Disseminated echovirus infection in a patient with multiple myeloma and a functional defect in complement. Treatment with intravenous immunoglobulin.

A man with IgG1 multiple myeloma developed fever, confusion, and progressive muscle weakness resulting in paralysis. Echovirus type 11 was isolated from cerebrospinal fluid, pleura, pleural fluid, and muscle, and muscle biopsy disclosed changes consistent with viral myositis. Immunologic evaluation revealed low serum levels of polyclonal IgG subtypes 1 and 3, reduced blood levels of T-helper/inducer and T-suppressor/cytotoxic cells, and a complement abnormality involving the function of the classical pathway C3 convertase, C4b2a. Therapy with intravenous immunoglobulin was associated with clinical recovery. This is the first reported case of disseminated central nervous system enteroviral infection in an adult with a B-cell malignancy, and in association with a documented complement abnormality. The findings suggest the efficacy of immunotherapy in this disease.

Outbreak of echovirus 11 infection in hospitalized neonates.

Between July 18 and August 5, 1986, a cluster of echovirus 11 infections occurred in hospitalized neonates. Ten infants were affected and one died. All cases occurring after the index case were infants who were in the nursery for at least 1 day when the index patient was also present. Risk factors for secondary infection included low birth weight or gestational age and receipt of antibiotics, red blood cell transfusions, nasogastric intubation or gavage feedings. Because viral infection had not been suspected in the index patient, isolation measures were not instituted until after onset of secondary cases. We conclude that more severely ill infants receiving intensive levels of care are at increased risk for nosocomial enteroviral infection. These infants may have a greater likelihood of exposure to the virus and/or increased host susceptibility. Outbreaks caused by cross-infection may be preventable by early recognition of patients colonized or infected with potentially pathogenic agents and prompt institution of appropriate isolation measures.

Echovirus keratoconjunctivitis.

PURPOSE: To investigate an outbreak of echovirus-related keratoconjunctivitis. METHODS: We undertook a retrospective study of recent cases of echovirus infection with recall and further evaluation of conjunctivitis patients. All patients from whom an echovirus was isolated in Liverpool during 1995 were included. The natural course of ocular echovirus disease was studied, including the likelihood of echovirus keratoconjunctivitis being linked with meningitis and the risk of long-term carriage of the virus in the conjunctiva. RESULTS: Of 10 unrelated patients with echovirus conjunctivitis, six also had a mild keratitis. None of these patients developed meningitis, and no cases of long-term carriage in the conjunctiva were encountered. There was no link between cases of echovirus meningitis and conjunctivitis. There was no corresponding increase in other ocular viral isolates. CONCLUSIONS: Echovirus is a relatively unrecognized cause of keratoconjunctivitis. Echoviral keratoconjunctivitis appears to be an independent ocular event unassociated with systemic sequelae. Long-term carriage in the conjunctiva does not appear to occur.

Perinatal echovirus and group B coxsackievirus infections.

Enteroviral infections late in pregnancy are common, especially during periods of high prevalence of community infection. Most of these infections, however, are not associated with significant maternal or neonatal disease. Conversely, as many as 65 per cent of women who give birth to infants with proven enteroviral infection have symptomatic disease during the perinatal period. Maternal echovirus or coxsackievirus B infections are not associated with an increased risk of spontaneous abortions, but stillbirths late in pregnancy have been described. Although a slightly increased risk for congenital heart defects and urogenital anomalies has been reported for the offspring of women who seroconverted to the group B coxsackievirus during pregnancy, these data are highly tentative. Transmission of enteroviruses from mother to infant is relatively common (30-50 per cent) and may occur through contact with maternal secretions during vaginal delivery, blood, or upper respiratory tract secretions. Intrauterine transmission has been documented, but its frequency is unknown. Postnatal transmission from maternal or nonmaternal sources also occurs regularly. Neonatal disease may range from inapparent infection to overwhelming systemic illness and death. Common clinical syndromes associated with neonatal enteroviral infections are meningoencephalitis, pneumonia, myocarditis, and hepatitis. The severity and outcome of perinatally acquired enteroviral infection is influenced by several factors, including the virus strain involved, mode of transmission, and presence of passively acquired serotype-specific maternal antibody. Newborn nursery outbreaks of nonpolio enteroviral infections usually coincide with seasonal peaks of enteroviral disease in the community. These outbreaks have been due mostly to echovirus 11 or group B coxsackievirus serotypes 1 to 5 and are associated with attack rates of up to 50 per cent.

