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2.
Mol Neurobiol ; 57(12): 4921-4928, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32813238

RESUMEN

The global pandemic of novel coronavirus disease 2019 (COVID-19) has taken the entire human race by surprise and led to an unprecedented number of mortalities worldwide so far. Current clinical studies have interpreted that angiotensin-converting enzyme 2 (ACE2) is the host receptor for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). In addition, ACE2 is the major component of the renin-angiotensin system. ACE2 deteriorates angiotensin II, a peptide that is responsible for the promotion of stroke. The downregulation of ACE2 further activates an immunological cascade. Thus, researchers need to explore and examine the possible links between COVID-19 and ischemic stroke (IS). Human ACE2 expression level and pattern in various tissues might be decisive for the vulnerability, symptoms, and treatment outcomes of the SARS-CoV-2 infection. The swift increase in the knowledge of SARS-CoV-2 has given creditable evidence that SARS-CoV-2 infected patients also encounter neurological deficits. As the SARS-CoV-2 binds to ACE2, it will hamper the activity of ACE2 in providing neuroprotection, especially in the case of stroke patients. Due to the downregulation of ACE2, the inflammatory response is activated in the ischemic penumbra. The COVID-19 pandemic has affected people with various pre-existing diseases, including IS, in such a way that these patients need special care and attention for their survival. Several clinical trials are currently ongoing worldwide as well as many other projects are in different stages of conceptualization and planning to facilitate the effective management of stroke patients with COVID-19 infection.


Asunto(s)
Betacoronavirus , Isquemia Encefálica/etiología , Infecciones por Coronavirus/fisiopatología , Pandemias , Neumonía Viral/fisiopatología , Sistema Renina-Angiotensina/fisiología , Accidente Cerebrovascular/etiología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Betacoronavirus/patogenicidad , Betacoronavirus/fisiología , Barrera Hematoencefálica , Isquemia Encefálica/epidemiología , Isquemia Encefálica/inmunología , Isquemia Encefálica/fisiopatología , Quimiotaxis de Leucocito , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/fisiopatología , Citocinas/fisiología , Encefalitis Viral/complicaciones , Encefalitis Viral/fisiopatología , Hemodinámica , Humanos , Inflamación , Modelos Inmunológicos , Modelos Neurológicos , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/fisiopatología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Peptidil-Dipeptidasa A/fisiología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Receptores Virales/fisiología , Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/inmunología , Accidente Cerebrovascular/fisiopatología
3.
J Neurovirol ; 26(3): 324-329, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32418055

RESUMEN

Coronavirus disease 2019 (COVID-19) was reported at the end of 2019 in China for the first time and has rapidly spread throughout the world as a pandemic. Since COVID-19 causes mild to severe acute respiratory syndrome, most studies in this field have only focused on different aspects of pathogenesis in the respiratory system. However, evidence suggests that COVID-19 may affect the central nervous system (CNS). Given the outbreak of COVID-19, it seems necessary to perform investigations on the possible neurological complications in patients who suffered from COVID-19. Here, we reviewed the evidence of the neuroinvasive potential of coronaviruses and discussed the possible pathogenic processes in CNS infection by COVID-19 to provide a precise insight for future studies.


Asunto(s)
Ataxia/epidemiología , Edema Encefálico/epidemiología , Infecciones por Coronavirus/epidemiología , Encefalitis Viral/epidemiología , Epilepsia/epidemiología , Esclerosis Múltiple/epidemiología , Pandemias , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Ataxia/complicaciones , Ataxia/diagnóstico , Ataxia/virología , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Barrera Hematoencefálica/patología , Barrera Hematoencefálica/virología , Edema Encefálico/complicaciones , Edema Encefálico/diagnóstico , Edema Encefálico/virología , Sistema Nervioso Central/patología , Sistema Nervioso Central/virología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Epilepsia/complicaciones , Epilepsia/diagnóstico , Epilepsia/virología , Humanos , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/virología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Prevalencia , Síndrome Respiratorio Agudo Grave/complicaciones , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/transmisión
4.
J Neurovirol ; 26(2): 143-148, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32447630

