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Ayyub M, Thomas JG, Hodeify R. An Overview of the Characteristics, Pathogenesis, Epidemiology, and Detection of Human Enterovirus in the Arabian Gulf Region. Viruses 2024; 16:1187. [PMID: 39205162 PMCID: PMC11359295 DOI: 10.3390/v16081187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Enteroviruses are RNA viruses that initiate infections through the gastrointestinal (GI) tract and are associated with enteric illness in individuals of all ages. Most serious infections of enteroviruses are in infants and young children where it is the common cause of aseptic meningitis and other systemic diseases, leading to a high mortality rate. Enteroviruses belong to the small non-enveloped family of the Picornaviridae family. The virus can spread mainly through fecal-oral and respiratory routes. In the Arabian Gulf countries, the incidence of enteroviral infections is only restricted to a few reports, and thus, knowledge of the epidemiology, characteristics, and pathogenesis of the virus in the gulf countries remains scarce. In this minireview, we sought to provide an overview of the characteristics of enterovirus and its pathogenesis, in addition to gathering the reports of enterovirus infection prevalence in Gulf Cooperation Council (GCC) countries. We also present a summary of the common methods used in its detection.
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Affiliation(s)
| | | | - Rawad Hodeify
- Department of Biotechnology, School of Arts and Sciences, American University of Ras Al Khaimah, Ras Al Khaimah 72603, United Arab Emirates; (M.A.); (J.G.T.)
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Sun M, Manson ML, Guo T, de Lange ECM. CNS Viral Infections-What to Consider for Improving Drug Treatment: A Plea for Using Mathematical Modeling Approaches. CNS Drugs 2024; 38:349-373. [PMID: 38580795 PMCID: PMC11026214 DOI: 10.1007/s40263-024-01082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/07/2024]
Abstract
Neurotropic viruses may cause meningitis, myelitis, encephalitis, or meningoencephalitis. These inflammatory conditions of the central nervous system (CNS) may have serious and devastating consequences if not treated adequately. In this review, we first summarize how neurotropic viruses can enter the CNS by (1) crossing the blood-brain barrier or blood-cerebrospinal fluid barrier; (2) invading the nose via the olfactory route; or (3) invading the peripheral nervous system. Neurotropic viruses may then enter the intracellular space of brain cells via endocytosis and/or membrane fusion. Antiviral drugs are currently used for different viral CNS infections, even though their use and dosing regimens within the CNS, with the exception of acyclovir, are minimally supported by clinical evidence. We therefore provide considerations to optimize drug treatment(s) for these neurotropic viruses. Antiviral drugs should cross the blood-brain barrier/blood cerebrospinal fluid barrier and pass the brain cellular membrane to inhibit these viruses inside the brain cells. Some antiviral drugs may also require intracellular conversion into their active metabolite(s). This illustrates the need to better understand these mechanisms because these processes dictate drug exposure within the CNS that ultimately determine the success of antiviral drugs for CNS infections. Finally, we discuss mathematical model-based approaches for optimizing antiviral treatments. Thereby emphasizing the potential of CNS physiologically based pharmacokinetic models because direct measurement of brain intracellular exposure in living humans faces ethical restrictions. Existing physiologically based pharmacokinetic models combined with in vitro pharmacokinetic/pharmacodynamic information can be used to predict drug exposure and evaluate efficacy of antiviral drugs within the CNS, to ultimately optimize the treatments of CNS viral infections.
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Affiliation(s)
- Ming Sun
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Martijn L Manson
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Tingjie Guo
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Elizabeth C M de Lange
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.
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Huff HV, Wilson-Murphy M. Neuroinfectious Diseases in Children: Pathophysiology, Outcomes, and Global Challenges. Pediatr Neurol 2024; 151:53-64. [PMID: 38103523 DOI: 10.1016/j.pediatrneurol.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 12/19/2023]
Abstract
Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections.
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Affiliation(s)
- Hanalise V Huff
- Department of Neurology, National Institutes of Health, Bethesda, Maryland
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Li Q, Wang R, Xu H, Zhang L, Fu Y, Tian J, Liu M, Feng G, Zeng Y, Chen X, Xie Z. Epidemiology and Disease Burden of Hospitalized Children With Viral Central Nervous System Infections in China, 2016 to 2020. Pediatr Neurol 2023; 138:38-44. [PMID: 36356470 DOI: 10.1016/j.pediatrneurol.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Viral central nervous system (CNS) infections seriously threaten the life and health of children, with a high mortality and severe sequelae in China and globally. Surveillance of viral CNS infections in children is important, especially in hospitalized children, to facilitate disease evaluation. METHODS In this study, we collected the data on the discharged Face Sheet of Medical Records from database from 2016 to 2020 and analyzed the epidemiologic characteristics and disease burden of hospitalized children (≤18 years old) with viral CNS infections in China. We classified the discharge diagnosis of viral CNS infection as viral encephalitis (VE), viral meningitis (VM), viral meningoencephalitis (VME), viral encephalomyelitis (VEM), and viral meningomyelitis (VMM). RESULTS A total of 42,641 cases of viral CNS infections were included in the database, consisting of 39,279 cases with VE (92.47%), 2011 cases with VM (4.73%), 1189 cases with VME (2.80%), 118 cases with VEM (0.28%), and 44 cases with VMM (0.10%). The number of hospitalized patients with viral CNS infections accounted for 0.74% (42,641 of 5,790,910) of all hospitalized cases. The onset of viral CNS infections presented seasonal characteristic, with peaks in June to July and December to January. Seizures are the most frequent complication of this disorder. Median length of stay and inpatient expenditures for patients with viral CNS infections were 9 days and 1144.36 USD. Causative viruses were identified in 4.33% (1848 of 42,641) of patients. CONCLUSIONS This study will help understand the clinical epidemiology and disease burden of hospitalized children with viral CNS infections in China.
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Affiliation(s)
- Qi Li
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Ran Wang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Xu
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Linlin Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiliang Fu
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiao Tian
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengjia Liu
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiangpeng Chen
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China.
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Mayr L, Steinmaurer T, Weseslindtner L, Madlener S, Strassl R, Gojo J, Azizi AA, Slavc I, Peyrl A. Viral infections in pediatric brain tumor patients treated with targeted therapies. Pediatr Blood Cancer 2023; 70:e30065. [PMID: 36308741 DOI: 10.1002/pbc.30065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Brain tumors are the most common solid malignancies and the leading cause of cancer-related mortality in children. While numerous studies report on viral infections in children with hematologic malignancies and solid organ transplantation, epidemiologic data on the incidence and outcome of viral infections in pediatric patients with brain tumors treated with targeted therapies are still lacking. OBJECTIVES/STUDY DESIGN We retrospectively reviewed all children with brain tumors receiving targeted therapies in a primary or recurrent setting at the Medical University of Vienna from 2006 to 2021. Demographic variables, quantitative and qualitative parameters of possible infections, and treatment outcomes were recorded. RESULTS In our cohort (n = 117), 36% of the patients developed at least one PCR-proven viral infection. Respiratory and gastrointestinal tract infections were most common, with 31% and 25%, respectively. Central nervous system (CNS) infections occurred in approximately 10%, with an almost equal distribution of varicella-zoster virus, John Cunningham virus (JCV), and enterovirus. Two patients tested PCR-positive for SARS-CoV-2 infection, with one virus-related death caused by a SARS-CoV-2-related acute respiratory distress syndrome. Patients receiving bevacizumab or mTOR inhibitors seem to have a greater susceptibility to viral infections. CONCLUSION Pediatric patients with brain tumors receiving targeted therapies have a higher risk of viral infections when compared to children receiving conventional chemotherapy or the general population, and life-threatening infections can occur. Fast detection and upfront treatment are paramount to prevent life-threatening infections in immunocompromised children suffering from brain tumors receiving targeted therapies.
