Aumento inusual de casos de mielitis en un hospital pediátrico en Argentina / Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Introducción: La asociación entre enterovirus D68 y cuadros de mielitis aguda fláccida ha sido descrita en Estados Unidos, en 2014. Desde ese año, se han reportado casos esporádicamente en Canadá y Europa. Se describe, en este estudio, una serie de casos con mielitis aguda fláccida en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" en Buenos Aires, Argentina, en 2016. Métodos: Estudio descriptivo, retrospectivo. Se incluyeron todos los pacientes internados desde el 1/04/2016 al 1/07/2016 con mielitis fláccida aguda con lesiones en la médula espinal que comprometieran la sustancia gris en la resonancia magnética nuclear. Se procesaron, para la búsqueda etiológica, muestras de secreciones nasofaríngeas, hisopados de materia fecal y líquido cefalorraquídeo. Resultados: Se incluyeron 10 pacientes. La mediana de edad fue 4 años (rango de 3 meses a 5 años). Ocho pacientes tuvieron una enfermedad febril autolimitada antes del inicio de los síntomas neurológicos. Los hallazgos neurológicos fueron debilidad fláccida de, al menos, un miembro, cervicoplejia (n= 2) y parálisis facial (n= 2). Todos los pacientes presentaron lesiones longitudinales en la médula espinal, con compromiso de sustancia gris, predominantemente, en el asta anterior. En todos los casos, se realizó una punción lumbar. En 7 pacientes, se observó pleocitosis. En cuatro niños, se identificó enterovirus D68 en secreciones nasofaríngeas y, en uno, se identificó el enterovirusD68 en el líquido cefalorraquídeo. Todos los pacientes persistieron con déficits neurológicos al momento del alta. Conclusiones: Se reporta el primer brote de mielitis aguda fláccida asociada a enterovirusD68 en Argentina. La vigilancia epidemiológica activa permitirá conocer la verdadera incidencia, epidemiología y etiología de esta enfermedad.

Introduction: The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016. Methods: Descriptive, retrospective study. All patients with acute flaccid myelitis and lesions in the spinal cord involving the gray matter, as observed in the magnetic resonance imaging (MRI) scan, hospitalized from 04/01/2016 to 07/01/2016, were included in the study. Samples of nasopharyngeal secretions, fecal swabs and cerebrospinal fluid were collected and processed to look for the causative agent. Results: Ten patients were included. The median age was 4 years old (range from 3 months to 5 years old). Eight patients had a self-limiting febrile condition before the onset of neurological symptoms. Neurological findings were flaccid weakness in, at least, one limb, cervical paralysis (n= 2) and facial paralysis (n= 2). All patients had longitudinal lesions in the spinal cord, with gray matter involvement, mainly in the anterior horn. In all cases, a lumbar puncture (spinal tap) was performed. Pleocytosis was observed in 7 patients. In four children, enterovirus D68 was identified in nasopharyngeal secretions, and in one, it was detected in the cerebrospinal fluid. Neurological deficit persisted in all patients at the time of discharge. Conclusions: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease.

Acute Longitudinal Myelitis As The First Presentation in Child with Systemic Lupus Erythematosus Concurrent with Positive Antiphospholipid Antibody.

Systemic lupus erythematosus (SLE) is a multi-system auto-immune disorder that is characterized by widespread immune deregulation, formation of auto–antibodies, and immune complexes, resulting in infl ammation and potential damage to variety of organs. 25-95% it is complicated by neurological or neuropsychiatric symptoms, which is referred to as neuropsychiatric SLE (NPSLE). NPSLE contain both central and peripheral nervous systems, which includes transverse myelitis. We report our experience of concurrent manifestation of transverse myelitis as an initial presentation of SLE, which suggests the common immune-mediated mechanisms of diseases. We here report the case of a 7-year-old girl with SLE who fi rst presented with features of TM. Th e patient developed ascending weakness starting from low extremities, experienced diffi culty in voiding. An initial diagnosis of TM was made on the basis of clinical fi ndings and MRI spine, which displayed T2 weighted high signal intensities at thoracic level. She partially respond to intravenous immunoglobulin therapy, and serological analysis revealed the presence of anti-dsDNA, anti nuclear antibody with decreased level of complements. Th e diagnosis was revised to acute transverse myelitis resulting from SLE. Additional methylprednisolone pulse therapy led to rapid clinical improvement. Th is was followed by oral prednisolone and cyclophosphamide pulse therapy. Th e crossreactivity of auto-antibodies and increased susceptibility to infection owing to immunologic changes associated with lupus may form the basis of the association. Systemic Lupus Erytheromyitis should consider as an etiology of transverse myelitis. Aggressive treatment may alter the course and lead to a better outcome.

Meningoencefalite e polioencefalomalacia causadas por Herpesvírus bovino-5 no estado do Pará / Meningoencephalitis and polioencephalomalacia caused by bovine herpesvirus-5 in the state of Pará, northern Brazil

O presente trabalho relata quatro casos de meningoencefalite por BHV-5 em quatro municípios no estado do Pará afetando bovinos de 1-2 anos, criados extensivamente. Três casos ocorreram de forma isolada e em um caso foram atingidos 3 animais do rebanho. Os principais sinais clínicos observados foram incoordenação, depressão acentuada, cegueira, decúbito lateral, opistótono e morte. O curso clínico foi de 3-4 dias. Macroscopicamente observaram-se áreas amolecidas, amareladas e cavitações no córtex cerebral. Microscopicamente observaram-se poliencefalomalacia no córtex cerebral, tálamo e núcleos da base, encefalite e meningite não supurativa e corpúsculos de inclusão intranucleares eosinofílicos em astrócitos. O diagnóstico foi realizado com base nos achados histológicos característicos.

Prognostic factors for spinal cord myelitis--an analysis of compiled literature data.

The effectiveness of radiotherapy in the treatment of malignant tumors in the head and neck, thorasic and upper abdominal regions is frequently limited by the tolerance of the spinal cord. Therefore knowledge of the factors that influence the tolerance of the spinal cord to radiation is of the upmost important. Safe limits for irradiation of the spinal cord determined in a number of clinical studies is on the conservative side from the point of view of tumor control probability. The bioeffect of a physical dose takes into account the treatment variables and the radiobiological characteristics of the relevant tissue; hence deciding spinal cord tolerance on the basis of bioeffect models would be better approach. The aim of the present study was to analyze the relationship of the prognostic factors with percentage incidence of spinal cord myelitis and to arrive at a spinal cord tolerance bioeffect dose TDF and ERD for optimum incidence of radiation myelitis.