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Ngan TTD, Tuyet NT, Hung DT, Cap NT, Nguyen DM, Dat VQ. Clinical characteristics and outcomes of patients with Herpes Simplex Encephalitis in Vietnam: a retrospective study. BMC Infect Dis 2024; 24:556. [PMID: 38831304 PMCID: PMC11149218 DOI: 10.1186/s12879-024-09453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is an important central nervous infection with severe neurological sequelae. The aim of this study was to describe clinical characteristic and outcomes of patients with HSE in Vietnam. METHODS This was a retrospective study of 66 patients with herpes simplex encephalitis who admitted to the National Hospital for Tropical Diseases, Hanoi, Vietnam from 2018 to 2021. The detection of herpes simplex virus (HSV) in cerebrospinal fluid was made by the real-time PCR assay. We reported the clinical manifestation on admission and evaluated clinical outcomes at the hospital discharge by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to analyze the independent risk factors of severe outcomes. RESULTS Of the 66 patients with laboratory confirmed HSE, the median age was 53 years (IQR 38-60) and 44 patients (69.7%) were male. The most common manifestations included fever (100%), followed by the consciousness disorder (95.5%). Other neurological manifestation were seizures (36.4%), memory disorders (31.8%), language disorders (19.7%) and behavioral disorders (13.6%). Conventional magnetic resonance imaging (MRI) showed 93.8% patients with temporal lobe lesions, followed by abnormalities in insula (50%), frontal lobe (34.4%) and 48.4% of patients had bilateral lesions. At discharge, 19 patients (28.8%) completely recovered, 15 patients (22.7%) had mild sequelae, 28 patients (42.4%) had moderate to severe sequelae. Severe neurological sequelae were memory disorders (55.8%), movement disorders (53.5%), language disorders (30.2%). Multivariate logistic regression analysis showed that Glasgow score decrement at admission, seizures, and time duration from onset of symptoms to the start of Acyclovir treatment > 4 days were independent factors associated with severe outcomes in HSE patients. CONCLUSION Glasgow score decrement, seizures and delay treatment with Acyclovir were associated with the poor outcome of patients with HSE.
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Affiliation(s)
- Ta Thi Dieu Ngan
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam.
- National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam.
- Hanoi Medical University Hospital, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
| | - Nguyen Thi Tuyet
- Thai Nguyen University of Medicine and Pharmacy, 284 Luong Ngoc Quyen Street, Thai Nguyen City, Thai Nguyen Province, Vietnam
| | - Dinh Trong Hung
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Trung Cap
- National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | | | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam
- Hanoi Medical University Hospital, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
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San Martin P, Aunhachoke K, Batac MCF, Lodrono-Lim K, Kwanthitinan C, Santoso D, Fonseka T, Nguyen M, Guzman-Holst A. Systematic Literature Review of Herpes Zoster Disease Burden in Southeast Asia. Infect Dis Ther 2023:10.1007/s40121-023-00822-0. [PMID: 37314653 DOI: 10.1007/s40121-023-00822-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/16/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Herpes zoster (HZ; i.e., shingles) is caused by the reactivation of varicella zoster virus leading to a painful dermatomal rash. An increasing trend in cases of HZ is evident worldwide; however, there is a lack of comprehensive reviews for Southeast Asian countries. METHODS We performed a systematic literature review of articles published until May 2022 that reported HZ epidemiology, clinical management, and health economic data in six Southeast Asian countries: Indonesia, Malaysia, the Philippines, Singapore, Thailand, and Vietnam. Literature searches were conducted in Medline, Scopus, Embase, and gray literature. Articles written in English or local languages were considered for inclusion. RESULTS In total, 72 publications were included in the study; 22 were case studies and over 60% originated in Singapore and Thailand. Only two studies (data from Thailand) reported incidence of HZ. The proportion of patients reported with HZ was 0.68-0.7% among dermatology clinics, 0.14% at one emergency department (5.3% of dermatology cases) in Singapore, and 3% of admissions at another hospital in Singapore. Pain was the most common symptom associated with HZ, reported in 74.21-100% of patients. HZ complications were reported in 10.2-21.2% of patients, and the proportions with postherpetic neuralgia and HZ ophthalmicus were 6.3-50% and 4.98-28.57%, respectively. Additionally, there is a lack of comprehensive, up-to-date HZ economic data, with only six studies identified for the Philippines, Singapore, and Thailand. CONCLUSIONS Overall, there are limited data reporting incidence and prevalence of HZ in Southeast Asia at a national level. High rates of complications, symptoms, and abundance of case reports suggest substantial healthcare resource utilization for patients with HZ and highlight the need for further research in Southeast Asia assessing the societal impact.
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Brindle HE, Bastos LS, Christley R, Contamin L, Dang LH, Anh DD, French N, Griffiths M, Nadjm B, van Doorn HR, Thai PQ, Duong TN, Choisy M. The spatio-temporal distribution of acute encephalitis syndrome and its association with climate and landcover in Vietnam. BMC Infect Dis 2023; 23:403. [PMID: 37312047 PMCID: PMC10262680 DOI: 10.1186/s12879-023-08300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Acute encephalitis syndrome (AES) differs in its spatio-temporal distribution in Vietnam with the highest incidence seen during the summer months in the northern provinces. AES has multiple aetiologies, and the cause remains unknown in many cases. While vector-borne disease such as Japanese encephalitis and dengue virus and non-vector-borne diseases such as influenza and enterovirus show evidence of seasonality, associations with climate variables and the spatio-temporal distribution in Vietnam differs between these. The aim of this study was therefore to understand the spatio-temporal distribution of, and risk factors for AES in Vietnam to help hypothesise the aetiology. METHODS The number of monthly cases per province for AES, meningitis and diseases including dengue fever; influenza-like-illness (ILI); hand, foot, and mouth disease (HFMD); and Streptococcus suis were obtained from the General Department for Preventive Medicine (GDPM) from 1998-2016. Covariates including climate, normalized difference vegetation index (NDVI), elevation, the number of pigs, socio-demographics, JEV vaccination coverage and the number of hospitals were also collected. Spatio-temporal multivariable mixed-effects negative binomial Bayesian models with an outcome of the number of cases of AES, a combination of the covariates and harmonic terms to determine the magnitude of seasonality were developed. RESULTS The national monthly incidence of AES declined by 63.3% over the study period. However, incidence increased in some provinces, particularly in the Northwest region. In northern Vietnam, the incidence peaked in the summer months in contrast to the southern provinces where incidence remained relatively constant throughout the year. The incidence of meningitis, ILI and S. suis infection; temperature, relative humidity with no lag, NDVI at a lag of one month, and the number of pigs per 100,000 population were positively associated with the number of cases of AES in all models in which these covariates were included. CONCLUSIONS The positive correlation of AES with temperature and humidity suggest that a number of cases may be due to vector-borne diseases, suggesting a need to focus on vaccination campaigns. However, further surveillance and research are recommended to investigate other possible aetiologies such as S. suis or Orientia tsutsugamushi.
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Affiliation(s)
- Hannah E Brindle
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
- Oxford University Clinical Research Unit, Hanoi City, Vietnam.
| | - Leonardo S Bastos
- Scientific Computing Programme, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Robert Christley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lucie Contamin
- Institut de Recherche Pour Le Développement, Hanoi, Vietnam
| | - Le Hai Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Michael Griffiths
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- MRC Unit The Gambia at the London, School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Marc Choisy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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Gajurel BP, Giri S, Rayamajhi S, Khanal N, Bishowkarma S, Mishra A, Karn R, Rajbhandari R, Ojha R. Epidemiological and clinical characteristics of central nervous system infections in a tertiary center: A retrospective study. Health Sci Rep 2023; 6:e1099. [PMID: 36778774 PMCID: PMC9901198 DOI: 10.1002/hsr2.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
Background and Aims Central nervous system (CNS) infection is one of the most common causes of morbidity, mortality, and hospital admission worldwide. The natural history of CNS infection is quite fatal. Early diagnosis and treatment have been proven to have a crucial role in patients' survival. The aim of this study was to identify the epidemiological and clinical patterns of patients diagnosed with CNS infections. Methods This study is a retrospective study conducted in a tertiary level hospital in Nepal in which patient diagnosed with CNS infections (September 2019 to 2021) were included. Data were collected and analyzed in SPSS. Results The mean age of the 95 patients included in the study was 45.18 ± 19.56. Meningoencephalitis (n = 44, 46.30%) was the most common infection diagnosed. Patients belonging to the age group 30-60 years had a higher frequency of focal neurological deficit, and other classical clinical features. All the patients who died during the treatment had associated comorbidities but no concurrent infections. Altered sensorium, fever, and headache were the common presenting symptoms in all the recovered patients. Conclusion To ensure optimum disease outcome, early diagnosis and prompt management are crucial. For this, recognizing the local disease patterns in terms of disease distribution, commonly implicated aetiologies, presenting symptoms, and prognostic factors is of utmost importance.
