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Shi DM, Song L, Wang J. [Etiological diagnostic methods and research progress of forest encephalitis]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2024; 42:152-155. [PMID: 38403427 DOI: 10.3760/cma.j.cn121094-20230703-00227] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Forest encephalitis is a natural focal disease transmitted through the bite of hard ticks, and its pathogen is the tick-borne encephalitis virus from the Flaviviridae family. The mortality rate of forest encephalitis is relatively high, making laboratory testing significant in diagnosing this disease. This article elaborates on the etiological diagnostic methods and recent research progress in forest encephalitis. Laboratory tests for forest encephalitis mainly include routine examinations, serological tests, virus isolation, and molecular biological testing. The detection of serum-specific IgM antibodies against the forest encephalitis virus is of great importance for early diagnosis, and specific IgG antibodies serve as a "gold standard" for differentiation from other diseases. Techniques such as enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence assay for detecting specific IgM antibodies in serum and/or cerebrospinal fluid, the serum hemagglutination inhibition test or serum complement fixation test, and the double serum hemagglutination inhibition test or complement fixation test all contribute to the early diagnosis. The development of molecular testing methods is rapid, and techniques such as metabolomics, digital PCR, and matrix metalloproteinases are also applied in the early diagnosis of forest encephalitis.
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Affiliation(s)
- D M Shi
- Department of Occupational Poisoning, Heilongjiang Institute of Labor Hygiene and Occupational Diseases, Harbin 150028, China
| | - L Song
- Department of Occupational Poisoning, Heilongjiang Institute of Labor Hygiene and Occupational Diseases, Harbin 150028, China
| | - J Wang
- Department of Occupational Poisoning, Heilongjiang Institute of Labor Hygiene and Occupational Diseases, Harbin 150028, China
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Itihas A, Jategaonkar S, Jain M, Narang R, Chauhan V, Tandale BV, Tomar S. Comparison of Clinical Profile and Outcomes of Japanese Encephalitis and Acute Encephalitis Syndrome among Rural Children. Indian J Pediatr 2023; 90:1038-1040. [PMID: 36765003 DOI: 10.1007/s12098-022-04424-5] [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: 05/18/2022] [Accepted: 10/31/2022] [Indexed: 02/12/2023]
Abstract
The study compared the clinical profile and outcomes of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) in children. Fifty-six consecutive children with symptoms fulfilling the WHO clinical case definition of AES from June 2018 to June 2020 were included in the study. All patients who tested positive for either serum or cerebrospinal fluid (CSF) anti-JE-IgM antibodies were JE patients (n = 24) and compared with non-JE AES cases (n = 32). Fever, seizures, and altered sensorium were the most common presenting symptoms. Low GCS, status epilepticus, meningeal irritation, raised CSF protein, and INR > 1.5 of JE children showed significant association with mortality (p value < 0.05), whereas only low GCS showed significant association in non-JE AES cases. The JE-specific mortality rate was 29%, which was less than the mortality rate of non-JE AES children at 41%. Both JE and non-JE AES children had a similar clinical profile, but only the JE children's poor clinical and laboratory parameters were associated with adverse outcomes.
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Affiliation(s)
- Anup Itihas
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - Smita Jategaonkar
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - Manish Jain
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India.
| | - Rahul Narang
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Varsha Chauhan
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - B V Tandale
- ICMR-National Institute of Virology, Epidemiology Group, Pune, Maharashtra, India
| | - Shilpa Tomar
- ICMR-National Institute of Virology, Hepatitis Group, Pune, Maharashtra, India
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Gudowska-Sawczuk M, Mroczko B. Selected Biomarkers of Tick-Borne Encephalitis: A Review. Int J Mol Sci 2021; 22:ijms221910615. [PMID: 34638953 PMCID: PMC8509006 DOI: 10.3390/ijms221910615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022] Open
Abstract
Tick-borne encephalitis (TBE) is an acute disease caused by the tick-borne encephalitis virus. Due to the viral nature of the condition, there is no effective causal treatment for full-blown disease. Current and nonspecific TBE treatments only relieve symptoms. Unfortunately, the first phase of TBE is characterized by flu-like symptoms, making diagnosis difficult during this period. The second phase is referred to as the neurological phase as it involves structures in the central nervous system-most commonly the meninges and, in more severe cases, the brain and the spinal cord. Therefore, it is important that early markers of TBE that will guide clinical decision-making and the choice of treatment are established. In this review, we performed an extensive search of literature reports relevant to biomarkers associated with TBE using the MEDLINE/PubMed database. We observed that apart from routinely determined specific immunoglobulins, free light chains may also be useful in the evaluation of intrathecal synthesis in the central nervous system (CNS) during TBEV infection. Moreover, selected metalloproteinases, chemokines, or cytokines appear to play an important role in the pathogenesis of TBE as a consequence of inflammatory reactions and recruitment of white blood cells into the CNS. Furthermore, we reported promising findings on tau protein or Toll-like receptors. It was also observed that some people may be predisposed to TBE. Therefore, to understand the role of selected tick-borne encephalitis biomarkers, we categorized these factors and discussed their potential application in the diagnosis, prognosis, monitoring, or management of TBE.
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Affiliation(s)
- Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-269 Bialystok, Poland;
- Correspondence: ; Tel.: +48-85-831-8703
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-269 Bialystok, Poland;
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-269 Bialystok, Poland
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Li Y, Zhang Y, Tan B. What can cerebrospinal fluid testing and brain autopsies tell us about viral neuroinvasion of SARS-CoV-2. J Med Virol 2021; 93:4247-4257. [PMID: 33724490 PMCID: PMC8250680 DOI: 10.1002/jmv.26943] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/08/2023]
Abstract
To provide instructive clues for clinical practice and further research of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we analyzed the existing literature on viral neuroinvasion of SARS-CoV-2 in coronavirus disease 2019 (COVID-19) patients. To date, SARS-CoV-2 has been detected in the cerebrospinal fluid (CSF) or brain parenchyma in quite a few patients, which provide undeniable evidence for the neuroinvasive potential of this novel coronavirus. In contrast with the cerebrum and cerebellum, the detection rate of SARS-CoV-2 was higher in the olfactory system and the brainstem, both of which also showed severe microgliosis and lymphocytic infiltrations. As compared with the number of patients who underwent viral testing in the central nervous system (CNS), the number of patients showing positive results seems very small. However, it seems too early to conclude that the neuroinvasion of SARS-CoV-2 is rare in COVID-19 patients because the detection methods or sampling procedures in some studies may not be suitable or sufficient to reveal the CNS infection induced by neurotropic viruses. Moreover, the primary symptoms and/or causes of death were distinctly different among examined patients, which probably caused more conspicuous pathological changes than those due to the direct infection that usually localized to specific brain areas. Unfortunately, most autopsy studies did not provide sufficient details about neurological symptoms or suspected diagnoses of the examined patients, and the documentation of neuropathological changes was often incomplete. Given the complex pathophysiology of COVID-19 and the characteristics of neurotropic viruses, it is understandable that any study of the CNS infection may inevitably have limitations.
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Affiliation(s)
- Yan‐Chao Li
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of MedicineJilin UniversityChangchunJilinChina
| | - Yan Zhang
- School of life ScienceJilin UniversityJilin ProvinceChina
| | - Bai‐Hong Tan
- Laboratory Teaching Center of Basic MedicineNorman Bethune Health Science Center of Jilin UniversityJilin ProvinceChina
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Lu S, Wei N, Jiang J, Wu L, Sheng J, Zhou J, Fang Q, Chen Y, Zheng S, Chen F, Liang T, Hu S. First report of manic-like symptoms in a COVID-19 patient with no previous history of a psychiatric disorder. J Affect Disord 2020; 277:337-340. [PMID: 32858315 PMCID: PMC7439825 DOI: 10.1016/j.jad.2020.08.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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] [Received: 03/07/2020] [Revised: 06/04/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.
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Affiliation(s)
- Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Ning Wei
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Jiajun Jiang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Lingling Wu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Jifang Sheng
- Department of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianying Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Fang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yu Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shufa Zheng
- Department of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang, China.
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China.
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6
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Fan S, Yuan H, Liu L, Li H, Wang S, Zhao W, Wu Y, Wang P, Hu Y, Han J, Lyu Y, Zhang W, Chen P, Wu H, Gong Y, Ma Z, Li Y, Yu J, Qiao X, Li G, Zhao Y, Wang D, Ren H, Peng B, Cui L, Wang J, Guan H. Pseudorabies virus encephalitis in humans: a case series study. J Neurovirol 2020; 26:556-564. [PMID: 32572833 DOI: 10.1007/s13365-020-00855-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/21/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
Pseudorabies virus (PRV) is known to cause severe encephalitis in juvenile pigs and various non-native hosts; recent evidences suggest that PRV might cause encephalitis in humans. In a multicenter cohort study in China, next-generation sequencing of cerebrospinal fluid (CSF) was performed to detect pathogens in all patients with clinically suspected central nervous system infections. This study involved all the patients whose CSF samples were positive for PRV-DNA; their clinical features were evaluated, and species-specific PCR and serological tests were sequentially applied for validation. Among the 472 patients tested from June 1, 2016, to December 1, 2018, six were positive for PRV-DNA, which were partially validated by PCR and serological tests. Additionally, we retrospectively examined another case with similar clinical and neuroimaging appearance and detected the presence of PRV-DNA. These patients had similar clinical manifestations, including a rapid progression of panencephalitis, and similar neuroimaging features of symmetric lesions in the basal ganglia and bilateral hemispheres. Six of the patients were engaged in occupations connected with swine production. PRV infection should be suspected in patients with rapidly progressive panencephalitis and characteristic neuroimaging features, especially with exposure to swine.
