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1.
Folia Med Cracov ; 59(1): 37-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180074

RESUMO

BACKGROUND: Parechovirus and enterovirus belong to a family of Picornaviridae, non- enveloped, small-sized RNA viruses, responsible for multiple human diseases. Recent introduction of molecular tests enabled the identi cation of parechovirus and enterovirus infections. Our aim was a retrospective analysis of signs and symptoms associated with confirmed parechovirus or enterovirus infections among children treated in the Department of Neonatology, St. Louis Regional Children's Hospital in Kraków, Poland. METHODS: Based on laboratory records, we identified all cases of parecho- or enterovirus infections confirmed by identification of viral RNA in nasal swab or cerebrospinal fluid samples. Hospital records and laboratory tests results of selected patients were then analyzed, and selected data were summarized, with emphasis on clinical and laboratory findings at admission. RESULTS: We identified 11 cases of parechovirus and three of enterovirus infections. All cases were neonates admitted to hospital with fever and irritability. Except for leukopenia in 50% of patients, no significant abnormalities were noted in blood counts and serum biochemistry, including low C-reactive protein and procalcitonin. In nine cases, cerebrospinal fluid was collected, the fluid protein concentrations and cell counts were moderately increased. Final diagnosis was meningitis in 12 children, and other viral infections in two. CONCLUSIONS: Viral infection, including parecho- and enteroviruses, should be considered in the etiology of fever and meningitis in neonates. The available molecular tests allow for detection of viral genetic material even in a scant biological specimen collected from neonates.


Assuntos
Infecções por Enterovirus/fisiopatologia , Meningite Viral/fisiopatologia , Infecções por Picornaviridae/fisiopatologia , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/metabolismo , Feminino , Febre , Hospitais Pediátricos , Humanos , Recém-Nascido , Leucopenia , Masculino , Meningite Viral/diagnóstico , Meningite Viral/metabolismo , Cavidade Nasal , Parechovirus , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/metabolismo , RNA Viral/líquido cefalorraquidiano , RNA Viral/metabolismo , Estudos Retrospectivos
2.
Curr Med Sci ; 39(2): 237-242, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016516

RESUMO

Few effective treatments for chronic Keshan disease have been available till now. The efficacy of long-term selenium supplementation in the treatment of chronic Keshan disease with congestive heart failure is inconclusive. This study aimed to determine whether selenium supplementation is associated with a decreased risk of cardiac death in chronic Keshan disease with congestive heart failure by ten years of follow-up. A retrospective long-term follow-up analysis was performed on a monitored cohort consisting of 302 chronic Keshan disease patients with a mean age of 40.8±11.4 years. Of the 302 chronic Keshan disease patients, 170 (56.3%) were given selenium supplementation until the end point of follow-up. Cox proportional hazards regression models were used to identify the independent predictors of cardiac events. Our results showed that during the follow-up, there were 101 deaths of patients with chronic Keshan disease in the selenium supplementation group (101/170, 59.4%) and 98 in non-selenium supplementation group (98/132, 74.2%). Multivariate analyses suggested that selenium supplementation was associated with a decreased risk of cardiac death (HR 0.39, 95% CI 0.28-0.53) after adjustment for baseline age, sex, cigarette smoking, family history of Keshan disease, body mass index (BMI), heart rate, electrocardiogram (ECG) abnormalities, blood pressure, initial cardiothoracic ratio, left ventricular ejection fractions (LVEF) and whole-blood selenium concentration. Our ten-year follow-up analysis indicated that selenium supplementation, specifically combined with the use of angiotensin-converting enzyme inhibitor and beta blocker therapy, improved the survival of patients with chronic Keshan disease with congestive heart failure. BMI, selenium deficiency, male, combined ECG abnormalities, LVEF, and fast heart rate increased the risk of cardiac events.


