RESUMO
We conducted a retrospective audit of the outcomes of patients 15 years of age and older from the greater Auckland region who had a diagnosis of encephalitis over a five-year period. Patients were identified via a database search of all patients who had a cerebrospinal fluid (CSF) viral polymerase chain reaction (PCR) panel requested between 2005 and 2009. All CSF viral PCR were performed at one laboratory. This test was used as a default marker for patients who may have had encephalitis. There were 37 patients who met our definition of encephalitis during the study. Their ages ranged from 15 to 88 years (median 51 years), and 59% were female. There was an admission rate of 7.4 admissions per year or an annual incidence of approximately 0.5 cases per 100,000. An infective cause was found in 10 patients (27%): varicella zoster in five patients (14%), herpes simplex in four (11%) and enterovirus in one patient (3%). An autoimmune paraneoplastic encephalitis was felt most likely in three patients (8%); a paraneoplastic antibody screen was performed in two of these three but was negative in both. The cause of encephalitis was not identified in the other 24 patients (65%). There were five deaths (in-hospital mortality rate 14%). Encephalitis is an uncommon but important disease, because of the significant mortality. The cause of encephalitis remained undetermined in two-thirds of patients.
Assuntos
Encefalite/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/epidemiologia , Encefalite/etiologia , Encefalite/mortalidade , Encefalite Viral/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Síndromes Paraneoplásicas/epidemiologia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/mortalidade , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Adulto JovemRESUMO
Previously, a strategy for monitoring pigs intended for cell transplantation was developed and successfully applied to several representative herds in New Zealand. A better understanding of porcine viruses' epidemiology in New Zealand has been achieved, and, as a result, a designated pathogen-free (DPF) herd has been chosen as a good candidate for xenotransplantation. This herd is free of all infectious agents relevant to xenotransplantation. The presented study of pig endogenous retrovirus (PERV) transmission with cocultures in vitro has shown no evidence of PERV transmission from DPF pig tissue. Additionally, in PERV-C-positive DPF donor pigs tested, a specific locus for PERV-C present in miniature swine possibly associated with the transmission of PERV was absent. The data on PERV transmission allowed classifying the DPF potential donors as "null" or noninfectious pigs.
Assuntos
Retrovirus Endógenos/patogenicidade , Infecções por Retroviridae/transmissão , Organismos Livres de Patógenos Específicos , Doenças dos Suínos/virologia , Transplante Heterólogo , Criação de Animais Domésticos/normas , Animais , Contagem de Células , Linhagem Celular , Retrovirus Endógenos/genética , Retrovirus Endógenos/isolamento & purificação , Feto , Humanos , Rim/embriologia , Rim/virologia , Masculino , Nova Zelândia , Infecções por Retroviridae/prevenção & controle , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Segurança , Suínos , Testículo/embriologia , Testículo/virologiaRESUMO
Previously a strategy for monitoring of pigs intended for cell transplantation was developed and successfully applied to several representative herds in New Zealand. A designated pathogen-free (DPF) herd has been chosen as a good candidate for xenotransplantation. This herd has previously tested free of infectious agents relevant to xenotransplantation and we present here an in depth study of porcine endogenous retrovirus (PERV) transmission. A panel of assays that describes the constraints for the transmission of PERV has been suggested. It includes a) infectivity test in coculture of DPF pig primary cells with both human and pig target cell lines; b) RT activity in supernatant of stimulated primary cells from DPF pigs; c) viral load in donor's blood plasma; d) PERV proviral copy number in DPF pig genome; e) PERV class C prevalence in the herd and its recombination potential. There was no evidence of PERV transmission from DPF pig tissue to either pig or human cells. Additionally, there was no evidence of PERV RNA present in pig blood plasma. PERV copy number differs in individual pigs from as low as 3 copies to 30 copies and the presence of PERV-C varied between animals and breeds. In all DPF pigs tested, a specific locus for PERV-C potentially associated with the recombination of PERV in miniature swine was absent. Presented data on the PERV transmission allows us to classify the DPF potential donors as "null" or noninfectious pigs.
