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1.
Immunity ; 54(1): 164-175.e6, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33382973

RESUMEN

Patients suffering from Coronavirus disease 2019 (COVID-19) can develop neurological sequelae, such as headache and neuroinflammatory or cerebrovascular disease. These conditions-termed here as Neuro-COVID-are more frequent in patients with severe COVID-19. To understand the etiology of these neurological sequelae, we utilized single-cell sequencing and examined the immune cell profiles from the cerebrospinal fluid (CSF) of Neuro-COVID patients compared with patients with non-inflammatory and autoimmune neurological diseases or with viral encephalitis. The CSF of Neuro-COVID patients exhibited an expansion of dedifferentiated monocytes and of exhausted CD4+ T cells. Neuro-COVID CSF leukocytes featured an enriched interferon signature; however, this was less pronounced than in viral encephalitis. Repertoire analysis revealed broad clonal T cell expansion and curtailed interferon response in severe compared with mild Neuro-COVID patients. Collectively, our findings document the CSF immune compartment in Neuro-COVID patients and suggest compromised antiviral responses in this setting.


Asunto(s)
/inmunología , Monocitos/inmunología , Enfermedades del Sistema Nervioso/inmunología , Linfocitos T/inmunología , /líquido cefalorraquídeo , /patología , Diferenciación Celular , Líquido Cefalorraquídeo/inmunología , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/inmunología , Perfilación de la Expresión Génica , Humanos , Interferones/genética , Interferones/inmunología , Leucocitos/inmunología , Activación de Linfocitos , Enfermedades del Sistema Nervioso/líquido cefalorraquídeo , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/patología , Receptores de Antígenos de Linfocitos T/genética , Receptores de Antígenos de Linfocitos T/metabolismo , Análisis de la Célula Individual
2.
BMJ Case Rep ; 13(9)2020 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-32938656

RESUMEN

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Encefalitis Viral/líquido cefalorraquídeo , Neumonía Viral/complicaciones , Adulto , Infecciones por Coronavirus/tratamiento farmacológico , Encefalitis Viral/diagnóstico , Encefalitis Viral/tratamiento farmacológico , Encefalitis Viral/virología , Humanos , Masculino , Pandemias , Neumonía Viral/tratamiento farmacológico , Inducción de Remisión
3.
Emerg Infect Dis ; 26(9): 2016-2021, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32487282

RESUMEN

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.


Asunto(s)
Betacoronavirus , Encefalopatías/virología , Infecciones por Coronavirus/complicaciones , Citocinas/líquido cefalorraquídeo , Encefalitis Viral/virología , Neumonía Viral/complicaciones , Adulto , Encefalopatías/líquido cefalorraquídeo , Infecciones por Coronavirus/líquido cefalorraquídeo , Infecciones por Coronavirus/virología , Encefalitis Viral/líquido cefalorraquídeo , Resultado Fatal , Femenino , Georgia , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/líquido cefalorraquídeo , Neumonía Viral/virología
4.
Medicine (Baltimore) ; 98(52): e18464, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876729

RESUMEN

Enterovirus 71 (EV71) is an important etiological agent of hand, foot, and mouth disease (HFMD), which can also lead to severe neurological complications (eg, encephalitis) in young children. Although a series of reports on EV71 infection have been published, the pathogenic mechanism of EV71 infection is still not fully understood.We evaluated the cerebrospinal fluid (CSF) levels of the inflammatory cytokines interleukin (IL)-8, IL-1ß, IL-6, IL-10, tumor necrosis factor (TNF)-α, and IL-12p70 in 88 children with EV71-related encephalitis and 19 children with febrile convulsion (FC) with the use of commercial cytometric bead array kits.The levels of IL-8, IL-1ß, IL-6, and IL-10 in CSF were significantly higher in encephalitis group when compared with those observed in FC group, while no significant changes were noted in the levels of TNF-α and IL-12p70. In addition, significant and positive correlations among CSF IL-8, IL-1ß, IL-6, and IL-10 were observed in encephalitis group. Furthermore, receiver operator characteristic analysis determined a cut-off value of 10.62 pg/mL for IL-6 to discriminate encephalitis patients from FCs with the sensitivity and specificity of 89.8% and 84.2%, respectively. Moreover, logistic regression analyses revealed that IL-6 was an independent predictor of EV71-related encephalitis (odds ratio = 23.241, P < .001).Our results indicate that 4 inflammatory cytokines (IL-8, IL-1ß, IL-6, and IL-10) play important roles in the pathogenesis of EV71 infection. IL-6 may be used for the evaluation of EV71-related encephalitis and as a potential therapy candidate for EV71 infection.