[Diagnosis of bacterial infections on vascular prosthesis. Histological and microbiological analysis]. / Diagnostic de l'infection des prothèses vasculaires. Analyse histologique et microbiologique.

A retrospective study of 212 vascular graft failures, using different criteria of infection evidenced a relatively high incidence of infectious complications. Vascular graft infection was assessed on one of the following criteria: clinical infection, positive bacteriological and/or virological examination of the graft, presence of characterized micro-organisms and of microstructures 0.1 to 0.5 micron in size at the blood/prosthesis surface at scanning electron microscopy, and presence of foci of persistent polymorphonuclear cells and lymphocytes at histological microscopy. In the absence of overlapping between these criteria, the present results raise the question of the adequacy of conventional bacteriological sampling on explanted artificial surfaces.

[Pathomorphology of uveitis caused by an echovirus]. / Patomorfologiia uveita, vyzvannogo virusom ECHO.

The monkey eyes infested by inoculation into the eye anterior chamber of the ECHO-19 virus from children with uveitis were studied morphologically. It was established electron microscopically that the inoculated virus is replicated in the capillary endothelium and stromal cells of the uveal tract. Crystal-like accumulation of virions and degenerative changes in the organelles are observed in these cells. Acute granulomatous alterative-exudative-hemorrhagic uveitis with the destruction of the iris, ciliary body and processes and secondary changes in the cornea and crystalline lens with the symptoms of keratitis and cataract develop in the anterior part of the eye as observed in the light microscope. The anterior and posterior goniosynechia develop. An acute inflammatory process is further transformed into a progressing autoimmune inflammation.

[Etiological study of uveitis in young children]. / Izuchenie étiologii uveita u detei rannego vozrasta.

The etiology of acute infectious diseases accompanied by uveitis in young children has been studied. In these investigations a high degree of contamination with virus ECHO 19 in patients with acute diseases accompanied by uveitis has been revealed and the ophthal motropic properties of the virus have been experimentally established, which indicates that certain variants of virus ECHO 19 play, probably, some role in the etiology of uveitis in young children.

An outbreak of aseptic meningitis due to echovirus 30 in a high school baseball club--possible role of severe exercise for a high attack rate.

In September 2008, an outbreak of aseptic meningitis caused by echovirus 30 occurred in Ota City, Gunma. Among the 26 people hospitalized, 17 were members of a high school baseball club. The attack rate within the club was as high as 40%. The other 9 patients were either their families or close relatives of the baseball club members, indicating the outbreak was confined to a limited community. Although numerous outbreaks of echoviral meningitis have been reported worldwide, those with such a high attack rate within a limited community are rare. Severe physical exercise in a hot temperature could be associated with this high attack rate.

[Study on an outbreak of echovirus type 6 of meningitis in Liu'an city, Anhui province].

