Síndrome manos, pies, boca. Casos atendidos en el cuerpo de guardia / Syndrome hands, feet, mouth. Cases attended in the body of guard / Síndrome mãos, pés, boca. Casos atendidos no corpo de guarda

RESUMEN La llamada «boca-mano-pie¼ es una enfermedad infecto contagiosa, generalmente benigna, que afecta fundamentalmente a niños pequeños. Se realizó un estudio descriptivo prospectivo a niños atendidos en el cuerpo de guardia con el diagnóstico del síndrome manos, pies, boca en el periodo de octubre a diciembre del año 2017 y enero del 2018, con el objetivo de describir su comportamiento a través de las variables sociodemográficas edad y sexo; área de salud, mes de aparición; factores de riesgo y principales signos y síntomas que motivaron la consulta. El universo y la muestra: constituidos por 507 casos. Para realizar la caracterización de la muestra estudiada se utilizaron estadígrafos descriptivos (frecuencias absolutas y relativas), los datos se procesaron a través del programa profesional estadístico SPSS 22.0 para Windows. Resultados: el 79.3% correspondían al grupo de edad de 1 a 5 años, del sexo femenino; el 40.8% pertenecían al policlínico René Vallejo; el 63.5% asistían a guarderías o círculos infantiles y el 100% manifestó fiebre, erupciones mucocutáneas típicas y malestar general como cuadro clínico. Concluyendo que predominó el grupo de edad entre 1 a 5 años del sexo femenino. El policlínico René Vallejo aportó el mayor número de los casos, en el mes de noviembre. La asistencia a guarderías o círculos infantiles, el hacinamiento junto a la edad menor de 5 años, constituyeron factores de riesgo; la fiebre, la erupción mucocutánea típica y el malestar general fueron los síntomas primarios encontrados en todos los pacientes estudiados.

ABSTRACT The so-called "mouth-hand-foot" is a contagious, usually benign, infectious disease that primarily affects young children. A prospective descriptive study was carried out on children treated in the guard body with the diagnosis of the hands, feet, mouth syndrome in the period from October to December of the year 2017 and January 2018, with the aim of describing their behavior through the sociodemographic variables age and sex; health area, month of appearance; risk factors and main signs and symptoms that motivated the consultation. The universe and the sample: constituted by 507 cases. To perform the characterization of the sample studied, descriptive statisticians (absolute and relative frequencies) were used, the data were processed through the statistical professional program SPSS 22.0 for Windows. Results: 79.3% corresponded to the age group of 1 to 5 years, of the female sex; 40.8% belonged to the René Vallejo polyclinic; 63.5% attended daycare centers or children's circles and 100% manifested fever, typical mucocutaneous rashes and malaise as a clinical picture. Concluding that the age group prevailed between 1 to 5 years of the female sex. The polyclinic René Vallejo contributed the largest number of cases, in the month of November. Attendance at nurseries or children's circles, overcrowding at the age of less than 5 years, were risk factors; Fever, typical mucocutaneous rash and general malaise were the primary symptoms found in all the patients studied.

RESUMO A chamada "boca-mão-pé" é uma doença infecciosa contagiosa, geralmente benigna, que afeta principalmente crianças pequenas. Foi realizado um estudo prospectivo descritivo em crianças tratadas no corpo da guarda com diagnóstico de síndrome das mãos, pés, boca no período de outubro a dezembro do ano de 2017 e janeiro de 2018, com o objetivo de descrever seu comportamento através da variáveis ​​sociodemográficas idade e sexo; área de saúde, mês de aparecimento; fatores de risco e principais sinais e sintomas que motivaram a consulta. O universo e a amostra: constituídos por 507 casos. Para realizar a caracterização da amostra estudada, foram utilizados estatísticos descritivos (frequências absolutas e relativas), os dados foram processados ​​por meio do programa estatístico profissional SPSS 22.0 for Windows. Resultados: 79,3% corresponderam à faixa etária de 1 a 5 anos, do sexo feminino; 40,8% pertenciam à policlínica René Vallejo; 63,5% frequentavam creches ou círculos infantis e 100% manifestavam febre, erupções cutâneas mucocutâneas e mal-estar como quadro clínico. Concluindo que a faixa etária predominou entre 1 e 5 anos do sexo feminino. A policlínica René Vallejo contribuiu com o maior número de casos, no mês de novembro. A presença em creches ou círculos infantis, superlotação com menos de 5 anos, foram fatores de risco; Febre, erupção cutânea mucocutânea típica e mal-estar geral foram os principais sintomas encontrados em todos os pacientes estudados.

