ABSTRACT
El Rotavirus es causa habitual de diarrea grave en niños pequeños a nivel mundial. Las manifestaciones clínicas incluyen: diarrea líquida, fiebre, y vómitos, llevando a estados de deshidratación y típica gastroenteritis; además pueden presentar múltiples complicaciones neurológicas, como convulsiones febriles o afebriles. La prevalencia real de estas convulsiones oscilaría entre el 2 y 6%. La fisiopatología de las mismas es aún incierta, pero se han propuesto teorías que intentan explicar un posible mecanismo, entre las que estarían involucrados factores genéticos, raciales, distribución de serotipos, factores pro-convulsivos e incluso alteraciones de la barrera hematoencefálica. Si bien este es un síndrome cuya etiología no es única, se tomará en cuenta la infección por rotavirus ya que este se ha identificado con mayor frecuencia, sobre todo en pacientes afebriles, evitando así procedimientos e intervenciones innecesarias para su diagnóstico.
The Rotavirus is common cause of severe diarrhea in young children worldwide. Clinical manifestations include: liquid diarrhea, fever, and vomiting, leading to states of dehydration and typical gastroenteritis; In addition, they may present multiple neurological complications, such as febrile seizures or afebrile seizures. The actual prevalence of these seizures would range between 2 and 6%. Their pathophysiology is still uncertain, but theories have been proposed that try to explain a possible mechanism, including genetic factors, racial, serotype distribution, pro-convulsive factors and even alterations of the blood-brain barrier. Although this is a syndrome whose etiology is not unique, rotavirus infection will be taken into account since it has been identified more frequently, especially in afebrile patients, thus avoiding unnecessary procedures and interventions for its diagnosis.
Subject(s)
Rotavirus Infections , GastroenteritisABSTRACT
Neurocysticercosis (NCC) is one of the major causes of childhood seizures in developing countries including India and Latin America. In this study neurological pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus antibodies (IgG) in their sera in order to estimate the possible burden of cysticercal etiology. The study included a total of 61 pediatric afebrile seizure subjects (aged one to 15 years old); there was a male predominance. All the sera were tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%) cases. The majority of cases with a positive ELISA test presented with generalized seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study one child without any significant findings on imaging was also found to be positive by serology. There was a statistically significant association found between the cases with multiple lesions on the brain and the ELISA-positivity (p = 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology. Hence, neurocysticercosis should be suspected in every child presenting with afebrile seizure especially with a radio-imaging supportive diagnosis in tropical developing countries or areas endemic for taeniasis/cysticercosis.
Neurocisticercose é uma das causas mais comuns de crises em crianças em países em desenvolvimento incluindo Índia e América Latina. Neste estudo casos neurológicos pediátricos, apresentando crises afebris foram selecionados através de anticorpos anti-Cysticercus (IgG) no seu soro para avaliar possível etiologia de Cysticercus. O estudo incluiu total de 61 casos pediátricos de indivíduos com crises afebris (idade de um a 15 anos); houve predominância de pacientes do sexo masculino. Todos os soros foram testados usando um kit comercial IgG-ELISA (UB-Magiwell Cysticercosis kit™) avaliado previamente. O anticorpo anti-Cysticercus no soro foi positivo em 23 de 61 casos (37,7%). A maioria dos casos com teste de ELISA positivo apresentava crises generalizadas (52,17%), seguida por casos de crises parciais complexas (26,08%) e crises parciais simples (21,73%). Dores de cabeça foram a queixa principal (73,91%). Outras manifestações foram vômitos (47,82%), palidez (34,78%), sensório alterado (26,08%) e fraqueza muscular (13,04%). Houve um caso de hemiparesia diagnosticado como NCC. Neste estudo uma criança sem quaisquer achados significantes às imagens apresentou sorologia positiva. Houve associação estatística significante entre os casos com múltiplas lesões no cérebro e a positividade pelo ELISA (p = 0,017). No seu conjunto a positividade pelo ELISA demonstra etiologia potencial para a cisticercose. Portanto neurocisticercose deve ser suspeitada em qualquer criança apresentado crises afebris com imagem que sugira diagnóstico em países tropicais em desenvolvimento ou em áreas endêmicas para teníase/cisticercose.