Asunto(s)
Citocinas/líquido cefalorraquídeo , Encefalitis Viral/líquido cefalorraquídeo , Enterovirus Humano A , Enfermedad de Boca, Mano y Pie/líquido cefalorraquídeo , Preescolar , China/epidemiología , Encefalitis Viral/virología , Femenino , Enfermedad de Boca, Mano y Pie/virología , Humanos , Lactante , Interleucina-10/líquido cefalorraquídeo , Interleucina-12/líquido cefalorraquídeo , Interleucina-1beta/líquido cefalorraquídeo , Interleucina-6/líquido cefalorraquídeo , Interleucina-8/líquido cefalorraquídeo , Masculino , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo
5.
Transpl Infect Dis ; 21(6): e13172, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31520510

RESUMEN

BACKGROUND: Human herpesvirus (HHV)-6B encephalitis has been recognized as a serious complication after allogeneic hematopoietic cell transplantation (allo-HCT). Little is known about the pathogenic mechanism for its progression. STUDY DESIGN: We retrospectively evaluated the 16 kinds of cytokines and chemokines in cerebrospinal fluid (CSF) and plasma in patients who developed HHV-6B encephalitis. Among a total of 20 patients, 12 were categorized as the poor prognosis group (died of encephalitis; n = 8 and retained sequelae; n = 4), and other eight patients were categorized as the good prognosis group (complete recovery; n = 8). RESULTS: Concentrations of CSF IL-6 and IL-8 at the onset of encephalitis were significantly higher in the poor prognosis group than in the good prognosis group (median CSF IL-6, 28.27 pg/mL vs 14.32 pg/mL, P = .004; median CSF IL-8, 128.70 pg/mL vs 59.43 pg/mL, P = .043). Regarding plasma, the concentration of each cytokine at the onset of encephalitis was not significantly different between the two groups, except IL-5. However, higher levels of IL-6, IL-7, and MCP-1 and lower levels of IL-12 were observed 1 week before the development of encephalitis in patients with poor prognosis (median IL-6; 464.17 pg/mL vs 47.82 pg/mL, P = .02; median IL-12; 1.63 pg/mL vs 6.57 pg/mL, P = .03). CONCLUSION: We found that one week before onset of HHV-6B encephalitis, poor prognosis patients had high plasma concentrations of IL-6, IL-7, and MCP-1 and low concentrations of IL-12. At the onset of encephalitis, high concentrations of IL-6 and IL-8 in CSF were more common in the poor prognosis group, consistent with other evidence that IL-6 can have a role in CNS disturbances. Our findings show that specific cytokine status is associated with severe brain damage in patients with HHV-6B encephalitis, demonstrate prognostic value of plasma IL-6 concentrations, and suggest evaluation of anti-cytokine therapeutics in patients with HHV-6B encephalitis.