Assuntos
Cardiomiopatias/tratamento farmacológico , Infecções por Enterovirus/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Selênio/administração & dosagem , Adulto , Cardiomiopatias/fisiopatologia , Doença Crônica , Suplementos Nutricionais , Eletrocardiografia/métodos , Infecções por Enterovirus/fisiopatologia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos
5.
Minerva Pediatr ; 71(2): 150-158, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30511561

RESUMO

Enterovirus (EV) and Parechovirus (HPeV) are a frequent cause of infection in children. This review gives an overview of possible causes for differences in clinical presentation. EV and HPeV can cause a meningitis with or without pleocytosis. Different possible mechanisms for meningitis without pleocytosis are given. Little is known about the prognosis and long-term effects of EV and HPeV meningitis in children. Only some studies with a small number of children with EV or HPeV meningitis are reported. The different possible mechanisms involved in the neurological outcome after EV or HPeV meningitis will be discussed.


Assuntos
Infecções por Enterovirus/epidemiologia , Meningite Viral/epidemiologia , Infecções por Picornaviridae/epidemiologia , Criança , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/virologia , Humanos , Leucocitose/epidemiologia , Leucocitose/virologia , Meningite Viral/fisiopatologia , Meningite Viral/virologia , Infecções por Picornaviridae/fisiopatologia , Infecções por Picornaviridae/virologia , Prognóstico
6.
Am J Epidemiol ; 188(2): 475-483, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30358846

RESUMO

Enterovirus A71 (EV-A71) is responsible for the majority of severe cases of hand, foot, and mouth disease, but little evidence is available on the severity profile of EV-A71 infections. We formulated a hierarchical Bayesian model that synthesized data on diseases/events associated with EV-A71 and EV-A71 antibody responses to infection among unvaccinated children from large clinical trials of EV-A71 vaccination, which were conducted in Jiangsu and Beijing during 2012 and 2013, to reconstruct the severity profile in a unified framework. On average, 15.1% of the children aged 6-35 months were infected by EV-A71 during 1-year follow-up in a mild epidemic season. We estimated that 9.7%, 2.2%, and 0.6% of children infected with EV-A71 were diagnosed with EV-A71-associated diseases, were hospitalized, and showed severe complications, respectively. We estimated on average 1 death per 10,000 EV-A71 infections for children aged 6-35 months. Approximately 70% of children had ≥4-fold rises in antibody titers after infection. Most EV-A71 infections in young children are mild, and overall 2.2% of the infected patients were hospitalized in the 2 trials. There remain several uncertainties about the immune response after infection and the duration of immunity against EV-A71 reinfection.


Assuntos
Teorema de Bayes , Infecções por Enterovirus/epidemiologia , Pré-Escolar , Infecções por Enterovirus/mortalidade , Infecções por Enterovirus/fisiopatologia , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de Doença
7.
Virology ; 526: 146-154, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30390563

RESUMO

Enterovirus D68 (EV-D68) is unique among enteroviruses because of the ability to cause severe respiratory disease as well as neurological disease. We developed separate models of respiratory and neurological disease following EV-D68 infection in AG129 mice that respond to antiviral treatment with guanidine. In four-week-old mice infected intranasally, EV-D68 replicates to high titers in lung tissue increasing the proinflammatory cytokines MCP-1 and IL-6. The respiratory infection also produces an acute viremia. In 10-day-old mice infected intraperitoneally, EV-D68 causes a neurological disease with weight-loss, paralysis, and mortality. In our respiratory model, treatment with guanidine provides a two-log reduction in lung virus titers, reduces MCP-1 and IL-6, and prevents histological lesions in the lungs. Importantly, viremia is prevented by early treatment with guanidine. In our neurological model, guanidine treatment protects mice from weight-loss, paralysis, and mortality. These results demonstrate the utility of these models for evaluation of antiviral therapies for EV-D68 infection.


