Clinical manifestations in the West Nile virus outbreak

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.

Serodiagnosis of tuberculous meningitis by enzyme-linked immunosorbent assay (ELISA)

IgG antibodies against glycolipids and proteins isolated from M. tuberculosis and BCG suspension were determined by ELISA in sera, in CSFs and in serum and CSF paired samples, from patients with tuberculous meningitis and from healthy control subjects. With specificities between 90 and 94% for the antigens used, we obtained senitivities of 75% for Pr-ELISA, 60% for G1-ELISA and 35% for BCG-ELISA. As specific antibodies were detected in serum and CSFs, only one sample is enough to perform the test. We concluded that Pr-ELISA and G1-ELISA could be used as a supporting test in TBM diagnosis, especially when repeated bacteriological methods failed to prove the presence of tubercle bacilli and in cases without evidence of pulmonary tuberculosis.

Clinical usefulness of rapid serodiagnosis in pulmonary tuberculosis by ELISA with glycolipidic antigens extracted from Mycobacterium tuberculosis and with whole BCG suspension

Antibodies against Mycobacterium tuberculosis glycolipids and whole BCG suspension were determined by ELISA on 58 sera from hospitalized patients with presumptive pulmonary tuberculosis and on 127 sera from control subjects. The experimental results demonstrated that the glycolipids are more adequate to be used as antigens than whole BCG suspension, as high sensitivity of the test was obtained. By using only one antigen, ELISA becomes more efficient in rapid diagnosis. ELISA with glycolipidic antigens should be used as a supporting test for direct smear examination in the diagnosis of pulmonary tuberculosis, especially in cases when repeated bacterial methods failed to prove the presence of M. tuberculosis.