Assuntos
Retrovirus Endógenos/patogenicidade , Infecções por Retroviridae/veterinária , Doenças dos Suínos/virologia , Animais , Linhagem Celular , Primers do DNA , Retrovirus Endógenos/enzimologia , Retrovirus Endógenos/genética , Humanos , Rim , Nova Zelândia , Reação em Cadeia da Polimerase , DNA Polimerase Dirigida por RNA/genética , DNA Polimerase Dirigida por RNA/metabolismo , Infecções por Retroviridae/transmissão , Organismos Livres de Patógenos Específicos , Suínos/virologia , Proteínas Virais/genéticaAssuntos
Infecções por Herpesviridae/patologia , Herpesvirus Humano 8/patogenicidade , Linfoma Relacionado a AIDS/diagnóstico , Linfoma de Células B/virologia , Neoplasias da Medula Espinal/virologia , Adulto , DNA Viral/análise , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/virologia , Herpesvirus Humano 8/genética , Humanos , Linfoma Relacionado a AIDS/patologia , Linfoma Relacionado a AIDS/virologia , Linfoma de Células B/diagnóstico , Linfoma de Células B/patologia , Masculino , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/patologiaRESUMO
Interest in porcine circovirus has been stimulated by the recent emergence of postweaning multisystemic wasting syndrome (PMWS) in pigs and the potential use of pig organs for xenotransplantation in humans. Porcine circovirus type 1 (PCV1) is considered to be widespread in pigs but nonpathogenic. Circovirus type 2 (PCV2) is a similar virus but has been differentiated only recently as a separate type. High tissue concentrations of PCV2 are associated with lesions in PMWS cases, but the etiological role of this agent in the disease remains unclear. The presence of PCV1 in New Zealand pigs has been previously reported based on serological data. PMWS has been recently recorded in New Zealand pigs. The epidemiology of PCV2 in New Zealand pigs has not been examined. The purpose of the study was to look for evidence of circoviruses in New Zealand pig herds. Pig circovirus DNA was sought in various tissues using the polymerase chain reaction. Circovirus type 2 was found in New Zealand pig herds, without any evidence that PMWS has ever occurred in these herds. Newborn piglets were shown to have infection, suggesting vertical transmission of the virus.
Assuntos
Circovirus/isolamento & purificação , Suínos/virologia , Envelhecimento , Animais , Infecções por Circoviridae/epidemiologia , Infecções por Circoviridae/veterinária , Pulmão/crescimento & desenvolvimento , Pulmão/virologia , Masculino , Nova Zelândia , Reação em Cadeia da Polimerase , Sêmen/virologia , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/virologiaRESUMO
This study represents a long-term follow-up of human patients receiving pig islet xenotransplantation. Eighteen patients had been monitored for up to 9 years for potentially xenotic pig viruses: pig endogenous retrovirus, pig cytomegalovirus, pig lymphotropic herpesvirus, and pig circovirus type 2. No evidence of viral infection was found.
Assuntos
Transplante das Ilhotas Pancreáticas/efeitos adversos , Doenças dos Suínos/transmissão , Transplante Heterólogo/efeitos adversos , Viroses/virologia , Vírus/isolamento & purificação , Zoonoses/virologia , Animais , Humanos , Leucócitos Mononucleares/virologia , Suínos , Doenças dos Suínos/virologia , Viroses/transmissão , Viroses/veterinária , Vírus/classificaçãoRESUMO
We report three childhood cases of myocarditis associated with human parvovirus (B19 virus). All three children presented with significant cardiac decompensation, with one requiring extracorporeal membrane oxygenation support. Left ventricular function was severely impaired in all three. Myocardial biopsy confirmed histological myocarditis and was positive for B19 virus by nested polymerase chain reaction. Serum was positive for IgG B19 virus but negative for IgM in all three cases. All three children were treated with diuretics, ACE inhibitors, and immunosuppression. Prednisone and cyclosporin were continued until there was echocardiographic and histological improvement. All made a full clinical and echocardiographic recovery.
Assuntos
Miocardite/virologia , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano , Criança , Pré-Escolar , Humanos , Lactente , MasculinoRESUMO
Subacute sclerosing panencephalitis (SSPE) and subacute measles encephalitis (SME) are both rare complications of measles virus infection. SSPE typically affects immunocompetent children, has an insidious onset and follows a steadily progressive course. SME mainly occurs in immunosuppressed children and has a rapidly progressive course. We describe a 43 year old immunocompetent man who presented with a rapidly progressive fatal encephalopathy. Histological examination of the brain showed a meningoencephalitis with inclusion bodies. Complement fixing antibody to measles virus was present in his serum and CSF. Measles virus RNA was found in the brain, spinal cord and eye, but not in the CSF. Analysis of the nucleoprotein gene isolated from this patient did not show similarity to SSPE strains of the measles virus. This patient demonstrates that subacute encephalitis secondary to measles virus infection can develop in an immunocompetent adult host.
