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Ferreira NE, da Costa AC, Kallas EG, Silveira CGT, de Oliveira ACS, Honorato L, Paião HGO, Lima SH, de M. Vasconcelos D, Côrtes MF, Costa SF, Mendoza TRT, Gomes HR, Witkin SS, Mendes-Correa MC. Encephalopathy Caused by Human Parvovirus B19 Genotype 1 Associated with Haemophilus influenzae Meningitis in a Newborn. Curr Issues Mol Biol 2023; 45:6958-6966. [PMID: 37754223 PMCID: PMC10529629 DOI: 10.3390/cimb45090439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 09/28/2023] Open
Abstract
Parvovirus B19 infection is associated with a wide range of clinical manifestations, from asymptomatic to severe neurological disorders. Its major clinical symptoms, fever and rash, are common to multiple viruses, and laboratory tests to detect B19 are frequently not available. Thus, the impact of B19 on public health remains unclear. We report the case of a 38-day old girl admitted to São Paulo Clinical Hospital, Brazil, with an initial diagnosis of bacterial meningitis, seizures, and acute hydrocephalus. Antibiotic therapy was maintained for one week after admission and discontinued after negative laboratory results were obtained. Nine days after symptoms onset, a cerebral spinal fluid (CSF) sample revealed persistent pleocytosis. The complete B19 complete genome was subsequently identified in her CSF by a metagenomic next-generation sequencing approach. This report highlights the possible involvement of B19 in the occurrence of acute neurological manifestations and emphasizes that its possible involvement might be better revealed by the use of metagenomic technology to detect viral agents in clinical situations of unknown or uncertain etiology.
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Affiliation(s)
- Noely Evangelista Ferreira
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Antonio C. da Costa
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Esper G. Kallas
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
| | - Cassia G. T. Silveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (C.G.T.S.); (A.C.S.d.O.)
| | - Ana Carolina S. de Oliveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (C.G.T.S.); (A.C.S.d.O.)
| | - Layla Honorato
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Heuder G. O. Paião
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Silvia H. Lima
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Dewton de M. Vasconcelos
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Marina F. Côrtes
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Silvia F. Costa
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Tania R. T. Mendoza
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
| | - Hélio R. Gomes
- Laboratório de Investigação Médica LIM 15, Hospital da Clinicas da, Faculdade de Medicina da, Universidade de São Paulo, São Paulo 01246-903, Brazil;
| | - Steven S. Witkin
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Maria C. Mendes-Correa
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (N.E.F.); (A.C.d.C.); (E.G.K.); (L.H.); (H.G.O.P.); (S.H.L.); (M.F.C.); (S.F.C.); (T.R.T.M.)
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; (D.d.M.V.); (S.S.W.)
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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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Wagner JN, Leibetseder A, Troescher A, Panholzer J, von Oertzen TJ. Efficacy and safety of intravenous immunoglobulins for the treatment of viral encephalitis: a systematic literature review. J Neurol 2021; 269:712-724. [PMID: 33675421 PMCID: PMC8782811 DOI: 10.1007/s00415-021-10494-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND For most viral encephalitides, therapy is merely supportive. Intravenous immunoglobulins (IVIG) have been used as a prophylactic and therapeutic approach. We conduct a systematic review on the safety and efficacy of IVIG in viral encephalitis. METHODS We conducted a systematic review assessing PubMed, Cochrane Database, Biosis Previews and the ClinicalTrials.gov website to identify all reports on patients with viral encephalitis treated with IVIG as of May 31, 2019. The main outcomes assessed were therapeutic efficacy and safety. For an increased homogeneity of the population, atypical viral infections were excluded, as were reports on prophylactic IVIG use, intrathecal application of immunoglobulins, or use of antibody-enriched IVIG-preparations. Data were extracted from published studies. Descriptive statistics were used. RESULTS We included a total of 44 studies (39 case reports). The case reports cover a total of 53 patients. Our search retrieved two prospective and three retrospective studies. These show heterogeneous results as to the efficacy of IVIG therapy. Only one study reports a significant association between IVIG-use and death (odds ratio 0.032; 95% confidence interval 0.0033-0.3024; p = 0.0027). None of the studies report significant differences in the number of serious adverse events. CONCLUSION Data on the efficacy of IVIG-therapy is heterogeneous. While it seems generally safe, evident superiority compared to supportive treatment has not been demonstrated so far. Future trials should also investigate the optimal dosing and timing of IVIG and their benefit in the immunosuppressed.