Coxsackie B2 Virus Infection Causing Multiorgan Failure and Cardiogenic Shock in a 42-Year-Old Man.

Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses.

Ginsenoside-Rb3 inhibits endothelial-mesenchymal transition of cardiac microvascular endothelial cells.

BACKGROUND: We investigated the effect of Ginsenoside-Rb3 (Rb3) on the endothelial-to-mesenchymal transition (EMT) of cardiac microvascular endothelial cells (CMVECs) following coxsackievirus B3 (CVB3) infection. METHODS: CMVECs were infected with 100 TCID50 CVB3 (CVB3 group) or treated with Rb3 (Rb3 group); stably cultured CMVECs were used as control. Cells treated with the Pyk2 inhibitor TAE226 and PI3K inhibitor LY294002 were used for additional experiments. Cell viability was assessed with the Cell Counting Kit-8 (CCK8). Expression of CD31 and α­smooth muscle actin (α-SMA) was evaluated by immunofluorescence (IF) and Western blotting (WB). Expression of Pyk2, PI3K, and AKT was assessed by real-time polymerase chain reaction (RT-PCR) and WB. RESULTS: Cell morphology, including cell pyknosis, and viability were significantly impaired by CVB3 infection (p < 0.05). However, the morphology of the Rb3 group was unaffected. The CCK8 assay showed that viability in the Rb3 group was increased compared with the CVB3 group (p < 0.05). Expression of CD31 decreased and α­SMA increased in the CVB3 group compared with the control group (p < 0.05), but CD31 increased while α­SMA decreased in the Rb3 group compared with the CVB3 group (p < 0.05). IF staining showed the same trends. The levels of Pyk2, PI3K, AKT, and CD31 were up-regulated in the Rb3 group compared with the CVB3 group, whereas α­SMA decreased (p < 0.05). In the Pyk2-inhibitor group, PI3K, AKT, and CD31 expression was down-regulated while α­SMA expression increased in comparison with the Rb3 group (p < 0.05). In the PI3K-inhibitor group, the levels of AKT and CD31 decreased while α­SMA increased (p < 0.05), although the level of Pyk2 expression showed no obvious change in comparison with the Rb3 group. CONCLUSION: Rb3 inhibited EMT in CMVECs following CVB3 infection via the Pyk2-PI3K-AKT signaling pathway.

Enfermedad boca mano pie. Presentación de un caso / Foot, hand and mouth disease. Case presentation

La enfermedad boca mano pie es una infección altamente contagiosa, causada por el virus Coxsackie A16 y el enterovirus 71. La transmisión ocurre por contacto directo con secreciones nasales, orales, materia fecal y gotas aerolizadas, en una ruta fecal-oral o ruta oral-oral, y a través de objetos contaminados. Se presenta el caso de un paciente de cuatro años de edad que acudió a la consulta de estomatología por la presencia de vesículas dolorosas en la mucosa bucal, las cuales dificultaban su alimentación. Además presentaba rash en manos y pies. Luego de indicársele tratamiento estomatológico, fue remitido al pediatra de su área de salud, quien concluyó el diagnostico de enfermedad boca mano pie. El componente bucal de esta entidad constituye, por lo general, el principal síntoma y el motivo de consulta, sin embargo, es poco conocida en el perfil estomatológico. En ello radica el interés de la presentación, ya que el conocimiento de la fisiopatología y el cuadro clínico de la afección, permite al estomatólogo realizar el diagnóstico diferencial y sospechar clínicamente la enfermedad. 

Foot, hand and mouth disease is a highly contagious disease, caused by the A16 Coxsackie virus and 71 enterovirus. The transmission occurs by the direct contact with nasal and oral secretions or fecal material and sprayed drops, in an oral fecal or fecal oral route and through contaminated objects. A case of a 4 year old patient came to the dental office due to the presence of painful blisters in the oral mucosa which made his feeding difficult. In addition he had a rash in hands and feet. After prescribing dental treatment he was referred to the pediatrician of his health area who conclude the diagnosis of foot, hand and mouth disease. The oral component is generally the main symptom and the chief complaint, however, its almost unknown in its oral profile. That is the reason for the interest of this presentation because knowing its physiopathology and the clinical characteristics of the presentation allows differential diagnosis and clinically suspect the disease.

