicaciones , Imagen por Resonancia Magnética , Mesencéfalo/diagnóstico por imagen , Mesencéfalo/patología , NiñoRESUMEN
ABSTRACT A healthy 6-year-old boy presented with an erythematous macular exanthema, meningeal signs and fever, initially diagnosed with probable bacterial meningitis and treated with antibiotic and anti-inflammatory drugs. Enteroviral meningitis was confirmed, but the skin lesions continued to evolve and the patient was ultimately diagnosed with erythema dyschromicum perstans. The boy was followed during three years until the spontaneous resolution of the dermatosis.
Asunto(s)
Humanos , Masculino , Niño , Infecciones por Enterovirus/complicaciones , Eritema/virología , Meningitis Viral/complicaciones , Infecciones por Enterovirus/diagnóstico , Eritema/diagnóstico , Meningitis Viral/diagnósticoRESUMEN
Pericardial effusion is the main complication of pericarditis, and can create serious consequences depending on the speed of development and etiology. The most common causes are neoplasms and idiopathic, even though viral etiology is a frequently underestimated cause because of the difficulty in its confirmation. In cases of significant pericardial effusion, pericardiocenthesis has demonstrated to be an effective and safe procedure. We present a clinical case of a 14 year old adolescent who complained of persistent abdominal pain, and whose study showed significant pericardial effusion. Pericardiocenthesis was performed, along with installation of a pigtail catheter which drained 500 ml of serohematic pericardial effusion. The etiologic study included an PCR (polymerase chain reaction) positive for Enterovirus. The patient recovered favorably and was dismissed from the hospital in good condition. The objective of this report is to expose a current revision of the clinical management of pericardial effusion and the technical skills of pericardiocenthesis. Knowledge of the technique is fundamental in the treatment of pericardial effusion, especially in situations associated with hemodynamic compromise.
El derrame pericárdico es la principal complicación de la pericarditis, la cual puede generar graves consecuencias dependiendo de la velocidad de instauración como de su etiología. Las principales causas reportadas son las neoplásicas y las idiopáticas, sin embargo, la etiología viral es subestimada debido a la dificultad de confirmar el diagnóstico. En casos de derrame pericárdico significativo la pericardiocentesis ha mostrado ser un procedimiento eficaz y seguro. Presentamos caso clínico de un adolescente de 14 a±os quién consulta por dolor abdominal persistente, cuyo estudio demuestra un derrame pericárdico. Se realizó pericardiocentesis e instalación de catéter pigtail dando salida a 500 mL de líquido pericárdico serohemático. Dentro del estudio etiológico presenta PCR (Reacción de Polimerasa en cadena) positivo para enterovirus. Paciente evoluciona favorablemente y es dado de alta en buenas condiciones. El objetivo del presente reporte es exponer la revisión actualizada del enfrentamiento clínico del derrame pericárdico y la técnica de pericardiocentesis. El conocimiento de la técnica de pericardiocentesis en fundamental en el tratamiento del derrame pericárdico, en especial en situaciones con compromiso hemodinámico.
Asunto(s)
Humanos , Masculino , Adolescente , Derrame Pericárdico/cirugía , Pericardiocentesis/métodos , Derrame Pericárdico/etiología , Infecciones por Enterovirus/complicacionesRESUMEN
En el período neonatal, la infección causada por enterovirus tiene un espectro amplio de manifestaciones clínicas, desde cuadros asintomáticos o leves, hasta infecciones diseminadasy graves, potencialmente mortales. En una cuarta parte de los casos se presenta en forma de cuadro séptico, con afectación multiorgánica. La existencia de hepatitis y coagulopatía es de mal pronóstico, generalmente asociado a la aparición de hemorragiasen órganos vitales. El tratamiento intensivo de soportey la administración de hemoderivados es fundamental en estos casos. En caso se supervivencia, la capacidad regeneradora del hígado es suficiente para normalizar la función hepática ypermitir un adecuado crecimiento del niño.Presentamos el caso de una recién nacida con una infección por enterovirus, que cursó con hepatitis y coagulopatía, y en la que la evolución fue favorable, con recuperación completay sin secuelas hemorrágicas. La madre había sufrido un proceso febril en las 24 horas previas al parto.