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Affiliation(s)
- Judith N Wagner
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020, Linz, Austria.
| | - Annette Leibetseder
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Anna Troescher
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Juergen Panholzer
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
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Vasquez A, Farias-Moeller R, Tatum W. Pediatric refractory and super-refractory status epilepticus. Seizure 2018; 68:62-71. [PMID: 29941225 DOI: 10.1016/j.seizure.2018.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/17/2018] [Accepted: 05/19/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To summarize the available evidence related to pediatric refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE), with emphasis on epidemiology, etiologies, therapeutic approaches, and clinical outcomes. METHODS Narrative review of the medical literature using MEDLINE database. RESULTS RSE is defined as status epilepticus (SE) that fails to respond to adequately used first- and second-line antiepileptic drugs. SRSE occurs when SE persist for 24 h or more after administration of anesthesia, or recurs after its withdrawal. RSE and SRSE represent complex neurological emergencies associated with long-term neurological dysfunction and high mortality. Challenges in management arise as the underlying etiology is not always promptly recognized and therapeutic options become limited with prolonged seizures. Treatment decisions mainly rely on case series or experts' opinions. The comparative effectiveness of different treatment strategies has not been evaluated in large prospective series or randomized clinical trials. Continuous infusion of anesthetic agents is the most common treatment for RSE and SRSE, although many questions on optimal dosing and rate of administration remain unanswered. The use of non-pharmacological therapies is documented in case series or reports with low level of evidence. In addition to neurological complications resulting from prolonged seizures, children with RSE/SRSE often develop systemic complications associated with polypharmacy and prolonged hospital stay. CONCLUSION RSE and SRSE are neurological emergencies with limited therapeutic options. Multi-national collaborative efforts are desirable to evaluate the safety and efficacy of current RSE/SRSE therapies, and potentially impact patients' outcomes.
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Affiliation(s)
- Alejandra Vasquez
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Raquel Farias-Moeller
- Department of Neurology, Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - William Tatum
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
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Palermo CI, Costanzo CM, Franchina C, Castiglione G, Giuliano L, Russo R, Conti A, Sofia V, Scalia G. Focal epilepsy as a long term sequela of Parvovirus B19 encephalitis. J Clin Virol 2016; 80:20-3. [PMID: 27130981 DOI: 10.1016/j.jcv.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
Abstract
Human Parvovirus B19 (PVB19), the etiological agent of the fifth disease, is associated with a large spectrum of pathologies, among which is encephalitis. Since it has been detected from the central nervous system in children or in immunocompromised patients, its causative role in serious neurological manifestations is still unclear. Here we report the case of an 18-year-old healthy boy who developed encephalitis complicated by prolonged status epilepticus. The detection of PVB19 DNA in his serum and, subsequently, in his cerebrospinal fluid supports the hypothesis that this virus could potentially play a role in the pathogenesis of neurological complications. In addition, the detection of viral DNA and the presence of specific IgM and IgG antibodies in serum, together with clinical findings such as skin rash, support the presence of a disseminated viral infection. In the presence of neurological disorders, especially when there are no specific signs, but seizures and rash are present, it is important to search for PVB19 both in immunocompromised and immunocompetent patients. Moreover, the introduction of the PVB19 DNA test into diagnostic protocols of neuropathies, especially those undiagnosed, could clarify the etiological agent that otherwise could remain unrecognized.
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Affiliation(s)
- Concetta Ilenia Palermo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy; O.U. Central Laboratory, Clinical Virology Unit, A.O.U Policlinico-Vittorio Emanuele, O.P "Gaspare Rodolico", Catania, Italy.