Effect of Andrographis paniculata Nees extract on coxsackievirus A16 in vitro / 中华临床感染病杂志

Objective To investigate the effect of Andrographis paniculata Nees(APN)extract on Coxsackievirus A16(CVA16)in vitro.Methods African green monkey kidney-derived Vero cells(Vero cells)were treated with APN extract at the concentration of 500.0,250.0,125.0,60.0,30.0,15.0,7.5 and 3.8 μg/mL,the cytotoxicity was determined with cell counting Kit-8 and the IC50was calculated by Probit unit regression method.Direct inactivating activity on CVA16,blocking of CVA16 adsorbing Vero cells and inhibition of CVA16 replication in Vero cells were determined and compared between Ribavirin(RBV) and APN extract with CVA16-infected Vero cells.SPSS 24.0 software was used to analyze the data.Results The selected concentrations of APN extract and RBV for experiment were 15.0, 7.5 and 3.8 μg/mL according to cytotoxicity test.Both of APN extract and RBV had neither direct inactivation on CVA 16 nor blocking of CVA16 adsorbing at the concentration of 15.0,7.5 and 3.8 μg/mL(F=1.54,1.52 and 0.67, 1.68,all P>0.05).However,both drugs had the capability of inhibiting CVA 16 replication in Vero cells at the concentration of 15.0 and 7.5 μg/mL(t=6.87,11.76 and 7.71,12.84,all P<0.05).Conclusion Experimental result shows that APN extract can effectively inhibit CVA 16 replication in Vero cells in vitro.

The Four-Way Stop Sign: Viruses, 12-Lipoxygenase, Islets, and Natural Killer Cells in Type 1 Diabetes Progression.

Natural killer (NK) cells represent an important effector arm against viral infection, and mounting evidence suggests that viral infection plays a role in the development of type 1 diabetes (T1D) in at least a portion of patients. NK cells recognize their target cells through a delicate balance of inhibitory and stimulatory receptors on their surface. If unbalanced, NK cells have great potential to wreak havoc in the pancreas due to the beta cell expression of the as-yet-defined NKp46 ligand through interactions with the activating NKp46 receptor found on the surface of most NK cells. Blocking interactions between NKp46 and its ligand protects mice from STZ-induced diabetes, but differential expression non-diabetic and diabetic donor samples have not been tested. Additional studies have shown that peripheral blood NK cells from human T1D patients have altered phenotypes that reduce the lytic and functional ability of the NK cells. Investigations of humanT1D pancreas tissues have indicated that the presence of NK cells may be beneficial despite their infrequent detection. In non-obese diabetic (NOD) mice, we have noted that NK cells express high levels of the proinflammatory mediator 12/15-lipoxygenase (12/15-LO), and decreased levels of stimulatory receptors. Conversely, NK cells of 12/15-LO deficient NOD mice, which are protected from diabetes development, express significantly higher levels of stimulatory receptors. Furthermore, the human NK92 cell line expresses the ALOX12 protein [human 12-lipoxygenase (12-LO), related to mouse 12/15-LO] via Western blotting. Human 12-LO is upregulated in the pancreas of both T1D and T2D human donors with insulin-containing islets, showing a link between 12-LO expression and diabetes progression. Therefore, our hypothesis is that NK cells in those susceptible to developing T1D are unable to function properly during viral infections of pancreatic beta cells due to increased 12-LO expression and activation, which contributes to increased interferon-gamma production and an imbalance in activating and inhibitory NK cell receptors, and may contribute to downstream autoimmune T cell responses. The work presented here outlines evidence from our lab, as well as published literature, supporting our hypothesis, including novel data.

[Observation on intestinal viral shedding time of hand, foot and mouth disease induced by coxsackievirus A6].

