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Bao NT, Luan VT, Liem BT, Nhu VHT, Viet DC, Tung TH, Burza S, Thanh NT. Extracorporeal life support and continuous renal replacement therapy in a patient with Enterovirus A71 associated cardiopulmonary failure: A case report. Medicine (Baltimore) 2024; 103:e36797. [PMID: 38181280 PMCID: PMC10766259 DOI: 10.1097/md.0000000000036797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported. PATIENT CONCERNS The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest. DIAGNOSES Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71. INTERVENTIONS The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO. OUTCOMES The patient achieved a favorable outcomes. LESSONS Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
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Affiliation(s)
- Nguyen Trung Bao
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Vo Thanh Luan
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Bui Thanh Liem
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Do Chau Viet
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Trinh Huu Tung
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Sakib Burza
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health in Harmony, London, United Kingdom
| | - Nguyen Tat Thanh
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Hayes LH, Hopkins SE, Liu S, Pardo CA, Garcia-Dominguez MA, Oleszek J, Yea C, Ciftci-Kavaklioglu B, Yeh EA, Dean J, Sadowsky CL, Desai J, Wiegand S, Farias-Moeller R, Nash K, Thakur KT, Vargas WS, Hong-Routson SJ, Yeshokumar A, Zhou MS, Makhani N, Wilson-Murphy M, Bove R, Zhang B, Benson LA. Challenges in the Clinical Recognition of Acute Flaccid Myelitis and its Implications. J Pediatr 2023; 253:55-62.e4. [PMID: 36115622 DOI: 10.1016/j.jpeds.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the challenges in diagnosing acute flaccid myelitis (AFM) and evaluate clinical features and treatment paradigms associated with under recognition. STUDY DESIGN This was a retrospective multicenter study of pediatric patients (≤18 years) who were diagnosed with AFM from 2014 to 2018 using the Centers for Disease Control and Prevention's case definition. RESULTS In 72% of the cases (126 of 175), AFM was not considered in the initial differential diagnosis (n = 108; 61.7%) and/or the patient was not referred for acute care (n = 90; 51.4%) at the initial clinical encounter, and this did not improve over time. Although many features of the presentation were similar in those initially diagnosed with AFM and those who were not; preceding illness, constipation, and reflexes differed significantly between the 2 groups. Patients with a non-AFM initial diagnosis more often required ventilatory support (26.2% vs 12.2%; OR, 0.4; 95% CI, 0.2-1.0; P = .05). These patients received immunomodulatory treatment later (3 days vs 2 days after neurologic symptom onset; 95% CI, -2 to 0; P = .05), particularly intravenous immunoglobulin (5 days vs 2 days; 95% CI, -4 to -2; P < .001). CONCLUSIONS Delayed recognition of AFM is concerning because of the risk for respiratory decompensation and need for intensive care monitoring. A non-AFM initial diagnosis was associated with delayed treatment that could have a clinical impact, particularly as new treatment options emerge.
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Affiliation(s)
- Leslie H Hayes
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, MA
| | - Shanshan Liu
- Department of Neurology and Institutional Centers for Clinical and Translational Research Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MA
| | | | - Joyce Oleszek
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Carmen Yea
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - E Ann Yeh
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janet Dean
- Department of Physical Medicine and Rehabilitation, International Center for Spinal Cord Injury, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Cristina L Sadowsky
- Department of Physical Medicine and Rehabilitation, International Center for Spinal Cord Injury, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Jay Desai
- Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Sarah Wiegand
- Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Raquel Farias-Moeller
- Division of Child Neurology, Department of Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Kendall Nash
- Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY
| | - Wendy S Vargas
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY
| | - Sue J Hong-Routson
- Division of Critical Care, Departments of Pediatrics & Neurology, Lurie Children's Hospital of Chicago, Chicago, IL
| | - Anusha Yeshokumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa S Zhou
- Department of Pediatrics, Yale School of Medicine, New Haven, CT; Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Naila Makhani
- Department of Pediatrics, Yale School of Medicine, New Haven, CT; Department of Neurology, Yale School of Medicine, New Haven, CT
| | | | - Riley Bove
- Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA
| | - Bo Zhang
- Department of Neurology and Institutional Centers for Clinical and Translational Research Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Leslie A Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA.
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3
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Bustos B R, Díaz F, Cores C, Castro Z F, Cruces P. [Acute flaccid myelitis and enterovirus infection: a severe emerging disease]. Andes Pediatr 2022; 93:552-560. [PMID: 37906854 DOI: 10.32641/andespediatr.v93i4.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2023]
Abstract
Acute flaccid myelitis (AFM) is a neuroinflammatory disease characterized by acute asymmetric weakness of the limbs associated with lesions of the gray matter of the spinal cord. It mainly affects children and has been increasingly identified since 2014. OBJECTIVE To describe a severe emerging neurological disease in Chile. CLINICAL CASE Three children (2 females), previously healthy were in cluded. The age at the onset was between 4 and 6 years. All presented an acute febrile illness associated with upper respiratory symptoms, rapid onset of proximal asymmetric limb weakness, spinal fluid pleocytosis, and enterovirus isolated from nasopharyngeal swab; two patients developed tetraparesis. The MRI of the spinal cord showed T2 hyperintensity of the grey matter. The three patients were admitted to the Pediatric Intensive Care Unit (PICU), and two required mechanical ventilation. No significant improvements were observed after the use of immunomodulatory therapy and plasma ex change. At 12 months of follow-up, one case was quadriplegic and ventilator-dependent; the second died of ventricular arrhythmia in the PICU, and the third one is under rehabilitation with partial recovery. CONCLUSIONS We report the first cases of this severe emerging neurological disease in our country. In a child with predominantly proximal and asymmetric acute limb paralysis, pediatricians must have a high index of suspicion for AFM. Since it can progress rapidly and lead to respiratory failure, suspected AFM should be considered a medical emergency.
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Affiliation(s)
| | - Franco Díaz
- Hospital El Carmen de Maipú, Santiago, Chile
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Wörner N, Rodrigo-García R, Antón A, Castellarnau E, Delgado I, Vazquez È, González S, Mayol L, Méndez M, Solé E, Rosal J, Andrés C, Casquero A, Lera E, Sancosmed M, Campins M, Pumarola T, Rodrigo C. Enterovirus-A71 Rhombencephalitis Outbreak in Catalonia: Characteristics, Management and Outcome. Pediatr Infect Dis J 2021; 40:628-633. [PMID: 34097655 PMCID: PMC8189429 DOI: 10.1097/inf.0000000000003114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Between April and June 2016, an outbreak of rhombencephalitis (RE) caused by enterovirus (EV) A71 was detected in Catalonia, Spain-the first documented in Western Europe. The clinical characteristics and outcome of patients with this condition differed from those reported in outbreaks occurring in Southeast Asia. METHODS Observational, multicenter study analyzing characteristics, treatment and outcome of patients with EV-A71 rhombencephalitis diagnosed in 6 publicly funded hospitals within the Catalonian Health Institute. A review of clinical characteristics, diagnosis, treatment and outcome of these patients was conducted. RESULTS Sixty-four patients met the clinical and virologic criteria for rhombencephalitis caused by EV-A71. All patients had symptoms suggesting viral disease, mainly fever, lethargy, ataxia and tremor, with 30% of hand-foot-mouth disease. Intravenous immunoglobulin therapy was given to 44/64 (69%) patients and methylprednisolone to 27/64 (42%). Six patients (9%) required pediatric intensive care unit admission. Three patients had acute flaccid paralysis of 1 limb, and another had autonomic nervous system (ANS) dysfunction with cardiorespiratory arrest. Outcome in all patients (except the patient with hypoxic-ischemic encephalopathy) was good, with complete resolution of the symptoms. CONCLUSIONS During the 2016 outbreak, rhombencephalitis without ANS symptoms was the predominant form of presentation and most patients showed no hand-foot-mouth disease. These findings contrast with those of other patient series reporting associated ANS dysfunction (10%-15%) and hand-foot-mouth disease (60%-80%). Complete recovery occurred in almost all cases. In light of the favorable outcome in untreated mild cases, therapies for this condition should be reserved for patients with moderate-severe infection. The main relevance of this study is to provide useful information for setting priorities, management approaches and adequate use of resources in future EV-A71 associated rhombencephalitis outbreaks.