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Affiliation(s)
- Lisa Mayr
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Tobias Steinmaurer
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Sibylle Madlener
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Virology, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Khalili M, Rahimi Hajiabadi H, Akbari M, Nasr Esfahani B, Saleh R, Moghim S. Viral aetiology of acute central nervous system infections in children, Iran. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Viral infections are increasingly an important cause of central nervous system (CNS) complications.
Hypothesis/Gap Statement. There is no comprehensive insight about CNS infections due to viral agents among Iranian children.
Aim. This study aimed to investigate the viral aetiology, clinical and epidemiological profile of children with acute infections of the CNS.
Methodology. A prospective study was conducted on children at the referral hospital in Isfahan, Iran, from June 2019 to June 2020. A multiplex PCR assay was used to detect the viral causative agent in cerebrospinal fluid and throat/rectal swab samples.
Results. Among 103 patients with eligible criteria, a confirmed or probable viral aetiology was detected in 41 (39.8 %) patients, including enteroviruses – 56.1 %, herpes simplex virus 1/2 (HSV-1/2) – 31.7 %, Epstein-Barr virus – 17.1 %, varicella-zoster virus (VZV) – 9.7 %, influenza A virus (H1N1) –4.9 % and mumps – 2.4 %. There was a higher proportion of PCR-positive samples in infants than in other age groups. Encephalitis and meningoencephalitis were diagnosed in 68.3 % (28/41) and 22 % (9/41) PCR-positive cases, respectively.
Conclusion. The findings of this research provide insights into the clinical and viral aetiological patterns of acute CNS infections in Iran, and the importance of molecular methods to identify CNS viruses. HSV and VZV were identified as important causes of encephalitis in young children.
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Affiliation(s)
- Maryam Khalili
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Rahimi Hajiabadi
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rana Saleh
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Moghim
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pangprasertkul S, Sanguansermsri C, Sudjaritruk T. Epstein-Barr virus meningoencephalitis in a young immunocompetent child: A case report. Heliyon 2022; 8:e11150. [PMID: 36299527 PMCID: PMC9589165 DOI: 10.1016/j.heliyon.2022.e11150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/07/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Epstein-Barr virus (EBV) usually causes mild, asymptomatic, and self-recovered infections in young children. Yet, neurological involvement of this virus has been reported. EBV meningoencephalitis is relatively rare in immunocompetent children. Herein, we describe a case of 2-year-old previously healthy girl presented with high-grade fever and exudative tonsillitis. Her neurological examination showed alteration of consciousness and neck stiffness. A history of generalized tonic-clonic seizures was noted. A diagnosis of EBV meningoencephalitis was definitely confirmed by a positive result for serum viral capsid antigen IgM, and a detection of EBV DNA in cerebrospinal fluid. Her neuroimaging studies demonstrated evidence of leptomeningeal enhancements along bilateral parietal cortical sulci and around the brainstem with a hypodense lesion in the left parietal area - the typical findings of EBV meningoencephalitis. This patient was treated with intravenous corticosteroid without antiviral agents. Her clinical symptoms gradually improved. She was discharged from the hospital on the 19th day of hospitalization without neurological sequelae. Although EBV is not a primary causative agent of meningoencephalitis in immunocompetent children, it should always be considered regardless of the presence or absence of classical infectious mononucleosis symptoms. Early recognition and properly treatment are important for a good prognosis.
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Affiliation(s)
- Sipang Pangprasertkul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tavitiya Sudjaritruk
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chen JH, Wu J, Yang XY, Li J, Huang NQ, Shi SP, Feng F, Li Q, Yu CY, Luo Y. Diagnostic Value of the Electroencephalogram and Cerebrospinal Fluid in Viral Encephalitis. Neurologist 2022; 27:225-229. [PMID: 35184121 DOI: 10.1097/nrl.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electroencephalogram (EEG) and cerebrospinal fluid (CSF) are widely used in the clinical diagnosis of viral encephalitis (VE), but their value in the diagnosis of VE and the detection rate of abnormal indicators need to be further supported by more clinical data. METHODS In this study, routine laboratory testing, biochemical examinations of cerebrospinal fluid (CSF) and EEG characteristics were performed in patients with VE to guide the diagnosis and treatment of VE in clinical settings. A total of 330 patients with VE were enrolled in the Department of Neurology of the Third Affiliated Hospital of Zunyi Medical University from January 1, 2015 to January 30, 2020. EEG, routine testing and assessment of biochemical indicators of CSF were performed within 10 days after admission, and the results were analyzed by paired χ 2 test to compare the diagnostic value of EEG and CSF for VE. RESULTS In 330 cases of VE, 283 cases (85.76%) had abnormal EEG, and 189 cases (57.27%) had abnormal CSF indicators. The incidence of EEG abnormalities was higher than that of CSF indicators, and the difference was statistically significant ( P <0.05). CONCLUSIONS Both the EEG and CSF analysis are valuable indicators in the diagnosis of VE patients. Compared with the CSF examination, the EEG examination had a better diagnostic efficacy for the diagnosis of VE. In addition, a normal EEG or a normal CSF level cannot exclude VE, and it is still necessary to develop new diagnostic indicators to cover all viral encephalitides.
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Affiliation(s)
| | - Jie Wu
- Scientific Research Center
| | | | | | | | - Shang-Peng Shi
- Department of Quality Management, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)
| | | | | | - Chang-Yin Yu
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Liu JJ, Teng LP, Hua CZ, Xie YP, Pan YX, Hu BF, Hu WL, Wang WJ. Etiological Analysis of Viral Encephalitis in Children in Zhejiang Province from 2018 to 2019. Diagnostics (Basel) 2022; 12:diagnostics12081964. [PMID: 36010314 PMCID: PMC9407060 DOI: 10.3390/diagnostics12081964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the common pathogens of viral encephalitis (VE) in children, and to provide guidance for the empirical diagnosis and treatment of patients with VE. Methods: A total of 227 cerebrospinal fluid (CSF) samples were collected from pediatric patients with VE in Zhejiang province from January 2018 to December 2019. The samples were tested using multiplex and singleplex Reverse Transcription-Polymerase Chain Reaction (RT-PCR) with primers specific to enterovirus (EV), varicella-zoster virus (VZV), mumps virus (MuV), cytomegalovirus (CMV), herpes simplex virus type 1 (HSV-1)/type 2 (HSV-2), Epstein–Barr virus (EBV), and human herpesvirus 6 (HHV-6). The data of the two analyses were compared and then verified using Sanger sequencing. Results: Of the 227 CSF samples, 90 were shown to be positive for multiplex RT-PCR with a positivity rate of 39.65% and a 95% confidence interval (33.2%, 46.1%). EV was the most common cause of VE, followed by EBV, HHV-6, MuV, CMV, VZV, and HSV-1. Most included cases occurred in summer, accounting for 49.78% of all cases. For EV, EBV, and HSV-2, multiplex RT-PCR showed a positivity rate of 34.36%, which was not statistically different from that of 30.4% shown by singleplex RT-PCR. The sequences of EV, EBV, VZV, MuV, CMV, HSV-1, HHV-6, and HSV-2 were confirmed by sequencing the PCR products obtained from multiplex and singleplex PCR. Conclusions: In children, VE is more prevalent in the summer than in other seasons in Zhejiang province, and EV may be the most common causative pathogen.
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Affiliation(s)
- Juan-Juan Liu
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Li-Ping Teng
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Department of Rheumatology Immunology and Allergy, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Chun-Zhen Hua
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Correspondence:
| | - Yong-Ping Xie
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Yan-Xiang Pan
- Department of Clinical Laboratory Center, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Bo-Fei Hu
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Wei-Lin Hu
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Department of Medical Microbiology, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Wei-Jian Wang
- Department of Research and Development, Health Gene Technologies Co., Ltd., Ningbo 315000, China
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Al-Qahtani SM, Shati AA, Alqahtani YA, Ali AS. Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review. Front Pediatr 2022; 10:923125. [PMID: 35783317 PMCID: PMC9249085 DOI: 10.3389/fped.2022.923125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.