RESUMEN

A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Encefalitis Viral/epidemiología , Meningitis/epidemiología , Pandemias , Neumonía Viral/epidemiología , Accidente Cerebrovascular/epidemiología , Betacoronavirus/genética , Betacoronavirus/metabolismo , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Cefalea/complicaciones , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/virología , Interacciones Huésped-Patógeno/genética , Humanos , Meningitis/complicaciones , Meningitis/diagnóstico , Meningitis/virología , Mialgia/complicaciones , Mialgia/diagnóstico , Mialgia/epidemiología , Mialgia/virología , Miositis/complicaciones , Miositis/diagnóstico , Miositis/epidemiología , Miositis/virología , Sistema Nervioso/patología , Sistema Nervioso/virología , Peptidil-Dipeptidasa A/genética , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Unión Proteica , Receptores Virales/genética , Receptores Virales/metabolismo , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/metabolismo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/virología , Internalización del Virus
6.
BMJ Case Rep ; 13(3)2020 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-32188617

RESUMEN

Human herpesvirus 6 (HHV-6) infection is the cause of roseola infantum in children. The reactivation of HHV-6 is associated with multiple clinical syndromes including encephalitis and myelitis, especially in haematopoietic stem cell transplant recipients. However, the virus can cause encephalitis in other immunosuppressed as well as immunocompetent individuals. We report a case of a 70-year-old woman who was immunocompromised secondary to treatment of rheumatoid arthritis with leflunomide and methotrexate. The patient presented with acute ataxia, diplopia and dysarthria. MRI brain showed an enhancing lesion in the midbrain. The diagnosis of HHV-6 encephalitis was made after HHV-6 A DNA was detected in both serum and cerebrospinal fluid. Treatment consisted of a 3-week course of intravenous ganciclovir along with physiotherapy. At a 3-month follow-up, repeat MRI brain showed a decrease in size and oedema of the lesion and the patient's neurological function was improved.


Asunto(s)
Ataxia Cerebelosa/diagnóstico , Encefalitis Viral/diagnóstico , Herpesvirus Humano 6/aislamiento & purificación , Huésped Inmunocomprometido , Infecciones por Roseolovirus/diagnóstico , Anciano , Antivirales/uso terapéutico , Ataxia Cerebelosa/complicaciones , Ataxia Cerebelosa/diagnóstico por imagen , Ataxia Cerebelosa/tratamiento farmacológico , Diagnóstico Diferencial , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico por imagen , Encefalitis Viral/tratamiento farmacológico , Femenino , Ganciclovir/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/diagnóstico por imagen , Infecciones por Roseolovirus/tratamiento farmacológico
7.
Viruses ; 12(1)2019 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-31861926

RESUMEN

Respiratory viruses infect the human upper respiratory tract, mostly causing mild diseases. However, in vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, these opportunistic pathogens can also affect the lower respiratory tract, causing a more severe disease (e.g., pneumonia). Respiratory viruses can also exacerbate asthma and lead to various types of respiratory distress syndromes. Furthermore, as they can adapt fast and cross the species barrier, some of these pathogens, like influenza A and SARS-CoV, have occasionally caused epidemics or pandemics, and were associated with more serious clinical diseases and even mortality. For a few decades now, data reported in the scientific literature has also demonstrated that several respiratory viruses have neuroinvasive capacities, since they can spread from the respiratory tract to the central nervous system (CNS). Viruses infecting human CNS cells could then cause different types of encephalopathy, including encephalitis, and long-term neurological diseases. Like other well-recognized neuroinvasive human viruses, respiratory viruses may damage the CNS as a result of misdirected host immune responses that could be associated with autoimmunity in susceptible individuals (virus-induced neuro-immunopathology) and/or viral replication, which directly causes damage to CNS cells (virus-induced neuropathology). The etiological agent of several neurological disorders remains unidentified. Opportunistic human respiratory pathogens could be associated with the triggering or the exacerbation of these disorders whose etiology remains poorly understood. Herein, we present a global portrait of some of the most prevalent or emerging human respiratory viruses that have been associated with possible pathogenic processes in CNS infection, with a special emphasis on human coronaviruses.