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Affiliation(s)
- Bikram P. Gajurel
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Subarna Giri
- Maharajgunj Medical Campus, Tribhuvan University Institute of MedicineKathmanduNepal
| | - Shivani Rayamajhi
- Maharajgunj Medical Campus, Tribhuvan University Institute of MedicineKathmanduNepal
| | - Niharika Khanal
- Maharajgunj Medical Campus, Tribhuvan University Institute of MedicineKathmanduNepal
| | - Sagar Bishowkarma
- Maharajgunj Medical Campus, Tribhuvan University Institute of MedicineKathmanduNepal
| | - Aman Mishra
- Maharajgunj Medical Campus, Tribhuvan University Institute of MedicineKathmanduNepal
| | - Ragesh Karn
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Reema Rajbhandari
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
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Brindle HE, Nadjm B, Choisy M, Christley R, Griffiths M, Baker S, Bryant JE, Campbell JI, Nguyen VVC, Nguyen TND, Vu TTH, Nguyen VH, Hoang BL, Le XL, Pham HM, Ta TDN, Ho DTN, Tran TN, Nguyen THN, Tran MP, Pham THP, Le VT, Nguyen DT, Hau TTT, Nguyen NV, Wertheim HFL, Thwaites GE, van Doorn HR. Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam. ECOHEALTH 2022; 19:463-474. [PMID: 36227390 PMCID: PMC9558024 DOI: 10.1007/s10393-022-01611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/20/2022] [Indexed: 06/16/2023]
Abstract
An estimated 73% of emerging infections are zoonotic in origin, with animal contact and encroachment on their habitats increasing the risk of spill-over events. In Vietnam, close exposure to a wide range of animals and animal products can lead to acquisition of zoonotic pathogens, a number of which cause central nervous system (CNS) infections. However, studies show the aetiology of CNS infections remains unknown in around half of cases. We used samples and data from hospitalised patients with CNS infections, enrolled into the Vietnam Initiative on Zoonotic Infections multicentre study, to determine the association between aetiology and animal contact including those in whom the cause was unknown. Among 933 patients, a pathogen or an antibody response to it was identified in 291 (31.2%, 95% CI 28.3-34.3%). The most common pathogens were Streptococcus suis (n = 91 (9.8%, 8.0-11.9%)) and Japanese encephalitis virus (JEV) (n = 72 (7.7%, 6.1-9.7%)). Commonly reported animal contact included keeping, raising or handling (n = 364 (39.0%, 35.9-42.2%)) and handling, cooking or consuming raw meat, blood or viscera in the 2 weeks prior to symptom onset (n = 371 (39.8%, 36.6-43.0%)), with the latter most commonly from pigs (n = 343 (36.9%, 33.8-40.1%). There was no association between an unknown aetiology and exposure to animals in a multivariate logistic regression. Further testing for unknown or undetected pathogens may increase diagnostic yield, however, given the high proportion of zoonotic pathogens and the presence of risk factors, increasing public awareness about zoonoses and preventive measures can be considered.
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Affiliation(s)
- Hannah E Brindle
- Oxford University Clinical Research Unit, Hanoi, Vietnam.
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK.
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Serekunda, The Gambia
| | - Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Rob Christley
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK
| | - Michael Griffiths
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Juliet E Bryant
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ty Thi Hang Vu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Bao Long Hoang
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Luat Le
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Ha My Pham
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Wellcome Trust Sanger Institute, Hinxton, UK
| | | | | | | | | | - My Phuc Tran
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Van Tan Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Thi Thu Trang Hau
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Research Group 2, AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- RadboudUMC, Nijmegen, The Netherlands
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Aetiologies and clinical presentation of central nervous system infections in Vietnamese patients: a prospective study. Sci Rep 2022; 12:18065. [PMID: 36302889 PMCID: PMC9613671 DOI: 10.1038/s41598-022-23007-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/21/2022] [Indexed: 01/24/2023] Open
Abstract
Knowledge of the clinical presentation of central nervous system (CNS) infections and the causative pathogens is crucial for appropriate diagnosis and rapid initiation of appropriate treatment to prevent severe neurological sequelae. The aim of this study is to understand the aetiology of CNS infections based on the clinical presentation of Vietnamese patients. A prospective hospital-based cohort study was conducted between May 2014 and May 2017. We screened 137 patients with clinically suspected CNS infection for fungal, bacterial and viral pathogens using their cerebrospinal fluid (CSF) and blood cultures. In addition, DNA or RNA extracted from CSF samples were subjected to nucleic acid testing (NAT) with a selective panel of bacterial, viral and fungal pathogens. At least one pathogen could be detected in 41% (n = 56) of the patients. The main pathogens causing CNS infections were Streptococcus suis (n = 16; 12%) and Neisseria meningitidis (n = 9; 7%), followed by Herpes simplex virus 1/2 (n = 4; 3%) and Klebsiella pneumoniae (n = 4; 3%). Other pathogens were only identified in a few cases. Patients with bacterial CNS infections were significantly older, had a worse outcome, a lower Glasgow Coma Scale (GCS), a higher rate of speech impairment and neck stiffness than patients with viral or tuberculous CNS infections. In northern Vietnam, adults are mostly affected by bacterial CNS infections, which have a severe clinical course and worse outcomes compared to viral or tuberculous CNS infections. Clinicians should be aware of the regional occurrence of pathogens to initiate rapid and appropriate diagnosis and treatment.
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Van CP, Nguyen TT, Bui ST, Nguyen TV, Tran HTT, Pham DT, Trieu LP, Nguyen MD. Invasive Meningococcal Disease Remains a Health Threat in Vietnam People's Army. Infect Drug Resist 2021; 14:5261-5269. [PMID: 34916810 PMCID: PMC8667609 DOI: 10.2147/idr.s339110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Despite strict surveillance, Neisseria meningitidis still causes life-threatening invasive meningococcal disease (IMD). The study aimed to describe the prevalence, clinical and subclinical features, and treatment outcomes of IMD among young soldiers of the Vietnam People's Army. METHODS A prospective, population-based surveillance study was conducted in all Vietnamese military hospitals from January 2014 to June 2021. The presence of Neisseria meningitidis was confirmed by PCR or culture from blood or/and CSF. Epidemiological indices (incidence, serogroups, and distribution of cases by length of service), medical history, clinical and sub-clinical features, and treatment outcomes were documented and analyzed. RESULTS There were 69 IMD cases (91% serogroup B) documented, mainly in conscripts (91%). The highest annual incidence was 3.33/100,000 soldiers per year. Of these cases, 44% were meningitis (n=30), 19% septicemia (n=13), and 38% meningococcemia (n=26). The most common clinical symptoms were neck stiffness (61 cases, 88%), petechial rash (51%), and shock (20 cases, 29%). Laboratory findings showed leukocytosis in 96% of IMD cases, PCT >0.05 (ng/mL) in 100%, elevated leukocyte count (>1,000/mm3) in 71%, and high protein >1 g/L in 70%. The overall mortality rate was 9%. Two cases were found to be resistant to ceftriaxone. Prognostic factors of severity included petechial rash (OR = 9.82, p < 0.001), septicemia (OR = 5.83, p < 0.001), meningococcemia (OR = 6.22, p < 0.001), low platelet count, prolonged prothrombin time; high PCT (AUC = 0.84, p < 0.001), and increased creatinine (AUC = 0.86, p < 0.001). CONCLUSION IMD remains a health threat in the armed forces in Vietnam, especially among new recruits. To the best of our knowledge, this is the first study in Vietnam describing ceftriaxone resistance in Neisseria meningitidis and suggests the need to reconsider standard empiric therapy for IMD.
