THE ROLE OF ENTEROVIRUSES IN THE DEVELOPMENT OF ISCHEMIC STROKE AND ITS OUTCOMES.

OBJECTIVE: The aim: To study the role of enteroviruses (EV) in the development of ischemic stroke and its outcome. PATIENTS AND METHODS: Materials and methods: The main group (MG) included 72 patients with acute cerebrovascular disorders were examined using the National Institutes of Health Stroke Scale and Barthel Index. The comparison group (CG) included 35 patients without cerebrovascular disease. Viruses were isolated from patients' sera and identified in neutralization test. EV genomes were detected in polymerase chain reaction (PCR). Serological diagnosis was performed by enzyme-linked immunosorbent assay. RESULTS: Results: EV genomes were more frequently detected in the patients' sera in MG than in CG (23.6 ± 5.9% and 2.9 ± 2.8%, p <0.05). The greater level of neurological deficits was in patients with positive PCR test results comparatively with patients with negative PCR test results (11.76 ± 0.31 and 10.97 ± 0, 27, p = 0.040). The regression of neurological deficit during the treatment was a worse in patients with positive PCR test results and presence of specific IgG compared with patients with positive PCR test results and absence of specific IgG (11.2 ± 2.6% and 19.6 ± 2.4%, p = 0.031). CONCLUSION: Conclusions: The trigger role of EV in the development of IS is established. PCR is recommended for diagnosis of EV in patients with IS.

SEASONAL FACTOR AND FREQUENCY OF DETECTION OF HERPES VIRUSES AND INFLUENZA VIRUS IN PATIENTS WITH ISCHEMIC STROKE.

OBJECTIVE: The aim: To determine the frequency of HSV1, HSV2, VZV, CMV, EBV, HHV6 and influenza virus detection in patients with ischemic stroke in different seasons. PATIENTS AND METHODS: Materials and methods: 144 patients with ischemic stroke were examined: 78 (54.2%) women and 66 (45.8%) men, mean age of 63.1 ± 0.8 years. Detection of the herpesvirus DNA and the influenza virus RNA was performed using PCR monthly in 12 patients. RESULTS: Results: A manifestation of a viral infection was detected in 32 (22.2%) and virus genomes were observed in 29 (90.6%) patients. Viral infection frequency is significantly lower in summer, compared to winter-autumn; p=0.033. HSV1 and HHV6 were the most common (19 (52.8%) and 16 (44.4%)); VZV was the least common (5 (13.9%)). Influenza virus RNA was detected in 10 (27.8%) patients. In winter-autumn the frequency of HSV1, HSV2, HHV6 viruses detection is significantly higher, compared to the spring-summer (p<0.05), and the difference is almost significant for the influenza virus (p=0.060) and the EBV (p=0.060). Association of stroke occurrence with the presence of two or more types of viruses is more common in winter, compared to the summer season: 11 (30.6%) vs. 3 (8.3%), p=0.017. CONCLUSION: Conclusions: Prevention and treatment of herpesvirus infections exacerbations, in particular HSV1 and HSV2, which significantly increase in winter, compared to summer, is an important direction of stroke prevention measures in risk groups.

Research of biological properties of enterovirus strains associated with ischemic stroke.

OBJECTIVE: Introduction: The research of biological properties of enteroviruses associated with ischemic stroke (IS) allows us to identify their intratypic differences. The aim: to identify genetic markers of strains of enteroviruses associated with IS. PATIENTS AND METHODS: Materials and methods: 11 strains of enteroviruses isolated from the serum of patients with IS were identified in the virus neutralization test. Genetic markers of isolated strains (Abent, marker S, marker rct40) were determined. RESULTS: Results: Eleven strains of enteroviruses were isolated from the serum of patients with IS. Eight viruses: Coxsackie B viruses (serotypes 2, 3, 4) and ECHO viruses (serotypes 6, 9, 27 (two strains), 29) were identified in these strains. Other three strains of enteroviruses were unidentified. Different combinations of genetic markers were found. Seven strains of enteroviruses (Coxsackie B2, B3, ECHO 6, ECHO 9, ECHO 27 (two strains) and one unidentified virus) had virulence markers: Abent-, rct40+ and S-. Three strains (Coxsackie B4, ECHO 29, one unidentified virus) had markers: Abent-, rct40+, S+. Another one unidentified virus had markers: Abent+, rct40+, S -. CONCLUSION: Conclusions: All 11 isolates of enteroviruses associated with IS had rct40+ marker, 10 of the 11 isolates had marker Abent- and 8 of 11 isolates had marker S-. The research of genetic markers allows to perform typic and intratypic differentiation of strains of enteroviruses associated with the IS.

The role of the persistent enterovirus infection in development of acute stroke.

INTRODUCTION: The role of enteroviruses in development of dilated cardiomyopathy, myocardial infarction, myocarditis, pericarditis is known. THE AIM: To examine the role of chronic enterovirus infections in development of acute stroke. MATERIAL AND METHODS: Blood samples from 72 patients with acute stroke (study group) and 35 patients without vascular disease (control group) were investigated by reverse transcription polymerase chain reaction for the presence of enterovirus RNA, by using virological method to detect enteroviruses, by ELISA for the levels of IgM and IgG antibodies to enteroviruses. RESULTS: The enteroviruses genomes were detected significantly often in the serum of patients with stroke (23,6 ± 5,9%) than in control group (2,9 ± 2,8%). The viruses were isolated and were identified as Coxsackie B (serotypes 2, 3, 4) and ECHO (serotypes 6, 9, 27 (two strains), 29), three strains have not been identified in study group. IgM to enteroviruses were not found in the sera of both groups of patients. IgG to enteroviruses were detected in 17 patients in study group (23,6 ± 5,9%) and 2 patients in control group (5,7 ± 3,9%). The presence of enteroviruses genomes and IgG in sera of patients in control group (11,1 ± 3,7%) indicate the persistence of enteroviruses. The proportion of patients with IgG to enteroviruses in sera is higher in study group (12,5 ± 3,9%) than in control group (5,7 ± 3,9%). CONCLUSION: The enterovirus infections play trigger role in development of acute stroke.