Asunto(s)
Citocinas/análisis , Encefalitis Viral/mortalidad , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Herpesvirus Humano 6/aislamiento & purificación , Infecciones por Roseolovirus/mortalidad , Adulto , Citocinas/inmunología , Encefalitis Viral/sangre , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/virología , Femenino , Herpesvirus Humano 6/inmunología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Infecciones por Roseolovirus/sangre , Infecciones por Roseolovirus/líquido cefalorraquídeo , Infecciones por Roseolovirus/virología , Trasplante Homólogo/efectos adversos
6.
Genes (Basel) ; 10(8)2019 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-31431002

RESUMEN

: Meningitis, encephalitis, and myelitis are various forms of acute central nervous system (CNS) inflammation, which can coexist and lead to serious sequelae. Known aetiologies include infections and immune-mediated processes. Despite advances in clinical microbiology over the past decades, the cause of acute CNS inflammation remains unknown in approximately 50% of cases. High-throughput sequencing was performed to search for viral sequences in cerebrospinal fluid (CSF) samples collected from 26 patients considered to have acute CNS inflammation of unknown origin, and 10 patients with defined causes of CNS diseases. In order to better grasp the clinical significance of viral sequence data obtained in CSF, 30 patients without CNS disease who had a lumbar puncture performed during elective spinal anaesthesia were also analysed. One case of human astrovirus (HAstV)-MLB2-related meningitis and disseminated infection was identified. No other viral sequences that can easily be linked to CNS inflammation were detected. Viral sequences obtained in all patient groups are discussed. While some of them reflect harmless viral infections, others result from reagent or sample contamination, as well as index hopping. Altogether, this study highlights the potential of high-throughput sequencing in identifying previously unknown viral neuropathogens, as well as the interpretation issues related to its application in clinical microbiology.


Asunto(s)
Líquido Cefalorraquídeo/virología , Encefalitis Viral/virología , Meningitis Viral/virología , Técnicas de Diagnóstico Molecular/métodos , Mielitis/virología , Análisis de Secuencia de ARN/métodos , Adolescente , Adulto , Niño , Encefalitis Viral/líquido cefalorraquídeo , Femenino , Humanos , Masculino , Meningitis Viral/líquido cefalorraquídeo , Persona de Mediana Edad , Mielitis/líquido cefalorraquídeo , ARN Viral/química , ARN Viral/genética
7.
J Infect Dis ; 220(8): 1302-1306, 2019 09 13.
Artículo en Inglés | MEDLINE | ID: mdl-31199457

RESUMEN

We report a case of cytomegalovirus encephalitis in a hematopoietic stem cell transplant recipient. A previously uncharacterized V787E mutation in UL54 was identified in cerebrospinal fluid but not plasma specimens. For the V787E recombinant virus, the half maximal effective concentrations for ganciclovir, foscarnet, and cidofovir were 8.6-, 3.4- and 2.9-fold higher than for wild-type virus, and the replicative capacity was lower. The introduction of a bulkier and negatively charged glutamate residue at position 787 could destabilize the finger domain of UL54 DNA polymerase. Viral genotyping of cerebrospinal fluid is warranted in subjects with cytomegalovirus encephalitis, owing to the low penetration of antivirals in this compartment.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/genética , Farmacorresistencia Viral Múltiple/genética , Encefalitis Viral/diagnóstico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Aciclovir/farmacología , Aciclovir/uso terapéutico , Profilaxis Antibiótica/métodos , Antivirales/farmacología , Antivirales/uso terapéutico , Líquido Cefalorraquídeo/virología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/prevención & control , Infecciones por Citomegalovirus/virología , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/prevención & control , Encefalitis Viral/virología , Femenino , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Humanos , Proteínas Inmediatas-Precoces/genética , Inmunosupresión/efectos adversos , Persona de Mediana Edad , Mutación , Leucemia-Linfoma Linfoblástico de Células Precursoras/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Proteínas Virales/genética
8.
Infez Med ; 27(2): 141-148, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31205036