Asunto(s)
Sistema Nervioso Central/virología , Infecciones por Coronavirus/virología , Coronavirus/fisiología , Coronavirus/patogenicidad , Infecciones del Sistema Respiratorio/virología , Animales , Enfermedades Virales del Sistema Nervioso Central/complicaciones , Enfermedades Virales del Sistema Nervioso Central/virología , Infecciones por Coronavirus/complicaciones , Encefalitis Viral/complicaciones , Encefalitis Viral/virología , Humanos , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/virología , Infecciones del Sistema Respiratorio/complicaciones , Replicación Viral
8.
BMJ Case Rep ; 12(11)2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31732545

RESUMEN

Enterovirus D68 (EV-D68) causes respiratory illnesses such as pneumonia, and has been reported to cause acute flaccid myelitis. Enterovirus A71 (EV-A71) is known to cause cardiopulmonary failure due to brainstem encephalitis, but there have been few reports of these conditions being associated with EV-D68. Outbreaks of EV-D68 infection have occurred in the USA, Canada, Europe and Asia. Clinical management is largely supportive and there are no specific antivirals available. The case patient, a 4-year-old girl, had cardiopulmonary failure due to brainstem encephalitis. EV-D68 was isolated from a throat swab. On admission, she had cardiopulmonary failure, which required intensive care using a ventilator and inotropic agents. Her cardiac function improved, but she had residual bulbar paralysis and limb weakness, which resolved over a 6-month period. This case confirms that EV-D68, may cause severe illness due to brainstem encephalitis, similar to that caused by EV-A71.


Asunto(s)
Tronco Encefálico/virología , Encefalitis Viral/complicaciones , Enterovirus Humano D , Infecciones por Enterovirus/complicaciones , Insuficiencia Cardíaca/virología , Insuficiencia Respiratoria/virología , Parálisis Bulbar Progresiva/terapia , Parálisis Bulbar Progresiva/virología , Preescolar , Femenino , Insuficiencia Cardíaca/terapia , Humanos , Insuficiencia Respiratoria/terapia
9.
Int J Infect Dis ; 89: 51-54, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31562933

RESUMEN

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Next-generation sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.


Asunto(s)
Antiinflamatorios/uso terapéutico , Antivirales/uso terapéutico , Encefalitis Viral/diagnóstico por imagen , Herpesvirus Suido 1/aislamiento & purificación , Enfermedades Pulmonares/diagnóstico por imagen , Síndrome de Necrosis Retiniana Aguda/diagnóstico por imagen , Enfermedades de los Porcinos/virología , Aciclovir/uso terapéutico , Adulto , Animales , Líquido Cefalorraquídeo/virología , Dexametasona/uso terapéutico , Encefalitis Viral/complicaciones , Encefalitis Viral/terapia , Encefalitis Viral/virología , Herpesvirus Suido 1/genética , Humanos , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/terapia , Enfermedades Pulmonares/virología , Masculino , Desprendimiento de Retina/tratamiento farmacológico , Síndrome de Necrosis Retiniana Aguda/complicaciones , Síndrome de Necrosis Retiniana Aguda/terapia , Síndrome de Necrosis Retiniana Aguda/virología , Aceites de Silicona/uso terapéutico , Porcinos , Vitrectomía , Cuerpo Vítreo/virología , Zoonosis
10.
Zhonghua Er Ke Za Zhi ; 57(7): 538-542, 2019 Jul 02.
Artículo en Chino | MEDLINE | ID: mdl-31269554

RESUMEN

Objective: To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A-associated encephalopathy (IAE) in children. Methods: The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children's Medical Center from December 2018 to January 2019 were retrospectively analyzed. Results: Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu-like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine-year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge. Conclusions: The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/tratamiento farmacológico , Encéfalo/diagnóstico por imagen , Inmunoglobulinas Intravenosas/administración & dosificación , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/diagnóstico , Gripe Humana/tratamiento farmacológico , Oseltamivir/uso terapéutico , Encefalopatías/virología , Niño , Preescolar , Electroencefalografía , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico por imagen , Encefalitis Viral/virología , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Gripe Humana/complicaciones , Gripe Humana/virología , Imagen por Resonancia Magnética , Masculino , Metilprednisolona , Estudios Retrospectivos , Resultado del Tratamiento
11.
BMC Neurol ; 19(1): 165, 2019 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-31315594

