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Gutierrez J, Katan M, Elkind MS. Inflammatory and Infectious Vasculopathies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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2
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Monteiro VS, Baía-da-Silva DC, Silva VA, Pivoto João GA, Marinho EPM, Cubas-Vega NC, Val FFA, Perez-Gomez AS, Monte RL, Mota A, Lacerda MVG, Souza Bastos M. Neurological Manifestations Associated with Parvovirus B19 Infection in Immunocompetent Children: Case Series and Systematic Review. J Trop Pediatr 2021; 67:fmab078. [PMID: 34545404 DOI: 10.1093/tropej/fmab078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An increasing number of reports have described human parvovirus B19 infection in association with a variety of neurological manifestations, especially in children. This study assessed the clinical and laboratory outcomes found in a case series of immunocompetent children who tested positive for parvovirus B19 by qualitative polymerase chain reaction assays of cerebrospinal fluid, in a tertiary referral center in the western Brazilian Amazon. We screened 178 children with clinically diagnosed central nervous system infections (meningoencephalitis). Of these, five (2.8%) were positive for parvovirus B19. A literature review also presented herein identified a further 50 cases of parvovirus B19 with neurological manifestations. Thus, even if the classic signs of parvovirus B19 infection are absent, such as the well-known rash, children with signs of neurological infection should also be evaluated for parvovirus B19 infection.
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Affiliation(s)
- Vinícius Silva Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Djane Clarys Baía-da-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Instituto Leônidas and Maria Deane, Fiocruz, Manaus 69.057-070, Brazil
| | - Valderjane Aprigio Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Guilherme Augusto Pivoto João
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Eveny Perlize Melo Marinho
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
| | - Nadia Carolina Cubas-Vega
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Fernando Fonseca Almeida Val
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Aline Stephanie Perez-Gomez
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Rossiclea Lins Monte
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Adolfo Mota
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Michele Souza Bastos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
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Cerasti D, Ormitti F, Pardatscher S, Malchiodi L, Picetti E, Menozzi R, Rossi S. Multiple Acute Ischemic Strokes in a COVID-19 Patient: a Case Report. ACTA ACUST UNITED AC 2020; 2:1213-1217. [PMID: 32838158 PMCID: PMC7334131 DOI: 10.1007/s42399-020-00388-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
We describe a case of a 47-year-old Italian, immunocompromised, and obese woman infected by COVID-19 presenting with fever (39.6 °C) and respiratory symptoms. Neurological examination was normal. Chest CT findings consist of bilateral interstitial pneumonia (visual score extension: 30%). The patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care. Seven days after admission to Covid-19 Unit, the patient rapidly developed worsening respiratory failure and acute respiratory distress syndrome (ARDS). She suddenly developed partial left hemispheric syndrome. A new HRCT scan of her thorax revealed diffuse ground-glass opacities in both lungs (visual score extension: 90%). Brain CT performed 2 h after sudden-onset left-sided weakness showed subtle low attenuation within the right insular ribbon and frontal lobe (ASPECT Score 8). Multiphasic CT angiography (MCTA) demonstrated occlusion of both the dominant inferior division of the right middle cerebral artery and the A2 segment of the right anterior cerebral artery. After 24 h, her pupils became dilated and unreactive, and brain CT demonstrated large bilateral infarctions of both the cerebellar and cerebral hemispheres. She had a rapid progression of interstitial pneumonia from COVID-19, developed multiple strokes, and died 1 day later. SARS-CoV-2 infection seems to predispose pluripathological subjects to cerebrovascular complications.