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MESH Headings
- Adult
- Animals
- Antibodies, Viral/cerebrospinal fluid
- Basal Ganglia/diagnostic imaging
- Basal Ganglia/pathology
- Basal Ganglia/virology
- Cerebrum/diagnostic imaging
- Cerebrum/pathology
- Cerebrum/virology
- China
- DNA, Viral/cerebrospinal fluid
- DNA, Viral/genetics
- Encephalitis, Viral/cerebrospinal fluid
- Encephalitis, Viral/diagnosis
- Encephalitis, Viral/pathology
- Encephalitis, Viral/virology
- Female
- Herpesvirus 1, Suid/genetics
- Herpesvirus 1, Suid/growth & development
- Herpesvirus 1, Suid/pathogenicity
- High-Throughput Nucleotide Sequencing
- Humans
- Magnetic Resonance Imaging
- Male
- Meat/virology
- Middle Aged
- Polymerase Chain Reaction
- Pseudorabies/cerebrospinal fluid
- Pseudorabies/diagnosis
- Pseudorabies/pathology
- Pseudorabies/virology
- Swine
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Affiliation(s)
- Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hongxun Yuan
- Department of Intensive Care Unit, Peking University International Hospital, Beijing, China
| | - Lei Liu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Hongfang Li
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shengnan Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weili Zhao
- Department of Neurology, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Yihan Wu
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, China
| | - Pei Wang
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Yafang Hu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Han
- Key Laboratory of Animal Epidemiology of the Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yanli Lyu
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Wuchao Zhang
- Key Laboratory of Animal Epidemiology of the Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Peng Chen
- Key Laboratory of Animal Epidemiology of the Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Honglong Wu
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Yanping Gong
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Zhenzi Ma
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Yongjun Li
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - JiaoJiao Yu
- Department of Intensive Care Unit, Peking University International Hospital, Beijing, China
| | - Xiaodong Qiao
- Department of Neurology, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Guoli Li
- Department of Neurology, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Yan Zhao
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, China
| | - Dexin Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Andriuta D, Roger PA, Thibault W, Toublanc B, Sauzay C, Castelain S, Godefroy O, Brochot E. COVID-19 encephalopathy: detection of antibodies against SARS-CoV-2 in CSF. J Neurol 2020; 267:2810-2811. [PMID: 32529577 PMCID: PMC7288264 DOI: 10.1007/s00415-020-09975-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Daniela Andriuta
- Department of Neurology and Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Amiens University Medical Center and Jules Verne University of Picardy, 80054, Amiens, France.
| | - Pierre-Alexandre Roger
- Department of Respiratory Intensive Care Unit and Lung Diseases, Amiens University Medical Center and Jules Verne University of Piacardy, Amiens, France
| | - William Thibault
- Department of Neurology and Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Amiens University Medical Center and Jules Verne University of Picardy, 80054, Amiens, France
| | - Bénédicte Toublanc
- Department of Respiratory Intensive Care Unit and Lung Diseases, Amiens University Medical Center and Jules Verne University of Piacardy, Amiens, France
- Department of Pneumology, Amiens University Medical Center and INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - Chloe Sauzay
- Department of Biochemistry, Amiens University Medical Center, Amiens, France
- CHIMERE Unit, EA7516, Jules Verne University of Picardie, Amiens, France
| | - Sandrine Castelain
- Department of Virology, Amiens University Medical Center, Amiens, France
- AGIR Reaserch Unit ER4294, Jules Verne University of Picardie, Amiens, France
| | - Olivier Godefroy
- Department of Neurology and Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Amiens University Medical Center and Jules Verne University of Picardy, 80054, Amiens, France
| | - Etienne Brochot
- Department of Virology, Amiens University Medical Center, Amiens, France
- AGIR Reaserch Unit ER4294, Jules Verne University of Picardie, Amiens, France
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Liu W, Fu S, Ma X, Chen X, Wu D, Zhou L, Yin Q, Li F, He Y, Lei W, Li Y, Xu S, Wang H, Wang Z, Wang H, Yu H, Liang G. An outbreak of Japanese encephalitis caused by genotype Ib Japanese encephalitis virus in China, 2018: A laboratory and field investigation. PLoS Negl Trop Dis 2020; 14:e0008312. [PMID: 32453787 PMCID: PMC7274457 DOI: 10.1371/journal.pntd.0008312] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/05/2020] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
Although Japanese encephalitis virus genotype Ib (JEV GIb) has replaced JEV GIII as the dominant genotype in endemic areas of Asia, no JEV GIb has been isolated from JE cases and natural mosquitoes at the same time in an outbreak of JE. In this study, we conducted virological and molecular biological laboratory tests on JE case samples (serum/cerebrospinal fluid) and locally collected mosquito samples from the 2018 JE outbreak in Ningxia, China. The result of JEV IgM antibody detection showed that 96% (67/70) of the suspected cases were laboratory-confirmed JE cases. Of the mosquitoes collected from local environments, 70% (17400/24900) were Culex tritaeniorhynchus of which 4.6% (16 /348 of the pools tested) were positive for JEV, other mosquitoes were negative. JEVs isolated from both the human cases and C. tritaeniorhynchus specimens belong to JEV GIb and are in the same evolutionary clade according to molecular evolution analyses. JEV GIb was detected simultaneously from specimens of JE cases and mosquito samples collected in nature in this study, suggesting that the JE outbreak that occurred in Ningxia in 2018 was due to infection of JEV GIb. Japanese encephalitis virus (JEV) is recognized as an important encephalitis pathogen all over the world. Its genotype is divided into GI-V. In recent years, JEV GIb (a temperate genotype) has gradually replaced GIII as the prevalent strain in JE endemic areas. Although JEV GIb originated from tropical Asia along with JEV GIa, it has rapidly spread for its advantages in wintering and infecting vectors. Although there have been epidemics caused by JEV GI and GIII, there have been no reports of a JE outbreak caused by JEV GIb alone in northeastern Asia. However, a JE outbreak occurred in the Ningxia Hui Autonomous Region in northern China in summer 2018 which was the first outbreak in Ningxia in recent decades. This paper presents a series of laboratory and field studies of this outbreak. The strain isolated from JE cases as well as JEV detected in Culex tritaeniorhynchus collected from local areas in nature all belonged to JEV GIb and were in the same evolutionary clade. This is the first report of a JE outbreak caused by JEV GIb infection in northeastern Asia (latitude 35 ° 14’– 39 ° 23’ N, longitude 104 ° 17’– 107 ° 39’ E), which used to be a low endemic area of JEV GIII.
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Affiliation(s)
- Wenjing Liu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao, People’s Republic of China
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Shihong Fu
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xuemin Ma
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, People’s Republic of China
| | - Xiaojing Chen
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, People’s Republic of China
| | - Dan Wu
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Liwei Zhou
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, People’s Republic of China
| | - Qikai Yin
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Fan Li
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Ying He
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Wenwen Lei
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yixing Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Songtao Xu
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Huaqing Wang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhenhai Wang
- Center for Neurology, General Hospital of Ningxia Medical University, Ningxia, People’s Republic of China
| | - Huanyu Wang
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- * E-mail: (HYW); (HY); (GDL)
| | - Hong Yu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao, People’s Republic of China
- * E-mail: (HYW); (HY); (GDL)
| | - Guodong Liang
- Department of Arbovirus, NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- * E-mail: (HYW); (HY); (GDL)
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9
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Mishra N, Ng TFF, Marine RL, Jain K, Ng J, Thakkar R, Caciula A, Price A, Garcia JA, Burns JC, Thakur KT, Hetzler KL, Routh JA, Konopka-Anstadt JL, Nix WA, Tokarz R, Briese T, Oberste MS, Lipkin WI. Antibodies to Enteroviruses in Cerebrospinal Fluid of Patients with Acute Flaccid Myelitis. mBio 2019; 10:e01903-19. [PMID: 31409689 PMCID: PMC6692520 DOI: 10.1128/mbio.01903-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/05/2023] Open
Abstract
Acute flaccid myelitis (AFM) has caused motor paralysis in >560 children in the United States since 2014. The temporal association of enterovirus (EV) outbreaks with increases in AFM cases and reports of fever, respiratory, or gastrointestinal illness prior to AFM in >90% of cases suggest a role for infectious agents. Cerebrospinal fluid (CSF) from 14 AFM and 5 non-AFM patients with central nervous system (CNS) diseases in 2018 were investigated by viral-capture high-throughput sequencing (VirCapSeq-VERT system). These CSF and serum samples, as well as multiple controls, were tested for antibodies to human EVs using peptide microarrays. EV RNA was confirmed in CSF from only 1 adult AFM case and 1 non-AFM case. In contrast, antibodies to EV peptides were present in CSF of 11 of 14 AFM patients (79%), significantly higher than controls, including non-AFM patients (1/5 [20%]), children with Kawasaki disease (0/10), and adults with non-AFM CNS diseases (2/11 [18%]) (P = 0.023, 0.0001, and 0.0028, respectively). Six of 14 CSF samples (43%) and 8 of 11 sera (73%) from AFM patients were immunoreactive to an EV-D68-specific peptide, whereas the three control groups were not immunoreactive in either CSF (0/5, 0/10, and 0/11; P = 0.008, 0.0003, and 0.035, respectively) or sera (0/2, 0/8, and 0/5; P = 0.139, 0.002, and 0.009, respectively).IMPORTANCE The presence in cerebrospinal fluid of antibodies to EV peptides at higher levels than non-AFM controls supports the plausibility of a link between EV infection and AFM that warrants further investigation and has the potential to lead to strategies for diagnosis and prevention of disease.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Antibodies, Viral/immunology
- Antigens, Viral/immunology
- Central Nervous System Viral Diseases/blood
- Central Nervous System Viral Diseases/cerebrospinal fluid
- Child
- Enterovirus D, Human/genetics
- Enterovirus D, Human/immunology
- Enterovirus D, Human/isolation & purification
- Enterovirus Infections/blood
- Enterovirus Infections/cerebrospinal fluid
- Female
- High-Throughput Nucleotide Sequencing
- Humans
- Male
- Middle Aged
- Myelitis/blood
- Myelitis/cerebrospinal fluid
- Neuromuscular Diseases/blood
- Neuromuscular Diseases/cerebrospinal fluid
- Protein Array Analysis
- RNA, Viral/blood
- RNA, Viral/cerebrospinal fluid
- RNA, Viral/genetics
- Young Adult
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Affiliation(s)
- Nischay Mishra
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komal Jain
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - James Ng
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Riddhi Thakkar
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adrian Caciula
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adam Price
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joel A Garcia
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia Irving University Medical Center, New York, New York, USA
| | - Kimbell L Hetzler
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janell A Routh
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rafal Tokarz
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Thomas Briese
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
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10
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Garg RK, Kumar N, Rizvi I, Jain A, Jaipuriar RS, Sharma PK, Malhotra HS, Nasar Khan D, Uniyal R. Case Report: Subacute Sclerosing Panencephalitis Presenting as Acute Encephalitis. Am J Trop Med Hyg 2019; 101:260-262. [PMID: 31134883 PMCID: PMC6609179 DOI: 10.4269/ajtmh.19-0215] [Citation(s) in RCA: 2] [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: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 08/30/2023] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is still a common disease in India which is characterized by a progressive mental decline, myoclonus, periodic encephalographic abnormalities, and raised anti-measles antibody titter in the cerebrospinal fluid. Acute fulminant SSPE is characterized by a rapid course of disease culminating in death, within 6 months. We report of a 10-year-old boy, who came with a 14-day history of continuous involuntary jerky movements of the left half of the body, including the head. There was a highly increased anti-measles IgG antibody titer, both in the cerebrospinal fluid and serum. We conclude that acute rapidly progressive SSPE can present as acute encephalitis syndrome.