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Affiliation(s)
- Chung Pham Van
- Department of Foodborne Infectious Disease, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
| | - The Trong Nguyen
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
- Department of Airborne Infectious Disease and Intensive Care Unit, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam
| | - Sy Tien Bui
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
- Department of Microbiology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Trong Van Nguyen
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
- Department of Microbiology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Huyen Thi Thanh Tran
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Dong Trac Pham
- Military Medical Department, Ministry of National Defense, Hanoi, Vietnam
| | - Long Phi Trieu
- Department of Microbiology, Military Institute of Preventive Medicine, Hanoi, Vietnam
| | - Manh Dang Nguyen
- Department of Foodborne Infectious Disease, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam
- Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam
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Lee GH, Kim J, Kim HW, Cho JW. Herpes simplex viruses (1 and 2) and varicella-zoster virus infections in an adult population with aseptic meningitis or encephalitis: A nine-year retrospective clinical study. Medicine (Baltimore) 2021; 100:e27856. [PMID: 34797322 PMCID: PMC8601327 DOI: 10.1097/md.0000000000027856] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Three α-herpesviruses are known to be associated with central nervous system (CNS) infection; however, there are limited data on the incidence and clinical characteristics of α-herpesviruses CNS infections. This study aimed to assess the clinical manifestations, laboratory findings, and outcomes in patients with human herpes simplex virus 1 (HSV-1), human herpes simplex virus 2 (HSV-2), and varicella-zoster virus (VZV) CNS infections.We identified cases of HSV-1, HSV-2, and VZV CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with HSV-1, HSV-2, and VZV polymerase chain reaction positivity in cerebrospinal fluid (CSF) who visited Pusan National University Hospital between 2010 and 2018.During the 9-year study period, a total of 727 CSF samples were examined, with 72.2% (525/727) patients identified as having a CNS infection. Of 471 patients with aseptic meningitis and encephalitis, the causative virus was identified in 145 patients, and no virus was detected in 337 patients. A total of 15.2% (80/525) were diagnosed with one of the 3 herpesviruses as causative agents, 59 patients had meningitis, and 21 patients had encephalitis. Eleven patients with HSV-1, 27 patients with HSV-2, and 42 patients with VZV CNS infections were included. The distribution of cases by age showed different patterns depending on the type of herpesvirus infection. Compared with the HSV-1 group, the median age in the HSV-2 group was younger (HSV-1: 58 years; HSV-2: 38 years; P = .004), and patients with VZV infections showed a bimodal age distribution. Encephalitis was more common in the HSV-1 group, and HSV-1 infection was associated with a poor prognosis at discharge. CSF white blood cell counts were significantly lower in patients infected with HSV-1 (117 × 106 cells/L) than in patients infected with VZV (301 × 106 cells/L) (P = .008).These 3 herpesviruses are important causes of CNS infections regardless of immunologic status. HSV-1 infection was commonly associated with encephalitis and poor prognosis; HSV-2 and VZV CNS infections were associated with a low risk of mortality and neurological sequelae.
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Affiliation(s)
- Gha-Hyun Lee
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jiyoung Kim
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
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Anh NT, Nhu LNT, Hong NTT, Phuc TM, Tam PTT, Huong DT, Anh TT, Deng X, Nghia HDT, Nguyen TT, Van Hung N, Thuan ND, Phuong PTH, Chau NVV, Baker S, Delwart E, Thwaites G, Van Tan L. Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam. Emerg Infect Dis 2021; 27:205-213. [PMID: 33350920 PMCID: PMC7774551 DOI: 10.3201/eid2701.202723] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Central nervous system (CNS) infection is a serious neurologic condition, although the etiology remains unknown in >50% of patients. We used metagenomic next-generation sequencing to detect viruses in 204 cerebrospinal fluid (CSF) samples from patients with acute CNS infection who were enrolled from Vietnam hospitals during 2012–2016. We detected 8 viral species in 107/204 (52.4%) of CSF samples. After virus-specific PCR confirmation, the detection rate was lowered to 30/204 (14.7%). Enteroviruses were the most common viruses detected (n = 23), followed by hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1), and gemycircularvirus (1). Analysis of enterovirus sequences revealed the predominance of echovirus 30 (9). Phylogenetically, the echovirus 30 strains belonged to genogroup V and VIIb. Our results expanded knowledge about the clinical burden of enterovirus in Vietnam and underscore the challenges of identifying a plausible viral pathogen in CSF of patients with CNS infections.
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Ngo CC, Katoh S, Hasebe F, Dhoubhadel BG, Hiraoka T, Hamaguchi S, Le ATK, Nguyen ATH, Dang AD, Smith C, Yoshida LM, Do CD, Pham TTT, Ariyoshi K. Characteristics and biomarkers of patients with central nervous system infection admitted to a referral hospital in Northern Vietnam. Trop Med Health 2021; 49:42. [PMID: 34020719 PMCID: PMC8139123 DOI: 10.1186/s41182-021-00322-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 01/26/2023] Open
Abstract
Background Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries; therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis. Methods We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014. All patients who were 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein 40 mg/dL) were included in the study. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA). Results Total number of patients admitted to the department was 7506; among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis); median age was 45 (IQR 3158), 62.6% were male, and 60.9% were tested for HIV infection. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture; an etiology was identified in 27.5% (n=112). S. suis (8.8%), N. meningitis (3.2%), and S. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. M. tuberculosis was found in 3.2%. Mixed pathogens were detected in 1.8% of the CSF samples. Rural residence (aOR 4.1, 95% CI 1.214.4) and raised CSF ADA (10 IU/L) (aOR 25.5, 95% CI 3.1212) were associated with bacterial meningitis when compared with viral meningitis; similarly, raised CSF ADA (10 IU/L) (aOR 42.2, 95% CI 2.0882) was associated with tubercular meningitis. Conclusions Addition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Raised CSF ADA (10 IU/L) was strongly associated with bacterial and tubercular meningitis. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00322-2.
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Affiliation(s)
- Cuong Chi Ngo
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Shungo Katoh
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan.,Department of General Internal Medicine and Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan
| | - Futoshi Hasebe
- Vietnam Research Station, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Bhim Gopal Dhoubhadel
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Respiratory Infections, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Tomoko Hiraoka
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of General Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Anh Thi Kim Le
- Vietnam Research Station, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | | | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, England
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Cuong Duy Do
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Thuy Thi Thanh Pham
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam.,The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. .,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
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11
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Hiraoka T, Cuong NC, Hamaguchi S, Kikuchi M, Katoh S, Anh LK, Anh NTH, Anh DD, Smith C, Maruyama H, Yoshida LM, Cuong DD, Thuy PT, Ariyoshi K. Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. PLoS Negl Trop Dis 2020; 14:e0008937. [PMID: 33351806 PMCID: PMC7810332 DOI: 10.1371/journal.pntd.0008937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/15/2021] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. Methodology/Principal findings Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm3 in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm3 CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm3 CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. Conclusions The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF. Eosinophilic meningitis (EM) is a rare meningitis accompanied by eosinophils in the CSF and caused by multiple etiologies. Angiostrongylus cantonensis, which is a rat lungworm parasite, is the most common cause in tropical Asia. Previous papers have defined EM as CSF eosinophils ≥10% or CSF eosinophils ≥10/mm3. However, the relationship of EM to parasitic meningitis (PM) remains unclear. This prospective study enrolled 679 patients with suspected CNS infection who were admitted to a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. The characteristics of patients with ≥10% CSF eosinophilia resembled those of patients with >16% blood eosinophilia without CSF eosinophils, whereas those of patients with ≥10/mm3 CSF eosinophilia were comparable with those of patients with typical bacterial meningitis. Serology or real-time PCR for A. cantonensis was positive in 3 out of 7 patients with ≥10% CSF eosinophilia and 6 out of 7 patients with > 16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. The percentage, in contrast to the absolute eosinophil count in CSF, is reliable for predicting parasitic EM. Patients with PM may present with eosinophilia in the peripheral blood but not in the CSF.
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Affiliation(s)
- Tomoko Hiraoka
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ngo Chi Cuong
- Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mihoko Kikuchi
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Shungo Katoh
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of General Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Le Kim Anh
- Vietnam Research Station, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Hanoi, Vietnam
| | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Chris Smith
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Haruhiko Maruyama
- Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Lay-Myint Yoshida
- Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Do Duy Cuong
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Pham Thanh Thuy
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
- Infection Prevention and Control, The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- * E-mail:
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12
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Dubot-Pérès A, Mayxay M, Phetsouvanh R, Lee SJ, Rattanavong S, Vongsouvath M, Davong V, Chansamouth V, Phommasone K, Moore C, Dittrich S, Lattana O, Sirisouk J, Phoumin P, Panyanivong P, Sengduangphachanh A, Sibounheuang B, Chanthongthip A, Simmalavong M, Sengdatka D, Seubsanith A, Keoluangkot V, Phimmasone P, Sisout K, Detleuxay K, Luangxay K, Phouangsouvanh I, Craig SB, Tulsiani SM, Burns MA, Dance DAB, Blacksell SD, de Lamballerie X, Newton PN. Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011. Emerg Infect Dis 2019; 25:898-910. [PMID: 31002063 PMCID: PMC6478220 DOI: 10.3201/eid2505.180914] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
During 2003–2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.