Objective: To observe the intestinal viral shedding time in patients with hand, food and mouth disease (HFMD) induced by coxsackievirus A6 (CA6). Method: Throat swab specimens and stool specimens of HFMD children were collected from those admitted to Hangzhou Children's Hospital between May and October 2015, while fluorescence quantitative PCR was used to detect the viral load.Eeighteen cases of HFMD children were followed up, who were confirmed as CA6 infection via laboratory tests.Stool specimen was collected every 4-7 days, and fluorescence PCR was used for virus nucleic acid detection until the stool viral nucleic acids of infected children turned to be negative.The intestinal virus shedding time of CA6-infected HFMD was compared with the intestinal virus shedding time of 65 children with enterovirus 71 (EV71) infection and 44 children with coxsackievirus A16 (CA16) infection of the previous studies (from May to September 2012). Result: The median stool viral load was 25×10(5) copies/ml (55×10(4) copies/mL, 9×10(6) copies/ml) in CA6-infected children.The numbers of stool virus nucleic acid turning negative were 0 case, 4 cases, 9 cases, 3 cases and 2 cases in 18 children at 1st, 2nd, 3rd, 4th, 5th weeks. At 5th week, the stool virus nucleic acid of children in CA6 group all turned to be negative.The positive rates of stool virus nucleic acid in EV71 group and CA16 group at the 5th week, however, were 31% and 27% respectively.There were statistically significant differences in distribution of positive rate of stool virus nucleic acid between CA6 infected children with EV71 and CA16 infected children (χ(2)=13.894, 10.698, P<0.05). Conclusion: The longest intestinal virus shedding time for CA6-infected HFMD children was 5 weeks, which is obviously shorter than that of EV71- infected children and CA16-infected children.

Enfermedad de mano, pie y boca en un hospital del Callao, 2016 / Hand, foot, and mouth disease in a hospital in Callao in 2016

RESUMEN La enfermedad de mano, pie y boca (EMPB) es una enfermedad exantemática viral, causada principalmente por Coxsackie A16, con una sintomatología típica consistente en fiebre; exantema pápulo-vesicular en manos, pies y genitales; y un enantema ulceroso en boca. En el verano del 2016 se presentó una diversidad de casos en un hospital del Callao en niños y adultos, con una sintomatología compatible con EMPB; el diagnóstico fue clínico, se aplicó terapia de soporte con resolución final de síntomas. En la última década se han presentado reportes en algunos países con una afectación atípica causada por el Coxsackie A6, produciendo lesiones más extensas y en adultos. Sin embargo, el diagnóstico sigue siendo clínico, solo necesitando confirmación virológica en casos atípicos o cuando el diagnóstico no es claro. La importancia de este reporte radica en describir los casos del Callao ocurridos en el verano del 2016, para servir de apoyo a los profesionales de la salud en el diagnóstico y manejo de pacientes con similar sintomatología.

ABSTRACT Hand, foot, and mouth disease (HFMD) is an exanthematous viral disease caused mainly by Coxsackie A16 with a typical symptomatology of fever, papulovesicular rash on the hands, feet, and genitals, and an ulcerous enanthem in the mouth. In the summer of 2016, a variety of cases presented at a hospital in Callao in children and adults with a symptomatology consistent with HFMD. A clinical diagnosis was made, and support therapy was applied, resulting in the resolution of symptoms. In the last decade, reports have emerged in some countries of an atypical involvement caused by Coxsackie A6, producing lesions that are more widely distributed in adults. However, the diagnosis remains clinical, only requiring virological confirmation in atypical cases or when the diagnosis is unclear. The importance of this report stems from its description of the cases in Callao that occurred in the summer of 2016 and serve as an example for health professionals in the diagnosis and management of patients with similar symptomatology.

[Genotype distribution of human enteroviruses isolated from swage in Shanghai during year 2013-2014].

Objective: To explore the time and genotype distribution of human enterovirus (HEV) isolated from sewage in Shanghai in 2013-2014. Methods: One sewage sample each was collected from two local sewage plants located in Minhang District and Jiading District on the same day at the day 24-28 of every month from 2013 to 2014. Each sample weighed 1 L. The specimens were concentrated by anionic membrane absorption, eluted with beef extract solution, and then used to inoculate RD, HEp-2, and L20B cell lines. A total of 249 enterovirus strains were isolated from sewage samples during the study period, including 185 non-polio enterovirus (NPEV) and 64 poliovirus (PV) strains, which were identified as vaccine strains. RT-PCR and Sanger sequencing were performed to identify HEV genotypes. Homologous analysis of VP1 sequences was conducted using BioEdit (version 7.0.0). Phylogenetic analysis was performed using the neighbor-joining method based on the alignment of VP1 gene sequences using MEGA (version 4.0.2). Results: Among 185 NPEV strains, 178 strains were successfully sequenced and classified into 15 genotypes, including coxsackievirus group B (CVB) 2, 3, and 5; enteric cytopathic human orphan (ECHO) virus 1, 3, 6, 7, 11, 13, 19, 20, 24, 25, and 30; and coxsackievirus group A 4. CVB5 and ECHO6 genotypes accounted for 33.5% (56 strains) and 24.9% (43 strains) of NPEV isolates, respectively. During the study period, HEV isolates were mainly isolated in summer and autumn in Minhang District. ECHO6 strains were frequently isolated from June 2013 to July 2014. Thereafter, the number of ECHO6 strains gradually reduced in the second half of 2014. CVB5 strains demonstrated scattered distribution from 2013 to the first half of 2014 and gradually increased in the second half of 2014. The distribution of ECHO6 and CVB5 strains in Jiading District was similar to that in Minhang District. In 2013-2014, CVB5 strains comprised C6 and C8 subgenotypes, which belong to two transmission chains and show large differences compared with foreign strains isolated during the same period. ECHO6 strains comprised C6, C8, and D9 subgenotypes, which belong to three transmission chains. Moreover, ECHO6 subgenotype D9 was a dominant subgenotype in Shanghai, with broad geographical distribution both at home and abroad. Conclusion: Poliovirus was identified as a vaccine strain in environmental surveillance from June 2013 to April 2014 in Shanghai. Several transmission strains of ECHO6 and CVB5 were identified, which were the dominant serotypes.