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Affiliation(s)
| | - Neeraj Kumar
- Department of Neurology, King George’s Medical University, Lucknow, India
| | - Imran Rizvi
- Department of Neurology, King George’s Medical University, Lucknow, India
| | - Amita Jain
- Department of Microbiology, King George’s Medical University, Lucknow, India
| | | | | | | | - Danish Nasar Khan
- Department of Microbiology, King George’s Medical University, Lucknow, India
| | - Ravi Uniyal
- Department of Neurology, King George’s Medical University, Lucknow, India
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11
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Rizvi I, Garg RK, Jain A, Malhotra HS, Kumar N, Uniyal R. Teaching Video NeuroImages: An unusual case of fulminant subacute sclerosing panencephalitis. Neurology 2019; 92:e1270. [PMID: 30858250 DOI: 10.1212/wnl.0000000000007103] [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: 06/09/2023] Open
Affiliation(s)
- Imran Rizvi
- From the Department of Neurology, King George's Medical University, Lucknow, India.
| | - Ravindra Kumar Garg
- From the Department of Neurology, King George's Medical University, Lucknow, India
| | - Amita Jain
- From the Department of Neurology, King George's Medical University, Lucknow, India
| | | | - Neeraj Kumar
- From the Department of Neurology, King George's Medical University, Lucknow, India
| | - Ravi Uniyal
- From the Department of Neurology, King George's Medical University, Lucknow, India
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12
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Damodar T, Mani RS, Prathyusha PV. Utility of rabies neutralizing antibody detection in cerebrospinal fluid and serum for ante-mortem diagnosis of human rabies. PLoS Negl Trop Dis 2019; 13:e0007128. [PMID: 30695032 PMCID: PMC6368332 DOI: 10.1371/journal.pntd.0007128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/08/2019] [Accepted: 01/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background Early ante-mortem laboratory confirmation of human rabies is essential to aid patient management and institute public health measures. Few studies have highlighted the diagnostic value of antibody detection in CSF/serum in rabies, and its utility is usually undermined owing to the late seroconversion and short survival in infected patients. This study was undertaken to examine the ante-mortem diagnostic utility and prognostic value of antibody detection by rapid fluorescent focus inhibition test (RFFIT) in cerebrospinal fluid (CSF)/serum samples received from clinically suspected human rabies cases from January 2015 to December 2017. Methodology/Principal findings Samples collected ante-mortem and post-mortem from 130 and 6 patients with clinically suspected rabies respectively, were received in the laboratory during the study period. Ante-mortem laboratory confirmation was achieved in 55/130 (42.3%) cases. Real time PCR for detection of viral nucleic acid performed on saliva, nuchal skin, brain tissue and CSF samples could confirm the diagnosis in 15 (27.2%) of the 55 laboratory confirmed cases. Ante-mortem diagnosis could be achieved by RFFIT (in CSF and/or serum) in 45 (34.6%) of the 130 clinically suspected cases, accounting for 81.8% of the total 55 laboratory confirmed cases. The sensitivity of CSF RFFIT increased with the day of sample collection (post-onset of symptoms) and was found to be 100% after 12 days of illness. Patients who had received prior vaccination had an increased probability of a positive RFFIT and negative PCR result. Patients who were positive by RFFIT alone at initial diagnosis had longer survival (albeit with neurological sequelae) than patients who were positive by PCR alone or both RFFIT and PCR. Conclusions/Significance Detection of antibodies in the CSF/serum is a valuable ante-mortem diagnostic tool in human rabies, especially in patients who survive beyond a week. It was also found to have a limited role as a prognostic marker to predict outcomes in patients. Ante-mortem diagnosis of human rabies is essential for patient management and public health measures. The detection of virus specific antibodies in the CSF/serum of patients with suspected rabies is thought to have a limited diagnostic role owing to late seroconversion and short survival in rabies. We examined the diagnostic and prognostic utility of antibody detection by rapid fluorescent focus inhibition test (RFFIT) in CSF/serum samples received from clinically suspected human rabies cases (2015–2017). RFFIT (in CSF and/or serum) could confirm ante-mortem diagnosis in 45 (34.6%) of the 130 clinically suspected cases, accounting for 81.8% of the total 55 laboratory confirmed cases. The sensitivity of CSF RFFIT increased with the day of sample collection (post-onset of symptoms) and was found to be 100% after 12 days of illness. Patients who had received prior vaccination had an increased likelihood of a positive RFFIT and negative PCR result. Patients who were positive by RFFIT alone at initial diagnosis had longer duration of survival, although with poor functional outcomes. Antibody detection by RFFIT in CSF/serum was found to have a diagnostic utility especially in patients who survived beyond a week and a limited prognostic role in human rabies.
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Affiliation(s)
- Tina Damodar
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Reeta S. Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- * E-mail:
| | - P. V. Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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13
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Dyachenko PA. Varicella-zoster virus cns disease clinical features in ukrainian patients. prospective study. Wiad Lek 2019; 72:1765-1768. [PMID: 31622263] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Introduction: Herpes zoster (HZ), or shingles, is localized disease characterized by unilateral radicular pain and a vesicular rash limited to the area of skin innervated by a single dorsal root or cranial sensory ganglion. Whereas varicella, or chickenpox, results from primary exogenous varicella-zoster virus (VZV) infection, HZ is caused by reactivation of endogenous VZV that has persisted in latent form within sensory ganglia following an earlier episode of chickenpox. The aim: To explore the clinical features, diagnosis, and treatment of CNS injury caused by VZV infection in a prospective single center study from January 2014 to January 2018. PATIENTS AND METHODS Materials and methods: 117 adult patients, among which young women predominated with confirmed VZV infection were analyzed in the study. CSF and blood contents, antibody for herpes zoster M and G classes, and MRI scans have been studied, but the crucial diagnostic sign was the presence of specific viral DNA in the CSF or blood. The main clinical manifestations of the disease were ganglionitis and ganglioradiculoneuritis. Another brain lesion like uveitis, encephalitis and vasculitis were observed also. A clinical case of an unusual course of VZV-infection is given. RESULTS Results and conclusions: The most common clinical variants of HZ were ganglionitis (69.7%). Cranial localization was observed in 31% of patients, spinal one - in 38.7%, injury to the meninges was found in 16.3% of patients.
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Affiliation(s)
- Pavel A Dyachenko
- Center of Infectious Disorders of the Nervous System, Si "L.V. Gromashevsky Institute of Epidemiology and Infection Diseases of Nams of Ukraine", KYIV, UKRAINE
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14
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Realegeno S, Niezgoda M, Yager PA, Kumar A, Hoque L, Orciari L, Sambhara S, Olson VA, Satheshkumar PS. An ELISA-based method for detection of rabies virus nucleoprotein-specific antibodies in human antemortem samples. PLoS One 2018; 13:e0207009. [PMID: 30403742 PMCID: PMC6221316 DOI: 10.1371/journal.pone.0207009] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022] Open
Abstract
Rabies is a fatal encephalitic disease in humans and animals caused by lyssaviruses, most commonly rabies virus (RABV). Human antemortem diagnosis of rabies is a complex process involving multiple sample types and tests for the detection of antibodies, antigen (protein), and nucleic acids (genomic RNA). Serological diagnosis of human rabies includes the detection of either neutralizing or binding antibodies in the cerebrospinal fluid (CSF) or serum samples from unimmunized individuals without prior rabies vaccination or passive immunization with purified immunoglobulins. While neutralizing antibodies are targeted against the surface-expressed glycoprotein (G protein), binding antibodies to viral antigens are predominantly against the nucleoprotein (N protein), although there can be antibodies against all RABV-expressed proteins. To determine N protein-specific antibody responses in the CSF and serum during RABV infection, we developed an enzyme-linked immunosorbent assay (ELISA) with purified recombinant N protein expressed in E. coli. N protein-specific immunoglobulin (Ig) subtypes IgG and IgM were detected in the CSF or serum of previously diagnosed human rabies cases. In addition, anti-N protein seroconversion was demonstrated over the course of illness in individual rabies cases. We compared the N protein ELISA results to those of an indirect fluorescent antibody (IFA) test, the current binding antibody assay used in diagnosis, and show that our ELISA is consistent with the IFA test. Sensitivity and specificity of the N protein ELISA ranged from 78.38-100% and 75.76-96.77% with respect to the IFA results. Our data provide evidence for the use of an N protein ELISA as an additional option for the detection of RABV-specific IgG or IgM antibodies in human CSF or serum specimens.