RESUMEN

Infectious meningitis and encephalitis are potentially life-threatening conditions caused mostly by bacterial and viral agents. Rapid diagnosis and prompt treatment are associated with a more favorable outcome. In recent years nucleic acid amplification tests have been developed to speed detection and identification of pathogens directly from cerebrospinal fluid (CSF). The aim of this study was to compare the diagnostic accuracy of a commercially available multiplex PCR assay for etiological diagnosis of infectious meningitis directly from CSF samples with culture. A secondary endpoint was to look for a possible screening threshold based on main CSF indices and urgent blood test results, to define CSF samples with low pre-test probability of PCR and/or culture-positive result. We performed a secondary analysis of results of CSF samples already processed as part of routine clinical care from February 2016 to December 2018. In all, 109 CSF samples were included in the study and a total of 14 bacteria were identified by either PCR, culture or both methods, along with nine samples positive for viruses. The comparison of PCR results with culture showed no significant difference: 7/109 (6.4%) vs 13/109 (11.9%) respectively, p=0.07. After exclusion of the isolates not detectable by the multiplex PCR panel, the diagnostic accuracy was: 100% (95% confidence interval (CI): 54.1% to 100%) sensitivity; 98.9% (95% CI: 93.5% to 99.9%) specificity; 85.7% (95% CI: 42% to 99.2%) positive predictive value; 100% (95% CI: 95.1% to 100%) negative predictive value; 96 (95% CI: 13.6 to 674.6) LR+; Zero LR-; Cohen's kappa: 0.918, p<0.0001. CSF protein value ≤ 28 mg/dl and CSF glucose/blood glucose ratio ≥0.78 were associated with both PCR-negative result for bacteria or viruses and culture-negative result. The multiplex PCR evaluated in this study showed a very good diagnostic performance compared to culture, and the thresholds found can be a useful tool to best choose which samples to test.


Asunto(s)
Encefalitis Infecciosa/diagnóstico , Meningitis Bacterianas/diagnóstico , Meningitis Fúngica/diagnóstico , Meningitis Viral/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/normas , Adulto , Anciano , Intervalos de Confianza , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Femenino , Hospitales Generales , Humanos , Encefalitis Infecciosa/líquido cefalorraquídeo , Encefalitis Infecciosa/microbiología , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiología , Meningitis Fúngica/líquido cefalorraquídeo , Meningitis Fúngica/microbiología , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/virología , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
9.
J Neurovirol ; 25(4): 589-596, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31102186

RESUMEN

Human adenovirus (HAdV) has been recognized as a significant viral pathogen implicated in neurological diseases, particularly in immunocompromised patients. However, its involvement in meningoencephalitis remains unclear. The aim of this study was to investigate HAdV and other viral co-infections in the cerebrospinal fluid (CSF) of patients suspected of having either meningoencephalitis or encephalitis. A total of 373 CSF samples from patients under clinical suspicion of neurological viral infection were included in this study. HAdV was investigated by conventional or multiplex real-time PCR, for different time periods. The frequency of HAdV central nervous system (CNS) infection was 1.08%, predominating in female patients with a predisposing condition, and presented with HAdV encephalitis. HAdV CNS infection was found to occur during the months of autumn and winter. The frequency of HAdV detected in CSF positive samples increased after the change in the diagnostic method from conventional to multiplex real-time PCR. There were no specific NMRI or EEG characteristics and two CSF samples with HAdV encephalitis had normal CSF WBC count. There were two cases of co-infection with HIV; no other co-infections with enterovirus or herpes family viruses were detected. All patients had good outcome. Although HAdV is rarely observable in CNS infectious syndromes, it must be investigated particularly in immunocompromised patients.


Asunto(s)
Adenovirus Humanos/genética , ADN Viral/genética , Encefalitis Viral/diagnóstico , Meningitis Viral/diagnóstico , Meningoencefalitis/diagnóstico , Adenovirus Humanos/clasificación , Adenovirus Humanos/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Estudios Transversales , ADN Viral/líquido cefalorraquídeo , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/patología , Encefalitis Viral/virología , Femenino , Humanos , Recuento de Leucocitos , Leucocitos/virología , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/patología , Meningitis Viral/virología , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/patología , Meningoencefalitis/virología , Persona de Mediana Edad , Estudios Prospectivos , Estaciones del Año , Carga Viral
10.
Pediatr Neurol ; 96: 70-73, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30935719

