ABSTRACT
Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.
Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.
Subject(s)
Enterovirus Infections/diagnosis , Meningitis, Viral/virology , Myelitis/virology , Paralysis/virology , Child , Enterovirus Infections/drug therapy , Enterovirus Infections/pathology , Female , Humans , Meningitis, Viral/drug therapy , Myelitis/drug therapy , Paralysis/drug therapy , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Neurogenic/virology , gamma-Globulins/administration & dosageSubject(s)
Antiviral Agents/therapeutic use , Enterovirus Infections/drug therapy , Neonatal Sepsis/drug therapy , Oxadiazoles/therapeutic use , Double-Blind Method , Enterovirus Infections/mortality , Female , Humans , Infant, Newborn , Male , Neonatal Sepsis/mortality , Oxazoles , Placebo Effect , Reproducibility of Results , Time Factors , Treatment OutcomeABSTRACT
X-linked agammaglobulinemia (XLA) has been associated with a broad range of infections, but enteroviral disease represents one of the most damaging infections. The risk of enteroviral infection in XLA is lower now than in the setting of intramuscular immunoglobulin or in patients without immunoglobulin replacement, but the rate of infection has not declined significantly in the era of intravenous immunoglobulin replacement. Enteroviruses can cause inflammation of nearly every organ, but in XLA, infections often manifest as dermatomyositis or chronic meningoencephalitis. Difficulty and delay in recognizing symptoms and lack of specific therapy contribute to the poor outcomes. Furthermore, cerebrospinal fluid detection of enteroviruses is not very sensitive. Reluctance to perform brain biopsies can lead to significant delays. The other feature compromising outcomes is the lack of specific therapy. High-dose peripheral and intraventricular immunoglobulin have been used, but failure is still common. New antienteroviral drugs are in development and show promise for immunodeficient patients with life-threatening infections with enterovirus.
Subject(s)
Agammaglobulinemia , Enterovirus Infections , Genetic Diseases, X-Linked , Agammaglobulinemia/diagnosis , Agammaglobulinemia/drug therapy , Agammaglobulinemia/epidemiology , Agammaglobulinemia/virology , Antiviral Agents/therapeutic use , Brain/diagnostic imaging , Brain/virology , Child, Preschool , Enterovirus/genetics , Enterovirus/isolation & purification , Enterovirus Infections/diagnosis , Enterovirus Infections/drug therapy , Enterovirus Infections/epidemiology , Enterovirus Infections/virology , Genetic Diseases, X-Linked/diagnosis , Genetic Diseases, X-Linked/drug therapy , Genetic Diseases, X-Linked/epidemiology , Genetic Diseases, X-Linked/virology , Humans , Magnetic Resonance Imaging , Male , Phenyl Ethers/therapeutic useABSTRACT
BACKGROUND: There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression. METHODS: Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 ± 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were re-catheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included. RESULTS: Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 ± 2.8% to 45.7 ± 8.6% (versus 20.0 ± 4.0% to 22.0 ± 9.0% in historical controls, p<0.01) and cardiac index from 3.28 ± 0.51 L/min/m(2) to 4.40 ± 0.49 L/min/m(2) (versus 3.50 ± 0.40 L/min/m(2) to 3.70 ± 0.50 L/min/m(2) in controls, p<0.01), regardless of the presence of viral genomes (p=0.98 and p=0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 ± 3.6% to 27.5 ± 10.6%). CONCLUSION: Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium.
Subject(s)
Cardiomyopathy, Dilated , Immunosuppressive Agents/therapeutic use , Myocarditis , Virus Diseases , Adenovirus Infections, Human/complications , Adenovirus Infections, Human/drug therapy , Adenovirus Infections, Human/immunology , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/immunology , Cardiomyopathy, Dilated/virology , Child , Child, Preschool , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/immunology , DNA, Viral/isolation & purification , Enterovirus Infections/complications , Enterovirus Infections/drug therapy , Enterovirus Infections/immunology , Genome, Viral , Herpes Simplex/complications , Herpes Simplex/drug therapy , Herpes Simplex/immunology , Humans , Infant , Myocarditis/drug therapy , Myocarditis/immunology , Myocarditis/virology , Myocardium/immunology , Virus Diseases/complications , Virus Diseases/drug therapy , Virus Diseases/immunologyABSTRACT
Los enterovirus son responsables de la mayoría de las meningitis virales agudas. Menos conocida es su incidencia en otras entidades neurológicos que afectan el sistema nervioso central (SNC). Se presentan dos casos clínicos, el primero corresponde a la encefalitis de curso agudo en un pacinete oncológico y el restante a una mielitis transversa aguada, que ilustran lo mencionado. En ambos casos fueron fundamentales las técnicas de reacción de cadena de polimerasa (PCR) aplicadas al líquido cefalorraquideo (LCR) para arribar al diagnóstico etiológico. Se menciona al Pleconaril como agente antiviral de utilidad. (AU)