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13
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Zida S, Kolia-Diafouka P, Kania D, Sotto A, Foulongne V, Bolloré K, Ouangraoua S, Méda N, Carrère-Kremer S, Van de Perre P, Tuaillon E. Combined testing for herpes simplex virus and Mycobacterium tuberculosis DNA in cerebrospinal fluid of patients with aseptic meningitis in Burkina Faso, West Africa. J Clin Lab Anal 2018; 33:e22719. [PMID: 30474140 DOI: 10.1002/jcla.22719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known about the involvement of herpes simplex virus (HSV) or Mycobacterium tuberculosis (MTB) as potentially curable causes of central nervous system (CNS) infections in sub-Saharan Africa. OBJECTIVE In this study, we developed a PCR assay dedicated to simultaneous testing of HSV1/HSV2 and MTB in Burkina Faso, a country where HSV is neglected as a cause of CNS infection and where TB prevalence is high. METHODS A consensus HSV1/HSV2 set of primers and probe were designed and combined to primers and probe targeting the IS6110 repetitive insertion sequence of MTB. Analytical performances of the assay were evaluated on reference materials. Cerebrospinal fluid (CSF) collected from subjects with aseptic meningitis was tested for HSV1/HSV2 and MTB DNA. RESULTS The UL29 gene was chosen as a highly conserved region targeted by the HSV1/HSV2 nucleic acid test. The lower limits of detection were estimated to be 2.45 copies/µL for HSV1, 1.72 copies/µL for HSV2, and 2.54 IS6110 copies per µL for MTB. The PCR was used in 202 CSF collected from subjects suspected of aseptic meningitis. Five samples (2.46%) tested positive, including two children positive for HSV1 (0.99%) and three adults tested positive for MTB (1.47%). CONCLUSION Using an in-house real-time PCR assay, we showed that both HSV and MTB are etiologic pathogens contributing to aseptic meningitis in Burkina Faso. This molecular test may have clinical utility for early diagnosis for those treatable CNS infections.
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Affiliation(s)
- Sylvie Zida
- UMR 1058, INSERM/EFS/Université de Montpellier, Montpellier, France.,Centre MURAZ, Bobo Dioulasso, Burkina Faso
| | | | | | | | | | - Karine Bolloré
- UMR 1058, INSERM/EFS/Université de Montpellier, Montpellier, France
| | | | - Nicolas Méda
- Ministère de la santé, Ouagadougou, Burkina Faso
| | | | | | - Edouard Tuaillon
- UMR 1058, INSERM/EFS/Université de Montpellier, Montpellier, France
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14
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Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. PLoS One 2018; 13:e0207440. [PMID: 30444898 PMCID: PMC6239303 DOI: 10.1371/journal.pone.0207440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Central nervous system (CNS) viral infections are important causes of morbidity and mortality worldwide but the systematic survey of patients admitted to hospitals with CNS infections in many countries, including Indonesia, is limited. To obtain more information regarding the causes of CNS infections in Indonesia, this study was performed to detect and identify viral agents associated with CNS infections amongst in-patients at a referral hospital in Manado, North Sulawesi, Indonesia. Adult patients admitted to R.D. Kandou General Hospital with presumed CNS infection were enrolled. Cerebrospinal fluid, serum, and throat swab samples were collected and tested using molecular, serological, and virus isolation assays. A confirmed viral etiology was established in three and a probable/possible in 11 out of 74 patients. The most common was herpes simplex virus 1 (7/74, 9.5%), followed by Epstein-Barr virus (2/74, 2.7%), cytomegalovirus (1/74, 1.4%), enterovirus D68 (1/74, 1.4%), rhinovirus A (1/74, 1.4%), dengue virus (1/64, 1.6%), and Japanese encephalitis virus (1/64, 1.6%). There were 20 fatal cases (27.0%) during hospitalization in which eight were associated with viral causes. We identified herpes simplex virus 1 as the most common cause of CNS infection among adults in North Sulawesi with most of the cases remaining undiagnosed. Our study highlights the challenges in establishing the etiology of viral CNS infections and the importance of using a wide range of molecular and serological detection methods to identify CNS viruses.
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15
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Li Y, Li H, Wen B, Zhang J, Li S, Xie Y, Lv X, Qu X, Huang R, Liu W. Cytokine expression profile in hospitalized children with herpes simplex virus-1 infection. Future Virol 2017. [DOI: 10.2217/fvl-2017-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: We aim to demonstrate the cytokine expression profile of children with herpes simplex virus-1 (HSV-1) infection. Methods: One hundred eighty three children with acute encephalitis were enrolled in this study. Out of those with HSV-1, multiple cytokines were measured. Results: Cytokine analysis of 13 HSV-1-infected patients revealed that IL-8 and granulocyte macrophage colony stimulating factor accumulated at significantly higher levels than macrophage inflammatory protein-1β in the cerebrospinal fluid. Additionally, IFN-γ in serum and cerebrospinal fluid was positively correlated with course of illness, while IL-10 in cerebrospinal fluid was negatively correlated with course of illness. Conclusion: Granulocyte macrophage colony stimulating factor, IL-8, macrophage inflammatory protein-1β, IFN-γ and IL-10 are involved in the HSV-1 immune response and pathogenesis.
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Affiliation(s)
- Yuanyuan Li
- Department of Neurology, The Third People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Haipeng Li
- Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, Hunan 423000, China
| | - Bo Wen
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
| | - Jian Zhang
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
| | - Shuochi Li
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
| | - Yuee Xie
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
| | - Xinjun Lv
- National Institute of Viral Disease Control & Prevention, China CDC, Beijing, China
| | - Xiaowang Qu
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
| | - Renbin Huang
- Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, Hunan 423000, China
| | - Wenpei Liu
- Translational Medicine Institute, The First People's Hospital of Chenzhou, University of South China, Chenzhou, Hunan, China
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16
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Ngwe Tun MM, V Muthugala R, Thi Thu Thuy N, Hoai Linh Ly P, Thi Hien Thu L, Thi Dinh D, Viet Hoang N, Thi Quynh Mai L, Moi ML, C Buerano C, Morita K, Hasebe F. Dengue Associated Acute Encephalitis Syndrome Cases in Son La Province, Vietnam in 2014. Jpn J Infect Dis 2017; 70:357-361. [PMID: 27795473 DOI: 10.7883/yoken.jjid.2016.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute encephalitis syndrome (AES) is associated with high morbidity and mortality, and affects both children and adults. The main etiologic agent is Japanese encephalitis virus (JEV); however, there are also reports of Dengue virus (DENV) encephalitis. The objectives of this study were to determine the proportion of patients with encephalitis due to JEV during the 2014 outbreak in Son La Province in Vietnam and to explore the association of DENV in non-JEV viral encephalitis cases. Of 90 patients, 6 (6.7%) were positive for anti-JEV immunoglobulin M (IgM), 5 (5.6%) were positive for anti-DENV IgM, 30 (33.3%) were positive for both anti-JEV and anti-DENV IgM, and 56 (62.2%) were positive for flavivirus immunoglobulin G (IgG). In 5 patients with AES, who had positive anti-DENV IgM results in at least one of the paired serum samples, DENV was confirmed by neutralization testing. The incidence of JEV infection was high. There is still a need to maintain and strengthen the national JEV immunization program. This noticeable occurrence of DENV infection was not reported in Son La Province in 2013-2014. Our data suggested that in addition to JEV, DENV was also a causative agent of AES in 2014 in Son La Province, and this finding also confirmed the local occurrence of DENV infection.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | | | | | | | - Le Thi Hien Thu
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Dang Thi Dinh
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Nguyen Viet Hoang
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Le Thi Quynh Mai
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Meng Ling Moi
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Corazon C Buerano
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Futoshi Hasebe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University.,Center for International Collaborative Research, Nagasaki University
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17
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Ng-Nguyen D, Stevenson MA, Traub RJ. A systematic review of taeniasis, cysticercosis and trichinellosis in Vietnam. Parasit Vectors 2017; 10:150. [PMID: 28320455 PMCID: PMC5359969 DOI: 10.1186/s13071-017-2085-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