RESUMEN

BACKGROUND: Nowadays, few surgery analysis has been reported in cases of epilepsy after viral encephalitis(VE). Herein, this study was to evaluate the efficacy of surgery and capability of stereoelectroencephalography (SEEG) in the definition of the epileptogenic zone (EZ) after VE, and also to explore the relationship between the SEEG features and the surgical outcomes. METHODS: We retrospectively analyzed 10 surgically treated patients that identified to suffer from epilepsy secondary to VE using SEEG, and investigated the SEEG features associated with surgical outcomes in these patients. Besides visual analysis, we used the epileptogenicity index (EI), a semi-quantitative and supplementary tool to evaluate the validity of SEEG in the context of VE. RESULTS: Among the 10 operated patients, 3 of them became completely seizure-free. The patients who got totally seizure free or significant improvement, the seizure onset was located either in the antero-mesial temporal structures or focal gyrus; patients who got worthwhile improvement or no improvement, the seizure started from multiple brain lobes. The number of electrodes classified as epileptogenic visually involved were closely correlated with EI positive onses.Anatomic areas defined and shown as EZ on MRI by visual assessment were also defined as epileptogenic by the EI in these cases. CONCLUSION: Apart from exploring the surgical outcome related to epilepsy after VE, we also bring insight into the relationship between the SEEG features and surgical outcome with the application of the supplementary methods.


Asunto(s)
Electroencefalografía/métodos , Encefalitis Viral/complicaciones , Epilepsia/cirugía , Adolescente , Adulto , Niño , Preescolar , Electrodos , Epilepsia/virología , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Convulsiones/cirugía , Resultado del Tratamiento , Adulto Joven
12.
Am J Emerg Med ; 37(9): 1808.e1-1808.e3, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31230923

RESUMEN

Influenza-associated acute encephalopathy (IAE) is more prevalent in children than in adults and often results in neurological sequelae or even death. Diagnosis of IAE is difficult as clinical presentation varies significantly and the influenza virus is rarely detected in cerebrospinal fluid. Moreover, seizures in adults due to influenza infection are rare. Herein, we describe the case of an adult presenting with both acute encephalitis and seizures. A 38-year-old female was admitted to the emergency department with acute respiratory symptoms and fever, followed by quick progression to stupor within 24 h. A rapid antigen test was influenza A-positive, and polymerase chain reaction of nasal secretions confirmed the H3N2 subtype. Brain magnetic resonance imaging showed bilateral water restriction lesions at the thalamus and the cerebellum and an electroencephalogram showed frequent episodic generalized sharp-and-slow waves over the bilateral frontal region. Based on the neuroimaging and laboratory findings, we diagnosed the patient with adult influenza A (H3N2)-related encephalitis complicated by seizure. Treatment with oseltamivir and anticonvulsants led to complete neurologic recovery by day 14. This report describes two unusual neurological manifestations of influenza A, i.e., encephalitis and seizures, in an adult. We emphasize that, in adults presenting with acute viral encephalitis, clinicians should consider influenza infection as part of the differential diagnosis, and that typical neuroimaging in conjunction with laboratory detection of influenza virus and/or intrathecal antibody production suggestive of IAE, may help establish an accurate diagnosis.


Asunto(s)
Encefalitis Viral/virología , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/diagnóstico , Enfermedad Aguda , Adulto , Anticonvulsivantes/administración & dosificación , Antivirales/administración & dosificación , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Diagnóstico Diferencial , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico , Encefalitis Viral/tratamiento farmacológico , Femenino , Humanos , Gripe Humana/complicaciones , Gripe Humana/tratamiento farmacológico , Gripe Humana/virología , Levetiracetam/administración & dosificación , Imagen por Resonancia Magnética , Oseltamivir/administración & dosificación , Convulsiones/tratamiento farmacológico , Convulsiones/etiología
15.
Tohoku J Exp Med ; 247(3): 189-195, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30890665

RESUMEN

Encephalitis is an inflammatory process involving the brain parenchyma associated with neurologic dysfunction. The main causes of infectious encephalitis are viruses, including Herpes simplex virus type 1 (HSV-1). As the mortality rate of HSV-1 encephalitis could be reduced with early acyclovir treatment, it is imperative to distinguish HSV-1 encephalitis from other type of viral encephalitis as early as possible. However, sophisticated methods for definitive diagnosis of HSV-1 encephalitis are not readily available. We aimed to explore distinctive clinical and laboratory features of HSV-1 encephalitis. All of the adult patients with viral encephalitis hospitalized between 2011-2017 were enrolled, including 16 patients with HSV-1 encephalitis and 51 patients non-HSV-1 viral encephalitis. Determination of viruses in cerebrospinal fluid was performed by PCR tests. Female sex, hyponatremia, and abnormalities in MRI were independently associated with HSV-1 encephalitis (p < 0.05 for each). In particular, hyponatremia (< 135 mEq/L) was found in nine patients with HSV-1 encephalitis (56.3%) and 10 patients with non-HSV-1 viral encephalitis (19.6%) (p = 0.005). As serum sodium is determined easily and quickly in clinical practice, the presence of hyponatremia among patients with viral encephalitis could be helpful for the early diagnosis of HSV-1 encephalitis before cerebrospinal fluid PCR results were available. Moreover, the presence of positive finding in MRI could further support the diagnosis. This is the first study that compared the serum sodium levels among patients between HSV-1 and non-HSV-1 viral encephalitis. We thus propose the diagnostic value of hyponatremia for HSV-1 encephalitis.