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Affiliation(s)
- Núria Wörner
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Rocío Rodrigo-García
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Andrés Antón
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Castellarnau
- Department of Pediatrics, Joan XXIII University Hospital, Tarragona, Spain
| | - Ignacio Delgado
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Èlida Vazquez
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sebastià González
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Lluís Mayol
- Department of Pediatrics, Josep Trueta University Hospital, Girona, Spain
| | - Maria Méndez
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Eduard Solé
- Department of Pediatrics, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Jaume Rosal
- Department of Pediatrics, Verge de la Cinta Hospital, Tortosa, Spain
| | - Cristina Andrés
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Alejandro Casquero
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Esther Lera
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mónica Sancosmed
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Magda Campins
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Tomàs Pumarola
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Rodrigo
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Faculty of Medicine at Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. Carlos Rodrigo, MD, PhD, is currently at the Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
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5
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Abstract
Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating paralysis in children and some adults. This article reviews the case definition of AFM as well as its epidemiology and association with enteroviral infection. The clinical presentation, diagnostic investigation with particular attention to electrodiagnostics, acute management, and surgical options are described. Clinical outcomes and considerations for acute and long-term rehabilitation management are discussed extensively based on review of current literature, highlighting avenues for further study.
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Affiliation(s)
- William Ide
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine
| | - Michelle Melicosta
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Melissa K Trovato
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Ste. 232, Baltimore, MD 21205, USA; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine.
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6
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Chen SD, Ju YT, Wei YJ, Hsieh ML, Liu CC, Wu JM, Wang JN. Timing of Endotracheal Intubation in Patients with Fulminant Enterovirus 71 Infection. Medicina (Kaunas) 2020; 56:medicina56040203. [PMID: 32344662 PMCID: PMC7230837 DOI: 10.3390/medicina56040203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
Background and objective: Enterovirus 71 (EV 71) infections may result in the rapid progression of cardiopulmonary failure. Early endotracheal intubation is considered to be of primary importance. However, the appropriate timing for this is still not known. The aim of this study is to investigate the timing of intubation of children with fulminant EV71 infection. Material and Methods: From March 1998 to May 2012, patients with severe EV71 infection who were admitted to the pediatric intensive care unit of the National Cheng Kung University Hospital were enrolled in this study. Medical records were retrospectively reviewed. The patients were classified into three groups in accordance with the outcome of intubation. We used rhombencephalitis grading to describe the neurological presentation of these patients. The study was approved by the institutional review board. Results: There were a total of 105 patients enrolled. Of these, 77 patients were in Grade I, and only three of them needed intubation, who were, however, soon extubated within 24 h. There were 10 patients in Grade II; nine of them needed intubation. In total, 18 patients belonged to Grade III, and all of them need to be intubated. We then compared the outcome of intubation of grades II and III. There was only one patient out of the nine patients in grade II who experienced failed extubation due to the progression of the disease. Among grade III patients, only four patients were successfully extubated. We also listed clinical parameters to determine which one could be a sign that indicated intubation. Comparing the favorable outcomes, cranial nerve involvement was a good indicator for the timing of intubation. Conclusions: This study showed that early intubation in Grade II provides favorable outcomes and improves morbidity and mortality. We also found that if cranial nerve involvement was present, then early intubation is indicated.
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Affiliation(s)
- Shen-Dar Chen
- Department of Pediatrics, Dalin Tzu Chi hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan;
| | - Ying-Tzu Ju
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70421, Taiwan; (Y.-T.J.); (Y.-J.W.); (M.-L.H.); (C.-C.L.); (J.-M.W.)
- Correspondence: ; Tel.: +886-6-2353535 (ext. 4189)
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7
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Lam KT, Zheng J, Xiang Z, Liu YP, Lau YL, Tu WW. Antiviral activity of human γδ-T cells against enterovirus 71. Hong Kong Med J 2019; 25 Suppl 9:21-23. [PMID: 31889030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- K T Lam
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - J Zheng
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Z Xiang
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Y P Liu
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Y L Lau
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - W W Tu
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
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Abstract
PURPOSE OF REVIEW This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or parainfectious autoimmune-mediated mechanisms; this article focuses primarily on the former. RECENT FINDINGS Some microorganisms exhibit neurotropism for the spinal cord (eg, enteroviruses such as poliovirus and flaviviruses such as West Nile virus), while others are more protean in neurologic manifestations (eg, herpesviruses such as varicella-zoster virus), and others are only rarely reported to cause myelopathy (eg, certain fungal and parasitic infections). Individuals who are immunocompromised are at increased risk of disseminated infection to the central nervous system. Within the last few years, an enterovirus D68 outbreak has been associated with cases of acute flaccid paralysis in children, and emerging Zika virus infection has been concurrent with cases of acute flaccid paralysis due to Guillain-Barré syndrome, although cases of myelitis have also been reported. Associated pathogens differ by geographic distribution, with myelopathies related to Borrelia burgdorferi (Lyme disease) and West Nile virus more commonly seen in the United States and parasitic infections encountered more often in Latin America, Southeast Asia, and Africa. Characteristic CSF and MRI patterns have been identified with many of these infections. SUMMARY A myriad of pathogens are associated with infectious myelopathies. Host factors, geographic distribution, clinical features, CSF profiles, and MRI findings can assist in formulating the differential diagnosis and ultimately guide management.
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Carballo CM, Erro MG, Sordelli N, Vazquez G, Mistchenko AS, Cejas C, Rodriguez M, Cisterna DM, Freire MC, Contrini MM, Lopez EL. Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016. Emerg Infect Dis 2019; 25:573-576. [PMID: 30602120 PMCID: PMC6390768 DOI: 10.3201/eid2503.170897] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
After a 2014 outbreak of severe respiratory illness caused by enterovirus D68 in the United States, sporadic cases of acute flaccid myelitis have been reported worldwide. We describe a cluster of acute flaccid myelitis cases in Argentina in 2016, adding data to the evidence of association between enterovirus D68 and this polio-like illness.
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10
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Tetro JA. Enterovirus D68 and acute flaccid myelitis: do we need a measles mentality? Microbes Infect 2019; 21:271-272. [PMID: 30844444 DOI: 10.1016/j.micinf.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jason A Tetro
- College of Biological Science, University of Guelph, Guelph, Ontario, Canada.