Taeniasis, cysticercosis and trichinellosis have been ranked as the most important food-borne parasites of humans in terms of public health, socioeconomic and trade impact. Despite this, information on these food-borne zoonoses in Vietnam is scarce and fragmented, and many local reports remain inaccessible to the international research community. This study aims to conduct comprehensive literature searches to report on the incidence and estimate the true prevalence of taeniasis in humans and T. solium cysticercosis in humans and pigs in Vietnam utilizing Bayesian models; in addition, to report the incidence and the distribution of trichinellosis. A Bayesian approach was used to estimate the true prevalence of taeniasis and cysticercosis based on published diagnostic test characteristics used in each published cross-sectional survey. The utilization of coproscopic-based examination of Taenia eggs in stool, although highly specific for genus-level detection, has poor sensitivity and led to an underestimation of the prevalence of human taeniasis. Similarly, post-mortem-based surveys of T. solium cysticercosis in pigs also led to the underestimation of prevalence of porcine cysticercosis. On the other hand, the low specificity of immunodiagnostic methods, in particular Ab-ELISA, led to a likely overestimation of T. solium cysticercosis in humans. Due to the use of imperfect diagnosis tests combined with poor descriptions of sampling methods, our ability to draw solid conclusions from these data is limited. We estimate that the true prevalence of taeniasis and T. solium cysticercosis in rural ‘hotspots’, is as high as 13% for each, in humans. Taeniasis and T. solium cysticercosis occurs in 60 of the 63 provinces of Vietnam. Most of the information relating to the distribution and prevalence of porcine cysticercosis is limited to commercial abattoir surveys. In Vietnam, Taenia asiatica appears to be confined to the north where it occurs sympatrically with T. solium and Taenia saginata. The status of T. asiatica in Central and South Vietnam remains unascertained. To date, five outbreaks of trichinellosis have been reported in the north and northwest of Vietnam, affecting a total of 114 people and responsible for eight fatalities. In the same region, studies of free-roaming pigs showed evidence of high levels of exposure to Trichinella and, in cases where larvae were recovered, the species present were identified as Trichinella spiralis. Based on five studies, the main risk factors for pork-borne zoonoses in Vietnam include the consumption of undercooked/raw meat and vegetables and the use of night-soil for fertilization of local produce. This systematic review draws attention to the importance of these pork-borne zoonoses.
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Affiliation(s)
- Dinh Ng-Nguyen
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, 3052, Australia. .,Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak province, Vietnam.
| | - Mark A Stevenson
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, 3052, Australia
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18
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Lee HG, William T, Menon J, Ralph AP, Ooi EE, Hou Y, Sessions O, Yeo TW. Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study. BMC Infect Dis 2016; 16:296. [PMID: 27306100 PMCID: PMC4910197 DOI: 10.1186/s12879-016-1640-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections. A better understanding of these is essential for the development of local guidelines for diagnosis and management. METHODS We conducted a prospective observational cohort study in patients aged 12 years and older with suspected central nervous system infections at Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia between February 2012 and March 2013. Cerebrospinal fluid was sent for microscopy, biochemistry, bacterial and mycobacterial cultures, Mycobacterium tuberculosis polymerase chain reaction (PCR), and multiplex and MassCode PCR for various viral and bacterial pathogens. RESULTS A total of 84 patients with clinically suspected meningitis and encephalitis were enrolled. An aetiological agent was confirmed in 37/84 (44 %) of the patients. The most common diagnoses were tuberculous meningitis (TBM) (41/84, 48.8 %) and cryptococcal meningoencephalitis (14/84, 16.6 %). Mycobacterium tuberculosis was confirmed in 13/41 (31.7 %) clinically diagnosed TBM patients by cerebrospinal fluid PCR or culture. The acute case fatality rate during hospital admission was 16/84 (19 %) in all patients, 4/43 (9 %) in non-TBM, and 12/41 (29 %) in TBM patients respectively (p = 0.02). CONCLUSION TBM is the most common cause of CNS infection in patients aged 12 years or older in Kota Kinabalu, Sabah, Malaysia and is associated with high mortality and morbidity. Further studies are required to improve the management and outcome of TBM.
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Affiliation(s)
- Heng Gee Lee
- Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia
| | - Jayaram Menon
- Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Anna P Ralph
- Menzies School of Health Research, Darwin, Australia
| | - Eng Eong Ooi
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Yan'an Hou
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - October Sessions
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Tsin Wen Yeo
- Menzies School of Health Research, Darwin, Australia. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
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19
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Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, Blacksell SD, Dance DAB, Dubot-Pérès A, Sengduangphachanh A, Phoumin P, Paris DH, Newton PN. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. LANCET GLOBAL HEALTH 2015; 3:e104-12. [PMID: 25617190 PMCID: PMC4547322 DOI: 10.1016/s2214-109x(14)70289-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Scrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease in endemic countries. Laos is representative of vast economically poor rural areas in Asia with little medical information to guide public health policy. We assessed whether these pathogens are important causes of CNS infections in Laos. Methods Between Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with CNS symptoms or signs requiring a lumbar puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations (culture, PCR, and serology) targeted so-called conventional bacterial infections (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups. Findings 1051 (95%) of 1112 patients who presented had CSF available for analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi, R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051 [4%]; p<0·0001) by use of conservative diagnostic definitions. CNS infections had a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional bacterial infections (p=0·076). Interpretation Our data suggest that R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp infections are important causes of CNS infections in Laos. Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of CNS infections. These severely neglected infections represent a potentially large proportion of treatable CNS disease burden across vast endemic areas and need more attention. Funding Wellcome Trust UK.
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Affiliation(s)
- Sabine Dittrich
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sue J Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phonepasith Panyanivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Scott B Craig
- University of the Sunshine Coast, Faculty of Science Health, Education and Engineering, Sippy Downs, Australia; Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Australia
| | - Suhella M Tulsiani
- Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Australia; Copenhagen Centre for Disaster Research Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Stuart D Blacksell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; UMR_D 190 "Emergence des Pathologies Virales", Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, Marseille, France
| | - Amphone Sengduangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Phonelavanh Phoumin
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Daniel H Paris
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK.
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20
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Le Minh V, Thi Khanh Nhu N, Vinh Phat V, Thompson C, Huong Lan NP, Thieu Nga TV, Thanh Tam PT, Tuyen HT, Hoang Nhu TD, Van Hao N, Thi Loan H, Minh Yen L, Parry CM, Trung Nghia HD, Campbell JI, Hien TT, Thwaites L, Thwaites G, Van Vinh Chau N, Baker S. In vitro activity of colistin in antimicrobial combination against carbapenem-resistant Acinetobacter baumannii isolated from patients with ventilator-associated pneumonia in Vietnam. J Med Microbiol 2015; 64:1162-1169. [PMID: 26297024 PMCID: PMC4755130 DOI: 10.1099/jmm.0.000137] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Acinetobacter baumannii has become one of the major infection threats in intensive care units (ICUs) globally. Since 2008, A. baumannii has been the leading cause of ventilator-associated pneumonia (VAP) in our ICU at an infectious disease hospital in southern Vietnam. The emergence of this pathogen in our setting is consistent with the persistence of a specific clone exhibiting resistance to carbapenems. Antimicrobial combinations may be a strategy to treat infections caused by these carbapenem-resistant A. baumannii. Therefore, we assessed potential antimicrobial combinations against local carbapenem-resistant A. baumannii by measuring in vitro interactions of colistin with four antimicrobials that are locally certified for treating VAP. We first performed antimicrobial susceptibility testing and multilocus variable number tandem repeat analysis (MLVA) genotyping on 74 A. baumannii isolated from quantitative tracheal aspirates from patients with VAP over an 18-month period. These 74 isolates could be subdivided into 21 main clusters by MLVA and >80 % were resistant to carbapenems. We selected 56 representative isolates for in vitro combination synergy testing. Synergy was observed in four (7 %), seven (13 %), 20 (36 %) and 38 (68 %) isolates with combinations of colistin with ceftazidime, ceftriaxone, imipenem and meropenem, respectively. Notably, more carbapenem-resistant A. baumannii isolates (36/43; 84 %) exhibited synergistic activity with a combination of colistin and meropenem than carbapenem-susceptible A. baumannii isolates (2/13; 15 %) (P = 0.023; Fisher's exact test). Our findings suggest that combinations of colistin and meropenem should be considered when treating carbapenem-resistant A. baumannii infections in Vietnam, and we advocate clinical trials investigating combination therapy for VAP.