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Affiliation(s)
- Saleh M. Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdelwahid Saeed Ali
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Zhu X, Liu P, Lu L, Zhong H, Xu M, Jia R, Su L, Cao L, Sun Y, Guo M, Sun J, Xu J. Development of a multiplex droplet digital PCR assay for detection of enterovirus, parechovirus, herpes simplex virus 1 and 2 simultaneously for diagnosis of viral CNS infections. Virol J 2022; 19:70. [PMID: 35443688 PMCID: PMC9020426 DOI: 10.1186/s12985-022-01798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Enterovirus (EV), parechovirus (HPeV), herpes simplex virus 1 and 2 (HSV1/2) are common viruses leading to viral central nervous system (CNS) infections which are increasingly predominant but exhibit deficiency in definite pathogen diagnosis with gold-standard quantitative PCR method. Previous studies have shown that droplet digital PCR (ddPCR) has great potential in pathogen detection and quantification, especially in low concentration samples. Methods Targeting four common viruses of EV, HPeV, HSV1, and HSV2 in cerebrospinal fluid (CSF), we developed a multiplex ddPCR assay using probe ratio-based multiplexing strategy, analyzed the performance, and evaluated it in 97 CSF samples collected from patients with suspected viral CNS infections on a two-channel ddPCR detection system. Results The four viruses were clearly distinguished by their corresponding fluorescence amplitude. The limits of detection for EV, HPeV, HSV1, and HSV2 were 5, 10, 5, and 10 copies per reaction, respectively. The dynamic range was at least four orders of magnitude spanning from 2000 to 2 copies per reaction. The results of 97 tested clinical CSF specimens were identical to those deduced from qPCR/qRT-PCR assays using commercial kits. Conclusion The multiplex ddPCR assay was demonstrated to be an accurate and robust method which could detect EV, HPeV, HSV1, and HSV2 simultaneously. It provides a useful tool for clinical diagnosis and disease monitoring of viral CNS infections. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-022-01798-y.
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Affiliation(s)
- Xunhua Zhu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Pengcheng Liu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lijuan Lu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Huaqing Zhong
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Menghua Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ran Jia
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liyun Su
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lingfeng Cao
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yameng Sun
- Shanghai Bio-Chain Biological Technology Co., Ltd, Shanghai, China
| | - Meijun Guo
- Shanghai Bio-Chain Biological Technology Co., Ltd, Shanghai, China
| | - Jianyue Sun
- Department of Pediatrics, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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12
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Assessment of a multiplex RT-PCR for Simultaneous, Rapid Screening of Common Viral Infections of Central Nervous System: A Prospective Study for Enteroviruses and Herpesviruses. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Acute meningitis is a common neurological disorder that affects both children and adults and has a high mortality rate. This study aimed to create a multiplex reverse transcriptase PCR system for screening clinical samples for the presence of the two viruses currently considered to be the most common causes of acute meningitis in Asia.
Materials and Methods
A single-tube RT multiplex PCR assay was developed and tested for sensitivity and specificity using primers that have been commonly used to screen for herpes simplex viruses 1 and 2 (HSV-1/2) and enterovirus (EV) in clinical samples. The procedure was then used to screen 303 clinical samples for the target viruses, which included 101 feces samples, 101 throat swabs, and 101 cerebrospinal fluid (CSF) samples obtained from 101 hospitalized Iranian children with suspected viral meningitis/meningoencephalitis, and the findings were compared to those of an RT monoplex PCR method.
Results
The RT-PCR approach demonstrated high precision, with no non-target virus amplification. The results of using this assay to screen clinical samples revealed that RT monoplex PCR had the same sensitivity as RT multiplex PCR for the three different types of specimens.
Conclusions
This newly developed multiplex RT-PCR method is a simple, fast diagnostic tool that can be used to screen clinical samples for viruses that cause acute meningitis/meningoencephalitis in children.
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13
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Masri A, Dwaikat A, Haroun N, Haikal L, Kharabsheh M, Daher A, Bakri F, Al Qudah A. Aseptic Meningitis and Its Viral Etiologies, Clinical Characteristics and Management Practices in Children: A Retrospective Hospital-Based Study From Jordan. Cureus 2022; 14:e24383. [PMID: 35611041 PMCID: PMC9124581 DOI: 10.7759/cureus.24383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose In this study, we aimed to describe the clinical characteristics, laboratory findings, aetiologies, and role of PCR in the decision on the management plan and duration of hospital stay in Jordanian children diagnosed with aseptic meningitis. Methods This retrospective observational cohort study included children diagnosed with meningitis who were admitted to the paediatric ward at Jordan University Hospital (JUH) during the period from January 2016 to August 2020. Patients were identified through the ICD9 discharge code of meningitis. Patients diagnosed with aseptic meningitis (defined as a patient with signs and symptoms of meningitis with a cerebrospinal fluid (CSF) white cell count of >5 cells/mm3, and a negative CSF Gram stain) were included, while patients who had low CSF glucose (<50% of serum) positive cerebrospinal fluid Gram stain and/or culture for bacterial meningitis were excluded. Files were reviewed to collect data on the clinical picture, viruses identified by the CSF viral polymerase chain reaction (PCR) panel, duration of medication, and hospital stay in patients with identified virus versus those with negative viral PCR. Results One hundred and thirty-one patients were included: 87 males (66.4%) and 44 females (33.5%). Fever was the most common presenting symptom, followed by headache, vomiting, and excessive sleep in 48.0%, 42.7%, and 35.8% of the patients, respectively. Prior oral antibiotic use was reported in 48/125 (38.4%) patients. White blood cell count (WBC) ranged from 4.800 to 22.000. cells/mL, 45 patients (34.3%) had counts above 15.000 cells/mL. C-reactive protein level was high in 61/103 (59.2%) patients. CSF WBC count was <100 in 62 (47.3%) patients while neutrophils predominance of >70% was present in 27 (20.6%) patients. Viral panel PCR was done for 100/131 (76.3%) patients and was positive in 66/100 (66%) patients; with enterovirus being the most common identified viruses (60/100; 60%). The average duration of hospital stay was 5.9 and 5.5 days for those with negative and positive PCR respectively. Ten (7.6%) patients had seizures upon presentation. None of the patients had any neurological sequel related to his meningitis. Conclusion Enteroviruses are the most common identified cause of paediatric aseptic meningitis in Jordan. Although PCR revealed an identified virus in around half of the patients, nevertheless, there was no adjustment in the management plan regarding duration of empirical antibiotic use and hospital stay. Increasing knowledge and awareness among clinicians on viral meningitis' lab characteristics might have great impact on duration of hospital stay and thus would be reflected on the patient and the healthcare system as well.
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Affiliation(s)
- Amira Masri
- Pediatrics, The University of Jordan, Amman, JOR
| | - Arwa Dwaikat
- Pediatrics, The University of Jordan, Amman, JOR
| | - Nour Haroun
- Medicine, The University of Jordan, Amman, JOR
| | - Lubna Haikal
- Pediatrics, The University of Jordan, Amman, JOR
| | | | - Amira Daher
- Pediatrics, The University of Jordan, Amman, JOR
| | - Faris Bakri
- Medicine/Infectious Disease, The University of Jordan, Amman, JOR
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14
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Rmadi Y, Elargoubi A, González-Sanz R, Mastouri M, Cabrerizo M, Aouni M. Molecular characterization of enterovirus detected in cerebrospinal fluid and wastewater samples in Monastir, Tunisia, 2014-2017. Virol J 2022; 19:45. [PMID: 35303921 PMCID: PMC8932122 DOI: 10.1186/s12985-022-01770-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Enteroviruses (EVs) are considered the main causative agents responsible for aseptic meningitis worldwide. This study was conducted in the Monastir region of Tunisia in order to know the prevalence of EV infections in children with meningitis symptoms. Detected EV types were compared to those identified in wastewater samples.
