[West Nile virus poliomyelitis after a holiday in Egypt]. / West-Nijl-viruspoliomyelitis na vakantie in Egypte.

BACKGROUND: Due to the worldwide near-extinction of poliovirus infections an acute presentation of poliomyelitis in the Netherlands has become extremely rare. However, in the differential diagnosis of such a disease presentation other pathogens need to be considered as well. CASE DESCRIPTION: A 44-year-old female presented with fever and a flaccid paresis of the left leg, following a holiday in Egypt. The laboratory investigation demonstrated an acute West Nile virus (WNV) infection, after which the diagnosis 'WNV poliomyelitis' was made. CONCLUSION: WNV poliomyelitis is a rare neurological complication of an infection with the WNV. The areas in Europe where WNV transmission to humans occurs are expanding. In the future, the number of neurological disorders caused by WNV is likely to increase, also in the Netherlands.

Development of a real-time PCR for identification of brachyspira species in human colonic biopsies.

BACKGROUND: Brachyspira species are fastidious anaerobic microorganisms, that infect the colon of various animals. The genus contains both important pathogens of livestock as well as commensals. Two species are known to infect humans: B. aalborgi and B. pilosicoli. There is some evidence suggesting that the veterinary pathogenic B. pilosicoli is a potential zoonotic agent, however, since diagnosis in humans is based on histopathology of colon biopsies, species identification is not routinely performed in human materials. METHODS: The study population comprised 57 patients with microscopic evidence of Brachyspira infection and 26 patients with no histopathological evidence of Brachyspira infection. Concomitant faecal samples were available from three infected patients. Based on publically available 16S rDNA gene sequences of all Brachyspira species, species-specific primer sets were designed. DNA was extracted and tested by real-time PCR and 16S rDNA was sequenced. RESULTS: Sensitivity and specificity for identification of Brachyspira species in colon biopsies was 100% and 87.7% respectively. Sequencing revealed B. pilosicoli in 15.4% of patients, B. aalborgi in 76.9% and a third species, tentatively named "Brachyspira hominis", in 26.2%. Ten patients (12.3%) had a double and two (3.1%) a triple infection. The presence of Brachyspira pilosicoli was significantly associated with inflammatory changes in the colon-biopsy (p=0.028). CONCLUSIONS: This newly designed PCR allows for sub-differentiation of Brachyspira species in patient material and thus allows large-scaled surveillance studies to elucidate the pathogenicity of human Brachyspira infections. One-third of affected patients appeared to be infected with a novel species.