RESUMEN

BACKGROUND: Enterovirus-A71 causes outbreaks of brainstem encephalitis, ranging from self-limited disease to acute flaccid paralysis. The aim of this study was to assess the role of cerebrospinal fluid (CSF) neopterin as a biomarker of disease severity in children with enterovirus-related brainstem encephalitis. METHODS: A descriptive, prospective cohort study was conducted from April 2016 to March 2017 in a tertiary hospital. Pediatric patients with a diagnosis of brainstem encephalitis with or without myelitis due to enterovirus infection were enrolled. The final study group comprised a convenience sample including all patients with sufficient CSF volume for neopterin determination. The major variables considered in estimating the severity were the diagnosis of encephalomyelitis, the presence of lesions and extensive lesions on brain and spinal magnetic resonance imaging (MRI), hospital stay length greater than seven days, and sequelae at day 30. RESULTS: Of 60 patients, CSF neopterin could be measured in 36. Median age was 26 months (interquartile range: 19 to 32). Thirty-three were diagnosed with brainstem encephalitis and three with encephalomyelitis. Enterovirus-A71 was the only identified genotype (25 of 25). CSF neopterin levels were elevated (>61 nmol/L) in 33 of 36 (92%), with a median of 347 nmol/L (interquartile range: 204 to 525). CSF neopterin was useful to distinguish patients with lesions on MRI (area under the receiver operating characteristic curve = 0.76; P = 0.02) and extensive lesions (area under the receiver operating characteristic curve = 0.76; P = 0.04). CONCLUSIONS: This study suggests an association between CSF neopterin levels and the presence of inflammatory lesions on MRI.


Asunto(s)
Tronco Encefálico , Encefalitis Viral/líquido cefalorraquídeo , Encefalomielitis/líquido cefalorraquídeo , Enterovirus Humano A/patogenicidad , Infecciones por Enterovirus/líquido cefalorraquídeo , Neopterin/líquido cefalorraquídeo , Tronco Encefálico/patología , Tronco Encefálico/fisiopatología , Tronco Encefálico/virología , Preescolar , Encefalitis Viral/patología , Encefalitis Viral/fisiopatología , Encefalitis Viral/virología , Encefalomielitis/patología , Encefalomielitis/fisiopatología , Encefalomielitis/virología , Infecciones por Enterovirus/patología , Infecciones por Enterovirus/fisiopatología , Infecciones por Enterovirus/virología , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos
11.
J Neurol Sci ; 398: 176-183, 2019 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-30731305

RESUMEN

Viral meningitis is an inflammation of the meninges associated with acute onset of meningeal symptoms and fever, pleocytosis of the cerebrospinal fluid, and no growth on routine bacterial culture. It is sometimes associated with viral encephalitis and meningoencephalitis. Viruses reach the central nervous system (CNS) hematogenously or in a retrograde manner from nerve endings. The viral etiology varies according to age and country. Molecular diagnostics technology has helped improve the rate of pathogen detection reducing unnecessary antibiotic use and length of hospitalization. Most of the viral infections detailed in this article have no specific treatment other than supportive care. Many of the viruses discussed are preventable by vaccination and proper skin protection against transmitting vectors.


Asunto(s)
Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Aséptica/diagnóstico , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/diagnóstico , Encefalitis Viral/inmunología , Humanos , Meningitis Aséptica/inmunología , Meningitis Viral/inmunología
12.
PLoS One ; 14(1): e0209993, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30640927