| | - Carmela Maria Costanzo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy; O.U. Central Laboratory, Clinical Virology Unit, A.O.U Policlinico-Vittorio Emanuele, O.P "Gaspare Rodolico", Catania, Italy
| | - Concetta Franchina
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy; O.U. Central Laboratory, Clinical Virology Unit, A.O.U Policlinico-Vittorio Emanuele, O.P "Gaspare Rodolico", Catania, Italy
| | - Giacomo Castiglione
- O.U. Intensive Care, A.O.U Policlinico-Vittorio Emanuele, O.P "Vittorio Emanuele II", Catania, Italy
| | - Loretta Giuliano
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Italy
| | - Raffaela Russo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy; O.U. Central Laboratory, Clinical Virology Unit, A.O.U Policlinico-Vittorio Emanuele, O.P "Gaspare Rodolico", Catania, Italy
| | - Alessandro Conti
- O.U. Intensive Care, A.O.U Policlinico-Vittorio Emanuele, O.P "Vittorio Emanuele II", Catania, Italy
| | - Vito Sofia
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Italy
| | - Guido Scalia
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy; O.U. Central Laboratory, Clinical Virology Unit, A.O.U Policlinico-Vittorio Emanuele, O.P "Gaspare Rodolico", Catania, Italy
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Samanta D, Willis E. Focal seizure associated with human parvovirus B19 infection in a non-encephalopathic child. World J Pediatr 2016; 12:118-20. [PMID: 26684306 DOI: 10.1007/s12519-015-0060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of acute symptomatic (at the time of documented brain insult) seizures and single unprovoked seizures are 29-39 and 23-61 per 100 000 per year, respectively. After stabilization of the patient, finding the etiology of the seizure is of paramount importance. A careful history and physical examination may allow a diagnosis without need for further evaluation. METHODS In the literature, severe central nervous system involvement has been reported from human parvovirus B19 infection. We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure. She was afebrile and didn't have any focal neurological abnormalities. She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities. RESULTS Parvovirus infection was suspected due to the characteristic erythematous malar rash. Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection. Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index (>1.1). IgG index was equivocal (0.9-1.1). CONCLUSIONS We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery. Timely diagnosis can provide counselling regarding future seizure recurrence risk, curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Erin Willis
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Watanabe T, Kawashima H. Acute encephalitis and encephalopathy associated with human parvovirus B19 infection in children. World J Clin Pediatr 2015; 4:126-134. [PMID: 26566485 PMCID: PMC4637803 DOI: 10.5409/wjcp.v4.i4.126] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/11/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Reports of neurologic manifestations of human parvovirus B19 (B19) infection have been on the rise. Acute encephalitis and encephalopathy is the most common, accounting for 38.8% of total B19-associated neurological manifestations. To date, 34 children with B19 encephalitis and encephalopathy have been reported, which includes 21 encephalitis and 13 encephalopathy cases. Ten (29%) were immunocompromised and 17 (39%) had underlying diseases. Fever at the onset of disease and rash presented in 44.1% and 20.6% of patients, respectively. Neurological manifestations include alteration of consciousness occurred in all patients, seizures in 15 (44.1%) patients, and focal neurologic signs in 12 (35.3%) patients. Anemia and pleocytosis in cerebrospinal fluid (CSF) occurred in 56.3% and 48.1% of patients, respectively. Serum Anti-B19 IgM (82.6%) and CSF B19 DNA (90%) were positive in the majority of cases. Some patients were treated with intravenous immunoglobulins and/or steroids, although an accurate evaluation of the efficacy of these treatment modalities cannot be determined. Nineteen (57.6%) patients recovered completely, 11 (33.3%) patients had some neurological sequelae and 3 (8.8%) patients died. Although the precise pathogenesis underlying the development of B19 encephalitis and encephalopathy is unclear, direct B19 infection or NS1protein of B19 toxicity in the brain, and immune-mediated brain injuries have been proposed.
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Suzuki M, Yoto Y, Ishikawa A, Asakura H, Tsutsumi H. Acute transverse myelitis associated with human parvovirus b19 infection. J Child Neurol 2014; 29:280-2. [PMID: 24049056 DOI: 10.1177/0883073813499824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe severe acute transverse myelitis in a previously healthy 9-year-old boy in whom primary human parvovirus B19 infection was confirmed serologically and B19 DNA was detected in his serum and cerebrospinal fluid. Besides erythema infectiosum, parvovirus B19 infection has various clinical manifestations; however, central nervous system involvement is rare. Even more unusual is parvovirus B19-associated acute transverse myelitis.
