[CSF RT-PCR standardization in pediatric patients with enteroviral central nervous system infection]

OBJECTIVE

We standardized the RT-PCR panviral CSF and determined its applicability in detecting acute enterovirus infection in the central nervous system in children under 15 years.

MATERIAL AND METHODS

RT-PCR was performed directly in CSF samples of 10 pediatric patients with suspected CNS infection and 9, with different conditions of the central nervous system.

RESULTS

80% (8/10) of RT-PCR samples were positive for enterovirus in patients with suspected CNS infection and no sample was positive in patients with different ailments.

CONCLUSIONS

Since enteroviruses are among the main etiologies of pediatric encephalitis, RT-PCR could be particularly useful for rapid detection in CSF.

[Is it necessary to perform a lumbar puncture in the evaluation of the febrile newborn infant without source?]

Lumbar puncture to detect bacterial meningitis is a recommended screening procedure to be performed in febrile newborn infants at admission to hospital.

OBJECTIVE

To evaluate the usefulness of this procedure performed at admission and eventually, in a second look if clinically justified.

PATIENTS AND METHOD

There were studied 1,841 febrile newborns consulting at the Emergency Department from January 1992 to December 2000 without source. All of them underwent a sepsis workup. The rate of meningitis incidence was calculated, and we analyzed the frequency of meningitis diagnosed in the initial evaluation and reappraisal.

RESULTS

There were 206 febrile patients with diagnosis of meningitis for an incidence of 11.2%, which 20 were bacterial (1.1%) and 186 aseptic meningitis (10.1%). In the initial evaluation 155 patients were diagnosed with meningitis (155/ 1.774 = 8.7%) and in reappraisal (mean 39,5 +/- 25,2 hours after) there were diagnosed another 51 cases (51/ 135 = 37.8%).

CONCLUSIONS

The meningitis was a common diagnosis in febrile newborns without source, with prevalence of aseptic meningitis. In almost 25% of cases we reached to this diagnosis by means of performing lumbar puncture after a reappraisal.

Fever of unknown origin: Chronic lymphatic leukemia versus lymphoma (Richter’s transformation)

Currently, malignancies are more common than infections as a cause of fever of unknown origin (FUO) in adults. Many malignant disorders are associated with fever, which may either be of the hectic-septic variety resembling an infectious disease or prolonged and low-grade. Neoplasms with either kind of fever may present as an FUO. The malignancies usually associated with fever are lymphoreticular malignancies involving the blood, liver, spleen, or bone marrow. Most malignancies do not have fever, e.g., chronic lymphatic leukemia (CLL), as part of their clinical presentation. We present a case of long-standing CLL in an elderly woman who presented with an FUO. Initially, it was thought that her FUO was caused by CLL or a CLL-related opportunistic infection. The naprosyn test was used in this patient with CLL and FUO to differentiate a malignant from an infectious etiology. Her response to naprosyn indicated that the etiology of her FUO was neoplastic rather than infectious. The absence of tonsillar enlargement and peripheral adenopathy, as well as the presence of fever, argued against CLL as the cause of her fever. Computed axial tomography scans showed central adenopathy in addition to splenomegaly. The presence of fever, splenomegaly, and central adenopathy indicated that the cause of her FUO was a lymphoma (Richter's transformation) and not CLL.

[Detection of viral aetiology in cerebral spinal fluid samples from 580 clinical cases]

OBJECTIVE

To investigate the viral aetiology in cerebral spinal fluid (Csf) from 580 cases of CNS infection or FUO in Yuedong district from 1990 to 1997.

METHODS

Virus isolation was done with Hep-2 and BHK-21 cells.

RESULTS

21 virus types of 5 kinds of viruses were isolated from 113 samples (19.5%). Clinically diagnosed diseases included viral encephalitis 17.8% (43/242), intracranial infection 20.2% (47/233), paralytic diseases 24.3% (9/37), FUO 37.5% (9/24), convulsion 16.0% (4/25), Guillain-Barre syndrome 5.3% (1/19). Virus infection included 11 cases of Poliovirus (constitutional ratio 0.0973, including 1 Polio-I, 8 Polio-II, 2 Polio-III); 54 cases of Coxsackie virus (0.477 9, including 11 CoxA24, 10 CoxBl, 2 Cox134, 3 CoxB5); 15 cases of ECHO virus (0.1327, including 4 ECHO-24, 3 ECRO-7, 2 ECHO-12 and each one of ECHO-3, 11,14,15,27,32); 25 cases of Enterovirus (0.2213, including 14 EV-70, 11 EV-71); 8 cases of Adenovirus (0.070 8, including 3 Adv-2, 3 Adv-3 and 2 Adv7). Results of different age groups indicated there was significant difference (P < 0.05) in virus detection rate in two age groups. Virus positive rates in different years were 1990-1991 14.2% (15/106), 1992-1993 14.1%(23/163), 1994-1995 26.1% (36/138), 1996-1997 22.5% (39/173), that showed a significant difference (P <0.05).

CONCLUSIONS

Virus infection rate of CNS diseases and FUO showed an a ascending trend, and the different virus types and kinds were isolated in different periods.

Detection of enteroviruses in the cerebrospinal fluid by polymerase chain reaction: prospective study of impact on the management of hospitalized children

A polymerase chain reaction kit (AMPLICOR EV) for the detection of enteroviruses (EV-PCR) in the cerebrospinal fluid (CSF) was evaluated in clinical conditions in a prospective blinded-intention study. Forty-three children (mean age 2.7 years) hospitalized for suspected meningitis or fever of unclear etiology were enrolled. EV-PCR was performed on a daily basis. Results were available in less than 2 days in 72% of cases. EV-PCR was positive in nine (21%) children, including three infants without CSF pleocytosis. Knowing their EV-PCR result would have allowed a saving of 18 hospital days and 12 days of antibiotic therapy. The EV-PCR in the CSF can thus be practically useful for children hospitalized for meningitis or fever if available on-site on a daily basis.