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11
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Abstract
RATIONALE We present the first case of enterovirus (EV) D68, lineage B3 infection, associated with acute flaccid myelitis (AFM) in Taiwan. AFM caused by EV D68 is relatively rare. This report highlights the importance of clinical recognition of the disease and discusses treatments that can benefit such patients. PATIENT CONCERNS A 5-year-old boy experienced sudden onset of acute flaccid paralysis (AFP) involving left arm after fever and respiratory symptoms for 3 days. DIAGNOSES Magnetic resonance imaging (MRI) of the spinal cord revealed signal changes over segments C1 to T5 on a T2-weighted image (T2WI), compatible with the diagnosis of AFM. The EV D68 strain, cultured from the throat of the patient was identified. INTERVENTIONS We administered intravenous immunoglobulin (IVIG, 1g/kg, twice), pulse steroid therapy (methylprednisolone, 30 mg/kg, twice) and oral prednisolone (1mg/kg/day). Rehabilitation was also arranged. OUTCOMES The patient still had mild muscle atrophy over left arm after following-up for 1 year. LESSONS Early diagnosis and prompt management are essential for managing this kind of patient. IVIG, pulse therapy, and oral prednisolone may play crucial roles in controlling its clinical course.
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Affiliation(s)
- I-.Ju Chen
- Department of Pediatrics, Cathay General Hospital
| | - Su-Ching Hu
- Department of Pediatrics, Cathay General Hospital
| | - Kun-Long Hung
- Department of Pediatrics, Cathay General Hospital
- School of Medicine
- Department of Pediatrics, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - Chiao-Wei Lo
- Department of Pediatrics, Cathay General Hospital
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12
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Bjerin O, Martín Muñoz D, Gerald C, Brytting M, Eriksson M. [Acute flaccid myelitis amongst Swedish children with a possible link to an outbreak of enterovirus D68]. Lakartidningen 2017; 114:ETDZ. [PMID: 29292957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute flaccid myelitis amongst Swedish children with a possible link to an outbreak of enterovirus D68 In september 2016 we had several cases of acute flaccid myelitis in our clinic. This coincided with an outbreak of enterovirus D68 (EV-D68) in Sweden during the same period. We describe three cases, of which one tested positive for EV-D68. Acute flaccid paralysis of one or more limbs preceded by an upper respiratory tract infection is highly suspicious of myelitis, and a viral cause must be included in the clinical work-up. In order to detect infection with EV-D68 in suspected acute flaccid myelitis, nasopharyngeal aspirate should be performed as early as possible. EV-D68 is normally not found in stool or cerebrospinal fluid tests but should be included in the clinical work-up. Treatment of acute flaccid myelitis is supportive only. There is no effective antiviral treatment and immunomodulating therapies show little effect. Persisting neurological deficits are common but lethal cases are rare.
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Affiliation(s)
- Olof Bjerin
- Karolinska sjukhuset - Solna, Sweden - pediatric neurology Solna, Sweden
| | - Daniel Martín Muñoz
- Karolinska Universitetssjukhuset - Div. Pediatric Neuroradiology, Dpt of Neuroradiology Stockholm, Sweden Karolinska Universitetssjukhuset - Div. Pediatric Neuroradiology, Dpt of Neuroradiology Stockholm, Sweden
| | - Cooray Gerald
- Karolinska Universitetssjukhuset Neurofysiologiska kliniken - Stockholm, Sweden Karolinska Universitetssjukhuset Neurofysiologiska kliniken - Stockholm, Sweden
| | - Mia Brytting
- The Public Health Agency of Sweden - Microbiology Solna, Sweden The Public Health Agency of Sweden - Microbiology Solna, Sweden
| | - Mats Eriksson
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden
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13
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Wang MG, Sun HM, Liu XM, Deng XQ. Clinical analysis of 59 children with hand foot and mouth diseases due to enterovirus EV71 and concomitant viral encephalitis. Eur Rev Med Pharmacol Sci 2017; 21:43-49. [PMID: 29165766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To analyzed the clinical features of children with HFMD and viral encephalitis and to summarize some treatments. PATIENTS AND METHODS A total of 59 children with HFMD were included in this study. All children underwent complete blood count, blood biochemical test cerebrospinal fluid examination, chest X-ray and brain MRI. RESULTS One child died 24 hours after admission due to central respiratory failure with myocardial damage. After the treatment, 58 children had normal temperature, resolved rash, normal complete blood count, biochemical blood tests and cerebrospinal fluid test, respiratory and circulatory symptoms and signs, as well as neurological symptoms, disappeared. The hospitalization time was 12-21 days. After follow-up for 1-3 months, all children were recovered, and without any severe sequelae. CONCLUSIONS HFMD and the complicated viral encephalitis usually occurred in the children < 3 years old. The clinical manifestations were not typical. Monitoring of the child's clinical symptoms, signs and relevant examinations was required.
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Affiliation(s)
- M-G Wang
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu, China.
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Moyer K, Wang H, Salamon D, Leber A, Mejias A. Enterovirus D68 in Hospitalized Children: Sequence Variation, Viral Loads and Clinical Outcomes. PLoS One 2016; 11:e0167111. [PMID: 27875593 PMCID: PMC5119825 DOI: 10.1371/journal.pone.0167111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background An outbreak of enterovirus D68 (EV-D68) caused severe respiratory illness in 2014. The disease spectrum of EV-D68 infections in children with underlying medical conditions other than asthma, the role of EV-D68 loads on clinical illness, and the variation of EV-D68 strains within the same institution over time have not been described. We sought to define the association between EV-D68 loads and sequence variation, and the clinical characteristic in hospitalized children at our institution from 2011 to 2014. Methods May through November 2014, and August to September 2011 to 2013, a convenience sample of nasopharyngeal specimens from children with rhinovirus (RV)/EV respiratory infections were tested for EV-D68 by RT-PCR. Clinical data were compared between children with RV/EV-non-EV-D68 and EV-D68 infections, and among children with EV-D68 infections categorized as healthy, asthmatics, and chronic medical conditions. EV-D68 loads were analyzed in relation to disease severity parameters and sequence variability characterized over time. Results In 2014, 44% (192/438) of samples tested positive for EV-D68 vs. 10% (13/130) in 2011–13 (p<0.0001). PICU admissions (p<0.0001) and non-invasive ventilation (p<0.0001) were more common in children with EV-D68 vs. RV/EV-non-EV-D68 infections. Asthmatic EV-D68+ children, required supplemental oxygen administration (p = 0.03) and PICU admissions (p <0.001) more frequently than healthy children or those with chronic medical conditions; however oxygen duration (p<0.0001), and both PICU and total hospital stay (p<0.01) were greater in children with underlying medical conditions, irrespective of viral burden. By phylogenetic analysis, the 2014 EV-D68 strains clustered into a new sublineage within clade B. Conclusions This is one of the largest pediatric cohorts described from the EV-D68 outbreak. Irrespective of viral loads, EV-D68 was associated with high morbidity in children with asthma and co-morbidities. While EV-D68 circulated before 2014, the outbreak isolates clustered differently than those from prior years.