Asunto(s)
Encefalitis por Herpes Simple/complicaciones , Encefalitis por Herpes Simple/virología , Encefalitis Viral/complicaciones , Encefalitis Viral/virología , Herpesvirus Humano 1/fisiología , Hiponatremia/complicaciones , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Encéfalo/virología , Encefalitis por Herpes Simple/epidemiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Resultado del Tratamiento
16.
BMC Pediatr ; 19(1): 59, 2019 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-30760232

RESUMEN

BACKGROUND: Hand, foot, and mouth disease (HFMD) is an acute viral infection occurring mostly in infants and children. Enterovirus 71 (EV71) infection mostly occurs in children < 5 years of age. Severe cases, however, are usually encountered in children under the age of 3 years, and exceedingly rare in teenagers > 14 years and adults. CASE PRESENTATION: We report a rare case of HFMD in a 16-year-old male teenager residing in Chonqing, China. The clinical presentation was typical of HFMD and included vesicular lesions and oral mucosal ulcers, macular and vesicular lesions on palms and soles. He developed severe neurological complications that were suggestive of brainstem encephalitis. EV71 RNA was detected in the patient's faecal samples by reverse transcription-polymerase chain reaction. Specific IgM antibody to EV71 was detected in both serum and cerebrospinal fluid by ELISA. Gamma immunoglobulin therapy at 25 g/day was administered for 2 days, along with methylprednisolone, mannitol, ganglioside, and creatine phosphate sodium. The patient showed neurological improvement and recovered completely in 1 month. CONCLUSIONS: This case indicates that EV71 infection may cause HFMD in teenagers with potentially severe neurological involvement. Clinicians should be aware of the possibility of HFMD occurring in adults and teenagers as prompt treatment could be life-saving in these patients.


Asunto(s)
Tronco Encefálico/virología , Encefalitis Viral/virología , Enterovirus Humano A/aislamiento & purificación , Infecciones por Enterovirus/diagnóstico , Enfermedad de Boca, Mano y Pie/virología , Adolescente , Encefalitis Viral/complicaciones , Heces/virología , Enfermedad de Boca, Mano y Pie/complicaciones , Humanos , Inmunoglobulina M/sangre , Inmunoglobulina M/líquido cefalorraquídeo , Masculino , ARN Viral/análisis
18.
Epilepsia ; 60(4): 626-635, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30770561

RESUMEN

OBJECTIVE: Viral encephalitis increases the risk for developing seizures and epilepsy. Indoleamine 2,3-dioxygenase 1 (Ido1) is induced by inflammatory cytokines and functions to metabolize tryptophan to kynurenine. Kynurenine can be further metabolized to produce kynurenic acid and the N-methyl-d-aspartate receptor agonist quinolinic acid (QuinA). In the present study, we sought to determine the role of Ido1 in promoting seizures in an animal model of viral encephalitis. METHODS: C57BL/6J and Ido1 knockout mice (Ido1-KO) were infected with Theiler's murine encephalomyelitis virus (TMEV). Quantitative real-time polymerase chain reaction was used to evaluate hippocampal expression of proinflammatory cytokines, Ido1, and viral RNA. Body weights and seizure scores were recorded daily. Elevated zero maze was used to assess differences in behavior, and hippocampal pathology was determined by immunohistochemistry. RESULTS: Infected C57BL/6J mice up-regulated proinflammatory cytokines, Ido1, and genes encoding the enzymatic cascade responsible for QuinA production in the kynurenine pathway prior to the onset of seizures. Seizure incidence was elevated in Ido1-KO compared to C57BL/6J mice. Infection increased locomotor activity in Ido1-KO compared to C57BL/6J mice. Furthermore, the occurrence of seizures was associated with hyperexcitability. Neither expression of proinflammatory cytokines nor viral RNA was altered as a result of genotype. Immunohistochemical analysis revealed increased hippocampal pathology in Ido1-KO mice. SIGNIFICANCE: Our findings suggest that Ido1 deletion promotes seizures and neuropathogenesis during acute TMEV encephalitis.


