RESUMO
Subacute sclerosing panencephalitis (SSPE), a post-measles progressive neurological disorder is still common in India because of indifferent vaccination compliance. However, the acute fulminant form of SSPE is extremely rare. An unusual case of fulminant SSPE in an 18-year-old man from south India with an ultra-short course of 19 days presenting with hemiparesis in absence of myoclonus and progressive cognitive decline, is reported. MRI showed frontal and parieto-occipital demyelination extending to nuclear areas. Antimeasles antibodies were demonstrable in CSF and serum with oligoclonal bands in CSF despite normal CSF protein and cell count. At autopsy, unlike classical SSPE, oligodendroglia containing measles viral antigen was sparse despite florid necrotizing leukoencephalitis with acute demyelination. Measles virus was isolated from the brain with hypermutation in M gene confirming the diagnosis. Phylogenetic analysis of the viral genotype indicated that it belonged to D7 genotype which is considered rare in India.
Assuntos
Encéfalo/patologia , Vírus do Sarampo/classificação , Panencefalite Esclerosante Subaguda/patologia , Panencefalite Esclerosante Subaguda/virologia , Adolescente , Anticorpos Antivirais/sangue , Anticorpos Antivirais/líquido cefalorraquidiano , Autopsia , Sequência de Bases , Encéfalo/virologia , Encefalopatias/patologia , Encefalopatias/virologia , Doenças Desmielinizantes/genética , Doenças Desmielinizantes/patologia , Genótipo , Humanos , Imageamento por Ressonância Magnética , Masculino , Vírus do Sarampo/genética , Vírus do Sarampo/imunologia , Vírus do Sarampo/isolamento & purificação , Mutação , Filogenia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de RNARESUMO
BACKGROUND: An outbreak of acute encephalitis of unknown origin with high case fatality (183 of 329 cases) was reported in children from Andhra Pradesh state in southern India during 2003. We investigated the causative agent. METHODS: Cell lines and peripheral blood lymphocyte co-cultures were used to isolate the causative agent from clinical samples. Identity of the agent was established by electron microscopy and serological and molecular assays. FINDINGS: Clinical samples tested negative for IgM antibodies to Japanese encephalitis, West Nile, dengue, and measles viruses, and for RNA of coronavirus, paramyxovirus, enterovirus, and influenza viruses. Virus was isolated from six patients with encephalitis and was identified as Chandipura virus by electron microscopy, complement fixation, and neutralisation tests. Chandipura virus RNA was detected in clinical samples from nine patients. Sequencing of five of these RNA samples showed 96.7-97.5% identity with the reference strain of 1965. Chandipura viral antigen and RNA were detected in brain tissue of a deceased child by immunofluorescent antibody test and PCR. Neutralising, IgG, and IgM antibodies to Chandipura virus were present in some patients' serum samples. Serum samples obtained after 4 days of illness were more frequently positive for IgM to Chandipura virus than were those obtained earlier (p<0.001). A similar trend was noted for neutralising antibodies. INTERPRETATION: Our findings suggest that this outbreak of acute encephalitis in Andhra Pradesh was associated with Chandipura virus, adding to the evidence suggesting that this virus should be considered as an important emerging pathogen.
Assuntos
Surtos de Doenças , Encefalite Viral/epidemiologia , Infecções por Rhabdoviridae/epidemiologia , Vesiculovirus , Doença Aguda , Adolescente , Anticorpos Antivirais/sangue , Encéfalo/virologia , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes , Encefalite Viral/diagnóstico , Encefalite Viral/mortalidade , Encefalite Viral/virologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Reação em Cadeia da Polimerase , Infecções por Rhabdoviridae/diagnóstico , Infecções por Rhabdoviridae/mortalidade , Testes Sorológicos , Taxa de Sobrevida , Vesiculovirus/isolamento & purificaçãoRESUMO
Clinical data of 104 hospitalized children during the 2003 epidemic of encephalitis in Andhra Pradesh state was retrospectively analysed to know the clinical profile and risk factors associated with mortality. Fever was the first symptom associated with altered sensorium, seizures, diarrhoea and vomiting. Evolution of illness was very rapid with high fatality (47%). Majority of deaths occurred within the first 24 h of illness due to brainstem involvement. On multiple logistic regression analysis, high-grade fever, absent oculocephalic reflex and Glasgow coma score <7 were found to be significantly contributing to the mortality. Evidence of Chandipura virus was detected in these cases as the etiological agent.
Assuntos
Tronco Encefálico/virologia , Surtos de Doenças , Encefalite Viral/epidemiologia , Vesiculovirus/patogenicidade , Tronco Encefálico/patologia , Criança , Pré-Escolar , Encefalite Viral/mortalidade , Encefalite Viral/fisiopatologia , Feminino , Humanos , Índia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Estudos RetrospectivosRESUMO
National Institute of Virology, India has instituted molecular surveillance of measles strains in the country. In phased manner, three major cities Pune, Chennai and Bangalore were covered. Throat swab and urine from suspected measles cases from Chennai and Pune and freshly frozen brain tissues, CSF from suspected SSPE case from Bangalore were subjected to RNA extraction and Measles N&H gene RT-PCR as per WHO standard protocols. PCR positive products were sequenced. Sequence alignment and phylogenetic analysis was carried out using WHO standard reference sequences. Virus isolation was attempted using B95a cell line. Measles genotype D7 was detected from two classical measles cases (Chennai and Pune) and in a fulminant SSPE case (Bangalore). This is the first detection of measles genotype D7 from India.