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Affiliation(s)
- Davide Cerasti
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, via Antonio Gramsci, 14, 43126 Parma, Italy
| | - Francesca Ormitti
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, via Antonio Gramsci, 14, 43126 Parma, Italy
| | - Stefano Pardatscher
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, via Antonio Gramsci, 14, 43126 Parma, Italy
| | - Laura Malchiodi
- Department of Emergency, Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy
| | - Edoardo Picetti
- Department of Emergency, Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, via Antonio Gramsci, 14, 43126 Parma, Italy
| | - Sandra Rossi
- Department of Emergency, Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy
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Kortela E, Hytönen J, Numminen J, Overmyer M, Saxen H, Oksi J. Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis. JMM Case Rep 2017; 4:e005090. [PMID: 29026617 PMCID: PMC5630958 DOI: 10.1099/jmmcr.0.005090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Lyme borreliosis is a multisystem tick-borne disease caused by Borrelia burgdorferi. Neurological manifestations are reported in up to 15 % of adult patients with Lyme disease, while the frequency among children is higher. The most common manifestations are painful radiculopathy, facial nerve paresis and lymphocytic meningitis. Epileptic seizures and cerebral vasculitis with stroke or aneurysms are very rare complications. Case presentation. We describe a paediatric patient with sensorineural auditory dysfunction, headache, fatigue and epileptic seizures as sequelae of meningoencephalitis/Lyme neuroborreliosis (LNB) caused by B. burgdorferi. Brain magnetic resonance imaging revealed widespread enhancement of the leptomeninges, cranial nerves and artery walls compatible with vasculitis and disturbances in cerebrospinal fluid (CSF) circulation. The patient was treated with ceftriaxone for 2 weeks. Two years later, the patient had an ischemic stroke. Brain magnetic resonance angiography revealed multiple aneurysms, which were not present previously. The largest aneurysm was operated rapidly. The patient was treated with another course of intravenous ceftriaxone for 4 weeks and pulse therapy with corticosteroids. He recovered well.
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Affiliation(s)
- Elisa Kortela
- Division of Infectious Diseases, Faculty of Medicine, University of Turku, University of Helsinki, Helsinki University Hospital, P.O. Box 348, 00029 HUS, Finland
| | - Jukka Hytönen
- Department of Medical Microbiology and Immunology and Microbiology and Genetics Department, University of Turku, Turku University Hospital, Turku, Finland
| | - Jussi Numminen
- Helsinki Medical Imaging Centre, University of Helsinki, Helsinki, Finland
| | - Margit Overmyer
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Division of Medicine, Faculty of Medicine, University of Turku, Turku University Hospital, P.O. Box 52, 20521 Turku, Finland
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5
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Fullerton HJ, Luna JM, Wintermark M, Hills NK, Tokarz R, Li Y, Glaser C, DeVeber GA, Lipkin WI, Elkind MSV. Parvovirus B19 Infection in Children With Arterial Ischemic Stroke. Stroke 2017; 48:2875-2877. [PMID: 28864597 DOI: 10.1161/strokeaha.117.018272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/07/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases. METHODS The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens. RESULTS Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries. CONCLUSIONS Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis.
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Affiliation(s)
- Heather J Fullerton
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Jorge M Luna
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Max Wintermark
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Nancy K Hills
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Rafal Tokarz
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Ying Li
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Carol Glaser
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Gabrielle A DeVeber
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - W Ian Lipkin
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.)
| | - Mitchell S V Elkind
- From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.).
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Abstract
Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.
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Affiliation(s)
- Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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7
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Gutierrez J, Katan M, Elkind MS. Collagen Vascular and Infectious Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Abstract
Stroke is as common as brain tumor in children. The etiology of childhood arterial ischemic stroke (AIS) appears to be multifactorial, resulting from the interaction between genetic predisposition and environmental triggers. The risk factors for AIS in children are markedly different from the atherosclerotic risk factors in adults. Trauma and infections have been identified as associations in previous studies and are exposures of particular interest because of their increased prevalence in the children. The aim of this review article is to provide an overview of the research studies that have addressed the role of infections and trauma in pediatric AIS.