Subject(s)
Adolescent , Animals , Child , Child, Preschool , Female , Humans , Infant , Male , Antibodies, Helminth/blood , Neurocysticercosis/diagnosis , Seizures, Febrile/parasitology , Taenia solium/immunology , Enzyme-Linked Immunosorbent Assay , Neurocysticercosis/complications , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Rotaviruses, noroviruses, astroviruses, and enteric adenoviruses cause acute gastroenteritis (AGE) in children. Some children with AGE have afebrile convulsions associated with viral gastroenteritis. The purpose of this study was to detect and genotype viruses from children with AGE or benign infantile seizures associated with mild gastroenteritis (BIS-MG). METHODS: Between August 2004 and June 2005, 311 children with AGE were included. Four viral agents, including rotavirus, norovirus, astrovirus, and adenovirus, were analyzed from stool specimens of each patient using the latex agglutination method, enzyme immunoassay, and reverse transcriptase polymerase chain reaction. Genotyping of each virus was performed in 217 of the 311 children. RESULTS: Among 217 children (male, 121; female, 96; mean age, 20.6+/-15.4 months), rotavirus was detected in 109 (50.2%), norovirus in 28 (12.9%), adenovirus in 13 (6.0%), and astrovirus in 2 children (0.9%). Genotyping of rotavirus revealed positive results in 97 children; P[8]G3 in 36, P[4]G2 in 21, P[6]G4 in 10, P[4]G4 in 9, P[8]G9 in 6, P[8]G1 in 6, P[4]G3 in 4, P[4]G9 in 3, and P[6]G2 in 2. Genotyping of norovirus showed GII-4 in 27 of 28 children and GII-6 in 1 child. Sixteen children were diagnosed with BIS-MG. Rotavirus was detected in 13 of 16 children with BIS-MG, and norovirus in 2 children. Genotyping of rotavirus detected in children with BIS-MG revealed P[8]G3 in 6 children, P[4]G2 in 2 children, and P[4]G9 in 1 child. CONCLUSION: Analysis of viruses from stool specimens indicates that both rotavirus and norovirus are the main viruses related to BIS-MG in children.
Subject(s)
Child , Female , Humans , Adenoviridae , Agglutination , Gastroenteritis , Genotype , Immunoenzyme Techniques , Latex , Norovirus , Reverse Transcriptase Polymerase Chain Reaction , Rotavirus , Seizures , VirusesABSTRACT
PURPOSE: The aim of this study is to characterize detailed clinical features of benign afebrile seizure with gastroenteritis. METHODS: We retrospectively investigated the medical records of 52 patients with benign afebrile seizure and gastroenteritis, who were admitted to the Department of Pediatrics Eulji University Hospital, between February 1996 and January 2005. RESULTS: There were 52 patients with benign afebrile seizure and gastroenteritis:18 boys and 34 girls. Most of the patients(86.5%) were from 12 to 23 months of age. In the monthly distribution, 71.1% were admitted between November and March. Most of the seizures(98.0%) were generalized and 53.9% of those were generalized tonic and clonic. The durations of the seizures were mostly within 5 minutes. 40 patients(76.9%) had 2 or more seizures. The interval between the onset of gastroenteritis and seizures was mostly from 2 to 4 days. Fifteen out of 32 patients were rotazyme positive. Chi-square test was performed to identify if there was any association between rotavirus and afebrile seizure. Rotavirus gastroenteritis has a stastically significant association with afebrile seizure compared to non-rotavirus gastroenteritis(P<0.01). The relative risk between rotavirus and non-rotavirus gastroenteritis was 3.35. However, there were no significant differences in clinical features between two groups. Cerebrospinal fluid was normal and cell counts, glucose and protein levels in all the patients examined. Either brain CT or MRI was performed in 9 patients and demonstrated no neuroradiological abnormalities. Electroencephalography was performed in 47 patients, of whom 43 patients(92.3%) showed normal electroencephalographic patterns. CONCLUSION: Benign afebrile seizure is characterized by the onset age between 12 months and 23 months, multiple episodes of seizure, short duration, generalized type, high incidence between November and March, and rotavirus as a major pathogen.