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Affiliation(s)
- Susan Realegeno
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael Niezgoda
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pamela A. Yager
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amrita Kumar
- Immunology and Pathogenesis Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laboni Hoque
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lillian Orciari
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Suryaprakash Sambhara
- Immunology and Pathogenesis Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria A. Olson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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15
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Motte J, Kneiphof J, Straßburger-Krogias K, Klasing A, Adams O, Haghikia A, Gold R. Detection of JC virus archetype in cerebrospinal fluid in a MS patient with dimethylfumarate treatment without lymphopenia or signs of PML. J Neurol 2018; 265:1880-1882. [PMID: 29948248 DOI: 10.1007/s00415-018-8931-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Abstract
We report a 76-year-old MS patient, treated with DMF for 3 years. Lymphocytes never showed values below 1240/µl. CSF analysis revealed 1,988,880 copies/ml of JCV-DNA, JCV-DNA was detectable in serum and anti-JCV-antibody in CSF and serum were highly positive. Stratify®-JCV-test was positive. CD8-positive T-lymphocytes were reduced. Therapy with mefloquine, mirtazapine and cidofovir resulted in complete elimination of the virus in serum and 90% reduction of viral load in CSF. This case shows that despite careful monitoring for lymphopenia JCV spreading to the CSF may occur during treatment with DMF.
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Affiliation(s)
- Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Janina Kneiphof
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Katrin Straßburger-Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Anja Klasing
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Ortwin Adams
- Institute for Virology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Aiden Haghikia
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
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16
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Abstract
A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/μl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T1-weighted imaging) revealed enhancement of the vessel walls at the stenotic lesions. Based on the diagnosis of VZV vasculopathy, methylprednisolone and valacicrovir were administered, followed by acyclovir, in addition to antithrombotic therapy using aspirin and warfarin. After these treatment, her right upper clumsiness was resolved and gadolinium-enhancement of the vessel walls was disappeared on MRI. VZV vasculopathy may cause ischemic stroke in young patients, especially in children. A careful history-taking about herpes is necessary to detect the disease as a potential cause in young stroke patients.
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Affiliation(s)
| | - Seigo Shindo
- Department of Neurology, Kumamoto Red Cross Hospital
| | - Kuniyasu Wada
- Department of Neurology, Kumamoto Red Cross Hospital
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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17
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Abstract
Incidence of neurologic manifestations associated with Zika virus infection has been increasing. In 2016, neuropsychological and cognitive changes developed in an adolescent after travel to a Zika virus–endemic area. Single-photon emission computed tomography and neuropsychological testing raised the possibility that Zika virus infection may lead to neuropsychiatric and cognitive symptoms.
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18
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Del Campo M, Feitosa IML, Ribeiro EM, Horovitz DDG, Pessoa ALS, França GVA, García-Alix A, Doriqui MJR, Wanderley HYC, Sanseverino MVT, Neri JICF, Pina-Neto JM, Santos ES, Verçosa I, Cernach MCSP, Medeiros PFV, Kerbage SC, Silva AA, van der Linden V, Martelli CMT, Cordeiro MT, Dhalia R, Vianna FSL, Victora CG, Cavalcanti DP, Schuler-Faccini L. The phenotypic spectrum of congenital Zika syndrome. Am J Med Genet A 2017; 173:841-857. [PMID: 28328129 DOI: 10.1002/ajmg.a.38170] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 12/24/2022]
Abstract
In October 2015, Zika virus (ZIKV) outbreak the Brazilian Ministry of Health (MoH). In response, the Brazilian Society of Medical Genetics established a task force (SBGM-ZETF) to study the phenotype of infants born with microcephaly due to ZIKV congenital infection and delineate the phenotypic spectrum of this newly recognized teratogen. This study was based on the clinical evaluation and neuroimaging of 83 infants born during the period from July, 2015 to March, 2016 and registered by the SBGM-ZETF. All 83 infants had significant findings on neuroimaging consistent with ZIKV congenital infection and 12 had confirmed ZIKV IgM in CSF. A recognizable phenotype of microcephaly, anomalies of the shape of skull and redundancy of the scalp consistent with the Fetal Brain Disruption Sequence (FBDS) was present in 70% of infants, but was most often subtle. In addition, features consistent with fetal immobility, ranging from dimples (30.1%), distal hand/finger contractures (20.5%), and feet malpositions (15.7%), to generalized arthrogryposis (9.6%), were present in these infants. Some cases had milder microcephaly or even a normal head circumference (HC), and other less distinctive findings. The detailed observation of the dysmorphic and neurologic features in these infants provides insight into the mechanisms and timings of the brain disruption and the sequence of developmental anomalies that may occur after prenatal infection by the ZIKV.
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Affiliation(s)
- Miguel Del Campo
- Division of Dysmorphology and Teratology, Department of Pediatrics, UCSD, San Diego, California
| | - Ian M L Feitosa
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Medicina Clínica, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Dafne D G Horovitz
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Alfredo García-Alix
- Institut de Recerca Pediàtrica Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Maria V T Sanseverino
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - João M Pina-Neto
- Faculdade de Medicina de Ribeirao Preto, Departamento de Genetica, Universidade de Sao Paolo, Ribeirao Preto, Brazil
| | | | - Islane Verçosa
- Centro de Aperfeiçoamento Visual Ver a Esperança Renascer/CAVIVER, Fortaleza, Brazil
| | - Mirlene C S P Cernach
- Departamento de Genetica Medica, Universidade Federal de Sao Paolo (UNIFESP), Sao Paolo, Brazil
| | | | | | - André A Silva
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- UNIVATES University, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Marli T Cordeiro
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Rafael Dhalia
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Fernanda S L Vianna
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cesar G Victora
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Denise P Cavalcanti
- Departamento de Genetica Medica, Universidade de Campinas UNICAMP, Campinas, Brazil
| | - Lavinia Schuler-Faccini
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Potiguar, Natal, Brazil
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19
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Parra B, Lizarazo J, Jiménez-Arango JA, Zea-Vera AF, González-Manrique G, Vargas J, Angarita JA, Zuñiga G, Lopez-Gonzalez R, Beltran CL, Rizcala KH, Morales MT, Pacheco O, Ospina ML, Kumar A, Cornblath DR, Muñoz LS, Osorio L, Barreras P, Pardo CA. Guillain-Barré Syndrome Associated with Zika Virus Infection in Colombia. N Engl J Med 2016; 375:1513-1523. [PMID: 27705091 DOI: 10.1056/nejmoa1605564] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [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: 11/19/2022]
Abstract
BACKGROUND Zika virus (ZIKV) infection has been linked to the Guillain-Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain-Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain-Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection. METHODS A total of 68 patients with the Guillain-Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays. RESULTS A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain-Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain-Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain-Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain-Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain-Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain-Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR. CONCLUSIONS The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain-Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain-Barré syndrome. (Funded by the Bart McLean Fund for Neuroimmunology Research and others.).
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Affiliation(s)
- Beatriz Parra
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jairo Lizarazo
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jorge A Jiménez-Arango
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Andrés F Zea-Vera
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Guillermo González-Manrique
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - José Vargas
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jorge A Angarita
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Gonzalo Zuñiga
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Reydmar Lopez-Gonzalez
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Cindy L Beltran
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Karen H Rizcala
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Maria T Morales
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Oscar Pacheco
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Martha L Ospina
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Anupama Kumar
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - David R Cornblath
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Laura S Muñoz
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Lyda Osorio
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Paula Barreras
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Carlos A Pardo
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
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Di Guardo G. Zika virus: issues of concern. New Microbiol 2016; 39:317. [PMID: 27551728] [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] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 06/06/2023]
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Piantadosi A, Rubin DB, McQuillen DP, Hsu L, Lederer PA, Ashbaugh CD, Duffalo C, Duncan R, Thon J, Bhattacharyya S, Basgoz N, Feske SK, Lyons JL. Emerging Cases of Powassan Virus Encephalitis in New England: Clinical Presentation, Imaging, and Review of the Literature. Clin Infect Dis 2016; 62:707-713. [PMID: 26668338 PMCID: PMC4850925 DOI: 10.1093/cid/civ1005] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [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: 08/29/2015] [Accepted: 11/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Powassan virus (POWV) is a rarely diagnosed cause of encephalitis in the United States. In the Northeast, it is transmitted by Ixodes scapularis, the same vector that transmits Lyme disease. The prevalence of POWV among animal hosts and vectors has been increasing. We present 8 cases of POWV encephalitis from Massachusetts and New Hampshire in 2013-2015. METHODS We abstracted clinical and epidemiological information for patients with POWV encephalitis diagnosed at 2 hospitals in Massachusetts from 2013 to 2015. We compared their brain imaging with those in published findings from Powassan and other viral encephalitides. RESULTS The patients ranged in age from 21 to 82 years, were, for the most part, previously healthy, and presented with syndromes of fever, headache, and altered consciousness. Infections occurred from May to September and were often associated with known tick exposures. In all patients, cerebrospinal fluid analyses showed pleocytosis with elevated protein. In 7 of 8 patients, brain magnetic resonance imaging demonstrated deep foci of increased T2/fluid-attenuation inversion recovery signal intensity. CONCLUSIONS We describe 8 cases of POWV encephalitis in Massachusetts and New Hampshire in 2013-2015. Prior to this, there had been only 2 cases of POWV encephalitis identified in Massachusetts. These cases may represent emergence of this virus in a region where its vector, I. scapularis, is known to be prevalent or may represent the emerging diagnosis of an underappreciated pathogen. We recommend testing for POWV in patients who present with encephalitis in the spring to fall in New England.