Assuntos
Antivirais/uso terapêutico , Modelos Animais de Doenças , Enterovirus Humano D , Infecções por Enterovirus/tratamento farmacológico , Guanidina/uso terapêutico , Doenças do Sistema Nervoso/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Animais , Citocinas/metabolismo , Infecções por Enterovirus/patologia , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/virologia , Feminino , Humanos , Pulmão/metabolismo , Pulmão/patologia , Pulmão/fisiopatologia , Pulmão/virologia , Masculino , Camundongos , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/virologia , Infecções Respiratórias/patologia , Infecções Respiratórias/fisiopatologia , Infecções Respiratórias/virologia , Resultado do Tratamento , Carga Viral/efeitos dos fármacos , Viremia/prevenção & controle
9.
Medicine (Baltimore) ; 97(43): e12930, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412100

RESUMO

Enterovirus and human parechovirus (HPeV) are RNA viruses belonging to the family Picornaviridae that frequently infect infants. These infections show a wide variety of clinical manifestations, from mild to severe. However, there are no known early clinical markers for diagnosis and prediction of disease severity. The aim of this study was to examine the clinical utility of urinary beta 2-microglobulin (ß2MG) for the early detection and prognosis of infantile enterovirus and HPeV infections.This retrospective study included 108 full-term infants younger than 60 days of age, including 15 with enterovirus or HPeV-3 (enterovirus/HPeV-3), 22 with respiratory syncytial virus (RSV), and 24 with bacterial infections. Laboratory data and clinical characteristics were compared among these 3 groups. Of the 15 patients with enterovirus/HPeV-3, 6 were treated with intravenous immunoglobulin (IVIG subgroup) because of severe clinical conditions.Urinary ß2MG to creatinine ratio (ß2MG/Cr) was significantly higher in the enterovirus/HPeV-3 group compared to bacterial and RSV infection groups (both P < .001). In the enterovirus/HPeV-3 group, mean peak urinary ß2MG/Cr was observed on day 1 or 2. Urinary ß2MG/Cr values were significantly higher in the IVIG subgroup than the non-IVIG subgroup (P < .001).Increased urinary ß2MG/Cr in early-stage infection may be a useful clinical marker for the detection and prediction of infantile enterovirus and HPeV infection severity.


Assuntos
Infecções por Enterovirus/diagnóstico , Enterovirus/isolamento & purificação , Parechovirus/isolamento & purificação , Infecções por Picornaviridae/diagnóstico , Microglobulina beta-2/urina , Biomarcadores/urina , Creatina/urina , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/urina , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções por Picornaviridae/fisiopatologia , Infecções por Picornaviridae/urina , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
Medicine (Baltimore) ; 97(36): e11831, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200066

RESUMO

RATIONALE: We present the first case of enterovirus (EV) D68, lineage B3 infection, associated with acute flaccid myelitis (AFM) in Taiwan. AFM caused by EV D68 is relatively rare. This report highlights the importance of clinical recognition of the disease and discusses treatments that can benefit such patients. PATIENT CONCERNS: A 5-year-old boy experienced sudden onset of acute flaccid paralysis (AFP) involving left arm after fever and respiratory symptoms for 3 days. DIAGNOSES: Magnetic resonance imaging (MRI) of the spinal cord revealed signal changes over segments C1 to T5 on a T2-weighted image (T2WI), compatible with the diagnosis of AFM. The EV D68 strain, cultured from the throat of the patient was identified. INTERVENTIONS: We administered intravenous immunoglobulin (IVIG, 1g/kg, twice), pulse steroid therapy (methylprednisolone, 30 mg/kg, twice) and oral prednisolone (1mg/kg/day). Rehabilitation was also arranged. OUTCOMES: The patient still had mild muscle atrophy over left arm after following-up for 1 year. LESSONS: Early diagnosis and prompt management are essential for managing this kind of patient. IVIG, pulse therapy, and oral prednisolone may play crucial roles in controlling its clinical course.