Asunto(s)
Humanos , Masculino , Recién Nacido , Femenino , Trastornos de la Coagulación Sanguínea , Enterovirus , Enterobiasis/complicaciones , Hepatitis , Infecciones por Enterovirus/complicacionesRESUMEN
El presente estudio describe los resultados de la investigación de los enterovirus humanos (HEV) mediante cultivo celular y reacción en cadena de la polimerasa y su tipificación molecular en 2167 casos de parálisis fláccida aguda, meningitis aséptica y encefalitis aguda, obtenidos entre 1991 y 1998 en la Argentina. La frecuencia de detección de HEV en parálisis fláccida aguda fue 19.5% (130/666) y de poliovirus Sabin 5.4% (36/666). La tasa de detección de HEV en los casos de meningitis fue 28.8% (231/801) y en encefalitis 3.0% (21/700). El grupo etario más afectado por las meningitis fue entre 1 y 9 años (75.3%) y en los casos de parálisis fláccida aguda, de 1 a 4 años (58%). En muestras de brotes de meningitis se identificó echovirus (E) 4, E9, E30 y E17, y en casos esporádicos virus coxsackie A (CAV) 2, B (CBV) 2 y CBV5, E7, E11, E19, E24 y E29, y enterovirus (EV) 71. Finalmente, en casos de encefalitis se detectó E4, E7 y E24. En casos de parálisis fláccida aguda se identificaron 28 serotipos distintos de enterovirus no polio. En la Argentina y en otros países latinoamericanos existe escasa información acerca de la circulación de los HEV y su relación con diversas enfermedades neurológicas. Este estudio proporciona información que puede servir como base para posteriores investigaciones.
This report describes the results of human enterovirus (HEV) detection and characterization using cell culture, polymerase chain reaction and molecular typing in 2167 samples obtained from acute flaccid paralysis, aseptic meningitis and acute encephalitis patients, from 1991 to 1998 in Argentina. HEV were isolated in 130 out of 666 cases (19.5%) and 36 out of 666 (5.4%). HEV RNA was detected in 28.8% (231/801) and 3.0% (21/700) of the patients with meningitis and encephalitis, respectively. Children with ages ranging from 1 to 9 years accounted for 75.3% of the meningitis cases and from 1 to 4 years for 58% of acute flaccid paralysis patients. Echovirus 4 (E4), E9, E30 and E17 were identified from meningitis outbreaks. Coxsackievirus A2 (CAV2), CBV2, CBV5, E7, E11, E19, E24, E29 and enterovirus 71 were recovered only from sporadic cases. Three different serotypes were identified in encephalitis patients: E4, E7 and E24. A total of 28 different serotypes of non-polio enteroviruses were detected from acute flaccid paralysis cases. The information here presented contributes to improving our knowledge about enteroviruses epidemiology in Argentina and their relationship with different neurological diseases. This study provides valuable data that could be useful to further research.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Brotes de Enfermedades , Enterovirus , Infecciones por Enterovirus/epidemiología , Meningitis Aséptica/epidemiología , Parálisis/epidemiología , Argentina/epidemiología , Técnicas de Cultivo de Célula , Infecciones por Coxsackievirus/diagnóstico , Infecciones por Coxsackievirus/epidemiología , Enterovirus Humano B/aislamiento & purificación , Infecciones por Enterovirus/complicaciones , Enterovirus/clasificación , Enterovirus/genética , Enterovirus/aislamiento & purificación , Heces/virología , Genoma Viral , Epidemiología Molecular , Meningitis Aséptica/diagnóstico , Meningitis Aséptica/virología , Reacción en Cadena de la Polimerasa , Parálisis/diagnóstico , Parálisis/virología , Serotipificación , Estadísticas no ParamétricasRESUMEN
No presente trabalho, são mostrados resultados de um estudo piloto direcionado à detecção de seqüências de enterovirus em tecido cardíaco obtido a partir de biópsias endomiocárdicas de pacientes com doenças cardíacas na região Amazônica. Seis amostras coletadas de três pacientes foram analisadas por RT-PCR obtendo-se três espécimes positivos e três negativos. Esses achados preliminares sugerem a participação dos enterovirus na etiologia de doenças cardíacas, principalmente miocardites, e justificam estudos mais amplos nesse assunto.