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MESH Headings
- Acyclovir/therapeutic use
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Viral/cerebrospinal fluid
- Antiviral Agents/therapeutic use
- Brain/diagnostic imaging
- Brain/pathology
- Brain/virology
- Encephalitis Viruses, Tick-Borne/drug effects
- Encephalitis Viruses, Tick-Borne/immunology
- Encephalitis Viruses, Tick-Borne/pathogenicity
- Encephalitis, Tick-Borne/diagnosis
- Encephalitis, Tick-Borne/diagnostic imaging
- Encephalitis, Tick-Borne/epidemiology
- Encephalitis, Tick-Borne/virology
- Female
- Flavivirus/drug effects
- Flavivirus/immunology
- Flavivirus/pathogenicity
- Humans
- Ixodes/virology
- Magnetic Resonance Imaging
- Male
- Massachusetts/epidemiology
- Meningitis, Bacterial/drug therapy
- Middle Aged
- New Hampshire/epidemiology
- Prevalence
- Seasons
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Anne Piantadosi
- Division of Infectious Disease, Massachusetts General Hospital
| | - Daniel B Rubin
- Department of Neurology, Brigham and Women's Hospital, Boston
| | - Daniel P McQuillen
- Department of Infectious Diseases, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington
| | | | | | - Cameron D Ashbaugh
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chad Duffalo
- Christiana Care Health System, Division of Infectious Diseases, Newark, Delaware
| | - Robert Duncan
- Department of Infectious Diseases, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington
| | - Jesse Thon
- Department of Neurology, Brigham and Women's Hospital, Boston
| | | | - Nesli Basgoz
- Division of Infectious Disease, Massachusetts General Hospital
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Boston
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Sherwood JA, Brittain DC, Howard JJ, Oliver J. Antibody and Viral Nucleic Acid Testing of Serum and Cerebrospinal Fluid for Diagnosis of Eastern Equine Encephalitis. J Clin Microbiol 2015; 53:2768-72. [PMID: 26063852 PMCID: PMC4508444 DOI: 10.1128/jcm.00647-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/09/2015] [Accepted: 05/26/2015] [Indexed: 11/20/2022] Open
Abstract
Eastern equine encephalitis diagnostic serum antibody can appear 6 days after the onset of symptoms, and its numbers can increase 4-fold in 4 days, arguing for early and frequent serum testing. In populations where cerebrospinal fluid viral nucleic acid testing sensitivity and specificity remain undetermined, cerebrospinal antibody testing should also be performed.
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Affiliation(s)
- James A Sherwood
- Department of Health of the State of New York, Syracuse, New York, USA
| | - David C Brittain
- Department of Health of the State of New York, Syracuse, New York, USA
| | - John J Howard
- Department of Health of the State of New York, Syracuse, New York, USA
| | - JoAnne Oliver
- Department of Health of the State of New York, Syracuse, New York, USA
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Kamila ŻW, Teresa R, Patrycja MG, Andrzej S. Neurological presentation of hemophagocytic lymphohistiocytosis. Neurol Neurochir Pol 2015; 49:329-31. [PMID: 26377985 DOI: 10.1016/j.pjnns.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/26/2015] [Accepted: 07/03/2015] [Indexed: 11/19/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory disorder arising from defects in critical regulatory pathways responsible for termination of inflammatory response. We are presenting a case report of a 20-year-old male, admitted to the Department of Neurology because of left lower limb weakness and balance disturbances. After a few days of hospitalization, fever occurred. Laboratory tests revealed anemia, neutropenia, lymphopenia, and thrombocytopenia. The clinical course and laboratory tests results confirmed the diagnosis of HLH. In our opinion, the disorder in the presented case occurred due to severe chronic active Epstein-Barr virus infection syndrome. We are presenting the case of pure neurological onset of hemophagocytic lymphohistiocytosis in an adult patient. Hemophagocytic lymphohistiocytosis, initially presenting with neurological symptoms, can occur in adult patients with irrelevant family history. It is a life-threatening but potentially curable condition requiring proper diagnostic and treatment management.
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Affiliation(s)
| | - Rog Teresa
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Szczudlik Andrzej
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Hoffmann B, Tappe D, Höper D, Herden C, Boldt A, Mawrin C, Niederstraßer O, Müller T, Jenckel M, van der Grinten E, Lutter C, Abendroth B, Teifke JP, Cadar D, Schmidt-Chanasit J, Ulrich RG, Beer M. A Variegated Squirrel Bornavirus Associated with Fatal Human Encephalitis. N Engl J Med 2015; 373:154-62. [PMID: 26154788 DOI: 10.1056/nejmoa1415627] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [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: 01/23/2023]
Abstract
Between 2011 and 2013, three breeders of variegated squirrels (Sciurus variegatoides) had encephalitis with similar clinical signs and died 2 to 4 months after onset of the clinical symptoms. With the use of a metagenomic approach that incorporated next-generation sequencing and real-time reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR), the presence of a previously unknown bornavirus was detected in a contact squirrel and in brain samples from the three patients. Phylogenetic analyses showed that this virus, tentatively named variegated squirrel 1 bornavirus (VSBV-1), forms a lineage separate from that of the known bornavirus species. (Funded by the Federal Ministry of Food and Agriculture [Germany] and others.).
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Affiliation(s)
- Bernd Hoffmann
- From the Institute of Diagnostic Virology (B.H., D.H., M.J., B.A., M.B.), Department of Experimental Animal Facilities and Biorisk Management (J.P.T.), and Institute of Novel and Emerging Infectious Diseases (R.G.U.), Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg (D.T., D.C., J.S.-C.), German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel (D.T., D.C., J.S.-C.), Institute of Veterinary Pathology, Justus-Liebig-University Gießen, Gießen (C.H.), Department of Neurology, Bergmannstrost Hospital (A.B., O.N.), and Department of Neurology, University Hospital Halle (Saale) (T.M.), Halle (Saale), Institute of Neuropathology, Otto-von-Guericke Universität, Magdeburg (C.M.), State Institute for Consumer Protection of Saxony-Anhalt, Department of Veterinary Medicine, Stendal (E.v.d.G.), and Special Service for Veterinarian Affairs and Consumer Protection, Salzlandkreis, Bernburg (Saale) (C.L.) - all in Germany
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Abstract
BACKGROUND A West Nile (WN) fever epidemic occurred in the region of Monastir, Tunisia, between August and October 2003. AIM OF THE STUDY We attempt to describe the epidemiology, clinical presentation, and outcome of patients with confirmed West Nile virus (WNV) infection. METHODS Three groups of specimens were prepared. One was made up of serum only (n = 43), the other of cerebrospinal fluid (CSF) only (n = 30), and the third group was made up of both (n = 40). These specimens were obtained from 113 patients. A serological diagnosis and evidence of WNV genome by nested reverse-transcriptase polymerase chain reaction (nRT-PCR) and TaqMan reverse transcription-polymerase chain reaction (RT-PCR) were carried out. RESULTS Thirty-eight cases (33.6%) were serologically positive. Results of nRT-PCR showed a total of 10 positive cases of WNV (8.8%) detected in group 1 (n = 1/43), group 2 (n = 5/30), and group 3 (n = 4/40) whereas the PCR TaqMan showed 18 positive samples (15.9%) found in group 1 (n = 3/43), group 2 (n = 9/30), and group 3 (n = 6/40). All TaqMan PCR positive cases were nRT-PCR positive. In addition, four serologically probable cases were confirmed by TaqMan PCR. The attempts to isolate WNV by cell culture were unsuccessful. Considering the results of TaqMan assay and the serological diagnosis, WNV infection was confirmed in a total of 42 patients. The main clinical presentations were meningoencephalitis (40%), febrile disease (95%), and meningitis (36%). Eight patients (19%) died. The highest case-fatality rates occurred among patients aged ≧55 years. The phylogenetic analysis revealed that isolates of WNV were closely related to the Tunisian strain 1997 (PAH001) and the Israeli one (Is-98). CONCLUSIONS West Nile virus is a reemerging global pathogen that remains an important public health challenge in the next decade.
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Abstract
PURPOSE OF REVIEW Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis, and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes, and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed. RECENT FINDINGS After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephalitis, myelitis, and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in cerebrospinal fluid and treated with intravenous acyclovir. SUMMARY Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.
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Affiliation(s)
- Maria A. Nagel
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045
| | - Don Gilden
- Department of Neurology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, Tel: 303-724-7326 Fax: 303-724-4329
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Jinnai A, Kikuchi T, Ishikawa M, Nishimura Y, Shibata K, Sakura H. [A case of rubella encephalitis presenting as clinically mild encephalitis/encephalopathy with a reversible splenial lesion]. Rinsho Shinkeigaku 2014; 54:668-670. [PMID: 25142541 DOI: 10.5692/clinicalneurol.54.668] [Citation(s) in RCA: 4] [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] [Indexed: 06/03/2023]
Abstract
A 26-year-old male was admitted because of a fever, headache and disturbance of consciousness with lymph node swelling of the neck two days after developing a rash. A neurological examination revealed restlessness with irritability in response to sensory stimuli, such as an injection. Diffusion-weighted brain magnetic resonance imaging (MRI) revealed a hyperintense ovoid lesion in the splenium of the corpus callosum, which showed a low coefficient in the ADC map: the lesion disappeared after 22 days. An enzyme immunoassay (EIA) of the serum and cerebrospinal IgM were positive for rubella virus. The patient was therefore diagnosed with rubella encephalitis. He recovered gradually and was discharged on day 19 after the onset of symptoms without any sequelae. To our knowledge, this is the first case of rubella encephalitis presenting as clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Although the exact mechanism underlying the development of rubella encephalitis is not well established, this case indicated that our patient had an immune-mediated secondary encephalitis. According to the survey of the pandemic of rubella from 2012 to April 2013 in Japan, the incidence of rubella encephalitis is thought to be relatively higher than was previously noted. This emphasizes the importance of vaccination for preventing encephalitis.
