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Wagner JN, Leibetseder A, Troescher A, Panholzer J, von Oertzen TJ. Characteristics and therapy of enteroviral encephalitis: case report and systematic literature review. Int J Infect Dis 2021; 113:93-102. [PMID: 34628025 DOI: 10.1016/j.ijid.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Enterovirus (EV) is a frequent cause of encephalitis. The optimal therapeutic approach remains a matter of debate. We present the case of an immunosuppressed patient with EV encephalitis treated successfully with intravenous immunoglobulin (IVIG) and report the results of a systematic review on the characteristics of EV encephalitis, as well as the safety and efficacy of IVIG therapy. METHODS A systematic review was conducted using the PubMed, Cochrane Database, BIOSIS Previews, and ClinicalTrials.gov databases to identify all reports on patients with EV encephalitis as of December 31, 2020. The main outcomes assessed were the efficacy and safety of the respective therapeutic approach. RESULTS A total of 73 articles were included: one prospective trial, one retrospective and prospective case series, one purely retrospective case series, and 70 case reports. The case reports included a total of 101 patients. Immunosuppressed patients were at higher risk of contracting EV encephalitis and experiencing a fatal course. Hypogammaglobulinaemia particularly predisposes to EV disease, even with a moderate reduction in serum IgG levels. IVIG therapy in the immunosuppressed may confer a survival advantage. CONCLUSIONS IVIG therapy is rarely associated with severe adverse events and may be considered in immunosuppressed patients with EV encephalitis. Future trials should investigate the optimal IVIG dosing and route of application, the benefit of antibody-enriched IVIG preparations, and the serum immunoglobulin level that should trigger prophylactic replacement.
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Affiliation(s)
- Judith N Wagner
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria.
| | - Annette Leibetseder
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Anna Troescher
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Juergen Panholzer
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
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Hassan J, Wangai L, Borus P, Khayeka-Wandabwa C, Karani LW, Kithinji M, Kiptoo M. Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children. BMC Res Notes 2017; 10:555. [PMID: 29100529 PMCID: PMC5670520 DOI: 10.1186/s13104-017-2843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Poliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly in capsid protein. Prolonged vaccine-related poliovirus shedding in human immunodeficiency virus (HIV) positive individuals has been linked to possible reservoir for reintroduction of polioviruses after eradication. The study therefore aimed at estimating the duration for vaccine-related poliovirus shedding among potentially and HIV-infected persons. Methods Poliovirus excretion was studied following vaccination of children aged ≤ 59 month per human immunodeficiency virus status after national immunization days. Their medical records were reviewed to identify the child’s HIV status, demographic and immunization data. Sequential stool samples were collected at site 2nd, 4th and 8th week after trivalent oral poliovirus vaccine (tOPV) was administered. To isolate suspected polioviruses and non-polio enteroviruses, characterize poliovirus subtypes by intratypic differentiation and Sabin vaccine derived poliovirus, real time polymerase chain reaction was applied. Shedding for ≥ 24 weeks was defined as long-term persistence. Results The mean age of the study population was 28.6 months, while the median age was 24 months. Of the children recruited, majority were in the 25–48 months (n = 12; 46.2%) age category. All the HIV-positive children (n = 10) had mild symptomatic HIV status and did shed vaccine-related polioviruses between weeks 2 and 4 respectively. No participant shed polioviruses for ≥ 6 weeks. Conclusions It was evident mildly symptomatic HIV+ children sustain the capacity to clear vaccine-related poliovirus. The oral poliovirus vaccine-2 (Sabin like) that was detected in one HIV-infected child’s stool 6 weeks after the national immunization days was predominantly non revertant. There was no evident prolonged poliovirus shedding among the participants enlisted in the present study. High powered studies are desired to further corroborate these findings.