RESUMEN

The objective of this study was to characterize the prevalence of viral encephalitis due to arbovirus infection of the Togaviridae and Flaviviridae families in São Paulo, Brazil. A total of 500 cerebrospinal fluid (CSF) samples collected between August 2012 and January 2013, from patients with symptoms of acute encephalitis were analyzed. Findings suggestive of viral encephalitis-elevations in cell concentration, glucose and total protein-were observed in 234 (46.8%) samples, designated as Group 1. The remaining 266 samples comprised Group 2. All samples were tested for Flaviviruses (dengue virus 1, 2, 3 and 4, yellow fever virus and West Nile virus), Alphavirus (NS5 region) and enterovirus by RT- PCR and for herpesviruses and enteroviruses using CLART-Entherpex. A presumptive viral etiological agent was detected in 26 samples (5.2%), 18 (8.0%) in Group 1 and 8 (3.0%) in Group 2. In Group 1 human herpesviruses were detected in 9 cases, enteroviruses in 7 cases, dengue viruses (DENV) in 2 CSFs and St. Louis encephalitis virus (SLEV) in one case. In Group 2 there were 3 CSFs positive for human herpesviruses, 2 for enteroviruses, 2 for DENV and 1 for SLEV. Detection of arboviruses, even though present in a minority of infected patients, identifies these viruses as a probable etiological agent of encephalitis. This is of special concern in regions where this class of viruses is endemic and has been linked to other recent epidemics.


Asunto(s)
Arbovirus/aislamiento & purificación , Encefalitis Viral/epidemiología , Encefalitis Viral/virología , Flaviviridae/aislamiento & purificación , Togaviridae/aislamiento & purificación , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Virus del Dengue/aislamiento & purificación , Virus de la Encefalitis de San Luis/aislamiento & purificación , Encefalitis Viral/líquido cefalorraquídeo , Enterovirus/aislamiento & purificación , Femenino , Herpesviridae/aislamiento & purificación , Humanos , Lactante , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Adulto Joven
13.
J Pediatr Hematol Oncol ; 41(1): e27-e29, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29315142

RESUMEN

A boy with central nervous system relapse of Burkitt leukemia developed fever and neurologic symptoms and cognitive impairment. He had received multi-drug chemotherapy including rituximab. Enterovirus (EV) was detected in cerebrospinal fluid by polymerase chain reaction, and magnetic resonance imaging findings were consistent with viral infection. The patient was treated with intravenous immunoglobulin and within 1 month cleared his EV. Rituximab can cause a profound B-cell deficiency predisposing patients to infections including EV encephalitis. This is the first report of enteroviral encephalitis in a child undergoing treatment for lymphoma with rituximab and suggests the need to watch for this complication of therapy.


Asunto(s)
Linfoma de Burkitt , Neoplasias del Sistema Nervioso Central , Encefalitis Viral , Infecciones por Enterovirus , Enterovirus/genética , Rituximab/efectos adversos , Linfoma de Burkitt/líquido cefalorraquídeo , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/genética , Linfoma de Burkitt/virología , Neoplasias del Sistema Nervioso Central/líquido cefalorraquídeo , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/genética , Neoplasias del Sistema Nervioso Central/virología , Preescolar , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/inducido químicamente , Encefalitis Viral/genética , Infecciones por Enterovirus/líquido cefalorraquídeo , Infecciones por Enterovirus/inducido químicamente , Infecciones por Enterovirus/genética , Humanos , Masculino , Rituximab/administración & dosificación
14.
Biomedica ; 38(2): 216-223, 2018 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-30184350

RESUMEN

Introduction: Viral encephalitis is a well-known inflammatory process associated with neurological dysfunction that might derive into severe brain damage or a fatal outcome. In México there is no epidemiological data that describes the prevalence of viral agents responsible for acute encephalitis. Objective: To identify the main viral agents by real time PCR involved in acute encephalitis in Mexico. Materials and methods: We obtained cerebral spinal fluid (CSF) samples from all patients with suspected viral encephalitis admitted to the emergency service of the Hospital Civil de Guadalajara "Fray Antonio Alcalde". To identify pathogens, we performed nucleic acid extraction using real-time PCR and RT-PCR. Results: Sixty-six patients were diagnosed with acute encephalitis from 2011 to 2014. A definitive viral etiological diagnosis was established in 16 patients (24%); the main causative agents were enteroviruses in 50% of the 16 positive samples, followed by herpes simplex virus (37%) and cytomegaloviruses (12.5%). Patients with encephalitis were predominantly male (63.3%) and a seasonal predominance was observed during autumn (37.5%). The main clinical characteristics in the acute encephalitis phase were fever (48.45) and cephalea (36.3), followed by seizures, disorientation, and muscular weakness (30.3%). Kerning sign was present in two cases (3%) and other two cases presented Brudzinski's sign (3%). Conclusions: CSF PCR is a suitable diagnostic technique for the identification of viral encephalitis caused by viral infections that allows an appropriate antiviral therapeutic treatment.