Assuntos
Encefalite/etiologia , Sarampo/complicações , Adulto , Encéfalo/patologia , Encéfalo/virologia , Eletroencefalografia , Encefalite/patologia , Encefalite/virologia , Evolução Fatal , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Masculino , Sarampo/patologia , Sarampo/virologia , Microscopia Eletrônica , RNA Viral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tomografia Computadorizada por Raios XRESUMO
The objectives of the present study were to establish the presence of hepatitis E virus (HEV) in New Zealand pigs, first by testing for HEV antibody in pig herds throughout New Zealand to measure the herd prevalence, then by attempting to amplify HEV genomic sequences by PCR. Antibody was measured by two independently designed ELISA serology tests. HEV RNA fragments were amplified by RT-PCR of nucleic acid extracted from faeces of 10-12-week-old piglets using primers targeting ORF1, ORF2, and ORF2/3. PCR products were subject to phylogenetic analysis. Antibody to HEV was found throughout New Zealand pig herds as well as in the different age groups within the herds. Twenty herds from 22 tested were positive for HEV antibody (91% herd prevalence). Phylogenetic analysis of the amplified sequences placed this New Zealand strain of HEV closest to the human European strain It-1 (AF 110390) and U.S. swine strain (AF 082843) with 88% and 83% similarity respectively in ORF1. It was concluded that HEV is widely distributed in the New Zealand pig population. Phylogenetic analysis shows that this is a new HEV strain, grouping most closely with the United States/European cluster, which includes HEV strains of both human and swine origin.
Assuntos
Vírus da Hepatite E/genética , Hepatite E/veterinária , Doenças dos Suínos/epidemiologia , Animais , Fezes/virologia , Anticorpos Anti-Hepatite/sangue , Hepatite E/epidemiologia , Hepatite E/virologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/imunologia , Vírus da Hepatite E/isolamento & purificação , Humanos , Dados de Sequência Molecular , Nova Zelândia/epidemiologia , Filogenia , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Suínos , Doenças dos Suínos/virologia , Zoonoses/virologiaRESUMO
A 53-year-old man developed progressive sensory disturbance and weakness in the legs, sphincter disturbance, back pain, systemic symptoms, and pancytopenia. Electrophysiological tests indicated a widespread lumbosacral polyradiculopathy. Spinal magnetic resonance imaging and routine cerebrospinal fluid analysis showed minor nonspecific abnormalities. Bone marrow and liver biopsies showed hemophagocytosis; and polymerase chain reaction of cerebrospinal fluid, bone marrow, and serum suggested active infection with human herpesvirus-6. Autopsy revealed that his neurological symptoms resulted from intravascular lymphomatosis (angiotropic large cell lymphoma), a rare variant of lymphoma with predilection for the nervous system.
Assuntos
Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Polirradiculopatia/diagnóstico , Polirradiculopatia/etiologia , Diagnóstico Diferencial , Evolução Fatal , Infecções por Herpesviridae/diagnóstico , Herpesvirus Humano 6 , Humanos , Região Lombossacral , Linfoma Difuso de Grandes Células B/virologia , Masculino , Pessoa de Meia-Idade , Pancitopenia/diagnóstico , Polirradiculopatia/virologiaRESUMO
Vaccine-associated paralytic poliomyelitis (VAPP) is a very rare complication of oral polio vaccine (OPV), seen predominantly with first exposure to OPV. Reversion of vaccine strain poliovirus to a more neurovirulent strain of the virus is thought to be necessary for paralytic disease to occur. Vaccine-associated poliomyelitis can occur in either recipients of the vaccine or in susceptible contacts. We describe an episode of VAPP in an infant in whom paralysis became evident at age 124 days, 14 days after administration of the second dose of OPV vaccine. The second dose of diphtheria-tetanus-pertussis- Haemophilus (DTPH) type-b vaccine had been given at the time of OPV administration, and the hepatitis B vaccine had been administered in the opposite leg. Paralysis was localized to the limb in which the DTPH had been injected.