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Affiliation(s)
- Katherine Moyer
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Huanyu Wang
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Douglas Salamon
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Amy Leber
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- * E-mail: (AM); (AL)
| | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail: (AM); (AL)
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Barkin JA, Czul F, Barkin JS, Klimas NG, Rey IR, Moshiree B. Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis. Dig Dis Sci 2016; 61:2344-2350. [PMID: 27344315 DOI: 10.1007/s10620-016-4227-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 06/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastroparesis (GP) is a disabling chronic gastroenterologic disorder with high morbidity that severely impacts patients' quality of life. GP can present acutely after a viral-like gastrointestinal illness resulting in speculation that in some patients, neurologic damage caused by the infection might underlie the pathogenesis of idiopathic gastroparesis (IGP). AIMS The aim of this study is to document case reports of Enterovirus (EV) infection as a possible cause of IGP. METHODS Eleven patients referred with a diagnosis of GP underwent workup to exclude known causes of GP. Those with a history of flu-like symptoms or gastroenteritis prior to onset of GP symptoms had gastric biopsies taken during upper endoscopy to assess for the presence of gastric mucosal EV infection. Data on presenting symptoms, extra-intestinal symptoms and conditions, prior nutritional support requirements, upper endoscopy findings, and response to therapy were cataloged. RESULTS Eleven patients were diagnosed as IGP. Nine had active EV infection on gastric biopsies and were included (7/9 female, mean age 43 years). Eight out of nine received EV treatment with antivirals and/or immune therapies, with a wide degree of variability in treatment regimens. Four out of eight who received EV treatment had symptomatic improvement. One patient had stable symptoms. Three patients are currently undergoing therapy. CONCLUSIONS Gastric EV infection was frequently detected (82 %) in patients undergoing investigation for IGP. Antiviral and/or immune therapies against EV seem to be favorable, as most of our patients had resolution of their GP symptoms after treatment. This is the first study to identify EV as a possible infectious etiology of IGP.
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Affiliation(s)
- Jodie A Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA.
| | - Frank Czul
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA
| | - Jamie S Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Davie, FL, 33328, USA
| | - Irma R Rey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Davie, FL, 33328, USA
| | - Baharak Moshiree
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA
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Abstract
UNLABELLED Enterovirus and parechovirus are a frequent cause of infection in children. This review is an overview of what is known from enterovirus and parechovirus infection in children and contains information about the epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of enterovirus and parechovirus infection in children. CONCLUSIONS EV and HPeV infections are a frequent cause of infection in childhood. The clinical presentation is diverse. RT-qPCR is the best way to detect an EV or HPeV. Cerebrospinal fluid, blood and feces have the highest sensitivity for detecting an EV or HPeV. There is no treatment for EV and HPeV infections. Two vaccines against EV 71 are just licensed in China and will be available on the private market. Little is known about the prognosis of EV and HPeV infections. WHAT IS KNOWN •EV and HPeV are a frequent cause of infection in children. What is new: •This review gives a brief overview over EV and HPeV infection in children.
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Affiliation(s)
- S C M de Crom
- Department of Pediatrics, St. Elisabeth Hospital, Tilburg, The Netherlands.
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - J W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A M van Furth
- Department of Pediatric Infectious Diseases Immunology and Rheumatology, VU Medical Centre, Amsterdam, The Netherlands
| | - C C Obihara
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Abstract
The first confirmed US case of severe respiratory tract infection caused by enterovirus D68 in an adult occurred in a pregnant woman with no history of asthma in August 2014. Before she came to the hospital, she had a productive cough, headache, and increasing dyspnea. At the hospital, she was hypoxic and required admittance to the intensive care unit and management with noninvasive bilevel positive pressure assistance. Analysis of a nasopharyngeal swab sent to the Centers for Disease Control and Prevention for a viral respiratory panel of tests confirmed enterovirus D68 infection. She eventually had an uneventful vaginal delivery, was discharged without oxygen supplementation, and has resumed normal activities. This case suggests that pregnant women may be a sentinel group infected with this pathogen, similar to what has been described for influenza virus infection.
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Affiliation(s)
- Nicholas S Ward
- Nicholas S. Ward is an attending physician, Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, and an associate professor, Warren Alpert Medical School, Brown University, Providence, Rhode Island. Brenna L. Hughes is an associate professor, Warren Alpert Medical School, and director, Division of Maternal Fetal Medicine fellowship, Women and Infants Hospital, Providence, Rhode Island. Leonard A. Mermel is an attending physician, Division of Infectious Diseases, Rhode Island Hospital, and a professor, Warren Alpert Medical School, Brown University
| | - Brenna L Hughes
- Nicholas S. Ward is an attending physician, Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, and an associate professor, Warren Alpert Medical School, Brown University, Providence, Rhode Island. Brenna L. Hughes is an associate professor, Warren Alpert Medical School, and director, Division of Maternal Fetal Medicine fellowship, Women and Infants Hospital, Providence, Rhode Island. Leonard A. Mermel is an attending physician, Division of Infectious Diseases, Rhode Island Hospital, and a professor, Warren Alpert Medical School, Brown University
| | - Leonard A Mermel
- Nicholas S. Ward is an attending physician, Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, and an associate professor, Warren Alpert Medical School, Brown University, Providence, Rhode Island. Brenna L. Hughes is an associate professor, Warren Alpert Medical School, and director, Division of Maternal Fetal Medicine fellowship, Women and Infants Hospital, Providence, Rhode Island. Leonard A. Mermel is an attending physician, Division of Infectious Diseases, Rhode Island Hospital, and a professor, Warren Alpert Medical School, Brown University.
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Thacker S, Cruce C, Rowlett JD. Update on Meningitis in Adolescents and Young Adults. Adolesc Med State Art Rev 2015; 26:658-674. [PMID: 27282017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
MESH Headings
- Adolescent
- Arbovirus Infections/diagnosis
- Arbovirus Infections/therapy
- Enterovirus Infections/diagnosis
- Enterovirus Infections/therapy
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/therapy
- Humans
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/therapy
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/prevention & control
- Meningitis, Meningococcal/therapy
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/prevention & control
- Meningitis, Pneumococcal/therapy
- Meningitis, Viral/diagnosis
- Meningitis, Viral/therapy
- Meningococcal Vaccines/therapeutic use
- Pneumococcal Vaccines/therapeutic use
- West Nile Fever/diagnosis
- West Nile Fever/therapy
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19
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Vongpunsawad S, Prachayangprecha S, Chansaenroj J, Haagmans BL, Smits SL, Poovorawan Y. Genome sequence of enterovirus D68 and clinical disease, Thailand. Emerg Infect Dis 2015; 21:384. [PMID: 25625890 PMCID: PMC4313665 DOI: 10.3201/eid2102.141742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Goss JF. Re-emerging infectious diseases. JEMS 2015; 40:60-62. [PMID: 26554185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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21
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Abstract
There are currently 12 species and over 100 serotypes that have been identified in the enterovirus genus, including the coxsackieviruses, echoviruses, and polioviruses. Since their discovery 65 years ago, much has been discovered and continues to be researched regarding the pathogenicity and scope of disease of nonpolio enteroviruses. Like many infections, enteroviruses have been found to affect neonates much differently, and often more severely, than older children and adults. Neonatal infections often cause mild illnesses with nonspecific symptoms, but they may also have severe presentations involving the cardiovascular, gastrointestinal, hematologic, or central nervous systems. This article provides an overview of what is known about nonpolio enteroviruses in neonates including epidemiology, transmission, clinical presentation, diagnosis, and treatment.
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Healy EG, Phadke R, Kidd M, Reilly MM, Lunn MP. Clinical, neuropathological and radiological evidence for a rare complication of rituximab therapy. Neuromuscul Disord 2015; 25:589-92. [PMID: 25958339 DOI: 10.1016/j.nmd.2015.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/05/2015] [Accepted: 04/07/2015] [Indexed: 11/18/2022]
Abstract
We report a rare case of myofasciitis and meningitis with deafness caused by systemic enterovirus infection in the setting of hypogammaglobulinaemia induced by rituximab. Whilst effective and generally safe, anti- CD 20 antibody therapy is increasingly recognised to result in unusual infectious complications to be considered in a treated patient presenting with neurological symptoms. These cases may pose diagnostic difficulties and can have atypical presentations. We present this rare complication of rituximab therapy, with histopathological confirmation of myofasciitis. In the older literature, enterovirus associated myofasciitis may have erroneously been termed dermatomyositis and we review the literature to demonstrate this important nosological point.