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Affiliation(s)
- Atsuko Jinnai
- Department of Medicine, Tokyo Women's Medical University Medical Center East
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Mukaino A, Kinoshita I, Fukushima N, Otsubo M, Kanbayashi T. [Case of herpes simplex encephalitis with hypersomnia and low orexin level in the cerebrospinal fluid]. Rinsho Shinkeigaku 2014; 54:207-211. [PMID: 24705834 DOI: 10.5692/clinicalneurol.54.207] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 60-year-old woman suffered from high fever (38°C) and abnormal behavior, was admitted to our hospital on the seventh day of the fever. At admission, she was stuporous, and a cerebrospinal fluid (CSF) analysis revealed pleocytosis (55/μl, monocytes). Fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images showed high-intensity signals in the medial temporal lobe, inferior surface of the frontal cortex, right cerebellar vermis, and left thalamus. We diagnosed herpes simplex encephalitis, based on the finding of an elevated titer of herpes simplex virus antibody in the CSF (2.90). She was started on treatment with acyclovir and steroid pulse therapy, which was followed by rapid clinical improvement. After recovering from the stupor, the patient exhibited the symptoms of hypersomnia with low orexin level in the CSF. Thus, we should bear in mind that other than consciousness disturbance, patients with herpes simplex encephalitis can also present with rare complications due to the extent of the lesions.
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Affiliation(s)
- Akihiro Mukaino
- Section of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital
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Abstract
JE is a flavivirus generated dreadful CNS disease which causes high mortality in various pediatric groups. JE disease is currently diagnosed by measuring the level of viral antigens and virus neutralization IgM antibodies in blood serum and CSF by ELISA. However, it is not possible to measure various disease-identifying molecules, structural and molecular changes occurred in tissues, and cells by using such routine methods. However, few important biomarkers such as cerebrospinal fluid, plasma, neuro-imaging, brain mapping, immunotyping, expression of nonstructural viral proteins, systematic mRNA profiling, DNA and protein microarrays, active caspase-3 activity, reactive oxygen species and reactive nitrogen species, levels of stress-associated signaling molecules, and proinflammatory cytokines could be used to confirm the disease at an earlier stage. These biomarkers may also help to diagnose mutant based environment specific alterations in JEV genotypes causing high pathogenesis and have immense future applications in diagnostics. There is an utmost need for the development of new more authentic, appropriate, and reliable physiological, immunological, biochemical, biophysical, molecular, and therapeutic biomarkers to confirm the disease well in time to start the clinical aid to the patients. Hence, the present review aims to discuss new emerging biomarkers that could facilitate more authentic and fast diagnosis of JE disease and its related disorders in the future.
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Affiliation(s)
- Ravi Kant Upadhyay
- Department of Zoology, D. D. U. Gorakhpur University, Gorakhpur, Uttar Pradesh 273009, India
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Cnops L, Papa A, Lagra F, Weyers P, Meersman K, Patsouros N, Van Esbroeck M. West Nile virus infection in Belgian traveler returning from Greece. Emerg Infect Dis 2013; 19:684-5. [PMID: 23762912 PMCID: PMC3647719 DOI: 10.3201/eid1904.121594] [Citation(s) in RCA: 13] [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: 11/30/2022] Open
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Zhang XS, Wang XX, Yu DS, Jiang JX, Zhang GY, Wang F, Li H. [Analysis of pathogen spectrum of Encephalitis/Meningitis in northwestern area of China]. Zhonghua Yu Fang Yi Xue Za Zhi 2013; 47:924-927. [PMID: 24378133] [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: 06/03/2023]
Abstract
OBJECTIVE To learn the characteristics of pathogen spectrum of Encephalitis /Meningitis in northwestern area of China. METHODS Between January 1st 2009 and March 31st 2011, a total of 569 patients with clinical symptoms of Encephalitis/Meningitis were selected from the hospitals in Gansu, Qinghai,Inner Mongolia and Xinjiang province. 1514 samples of specimen were collected from the 515 patients, to detect the IgM of Japanese encephalitis virus (JEV), enterovirus (EV, including Coxsackie virus, ECHO virus and enterovirus 71), Mumps virus, Herpes simplex virus (HSV) in blood and cerebrospinal fluid. Meanwhile, Neisseria meningitis (Nm), Haemophilus influenzae Type B (Hib), Staphylococcus, Streptococcus pneumonia, Streptococcus Suis, E. Coli and Cryptococci were also identified. The detection results were analyzed by different region, time and age range. RESULTS Pathogenic bacteria were identified in the specimen from 16 patients, with the rate at 3.65%, of which the dominant ones were Streptococcus pneumonia (7 patients, 43.75%). Virus were identified in the specimen from 132 patients, with the rate at 27.05%, of which the dominant types were EV and HSV, accounting for 33.33% (44 cases) and 31.82% (42 cases) respectively. The detection rate of virus showed a significant seasonal trend, with the peak appearing between June and November each year. The peak of EV detection was between July and September, with 24 cases detected out; the peak of HSV was between June and August (11 cases detected out); mumps virus was mainly found between July and December (25 cases). There was no significant time-distribution found in the detection of bacteria. The EV and HSV were mainly distributed in Gansu and Qinghai province (70 cases) ;most of mumps virus were found in Gansu province (24 cases);and JEV were only found in Gansu province (20 cases). The viral pathogen spectrum was identified in all ages, and the EV and mumps virus were mainly found in children aged 0-14 years old (42 and 17 cases respectively) ; JEV were identified in people over 15 years old, with 13 detected out of the 20 patients. CONCLUSION The main pathogen of acute encephalitis and meningitis in northwestern area of China was virus, and the main pathogens of encephalitis and meningitis in children under 15 years were Herpes simplex virus and Mumps virus.
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Affiliation(s)
- Xiao-shu Zhang
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Xu-xia Wang
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - De-shan Yu
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Jian-xiang Jiang
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Guang-ye Zhang
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Fang Wang
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Hui Li
- Office for Immunization Programme of Gansu Center for Disease Control and Prevention, Lanzhou 730000, China.
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Gnanadurai CW, Zhou M, He W, Leyson CM, Huang CT, Salyards G, Harvey SB, Chen Z, He B, Yang Y, Hooper DC, Dietzchold B, Fu ZF. Presence of virus neutralizing antibodies in cerebral spinal fluid correlates with non-lethal rabies in dogs. PLoS Negl Trop Dis 2013; 7:e2375. [PMID: 24069466 PMCID: PMC3777866 DOI: 10.1371/journal.pntd.0002375] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/01/2013] [Indexed: 12/03/2022] Open
Abstract
Background Rabies is traditionally considered a uniformly fatal disease after onset of clinical manifestations. However, increasing evidence indicates that non-lethal infection as well as recovery from flaccid paralysis and encephalitis occurs in laboratory animals as well as humans. Methodology/Principal Findings Non-lethal rabies infection in dogs experimentally infected with wild type dog rabies virus (RABV, wt DRV-Mexico) correlates with the presence of high level of virus neutralizing antibodies (VNA) in the cerebral spinal fluid (CSF) and mild immune cell accumulation in the central nervous system (CNS). By contrast, dogs that succumbed to rabies showed only little or no VNA in the serum or in the CSF and severe inflammation in the CNS. Dogs vaccinated with a rabies vaccine showed no clinical signs of rabies and survived challenge with a lethal dose of wild-type DRV. VNA was detected in the serum, but not in the CSF of immunized dogs. Thus the presence of VNA is critical for inhibiting virus spread within the CNS and eventually clearing the virus from the CNS. Conclusions/Significance Non-lethal infection with wt RABV correlates with the presence of VNA in the CNS. Therefore production of VNA within the CNS or invasion of VNA from the periphery into the CNS via compromised blood-brain barrier is important for clearing the virus infection from CNS, thereby preventing an otherwise lethal rabies virus infection. Inexorable lethality is still commonly attributed to rabies infection, although there is increasing evidence for non-lethal infection and even recovery from clinical rabies in various animal species and humans. This paper reports non-lethal infection in dogs. The striking difference between dogs that survived a wt RABV infection and dogs that succumbed to the infection is that the surviving dogs showed high level of VNA in the serum and in the CSF, as well as mild immune cell accumulation in the CNS, whereas dogs that succumbed to disease showed little or no VNA in the serum or in the CSF and developed severe CNS inflammation. Considering the role of VNA in clearing the virus from the CNS, production of VNA within the CNS or infiltration of VNA from the periphery into the CNS across the blood-brain barrier appears to be important for clearing the virus from CNS thereby preventing a lethal rabies infection.
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Affiliation(s)
- Clement W. Gnanadurai
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Ming Zhou
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Wenqi He
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Christina M. Leyson
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Chien-tsun Huang
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Gregory Salyards
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Stephen B. Harvey
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Zhenhai Chen
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Biao He
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Yang Yang
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
- State-key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - D. C. Hooper
- Departments of Cancer Biology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Berhnard Dietzchold
- Departments of Cancer Biology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Zhen F. Fu
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
- State-key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
- * E-mail:
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Abstract
Protein microarrays have been developed to study antibody reactivity against a large number of antigens, demonstrating extensive perspective for clinical application. We developed a viral antigen array by spotting four recombinant antigens and synthetic peptide, including glycoprotein G of herpes simplex virus (HSV) type 1 and 2, phosphoprotein 150 of cytomegalovirus (CMV), Rubella virus (RV) core plus glycoprotein E1 and E2 as well as a E1 peptide with the optimal concentrations on activated glass slides to simultaneously detect IgG and IgM against HSV1, HSV2, CMV and RV in clinical specimens of sera and cerebrospinal fluids (CSFs). The positive reference sera were initially used to measure the sensitivity and specificity of the array with the optimal conditions. Then clinical specimens of 144 sera and 93 CSFs were tested for IgG and IgM antibodies directed against HSV1, HSV2, CMV and RV by the antigen array. Specificity of the antigen array for viral antibodies detection was satisfying compared to commercial ELISA kits but sensitivity of the array varied relying on quality and antigenic epitopes of the spotting antigens. In short, the recombinant antigen array has potential to simultaneous detect multiple viral antibodies using minute amount (3 µl) of samples, which holds the particularly advantage to detect viral antibodies in clinical CSFs being suspicious of neonatal meningitis and encephalitis.