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Affiliation(s)
- Elena Moraitis
- Rheumatology/Infectious Diseases and Immunity Unit UCL Institute of Child Health and Rheumatology Department, Great Ormond Street Hospital for Children, London, UK,
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9
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Barah F, Whiteside S, Batista S, Morris J. Neurological aspects of human parvovirus B19 infection: a systematic review. Rev Med Virol 2014; 24:154-68. [PMID: 24459081 PMCID: PMC4238837 DOI: 10.1002/rmv.1782] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 02/06/2023]
Abstract
Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required. © 2014 The Authors. Reviews in Medical Virology published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Faraj Barah
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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10
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Mallick AA, O’Callaghan FJK. Risk factors and treatment outcomes of childhood stroke. Expert Rev Neurother 2014; 10:1331-46. [DOI: 10.1586/ern.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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11
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Mechanisms of pediatric cerebral arteriopathy: an inflammatory debate. Pediatr Neurol 2013; 48:14-23. [PMID: 23290015 DOI: 10.1016/j.pediatrneurol.2012.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/27/2012] [Indexed: 11/21/2022]
Abstract
Arteriopathy is the leading cause of childhood arterial ischemic stroke, but its mechanisms are poorly understood. This review explores the possible role of inflammatory mechanisms and evidence for inflammatory pathophysiology in specific pediatric cerebral arteriopathies. Pathologically proven small-vessel central nervous system vasculitis provides a definitive inflammatory model where available treatments are likely improving outcomes. In contrast, a common large-vessel arteriopathy presents many features suggestive of inflammation, but definitive proof remains elusive. Recent advances and future research directions, including biomarker, neuroimaging, and pathologic approaches and how they might address these important clinical questions, are discussed.
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12
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de Jong EP, Walther FJ, Kroes ACM, Oepkes D. Parvovirus B19 infection in pregnancy: new insights and management. Prenat Diagn 2011; 31:419-25. [PMID: 21351281 DOI: 10.1002/pd.2714] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 11/07/2022]
Abstract
In this article, we review the virology, pathology, epidemiology and clinical spectrum of intrauterine human parvovirus B19 (B19V) infection, including intrauterine fetal death, non-immune hydrops fetalis, thrombocytopenia and neurological manifestations such as pediatric stroke and perivascular calcifications. In addition, we discuss the new insights into the neurodevelopmental outcome of intrauterine B19V infection. Current diagnosis and management of B19V infection is summarized, including a diagnostic and follow-up flowchart for practical clinical use.
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Affiliation(s)
- E P de Jong
- Department of Pediatrics, HAGA Hospital, Juliana's Childrens Hospital, The Hague, The Netherlands.
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13
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Kutlesa M, Tesović G, Knezović I, Mise B, Visković K, Barisić N. Ischemic stroke associated with adenoviral infection in a 4-year-old boy. Wien Klin Wochenschr 2010; 121:776-9. [PMID: 20047116 DOI: 10.1007/s00508-009-1286-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 10/14/2009] [Indexed: 11/25/2022]
Abstract
We present a case of childhood arterial ischemic stroke associated with proven adenoviral upper respiratory tract infection in a previously healthy 4-year-old boy. Adenoviral meningitis and encephalitis have been reported repeatedly, thus confirming the neuroinvasive capability of these viruses. However, an association between adenoviral infection and arterial ischemic stroke has not been described thus far. HIV and varicella zoster virus are the only microorganisms that have been consistently associated with arterial ischemic stroke in the absence of acute central nervous system infection. In HIV-infected individuals ischemic stroke can be caused by vasculitis and hypercoagulability. Granulomatous arteritis of the vessel wall causes post-varicella cerebral infarction and ischemic stroke after herpes zoster ophthalmicus. We suggest that in our patient a post-varicella cerebral infarction-like mechanism of adenoviral spread to the affected artery wall occurred through the ophthalmic branch of the trigeminal nerve. Adenoviruses are neuroinvasive and inflamed conjunctiva might have permitted introduction of the virus into ophthalmic nerve tissue. In consequence, the stenotic lesion of the artery might have been induced by the presence of adenovirus and the subsequent inflammatory reaction. We recommend a prompt quest for adenoviral infection in all previously healthy children with fever and clinical presentation compatible with ischemic stroke, because timely diagnosis and treatment could improve the outcome and hasten neurological recovery.
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Affiliation(s)
- Marko Kutlesa
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia.
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14
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Greco F, Barbagallo ML, Chiodo DC, Guglielmino R, Sorge G. Severe ataxia as a complication of human parvovirus B19 acute encephalitis in a child. J Child Neurol 2008; 23:1078-80. [PMID: 18487517 DOI: 10.1177/0883073808315420] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Human parvovirus B19 generally causes erythema infectiosum in childhood, but it can be associated with unusual findings, particularly in immunocompromised patients. This is a report about an immunocompetent 4-year-old female child affected with acute encephalitis by parvovirus B19, documented by polymerase chain reaction performed on cerebrospinal fluid, who was treated with intravenous immunoglobulins and dexamethasone and who developed a cerebellar syndrome with ataxia, dysmetria, and dysarthria. To the best of the authors' knowledge, this may be the first report of human parvovirus B19 encephalitis complicated by severe ataxia in childhood.