Assuntos
Paralisia/induzido quimicamente , Poliomielite/induzido quimicamente , Vacina Antipólio Oral/efeitos adversos , Eletromiografia/métodos , Humanos , Lactente , Perna (Membro)/fisiopatologia , Masculino , Hipotonia Muscular/complicações , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/fisiopatologia , Paralisia/complicações , Paralisia/fisiopatologia , Poliomielite/complicaçõesRESUMO
TT-virus (TTV, patient initials: T.T.), a novel DNA virus, was first isolated in Japan in 1997 from serum of a patient with post-transfusion hepatitis of unknown aetiology. To date, the contribution of TTV to liver disease remains doubtful. The potential for transmission via blood and blood products makes it essential to establish the prevalence of TTV viraemia in the blood donor population. 413 blood donor serum samples were chosen randomly, the DNA was extracted and TTV-specific DNA amplified by nested polymerase chain reaction (PCR). TTV infection was present in 13 out of 413 (3.15%) blood donors in the Auckland region of New Zealand using a set of primers targeting open reading frame (ORF) 1. These 13 amplification products (264 bp) were sequenced and TTV genotypes determined. Alignment with published TTV sequences showed that seven (53.8%) of the thirteen positive serum samples belonged to genotype 1, five (38.5%) belonged to genotype 2 and one (7.7%) could not be classified as either genotype 1 or 2. One hundred twenty-seven blood donor serum samples were retested with a second set of primers targeting the 5' region of the TTV genome in a single round PCR. Forty-three samples were positive for TTV DNA with these primers resulting in a prevalence of 37%. The data demonstrate that TTV is present among New Zealand blood donors and support the need for further investigation into the natural history of TTV infection.
Assuntos
Doadores de Sangue , Infecções por Vírus de DNA/virologia , Vírus de DNA/isolamento & purificação , Infecções por Vírus de DNA/epidemiologia , DNA Viral/análise , DNA Viral/sangue , Genótipo , Humanos , Dados de Sequência Molecular , Nova Zelândia/epidemiologia , Filogenia , Reação em Cadeia da Polimerase , Prevalência , Alinhamento de Sequência , Análise de Sequência de DNARESUMO
Transplantation of pig tissues into humans has the potential for cotransferring pig infections. Knowledge of the epidemiology of pig infections transmissible to humans allows the development of risk limitation strategies at the source herd level, but potentially infectious pig endogenous retrovirus (PERV) is ubiquitous in all domestic pigs and therefore is not avoidable. Using a specific and sensitive RT-PCR and nested PCR for PERV nucleic acids with primers, the screening of pigs from New Zealand herds for the presence and expression of the PERV was conducted. The presence of PERV proviral DNA (pol and env region) and viral RNA was demonstrated in all tested pig tissues including pancreas, liver, spleen, brain, heart, and PBMC. Using the same assays it was established that different tissues (liver, spleen, and heart) of nude and nonobese diabetic (NOD) mice previously transplanted with nonencapsulated pig islets were PERV DNA and RNA negative. Alginate polylysine capsules prepared with encapsulated pig islets were tested for possible leakage of viral particles or viral nucleic acids. RNA was extracted from the supernatant of viable encapsulated pig islet cells grown in culture for 2 months. No evidence of PERV RNA or of cellular nucleic acids could be found. Two adult type I diabetic subjects were transplanted with 1 x 10(6) neonatal pig islets encased in alginate capsules into the peritoneal cavity. One patient was immunosuppressed. Both showed evidence of graft function (up to 34% reduction in insulin dose, corresponding increase in serum pig C-peptide) for up to 2 years. DNA and RNA were extracted from PBMC and blood plasma of both patients at 19 months posttransplant. No evidence of PERV proviral DNA or RNA could be detected. Piglet islets contain PERV DNA and RNA, but this does not traverse the capsules used or produce any evidence of infection in nude and nonobese diabetic (NOD) mice or humans.