Assuntos
Enterovirus Humano D , Infecções por Enterovirus/complicações , Mielite/complicações , Paralisia/complicações , Doença Aguda , Pré-Escolar , Diagnóstico Diferencial , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/terapia , Humanos , Masculino , Mielite/diagnóstico , Mielite/fisiopatologia , Mielite/terapia , Paralisia/diagnóstico , Paralisia/fisiopatologia , Paralisia/terapia , Medula Espinal/diagnóstico por imagem , Extremidade Superior/fisiopatologia
11.
Euro Surveill ; 23(37)2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30229724

RESUMO

BackgroundUnderstanding enterovirus D68 (EV-D68) circulation patterns as well as risk factors for severe respiratory and neurological illness is important for developing preventive strategies. Methods: Between 2010 and 2016, 11,132 respiratory specimens from hospitalised patients in Lyon, France, were screened for EV-D68 by PCR. Phylogenetic relationships of the viral-protein-1 sequences were reconstructed using maximum-likelihood and Bayesian-Markov-Chain-Monte-Carlo approaches. Results: Overall, 171 infections with a biennial pattern were detected, including seven, one, 55, none, 42, one and 65 cases annually during 2010-16. Children (< 16 years-old; n = 150) were mostly affected and 71% (n = 121) of the total patients were under 5 years-old. In 146 patients with medical reviews, 73% (n = 107) presented with acute respiratory distress. Among paediatric patients with medical reviews (n = 133), 55% (n=73) had an asthma/wheezing history, while among adults (n = 13), 11 had underlying diseases. In total, 45 patients had severe infections and 28 patients needed intensive care unit stays. No acute flaccid myelitis (AFM) was detected. We found genotypes A, B1, B2 B3 and D circulating, and no associations between these and clinical presentations. During the study, new genotypes continuously emerged, being replaced over time. We estimated that ancestors of currently circulating genotypes emerged in the late-1990s to 2010. Rises of the EV-D68 effective population size in Lyon coincided with infection upsurges. Phylogenetic analyses showed ongoing diversification of EV-D68 worldwide, coinciding with more infections in recent years and increases of reported AFM paediatric cases. Conclusions: Reinforcement of diagnostic capacities and clinical-based surveillance of EV-D68 infections is needed in Europe to assess the EV-D68 burden.


Assuntos
Enterovirus Humano D/genética , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/virologia , Infecções Respiratórias/virologia , Proteínas Estruturais Virais/genética , Adolescente , Adulto , Criança , Pré-Escolar , Enterovirus Humano D/classificação , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/fisiopatologia , Feminino , França/epidemiologia , Genótipo , Hospitalização , Hospitais Universitários , Humanos , Lactente , Pulmão/virologia , Masculino , Dados de Sequência Molecular , Paralisia/etiologia , Paralisia/virologia , Filogenia , Reação em Cadeia da Polimerase , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/fisiopatologia
12.
Auris Nasus Larynx ; 45(5): 1093-1097, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29366609

RESUMO

Cluster of acute flaccid paralysis and cranial nerve dysfunction was associated with a 2014 outbreak of enterovirus D68 (EV-D68) respiratory illness in US. We describe a 33 year-old male patient of refractory dysphagia due to EV-D68-induced brainstem encephalitis successfully treated by surgery. Following acute upper respiratory tract infection, he developed dysphagia and bilateral facial paralysis. A coughing reflex was readily produced when the laryngopharyngeal fiberscope touched the epiglottis, however, water infusion induced only very weak and slow swallowing reflex, suggesting that only motor component was impaired but sensory function was preserved during swallowing. Despite eight months-conservative rehabilitations, Food Intake Level Scale (FILS) remained level 4. Therefore, corrective surgeries including cricopharyngeal myotomy, laryngeal suspension, and pharyngeal flap were performed. Thirty-six days after surgery, FILS rapidly and dramatically improved to level 8. This is the first report describing a successful surgical intervention for EV-D68-induced refractory dysphagia. Surgical treatment was suitable for EV-D68-induced dysphagia, perhaps because sensory function was preserved and only motor disturbance was present during the pharyngeal stage of swallowing.


