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Hait AS, Thomsen MM, Larsen SM, Helleberg M, Mardahl M, Barfod TS, Christiansen M, Brandt C, Mogensen TH. Whole-Exome Sequencing of Patients With Recurrent HSV-2 Lymphocytic Mollaret Meningitis. J Infect Dis 2020; 223:1776-1786. [PMID: 32946550 DOI: 10.1093/infdis/jiaa589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
Recurrent lymphocytic meningitis, also referred to as Mollaret meningitis, is a rare neurological disease characterized mainly by reactivation of herpes simplex virus 2 (HSV-2) from sensory ganglia. However, the underlying host immune determinants and viral factors rendering some individuals unable to maintain HSV-2 latency are largely unknown. We collected a cohort of 15 patients diagnosed with Mollaret meningitis. By whole-exome sequencing we identified rare host genetic variants predicted to be deleterious in molecules involved in (1) ubiquitin-proteasome pathways, (2) the autophagy machinery, and (3) cell proliferation/apoptosis. Moreover, infection of patient cells with HSV-2 or stimulation by virus-derived double-stranded DNA ligands revealed reduced antiviral interferon responses in most patients. These findings may contribute to a better understanding of disease pathogenesis and protective immunity to HSV in the central nervous system, and may ultimately be of importance for identification of targets for development of improved prophylaxis and treatment of this disease.
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Affiliation(s)
- Alon Schneider Hait
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Michelle M Thomsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Simon M Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maibritt Mardahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Toke S Barfod
- Department of Internal medicine, Section for Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Mette Christiansen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Brandt
- Department of Internal medicine, Section for Infectious Diseases, Zealand University Hospital, Roskilde, Denmark.,Department of Pulmonology and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Petel D, Barton M, Renaud C, Ouchenir L, Brophy J, Bowes J, Khan S, Bitnun A, McDonald J, Boisvert AA, Ting J, Roberts A, Robinson JL. Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators' Collaborative Network on Infections in Canada (PICNIC) study. BMC Pediatr 2020; 20:252. [PMID: 32456669 PMCID: PMC7249448 DOI: 10.1186/s12887-020-02151-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/18/2020] [Indexed: 01/27/2023] Open
Abstract
Background The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. Methods In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. Results Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002). Conclusions Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures.
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Affiliation(s)
- Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Christian Renaud
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lynda Ouchenir
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Khan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jane McDonald
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | - Joseph Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, 4-590 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
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Alhazmi A, Lazrek M, Alidjinou EK, Engelmann I, Schuffenecker I, Dubos F, Hober D. Repeated viral meningitis in a newborn. J Neurovirol 2020; 26:449-451. [PMID: 32026339 DOI: 10.1007/s13365-020-00829-0] [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: 06/25/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Abstract
Human enteroviruses (EV) are the most common cause of viral meningitis in children. Human parechoviruses (HPeV) are increasingly being recognized as a cause of central nervous system (CNS) infections and sepsis-like disease in children. Both viruses belong to Picornaviridae family. The clinical picture in EV and HPeV infections is usually nonspecific. Therefore, molecular detection of both viruses is needed for etiological diagnosis. In this case report, we describe and discuss clinical and laboratory findings of two consecutive episodes of viral meningitis caused by EV and HPeV, respectively, occurring in the first month of a newborn's life.
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Affiliation(s)
- Abdulaziz Alhazmi
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France.,Univ Jazan, Microbiology Department, Jazan, Saudi Arabia
| | - Mouna Lazrek
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France
| | | | - Ilka Engelmann
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France
| | | | - Francois Dubos
- Univ Lille, CHU Lille, Urgences Pédiatriques et Maladies Infectieuses, F-59037, Lille, France
| | - Didier Hober
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France.
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