Asunto(s)
Encefalitis Viral/complicaciones , Indolamina-Pirrol 2,3,-Dioxigenasa/metabolismo , Convulsiones/enzimología , Animales , Infecciones por Cardiovirus/complicaciones , Modelos Animales de Enfermedad , Encefalitis Viral/enzimología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Convulsiones/virología , Theilovirus
19.
Transpl Infect Dis ; 21(1): e13003, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30256500

RESUMEN

BACKGROUND: Human herpesvirus 6 (HHV6) is a cause of post-transplant acute limbic encephalitis (PALE). Seizures are associated with this disorder yet no predictive biomarkers have been identified. The objective of this study was to evaluate lab and neurodiagnostic biomarkers in patients with HHV6 associated PALE. METHODS: A retrospective chart review was performed at our institutions between 2000 and 2017. Patients were identified through a clinical database. Inclusion criteria included: age less than 18 years, HHV6 (quantitative real-time PCR or meningoencephalitis panel) tested in CSF and serum. Biomarkers of serum and CSF viral load, EEG, and MRI were reviewed along with clinical data. RESULTS: In total, 11 patients met inclusion criteria. All patients had undergone hematopoietic stem cell transplantation. Five of 11 patients had seizures as part of their clinical course, all being controlled with antiepileptic monotherapy. Seizure semiology was focal-onset in three cases and generalized in two. Neuroimaging was normal in all patients within seven days but six patients developed T2 signal intensities in the temporal lobes on repeat imaging between 14-28 days. The median CSF HHV6 viral load for all patients was 47 300 copies/mL although the median viral load was 2586 copies/mL in patients who had seizure compared to 473 969 copies/mL in those who had not (P = 0.02). Those with seizures tended to be younger (median 6.5 years compared to 11 years, P = 0.27). All patients with seizures had an EEG with 80% demonstrating abnormalities. CONCLUSION: In patients with post-hematopoietic stem cell transplant HHV6 associated PALE, lower CSF viral load may be associated with a higher likelihood to have seizures. This may indicate a primary infection as opposed to secondary reactivation phenomenon.


Asunto(s)
Encefalitis Viral/diagnóstico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Herpesvirus Humano 6/aislamiento & purificación , Encefalitis Límbica/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Infecciones por Roseolovirus/diagnóstico , Convulsiones/diagnóstico , Enfermedad Aguda , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Niño , Electroencefalografía , Encefalitis Viral/complicaciones , Encefalitis Viral/virología , Femenino , Humanos , Encefalitis Límbica/sangre , Encefalitis Límbica/líquido cefalorraquídeo , Encefalitis Límbica/virología , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/líquido cefalorraquídeo , Complicaciones Posoperatorias/virología , Estudios Retrospectivos , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/virología , Convulsiones/sangre , Convulsiones/líquido cefalorraquídeo , Convulsiones/virología , Carga Viral
20.
Trends Mol Med ; 24(11): 950-962, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30314877

RESUMEN

Neurotropic RNA virus infections cause a major neurological disease burden. Due to the morbidity and mortality rates of viral encephalitides worldwide, there is a need to develop clinical treatments. Features of the central nervous system (CNS), including interconnected cell types and limited regeneration, provide unique challenges. Viral encephalitis and antiviral immunity can disrupt the CNS environment, leaving patients with poor neurological outcomes despite virologic control. The cellular mechanism(s) underlying neurological recovery are not fully understood, but involve neuroimmune interactions that, until recently, primarily focused on microglia. With increasing evidence that astrocytes also have significant roles in inflammatory responses to viruses, here we summarize recent astrocyte contributions to acute virologic control and neurological impairments during recovery from viral infection.


Asunto(s)
Astrocitos/metabolismo , Encefalitis Viral/complicaciones , Encefalitis Viral/virología , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/metabolismo , Animales , Astrocitos/virología , Biomarcadores , Barrera Hematoencefálica/inmunología , Barrera Hematoencefálica/metabolismo , Barrera Hematoencefálica/virología , Comunicación Celular , Interacciones Huésped-Patógeno , Humanos , Microglía/metabolismo , Enfermedades del Sistema Nervioso/fisiopatología , Transducción de Señal , Linfocitos T/inmunología , Linfocitos T/metabolismo
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