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Affiliation(s)
- E G Healy
- Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK
| | - R Phadke
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Kidd
- Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M M Reilly
- Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - M P Lunn
- Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
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Banjac L, Nikcević D, Vujosević D, Raonić J, Banjac G. Tachycardia in a newborn with enterovirus infection. Acta Clin Croat 2014; 53:102-106. [PMID: 24974673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Enterovirus infections are common in the neonatal period. Newborns are at a higher risk of severe disease including meningoencephalitis, sepsis syndrome, cardiovascular collapse, or hepatitis. The mechanism of heart failure in patients with enterovirus infection remains unknown. Early diagnosis may help clinicians predict complications in those infants initially presenting with severe disease. An 11-day-old male newborn was admitted to our neonatal intensive care unit because of tachycardia and crises of cyanosis. His elder brother had febrile illness. The newborn was cyanotic, in respiratory distress, with tachycardia, low blood pressure and prolonged capillary refilling time. Limb pulse oximeter was around 85%. During the first day of hospitalization, the newborn had one febrile episode. Laboratory data: elevated transaminases, markers of inflammation negative, all bacterial cultures negative. Enterovirus RNA was detected in blood sample. Other blood findings were without significant abnormalities. Electrocardiogram showed tachycardia, with narrow QRS complexes (atrial tachycardia) and heart rate up to 280/min. In order to convert the rhythm, the patient was administered adenosine and amiodarone. In the further course of hospitalization, the patient was in good general condition, eucardiac and eupneic. Newborns with tachycardia and a family history of febrile illness should be suspected to have enterovirus infection. Enterovirus infection is a highly contagious and potentially life-threatening infection if not detected early. The use of sensitive molecular-based amplification methods offers potential benefits for early diagnosis and timely treatment.
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Mancio J, Bettencourt N, Oliveira M, Pires-Morais G, Ribeiro VG. Acute right ventricular myocarditis presenting with chest pain and syncope. BMJ Case Rep 2013; 2013:bcr2012007173. [PMID: 24096068 PMCID: PMC3822266 DOI: 10.1136/bcr-2012-007173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Myocarditis is assumed to involve both ventricles equally. Right ventricular predominant involvement is rarely described. A case of acute viral right ventricular myocarditis presenting with chest pain and syncope, grade 3 atrioventricular block, right ventricular dilatation and free wall hypokinesia is reported. Cardiac MRI showed late enhancement of the right ventricular free wall without involvement of the left ventricle. Anti-Coxsackie A9 virus neutralising IgM-type antibodies titre was elevated. This case emphasises that manifestations of myocarditis can be limited to the right ventricle and should be considered in the differential diagnosis of right ventricular enlargement.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Hospital Center of Vila Nova de Gaia and Espinho, Vila Nova de Gaia, Portugal
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25
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Lysenko IM, Romantsov MG. [Syndrome "sickly child"]. Lik Sprava 2013:48-59. [PMID: 23951910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Scientific review is devoted to the urgent problem of child health care--Syndrome "sickly child" described in detail the category of "frequently ill children" repeated respiratory diseases, the pathogens that cause diseases of the respiratory tract. Paying attention to factors contributing to re-respiratory morbidity, including genetically determined causes (disturbances in the state of health of the mother), is represented by the genetic determinism of repeated and recurrent diseases related to blood groups. The development of an immune imbalance is manifested by changes in the cellular, humoral immune response and nonspecific resistance factors characterizing the changes of local immunity in this category of children that shape the development of chronic disease. We describe the effect of an allergic component to the severity of respiratory disease and the relationship with the mechanisms of neuroendocrine and immune systems. Correction of the immune resistance of sickly children was conducted cycloferon contributing to reduce the incidence and duration of repeated episodes of acute respiratory infections per year.
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Lu GP, Zhu QR. [Thinking about the intervention strategy for critically ill hand-foot-and-mouth disease caused by enterovirus 71 infection]. Zhonghua Er Ke Za Zhi 2012; 50:244-248. [PMID: 22801222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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27
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Clinical Experts Group of the Ministry of Health for Hand, Foot and Mouth Disease. [Experts consensus on rescue and treatment of severe cases with enterovirus 71 (EV71) infection]. Zhonghua Er Ke Za Zhi 2011; 49:675-8. [PMID: 22176902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Koroleva GA, Lukashev AN, Khudiakova LV, Mustafina AN, Lashkevich VA. [Encephalomyelitis caused by enterovirus type 71 in children]. Vopr Virusol 2010; 55:4-10. [PMID: 21381332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Enterovirus type 71 (EV71) is a causative agent of large outbreaks of hand, foot, and mouth disease (HFMD) in Europe (Bulgaria, 1975; Hungary, 1978) and South-East Asia (Malaysia, 1977; Taiwan, 1998; Singapore, 2000-2007; People's Republic of China, 2007-2009). HFMD afflicted children less than 10 years of age and resulted in recovery within 3-7 days. In a small percentage of infants (aged 6 months to 3 years), HFMD was accompanied by acute neurological complications, such as serous meningitis, poliomyelitis-like syndrome (extremity pareses and muscle paralyses); brain stem encephalitis (myoclonic jerks, tremor, lethargy, swallowing and speech disorders, cardiopulmonary failure, pulmonary edema, shock, coma, death). X-ray study revealed pulmonary hemorrhages and edema. Mortality rates were as high as 82-94% in severe cases. Incapacitating motor, respiratory, and psychoemotional disorders persisted in some surviving children. Pathomorphologically, patients with central nervous system disease and cardiopulmonary failure were found to have acute inflammation of the grey matter of the brain stem (medulla oblongata, pons) and spinal cord. Inflammatory changes in the lung and myocardial tissues were negligible or absent. Fatal pulmonary edema was neurogenic in origin and resulted from damage to the respiratory and vasomotor centers of the brain stem.
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Cao R, Han J, Deng Y, Yu M, Qin E, Qin C. Presence of high-titer neutralizing antibodies against enterovirus 71 in intravenous immunoglobulin manufactured from Chinese donors. Clin Infect Dis 2010; 50:125-6. [PMID: 20001529 DOI: 10.1086/649012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Liu JT, Peng D, Guan XH, Zou DD, Zhao DC. [Clinical characteristics and treatment assessments of severe enterovirus 71 infected children]. Zhonghua Er Ke Za Zhi 2010; 48:24-28. [PMID: 20441698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To facilitate early recognition of ominous clinical manifestations, to understand pathophysiology and assess treatment effects in patients with severe enterovirus 71 (EV71) associated hand, foot and mouth disease (HFMD). METHOD A retrospective analysis was performed based on the clinical records, laboratory data and treatment effects which were collected from twelve severe EV71 infected cases from nine hospitals in 2008, in Hubei province, China. RESULT Of the 12 severe cases, ten (83.3%) were male and two female. The median age was 1.96 yrs (8 m to 7 yrs). The mean hyperthermic duration was 6 days with the peak temperature over 38.5 degrees C, and mean rash duration was 7 days. Fever and rash emerged simultaneously in 4 of 5 cases with cardiopulmonary failure. The severe complications included encephalitis (10 cases), pulmonary edema or hemorrhage (5 cases). Eleven cases were checked with magnetic resonance imaging (MRI) and four cases showed characteristics of encephalitis or meningitis, two with images of naso sinusitis and ethmoid-mastoid inflammation. Chest X-ray examination showed with pulmonary edema on single or both sides (5 cases), bronchitis (4 cases), and normal image (3 cases). There was no specific finding in the cardiac ultrasound and electrocardiogram in any of the patients, as well as the white blood cell count, blood glucose, prothrombin time, partial thromboplastin time and D-dimer. Cerebrospinal fluid showed aseptic meningitis with the increase of cell count in 7 cases. All patients were treated with antibiotics and/or antivirals, such as cephalosporins, ribavirin etc. Eleven patients were treated with intravenous immunoglobulin (total dose 2 - 4.5 g/kg) for 2 - 5 days, and the highest blood concentration of immunoglobulin was detected increasing at 7 g/L. Seven cases were also treated with methylprednisolone 10 - 30 mg/(kg x d), four with dopamine, dobutamine, or digitalis. In addition, by using continuous positive airway pressure by nasal catheter and maintenance of circulation in the cases with cardiopulmonary failure could not relieve the symptoms of dyspnoea, and mechanical ventilation was required to maintain for a mean of 72 hrs (24 - 96 hrs). Except one case died of pulmonary edema in the early stage, others were cured without sequelae. CONCLUSION Severe EV71 infection is more common in children younger than 3 years old, in which the profound complications include encephalitis and pulmonary edema. The mechanical ventilation should be critically urged for child with complicating cardiopulmonary failure as soon.