Methods Two hundred CSF samples collected from hospitalized patients suspected of having aseptic meningitis for an EV infection between May 2014 and May 2017 and 80 wastewater samples collected in the same time-period were analyzed. EV detection and genotyping were performed using PCR methods followed by sequencing. Phylogenetic analyses in the 3′-VP1 region were also carried-out. Results EVs were detected in 12% (24/200) CSF and in 35% (28/80) wastewater samples. EV genotyping was reached in 50% (12/24) CSF-positive samples and in 64% (18/28) sewage. Most frequent types detected in CSF were CVB3, E-30 and E-9 (25% each). In wastewater samples, the same EVs were identified, but also other types non-detected in CSF samples, such as E-17,CVA9 and CVB1 from EV species B, and EV-A71 and CVA8 from EV-A, suggesting their likely lower pathogenicity. Phylogenetic analysis showed that within the same type, different strains circulate in Tunisia. For some of the EV types such as E-9, E-11 or CVB3, the same strains were detected in CSF and wastewater samples. Conclusions Epidemiological studies are important for the surveillance of the EV infections and to better understand the emergence of certain types and variants.
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Affiliation(s)
- Yosra Rmadi
- Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, LR99-ES27, 5000, Monastir, Tunisia
| | - Aida Elargoubi
- Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rubén González-Sanz
- Enterovirus and Viral Gastrointestinal Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Maha Mastouri
- Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, LR99-ES27, 5000, Monastir, Tunisia.,Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Maria Cabrerizo
- Enterovirus and Viral Gastrointestinal Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Mahjoub Aouni
- Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, LR99-ES27, 5000, Monastir, Tunisia
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15
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Gams Massi D, Mintyene Mintyene MRR, Magnerou AM, Eko SM, Kenmegne C, Mbahe S, Sounga Bandzouzi PE, Mbatchou Ngahane HB, Mapoure NY. Spectrum of central nervous system infections in a tertiary health care centre in Cameroon. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:18. [PMID: 35153469 PMCID: PMC8817769 DOI: 10.1186/s41983-022-00454-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) infections are serious and debilitating diseases with significant mortality, and high prevalence in the context of human immunodeficiency virus (HIV) pandemic in Africa. However, their diagnosis remains challenging due to outdated technical platform. We aimed to determine the frequency of CNS infection and to describe the epidemiological, clinical and outcome of this at the Douala General Hospital (DGH), Cameroon. To carry out this study, we collected the medical records of patients hospitalized for CNS infections in the internal medicine department of DGH from January 2015 to December 2019. RESULTS Among 8430 files reviewed, 336 cases of CNS infection were identified giving a frequency of CNS infection of 3.99% among which 204 files were included in the study (54.4% were male). HIV infection was found in 147 patients (72.1%) with 38.1% (n = 56) of them on regular follow-up. The most common clinical signs were fever (84.8%), headache (68.6%), meningeal syndrome (38.7%), and seizures (36.3%). Cerebral toxoplasmosis (24.5%), cryptococcal meningitis (21.1%), and acute bacterial meningitis (8.3%) were leading aetiologies. Of the 143 CSF samples, 70.6% (n = 101) were sterile. The in-hospital mortality rate was 23.5% with CNS infection of unknown cause (22.1%) be independently associated to this [OR = 2.24; 95% CI 1.04-4.80, p = 0.039]. CONCLUSION Clinical presentations of CNS infections are same with classical data. HIV-related opportunistic infections are the main aetiologies. About one over four patients with CNS died. Two thirds of CSF are sterile using basic laboratory assessment giving a need to identify simple tests to increase sensibility and specificity of diagnostic tools in our setting.
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Affiliation(s)
- Daniel Gams Massi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Internal Medicine Department, Douala General Hospital, PO Box: 4856, Douala, Cameroon
| | | | - Annick Mélanie Magnerou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Internal Medicine Department, Douala Gyneco-Obstetric and Paediatric Hospital, Douala, Cameroon
| | | | - Caroline Kenmegne
- Internal Medicine Department, Douala General Hospital, PO Box: 4856, Douala, Cameroon
| | - Salomon Mbahe
- Internal Medicine Department, Douala General Hospital, PO Box: 4856, Douala, Cameroon
| | | | - Hugo Bertrand Mbatchou Ngahane
- Internal Medicine Department, Douala General Hospital, PO Box: 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Njankouo Yacouba Mapoure
- Internal Medicine Department, Douala General Hospital, PO Box: 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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16
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Evaluation of Multiplex Real-time PCR and WHO Criteria for Diagnosing Childhood Bacterial Meningitis in a Tertiary Referral Hospital in Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect.101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Childhood bacterial meningitis (BM) requires prompt and precise diagnosis to provide proper treatment and decline mortality and morbidity. Objectives: We aimed to evaluate the World Health Organization (WHO) criteria and polymerase chain reaction (PCR) for diagnosing BM in children admitted to a tertiary referral hospital in Shiraz, southern Iran. Materials: We included all 492 children aged one month to 17 years suspected of meningitis who had cerebrospinal fluid (CSF) leukocytosis admitted to Nemazi Hospital from August 2016 to September 2017. The CSF specimens were examined for routine analysis, Gram staining, and culture. A multiplex real-time PCR was used to identify Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis in the CSF samples. Seven viruses were also investigated using real-time PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the WHO criteria and the multiplex real-time PCR results. Results: Seventy-four CSF samples had leukocytosis. Nineteen (22.9%) patients had BM caused by S. pneumoniae (n = 14), Hib (n = 2), Salmonella enterica (n = 2), and N. meningitidis (n = 1). The PCR test detected all cases, except for two with Salmonella meningitis (sensitivity 89.4%, specificity 100%, PPV 100%, and NPV 96%). The WHO criteria detected all cases, except three who received antibiotics at least four days before performing lumbar puncture (sensitivity 84.2%, specificity 98.2%, PPV 94.1%, and NPV 94.7%). Enterovirus was the most common viral etiology (6.75%). Conclusions: The WHO criteria and the multiplex real-time PCR had high accuracy in our setting, and their use could decrease the antibiotic over-prescription in febrile children suspected of meningitis.
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17
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Targeting tight junctions to fight against viral neuroinvasion. Trends Mol Med 2021; 28:12-24. [PMID: 34810086 DOI: 10.1016/j.molmed.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
The clinical impact of viral neuroinvasion on the central nervous system (CNS) ranges from barely detectable to deadly, including acute and chronic outcomes. Developing innovative therapeutic strategies is important to mitigate virus-induced neurological and psychiatric disorders. A key gatekeeper to the CNS is the neurovascular unit (NVU), a major obstacle to viral neuroinvasion and antiviral therapies. The NVU isolates the brain from the blood through firm sealing operated by the tight junctions (TJs) of endothelial cells. Here, we make the thought-provoking assumption that TJs can be targets to prevent or treat viral neuroinvasion and resulting disorders. This review aims at defining the conceptual diverse mode of actions of such approaches, evaluates their feasibility, and discusses future challenges in the field.