Genotype distribution of human enteroviruses isolated from swage in Shanghai during year 2013-2014 / 中华预防医学杂志

Objective@#To explore the time and genotype distribution of human enterovirus (HEV) isolated from sewage in Shanghai in 2013-2014.@*Methods@#One sewage sample each was collected from two local sewage plants located in Minhang District and Jiading District on the same day at the day 24-28 of every month from 2013 to 2014. Each sample weighed 1 L. The specimens were concentrated by anionic membrane absorption, eluted with beef extract solution, and then used to inoculate RD, HEp-2, and L20B cell lines. A total of 249 enterovirus strains were isolated from sewage samples during the study period, including 185 non-polio enterovirus (NPEV) and 64 poliovirus (PV) strains, which were identified as vaccine strains. RT-PCR and Sanger sequencing were performed to identify HEV genotypes. Homologous analysis of VP1 sequences was conducted using BioEdit (version 7.0.0). Phylogenetic analysis was performed using the neighbor-joining method based on the alignment of VP1 gene sequences using MEGA (version 4.0.2).@*Results@#Among 185 NPEV strains, 178 strains were successfully sequenced and classified into 15 genotypes, including coxsackievirus group B (CVB) 2, 3, and 5; enteric cytopathic human orphan (ECHO) virus 1, 3, 6, 7, 11, 13, 19, 20, 24, 25, and 30; and coxsackievirus group A 4. CVB5 and ECHO6 genotypes accounted for 33.5% (56 strains) and 24.9% (43 strains) of NPEV isolates, respectively. During the study period, HEV isolates were mainly isolated in summer and autumn in Minhang District. ECHO6 strains were frequently isolated from June 2013 to July 2014. Thereafter, the number of ECHO6 strains gradually reduced in the second half of 2014. CVB5 strains demonstrated scattered distribution from 2013 to the first half of 2014 and gradually increased in the second half of 2014. The distribution of ECHO6 and CVB5 strains in Jiading District was similar to that in Minhang District. In 2013-2014, CVB5 strains comprised C6 and C8 subgenotypes, which belong to two transmission chains and show large differences compared with foreign strains isolated during the same period. ECHO6 strains comprised C6, C8, and D9 subgenotypes, which belong to three transmission chains. Moreover, ECHO6 subgenotype D9 was a dominant subgenotype in Shanghai, with broad geographical distribution both at home and abroad.@*Conclusion@#Poliovirus was identified as a vaccine strain in environmental surveillance from June 2013 to April 2014 in Shanghai. Several transmission strains of ECHO6 and CVB5 were identified, which were the dominant serotypes.

Observation on intestinal viral shedding time of hand, foot and mouth disease induced by coxsackievirus A6 / 中华儿科杂志

