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Ismail A, Saahath A, Ismail Y, Ismail MF, Zubair Z, Subbaram K. 'Tomato flu' a new epidemic in India: Virology, epidemiology, and clinical features. New Microbes New Infect 2022; 51:101070. [PMID: 36582550 PMCID: PMC9792351 DOI: 10.1016/j.nmni.2022.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
This article aims to highlight the current update on the 'tomato flu' outbreak in India. Recently there was an outbreak of a new illness in some parts of India. The disease was very contagious and it manifested with a rash mainly noticed in children younger than nine years. The rash was very painful and blisters were the size of small tomatoes, hence it was termed 'tomato flu'. A detailed literature review was performed on the virology, replication, epidemiology, and clinical features of this disease. The current outbreak was compared with similar other diseases of the past. The affected children exhibited severe rash in the palms, soles, oral cavity, and other body parts. They developed febrile illness with a sore throat, and myalgia followed by blisters on the tongue, gums, and cheeks. The affected children did not develop any complications leading to death. The therapy involved mainly symptomatic, supportive treatment with isolation and maintaining hygienic practices. The causative agent was identified to be Coxsackievirus A16, an RNA virus belonging to the family, Picornaviridae. We conclude that the recent Indian epidemic of this disease might be due to a new variant of Coxsackievirus A16 actually causing HFMD.
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Affiliation(s)
| | | | | | | | | | - Kannan Subbaram
- Corresponding author. School of Medicine, The Maldives National University, Male’, Maldives.
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Moltoni G, D'Arco F, Pasquini L, Carducci C, Bhatia A, Longo D, Kaliakatsos M, Lancella L, Romano A, Di Napoli A, Bozzao A, Rossi-Espagnet MC. Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child. Pediatr Radiol 2020; 50:1757-1767. [PMID: 32651625 DOI: 10.1007/s00247-020-04746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Non-congenital viral infections of the central nervous system in children can represent a severe clinical condition that needs a prompt diagnosis and management. However, the aetiological diagnosis can be challenging because symptoms are often nonspecific and cerebrospinal fluid analysis is not always diagnostic. In this context, neuroimaging represents a helpful tool, even though radiologic patterns sometimes overlap. The purpose of this pictorial essay is to suggest a schematic representation of different radiologic patterns of non-congenital viral encephalomyelitis based on the predominant viral tropism and vulnerability of specific regions: cortical grey matter, deep grey matter, white matter, brainstem, cerebellum and spine.
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Affiliation(s)
- Giulia Moltoni
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Felice D'Arco
- Neuroradiology Unit, Great Ormond Street Hospital, London, UK
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Chiara Carducci
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Aashim Bhatia
- Neuroradiology Unit, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Daniela Longo
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Marios Kaliakatsos
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Laura Lancella
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy.
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
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Carmo RLD, Alves Simão AK, Amaral LLFD, Inada BSY, Silveira CF, Campos CMDS, Freitas LF, Bonadio V, Marussi VHR. Neuroimaging of Emergent and Reemergent Infections. Radiographics 2020; 39:1649-1671. [PMID: 31589575 DOI: 10.1148/rg.2019190020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Infectious diseases emerge and reemerge over the years, and many of them can cause neurologic disease. Several factors contribute to the emergence and reemergence of these conditions, including human population growth, an increase in international travel, the geographic expansion of recognized pathogens to areas where they were previously nonendemic, and greater contact with wild animal reservoirs. The antivaccination social movement has played an important role in the reemergence of infectious diseases, especially some viral conditions. The authors review different viral (arboviruses such as dengue, chikungunya, and Zika virus; enterovirus 71; measles; and influenza), bacterial (syphilis, Lyme disease, and listeriosis), and parasitic (Chagas disease) diseases, focusing primarily on their neurologic complications. Although there are several additional infectious diseases with central nervous system manifestations that could be classified as emergent or reemergent, those listed here are the most relevant from an epidemiologic standpoint and are representative of important public health issues on all continents. The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified at CT and MRI, and radiology is central to the diagnosis and follow-up of such conditions. Given the increasing relevance of emerging and reemerging infections in clinical practice and public health scenarios, radiologists should be familiar with these infections. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Rafael Lourenço do Carmo
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Aylla Keiner Alves Simão
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Lázaro Luís Faria do Amaral
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Bruno Shigueo Yonekura Inada
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Camila Filardi Silveira
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | | | - Leonardo Furtado Freitas
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Victor Bonadio
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Victor Hugo Rocha Marussi
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
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Magnetic resonanse imaging as a prognostic tool in encephalitis in children. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10355-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We provide the data on the modern use of MRI of different modalities as a prognostic tool in the encephalitis diagnostics in pediatrics. According to the recent scientific knowledge, this implementation is possible, but its efficacy depends on the modality of MRI: structural, functional or MRI with contrast. Structural MRI efficacy in children with encephalitis is dubious and clearly depends on the etiology and phase of the inflammatory process. In the recent years, the implementation of the functional MRI methods (DTI MRS) and MRI with contrast significantly changed the imaging practice; there are some reports that these modalities of MRI are more effective as a prognostic tool in encephalitis than the structural one. Thus, a future research in this field is needed.