Asunto(s)
Virus de la Encefalitis/aislamiento & purificación , Encefalitis Viral/virología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Preescolar , Encefalitis Viral/líquido cefalorraquídeo , Femenino , Humanos , Lactante , Masculino , México , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Tiempo , Adulto Joven
15.
New Microbiol ; 41(2): 118-125, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29620789

RESUMEN

Infectious diseases of the central nervous system (CNS) such as meningitis/encephalitis (ME) require rapid identification of causative pathogens for effective treatment. This study evaluated the analytical performance and clinical utility of a fully automated multiplex PCR test to improve the microbiological diagnostic workup of ME. Seventy-seven cerebrospinal fluid (CSF) samples from 77 patients with suspected ME were studied. The samples were tested by FilmArray™ (FA) ME Panel test and the results were compared with those obtained using conventional microbiological procedures (CMP). Furthermore, the assay's validity was evaluated testing 5 pooled CSF samples positive for different pathogens. The data showed a good concordance (90.9%) between the FA ME panel test and CMP results. Discrepant results were observed in CSF samples with low viral load (5/77) and in samples of patients (2/77) undergoing antimicrobial therapy for fungal infection. The ability of the FA ME panel test to correctly detect the target pathogens was confirmed. Faster microbiological diagnosis was obtained by the FA ME test in comparison to CMP for both bacterial and viral analytes (P<0.001). Implementation of microbiological diagnostic workup with FA ME panel test may improve the management of patients with suspected CNS infection.


Asunto(s)
Automatización de Laboratorios/métodos , Encefalitis Viral/diagnóstico , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Adulto , Bacterias/clasificación , Bacterias/aislamiento & purificación , Niño , Encefalitis Viral/líquido cefalorraquídeo , Femenino , Humanos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Virus/clasificación , Virus/aislamiento & purificación
16.
J Neurovirol ; 24(3): 333-338, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29536269

RESUMEN

Neurological manifestations associated with HHV-7 have been described in primary infection in children, and very occasionally in immunocompromised adult patients. However, the role of HHV-7 reactivation as a cause of central nervous system (CNS) diseases in immunocompetent adults has not yet been defined. We retrospectively analyzed clinical and microbiological features of adults with neurological symptoms who underwent lumbar puncture and a multiplex polymerase chain reaction (PCR) for herpesviruses (HHV-1-8) and enteroviruses performed in cerebrospinal fluid (CSF), during a 4-year period. A total of 251 subjects were included. Mean age was 55 years, ranging 15-89. Globally, HHV-7 DNA was detected in CSF in 14 patients (5.6%). It was detected in 1 of 36 patients with microbiologically confirmed CNS infections, and in 7 of 172 patients with diagnoses of non-infectious neurological disorders (Specificity 0.96, 95% confidence interval 0.93-0.99). Additionally, HHV-7 DNA was detected in 6 of 21 patients (28.6%) with probable CNS infections (compatible clinical syndrome and CSF changes) in the absence of other causative agent: four meningitis, one myelitis, and one encephalitis. Treatment with foscarnet was effective in achieving improvement of symptoms and clearance of HHV-7 DNA in CSF in the cases of encephalitis and myelitis, while ganciclovir was ineffective in the case of encephalitis. Our results show that HHV-7 reactivation may cause CNS disease in immunocompetent adults and that detection of HHV-7 DNA in CSF as a false-positive result or as asymptomatic reactivation in adult patients with neurological diseases is uncommon. Foscarnet seems the first-line treatment for HHV-7 CNS disease.