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Affiliation(s)
- Filippo Greco
- Department of Pediatrics, University of Catania, Catania, Italy.
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15
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Vargiami E, Zafeiriou DI, Gombakis NP, Kirkham FJ, Athanasiou-Metaxa M. Hemolytic anemia presenting with idiopathic intracranial hypertension. Pediatr Neurol 2008; 38:53-4. [PMID: 18054695 DOI: 10.1016/j.pediatrneurol.2007.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 07/25/2007] [Accepted: 08/27/2007] [Indexed: 11/19/2022]
Abstract
We report on an 8-year-old girl with hemolytic anemia because of infection with parvovirus B19 and increased intracranial pressure. She presented acutely with headache, vomiting, and mild scleral and mucosal icterus. Upon evaluation, the patient exhibited profound hemolytic anemia, papilledema, and increased intracranial pressure. The patient was treated with intravenous immunoglobulin, prednisone, and packed red blood cells. Concurrent with an improvement of her anemia, she experienced a gradual resolution of her headache, vomiting, and optic-disc swelling. Signs of idiopathic intracranial hypertension may occur as a consequence of severe anemia, and are reversible upon correction of the underlying hematologic disorder.
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Affiliation(s)
- Euthymia Vargiami
- First Department of Pediatrics, Aristotle University of Thessaloniki, Greece
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16
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Riou EM, Amlie-Lefond C, Echenne B, Farmer M, Sébire G. Cerebrospinal fluid analysis in the diagnosis and treatment of arterial ischemic stroke. Pediatr Neurol 2008; 38:1-9. [PMID: 18054685 DOI: 10.1016/j.pediatrneurol.2007.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 07/27/2007] [Accepted: 09/10/2007] [Indexed: 01/04/2023]
Abstract
With the advent of magnetic resonance imaging as a rapid and accurate way to diagnose arterial ischemic stroke, cerebrospinal fluid assessment is rarely performed, unless infectious or inflammatory processes are obvious. Recent advances in the understanding of the pathophysiology of childhood stroke have implicated a growing list of discrete or occult infectious and inflammatory conditions which may involve intracranial arteries and neighboring structures. Cerebrospinal-fluid assessment may allow the detection of markers identifying processes (including infectious, inflammatory, metabolic, and traumatic) potentially involved in cerebral vasculopathy and stroke. The analysis of cerebrospinal fluid in arterial ischemic strokes, including apparently idiopathic strokes, may yield essential information on pathophysiology, allowing for optimal therapeutic decisions and prognostic considerations.
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Affiliation(s)
- Emilie M Riou
- Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
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17
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Soares-Fernandes JP, Maré R. Isolated velopalatine paralysis associated with parvovirus B19 infection. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 64:603-5. [PMID: 17119802 DOI: 10.1590/s0004-282x2006000400015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/29/2006] [Indexed: 11/22/2022]
Abstract
A case of isolated velopalatine paralysis in an 8-year-old boy is presented. The symptoms were sudden-onset of nasal speech, regurgitation of liquids into the nose and dysphagia. Brain MRI and cerebrospinal fluid examination were normal. Infectious serologies disclosed an antibody arrangement towards parvovirus B19 that was typical of recent infection. In the absence of other positive data, the possibility of a correlation between the tenth nerve palsy and parvovirus infection is discussed.
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Affiliation(s)
- João P Soares-Fernandes
- Department of Neuroradiology, Hospital de S. Marcos, and School of Health Sciences, University of Minho, Braga, Portugal.