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MRI reveals segmental distribution of enterovirus lesions in the central nervous system: a probable clinical evidence of retrograde axonal transport of EV-A71. J Neurovirol 2019; 25:354-362. [DOI: 10.1007/s13365-019-00724-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
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Jones E, Pillay TD, Liu F, Luo L, Bazo-Alvarez JC, Yuan C, Zhao S, Chen Q, Li Y, Liao Q, Yu H, Rogier van Doorn H, Sabanathan S. Outcomes following severe hand foot and mouth disease: A systematic review and meta-analysis. Eur J Paediatr Neurol 2018; 22:763-773. [PMID: 29778429 PMCID: PMC6148319 DOI: 10.1016/j.ejpn.2018.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/23/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) is associated with acute neurological disease in children. This study aimed to estimate the burden of long-term sequelae and death following severe HFMD. METHODS This systematic review and meta-analysis pooled all reports from English and Chinese databases including MEDLINE and Wangfang on outbreaks of clinically diagnosed HFMD and/or laboratory-confirmed EV-A71 with at least 7 days' follow-up published between 1st January 1966 and 19th October 2015. Two independent reviewers assessed the literature. We used a random effects meta-analysis to estimate cumulative incidence of neurological sequelae or death. Studies were assessed for methodological and reporting quality. PROSPERO registration number: 10.15124/CRD42015021981. FINDINGS 43 studies were included in the review, and 599 children from 9 studies were included in the primary analysis. Estimated cumulative incidence of death or neurological sequelae at maximum follow up was 19.8% (95% CI:10.2%, 31.3%). Heterogeneity (Iˆ2) was 88.57%, partly accounted for by year of data collection and reporting quality of studies. Incidence by acute disease severity was 0.00% (0.00, 0.00) for grade IIa; 17.0% (7.9, 28.2) for grade IIb/III; 81.6% (65.1, 94.5) for grade IV (p = 0.00) disease. CONCLUSIONS HFMD with neurological involvement is associated with a substantial burden of long-term neurological sequelae. Grade of acute disease severity was a strong predictor of outcome. Strengths of this study include its bilingual approach and clinical applicability. Future prospective and interventional studies must use rigorous methodology to assess long-term outcomes in survivors. FUNDING There was no specific funding for this study. See below for researcher funding.
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Affiliation(s)
- Eben Jones
- University Hospital Lewisham, National Health Service, London, UK
| | - Timesh D Pillay
- University Hospital Lewisham, National Health Service, London, UK.
| | - Fengfeng Liu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Luo
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Carlos Bazo-Alvarez
- Methodology Research Group, Department of Primary Care and Population Health, University College London (UCL), London, UK
| | - Chen Yuan
- Zhoushan Center for Disease Control and Prevention, Zhoushan, Zhejiang, China
| | - Shanlu Zhao
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Qi Chen
- Hubei Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ha Noi, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Saraswathy Sabanathan
- Oxford University Clinical Research Unit, Ha Noi, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
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Machine Learning Algorithms for Risk Prediction of Severe Hand-Foot-Mouth Disease in Children. Sci Rep 2017; 7:5368. [PMID: 28710409 PMCID: PMC5511270 DOI: 10.1038/s41598-017-05505-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/06/2017] [Indexed: 11/08/2022] Open
Abstract
The identification of indicators for severe HFMD is critical for early prevention and control of the disease. With this goal in mind, 185 severe and 345 mild HFMD cases were assessed. Patient demographics, clinical features, MRI findings, and laboratory test results were collected. Gradient boosting tree (GBT) was then used to determine the relative importance (RI) and interaction effects of the variables. Results indicated that elevated white blood cell (WBC) count > 15 × 109/L (RI: 49.47, p < 0.001) was the top predictor of severe HFMD, followed by spinal cord involvement (RI: 26.62, p < 0.001), spinal nerve roots involvement (RI: 10.34, p < 0.001), hyperglycemia (RI: 3.40, p < 0.001), and brain or spinal meninges involvement (RI: 2.45, p = 0.003). Interactions between elevated WBC count and hyperglycemia (H statistic: 0.231, 95% CI: 0-0.262, p = 0.031), between spinal cord involvement and duration of fever ≥3 days (H statistic: 0.291, 95% CI: 0.035-0.326, p = 0.035), and between brainstem involvement and body temperature (H statistic: 0.313, 95% CI: 0-0.273, p = 0.017) were observed. Therefore, GBT is capable to identify the predictors for severe HFMD and their interaction effects, outperforming conventional regression methods.