Assuntos
Transtornos de Deglutição/cirurgia , Encefalite/fisiopatologia , Enterovirus Humano D , Infecções por Enterovirus/fisiopatologia , Laringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Músculos Faríngeos/cirurgia , Faringe/cirurgia , Adulto , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Encefalite/complicações , Infecções por Enterovirus/complicações , Paralisia Facial/etiologia , Humanos , Masculino , Miotomia/métodos , Retalhos Cirúrgicos
13.
Viruses ; 10(1)2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-29329211

RESUMO

Enterovirus D68 (EV-D68) caused a large outbreak in the summer and fall of 2014 in the United States. It causes serious respiratory disease, but causation of associated paralysis is controversial, because the virus is not routinely identified in cerebrospinal fluid. To establish clinical correlates with human disease, we evaluated EV-D68 infection in non-lethal paralysis mouse models. Ten-day-old mice lacking interferon responses were injected intraperitoneally with the virus. Paralysis developed in hindlimbs. After six weeks of paralysis, the motor neurons were depleted due to viral infection. Hindlimb muscles were also infected and degenerating. Even at the earliest stage of paralysis, muscles were still infected and were degenerating, in addition to presence of virus in the spinal cord. To model natural respiratory infection, five-day-old mice were infected intranasally with EV-D68. Two of the four infected mice developed forelimb paralysis. The affected limbs had muscle disease, but no spinal cord infection was detected. The unique contributions of this study are that EV-D68 causes paralysis in mice, and that causation by muscle disease, with or without spinal cord disease, may help to resolve the controversy that the virus can cause paralysis, even if it cannot be identified in cerebrospinal fluid.


Assuntos
Enterovirus Humano D/patogenicidade , Infecções por Enterovirus/fisiopatologia , Mielite/virologia , Miosite/virologia , Paralisia/etiologia , Animais , Infecções por Enterovirus/virologia , Masculino , Camundongos , Neurônios Motores/virologia , Atrofia Muscular/fisiopatologia , Atrofia Muscular/virologia , Mielite/fisiopatologia , Miosite/fisiopatologia , Paralisia/virologia , Receptor de Interferon alfa e beta/deficiência , Receptores de Interferon/deficiência , Medula Espinal/virologia
14.
J Virol ; 91(23)2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-28931688

RESUMO

RNA viruses accumulate mutations to rapidly adapt to environmental changes. Enterovirus A71 (EV-A71) causes various clinical manifestations with occasional severe neurological complications. However, the mechanism by which EV-A71 evolves within the human body is unclear. Utilizing deep sequencing and haplotype analyses of viruses from various tissues of an autopsy patient, we sought to define the evolutionary pathway by which enterovirus A71 evolves fitness for invading the central nervous system in humans. Broad mutant spectra with divergent mutations were observed at the initial infection sites in the respiratory and digestive systems. After viral invasion, we identified a haplotype switch and dominant haplotype, with glycine at VP1 residue 31 (VP1-31G) in viral particles disseminated into the integumentary and central nervous systems. In vitro viral growth and fitness analyses indicated that VP1-31G conferred growth and a fitness advantage in human neuronal cells, whereas VP1-31D conferred enhanced replication in human colorectal cells. A higher proportion of VP1-31G was also found among fatal cases, suggesting that it may facilitate central nervous system infection in humans. Our data provide the first glimpse of EV-A71 quasispecies from oral tissues to the central nervous system within humans, showing broad implications for the surveillance and pathogenesis of this reemerging viral pathogen.IMPORTANCE EV-A71 continues to be a worldwide burden to public health. Although EV-A71 is the major etiological agent of hand, foot, and mouth disease, it can also cause neurological pulmonary edema, encephalitis, and even death, especially in children. Understanding selection processes enabling dissemination and accurately estimating EV-A71 diversity during invasion in humans are critical for applications in viral pathogenesis and vaccine studies. Here, we define a selection bottleneck appearing in respiratory and digestive tissues. Glycine substitution at VP1 residue 31 helps viruses break through the bottleneck and invade the central nervous system. This substitution is also advantageous for replication in neuronal cells in vitro Considering that fatal cases contain enhanced glycine substitution at VP1-31, we suggest that the increased prevalence of VP1-31G may alter viral tropism and aid central nervous system invasion. Our findings provide new insights into a dynamic mutant spectral switch active during acute viral infection with emerging viral pathogens.