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18
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Laurenz M, Winkelmann B, Roigas J, Zimmering M, Querfeld U, Müller D. Severe parvovirus B19 encephalitis after renal transplantation. Pediatr Transplant 2006; 10:978-81. [PMID: 17096771 DOI: 10.1111/j.1399-3046.2006.00599.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Human parvovirus B19 is a common cause of benign erythema infectiosum (fifth disease) in otherwise healthy children. Immunocompromized patients are at risk of developing chronic infections leading to chronic hyporegenerative anemia. We report the case of a nine-year-old boy who presented five days after renal transplantation with seizures and signs of encephalitis on MRI. The clinical course was characterized by anemia and seroconversion for parvovirus B19 accompanied by a high viral load (>10(9) copies per milliliter). A transfusion of red blood cells that the patient required after transplantation was found to be negative for parvovirus B19, leaving the donated organ as the most likely source of infection. Reduction of the immunosuppressive regimen led to complete recovery of the patient with a stable RBC count upon discharge. Parvovirus B19 infections should be considered in the differential diagnosis of seizures after solid organ transplantation.
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Affiliation(s)
- M Laurenz
- Department of Pediatric Nephrology, Charité Universitätsmedizin, Berlin, Germany
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19
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Abstract
Human parvovirus B19 is the agent that causes erythema infectiosum (fifth disease), a disease that is generally benign and self-limiting. This virus also is associated with severe disease in hemolytic or immunocompromised patients. It rarely causes meningoencephalitis in healthy children. Herein we present the case of a 10-year-old healthy girl with refractory status epilepticus possibly owing to human parvovirus B19 encephalitis who was successfully treated with high-dose corticosteroids. To our knowledge, this is the first report of human parvovirus B19 encephalitis complicated by refractory status epilepticus in a child.
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Affiliation(s)
- Ilknur Erol
- Department of Pediatrics, Neurology Division, Baskent University School of Medicine, 6.Cadde 72/3 Bahcelievler, 06490 Ankara, Turkey.
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20
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de Jong EP, de Haan TR, Kroes ACM, Beersma MFC, Oepkes D, Walther FJ. Parvovirus B19 infection in pregnancy. J Clin Virol 2006; 36:1-7. [PMID: 16488187 DOI: 10.1016/j.jcv.2006.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 12/30/2005] [Accepted: 01/10/2006] [Indexed: 10/25/2022]
Abstract
Parvovirus B19 is a small single-stranded DNA virus and a potent inhibitor of erythropoiesis, due to its cytotoxicity to erythroid progenitor cells. Infection with parvovirus B19 during pregnancy can cause several serious complications in the fetus, such as fetal anemia, neurological anomalies, hydrops fetalis, and fetal death. Early diagnosis and treatment of intrauterine parvovirus B19 infection is essential in preventing these fetal complications. Testing maternal serum for IgM antibodies against parvovirus B19 and DNA detection by PCR can confirm maternal infection. If maternal infection has occurred, ultrasound investigation of the fetus and measurement of the peak systolic flow velocity of the middle cerebral artery are sensitive non-invasive procedures to diagnose fetal anemia and hydrops. Intrauterine transfusion is currently the only effective treatment to alleviate fetal anemia, but if the fetus is (near) term, induction of delivery should be considered. Most maternal infections with parvovirus B19 occur through contact with infected children at home. Individual counseling of susceptible pregnant women will reduce unnecessary fetal deaths.