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Affiliation(s)
- Vien Le Minh
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA
| | - Nguyen Thi Khanh Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
| | - Voong Vinh Phat
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne Thompson
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Nguyen Phu Huong Lan
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Do Hoang Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Christopher M Parry
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Tran Tinh Hien
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Louise Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Guy Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | | | - Stephen Baker
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,London School of Hygiene and Tropical Medicine, London, UK.,Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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21
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Dittrich S, Sunyakumthorn P, Rattanavong S, Phetsouvanh R, Panyanivong P, Sengduangphachanh A, Phouminh P, Anantatat T, Chanthongthip A, Lee SJ, Dubot-Pérès A, Day NPJ, Paris DH, Newton PN, Turner GDH. Blood-Brain Barrier Function and Biomarkers of Central Nervous System Injury in Rickettsial Versus Other Neurological Infections in Laos. Am J Trop Med Hyg 2015; 93:232-237. [PMID: 26055741 PMCID: PMC4530739 DOI: 10.4269/ajtmh.15-0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/29/2015] [Indexed: 11/16/2022] Open
Abstract
Blood–brain barrier (BBB) function and cerebrospinal fluid (CSF) biomarkers were measured in patients admitted to hospital with severe neurological infections in the Lao People's Democratic Republic (N = 66), including bacterial meningitis (BM; N = 9) or tuberculosis meningitis (TBM; N = 11), Japanese encephalitis virus (JEV; N = 25), and rickettsial infections (N = 21) including murine and scrub typhus patients. The albumin index (AI) and glial fibrillary acidic protein (GFAP) levels were significantly higher in BM and TBM than other diseases but were also raised in individual rickettsial patients. Total tau protein was significantly raised in the CSF of JEV patients. No differences were found between clinical or neurological symptoms, AI, or biomarker levels that allowed distinction between severe neurological involvement by Orientia tsutsugamushi compared with Rickettsia species.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gareth D. H. Turner
- *Address correspondence to Gareth D. H. Turner, Mahidol-Oxford Tropical Medicine Research Unit, 3rd Floor, 60th Anniversary Chalermprakiat Building, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail:
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22
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Akhvlediani T, Bautista CT, Shakarishvili R, Tsertsvadze T, Imnadze P, Tatishvili N, Davitashvili T, Samkharadze T, Chlikadze R, Dvali N, Dzigua L, Karchava M, Gatserelia L, Macharashvili N, Kvirkvelia N, Habashy EE, Farrell M, Rowlinson E, Sejvar J, Hepburn M, Pimentel G, Dueger E, House B, Rivard R. Etiologic agents of central nervous system infections among febrile hospitalized patients in the country of Georgia. PLoS One 2014; 9:e111393. [PMID: 25369023 PMCID: PMC4219716 DOI: 10.1371/journal.pone.0111393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives There is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis. Methods Children and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Cerebrospinal fluid (CSF) was collected for bacterial culture, and in-house and multiplex RT-PCR testing was conducted for herpes simplex virus (HSV) types 1 and 2, mumps virus, enterovirus, varicella zoster virus (VZV), Streptococcus pneumoniae, HiB and Neisseria meningitidis. Results Out of 140 enrolled patients, the mean age was 23.9 years, and 58% were children. Bacterial or viral etiologies were determined in 51% of patients. Five Streptococcus pneumoniae cultures were isolated from CSF. Based on in-house PCR analysis, 25 patients were positive for S. pneumoniae, 6 for N. meningitidis, and 1 for H. influenzae. Viral multiplex PCR identified infections with enterovirus (n = 26), VZV (n = 4), and HSV-1 (n = 2). No patient was positive for mumps or HSV-2. Conclusions Study findings indicate that S. pneumoniae and enteroviruses are the main etiologies in this patient cohort. The utility of molecular diagnostics for pathogen identification combined with the knowledge provided by the investigation may improve health outcomes of CNS infection cases in Georgia.
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Affiliation(s)
- Tamar Akhvlediani
- I. Javakhishvili Tbilisi State University, Department of Neurology and Neurosurgery, Tbilisi, Georgia
- US Army Medical Research Unit-Georgia (USAMRU-G), Tbilisi, Georgia
- * E-mail:
| | - Christian T. Bautista
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Roman Shakarishvili
- P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nana Tatishvili
- Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia
| | - Tamar Davitashvili
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Tamar Samkharadze
- Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia
| | - Rusudan Chlikadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Natia Dvali
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Lela Dzigua
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Mariam Karchava
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Lana Gatserelia
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Nino Macharashvili
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Nana Kvirkvelia
- P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia
| | - Engy Emil Habashy
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Margaret Farrell
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Emily Rowlinson
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - James Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Hepburn
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
| | - Guillermo Pimentel
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erica Dueger
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brent House
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Robert Rivard
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
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23
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Dando SJ, Mackay-Sim A, Norton R, Currie BJ, St John JA, Ekberg JAK, Batzloff M, Ulett GC, Beacham IR. Pathogens penetrating the central nervous system: infection pathways and the cellular and molecular mechanisms of invasion. Clin Microbiol Rev 2014; 27:691-726. [PMID: 25278572 PMCID: PMC4187632 DOI: 10.1128/cmr.00118-13] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The brain is well protected against microbial invasion by cellular barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB). In addition, cells within the central nervous system (CNS) are capable of producing an immune response against invading pathogens. Nonetheless, a range of pathogenic microbes make their way to the CNS, and the resulting infections can cause significant morbidity and mortality. Bacteria, amoebae, fungi, and viruses are capable of CNS invasion, with the latter using axonal transport as a common route of infection. In this review, we compare the mechanisms by which bacterial pathogens reach the CNS and infect the brain. In particular, we focus on recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.
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Affiliation(s)
- Samantha J Dando
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Alan Mackay-Sim
- Eskitis Institute for Drug Discovery, Griffith University, Brisbane, Queensland, Australia
| | - Robert Norton
- Townsville Hospital, Townsville, Queensland, Australia
| | - Bart J Currie
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - James A St John
- Eskitis Institute for Drug Discovery, Griffith University, Brisbane, Queensland, Australia
| | - Jenny A K Ekberg
- Eskitis Institute for Drug Discovery, Griffith University, Brisbane, Queensland, Australia School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Batzloff
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Glen C Ulett
- School of Medical Science and Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Ifor R Beacham
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
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24
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Tan LV, Thai LH, Phu NH, Nghia HDT, Chuong LV, Sinh DX, Phong ND, Mai NTH, Man DNH, Hien VM, Vinh NT, Day J, Chau NVV, Hien TT, Farrar J, de Jong MD, Thwaites G, van Doorn HR, Chau TTH. Viral aetiology of central nervous system infections in adults admitted to a tertiary referral hospital in southern Vietnam over 12 years. PLoS Negl Trop Dis 2014; 8:e3127. [PMID: 25165820 PMCID: PMC4148224 DOI: 10.1371/journal.pntd.0003127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background Central nervous system (CNS) infections are important diseases in both children and adults worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the viral causes of the diseases is of public health importance, in order to better inform immunization policy, and may influence clinical management. Methodology/Principal Findings Study was conducted at the Hospital for Tropical Diseases in Ho Chi Minh City, a primary, secondary, and tertiary referral hospital for all southern provinces of Vietnam. Between December 1996 and May 2008, patients with CNS infections of presumed viral origin were enrolled. Laboratory diagnostics consisted of molecular and serological tests targeted at 14 meningitis/encephalitis-associated viruses. Of 291 enrolled patients, fatal outcome and neurological sequelae were recorded in 10% (28/291) and 27% (78/291), respectively. Mortality was especially high (9/19, 47%) amongst those with confirmed herpes simplex encephalitis which is attributed to the limited availability of intravenous acyclovir/valacyclovir. Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses were the most common viruses detected, responsible for 36 (12%), 19 (6.5%), 19 (6.5%) and 8 (2.7%) respectively, followed by rubella virus (6, 2%), varicella zoster virus (5, 1.7%), mumps virus (2, 0.7%), cytomegalovirus (1, 0.3%), and rabies virus (1, 0.3%). Conclusions/Significance Viral infections of the CNS in adults in Vietnam are associated with high morbidity and mortality. Despite extensive laboratory testing, 68% of the patients remain undiagnosed. Together with our previous reports, the data confirm that Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses are the leading identified causes of CNS viral infections in Vietnam, suggest that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis is preventable by adequate vaccination/treatment, and are therefore of public health significance. Central nervous system (CNS) infections are important diseases worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the causes of the diseases is of public health importance, in order to better inform immunization policy, and influence clinical management. We describe the clinical features and infectious causes of 291 adults with clinically suspected CNS infections of presumed viral origin. We show that CNS viral infections in Vietnam are associated with high morbidity and mortality. Mortality was especially high (47%) amongst those with herpes simplex encephalitis which is attributed to the limited availability specific antiviral drugs in our setting. Japanese encephalitis virus, dengue viruses, herpes simplex virus and enteroviruses were the most common viruses detected, followed by rubella virus, varicella zoster virus, mumps virus, cytomegalovirus, and rabies virus. Our study represents the broadest yet investigation of the possible viral causes of the CNS infections in adults in Vietnam, with a diagnostic yield of 32%. The results show that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis could be prevented by adequate vaccination or treatment, and are therefore of public health significance.