Objective@#To observe the intestinal viral shedding time in patients with hand, food and mouth disease (HFMD) induced by coxsackievirus A6 (CA6).@*Method@#Throat swab specimens and stool specimens of HFMD children were collected from those admitted to Hangzhou Children′s Hospital between May and October 2015, while fluorescence quantitative PCR was used to detect the viral load.Eeighteen cases of HFMD children were followed up, who were confirmed as CA6 infection via laboratory tests.Stool specimen was collected every 4-7 days, and fluorescence PCR was used for virus nucleic acid detection until the stool viral nucleic acids of infected children turned to be negative.The intestinal virus shedding time of CA6-infected HFMD was compared with the intestinal virus shedding time of 65 children with enterovirus 71 (EV71) infection and 44 children with coxsackievirus A16 (CA16) infection of the previous studies (from May to September 2012).@*Result@#The median stool viral load was 25×105 copies/ml (55×104 copies/mL, 9×106 copies/ml) in CA6-infected children.The numbers of stool virus nucleic acid turning negative were 0 case, 4 cases, 9 cases, 3 cases and 2 cases in 18 children at 1st, 2nd, 3rd, 4th, 5th weeks. At 5th week, the stool virus nucleic acid of children in CA6 group all turned to be negative.The positive rates of stool virus nucleic acid in EV71 group and CA16 group at the 5th week, however, were 31% and 27% respectively.There were statistically significant differences in distribution of positive rate of stool virus nucleic acid between CA6 infected children with EV71 and CA16 infected children (χ2=13.894, 10.698, P<0.05).@*Conclusion@#The longest intestinal virus shedding time for CA6-infected HFMD children was 5 weeks, which is obviously shorter than that of EV71- infected children and CA16-infected children.

Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014-2015.

The clinical impact of enteroviruses associated with hand, foot and mouth disease (HFMD) is unknown outside Asia, and the prevalence of enterovirus A71 (EV-A71) in particular might be underestimated. To investigate the prevalence of enterovirus serotypes and the clinical presentations associated with HFMD in France, we conducted prospective ambulatory clinic-based surveillance of children during April 2014-March 2015. Throat or buccal swabs were collected from children with HFMD and tested for the enterovirus genome. Physical examinations were recorded on a standardized form. An enterovirus infection was detected in 523 (79.3%) of 659 children tested. Two epidemic waves occurred, dominated by coxsackievirus (CV) A6, which was detected in 53.9% of enterovirus-infected children. CV-A6 was more frequently related to atypical HFMD manifestations (eruptions extended to limbs and face). Early awareness and documentation of HFMD outbreaks can be achieved by syndromic surveillance of HFMD by ambulatory pediatricians and rapid enterovirus testing and genotyping.

Prediction and identification of immunodominant B cell linear epitopes in capsid proteins VP1 to VP3 of Coxsackievirus A16 / 中华临床感染病杂志

Objective To identify immunodominant B linear cell epitopes in capsid proteins VP1 to VP3 of Coxsackievirus A16 (CVA16) strain YY157.Methods The protean algorithms of bioinformatic software Lasergene were used to analyze antigenicity, hydrophilicity and surface probability of amino acid sequence of CVA16 capsid proteins VP1 to VP3.Multiple regions containing potential lineal B cell epitopes were predicted and their corresponding average indexes were calculated by BepiPred 1.0 Server.Corresponding peptides were synthesized and examined in peptide-enzyme-linked immunosorbent assay (ELISA) individually to check whether it reacted positively or negatively toward sera from children with confirmed CVA16 infection.Results Totally 21 possible B cell linear epitopes were predicted according to their relatively strong antigenicity, hydrophilicity and surface probability.The corresponding synthetic peptides reacted positively with sera of CVA16-infected children in a varying extent.Conclusion Immunodominant B cell linear epitopes of capsid proteins VP1 to VP3 of CVA16 strain YY157 are successfully predicted and confirmed.

High-degree atrioventricular block in a child with acute myocarditis.

BACKGROUND: Viral myocarditis is a common cause of transient electrocardiogram (EKG) abnormalities in children. The clinical presentation of acute myocarditis ranges from asymptomatic infection to fulminant heart failure and sudden death. Many children present with nonspecific symptoms such as dyspnea or vomiting, frequently leading to misdiagnosis. EKG abnormalities are a sensitive indicator of acute myocarditis and are present in more than 90% of cases. CASE REPORT: A 13-year-old female suffered a syncopal episode and was found to have high-grade atrioventricular (AV) block caused by acute presumed viral myocarditis. With close monitoring, the EKG abnormalities resolved over the following 48 hours. In this case report, we discuss the incidence, pathogenesis, and outcomes of conduction disturbances in acute myocarditis. CONCLUSION: High-degree AV block can occur in patients with acute myocarditis, and higher-degree AV block is correlated with greater myocardial injury. Additionally, severity of pathological changes may reflect the reversibility of AV block. In the majority of cases, however, this rhythm disturbance is transient and does not require permanent pacemaker placement.

A case of myocarditis following neonatal meningitis caused by coxsackievirus B1 in spite of intravenous immunoglobulin treatment.