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Affiliation(s)
- Jing-tao Liu
- Department of Pediatrics, Zhong Nan Hospital, Wuhan University, Wuhan 430071, China
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Liu XJ, Li W, Zhang YQ, Liu YM, Liu LZ. [Clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 infection]. Zhongguo Dang Dai Er Ke Za Zhi 2009; 11:967-969. [PMID: 20113599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To study the clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 (EV71) infection. METHODS The clinical data of 32 hospitalized children with serious brainstem encephalitis caused by EV71 infection between May and December 2008 were retrospectively reviewed. RESULTS The children whose age was younger than 3 years old accounted for 88% (22 cases). Fever(>38.5 degrees centigrade)lasting at least 3 days, frequent vomiting and limb twitch were presented as the main manifestations in the 32 children. Cyanosis, tachypnea, tachycardia and cold extremities were observed, and pulmonary edema or even pulmonary hemorrhage occurred in 8 children 3 to 4 days after the onset. The 32 children received a medical treatment: reduction of intracranial pressure with mannitol or frusemide, inhibition of inflammation reactivity with gamma globulin and methylprednisolone, and improvement of cardiac function and pulmonary edema with innotropic agents, fluid restriction and positive mechanical ventilation. CONCLUSIONS Vegetative nerve functional disturbance is the main clinical feature of brainstem encephalitis caused by EV71 infection in children. An early identification and treatment of pulmonary edema or hemorrhage is of great importance.
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Affiliation(s)
- Xiao-Jun Liu
- Department of Neurology, Tianjin Children's Hospital, Tianjin 300074, China
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Cheng MF, Chen BC, Huang TS, Hsieh KS, Chen SN, Liu YC. Clinical application of reverse-transcription polymerase chain reaction and intravenous immunoglobulin for enterovirus encephalitis. Jpn J Infect Dis 2008; 61:18-24. [PMID: 18219129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although polymerase chain reaction (PCR) is a highly sensitive procedure for the diagnosis of enteroviruses, it has never been systemically applied to the treatment of enteroviral encephalitis using intravenous immunoglobulin (IVIg). We conducted a 2-year randomized, controlled comparison of reverse transcription (RT)-PCR of cerebrospinal fluid (CSF) with traditional viral isolation to guide IVIg treatment. Seventy-five patients were enrolled and classified into three groups: one group with clinical manifestations of enteroviral infections and two without. The latter two groups were separated on the basis of whether IVIg treatment was guided by RT-PCR or virus culture assay. CSF specimens from the 18 confirmed cases of enteroviral encephalitis were RT-PCR positive for enterovirus in all but one case. Of the remaining 57 cases of nonenteroviral encephalitis, only 4 were positive for enterovirus RT-PCR. One patient in the group of IVIg treatment guided by viral isolation subsequently displayed a sequel of epilepsy. No patients in the IVIg treatment groups guided by RT-PCR had any neurological sequelae. In conclusion, the use of RT-PCR allowed rapid, sensitive, and specific detection of enteroviral RNA in CSF. When used to guide IVIg treatment, RT-PCR may shorten hospitalization and improve outcomes of patients with enteroviral encephalitis.
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Affiliation(s)
- Ming-Fang Cheng
- Department of Pediatrics, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan
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33
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Abstract
PURPOSE OF REVIEW To highlight some of the recent key epidemiologic and clinical diagnostic dilemmas of aseptic meningitis and to evaluate some tests that may help distinguish aseptic compared with bacterial meningitis. RECENT FINDINGS Enteroviruses remain the most common cause of aseptic meningitis. Certain enteroviruses (e.g. coxsackie B5, echovirus 6, 9 and 30) are more likely to cause meningitis outbreaks, while others (coxsackie A9, B3 and B4) are mostly endemic. Nucleic acid tests are more sensitive than cultures in diagnosing enteroviral infections. In centers where the turnaround time for these tests is less than 24 h, there can be substantial cost savings and avoidance of unnecessary treatment of aseptic meningitis with antibiotics. Serum and stool specimens are important adjunct samples for diagnosing enteroviral infections in children. Cerebrospinal fluid protein (> or = 0.5 g/l) and serum procalcitonin (> or = 0.5 ng/ml) appear to be useful laboratory markers for distinguishing between bacterial and aseptic meningitis in children aged 28 days to 16 years, but they have relatively low sensitivity and specificity. SUMMARY Enteroviruses are the major causes of aseptic meningitis. The major focus of diagnosis remains ruling out bacterial infection or confirming enteroviral etiology of infection. Properly implemented nucleic acid tests have the potential to reduce cost and unnecessary treatment.
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Affiliation(s)
- Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Tan EL, Tan TMC, Chow VTK, Poh CL. Enhanced potency and efficacy of 29-mer shRNAs in inhibition of Enterovirus 71. Antiviral Res 2007; 74:9-15. [PMID: 17316836 DOI: 10.1016/j.antiviral.2007.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 01/03/2007] [Accepted: 01/04/2007] [Indexed: 12/17/2022]
Abstract
Enterovirus 71 (EV71) is the main causative agent of hand, foot, and mouth disease (HFMD) in young children. It has been associated with severe neurological complications and has caused significant mortalities in large-scale outbreaks in Asia. In this study, we demonstrated an enhanced silencing of EV71 through the use of chemically synthesized 29-mer shRNAs. The 29-mer shRNAs were designed to target three highly conserved regions of EV71 genome. Transfection of rhabdomyosarcoma (RD) cells with the 29-mer shRNAs significantly inhibited EV71 replication in a dose-dependent manner as demonstrated by reduction of viral RNA, VP1 protein and plaque forming units. The inhibitory effects were more potent and were achieved at 10-fold lower concentrations when compared to 19-mer siRNAs reported previously [Sim, A.C.N., Luhur, A., Tan, T.M.C., Chow, V.T.K., Poh, C.L., 2005. RNA interference against Enterovirus 71 infection. Virology 341, 72-79]. The viral inhibitory effects lasted 72 h post-infection and there was no adverse off-target silencing effect. Gene silencing by 29-mer shRNAs targeted at the 3D(pol) region (sh-3D) was the most effective, achieving 91% viral inhibition. Further evaluation found that no enhanced inhibitory effects were observed when sh-3D was cotransfected with each of the other two candidates. This study showed an improvement in triggering RNAi using the more potent 29-mer shRNAs, indicating its therapeutic potential against EV71.