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Affiliation(s)
- Masashi Suzuki
- 1Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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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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Chambers RHM, Gooden MA, Gilbert TDE, Jackson ST. Childhood chorea-encephalopathy associated with recent parvovirus B19 infection in two Jamaican children. ACTA ACUST UNITED AC 2011; 30:339-44. [PMID: 21118630 DOI: 10.1179/146532810x12858955921438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This case report highlights the course of two healthy unrelated children with an encephalopathy characterised by dyskinesia, seizures, hemiparesis and behavioural change associated with recent human parvovirus B19 infection. The cases are compared with a previously described case of childhood chorea encephalopathy associated with human parvovirus B19 infection.
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Affiliation(s)
- R H Melbourne Chambers
- Department of Obstetrics, Gynaecology & Child Health, University of the West Indies, Kingston, Jamaica.
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12
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The uncommon causes of status epilepticus: a systematic review. Epilepsy Res 2010; 91:111-22. [PMID: 20709500 DOI: 10.1016/j.eplepsyres.2010.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 07/14/2010] [Accepted: 07/18/2010] [Indexed: 01/01/2023]
Abstract
This paper reports the first systematic review of uncommon causes of status epilepticus reported in the literature between 1990 and 2008. Uncommon causes are defined as those not listed in the main epidemiological studies of status epilepticus. 181 causes were identified. These were easily categorised into 5 specific aetiological categories: immunological disorders, mitochondrial disorders, infectious diseases, genetic disorders and drugs/toxins. A sixth category of 'other causes' has also been included. Knowledge of these causes is important for clinical management and treatment, and also for a better understanding of the pathophysiology of status epilepticus.
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Watemberg N, Segal G. A suggested approach to the etiologic evaluation of status epilepticus in children: what to seek after the usual causes have been ruled out. J Child Neurol 2010; 25:203-11. [PMID: 19833976 DOI: 10.1177/0883073809337032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Status epilepticus represents a true neurologic emergency that requires immediate treatment to stop seizure activity and prompt diagnostic evaluation to recognize potentially treatable causes. Although an etiology may be detected in many cases, in a significant number of patients the cause is not established by the usual laboratory or neuroimaging studies. We performed an extensive literature review of all unusual and often overlooked causes of status epilepticus in children, in an attempt to provide physicians with practical information on the diagnostic approach to patients, particularly those with refractory status epilepticus, for whom an etiology can not be detected by routine diagnostic protocols.
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Affiliation(s)
- Nathan Watemberg
- Child Neurology Unit, Meir Medical Center, Tel Aviv University School of Medicine, Kfar Saba, Israel.
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Kalita J, Nair PP, Misra UK. Status epilepticus in encephalitis: a study of clinical findings, magnetic resonance imaging, and response to antiepileptic drugs. J Neurovirol 2008; 14:412-7. [PMID: 18989815 DOI: 10.1080/13550280802266523] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study evaluates clinical findings, magnetic resonance imaging (MRI), and response to antiepileptic drugs (AEDs) in encephalitis patients with status epilepticus (SE). Encephalitis patients with SE were included and they were grouped into herpes (HSE), Japanese (JE), dengue, and nonspecific encephalitis on the basis of virological studies. The demographic and clinical details, including SE type and duration, were noted. Cranial MRI and cerebrospinal fluid (CSF) were carried out. Response to first, second, and third AEDs were noted and the patients not responding to the second AED were considered refractory SE. The relationships of the mortality and the refractoriness of SE with various clinical findings, MRI, CSF, and the type of encephalitis were evaluated. Thirty SE patients with encephalitis aged 1 to 64 years were included. Nine patients had JE, 4 HSE, 1 dengue, and 16 nonspecific encephalitis. Generalized convulsive SE was present in 26 and nonconvulsive SE in 4 patients. The mean duration of SE was 21 (0.83 to 72) h. MRI was abnormal in 20 patients. A 46.7% of patients responded to the first AED and 36.7% remained refractory to the second AED. In 26.7% patients, the seizure continued even after the third AED. The response to AED was not related to the clinical, MRI, and laboratory variables. Nine patients died and the mortality was related to gender and Glasgow Coma Scale (GCS) score. In encephalitis with SE, 46.7% patients responded to the fist AED and 36.7% remained refractory to the second AED. One third of patients of died, which was related to the depth of coma.
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Affiliation(s)
- J Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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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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