OBJECTIVE: To understand the epidemiological, clinical and etiological characteristics of an Echovirus type 6 meningitis outbreak in Jinzhai county, Liu'an city in Anhui, and to find out the proper way in controlling the aseptic meningitis outbreak. METHODS: A surveillance system for aseptic meningitis was established in Jinzhai to confirm the case definition. Stool or cerebrospinal fluid (CSF) specimens from some cases were collected for entero-viruses isolation and identification. Case-control study was conducted. The case group involved patients while the controls would include: patients' classmate with same gender and the age difference was not over one year. Neutralization antibody in serum specimens were collected and tested in cases and in healthy people. RESULTS: 105 cases were distributed in 17 of the 30 towns in Jinzhai county while 41.0% of the cases were in Banzhuyuan town with an incidence rate of 203/10(5). Cases were clustered by school and classroom with age ranging from 3 to 15 years old and the highest as 10.9/10(5) in the 6 to 10 group. The incidence in males was 24.2/10(5) compared to 8.4/10(5) in females. The main clinic characteristics of cases were: fever, headache and vomiting. Echovirus type 6 from 25 of the 72 CSF samples (35%) was isolated. When comparing the cases group with control group, the OR of drinking home-made beverages was 4.1 (95% CI: 1.4-12.0), especially the beverages sacked by plastic bag: 3.3 (95% CI: 1.3-8.8). 6 out of 7 workers engaging in producing home-made beverages were detected to have carried Echovirus type 6 from their stool specimens. The Echovirus type 6 neutralization antibody positive rate in cases (73.5%) was significantly higher than that in 100 healthy people (46.0%) (X2 = 12. 526, P = 0.000). CONCLUSION: This episode of meningitis outbreak was caused by Echovirus type 6. The proportion of drinking home-made beverages, especially the beverages sacked by plastic bag in cases group was higher than in control group.

Central nervous system echovirus infection in Bruton's X-linked hypogammaglobulinemia.

A patient with Bruton's X-linked hypogammaglobulinemia, who developed the typical syndrome associated with systemic echovirus 3 infection whilst on routine intramuscular gammaglobulin replacement therapy, is described. Following regular infusions of specific antibody-containing plasma from his spouse, he has shown sustained clinical improvement over a period of two years, and is, therefore, one of the very rare cases with this syndrome to survive for more than a few months.

A community outbreak of echovirus infection associated with an outdoor swimming pool.

Forty-six people became ill with vomiting, diarrhoea and headache within days of an outdoor swimming pool opening for the summer season in a small seaside village. During the weekend of the outbreak, 185 tickets to the pool had been sold. It was found that 34 bathers were ill, and one subject had vomited into the pool. All other cases arose after this incident. The risk of infection was greatest among those who swallowed pool water (24/28 versus 10/17, p = 0.07). Echovirus 30 was isolated from the case who vomited into the pool and from six other cases. Normal chlorine levels had not been adequate to contain the infection risk from vomitus, and, in future, pool attendants witnessing such incidents should consider closing the pool to the public and seeking advice on superchlorination.

[Clinical characteristics of various neuroviroses in relation to their etiology]. / Características clínicas de algunas neurovirosis en relación con su etiología

No clinical, cytochemical nor electroencephalographic standards of behavior, specific for each etiology were found in a series of 67 cases of viral infection of the nervous system; however, the severeness was greater in cases of infectious mononucleosis with encephalic involvement and in cases caused by Coxsackie B5 possibly because these appeared in younger patients. The group with greater percentage of definitive motor and intellectual sequelae was found in cases with infectious mononucleosis and ECHO. Cases due to herpes simplex were not more severe during the acute stage, but followed a course with an important percentage of definitive sequelae. Meningoencephalitides from parotiditis were milder, and only in one case did they show permanent motor sequelae.

Viral antibodies in agricultural populations exposed to aerosols from wastewater irrigation during a viral disease outbreak.

The presence of antibodies to eight enteroviruses (echovirus types 4, 7, and 9, coxsackievirus types A9, B1, B3, and B4, and hepatitis A virus) and varicella-zoster virus was determined during a two-year period, 1980-1981, in paired blood samples of 777 persons in selected agricultural communities (kibbutzim) in Israel. These communities were divided into several categories on the basis of wastewater utilization for sprinkler irrigation and/or fish ponds. Among the nine viral antibodies studied, there was a consistent and significant excess of antibodies to echovirus type 4 only, particularly in the age group 0-5 years, in kibbutzim that had been exposed to aerosols from sprinkler irrigation with partially treated wastewater from nearby towns. This finding may be attributed to a major national echovirus type 4 epidemic, which had peaked shortly before the collection of the blood samples. The fact that no similar excess of the other viral antibodies studied was found in any of the kibbutz categories suggests that, under nonepidemic conditions, exposure to wastewater aerosols usually does not lead to an excess in enteroviral infection. No excess of clinical cases of echovirus type 4-associated disease (meningitis or encephalitis) was detected in the communities exposed to wastewater aerosol.