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Affiliation(s)
- Eng Lee Tan
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, MD4A, 5 Science Drive 2, Singapore 117597, Singapore
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35
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Wang SM, Lei HY, Huang MC, Su LY, Lin HC, Yu CK, Wang JL, Liu CC. Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis. J Clin Virol 2006; 37:47-52. [PMID: 16861032 DOI: 10.1016/j.jcv.2006.05.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 02/16/2006] [Accepted: 05/26/2006] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several epidemics of enterovirus 71 (EV71) infections occurred in Taiwan since 1998. OBJECTIVES We performed the study to determine the changes in cytokine profiles associated with administration of intravenous immunoglobulin (IVIG) in patients with EV71-associated brainstem encephalitis complicated by autonomic nervous system (ANS) dysfunction and pulmonary edema. STUDY DESIGN Plasma cytokine concentrations (IL-1beta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-2, IL-4, IL-5, IL-10, and IL-13) were monitored on admission and within 12-24h after administration of IVIG in a cohort of children (n=22) with virologically confirmed EV71 infection, from March 2000 through April 2004. RESULT Plasma levels of IFN-gamma, IL-6, IL-8, IL-10, and IL-13 levels significantly decreased in patients with pulmonary edema after administration of IVIG, P<0.05. Plasma levels of IL-6 and IL-8 were significantly decreased in patients with ANS dysregulation after administration of IVIG, P<0.05. Administration of IVIG was not associated with significant changes in plasma concentration of IL-1beta, IL-2, IL-4, IL-5 IL-10, IL-13 and TNF-alpha in patients with ANS dysregulation. CONCLUSIONS These findings suggest that IVIG might be considered to have a therapeutic role in EV71-associated brainstem encephalitis. A clinical trial is needed to support this hypothesis.
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Affiliation(s)
- Shih-Min Wang
- Department of Emergency Medicine, National Cheng Kung University & Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan
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36
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Enoki H. [Acute flaccid paralysis during febrile illness in an infant]. No To Hattatsu 2006; 38:329-30. [PMID: 16986731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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37
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Affiliation(s)
- Tadashi Matsubayashi
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
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38
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Abstract
OBJECTIVE The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection. METHODS A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison. RESULTS The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2+/-5.0 vs 4.9+/-1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%). CONCLUSION Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.
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Affiliation(s)
- Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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39
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Peigue-Lafeuille H, Archimbaud C, Mirand A, Chambon M, Regagnon C, Laurichesse H, Clavelou P, Labbé A, Bailly JL, Henquell C. Du diagnostic moléculaire initial prospectif des méningites à entérovirus⋯ à la lutte contre l'antibiorésistance. Med Mal Infect 2006; 36:124-31. [PMID: 16480842 DOI: 10.1016/j.medmal.2005.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
Meningitis initially presents with intense manifestations that are not generally specific to a given etiology. The first major question for the physician is to decide whether to initiate a probabilistic treatment. Enteroviruses are a major cause of aseptic meningitis, which is benign in immunocompetent patients. Molecular diagnosis is now becoming the gold standard and its prospective use at the time of patient admission, on the sole basis of clinical suspicion of meningitis, has yielded more reliable data. Cytological and biochemical data from CSF analyses are of low predictive value to influence the initial decision to treat with antibiotics. In addition, cases of meningitis during winter are not uncommon. Adults are concerned in about 25% of cases. Thus, if molecular diagnostic tools are not rapidly available, patient management may be inconsistent, leading to unnecessary scans, laboratory investigations and treatment (including overconsumption of antibiotics). Current progress in the automation and practicability of viral genomic detection yields the result within a few hours after admission. Rapid molecular viral diagnosis of a benign disease that does not require treatment but which is initially worrying is of unquestionable advantage. It is of benefit to both the patient and the community because of its input on health economics, the needless consumption of drugs and, as a result, resistance to antibiotics. The diagnosis of meningitis can no longer remain a retrospective diagnosis after elimination of all the possible causes, since not prescribing unnecessary laboratory tests and not treating are true therapeutic decisions.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Case Management
- Cerebrospinal Fluid/virology
- Child
- Child, Preschool
- Diagnosis, Differential
- Drug Resistance
- Drug Utilization
- Early Diagnosis
- Encephalitis, Herpes Simplex/diagnosis
- Enterovirus/isolation & purification
- Enterovirus Infections/cerebrospinal fluid
- Enterovirus Infections/diagnosis
- Enterovirus Infections/epidemiology
- Enterovirus Infections/therapy
- France/epidemiology
- Genome, Viral
- Humans
- Incidence
- Infant
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/epidemiology
- Meningitis, Aseptic/therapy
- Middle Aged
- RNA, Viral/cerebrospinal fluid
- Reverse Transcriptase Polymerase Chain Reaction
- Unnecessary Procedures
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Affiliation(s)
- H Peigue-Lafeuille
- Laboratoire de virologie, centre de biologie, CHRU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France.
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40
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Sim ACN, Luhur A, Tan TMC, Chow VTK, Poh CL. RNA interference against enterovirus 71 infection. Virology 2005; 341:72-9. [PMID: 16083932 DOI: 10.1016/j.virol.2005.06.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 06/13/2005] [Accepted: 06/20/2005] [Indexed: 01/30/2023]
Abstract
Enterovirus 71 (EV71) is a highly infectious major causative agent of hand, foot, and mouth disease (HFMD) which could lead to severe neurological complications. There is currently no effective therapy against EV71. In this study, RNA interference (RNAi) is employed as a therapeutic approach for specific viral inhibition. Various regions of the EV71 genome were targeted for inhibition by chemically synthesized siRNAs. Transfection of rhabdomyosarcoma (RD) cells with siRNA targeting the 3'UTR, 2C, 3C, or 3D region significantly alleviated cytopathic effects of EV71. The inhibitory effect was dosage-dependent with a corresponding decrease in viral RNA, viral proteins, and plaque formations by EV71. Viral inhibition of siRNA transfected RD cells was still evident after 48 h. In addition, no significant adverse off-target silencing effects were observed. These results demonstrated the potential and feasibility for the use of siRNA as an antiviral therapy for EV71 infections.
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Affiliation(s)
- Adrian Chong Nyi Sim
- Department of Microbiology, Faculty of Medicine, National University of Singapore, MD4A, 5 Science Drive 2, 117597, Singapore.
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41
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Maslin J. [Enterovirus meeting (St Etienne, October 12-13, 2004)]. Med Trop (Mars) 2005; 65:207-8. [PMID: 16038367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- J Maslin
- Laboratoire de biologie médicale, Hôpital d'Instruction des Armées du Val de Grâce.
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42
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Tsai WH, Lee WT, Lu CY, Peng SSF, Shen YZ. Cerebral infarction associated with possible enteroviral infection in an infant. Acta Paediatr Taiwan 2004; 45:296-300. [PMID: 15868815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Enterovirus infection has been rarely reported to cause cerebral infarction in infants. We describe a 2-month-old boy with right focal seizure and right hemiparesis associated with enterovirus infection during an epidemic of enterovirus 71 infection in Taiwan in 1998. Magnetic resonance imaging and angiography showed vasculitis in the left anterior cerebral artery with cerebral infarction. In the unclarified pathogenesis of cerebral disease in enterovirus infection, this case suggests focal vasculitis with subsequent cerebral infarction. Enterovirus-related vasculitis of the central nervous system is thus another consideration when facing a child with focal seizure, acute hemiplegia and cerebral infarction.