Asunto(s)
ADN Viral/genética , Encefalitis Viral/diagnóstico , Herpesvirus Humano 7/genética , Meningitis Viral/diagnóstico , Mielitis/diagnóstico , Infecciones por Roseolovirus/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , ADN Viral/líquido cefalorraquídeo , ADN Viral/aislamiento & purificación , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/tratamiento farmacológico , Encefalitis Viral/virología , Femenino , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Herpesvirus Humano 7/aislamiento & purificación , Humanos , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/tratamiento farmacológico , Meningitis Viral/virología , Persona de Mediana Edad , Mielitis/líquido cefalorraquídeo , Mielitis/tratamiento farmacológico , Mielitis/virología , Estudios Retrospectivos , Infecciones por Roseolovirus/líquido cefalorraquídeo , Infecciones por Roseolovirus/tratamiento farmacológico , Infecciones por Roseolovirus/virología , Punción Espinal/métodos
19.
J Med Virol ; 90(3): 609-611, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28976585

RESUMEN

In 2009, the Usutu virus (USUV) was first reported as a cause of human neuroinvasive disorders. In Switzerland, USUV has been detected in wild birds with a seroprevalence of up to 6.59% in captive specimens sampled from zoo enclosures. This study investigates the clinical prevalence of USUV in human acute neuroinvasive disorders in Switzerland. Two hundred and fifty-eight cerebrospinal fluid samples collected between 2015 and 2017 for routine clinical care in a tertiary level hospital (Geneva) were tested for USUV by rRT-PCR. No samples were found positive, suggesting the absence, or the extremely low circulation of USUV in Western Switzerland.


Asunto(s)
Infecciones por Flavivirus/líquido cefalorraquídeo , Flavivirus/aislamiento & purificación , Enfermedades del Sistema Nervioso/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Estudios de Cohortes , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/epidemiología , Flavivirus/genética , Infecciones por Flavivirus/epidemiología , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Proyectos Piloto , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Suiza/epidemiología , Centros de Atención Terciaria , Adulto Joven
20.
Dis Markers ; 2017: 2594231, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28912622

RESUMEN

OBJECTIVE: To compare local and systemic profiles between different disease pathologies (pneumonia and encephalitis) induced by influenza A virus (IAV). METHODS: An IAV pneumonia model was created by intranasal inoculation of C57BL/6 mice with influenza A/WSN/33 (H1N1) virus. Lung lavage and blood collection were performed on day 3 after IAV inoculation. Similarly, an IAV encephalitis mouse model was created by direct intracranial IAV inoculation. Cerebrospinal fluid (CSF) and blood collection were conducted according to the same schedule. Cytokine/chemokine profiles were produced for each collected sample. Then the data were compared visually using radar charts. RESULTS: Serum cytokine profiles were similar in pneumonia and encephalitis models, but local responses between the bronchoalveolar lavage fluid (BALF) in the pneumonia model and CSF in the encephalitis model differed. Moreover, to varying degrees, the profiles of local cytokines/chemokines differed from those of serum in both the pneumonia and encephalitis models. CONCLUSION: Investigating local samples such as BALF and CSF is important for evaluating local immune responses, providing insight into pathology at the primary loci of infection. Serum data alone might be insufficient to elucidate local immune responses and might not enable clinicians to devise the most appropriate treatment strategies.


Asunto(s)
Encefalitis Viral/inmunología , Infecciones por Orthomyxoviridae/inmunología , Neumonía Viral/inmunología , Animales , Líquido del Lavado Bronquioalveolar/inmunología , Citocinas/sangre , Citocinas/líquido cefalorraquídeo , Encefalitis Viral/sangre , Encefalitis Viral/líquido cefalorraquídeo , Subtipo H1N1 del Virus de la Influenza A/inmunología , Ratones , Ratones Endogámicos C57BL , Infecciones por Orthomyxoviridae/sangre , Infecciones por Orthomyxoviridae/líquido cefalorraquídeo , Neumonía Viral/sangre , Neumonía Viral/líquido cefalorraquídeo
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