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Affiliation(s)
- Yi Liu
- Pediatric Research Institute, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Fengling Yu
- Clinical Laboratory, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Haiyan Huang
- Key Laboratory for Biotech-Drugs of the Ministry of Health, Shandong Medicinal Biotechnology Center, Shandong Academy of Medical Sciences, Ji’nan, China
| | - Jinxiang Han
- Key Laboratory for Biotech-Drugs of the Ministry of Health, Shandong Medicinal Biotechnology Center, Shandong Academy of Medical Sciences, Ji’nan, China
- * E-mail:
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Wang XX, Jiang JX, Wang F, Zhang XS, Yu DS, Wang P, Zhao H, Li H. [Analysis on epidemiology and the main clinical symptoms of viral encephalitis in Gansu, 2009-2011]. Zhonghua Yu Fang Yi Xue Za Zhi 2012; 46:1099-1102. [PMID: 23363967] [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: 06/01/2023]
Abstract
OBJECTIVE To understand the epidemiological characteristics and the main clinical symptoms of viral encephalitis in Gansu. METHODS A total of 322 viral encephalitis patients were recruited from province sentinel hospitals in Gansu province from 2009 to 2011, and their basic information were collected as well as their serum samples and cerebrospinal fluid samples. 296 out of the 322 cases were qualified for our study. Based on the patients' epidemiological characteristics and clinical features, we determined the detection of the virus types (at least one kind of virus detection was carried out for each case). ELISA was applied to test the IgM antibody of Japanese encephalitis (JE) virus (JEV), enterovirus (EV: including Coxsackie virus, echovirus, enterovirus 71), mumps virus and herpes simplex virus (HSV) in cerebrospinal fluid and serum specimen. The difference of positive detected rate between types of virus, among patients from different regions, time, or at different ages, as well as the different clinical symptoms between JE patients and other viral encephalitis patients, were analyzed and compared. RESULTS The positive detected rate of virus in the 296 patients was 27.03% (80/296); the positive rate of JEV, EV, mumps virus, HSV detected was separately 7.53% (22/292), 8.75% (23/263), 13.84% (22/159) and 15.09% (40/265), and the difference was statistically significant (χ(2) = 10.849, P < 0.05). 90.91% (20/22) of the JEV positive cases were distributed in Tianshui, Longnan and Pingliang, and 95.45% (21/22) patients were infected from July to September. All the 23 EV detected positive patients were infected from April to December, while the ages of patients ranged from 1 to 44 years old. Mumps virus, HSV testing positive cases had onset every month. Logistic regression analysis showed that the patients who had the symptoms as disturbance of consciousness (OR = 15.487, 95%CI: 2.266 - 105.852), somnolence (OR = 11.659, 95%CI: 1.783 - 76.242), convulsions (OR = 11.062, 95%CI: 1.687 - 72.530) were more likely to infect JEV. CONCLUSION HSV was the principal pathogen of viral encephalitis in Gansu. An obvious central tendency in the regional and time distribution was found in JEV infection; and the clinical symptoms of JE patients were more severe.
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Affiliation(s)
- Xu-xia Wang
- Immunization Program Institute, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China
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Fening SW, Esper F, Scholl D, Huang YT. HSV IgG antibody inhibits virus detection in CSF. J Clin Virol 2012; 55:164-7. [PMID: 22841844 DOI: 10.1016/j.jcv.2012.07.002] [Citation(s) in RCA: 5] [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: 04/27/2012] [Revised: 06/19/2012] [Accepted: 07/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Before PCR testing of cerebrospinal fluid (CSF), laboratory diagnosis of herpes encephalitis (HSE) was based on virus isolation from brain biopsy. Viral isolation from CSF has limited clinical value due to low virus recovery; the cause for which has not been demonstrated. OBJECTIVE To investigate the role of anti-HSV antibodies on recovery of HSV from CSF via cell culture. STUDY DESIGN HSV-positive CSF samples were evaluated for their ability to neutralize HSV in cell culture. The presence of HSV-specific IgG and IgM antibodies were analyzed using HSV-infected cells. To identify whether HSV-specific IgG is the cause of viral inhibition, IgG was removed using anti-human IgG magnetic beads. Viral inhibition from CSF originating from asymptomatic patients was examined as a comparison. RESULTS CSF from 13 patients with acute HSV CNS disease was analyzed. All displayed high levels of viral neutralization to both HSV-1 and HSV-2 regardless of the infecting subtype. Interestingly, all the CSF samples stained strongly for anti-IgG antibody but none for anti-IgM antibody. Removal of IgG from CSF eliminated the viral inhibitory activity. Neutralizing IgG antibody was also found to be common in CSF of most patients, even in the absence of HSV disease. CONCLUSIONS Viral specific IgG is the major determinant of viral inhibition in CSF and prevents virus recovery in cell culture. In CSF from HSE un-infected patients, viral inhibitory IgG originates from circulating serum antibody and is commonly present in CSF. However, this inhibitory IgG is not protective for the development of HSV disease.
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Affiliation(s)
- Stacy Weber Fening
- Case Western Reserve University, Cleveland, OH 44106-7219, United States.
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Brecht I, Weissbrich B, Braun J, Toyka KV, Weishaupt A, Buttmann M. Intrathecal, polyspecific antiviral immune response in oligoclonal band negative multiple sclerosis. PLoS One 2012; 7:e40431. [PMID: 22792316 PMCID: PMC3392215 DOI: 10.1371/journal.pone.0040431] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/06/2012] [Indexed: 11/21/2022] Open
Abstract
Background Oligoclonal bands (OCB) are detected in the cerebrospinal fluid (CSF) in more than 95% of patients with multiple sclerosis (MS) in the Western hemisphere. Here we evaluated the intrathecal, polyspecific antiviral immune response as a potential diagnostic CSF marker for OCB-negative MS patients. Methodology/Principal Findings We tested 46 OCB-negative German patients with paraclinically well defined, definite MS. Sixteen OCB-negative patients with a clear diagnosis of other autoimmune CNS disorders and 37 neurological patients without evidence for autoimmune CNS inflammation served as control groups. Antibodies against measles, rubella, varicella zoster and herpes simplex virus in paired serum and CSF samples were determined by ELISA, and virus-specific immunoglobulin G antibody indices were calculated. An intrathecal antibody synthesis against at least one neurotropic virus was detected in 8 of 26 (31%) patients with relapsing-remitting MS, 8 of 12 (67%) with secondary progressive MS and 5 of 8 (63%) with primary progressive MS, in 3 of 16 (19%) CNS autoimmune and 3 of 37 (8%) non-autoimmune control patients. Antibody synthesis against two or more viruses was found in 11 of 46 (24%) MS patients but in neither of the two control groups. On average, MS patients with a positive antiviral immune response were older and had a longer disease duration than those without. Conclusion Determination of the intrathecal, polyspecific antiviral immune response may allow to establish a CSF-supported diagnosis of MS in OCB-negative patients when two or more of the four virus antibody indices are elevated.
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Affiliation(s)
- Isabel Brecht
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Benedikt Weissbrich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Julia Braun
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | | | | | - Mathias Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
- * E-mail:
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Garg RK, Malhotra HS, Gupta A, Kumar N, Jain A. Concurrent dengue virus and Japanese encephalitis virus infection of the brain: is it co-infection or co-detection? Infection 2012; 40:589-93. [PMID: 22696307 DOI: 10.1007/s15010-012-0284-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
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Folk S, Steinbecker S, Windmeyer J, Macneil A, Campbell S, Rollin PE. Lymphocytic choriomeningitis with severe manifestations, Missouri, USA. Emerg Infect Dis 2012; 17:1973-4. [PMID: 22000392 PMCID: PMC3310686 DOI: 10.3201/eid1710.110911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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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40
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Dekonenko EP, Belialetdinova IK, Shakarian AK, Mitrofanova IV, Leont'eva II, Prytkova MI, Sokolova MV, Shakhil'dian SV, Turkot NV. [Atypical course of herpetic encephalitis in a adolescent]. Zh Nevrol Psikhiatr Im S S Korsakova 2012; 112:67-69. [PMID: 22677670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
MESH Headings
- Adolescent
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Electroencephalography
- Encephalitis, Herpes Simplex/blood
- Encephalitis, Herpes Simplex/cerebrospinal fluid
- Encephalitis, Herpes Simplex/diagnosis
- Encephalitis, Herpes Simplex/psychology
- Female
- Herpesvirus 1, Human/immunology
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/immunology
- Herpesvirus 2, Human/isolation & purification
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/cerebrospinal fluid
- Immunoglobulin M/blood
- Immunoglobulin M/cerebrospinal fluid
- Magnetic Resonance Imaging
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Giza E, Karachristianou S, Roilides E, Anastasiou A. An adult patient with rubella encephalitis. Neurosciences (Riyadh) 2012; 17:78-79. [PMID: 22246018] [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: 05/31/2023]
Affiliation(s)
- Evangelia Giza
- Department of Neurology, Hippocration General Hospital, Konstantinoupoleos, Thessaloniki, Greece.
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42
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Tang XY, Kang K, Li XL, Chen HM, Xu BL. [Surveillance on Japanese encephalitis in Henan province, 2006 - 2010]. Zhonghua Liu Xing Bing Xue Za Zhi 2011; 32:1128-1130. [PMID: 22336549] [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: 05/31/2023]
Abstract
OBJECTIVE To analyze the epidemiological characteristics and risk factors of Japanese encephalitis (JE) in Henan province. METHODS Epidemiological characteristics and related factors of JE cases in Henan province from 2006 to 2010 were analyzed with descriptive epidemiological method and JE IgM antibodies of the serum or cerebrospinal fluid of the cases were detected by ELISA. RESULTS 3099 cases were reported in Henan province from 2006 to 2010. The incidence fluctuated from 0.39/100 000 to 1.08/100 000, and the incidence rate was decreasing. Patients were concentrated mainly in Xinyang, Nanyang and Luoyang cities, which accounted for 60.12% of the total. The peak season was in July-September, accounted for 93.26% of all the cases. Most cases were in 0 - 14 year old (83.61%) in the whole province. However, in Luoyang city, number of cases in the ≥ 15 year old group, had an obvious increase (57.63%). Compared with the provincial data, significant difference was found between the two ≥ 15 year old groups (χ(2) = 330.0341, P < 0.05) statistically. 20.23% of the JE cases were vaccinated but 75.54% of them did not complete the whole course. 79.77% of the cases were not sure if they had received the vaccination. 42.98% of the JE cases were confirmed through laboratory tests but other 45.95% of them were clinically diagnosed, with the rest 11.07% were suspected cases. CONCLUSION The distribution of JE cases showed seasonal, regional characteristics and crowd differences in Henan province. Basic immunization and the program on strengthening immunization of JE should be further standardized. The laboratory diagnosis rate of JE cases should be further improved.