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Affiliation(s)
- Wen-Hsin Tsai
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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43
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Abstract
The nonpoliovirus enteroviruses commonly infect newborns, with consequences ranging from asymptomatic infection and benign illness, to severe, life-threatening disease. Frequently occurring symptoms include fever, irritability, lethargy, anorexia, and rash. Although most illnesses are mild, severe disease develops in a subset of newborns infected in the first 2 weeks of life. Severe disease may consist of sepsis, meningoencephalitis, myocarditis, pneumonia, hepatitis, and/or coagulopathy. Substantial mortality rates have been reported, and long-term sequelae may occur among survivors. Risk factors and clinical features associated with severe disease include absence of neutralizing antibody to the infecting serotype, maternal illness prior to or at delivery, prematurity, illness onset within the first few days of life, multiorgan disease, severe hepatitis, positive serum viral culture, and specific infecting serotype (e.g. group B coxsackieviruses and echovirus 11). Whereas the mainstay of diagnosis has traditionally been viral isolation in tissue culture, the polymerase chain reaction has been demonstrated to be more sensitive than culture, highly specific, and rapid. Immunoglobulin has been used as a therapeutic agent for neonates with enterovirus disease; however, clinical efficacy has not been proven. Specific antiviral therapy for enteroviruses is in development. Pleconaril is an investigational agent that inhibits viral attachment to host cell receptors and uncoating of viral nucleic acid. It has broad and potent anti-enterovirus activity, excellent oral bioavailability, and is well tolerated. Some clinical trials have demonstrated benefit in children and adults with enterovirus meningitis, and in adults with upper respiratory tract infections caused by picornaviruses (rhinoviruses or enteroviruses). Data summarizing compassionate use for severe enterovirus diseases (including neonatal sepsis) also suggest possible benefit. Limited pharmacokinetic data are available in infants and neonates. A multicenter, placebo-controlled, randomized trial of pleconaril in neonates with severe hepatitis, coagulopathy, and/or myocarditis is currently being conducted.
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Affiliation(s)
- Mark J Abzug
- Department of Pediatrics, Pediatric Infectious Diseases, University of Colorado School of Medicine and The Children's Hospital, Denver, Colorado 80218, USA
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44
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Abstract
Heart failure from myocarditis may be transient or may progress to unremitting severe cardiac failure. This study was performed to determine the outcomes and prognostic features of pediatric patients with myocarditis. Patients with the diagnosis of myocarditis between 1990 and 2001 were identified through the coding system of Yale-New Haven Hospital. A total of 28 patients were included, with ages ranging from 1 day to 20 years. Before discharge, 11 patients developed unremitting severe cardiac failure. Of the remaining 17 patients, at the time of discharge 10 had normal systolic function and 7 had decreased systolic function. Unremitting cardiac failure developed in 9 of 14 patients (64%) with an ejection fraction < 30% and in only 2 of 14 (14%) of those with an ejection fraction > or = 30% on admission (p < 0.01). Furthermore, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation on admission as well as arrhythmia were significantly associated with development of unremitting severe cardiac failure. In this series of patients with myocarditis, by the time of discharge 39% of the patients had developed unremitting severe cardiac failure, 25% had depressed systolic function, and 36% had normal systolic function. Predictive factors at admission for poor outcome were ejection fraction < 30%, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation.
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Affiliation(s)
- B Kühn
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8064, USA.
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45
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Abstract
BACKGROUND Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000. METHODS The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups. RESULTS Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone. CONCLUSIONS Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.
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Affiliation(s)
- Luan-Yin Chang
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan
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46
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Caddle S. Enteroviruses. Pediatr Rev 2003; 24:358-9; discussion 358-9. [PMID: 14523164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Steve Caddle
- Children's Hospital at Montefiore, Bronx, NY, USA
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47
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Affiliation(s)
- Jason G Newland
- Department of Pediatrics, University of Nebraska Medical Center/Creighton University Medical Center, Omaha, NE, USA
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48
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Prager P, Nolan M, Andrews IP, Williams GD. Neurogenic pulmonary edema in enterovirus 71 encephalitis is not uniformly fatal but causes severe morbidity in survivors. Pediatr Crit Care Med 2003; 4:377-81. [PMID: 12831425 DOI: 10.1097/01.pcc.0000074274.58997.fe] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
During the Australian summer of 2000/2001, there was an outbreak of enterovirus 71 infection in Sydney. Between December 2000 and May 2001, approximately 200 children presented to Sydney Children's Hospital with hand-foot-and-mouth disease and 18 experienced neurologic complications. Four presented with acute invasive central nervous system disease and severe pulmonary edema. We describe the cardiorespiratory disturbances and intensive care management of these four consecutive children successfully treated for neurogenic pulmonary edema attributed to proven enterovirus 71 infection. All four survived the acute stage of the illness. However, all four have been left with significant debilitating morbidity. Epidemic enterovirus 71 brainstem encephalitis presenting as neurogenic pulmonary edema can be successfully managed in the pediatric intensive care unit but has great potential to yield a large number of handicapped toddlers and become "the poliomyelitis of the 21st century."
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Affiliation(s)
- Peter Prager
- Department of Intensive Care, Sydney Children's Hospital, Randwick, Australia
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49
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Floyed R, Kerley N. A neonate with sepsis. Clin Pediatr (Phila) 2003; 42:467-8; discussion 468-70. [PMID: 12862355 DOI: 10.1177/000992280304200516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rebecca Floyed
- Department of Pediatrics, LSU Health Sciences Center, New Orleans, Louisiana, USA
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50
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Yasukawa H, Yajima T, Duplain H, Iwatate M, Kido M, Hoshijima M, Weitzman MD, Nakamura T, Woodard S, Xiong D, Yoshimura A, Chien KR, Knowlton KU. The suppressor of cytokine signaling-1 (SOCS1) is a novel therapeutic target for enterovirus-induced cardiac injury. J Clin Invest 2003; 111:469-78. [PMID: 12588885 PMCID: PMC151924 DOI: 10.1172/jci16491] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Enteroviral infections of the heart are among the most commonly identified causes of acute myocarditis in children and adults and have been implicated in dilated cardiomyopathy. Although there is considerable information regarding the cellular immune response in myocarditis, little is known about innate signaling mechanisms within the infected cardiac myocyte that contribute to the host defense against viral infection. Here we show the essential role of Janus kinase (JAK) signaling in cardiac myocyte antiviral defense and a negative role of an intrinsic JAK inhibitor, the suppressor of cytokine signaling (SOCS), in the early disease process. Cardiac myocyte-specific transgenic expression of SOCS1 inhibited enterovirus-induced signaling of JAK and the signal transducers and activators of transcription (STAT), with accompanying increases in viral replication, cardiomyopathy, and mortality in coxsackievirus-infected mice. Furthermore, the inhibition of SOCS in the cardiac myocyte through adeno-associated virus-mediated (AAV-mediated) expression of a dominant-negative SOCS1 increased the myocyte resistance to the acute cardiac injury caused by enteroviral infection. These results indicate that strategies directed at inhibition of SOCS in the heart and perhaps other organs can augment the host-cell antiviral system, thus preventing viral-mediated end-organ damage during the early stages of infection.
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Affiliation(s)
- Hideo Yasukawa
- Institute of Molecular Medicine, Department of Medicine, and. Division of Cardiothoracic Surgery, University of California at San Diego, La Jolla, California 92093-0613, USA
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