Enteroviral infection is one of the most common neonatal infections, and most patients recover without complications. This report describes a neonate who experienced meningitis followed by myocarditis. A 4-day-old boy was admitted with fever, diagnosed with enteroviral meningitis and treated with intravenous immunoglobulin (IVIG). However, myocarditis was subsequently diagnosed in spite of IVIG treatment, and coxsackievirus B1 (CXB1) was revealed as a cause. A left ventricular aneurysm persisted even though the patient recovered with repeated high-dose IVIG treatment and cardiac supportive care. This report describes a rare case where myocarditis developed several days after a diagnosis of CXB1 meningitis in spite of IVIG treatment. It is important to pay attention to the patient's clinical condition until the end of the second viremia of enterovirus and to consider high-dose IVIG treatment when treating enteroviral infections for neonates.

Cerebrospinal fluid characteristics and clinical features in children with severe hand, foot and mouth disease induced by enterovirus 71 infection / 中华临床感染病杂志

Objective To investigate cerebrospinal fluid characteristics and clinical features in children with severe hand,foot and mouth disease (HFMD) induced by enterovirus 71 (EV71) infection.Methods A total of 114 children with severe HFMD,in whom EV71 was detected by reverse transcription polymerase chain reaction (RT-PCR),were admitted in Hangzhou Children's Hospital during May and August 2013.Seventy-eight children with severe HFMD induced by other enteroviruses admitted at the same period served as controls.The results of cerebrospinal fluids (CSF) routine examination and biochemical tests,and the clinical symptoms were compared between two groups.Differences in enumeration data were compared with x2 test,and measurement data were compared with Mann-Whitney U test.Results The incidences of vomiting and limb shaking in EV71 infection group were 35.1％ and 50.9％,which were higher than those in control group (x2 =7.864 and 19.682,P ＜ 0.05).The incidence of limb shaking in children with nucleated cells count ≥ 100 × 106/L in EV71 group was higher than that with nucleated cells count ＜ 100 × 106/L (72.3％ vs.35.8％,x2 =14.740,P =0.000).The nucleated cells count,protein quantity and their positive rates in EVT1 infected group were higher than those in control group (Z =-9.458 and-6.591,P=0.000; x2=105.421 and 10.932,P =0.000 and 0.001).Conclusion The symptoms of nervous system damage and abnormal CSF examination were more serious in HFMD induced by EV71 infection,and in EV71 infected patients the incidence of limb shaking is correlated with nucleated cell count in CSF.

Protective Effects of Folic Acid on Cardiac Development Related Genes GATA-4 and NKx2.5 Expression of Offspring Rats with Maternal Coxsackievirus B3 Infection / 天津医药

Objective To investigate the effects of oral folic acid on cardiac development related gene expression of offspring in an experimental model of coxsackievirus B3(CVB3) infection of pregnant rats. Methods SD female rats were randomized into control group, folic acid group, CVB3 group and CVB3+folic acid group. The female rats were given folic acid by gavage for 2 weeks before pregnancy in folic acid group and CVB3+folic acid group. After conception for 7 days, rat model was established by intraperitoneal injection of CVB3 for 5 days in CVB3 group and CVB3+folic acid group. After nat-ural childbirth neonatal heart was taken and stored in liquid nitrogen. The morphological changes of neonatal rat myocardial tissues were observed by HE staining. The expressions of GATA-4 and NKx2.5 mRNA were detected by RT-PCR and West-ern blot assay. Results There was significant myocardial injury, such as myocardial fiber disarray and myocardial fiber breakage, in neonatal rats in CVB3 group. These damages were improved in CVB3+folic acid group. The expression levels of GATA-4 and NKx2.5 genes in myocardial tissues were significantly lower in CVB3 group than those of control group (P<0.05). The expression levels of GATA-4 and NKx2.5 proteins in myocardial tissues were significantly higher in CVB3+folic acid group than those of CVB3 group (P<0.05). Conclusion CVB3 infection in the early pregnancy inhibited the expres-sion of neonatal rat cardiac development factor. Folic acid supplementation has obvious protective effects on the neonatal rat cardiac development.