Assuntos
Enterovirus Humano A/genética , Enterovirus Humano A/patogenicidade , Infecções por Enterovirus/virologia , Evolução Molecular , Mutação , Quase-Espécies , Substituição de Aminoácidos , Proteínas do Capsídeo/química , Proteínas do Capsídeo/genética , Sistema Nervoso Central/virologia , Criança , Enterovirus Humano A/crescimento & desenvolvimento , Infecções por Enterovirus/fisiopatologia , Trato Gastrointestinal/virologia , Haplótipos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Plasma/virologia , Sistema Respiratório/virologia , Estudos Retrospectivos , Replicação Viral
15.
Virology ; 508: 150-158, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28545002

RESUMO

Enterovirus71 (EV71) is the major causative agent of hand, foot and mouth disease, which threatens the health of infants and young children. The expression of inflammatory cytokines induced by this viral infection aggravate the illness. Here, we describe the anti-EV71 activity of a specific p38 inhibitor that regulates the p38-MAPK signaling pathway. PD169316 was specifically selected from a MAPK compound library due to its significant inhibitory effect on EV71 replication. PD169316 also reduced EV71-induced apoptosis. Animal experiments showed that PD169316 can dampen the replication of EV71, reduce tissue damage and inhibit the release of inflammatory cytokines, thereby alleviating the severe diseases caused by EV71 in suckling mice.


Assuntos
Antivirais/administração & dosagem , Enterovirus Humano A/efeitos dos fármacos , Infecções por Enterovirus/virologia , Inibidores Enzimáticos/administração & dosagem , Imidazóis/administração & dosagem , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores , Animais , Apoptose , Enterovirus Humano A/fisiologia , Infecções por Enterovirus/tratamento farmacológico , Infecções por Enterovirus/fisiopatologia , Feminino , Humanos , Masculino , Camundongos , Replicação Viral/efeitos dos fármacos , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
16.
Int J Infect Dis ; 59: 77-81, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28435023

RESUMO

BACKGROUND: Viral central nervous system (CNS) infections are typically characterized by a cerebrospinal fluid (CSF) lymphocytic pleocytosis. A CSF neutrophilic pleocytosis presentation has been described, but its prognostic and clinical significance is unknown. The objectives of this study were to (1) compare the clinical and laboratory characteristics of viral CNS infections with a CSF neutrophilic pleocytosis to those with a lymphocytic pleocytosis, and (2) evaluate factors associated with an adverse clinical outcome. METHODS: A retrospective study of patients with confirmed viral CNS infections was conducted. The patients were divided into those with CSF neutrophilic pleocytosis and those with CSF lymphocytic pleocytosis. Clinical findings and outcomes were compared between the two groups. RESULTS: Of the 182 patients included in the study, 45 (24.7%) had CSF neutrophilic pleocytosis. Enterovirus infections were the cause of 64% of neutrophil-predominant CSF and 33% of lymphocyte-predominant CSF (p<0.001), while herpes infections were the cause of 46% of lymphocytic pleocytosis and 20% of neutrophilic pleocytosis (p=0.003). Moreover, neutrophilic pleocytosis was seen more commonly in younger patients (p=0.001), patients with respiratory symptoms (p=0.04), and patients with higher CSF white cell counts (p=0.004). Twenty-nine patients had an adverse clinical outcome (15.9%); the only predictor independently associated with an adverse clinical outcome on multivariable logistic regression analysis was an encephalitis presentation (p=0.01). CONCLUSIONS: The results of a study exploring the association between CSF neutrophilic pleocytosis and clinical and prognostic significance are presented here. This study suggests that CSF neutrophilic pleocytosis is not associated with higher adverse clinical outcomes.