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Affiliation(s)
- Joanne Hassan
- Institute of Tropical Medicine and Infectious Diseases (ITROMID), Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya. .,Kenya Medical Research Institute (KEMRI), P.O. Box 54628-00200, Nairobi, Kenya.
| | | | - Peter Borus
- World Health Organization (WHO), Nairobi, Kenya
| | - Christopher Khayeka-Wandabwa
- Health Sciences Platform, School of Pharmaceutical Science and Technology (SPST), Tianjin University, 92 Weijin road, Nankai District, Tianjin, 300072, People's Republic of China. .,African Population and Health Research Center (APHRC), Nairobi, Kenya.
| | - Lucy Wanja Karani
- Institute of Tropical Medicine and Infectious Diseases (ITROMID), Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya
| | | | - Michael Kiptoo
- Institute of Tropical Medicine and Infectious Diseases (ITROMID), Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya.,South Eastern Kenya University (SEKU), Kwa Vonza, Kenya
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Benschop KSM, van der Avoort HGAM, Duizer E, Koopmans MPG. Antivirals against enteroviruses: a critical review from a public-health perspective. Antivir Ther 2015; 20:121-30. [PMID: 25643052 DOI: 10.3851/imp2939] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 10/24/2022]
Abstract
The enteroviruses (EVs) of the Picornaviridae family are the most common viral pathogens known. Most EV infections are mild and self-limiting but manifestations can be severe in children and immunodeficient individuals. Antiviral development is actively pursued to benefit these high-risk patients and, given the alarming problem of antimicrobial drug resistance, antiviral drug resistance is a public-health concern. Picornavirus antivirals can be used off-label or as part of outbreak control measures. They may be used in the final stages of poliovirus eradication and to mitigate EV-A71 outbreaks. We review the potential emergence of drug-resistant strains and their impact on EV transmission and endemic circulation. We include non-picornavirus antivirals that inhibit EV replication, for example, ribavirin, a treatment for infection with HCV, and amantadine, a treatment for influenza A. They may have spurred resistance emergence in HCV or influenza A patients who are unknowingly coinfected with EV. The public-health challenge is always to find a balance between individual benefit and the long-term health of the larger population.
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Affiliation(s)
- Kimberley S M Benschop
- Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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Chen CY, Kuo CC, Lo CP, Huang MY, Wang YM, Wang WY. Eosinophilic meningoencephalitis caused by Angiostrongylus cantonesis. QJM 2014; 107:573-5. [PMID: 22198942 DOI: 10.1093/qjmed/hcr261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C-Y Chen
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - C-C Kuo
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - C-P Lo
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - M-Y Huang
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Y-M Wang
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - W-Y Wang
- From the Department of Nuclear Medicine, Department of Neurology, Department of Radiology and Division of Infectious Diseases and Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
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5
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Wildenbeest JG, van den Broek PJ, Benschop KSM, Koen G, Wierenga PC, Vossen ACTM, Kuijpers TW, Wolthers KC. Pleconaril revisited: clinical course of chronic enteroviral meningoencephalitis after treatment correlates with in vitro susceptibility. Antivir Ther 2011; 17:459-66. [PMID: 22293148 DOI: 10.3851/imp1936] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Human enteroviruses (HEVs) can cause severe infections, especially in patients with a deficient humoral immune response, such as X-linked agammaglobulinemia. In this patient group, chronic enteroviral meningitis (CEMA) is feared because of extensive morbidity and high fatality rate. Treatment options consist of intravenous immunoglobulin (IVIG), with various outcomes. Pleconaril is an antiviral agent with in vitro activity against HEVs that has been used in the treatment of HEV infections. METHODS The efficacy of pleconaril and IVIG against HEV isolated from the patients was assessed in vitro in two patients with CEMA. RESULTS Echovirus 11 was found in the cerebrospinal fluid (CSF) of case 1. Treatment with high-dose IVIG and pleconaril did not provide any clinical improvement and HEV PCR in CSF remained positive. Case 2 (echovirus 13 positive in CSF) was also treated with IVIG and pleconaril. The patient recovered completely and HEV PCR in CSF became negative. Recent IVIG batches contained low titres of neutralizing antibodies against the patient strains. Echovirus 11 (case 1) was resistant to pleconaril in vitro, whereas echovirus 13 (case 2) was susceptible, in accordance with virological response after treatment and subsequent clinical results. CONCLUSIONS This is the first report that evaluates efficacy of antiviral treatment in CEMA patients in relation to in vitro susceptibility of clinical virus isolates. Since pleconaril is no longer available for compassionate use we strongly propagate that new drugs should be developed against these potential life threatening HEV infections.