Changes of serum cytokines in children with viral myocarditis induced by coxsackie virus type B and its clinical significance / 中国医师进修杂志

ObjectiveTo explore the changes of serum macrophage migration inhibitory factor (MIF),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF- α ) levels,and the relationship with creatine kinase-MB (CK-MB) in children with viral myocarditis induced by coxsackie virus type B,and its clinical significance.MethodsSerum MIF,IL-6 and TNF- α levels were detected by enzyme-linked immunosorbent assay (ELISA) in 58 cases with viral myocarditis induced by coxsackie virus type B in acute phase (viral myocarditis group) and 40 cases hospitalized children (control group).CK-MB was measured by Hitachi 7180 fully automated clinical chemistry analyzer.ResultsSerum MIF,IL-6 and TNF-o levels of viral myocarditis group [ (59.15 ± 25.35 ),(68.52 ± 12.78 ),(85.31 ± 34.18) ng/L] were significantly higher than those of control group [ ( 36.78 ± 12.06 ),( 28.75 ± 16.03 ),( 52.91 ± 14.39 ) ng/L ] (P ＜ 0.01 ),and CK-MB of viral myocarditis group [(46.74 ± 23.89) U/L] was also significantly higher than that of control group [ ( 19.23 ± 11.56 ) U/L ] (P ＜ 0.01 ).There was positive correlation in children with viral myocarditis between MIF,IL-6,TNF- α and CK-MB (r =0.74,0.63,0.69,P ＜ 0.05).ConclusionsIt suggests that immune dysfunction exist in children with viral myocarditis induced by coxsackie virus type B.MIF,IL-6 and TNF- αmight take part in development of myocarditis,and the detection of them can evaluate severity of myocarditis.

Prevalencia de enterovirus en recién nacidos y lactantes que consultaron a un centro de atención de primer nivel, Armenia, Colombia, 2009 / Prevalence of enterovirus infection in infants in Armenia, Colombia, 2009

Introducción. Los enterovirus están distribuidos por todo el mundo; sin embargo, existe escasa información sobre su circulación en Colombia. Objetivo. Estimar la prevalencia de circulación de enterovirus en niños menores de un año que asistieron a un centro de atención de primer nivel en Armenia, Colombia, en el 2009, e identificar los principales serotipos de enterovirus circulantes. Materiales y métodos. Se tomaron 320 muestras de heces de niños menores de un año de edad. La presencia de enterovirus se determinó mediante transcripción inversa y la reacción en cadena de la polimerasa anidada (RT-N-PCR), empleando iniciadores genéricos de enterovirus. Las muestras que resultaron positivas en la RT-N-PCR, se inocularon en cultivos celulares apropiados para enterovirus. Los aislamientos obtenidos se identificaron por neutralización con la mezcla de sueros de Lim-Benyesh-Melnick. Resultados. Se detectaron enterovirus en 43 de las 320 (13,3 %) muestras de heces mediante RTN-PCR (IC95%: 9,7 a 17,1). Se obtuvo aislamiento viral en 26 de las 43 (60,4 %) muestras de heces positivas por RT-N-PCR. De los 26 aislamientos obtenidos, en 15 se identificó Coxsackie virus B (ocho CVB1, dos CVB2 y cinco CVB5) y 11 echovirus (seis E6 y cinco E30). Conclusiones. La circulación de enterovirus en la población infantil estudiada fue de 13,3 % y los serotipos de enterovirus aislados corresponden con los serotipos de mayor prevalencia global. Los resultados obtenidos indican la factibilidad de emplear la RT-N-PCR como herramienta para vigilar la circulación de enterovirus en muestras de heces.

Introduction. Despite world wide circulation of enteroviruses, little information has accumulated on the circulation of enteroviruses in Colombia. Objective. The prevalence of enterovirus circulation was examined in children under 1 year to identify the most common enterovirus serotypes. Materials and methods. Fecal samples were collected from 320 children under 1 year of age who attended a first-level health center in the city of Armenia, Colombia, in 2009. Enterovirus detection was performed by reverse transcription reaction and nested polymerase chain reaction (RT-N-PCR) using generic enterovirus primers. Samples testing positive in the RT-N-PCR were inoculated into cell cultures susceptible to enterovirus. All isolates were typed by seroneutralization with Lim-Benyesh-Melnick antiserum pools. Results. Overall, enteroviral RNA was detected in 43 of 320 (13.3%; 95% CI: 9.7 to 17.1) fecal samples by RT-N-PCR. Viral isolation was possible in 26 of 43 (60.4%) of the positive samples. Of these, 15 were Coxsackievirus B (eight CVB1, two CVB2, five CVB5) and 11 Echovirus (six E6 and five E30). Conclusions. The enteroviral circulation in a population on newly bornes up to 1 year old was 13.3%;the most frequent enterovirus was the same as those serotypes most commonly isolated in other parts of the world. The use of RT-N-PCR was demonstrably feasible as a tool to monitor the presence of enterovirus in stool samples.