Assuntos
Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/virologia , Infecções por Enterovirus/líquido cefalorraquidiano , Leucocitose , Neutrófilos , Adolescente , Adulto , Infecções do Sistema Nervoso Central/fisiopatologia , Infecções por Enterovirus/patologia , Infecções por Enterovirus/fisiopatologia , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
17.
Clin Microbiol Infect ; 23(11): 874-881, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28344164

RESUMO

OBJECTIVES: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.


Assuntos
Tronco Encefálico/virologia , Surtos de Doenças/estatística & dados numéricos , Encefalite Viral , Enterovirus Humano A/genética , Infecções por Enterovirus , Anti-Inflamatórios/uso terapêutico , Pré-Escolar , Encefalite Viral/epidemiologia , Encefalite Viral/fisiopatologia , Encefalite Viral/terapia , Encefalite Viral/virologia , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/terapia , Infecções por Enterovirus/virologia , Feminino , Humanos , Lactente , Masculino , Epidemiologia Molecular , Espanha/epidemiologia
18.
Neuropediatrics ; 48(3): 190-193, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28335042

RESUMO

Acute sensory neuronopathy (SNN) is a rapidly developing peripheral nervous system disease that primarily affects sensory neurons in the dorsal root ganglion or trigeminal ganglion, leading to the impairment of sensory axons. SNN is notably uncommon in childhood; only three cases of childhood or adolescent SNN have been reported to date. Moreover, SSN has never been reported in association with enterovirus infection. Here, we report the case of a 3-year-old girl who was initially diagnosed with enterovirus infection based on the presentation of fevers, rashes on all extremities, and ulceration over the posterior pharynx. Nine days later, she presented with ataxic and wide-based gait and dysmetria affecting the extremities, with an absence of sensory nerve action potentials in the upper and lower limbs. The patient was diagnosed with acute SNN based on the criteria developed by Camdessanché et al in 2009. To our knowledge, this is the youngest case of SNN reported to date. In addition, this case reveals that enterovirus infection can be associated with acute SNN in children in rare cases. Accurate diagnosis relies on clinical suspicion, comprehensive knowledge of the patient's history, and careful characterization of abnormal findings in electrodiagnostic studies.


Assuntos
Infecções por Enterovirus/complicações , Infecções por Enterovirus/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Biomarcadores/metabolismo , Pré-Escolar , Diagnóstico Diferencial , Eletromiografia , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/terapia , Feminino , Humanos , Condução Nervosa , Doenças do Sistema Nervoso Periférico/fisiopatologia
19.
BMC Infect Dis ; 17(1): 153, 2017 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-28212620

RESUMO

BACKGROUND: Enterovirus 71 (EV-A71) shows a potential of rapid death, but the natural history of the infection is poorly known. This study aimed to examine the natural history of EV-A71 infection. METHODS: This was a prospective longitudinal observational study performed between January 1st and October 31st, 2012, at three hospitals in Guangdong, China. Subjects with positive EV-A71 RNA laboratory test results were included. Disease progression was documented with MRI, autopsies, and follow-up. Symptoms/signs with potential association with risk of death were analyzed. RESULTS: Among the 288 patients, neurologic symptoms and signs were observed (emotional movement disorders, dyskinesia, involuntary movements, autonomic dysfunction, and disturbance of consciousness). Some of them occurred as initial symptoms. Myoclonic jerks/tremors were observed among >50% of the patients; nearly 40% of patients presented fatigue and 25% were with vomiting. Twenty-eight patients (9.7%) presented poor peripheral perfusion within 53.4 ± 26.1 h; 23 patients (8.0%) presented pulmonary edema and/or hemorrhage within 62.9 ± 28.6 h. Seventeen (5.9%) patients were in a coma. Seven (2.4%) patients died within 62.9 ± 28.6 h. Seventy-seven survivors underwent head and spinal cord MRI and 37.7% (29/77) showed abnormalities. Two fatal cases showed neuronal necrosis, softening, perivascular cuffing, colloid, and neuronophagia phenomenon in the brainstem. CONCLUSIONS: Patients with EV-A71 infection showed high complexity of symptoms and onset timing. Death risk may be indicated by autokinetic eyeball, eyeball ataxia, severe coma, respiratory rhythm abnormality, absent pharyngeal reflex, ultrahyperpyrexia, excessive tachycardia, pulmonary edema and/or hemorrhage, and refractory shock and ataxic respiration. Early assessment of these symptoms/signs is important for proper management.