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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6
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Khetsuriani N, Helfand R, Pallansch M, Kew O, Fowlkes A, Oberste MS, Tukei P, Muli J, Makokha E, Gary H. Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya. BMC Infect Dis 2009; 9:136. [PMID: 19698184 PMCID: PMC2739212 DOI: 10.1186/1471-2334-9-136] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 08/23/2009] [Indexed: 11/10/2022] Open
Abstract
Background Immunodeficient persons with persistent vaccine-related poliovirus infection may serve as a potential reservoir for reintroduction of polioviruses after wild poliovirus eradication, posing a risk of their further circulation in inadequately immunized populations. Methods To estimate the potential for vaccine-related poliovirus persistence among HIV-infected persons, we studied poliovirus excretion following vaccination among children at an orphanage in Kenya. For 12 months after national immunization days, we collected serial stool specimens from orphanage residents aged <5 years at enrollment and recorded their HIV status and demographic, clinical, immunological, and immunization data. To detect and characterize isolated polioviruses and non-polio enteroviruses (NPEV), we used viral culture, typing and intratypic differentiation of isolates by PCR, ELISA, and nucleic acid sequencing. Long-term persistence was defined as shedding for ≥ 6 months. Results Twenty-four children (15 HIV-infected, 9 HIV-uninfected) were enrolled, and 255 specimens (170 from HIV-infected, 85 from HIV-uninfected) were collected. All HIV-infected children had mildly or moderately symptomatic HIV-disease and moderate-to-severe immunosuppression. Fifteen participants shed vaccine-related polioviruses, and 22 shed NPEV at some point during the study period. Of 46 poliovirus-positive specimens, 31 were from HIV-infected, and 15 from HIV-uninfected children. No participant shed polioviruses for ≥ 6 months. Genomic sequencing of poliovirus isolates did not reveal any genetic evidence of long-term shedding. There was no long-term shedding of NPEV. Conclusion The results indicate that mildly to moderately symptomatic HIV-infected children retain the ability to clear enteroviruses, including vaccine-related poliovirus. Larger studies are needed to confirm and generalize these findings.
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Affiliation(s)
- Nino Khetsuriani
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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A case of enteroviral meningoencephalitis presenting as rapidly progressive dementia. ACTA ACUST UNITED AC 2008; 4:399-403. [PMID: 18477991 DOI: 10.1038/ncpneuro0804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 01/16/2008] [Indexed: 11/08/2022]
Abstract
BACKGROUND A 70-year-old immunocompetent male presented to a memory disorders clinic with a 7-month illness that had begun with somatic complaints including transient right temporal head pain, left buttock pain, and right conjunctival injection. About 3 months after the first signs of illness, the patient had begun to develop insidious cognitive and behavioral decline, which progressed most rapidly in the 2 months before presentation. An assessment completed during hospitalization for intermittent fevers and confusion had not revealed an infectious etiology, although mild pleocytosis in the cerebrospinal fluid had been noted. Upon presentation to the memory disorders clinic, the patient was disoriented, distractible, laughed at inappropriate moments, and followed only one-step commands. He had hypophonic speech and had mildly increased axial tone. He scored 5 out of 30 on the Mini Mental State Examination and was admitted for expedited evaluation. INVESTIGATIONS Physical examination, brain MRI, electroencephalogram, lumbar puncture, autoimmune and paraneoplastic testing, cerebral angiogram, cerebrospinal fluid analysis, enterovirus group-specific reverse transcriptase polymerase chain reaction assay, and RNA sequencing in brain biopsy samples. DIAGNOSIS Enteroviral meningoencephalitis. MANAGEMENT Intravenous steroids with oral taper and intravenous immunoglobulin.