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18
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Lee GH, Kim J, Kim HW, Cho JW. Herpes simplex viruses (1 and 2) and varicella-zoster virus infections in an adult population with aseptic meningitis or encephalitis: A nine-year retrospective clinical study. Medicine (Baltimore) 2021; 100:e27856. [PMID: 34797322 PMCID: PMC8601327 DOI: 10.1097/md.0000000000027856] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Three α-herpesviruses are known to be associated with central nervous system (CNS) infection; however, there are limited data on the incidence and clinical characteristics of α-herpesviruses CNS infections. This study aimed to assess the clinical manifestations, laboratory findings, and outcomes in patients with human herpes simplex virus 1 (HSV-1), human herpes simplex virus 2 (HSV-2), and varicella-zoster virus (VZV) CNS infections.We identified cases of HSV-1, HSV-2, and VZV CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with HSV-1, HSV-2, and VZV polymerase chain reaction positivity in cerebrospinal fluid (CSF) who visited Pusan National University Hospital between 2010 and 2018.During the 9-year study period, a total of 727 CSF samples were examined, with 72.2% (525/727) patients identified as having a CNS infection. Of 471 patients with aseptic meningitis and encephalitis, the causative virus was identified in 145 patients, and no virus was detected in 337 patients. A total of 15.2% (80/525) were diagnosed with one of the 3 herpesviruses as causative agents, 59 patients had meningitis, and 21 patients had encephalitis. Eleven patients with HSV-1, 27 patients with HSV-2, and 42 patients with VZV CNS infections were included. The distribution of cases by age showed different patterns depending on the type of herpesvirus infection. Compared with the HSV-1 group, the median age in the HSV-2 group was younger (HSV-1: 58 years; HSV-2: 38 years; P = .004), and patients with VZV infections showed a bimodal age distribution. Encephalitis was more common in the HSV-1 group, and HSV-1 infection was associated with a poor prognosis at discharge. CSF white blood cell counts were significantly lower in patients infected with HSV-1 (117 × 106 cells/L) than in patients infected with VZV (301 × 106 cells/L) (P = .008).These 3 herpesviruses are important causes of CNS infections regardless of immunologic status. HSV-1 infection was commonly associated with encephalitis and poor prognosis; HSV-2 and VZV CNS infections were associated with a low risk of mortality and neurological sequelae.
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Affiliation(s)
- Gha-Hyun Lee
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jiyoung Kim
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
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19
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Leon LL, Lima RGD, Boffi LC, Bindilatti RN, Garlipp CR, Costa SCB, Bonon SHA. Arbovirus, herpesvirus, and enterovirus associated with neurological syndromes in adult patients of a university hospital, 2017-2018. Rev Soc Bras Med Trop 2021; 54:e0127. [PMID: 34787257 PMCID: PMC8582960 DOI: 10.1590/0037-8682-0127-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Herpesviruses, enteroviruses, and arboviruses are important because of their clinical relevance and ability to cause meningitis, encephalitis, meningoencephalitis, and other diseases. The clinical virology associated with diagnostic technologies can reduce the morbidity and mortality of such neurological manifestations. Here we aimed to identify the genomes of agents that cause neurological syndromes in cerebrospinal fluid (CSF) samples from patients with suspected nervous system infections admitted to the University Hospital of the University of Campinas, São Paulo, Brazil, in 2017-2018. METHODS: CSF samples collected from adult patients with neurological syndrome symptoms and negative CSF culture results were analyzed using polymerase chain reaction (PCR), reverse transcriptase-PCR, and real-time PCR, and their results were compared with their clinical symptoms. One CSF sample was obtained from each patient. RESULTS: Viral genomes were detected in 148/420 (35.2%) CSF samples: one of 148 (0.2%) was positive for herpes simplex virus-1; two (0.5%) for herpes simplex virus-2; eight (1.9%) for varicella-zoster virus; four (1%) for Epstein-Barr virus; one (0.2%) for cytomegalovirus; 32 (7.6%) for human herpesvirus-6; 30 (7.1%) for non-polio enterovirus; 67 (16.0%) for dengue virus, three (0.7%) for yellow fever virus, and 21 (5%) for Zika virus. CONCLUSIONS: The viral genomes were found in 35.2% of all analyzed samples, showing the high prevalence of viruses in the nervous system and the importance of using a nucleic acid amplification test to detect viral agents in CSF samples.
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Affiliation(s)
- Lucas Lopes Leon
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
| | - Rodrigo Gonçalves de Lima
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
| | - Lídia Cristian Boffi
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
| | - Raissa Nery Bindilatti
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
| | - Célia Regina Garlipp
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Patologia Clínica, Campinas, SP, Brasil
| | - Sandra Cecília Botelho Costa
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
| | - Sandra Helena Alves Bonon
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório de Virologia, Campinas, SP, Brasil
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20
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Mathew S, Al Khatib HA, Al Ansari K, Nader J, Nasrallah GK, Younes NN, Coyle PV, Al Thani AA, Al Maslamani MA, Yassine HM. Epidemiology Profile of Viral Meningitis Infections Among Patients in Qatar (2015-2018). Front Med (Lausanne) 2021; 8:663694. [PMID: 34222280 PMCID: PMC8241925 DOI: 10.3389/fmed.2021.663694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Little is known about the etiology of meningitis in the MENA region, including Qatar. Viral agents are considered the major cause for meningitis worldwide. Here, we present primary data about the etiology and clinical and demographic characteristics of viral meningitis (VM) in Qatar between 2015 and 2018. Methods: We retrospectively collected data from Hamad Medical Corporation (HMC), which provides about 80% of healthcare services in Qatar. Data were collected for the period between 2015 and 2018. During this time period, 6,705 specimens were collected from patients with suspected meningitis attending HMC and primary healthcare centers. These specimens were tested for a panel of viruses using the “FTD Viral meningitis” multiplex real-time PCR kit that detects Adenovirus (ADV), Human herpesvirus 1&2 (HSV1 and HSV2), Epstein–Barr virus (EBV), Enteroviruses (EV), Cytomegalovirus (CMV), Varicella zoster virus (VZV), and Parechovirus (PV). Results: Only 10.9% (732/6,705) of all suspected meningitis cases were caused by viral agents. 60.9% of the reported cases were males, compared to 39.1% in females. Most of the infections (73.9%) were reported in children younger than 10 years of age. EV were identified as the main causative agent (68.7%), followed by EBV (7.5%) and ADV (6.8%). Other viral agents including VZV, PV, HSV-1, and HSV-2 were also detected with a lower frequency. Confirmed VM were more prevalent among Qatari subjects compared to other nationalities. We observed no specific seasonality of viral agents, but a slight rise was recorded during the spring seasons (March to June). Fever (59.4%, 435/732) and acute central nervous system (CNS) infection (15.6%, 114/732) were initial symptoms of most cases. Conclusion: This is the first report about the molecular epidemiology of VM in Qatar. In line with the international records, our data showed that EV is responsible for 68.7% of Qatar's VM cases. Further studies are needed to genotype and serotype the identified viruses.
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Affiliation(s)
- Shilu Mathew
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al Khatib
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | | | - Gheyath K Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Nadin N Younes
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | - Asmaa A Al Thani
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Hadi M Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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21
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Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Arch Virol 2021; 166:335-345. [PMID: 33392820 PMCID: PMC7779091 DOI: 10.1007/s00705-020-04891-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
Meningitis is a serious condition that affects the central nervous system. It is an inflammation of the meninges, which is the membrane that surrounds both the brain and the spinal cord. Meningitis can be caused by bacterial, viral, or fungal infections. Many viruses, such as enteroviruses, herpesviruses, and influenza viruses, can cause this neurological disorder. However, enteroviruses have been found to be the underlying cause of most viral meningitis cases worldwide. With few exceptions, the clinical manifestations and symptoms associated with viral meningitis are similar for the different causative agents, which makes it difficult to diagnose the disease at early stages. The pathogenesis of viral meningitis is not clearly defined, and more studies are needed to improve the health care of patients in terms of early diagnosis and management. This review article discusses the most common causative agents, epidemiology, clinical features, diagnosis, and pathogenesis of viral meningitis.
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Affiliation(s)
- Amira Kohil
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Sara Jemmieh
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Maria K Smatti
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar.