In the present report we describe the results from a pilot study aimed at detecting enterovirus sequence in cardiac tissues, obtained through endomyocardial biopsies, from patients suffering from cardiac diseases in the Amazon region. Six samples that were collected from three patients were analysed by RT-PCR showing 3 positive and 3 negative results. These preliminary findings suggest the participation of enteroviruses in the etiology of cardiac diseases, mainly myocarditis, and warrant further and broader local studies on this subject.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Cardiopatías/virología , Corazón/virología , Enterovirus/aislamiento & purificación , Infecciones por Enterovirus/complicaciones , Miocardio/patología , Brasil , Cardiopatías/etiología , Cardiopatías/patología , ADN Viral/análisis , Enterovirus/genética , Infecciones por Enterovirus/patología , Reacción en Cadena de la PolimerasaRESUMEN
Säo apresentados os resultados dos estudos sobre o comportamento do Enterovirus-70 (EV-70) na regiäo metropolitana de Säo Paulo desde sua provável introduçäo no veräo de 1984, determinando extensa de conjuntivite hemorrágica aguda (C.H.A.), até o final de 1987 abrangendo preríodo em que este agravo foi pouco notado. Na fase epidêmica ocorrida no primeiro trimestre de 1984 foram estudados 291 indivíduos divididos em três grupos denominados A, B e C, o primeiro formado por pessoas atingidas pela C.H.A. e os outros dois por indivíduos näo atingidos por este agravo mas que, respectivamente, referiam contato domiciliar com casos de C.H.A. e os que näo referiam o citado contato. A demonstraçäo de anticorpos se fez pela técnica de imunofluorescência (IFI) para detectar IgM específico para EV-70 e pela prova de neutralizaçäo em cultura de células BHK-21. Verificou-se que 56,7%,33,3%e 20,6% dos indivíduos pertencentes, respectivamente, aos grupos A,B e C apresentavam anticorpos específicos da classe IgM. No grupo A a faixa etária mais atingida foi a de 10 a 29 anos. No período que vai do fim da primeira e única epidemia até o final de 1987, identificaram-se três casos esporádicos de C.H.A. e 10 pacientes com afecçäo neurológica aguda associada à infecçäo recente pelo EV-70. Nove, destes 10 casos, apresentaram paralisia de nervos cranianos, todos evoluindo sem sequelas clinicamente discerníveis. As formas assintomáticas e os casos esporádicos de C.H.A. e de afecçoes neurológicas mantiveram a circulaçäo do EV-70 no período epidêmico
Asunto(s)
Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Conjuntivitis Hemorrágica Aguda/epidemiología , Infecciones por Enterovirus/epidemiología , Enterovirus/patogenicidad , Anticuerpos Antivirales/análisis , Brasil/epidemiología , Enfermedades del Sistema Nervioso Central/etiología , Infecciones por Enterovirus/complicaciones , Enterovirus/inmunología , Técnica del Anticuerpo Fluorescente , Inmunoglobulina M/análisis , Pruebas de NeutralizaciónRESUMEN
Se informa el primer caso confirmado de radiculomielitis post-conjuntivitis hemorrágica aguda (CHA) ocurrido en Panamá y probablemente en el continente americano. Se describen sus características epidemiológicas, las manifestaciones clínicas y su diagnóstico virológico