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Neuroimaging of Infectious and Inflammatory Diseases of the Pediatric Cerebellum and Brainstem. Neuroimaging Clin N Am 2017; 26:471-87. [PMID: 27423804 DOI: 10.1016/j.nic.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cerebellar involvement by infectious-inflammatory conditions is rare in children. Most patients present with acute ataxia, and are typically previously healthy, young (often preschool) children. Viral involvement is the most common cause and ranges from acute postinfectious ataxia to acute cerebellitis MR imaging plays a crucial role in the evaluation of patients suspected of harboring inflammatory-infectious involvement of the cerebellum and brainstem. Knowledge of the imaging features of these disorders and technical competence on pediatric MR imaging are necessary for a correct interpretation of findings, which in turn prompts further management.
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Abdelgawad MS, El-Nekidy AEA, Abouyoussef RA, El-Fatary A. MRI findings of enteroviral encephalomyelitis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Qin Y, Lin L, Chen Y, Wu S, Si X, Wu H, Zhai X, Wang Y, Tong L, Pan B, Zhong X, Wang T, Zhao W, Zhong Z. Curcumin inhibits the replication of enterovirus 71 in vitro. Acta Pharm Sin B 2014; 4:284-94. [PMID: 26579397 PMCID: PMC4629085 DOI: 10.1016/j.apsb.2014.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/06/2014] [Accepted: 06/20/2014] [Indexed: 11/16/2022] Open
Abstract
Human enterovirus 71 (EV71) is the main causative pathogen of hand, foot, and mouth disease (HFMD) in children. The epidemic of HFMD has been a public health problem in Asia-Pacific region for decades, and no vaccine and effective antiviral medicine are available. Curcumin has been used as a traditional medicine for centuries to treat a diversity of disorders including viral infections. In this study, we demonstrated that curcumin showed potent antiviral effect again EV71. In Vero cells infected with EV71, the addition of curcumin significantly suppressed the synthesis of viral RNA, the expression of viral protein, and the overall production of viral progeny. Similar with the previous reports, curcumin reduced the production of ROS induced by viral infection. However, the antioxidant property of curcumin did not contribute to its antiviral activity, since N-acetyl-l-cysteine, the potent antioxidant failed to suppress viral replication. This study also showed that extracellular signal-regulated kinase (ERK) was activated by either viral infection or curcumin treatment, but the activated ERK did not interfere with the antiviral effect of curcumin, indicating ERK is not involved in the antiviral mechanism of curcumin. Unlike the previous reports that curcumin inhibited protein degradation through ubiquitin–proteasome system (UPS), we found that curcumin had no impact on UPS in control cells. However, curcumin did reduce the activity of proteasomes which was increased by viral infection. In addition, the accumulation of the short-lived proteins, p53 and p21, was increased by the treatment of curcumin in EV71-infected cells. We further probed the antiviral mechanism of curcumin by examining the expression of GBF1 and PI4KB, both of which are required for the formation of viral replication complex. We found that curcumin significantly reduced the level of both proteins. Moreover, the decreased expression of either GBF1 or PI4KB by the application of siRNAs was sufficient to suppress viral replication. We also demonstrated that curcumin showed anti-apoptotic activity at the early stage of viral infection. The results of this study provide solid evidence that curcumin has potent anti-EV71 activity. Whether or not the down-regulated GBF1 and PI4KB by curcumin contribute to its antiviral effect needs further studies.
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Key Words
- Apoptosis
- CVB, coxsackieviurs B
- Curcumin
- DCFH-DA, dichloro-dihydro-fluorescein diacetate
- ERK, extracellular signal-regulated kinase
- EV71, enterovirus 71
- Enterovirus 71
- GBF1
- GBF1, Golgi brefeldin A resistant guanine nucleotide exchange factor 1
- GEF, guanine nucleotide exchange factor
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HFMD, hand, foot, and mouth disease
- HIV, human immunodeficiency virus
- HPV, human papillomavirus
- NAC, N-acetyl-l-cysteine
- PARP-1, poly(ADP-ribose) polymerase
- PGC-1α, peroxisome proliferator-activated receptor-gamma co-activator 1 alpha
- PI4KB
- PI4KB, phosphatidylinositol 4-kinase class III catalytic subunit β
- PI4P, phosphatidylinositol 4-phosphate
- ROS, reactive oxygen species
- SLLVY-AMC, succinyl-Leu-Leu-Val-Tyr-7-amino-4-methylcoumarin
- UPS, ubiquitin–proteasome system
- Ubiquitin–proteasome system
- Viral replication
- p.i., post-infection
- siRNA, small interfering RNA
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