Assuntos
Diabetes Mellitus Tipo 1/terapia , Retrovirus Endógenos/isolamento & purificação , Transplante das Ilhotas Pancreáticas/métodos , Infecções por Retroviridae/diagnóstico , Zoonoses/virologia , Adulto , Animais , Cápsulas , Retrovirus Endógenos/genética , Feminino , Humanos , Masculino , RNA Viral/análise , Segurança , Suínos , Transplante HeterólogoAssuntos
Meningite Viral/diagnóstico , Infecções por Parvoviridae/diagnóstico , Parvovirus B19 Humano/isolamento & purificação , Pré-Escolar , Doença Crônica , DNA Viral/análise , Feminino , Humanos , Meningite Viral/complicações , Infecções por Parvoviridae/complicações , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaçõesRESUMO
This report describes the containment of a potential enterovirus epidemic in a neonatal intensive care unit. A case of neonatal enterovirus meningitis and myocarditis was identified. Polymerase chain reaction (PCR) was used to assist in appropriate cohorting of contacts. One further infant became cross-infected with Coxsackie B4. Serum PCR was accurate in detecting the infection in the early stages in this asymptomatic neonate. Neonatal enterovirus infection is relatively rare but has the potential to cause outbreaks in neonatal wards. PCR can be used to diagnose and monitor for cross infection.
Assuntos
Infecções por Coxsackievirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Enterovirus Humano B , Controle de Infecções/métodos , Unidades de Terapia Intensiva Neonatal , Meningite Viral/prevenção & controle , Miocardite/prevenção & controle , Infecções por Coxsackievirus/diagnóstico , Infecções por Coxsackievirus/virologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/virologia , DNA Viral/análise , Enterovirus Humano B/genética , Humanos , Recém-Nascido , Masculino , Meningite Viral/diagnóstico , Meningite Viral/virologia , Miocardite/diagnóstico , Miocardite/virologia , Reação em Cadeia da PolimeraseRESUMO
We describe a 46-year-old man in whom retinitis was diagnosed as his initial HIV and AIDS defining illness. A diagnosis of CMV infection was made based on the clinical appearance of the fundus and confirmed by DNA polymerase chain reaction (PCR) on his vitreous biopsy. His CD4+ T lymphocyte count at the time was 580 x 10(6)/l (16%) with a CD4:CD8 ration of 0.28. He had a splenectomy following trauma more than 20 years earlier. He responded very well to intravenous and oral ganciclovir and remains recurrence-free almost 2 years later. This case and others highlight two issues: (i) CMV retinitis in HIV positive is not confined to those with very low CD4+ T lymphocyte counts; (ii) previous splenectomy may have an impact on CD4+ cell numbers and function.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/imunologia , Contagem de Linfócito CD4 , Retinite por Citomegalovirus/imunologia , Infecções por HIV/imunologia , Esplenectomia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Relação CD4-CD8 , Retinite por Citomegalovirus/complicações , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Auxiliares-IndutoresRESUMO
A case of chickenpox monoarthritis is described. The presence of varicella zoster virus (VZV) within the joint was demonstrated by the detection of viral DNA in synovial fluid at a time when peripheral blood cells were negative. This strongly suggests a direct role of VZV in causing monoarthritis complicating chickenpox. The use of the polymerase chain reaction allows more rapid (2 days) confirmation of the diagnosis. Early enough diagnosis would raise the question of using acyclovir to shorten the duration of arthritis.
Assuntos
Artrite Infecciosa/virologia , Varicela/complicações , Herpesvirus Humano 3/isolamento & purificação , Líquido Sinovial/virologia , Anticorpos Antivirais , Artrite Infecciosa/imunologia , Varicela/diagnóstico , Varicela/imunologia , Criança , Reações Cruzadas , DNA Viral/análise , Feminino , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/imunologia , Humanos , Articulação do Joelho/virologia , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: Although some studies have reported the presence of Mycobacterium tuberculosis (MTb) DNA in tissues affected by sarcoidosis, the data are conflicting. The aim of this study was to collect prospectively tissue from patients with sarcoidosis in whom tuberculosis had been excluded, and to use polymerase chain reaction (PCR) to search for DNA sequences specific for MTb. METHODS: Fresh tissue samples (node or lung biopsy) taken from 23 patients with newly diagnosed sarcoidosis, 10 with other respiratory disease, and four patients with culture positive tuberculosis were analysed using PCR to amplify a 123 bp fragment of IS6110, the insertion element present in MTb, and nested PCR to further amplify an 85 bp sequence within the 123 bp product. DNA was also extracted from formalin fixed tissue from eight additional patients with sarcoidosis. RESULTS: MTb DNA was not detected in any of the tissue samples from patients with sarcoidosis or other respiratory disease but was found in all four patients with tuberculosis. CONCLUSIONS: This study has shown the absence of MTb DNA in lymph node and lung biopsy samples from patients with sarcoidosis. MTb is therefore unlikely to be a factor in the pathogenesis of this disease.