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8
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Padate BP, Keidan J. Enteroviral meningoencephalitis in a patient with non-Hodgkin's lymphoma treated previously with rituximab. ACTA ACUST UNITED AC 2006; 28:69-71. [PMID: 16430465 DOI: 10.1111/j.1365-2257.2006.00751.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 75-year-old man, with a long history of recurrent lymphoplasmacytoid lymphoma, presented with diffuse large-cell lymphoma affecting adrenal glands and causing severe hypoadrenalism. The lymphoma responded to rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) chemotherapy. Seven months postcompletion of chemotherapy, he developed signs of gastroenteritis and septicaemia. He deteriorated 24 h postadmission with a significant fall in Glasgow Coma Scale Score. Polymerase chain reaction testing of cerebrospinal fluid suggested enteroviral encephalitis. He responded symptomatically to intravenous immunoglobulins. His immunoglobulin levels were monitored weekly and supplemented to maintain immunoglobulin G level at 10 g/l, but in spite of this, his neurological condition deteriorated and he died after 14 weeks. Rituximab can cause prolonged B-cell deficiency. We speculate that profound immunosuppression induced by rituximab, together with previous chemotherapy, predisposed this patient to fatal enteroviral meningoencephalitis.
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MESH Headings
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Enterovirus Infections/cerebrospinal fluid
- Enterovirus Infections/drug therapy
- Enterovirus Infections/etiology
- Fatal Outcome
- Humans
- Immunoglobulins, Intravenous/administration & dosage
- Immunosuppression Therapy/adverse effects
- Leukemia, Lymphocytic, Chronic, B-Cell/cerebrospinal fluid
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Meningoencephalitis/cerebrospinal fluid
- Meningoencephalitis/drug therapy
- Meningoencephalitis/etiology
- Prednisone/administration & dosage
- Prednisone/adverse effects
- RNA, Viral/cerebrospinal fluid
- Rituximab
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- B P Padate
- Department of Haematology, The Queen Elizabeth Hospital King's Lynn NHS Trust, King's Lynn, United Kingdom
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9
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Desmond RA, Accortt NA, Talley L, Villano SA, Soong SJ, Whitley RJ. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother 2006; 50:2409-14. [PMID: 16801419 PMCID: PMC1489762 DOI: 10.1128/aac.00227-06] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enteroviral meningitis causes appreciable morbidity in adults, including hospitalization, decreased activity, and headache. Limited data define the natural history of disease. No antiviral therapeutic agent has demonstrated improved outcome in controlled clinical trials. Pleconaril, an inhibitor of enterovirus replication, was tested in two placebo-controlled clinical trials. Of 607 randomized patients in a multicenter, double-blind placebo-controlled study of pleconaril (200 mg three times daily versus an identical-appearing placebo), 240 patients were confirmed to have enterovirus infection. The time to headache resolution was evaluated by using Kaplan-Meier survival methodology. A Cox regression model evaluated multivariate factors associated with disease resolution. Resolution of headache in patients with concomitant moderate to severe nausea at baseline occurred at a median of 9.5 days in the absence of therapy and was reduced to 7.0 days for pleconaril recipients (P = 0.009). For a headache score of > 5 alone, treated patients resolved headache significantly more rapidly (P = 0.005). Males resolved headache 50% faster than females. Regardless of randomization group, patients with a baseline headache score of 5 or greater resolved headache 50% more slowly than patients with a baseline headache score of 4. No differences in either clinical or laboratory adverse events were noted. Over 50% of untreated patients had a persistent headache that was greater than 1 week in duration. Pleconaril shortened the course of illness compared to placebo recipients, especially in the early disease course. However, the benefit was achieved only modestly in a subgroup analysis of patients with more severe disease after adjusting for confounding variables.
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Affiliation(s)
- R A Desmond
- Department of Biostatistics and Bioinformatics, Medical Statistics Section, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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10
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Abstract
An 11-year-old boy with episodes of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) is reported. Two PFAPA episodes were associated with aseptic encephalitis and seizures. Recurrent acute aseptic encephalitis or seizures have never been reported during the febrile episodes of PFAPA. This possible association is discussed within the context of the etiology of PFAPA.
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Affiliation(s)
- Richard E Frye
- Department of Pediatrics, University of Florida, Gainesville 32610-0296, USA.