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Affiliation(s)
- Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- * E-mail:
| | - Le Hong Thai
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ly Van Chuong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dinh Xuan Sinh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | - Vo Minh Hien
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Jeremy Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Menno D. de Jong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, Academic Medical, Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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25
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Streptococcus suis, an important pig pathogen and emerging zoonotic agent-an update on the worldwide distribution based on serotyping and sequence typing. Emerg Microbes Infect 2014; 3:e45. [PMID: 26038745 PMCID: PMC4078792 DOI: 10.1038/emi.2014.45] [Citation(s) in RCA: 451] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 12/18/2022]
Abstract
Streptococcus suis is an important pathogen causing economic problems in the pig
industry. Moreover, it is a zoonotic agent causing severe infections to people in close
contact with infected pigs or pork-derived products. Although considered sporadic in the
past, human S. suis infections have been reported during the last 45 years, with
two large outbreaks recorded in China. In fact, the number of reported human cases has
significantly increased in recent years. In this review, we present the worldwide
distribution of serotypes and sequence types (STs), as determined by multilocus sequence
typing, for pigs (between 2002 and 2013) and humans (between 1968 and 2013). The methods
employed for S. suis identification and typing, the current epidemiological
knowledge regarding serotypes and STs and the zoonotic potential of S. suis are
discussed. Increased awareness of S. suis in both human and veterinary diagnostic
laboratories and further establishment of typing methods will contribute to our knowledge
of this pathogen, especially in regions where complete and/or recent data is lacking. More
research is required to understand differences in virulence that occur among S.
suis strains and if these differences can be associated with specific serotypes or
STs.
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26
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Choi R, Kim GM, Jo IJ, Sim MS, Song KJ, Kim BJ, Na DL, Huh HJ, Kim JW, Ki CS, Lee NY. Incidence and clinical features of herpes simplex viruses (1 and 2) and varicella-zoster virus infections in an adult Korean population with aseptic meningitis or encephalitis. J Med Virol 2014; 86:957-62. [PMID: 24610349 DOI: 10.1002/jmv.23920] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 01/05/2023]
Abstract
Since there are limited data on the incidence and clinical findings of central nervous system (CNS) infection by three α-herpesviruses including human herpes simplex virus 1 (HSV-1), HSV-2 and varicella-zoster virus (VZV) in Korea, a retrospective analysis of clinical data and polymerase chain reaction (PCR) results was performed in patients who presented with suspicion of acute viral meningitis and/or encephalitis at the emergency department of a tertiary referral hospital in Seoul, Korea. During the 3-year study period, a total of 224 cerebrospinal fluid (CSF) samples from 224 patients were examined. Among the 224 patients, 135 (60.3%) patients were identified as having aseptic meningitis (n = 70, 51.9%), encephalitis (n = 41, 30.4%) or meningoencephalitis (n = 24, 17.8%) at discharge. Twenty-four (17.8%) patients were identified as having VZV meningitis (n = 16, 11.9%), VZV meningoencephalitis (n = 2, 1.5%), HSV-2 meningitis (n = 4, 3.0%), or HSV-1 encephalitis (n = 2, 1.5%). Of the 24 patients infected with the three herpesviruses, immunocompromised patients accounted for 33.3% (n = 8). Skin rashes were observed in half (n = 9) of the patients with VZV, and none with HSV-1 or HSV-2. One patient with VZV meningitis and four patients with brain parenchymal involvement had neurologic sequelae. In conclusion, three herpesviruses are important causative agents of CNS infectious disease with significant morbidity in adults, regardless of the immunologic status. Therefore, CSF should be examined for HSV-1, HSV-2, and VZV using sensitive diagnostic methods in all cases of adult patients with clinical manifestations of CNS disease in order to identify the correct etiology and to determine appropriate therapy.
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Affiliation(s)
- Rihwa Choi
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Le VT, de Jong MD, Nguyen VK, Nguyen VT, Taylor W, Wertheim HFL, van der Ende A, van der Hoek L, Canuti M, Crusat M, Sona S, Nguyen HU, Giri A, Nguyen TTCB, Ho DTN, Farrar J, Bryant JE, Tran TH, Nguyen VVC, van Doorn HR. Limited geographic distribution of the novel cyclovirus CyCV-VN. Sci Rep 2014; 4:3967. [PMID: 24495921 PMCID: PMC3913916 DOI: 10.1038/srep03967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/17/2014] [Indexed: 01/03/2023] Open
Abstract
A novel cyclovirus, CyCV-VN, was recently identified in cerebrospinal fluid (CSF) from patients with central nervous system (CNS) infections in central and southern Vietnam. To explore the geographic distribution of this novel virus, more than 600 CSF specimens from patients with suspected CNS infections in northern Vietnam, Cambodia, Nepal and The Netherlands were screened for the presence of CyCV-VN but all were negative. Sequence comparison and phylogenetic analysis between CyCV-VN and another novel cyclovirus recently identified in CSF from Malawian patients indicated that these represent distinct cycloviral species, albeit phylogenetically closely related. The data suggest that CyCV-VN has a limited geographic distribution within southern and central Vietnam. Further research is needed to determine the global distribution and diversity of cycloviruses and importantly their possible association with human disease.
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Affiliation(s)
- Van Tan Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Menno D de Jong
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Van Kinh Nguyen
- 1] National Hospital for Tropical Diseases, Hanoi, Vietnam [2] Hanoi Medical University, Hanoi, Vietnam
| | - Vu Trung Nguyen
- 1] National Hospital for Tropical Diseases, Hanoi, Vietnam [2] Hanoi Medical University, Hanoi, Vietnam
| | - Walter Taylor
- 1] Oxford University Clinical Research Unit, Hanoi, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Heiman F L Wertheim
- 1] Oxford University Clinical Research Unit, Hanoi, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arie van der Ende
- 1] Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands [2] The Netherlands National Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands
| | - Lia van der Hoek
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marta Canuti
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Crusat
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Soeng Sona
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | - Hanh Uyen Nguyen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Abhishek Giri
- Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
| | | | - Dang Trung Nghia Ho
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam [3] Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Jeremy Farrar
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Juliet E Bryant
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tinh Hien Tran
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - H Rogier van Doorn
- 1] Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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28
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Viral aetiology and clinico-epidemiological features of acute encephalitis syndrome in eastern India. Epidemiol Infect 2014; 142:2514-21. [DOI: 10.1017/s0950268813003397] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYThis study reports clinico-epidemiological features and viral agents causing acute encephalitis syndrome (AES) in the eastern Indian region through hospital-based case enrolment during April 2011 to July 2012. Blood and CSF samples of 526 AES cases were investigated by serology and/or PCR. Viral aetiology was identified in 91 (17·2%) cases. Herpes simplex virus (HSV; types I or II) was most common (16·1%), followed by measles (2·6%), Japanese encephalitis virus (1·5%), dengue virus (0·57%), varicella zoster virus (0·38%) and enteroviruses (0·19%). Rash, paresis and cranial nerve palsies were significantly higher (P < 0·05) with viral AES. Case-fatality rates were 10·9% and 6·2% in AES cases with and without viral aetiology, respectively. Simultaneous infection of HSV I and measles was observed in seven cases. This report provides the first evidence on viral aetiology of AES viruses from eastern India showing dominance of HSV that will be useful in informing the public health system.