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Affiliation(s)
- Eveline P de Jong
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Lynch JK, Pavlakis S, Deveber G. Treatment and prevention of cerebrovascular disorders in children. Curr Treat Options Neurol 2006; 7:469-80. [PMID: 16221370 DOI: 10.1007/s11940-005-0047-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cerebrovascular disorders are an important cause of mortality and chronic morbidity in children. Ischemic stroke is more common than cerebral venous thrombosis and hemorrhagic stroke in children. Several medical disorders have been associated with stroke in children, and a thorough evaluation of underlying causes is needed to determine the best treatment and prevention strategy. The treatment and prevention of stroke in children is not well studied, and current recommendations are based on adult studies, nonrandomized trials, or expert opinion. Children with stroke require immediate, special attention and if possible should be stabilized and transferred to an institution that can offer pediatric neurovascular expertise and care. All children with stroke should be referred to or have their care managed by a pediatric neurologist. The treatment of stroke in adults is well studied, and when applicable this evidence should be considered in the treatment of children with stroke. Data from animal and adult stroke studies have demonstrated a benefit for the aggressive treatment of infection, fever, blood pressure, hypo/hyperglycemia, intracranial pressure, and seizures, and should be applied to children with stroke. The use of thrombolytic, antithrombotic, and antiplatelet therapies is based on adult studies, cohort studies, and/or expert opinion. Two consensus guidelines regarding the treatment of arterial ischemic stroke and cerebral venous thrombosis were recently published and recommend the use of anticoagulants or antiplatelet agents in the acute setting, depending on the underlying cause of stroke. The evidence for the primary prevention of stroke in children is restricted to sickle cell disease (SCD) and derived from the Stroke Prevention in Sickle Cell Study Project studies. Long-term chronic transfusion therapy to maintain hemoglobin S levels below 30% is indicated in children with SCD and intracranial stenosis. It has also been recently determined that chronic transfusion therapy should not be stopped in children with SCD and an increased risk for stroke. The recurrence rate of arterial ischemic stroke (AIS) in children ranges from 6% to 30% and is highest among children with recurrent transient ischemic attack, cardiac disease, arteriopathies, and metabolic and coagulation abnormalities. Recommendations for secondary prevention are based on adult studies and the underlying pathophysiology of the stroke. Antiplatelet therapy (aspirin 1-5 mg/kg/day) is recommended in most children with a history of AIS. Although there is minimal evidence to support its use in children, anticoagulation may be indicated in AIS associated with extracranial arterial dissection, prothrombotic disorders, cardiac disease, severe intracranial stenosis, and recurrent AIS while on antiplatelet therapy.
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Abstract
PURPOSE OF REVIEW To facilitate and standardize the diagnosis of cerebrovascular conditions in childhood, particularly in the field of arterial ischemic diseases. RECENT FINDINGS Progress in diagnostic techniques in the past decade have led to newly established etiologies for childhood stroke, most of which represent some form of vascular pathology. These advances must be integrated into a modern nomenclature system with revised definitions of stroke and arterial wall diseases-arteriopathies-in childhood. SUMMARY This nomenclature system is intended to facilitate and enhance clinical research in childhood stroke, particularly multicenter collaborative studies.
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Affiliation(s)
- Guillaume Sébire
- Service de Neurologie Pédiatrique, CHU de Sherbrooke, Université de Sherbrooke, Canada.
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23
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Umapathi T, Kor AC, Venketasubramanian N, Lim CCT, Pang BC, Yeo TT, Lee CC, Lim PL, Ponnudurai K, Chuah KL, Tan PH, Tai DYH, Ang SPB. Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). J Neurol 2004; 251:1227-31. [PMID: 15503102 PMCID: PMC7088071 DOI: 10.1007/s00415-004-0519-8] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 04/20/2004] [Accepted: 04/28/2004] [Indexed: 12/24/2022]
Abstract
Of the 206 patients who contracted Severe Acute Respiratory Syndrome (SARS) in Singapore five developed large artery cerebral infarctions. Four patients were critically-ill and three died. Intravenous immunoglobulin was given to three patients. An increased incidence of deep venous thrombosis and pulmonary embolism was also observed among the critically-ill patients. We believe our experience warrants an increased vigilance against stroke and other thrombotic complications among critically-ill SARS patients in future outbreaks, especially if treatment such as intravenous immunoglobulin, that increases pro-thrombotic tendency, is contemplated.
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Affiliation(s)
- T Umapathi
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433.
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Hsu D, Sandborg C, Hahn JS. Frontal lobe seizures and uveitis associated with acute human parvovirus B19 infection. J Child Neurol 2004; 19:304-6. [PMID: 15163099 DOI: 10.1177/088307380401900413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We report a 5-year-old girl who developed repeated episodes of behavioral alterations shortly after human parvovirus B19 infection and uveitis. Video-electroencephalographic study demonstrated that these brief episodes were frontal lobe seizures. Seizures responded promptly to antiepilepsy medications. Further diagnostic testing did not reveal any rheumatologic disorders. Human parvovirus B19 infections in children are more commonly associated with febrile seizures and meningoencephalitis. Our case demonstrates that, rarely, it may be associated with the development of partial epilepsy.
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Affiliation(s)
- David Hsu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, California 94305-5235, USA
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