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11
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Gharbi J, Jaïdane H, Ben M'hadheb M, El Hiar R, Chouchene C, Gueddiche MN, Aouni M. Epidemiological study of non-polio enterovirus neurological infections in children in the region of Monastir, Tunisia. Diagn Microbiol Infect Dis 2005; 54:31-6. [PMID: 16290030 DOI: 10.1016/j.diagmicrobio.2005.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 08/20/2005] [Indexed: 11/29/2022]
Abstract
The epidemiological, virological, and clinical syndromes of 86 children younger than 13 years suspected of having neurological diseases and admitted to Fattouma Bourguiba Hospital of Monastir from January 2002 to November 2003 were analyzed. The presence of enterovirus was studied in cerebrospinal fluid (CSF) samples by reverse transcription-polymerase chain reaction (RT-PCR) and by isolation on cell culture. Sixty-one (71%) specimens were positive by RT-PCR, whereas 45 (52.3%) were detected by cell culture. Eighty percent (n = 36) of cultured enteroviruses were identified, whereas 20% were untyped. Echoviruses were isolated most frequently, with 32 cases (71.1%) in children. Echovirus 6 was the most commonly identified serotype (22.2%), followed by echovirus 13 (20%). The highest incidence on neurological infection (19.6%) occurred in children less than 6 months of age. The infected children were predominantly male (62.3%). Enteroviruses were detected in all the period of the year with the highest rate in the spring and summer months. Aseptic meningitis was the most commonly diagnosed disease (49%).
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Affiliation(s)
- Jawhar Gharbi
- Laboratoire des Maladies Dominantes Transmissibles (MDT-01), Faculté de Pharmacie de Monastir, Université de Monastir, 5000 Monastir, Tunisia.
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Webster ADB. Pleconaril--an advance in the treatment of enteroviral infection in immuno-compromised patients. J Clin Virol 2005; 32:1-6. [PMID: 15571999 PMCID: PMC7108213 DOI: 10.1016/j.jcv.2004.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/18/2004] [Accepted: 06/21/2004] [Indexed: 10/26/2022]
Affiliation(s)
- A D B Webster
- Clinical Immunology, UCL Centre for Research into Primary Immunodeficiency, University College Medical School, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
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13
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Guney C, Ozkaya E, Yapar M, Gumus I, Kubar A, Doganci L. Laboratory diagnosis of enteroviral infections of the central nervous system by using a nested RT-polymerase chain reaction (PCR) assay. Diagn Microbiol Infect Dis 2004; 47:557-62. [PMID: 14711475 DOI: 10.1016/s0732-8893(03)00148-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Enteroviruses are the most common pathogens identified in infants hospitalized for suspected aseptic meningitis. Rapid detection of enterovirus infection is essential in taking the decision for treatment with antiviral agents and applying infection control measures in hospitalized pediatric patients. The purpose of this study was to compare the results of conventional virus isolation with those of enteroviral RNA detection by reverse transcription (RT)-PCR method in identical specimens from cases of suspected aseptic meningitis. Cerebrospinal fluid (CSF) samples were collected for viral examination from 68 pediatric patients with suspected aseptic meningitis from 1999 to 2002. These samples were inoculated in HeLa, Hep-2 and RD cell culture. The viral RNA was investigated by in-house RT-PCR method. The isolated viruses were typed by neutralization test. 36 of the 68 specimens were detected to be enterovirus positive by culture method, while 43 of them yielded positive results when RT-PCR method is used. Discrepancies occurred between the two methods in 15 specimens. While 11 specimens were positive by RT-PCR, these are found to be culture-negative. The isolated viruses were typed as Echovirus 30 (n: 30), Group B coxsackievirus (n: 5) and one isolate could not be typed by neutralization. Because of higher sensitivity and rapidity of RT-PCR, it is superior (p = 0.016) to virus culture of CSF for the diagnosis of enterovirus meningitis. Although the clinical usefulness of viral culture from CSF is limited, the final laboratory identification needs cultural techniques.
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Affiliation(s)
- Cakir Guney
- Division of Virology, Department of Microbiology and Clinical Microbiology, Gulhane Military Medical Academy and School of Medicine, 06018 Ankara, Turkey.
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