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29
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Pappas G. Socio-economic, industrial and cultural parameters of pig-borne infections. Clin Microbiol Infect 2013; 19:605-10. [PMID: 23738656 DOI: 10.1111/1469-0691.12262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/03/2013] [Indexed: 12/17/2022]
Abstract
The pork-processing industry has been possibly the fastest growing sector of the food industry in recent years. Specialization, genetic homogenization of the pig population, high density of the breeding population, reduced human-animal interactions, slaughter at a lower age and increased international trade of live animals and pork are parameters that affect, positively or negatively, the emergence of novel pig-borne pathogens, many of which are pig-specific, and many of which have significant zoonotic potential, as observed in recent outbreaks of Nipah virus and Streptococcus suis in Southeast Asia and China, respectively. Numerous other pathogens are transmitted to humans through direct contact with or consumption of pig products, and globalization trends in trade and human population movements have resulted in outbreaks of pig-borne diseases even in Muslim countries and in Israel, where pork consumption is religiously prohibited. The role of pigs as potential reservoirs of antibiotic-resistant pathogens or genes encoding resistance, and the role of feral pigs as a reservoir of zoonotic disease, are scientific fields in direct need of further research.
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Affiliation(s)
- G Pappas
- Institute of Continuing Medical Education of Ioannina, Ioannina, Greece.
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30
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Quaglia A, Karlsson M, Larsson M, Taylor WR, Diep NTN, Trinh DT, Trung NV, Van Kinh N, Wertheim HFL. Total lactate dehydrogenase in cerebrospinal fluid for identification of bacterial meningitis. J Med Microbiol 2013; 62:1772-1773. [DOI: 10.1099/jmm.0.058156-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anders Quaglia
- Department of Clinical Science and Education, Sachsska Children’s Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Karlsson
- Department of Clinical Chemistry, Central Hospital Karlstad, Sweden
- Department of Clinical Science and Education, Sachsska Children’s Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Larsson
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
- Wellcome Trust Major Overseas Program Vietnam, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Walter R. Taylor
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
- Wellcome Trust Major Overseas Program Vietnam, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Nguyen Thi Ngoc Diep
- Wellcome Trust Major Overseas Program Vietnam, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | | | | | - Heiman F. L. Wertheim
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
- Wellcome Trust Major Overseas Program Vietnam, Oxford University Clinical Research Unit, Hanoi, Vietnam
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31
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Epidemiologic Characteristics of Patients Treated in a Referral Center With the Diagnosis of Central Nervous System Infection in North of Iran, from March 2008 to March 2012: A Retrospective Observational Registry Study. ARCHIVES OF NEUROSCIENCE 2013. [DOI: 10.5812/archneurosci.13894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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32
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Mengistu A, Gaeseb J, Uaaka G, Ndjavera C, Kambyambya K, Indongo L, Kalemeera F, Ntege C, Mabirizi D, Joshi MP, Sagwa E. Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis. J Pharm Policy Pract 2013; 6:4. [PMID: 24764539 PMCID: PMC3987067 DOI: 10.1186/2052-3211-6-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Bacterial meningitis is a medical emergency associated with high mortality rates. Cerebrospinal fluid (CSF) culture is the "gold standard" for diagnosis of meningitis and it is important to establish the susceptibility of the causative microorganism to rationalize treatment. The Namibia Standard Treatment Guidelines (STGs) recommends initiation of empirical antibiotic treatment in patients with signs and symptoms of meningitis after taking a CSF sample for culture and sensitivity. The objective of this study was to assess the antimicrobial sensitivity patterns of microorganisms isolated from CSF to antibiotics commonly used in the empirical treatment of suspected bacterial meningitis in Namibia. METHODS This was a cross-sectional descriptive study of routinely collected antibiotic susceptibility data from the Namibia Institute of Pathology (NIP) database. Results of CSF culture and sensitivity from January 1, 2009 to May 31, 2012, from 33 state hospitals throughout Namibia were analysed. RESULTS The most common pathogens isolated were Streptococcus species, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and Escherichia coli. The common isolates from CSF showed high resistance (34.3% -73.5%) to penicillin. Over one third (34.3%) of Streptococcus were resistance to penicillin which was higher than 24.8% resistance in the United States. Meningococci were susceptible to several antimicrobial agents including penicillin. The sensitivity to cephalosporins remained high for Streptococcus, Neisseria, E. coli and Haemophilus. The highest percentage of resistance to cephalosporins was seen among ESBL K. pneumoniae (n = 7, 71%-100%), other Klebsiella species (n = 7, 28%-80%), and Staphylococcus (n = 36, 25%-40%). CONCLUSIONS The common organisms isolated from CSF were Streptococcus Pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and E. coli. All common organisms isolated from CSF showed high sensitivity to cephalosporins used in the empirical treatment of meningitis. The resistance of the common isolates to penicillin is high. Most ESBL K. pneumoniae were isolated from CSF samples drawn from neonates and were found to be resistant to the antibiotics recommended in the Namibia STGs. Based on the above findings, it is recommended to use a combination of aminoglycoside and third-generation cephalosporin to treat non-ESBL Klebsiella isolates. Carbapenems (e.g., meropenem) and piperacillin/tazobactam should be considered for treating severely ill patients with suspected ESBL Klebsiella infection. Namibia should have a national antimicrobial resistance surveillance system for early detection of antibiotics that may no longer be effective in treating meningitis and other life-threatening infections due to resistance.
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Affiliation(s)
| | | | | | | | | | | | - Francis Kalemeera
- Systems for Improved Access to Pharmaceuticals and Services, implemented by Management Sciences for Health, Windhoek, Namibia
| | - Christopher Ntege
- Systems for Improved Access to Pharmaceuticals and Services, implemented by Management Sciences for Health, Windhoek, Namibia
| | - David Mabirizi
- Systems for Improved Access to Pharmaceuticals and Services, implemented by Management Sciences for Health, Windhoek, Namibia
| | - Mohan P Joshi
- Systems for Improved Access to Pharmaceuticals and Services, implemented by Management Sciences for Health, Windhoek, Namibia
| | - Evans Sagwa
- Systems for Improved Access to Pharmaceuticals and Services, implemented by Management Sciences for Health, Windhoek, Namibia
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33
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Elliott I, Dittrich S, Paris D, Sengduanphachanh A, Phoumin P, Newton PN. The use of dried cerebrospinal fluid filter paper spots as a substrate for PCR diagnosis of the aetiology of bacterial meningitis in the Lao PDR. Clin Microbiol Infect 2013; 19:E466-72. [PMID: 23738720 PMCID: PMC4285853 DOI: 10.1111/1469-0691.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/24/2013] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
Abstract
We investigated whether dried cerebrospinal fluid (CSF) conserved on filter paper can be used as a substrate for accurate PCR diagnosis of important causes of bacterial meningitis in the Lao PDR. Using mock CSF, we investigated and optimized filter paper varieties, paper punch sizes, elution volumes and quantities of DNA template to achieve sensitive and reliable detection of bacterial DNA from filter paper specimens. FTA Elute Micro Card™ (Whatman, Maidstone, UK) was the most sensitive, consistent and practical variety of filter paper. Following optimization, the lower limit of detection for Streptococcus pneumoniae from dried mock CSF spots was 14 genomic equivalents (GE)/μL (interquartile range 5.5 GE/μL) or 230 (IQR 65) colony forming units/mL. A prospective clinical evaluation for S. pneumoniae, S. suis and Neisseria meningitidis was performed. Culture and PCR performed on fresh liquid CSF from patients admitted with a clinical diagnosis of meningitis (n = 73) were compared with results derived from dried CSF spots. Four of five fresh PCR-positive CSF samples also tested PCR positive from dried CSF spots, with one patient under the limit of detection. In a retrospective study of S. pneumoniae samples (n = 20), the median (IQR; range) CSF S. pneumoniae bacterial load was 1.1 × 10(4) GE/μL (1.2 × 10(5) ; 1 to 6.1 × 10(6) DNA GE/μL). Utilizing the optimized methodology, we estimate an extrapolated sensitivity of 90%, based on the range of CSF genome counts found in Laos. Dried CSF filter paper spots could potentially help us to better understand the epidemiology of bacterial meningitis in resource-poor settings and guide empirical treatments and vaccination policies.
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Affiliation(s)
- I Elliott
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
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