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Kim JW, Chae SA, Kim SY, Lee NM, Yi DY, Yun SW, Lim IS. Trends in Pediatric Meningitis in South Korea during 2009 to 2017: Analysis of the Health Insurance Review and Assessment Service Database. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2020.00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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23
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Aldriweesh MA, Shafaay EA, Alwatban SM, Alkethami OM, Aljuraisi FN, Bosaeed M, Alharbi NK. Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay. Front Neurol 2020; 11:602267. [PMID: 33424752 PMCID: PMC7793969 DOI: 10.3389/fneur.2020.602267] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Central nervous system (CNS) infection is associated with high rates of morbidity and mortality, and despite advancements in molecular testing, aseptic meningitis remains challenging to diagnose. Aseptic meningitis cases are often underreported worldwide, which impacts the quality of patient care. Therefore, we aimed to assess the results of BioFire® FilmArray® meningitis/encephalitis (ME) PCR panel, clinical characteristics, and etiologies of aseptic meningitis patients. Methods: From January 2018 to January 2020, all pediatric and adult patients in a large tertiary medical center who underwent lumbar puncture and cerebrospinal fluid (CSF) testing by a ME multiplex PCR panel and who fit the aseptic meningitis definition were retrospectively reviewed. Results: Data were reviewed from 1,607 patients; 240 met the inclusion criteria (54.6% males; 68.8% <4 years of age). The rate of detected viral causes of aseptic meningitis was 40.4%; therefore, 59.6% of the patients remained with unidentified etiology. Among the identified viral meningitis, enterovirus and human herpesvirus 6 (HHV-6) were the most common (25 and 7.9%, respectively). The median length of hospital stay was 6 days, and it was longer in patients with unidentifiable aseptic meningitis (p < 0.0001). Conclusion: Aseptic meningitis is common among suspected meningitis patients, but most cases remained of unknown etiology. The most common identified viruses were enterovirus followed by HHV-6, and there is predominance in males and the pediatric age group. These results highlight that further research is needed to identify other etiologies and possible additional viral pathogens for aseptic meningitis in the current diagnostic methods.
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Affiliation(s)
- Mohammed A Aldriweesh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Edi A Shafaay
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saud M Alwatban
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Obeid M Alkethami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Faisal N Aljuraisi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Naif Khalaf Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Tagnouokam-Ngoupo PA, Toby R, Bomba Ebede MO, Kenmoe S, Ngo-Malabo ET, Sadeuh-Mba SA, Biwole-Sida M, Njouom R. Detection of herpesviruses and enteroviruses in patients with suspected infectious meningoencephalitis in three referral hospitals in Yaounde, Cameroon. J Med Virol 2020; 92:3843-3848. [PMID: 32492202 DOI: 10.1002/jmv.26109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/24/2020] [Accepted: 05/31/2020] [Indexed: 11/10/2022]
Abstract
In Cameroon, routine diagnosis of central nervous system (CNS) infections is based on the detection of bacteria, fungi, parasites, and mycobacteria in cerebrospinal fluids. Therefore, there is no data on viral etiologies of meningoencephalitis (ME) in the country. We aim to identify viral etiologies (herpesviruses and enteroviruses) of ME in Cameroon, to provide useful information to physicians that will help improving management of ME. From February to May 2018, adult patients with clinical signs of ME in three referral hospitals in Yaounde were included. Detection of herpesviruses and enteroviruses was performed using reverse transcriptase polymerase chain reaction. P value of 5% was chosen as the threshold for statistical significance in statistical analyses. Eighty-one patients were included and 15 (18.51%) were positive for herpesviruses. No enterovirus was detected. The most prevalent virus was Epstein-Barr virus (8.6%) and most of herpesviruses were detected from human immunodefeciency virus (HIV)-positive patients (86.7%). The overall mortality rate was high, 60.5% (49/81) and analysis of risk factors showed that HIV-positive status and altered state of consciousness were associated with higher risk of death (odds ratio [OR], 5.41; confidence interval [CI]: 1.91-16.88; P = .002 and OR, 3.24; CI: 1.11-0.13; P = .036 respectively). We showed that herpesviruses are present in patients with ME symptoms in Yaounde and can be sometimes in coinfection with others common pathogens of CNS infections. There is therefore a need for increased clinician awareness and education regarding the diagnostic and management of CNS infections in Cameroon to limit unnecessary use of antibiotics.
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Affiliation(s)
| | - Roselyne Toby
- Infectious Disease Ward, Yaounde Central Hospital, Yaounde, Cameroon
| | | | - Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | | | | | - Magloire Biwole-Sida
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaounde, Cameroon
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25
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Cheng H, Chen D, Peng X, Wu P, Jiang L, Hu Y. Clinical characteristics of Epstein-Barr virus infection in the pediatric nervous system. BMC Infect Dis 2020; 20:886. [PMID: 33238935 PMCID: PMC7691062 DOI: 10.1186/s12879-020-05623-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the clinical characteristics of Epstein-Barr virus (EBV) infection in the pediatric nervous system (NS). METHODS We retrospectively analyzed the clinical data and follow-up results of 89 children with neurological damage caused by EBV who were hospitalized in the children's hospital of Chongqing Medical University from January 2008 to April 2019. RESULTS EBV infection of the NS can occur at any time of the year. The highest incidence was seen in the age group of 0-4 years. Fever is the main clinical feature (74/89, 83.1%). The main clinical types were encephalitis/meningoencephalitis (64/89, 71.9%), acute myelitis (2/89, 2.2%), acute disseminated encephalomyelitis (ADEM) (3/89, 3.4%), Guillain-Barré Syndrome (GBS) (15/89, 16.9%), neurological damage caused by EBV-hemophagocytic lymphohistiocytosis (EBV-HLH) (4/89, 4.5%), and NS-post-transplant lymphoproliferative disorder (NS-PTLD) (1/89, 1.1%). Anti-N-methyl-D-aspartate receptor encephalitis was found during the convalescence of EBV encephalitis. EBV encephalitis/meningitis showed no symptoms of tonsillitis, lymph node enlargement, skin rash, hepatosplenomegaly. Acute motor axonal neuropathy is the chief complication in GBS caused by EBV. CONCLUSION There were significant differences in neurological complications caused by EBV. The prognosis of EBV infection in the NS is generally good. These illnesses are often self-limiting. A few cases may show residual sequelae.
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Affiliation(s)
- Huan Cheng
- Department of Neurology, Children’s Hospital of Chongqing Medical University, No.136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Doudou Chen
- Department of Neurology, Children’s Hospital of Chongqing Medical University, No.136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoling Peng
- Division of Science and Technology, Beijing Normal University-Hongkong Baptist University United International College, Zhuhai, China
| | - Peng Wu
- Department of Neurology, Children’s Hospital of Chongqing Medical University, No.136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children’s Hospital of Chongqing Medical University, No.136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children’s Hospital of Chongqing Medical University, No.136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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26
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Gonçalves BC, Lopes Barbosa MG, Silva Olak AP, Belebecha Terezo N, Nishi L, Watanabe MA, Marinello P, Zendrini Rechenchoski D, Dejato Rocha SP, Faccin-Galhardi LC. Antiviral therapies: advances and perspectives. Fundam Clin Pharmacol 2020; 35:305-320. [PMID: 33011993 PMCID: PMC7675511 DOI: 10.1111/fcp.12609] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
Viral infections cause high morbidity and mortality, threaten public health, and impose a socioeconomic burden. We have seen the recent emergence of SARS‐CoV‐2 (Severe Acute Respiratory Syndrome Coronavirus 2), the causative agent of COVID‐19 that has already infected more than 29 million people, with more than 900 000 deaths since its identification in December 2019. Considering the significant impact of viral infections, research and development of new antivirals and control strategies are essential. In this paper, we summarize 96 antivirals approved by the Food and Drug Administration between 1987 and 2019. Of these, 49 (51%) are used in treatments against human immunodeficiency virus (HIV), four against human papillomavirus, six against cytomegalovirus, eight against hepatitis B virus, five against influenza, six against herpes simplex virus, 17 against hepatitis C virus and one against respiratory syncytial virus. This review also describes future perspectives for new antiviral therapies such as nanotechnologies, monoclonal antibodies and the CRISPR‐Cas system. These strategies are suggested as inhibitors of viral replication by various means, such as direct binding to the viral particle, blocking the infection, changes in intracellular mechanisms or viral genes, preventing replication and virion formation. We also observed that a large number of viral agents have no therapy available and the majority of those approved in the last 32 years are restricted to some groups, especially anti‐HIV. Additionally, the emergence of new viruses and strains resistant to available antivirals has necessitated the formulation of new antivirals.