Assuntos
Encefalite Viral/diagnóstico , Enterovirus Humano A/patogenicidade , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/virologia , Hemorragia/diagnóstico , Edema Pulmonar/diagnóstico , Transtornos Respiratórios/diagnóstico , Autopsia , Criança , Pré-Escolar , China/epidemiologia , Coma , Surtos de Doenças , Progressão da Doença , Encefalite Viral/mortalidade , Encefalite Viral/fisiopatologia , Enterovirus Humano A/isolamento & purificação , Infecções por Enterovirus/mortalidade , Infecções por Enterovirus/fisiopatologia , Feminino , Hemorragia/mortalidade , Hemorragia/fisiopatologia , Humanos , Lactente , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Edema Pulmonar/mortalidade , Edema Pulmonar/fisiopatologia , Transtornos Respiratórios/mortalidade , Transtornos Respiratórios/fisiopatologia , Taxa Respiratória/fisiologia
20.
J Emerg Med ; 52(6): e245-e247, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28174033

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) is increasing in incidence in the United States and presenting to emergency departments (EDs) across the country. This clinical entity presents as acute paralysis, with magnetic resonance imaging changes in the gray matter only in children younger than 21 years of age. The etiology is unknown, although preceding viral illnesses are common. There are no consensus guidelines regarding treatment. CASE REPORT: A 4-month-old girl presented with decreased bilateral arm movement. The history consisted of a recent upper respiratory illness and abrupt decline in movement. She was found to have truncal and peripheral hypotonia, while maintaining her airway. Magnetic resonance imaging found gray matter hyperintensity at C2-C6, with no white matter changes. The patient was positive for enterovirus. Intravenous steroids and intravenous immunoglobulin were given, with slight improvement prior to discharge to an inpatient rehabilitation center. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: AFM was largely nonexistent in the United States after implementation of the polio vaccine, but the incidence has recently increased. Pediatric patients are now presenting to EDs with acute hypotonia, and emergency physicians must recognize how to differentiate this emerging diagnosis from other causes of acute flaccid paralysis. The clinical course of AFM does not seem to change acutely, in stark contrast to disease entities like botulism, which can change in hours. Patients with AFM do not need aggressive ED diagnostic evaluation, but rather transfer to a pediatric hospital for further care. Therefore, discerning the etiology of pediatric hypotonia with history and physical examination alone is important.


Assuntos
Infecções por Enterovirus/complicações , Hipotonia Muscular/etiologia , Hipotonia Muscular/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Infecções por Enterovirus/fisiopatologia , Feminino , Humanos , Imunoglobulinas/farmacologia , Imunoglobulinas/uso terapêutico , Fatores Imunológicos/farmacologia , Fatores Imunológicos/uso terapêutico , Lactente , Imagem por Ressonância Magnética/métodos , Hemissuccinato de Metilprednisolona/farmacologia , Hemissuccinato de Metilprednisolona/uso terapêutico , Hipotonia Muscular/diagnóstico , Esteroides/farmacologia , Esteroides/uso terapêutico
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