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Affiliation(s)
- Xiao-yan Tang
- The Institute for Infectious Disease Control, Center for Disease Control and Prevention of Henan Province, Zhengzhou, China
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43
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Delfraro A, Burgueño A, Morel N, González G, García A, Morelli J, Pérez W, Chiparelli H, Arbiza J. Fatal human case of Western equine encephalitis, Uruguay. Emerg Infect Dis 2011; 17:952-4. [PMID: 21529429 PMCID: PMC3321764 DOI: 10.3201/eid1705.101068] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
MESH Headings
- Adolescent
- Animals
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Antibodies, Viral/immunology
- Encephalitis Virus, Eastern Equine/classification
- Encephalitis Virus, Eastern Equine/genetics
- Encephalitis Virus, Eastern Equine/immunology
- Encephalitis Virus, Eastern Equine/physiology
- Encephalomyelitis, Western Equine/diagnosis
- Encephalomyelitis, Western Equine/immunology
- Encephalomyelitis, Western Equine/virology
- Fatal Outcome
- Humans
- Male
- Phylogeny
- RNA, Viral/genetics
- Uruguay
- Viral Nonstructural Proteins/genetics
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45
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Sojka M, Wsolova L, Petrovičova A. Coxsackieviral infections involved in aseptic meningitis: a study in Slovakia from 2005 to 2009. Euro Surveill 2011; 16:19927. [PMID: 21813079] [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: 05/31/2023] Open
Abstract
A wide range of diseases is associated with enteroviruses.They are reported to be responsible for viral meningitis, especially in children, but also in adults.This study analysed infection with eight selected coxsackievirus serotypes as the cause of aseptic meningitis in 480 patients in Slovakia from 2005 to 2009,using a quantitative assay for the detection of intrathecal antibodies. Intrathecal production of antibodies against selected coxsackieviruses was proved in 21%of these patients. A significant decrease from 35% in 2005 to 8,5% in 2009 (p=0.004) in the proportion of patients with proven intrathecal production of virus specific antibodies was observed during the study period. We conclude that coxsackievirus B4 was the endemic serotype in Slovakia and was responsible for most cases of coxsackieviral meningitis in the study period.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Antibodies, Neutralizing
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Child
- Child, Preschool
- Coxsackievirus Infections/diagnosis
- Coxsackievirus Infections/epidemiology
- Coxsackievirus Infections/virology
- Enterovirus/classification
- Enterovirus/isolation & purification
- Enterovirus B, Human/classification
- Enterovirus B, Human/isolation & purification
- Female
- Humans
- Infant
- Male
- Meningitis, Aseptic/blood
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/epidemiology
- Meningitis, Aseptic/virology
- Middle Aged
- Neutralization Tests
- Population Surveillance
- Prevalence
- Serotyping
- Slovakia/epidemiology
- Young Adult
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Affiliation(s)
- M Sojka
- Department of Virology, Slovak Medical University, Bratislava, Slovakia.
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46
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Birlea M, Arendt G, Orhan E, Schmid DS, Bellini WJ, Schmidt C, Gilden D, Cohrs RJ. Subclinical reactivation of varicella zoster virus in all stages of HIV infection. J Neurol Sci 2011; 304:22-4. [PMID: 21419427 PMCID: PMC3176733 DOI: 10.1016/j.jns.2011.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/17/2011] [Accepted: 02/23/2011] [Indexed: 12/30/2022]
Abstract
Analysis of 200 paired serum and cerebrospinal fluid (CSF) samples from 180 HIV-positive individuals, 136 of whom had AIDS, revealed intrathecal synthesis of antibodies specific for varicella zoster virus (VZV) in 28 (16%) individuals, measles virus in 15 (8%), herpes simplex virus-1 (HSV-1) in 1 (0.6%), and HSV-2 in none. Of the 28 subjects with a positive VZV antibody specificity index, only 1 had zoster rash at the time of serum and CSF sampling; of the total 180 HIV-positive subjects, 146 (81%) had no history of zoster. Based on an estimated 33.4 million HIV-positive individuals worldwide, subclinical reactivation of VZV in even less than 16% of HIV-positive people suggests the possibility that millions of people have active VZV infection of the central nervous system. In cases of VZV vasculopathy, myelopathy and even zoster sine herpete, the CSF is often positive for anti-VZV antibody, but negative for VZV DNA. To rule out VZV infection of the nervous system, CSF must be tested for VZV DNA and anti-VZV IgG and IgM antibody.
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Affiliation(s)
- Marius Birlea
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gabriele Arendt
- Department of Neurology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Eser Orhan
- Department of Neurology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - D. Scott Schmid
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Christian Schmidt
- Department of Neurology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Don Gilden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Randall J. Cohrs
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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Ergünay K, Özkul A. [Confirmation of West Nile virus seroreactivity in central nervous system infections of unknown etiology from Ankara Province, Central Anatolia, Turkey]. MIKROBIYOL BUL 2011; 45:381-383. [PMID: 21644083] [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: 05/30/2023]
Abstract
West Nile virus (WNV) infections may trigger febrile conditions and/or neuroinvasive disease in a portion of the exposed individuals. Serosurveillance data from various regions of Turkey indicate WNV activity. The aim of this study was to confirm the antibody specificity of the serum samples via virus neutralization assay, previously reported to be reactive for WNV IgM. The samples originated from two individuals with the preliminary diagnosis of aseptic meningitis/encephalitis of unknown etiology in 2009 and had been classified as probable WNV infections. Cerebrospinal fluid and sera samples of these patients had been evaluated as negative for WNV RNA and IgG antibodies. Only one serum sample could be included in the neutralization assay due to the limited amounts in the current investigation. The sample was observed as positive in dilutions of 1/20 and 1/40, thus confirming the diagnosis of WNV-related central nervous system infection in a 62 year-old female patient from Ankara, Central Anatolia, Turkey.
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Affiliation(s)
- Koray Ergünay
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Ankara, Turkey.
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Sirbu A, Ceianu CS, Panculescu-Gatej RI, Vazquez A, Tenorio A, Rebreanu R, Niedrig M, Nicolescu G, Pistol A. Outbreak of West Nile virus infection in humans, Romania, July to October 2010. Euro Surveill 2011; 16:19762. [PMID: 21251489] [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: 05/30/2023] Open
Abstract
A total of 57 cases of West Nile virus infection (54 with neuroinvasive infection and three with fever) were identified in Romania between July and October 2010.The median age of the cases was 53.4 years, with the highest incidence in the age group 60–69 years.The case fatality rate was 8.8%. Cases were distributed in 19 districts in the southern, western, central and eastern parts of the country. Molecular investigation revealed lineage 2 West Nile virus, related to the Volgograd 2007 strain.
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Affiliation(s)
- A Sirbu
- National Institute of Public Health - National Centre for Surveillance and Control of Communicable Diseases, Bucharest, Romania.
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Manning L, Laman M, Edoni H, Mueller I, Karunajeewa HA, Smith D, Hwaiwhanje I, Siba PM, Davis TME. Subacute sclerosing panencephalitis in papua new guinean children: the cost of continuing inadequate measles vaccine coverage. PLoS Negl Trop Dis 2011; 5:e932. [PMID: 21245918 PMCID: PMC3014974 DOI: 10.1371/journal.pntd.0000932] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION subacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤ 70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence. METHODOLOGY/PRINCIPAL FINDINGS as part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002. CONCLUSIONS/SIGNIFICANCE SSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities.
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Affiliation(s)
- Laurens Manning
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Henry Edoni
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Harin A. Karunajeewa
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - David Smith
- School of Biological, Biomolecular and Chemical Sciences, and School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Ilomo Hwaiwhanje
- Pediatrics Division, Modilon General Hospital, Madang, Papua New Guinea
| | - Peter M. Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Timothy M. E. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Kubiak K, Dzika E, Równiak J, Dziedziech M, Dzisko J, Dzikowiec M. [Serological confirmation of the prevalence of tick-borne encephalitis virus among patients with neurological infections in the Warmia-Masuria province in 2006-2010]. Przegl Epidemiol 2011; 65:587-591. [PMID: 22390044] [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: 05/31/2023]
Abstract
The aim of the study was to analyze of tick-borne encephalitis (TBE) in the Warmia-Masuria province on the basis of serological testing of 878 patients with symptoms of neurological infections, diagnosed in 2006-2010 in the Voivodeship Sanitary-Epidemiological Station in Olsztyn. Specific IgM and IgG antibodies against the TBE virus were detected in serum and cerebrospinal fluid samples by ELISA method. Percentage of persons with serologically confirmed TBE was 15.5%. This confirms contact with TBE virus and its role as the suspected cause of neurological infections in patients in the Warmia-Masuria province. Men and people over 46 years of age were more commonly seropositive. Among examined patients the percentage of seropositive men was 18.1% and the proportion of seropositive women was - 12.9%. Most positive results were found in patients between 46 and 50 years of age (20.7%) and in those aged 56-60 years (19.5%). Seasonal patterns were detected, with highest proportion of seropositive results in July, August and October.
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Affiliation(s)
- Katarzyna Kubiak
- Katedra Biologii Medycznej, Uniwersytet Warmińsko Mazurskiego w Olsztynie.
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