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Affiliation(s)
- Bruna Carolina Gonçalves
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Mário Gabriel Lopes Barbosa
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Anna Paula Silva Olak
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Natalia Belebecha Terezo
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Leticia Nishi
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Maria Angélica Watanabe
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Poliana Marinello
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Daniele Zendrini Rechenchoski
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Sergio Paulo Dejato Rocha
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
| | - Lígia Carla Faccin-Galhardi
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, 86057-970, Brazil
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Chunder R, Schropp V, Kuerten S. B Cells in Multiple Sclerosis and Virus-Induced Neuroinflammation. Front Neurol 2020; 11:591894. [PMID: 33224101 PMCID: PMC7670072 DOI: 10.3389/fneur.2020.591894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/05/2020] [Indexed: 01/02/2023] Open
Abstract
Neuroinflammation can be defined as an inflammatory response within the central nervous system (CNS) mediated by a complex crosstalk between CNS-resident and infiltrating immune cells from the periphery. Triggers for neuroinflammation not only include pathogens, trauma and toxic metabolites, but also autoimmune diseases such as neuromyelitis optica spectrum disorders and multiple sclerosis (MS) where the inflammatory response is recognized as a disease-escalating factor. B cells are not considered as the first responders of neuroinflammation, yet they have recently gained focus as a key component involved in the disease pathogenesis of several neuroinflammatory disorders like MS. Traditionally, the prime focus of the role of B cells in any disease, including neuroinflammatory diseases, was their ability to produce antibodies. While that may indeed be an important contribution of B cells in mediating disease pathogenesis, several lines of recent evidence indicate that B cells are multifunctional players during an inflammatory response, including their ability to present antigens and produce an array of cytokines. Moreover, interaction between B cells and other cellular components of the immune system or nervous system can either promote or dampen neuroinflammation depending on the disease. Given that the interest in B cells in neuroinflammation is relatively new, the precise roles that they play in the pathophysiology and progression of different neuroinflammatory disorders have not yet been well-elucidated. Furthermore, the possibility that they might change their function during the course of neuroinflammation adds another level of complexity and the puzzle remains incomplete. Indeed, advancing our knowledge on the role of B cells in neuroinflammation would also allow us to tackle these disorders better. Here, we review the available literature to explore the relationship between autoimmune and infectious neuroinflammation with a focus on the involvement of B cells in MS and viral infections of the CNS.
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Affiliation(s)
- Rittika Chunder
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Verena Schropp
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Stefanie Kuerten
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Alhazmi A, Sane F, Lazrek M, Nekoua MP, Badia-Boungou F, Engelmann I, Alidjinou EK, Hober D. Enteroviruses and Type 1 Diabetes Mellitus: An Overlooked Relationship in Some Regions. Microorganisms 2020; 8:microorganisms8101458. [PMID: 32977495 PMCID: PMC7598226 DOI: 10.3390/microorganisms8101458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) infect millions of people annually. EV infections can be asymptomatic or symptomatic with conditions ranging from mild illnesses to serious diseases such as dilated cardiomyopathy. A causal relationship between EV infections and type 1 diabetes mellitus (T1DM) has been heavily debated, with some studies suggesting that this relationship is not yet conclusive and requires additional evidence, whereas others strongly argue for this correlation. While this relationship is well investigated in some developed countries like the USA and Finland, it is understudied or neglected in other countries like Russia for many reasons such as the low incidence of T1DM. Although the Middle East and North Africa (MENA) are highly affected by T1DM, the role of EVs in the disease in MENA has not been investigated extensively. Therefore, we aimed to address the relationship between T1DM and EVs in MENA and other regions globally.
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Affiliation(s)
- Abdulaziz Alhazmi
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Microbiology and Parasitology Department, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Famara Sane
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Mouna Lazrek
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Magloire Pandoua Nekoua
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Laboratoire de Biologie et Physiologie Cellulaires, Institut des Sciences Biomédicales Appliquées (ISBA), Faculté des Sciences et Techniques (FAST), Université d’Abomey-Calavi, 01 BP 526 Cotonou, Benin
| | - Francis Badia-Boungou
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Ilka Engelmann
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Enagnon Kazali Alidjinou
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Didier Hober
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Correspondence: ; Tel.: +33-3-20-44-66-88
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29
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Angel-Ambrocio AH, Bautista-Carbajal P, García-León ML, Gomora-Herrera MJ, Pedernera-Astegiano EA, Wong-Chew RM. Microglia HMC3 cells are highly susceptible to Rhinovirus infection. Virus Res 2020; 288:198110. [PMID: 32768491 DOI: 10.1016/j.virusres.2020.198110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/13/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
Human rhinovirus (HRV) affects the lower and upper respiratory tract, however, some studies suggest that HRV infection can lead to extrapulmonary complications in critical illness. Moreover, some reports have shown the presence of HRV in patients with Central Nervous System (CNS) disease. During a CNS infection, the microglia cells are the first line of defense against pathogens. In this study, the susceptibility of the human microglial clone 3 cell line (HMC3) to HRV infection was analyzed. Our findings demonstrate for the first time that HRV is capable of completing the entire viral cycle in microglial cells.
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Affiliation(s)
| | | | | | - María José Gomora-Herrera
- Departamento de Embriología y Genética, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | | | - Rosa María Wong-Chew
- División de Investigación, Facultad de Medicina. Universidad Nacional Autónoma de Mexico.
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Branscome H, Paul S, Yin D, El-Hage N, Agbottah ET, Zadeh MA, Liotta LA, Kashanchi F. Use of Stem Cell Extracellular Vesicles as a "Holistic" Approach to CNS Repair. Front Cell Dev Biol 2020; 8:455. [PMID: 32587858 PMCID: PMC7298153 DOI: 10.3389/fcell.2020.00455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Neurodegeneration is a hallmark of many diseases and disorders of the central nervous system (CNS). High levels of neuroinflammation are often associated with irreparable damage to CNS cells due to the dysregulation of signaling cascades that are unable to restore a homeostatic balance. Due to the inherent complexity of the CNS, development of CNS-related therapeutics has met limited success. While stem cell therapy has been evaluated in the context of CNS repair, the mechanisms responsible for their functional properties have not been clearly defined. In recent years, there has been growing interest in the use of stem cell extracellular vesicles (EVs) for the treatment of various CNS pathologies as these vesicles are believed to mediate many of the functional effects associated with their donor stem cells. The potency of stem cell EVs is believed to be largely driven by their biological cargo which includes various types of RNAs, proteins, and cytokines. In this review, we describe the characteristic properties of stem cell EVs and summarize their reported neuroprotective and immunomodulatory functions. A special emphasis is placed on the identification of specific biological cargo, including proteins and non-coding RNA molecules, that have been found to be associated with stem cell EVs. Collectively, this review highlights the potential of stem cell EVs as an alternative to traditional stem cell therapy for the repair of cellular damage associated with diverse CNS pathologies.
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Affiliation(s)
- Heather Branscome
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, United States
- American Type Culture Collection (ATCC), Manassas, VA, United States
| | - Siddhartha Paul
- American Type Culture Collection (ATCC) Cell Systems, Gaithersburg, MD, United States
| | - Dezhong Yin
- American Type Culture Collection (ATCC) Cell Systems, Gaithersburg, MD, United States
| | - Nazira El-Hage
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Emmanuel T. Agbottah
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, United States
| | - Mohammad Asad Zadeh
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, United States
| | - Lance A. Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, United States
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, United States
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31
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Vilmane A, Terentjeva A, Tamosiunas PL, Suna N, Suna I, Petraityte-Burneikiene R, Murovska M, Rasa-Dzelzkaleja S, Nora-Krukle Z. Human Parvoviruses May Affect the Development and Clinical Course of Meningitis and Meningoencephalitis. Brain Sci 2020; 10:brainsci10060339. [PMID: 32503112 PMCID: PMC7349785 DOI: 10.3390/brainsci10060339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
Meningitis and meningoencephalitis are neurological inflammatory diseases, and although routine diagnostics include testing of a wide range of pathogens, still in many cases, no causative agent is detected. Human parvovirus B19 (B19V), human bocaviruses 1–4 (HBoV1–4), and human parvovirus 4 (hPARV4) are members of the Parvoviridae family and are associated with a wide range of clinical manifestations including neurological disorders. The main aim of this study was to determine whether human parvoviruses infection markers are present among patients with meningitis/meningoencephalitis in Latvia as well as to clarify the role of these viruses on the clinical course of the mentioned diseases. Our study revealed HBoV1–4 and B19V genomic sequences in 52.38% and 16.67% of patients, respectively. Furthermore, symptoms such as the presence of a headache and its severity, fatigue, disorientation, and difficulties to concentrate were significantly frequently present in patients with active parvovirus infection in comparison with parvoviruses negative patients, therefore we suggest that HBoV1–4 and B19V infection should be included in the diagnostics to reduce the number of meningitis/meningoencephalitis with unknown/unexplained etiology.
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Affiliation(s)
- Anda Vilmane
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
- Correspondence: ; Tel.: +371-67060838
| | - Anna Terentjeva
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Paulius L. Tamosiunas
- Vilnius University Life Sciences Center Institute of Biotechnology, 7 Sauletekio Al., 10257 Vilnius, Lithuania; (P.L.T.); (R.P.-B.)
| | - Normunds Suna
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital “Gaiļezers”, 2 Hipokrata St., LV-1038 Riga, Latvia; (N.S.); (I.S.)
| | - Inga Suna
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital “Gaiļezers”, 2 Hipokrata St., LV-1038 Riga, Latvia; (N.S.); (I.S.)
| | - Rasa Petraityte-Burneikiene
- Vilnius University Life Sciences Center Institute of Biotechnology, 7 Sauletekio Al., 10257 Vilnius, Lithuania; (P.L.T.); (R.P.-B.)
| | - Modra Murovska
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Santa Rasa-Dzelzkaleja
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Zaiga Nora-Krukle
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
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Postels DG, Soldatos A, LaRovere KL. Outcomes measures in children after acute central nervous system infections and malaria. Curr Opin Pediatr 2019; 31:756-762. [PMID: 31693584 DOI: 10.1097/mop.0000000000000823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Acute central nervous system (CNS) infections in children result in significant mortality and neurologic morbidity worldwide. This article summarizes the recent pediatric literature published on outcomes measures used after acute infectious meningitis, encephalitis, and cerebral malaria, and highlights ongoing research efforts to standardize outcomes measurements. Search terms were geared toward functional, cognitive, behavioral, and other outcome assessments. RECENT FINDINGS Recent data suggest that, depending on microbiological cause, there are differences in currently used outcome measures following acute CNS infections. Outcomes assessments include a variety of formal psychological tests (structured interviews and neuropsychological tests of cognitive and motor functioning) and dichotomized or ordinal scales. Standardization of outcome measures, however, is lacking. Global efforts to standardize outcomes that encompass both the child and family are ongoing. SUMMARY Centers worldwide can track and measure a variety of cognitive, behavioral, and functional outcomes after acute CNS infections. Standardized documentation and coding of clinically important outcomes is needed. Further research to evaluate effective practices using acute adjunctive and rehabilitation therapies will be aided by outcome measure standardization.
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Affiliation(s)
- Douglas G Postels
- Department of Neurology, Children's National Health System, Washington, District of Columbia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
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Peer V, Schwartz N, Green MS. Consistent, Excess Viral Meningitis Incidence Rates in Young Males: A Multi-country, Multi-year, Meta-analysis of National Data. The Importance of Sex as a Biological Variable. EClinicalMedicine 2019; 15:62-71. [PMID: 31709415 PMCID: PMC6833362 DOI: 10.1016/j.eclinm.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sex can be an important biological variable in the immune response to infections and the response to vaccines. The magnitude and consistency in age-specific sex differences in the incidence of viral infections remain unclear. METHODS We obtained data from national official agencies on cases of viral meningitis by sex and age group over a period of 6-16 years from five countries: Canada, Czech Republic, Germany, Israel, and Poland. Male to female incidence rate ratios (RR) were computed for each year, by country, and age group. For each age group, we used meta-analysis methodology to combine the incidence RRs. Meta-regression was conducted to the estimate the effects of age, country, and time period on the RR. FINDINGS In the age groups < 1, 1-4, 5-9, 10-14, there were consistently higher incidence rates in males, over countries and time. The pooled incidence RRs (with 95% CI) were 1.38 (1.30-1.47), 1.94 (1.85-2.03), 1.98 (1.88-2.07), and 1.58 (1.47-1.71) respectively. In young and middle-age adults there were no differences with pooled incidence RRs of 1.00 (0.97-1.03), and 0.97 (0.94-1.00), respectively. Sensitivity analysis confirms that the results are stable and robust. Meta-regression showed that almost all the variations in the incidence RRs were contributed by age group. INTERPRETATION The higher incidence rates from viral meningitis in males under the age of 15 are remarkably consistent across countries and time-periods. These findings emphasize the importance of sex as a biological variable in infectious diseases. This could provide keys to the mechanisms of infection and lead to more personalized treatment and vaccine doses and schedules. FUNDING There was no funding source for this article.
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Rhinovirus-associated acute encephalitis/encephalopathy and cerebellitis. Brain Dev 2019; 41:551-554. [PMID: 30850156 DOI: 10.1016/j.braindev.2019.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Rhinovirus is a common respiratory pathogen for children throughout the year; nevertheless, its central nervous system involvement is extremely rare, and only two cases have been reported to date: meningitis and sepsis-like illness. PATIENT A previously healthy 2-year-old Japanese boy developed fever, followed by seizures and lethargy. His cerebrospinal fluid cell count and protein level were slightly increased; brain magnetic resonance imaging showed abnormal intensities in the bilateral cerebellar dentate nuclei, which were prominent in diffusion-weighted images. After his consciousness disturbance improved, cerebellar dysfunction became apparent. He was treated symptomatically, without steroids or any other immunosuppressants. He almost recovered within a few months; however, cerebellar atrophy became evident on brain magnetic resonance imaging. Using acute specimens, human rhinovirus A was detected in his throat swab and cerebrospinal fluid. DISCUSSION Acute cerebellitis, in which cerebellar inflammation is predominant, is occasionally accompanied by cerebral symptoms, such as consciousness disturbance and seizures. As a causative pathogen, rotavirus is the most common; however, rhinovirus-associated acute encephalitis/encephalopathy and concurrent cerebellitis have not been reported before. Further research, using recent molecular techniques to detect various central nervous system pathogens, including rhinovirus, is needed to delineate the underlying pathophysiology.
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