Hand Foot Mouth Disease with Meningomyeloencephalitis Caused by Enterovirus 71 / 대한소아신경학회지

Hand-foot-and-mouth disease (HFMD) is a viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. It is caused by members of the enterovirus genus, namely, coxsackievirus A16 or enterovirus 71. HFMD is more severe in infants and children than adults, but generally, the disease has a mild course and is self-limiting. However, in recent epidemiology of HFMD in Asia, severe cases with complications have been reported. Enterovirus 71 may cause myocarditis, pneumonia, and severe neurological complications such as brainstem encephalitis, aseptic meningitis, acute flaccid paralysis, meningoencephalitis, meningomyeloencephalitis, and even death. A large outbreak of HFMD in Taiwan and Singapore caused by enterovirus 71 had a high mortality rate; the deaths resulted from pulmonary hemorrhage, interstitial pneumonitis, or brainstem encephalitis. HFMD was also epidemic in Korea in the spring of 2010. Severe cases with complications including neurological complications and death have been reported in HFMD patients, thus it has become a public health issue. We report five children who had severe HFMD caused by enterovirus 71 with meningomyeloencephalitis which caused a disturbance in consciousness, motor weakness, strabismus, and voiding difficulty. There was no mortality, and no patients exhibited sequelae.

Granulomatous meningomyeloencephalitis in a calf caused by Mycobacterium bovis / Meningomieloencefalite granulomatosa em um bezerro, causada por Mycobacterium bovis

Bovine tuberculosis is a chronic disease caused by Mycobacterium bovis, characterized by respiratory disorders, emaciation and lymphadenomegaly. Neurological signs associated with granulomatous lesions in the central nervous system are rarely seen. In Brazil, the National Program for Control and Eradication of bovine tuberculosis has begun in 2001, and notification of the disease is compulsory. A case of tuberculous meningomyeloencephalitis is reported in a dairy calf less than one year old presenting neurological signs (irritability, aggressiveness, weakness, dizziness and recumbency) which progressed to death in three days. Brain, spinal cord, and lung tissue samples were examined histopathologically. The spinal cord showed granulomatous meningomyelitis with Langhans giant cells in the meninges and perivascular mononuclear cuffing in the white and gray matter. There were a few granulomas in the cerebral cortex with a central area of necrosis surrounded by mononuclear infiltrate. Mononuclear perivascular cuffing, satellitosis, hyperemia, and severe granulomatous meningitis with Langhans giant cells were observed in the neuropile. Samples of brain were inoculated into Petragnani and Stonebrink media. M. bovis was isolated and identified by PCR with JB21-JB22 primers. Considering the 2,888 samples of bovine CNS sent for surveillance of neurological syndrome and negative for Rabies, this was the only case of tuberculous meningomyeloencephalitis (0,035%) diagnosed from 2004 to 2008 by the Laboratory of Anatomopathology of Instituto Biológico. Although tuberculous meningomyeloencephalitis is not so frequent, it's important to diagnose M. bovis as a causative agent of bovine neurological disorders. In accordance with Brazilian regulations, sanitary measures in the infected herd (test-and-slaughter) should be adopted.

A tuberculose bovina é uma doença crônica causada por Mycobacterium bovis, caracterizada por desordens respiratórias, emaciação e linfadenomegalia. Em raros casos, sinais neurológicos associados com lesões granulomatosas no sistema nervoso central são observados. O Brasil iniciou o Programa Nacional para Controle e Erradicação dessa doença em 2001, tornando a notificação compulsória. Um caso de meningomieloencefalite tuberculosa é relatado em uma bezerra leiteira com um ano de idade, que apresentou sinais neurológicos (irritabilidade e agressividade, fraqueza e tontura, decúbito) que progrediram para morte em três dias. A medula espinhal apresentou meningomielite granulomatosa, com células gigantes tipo Langhans nas meninges e manguito perivascular mononuclear na substância branca e cinzenta. Havia alguns granulomas no córtex cerebral, com área central de necrose circundada por infiltrado mononuclear. No neurópilo observou-se manguito perivascular mononuclear, satelitose, hiperemia e severa meningite granulomatosa com células gigantes tipo Langhans. Amostras de cérebro foram inoculadas nos meios de cultivo Petragnani e Stonebrink e M. bovis foi isolado e identificado por PCR com primers JB21-JB22. Considerando as 2.888 amostras de SNC bovino enviadas para a vigilância epidemiológica de síndrome neurológica e negativas para raiva, este foi o único caso (0,035%) de meningomieloencefalite tuberculosa diagnosticado pelo Laboratório de Anatomia Patológica do Instituto Biológico no período de 2004 a 2008. Embora a meningomieloencefalite tuberculosa não seja tão freqüente, é importante incluir a infecção por M. bovis no diagnóstico diferencial de lesões do sistema nervoso central de bovinos. De acordo com a legislação brasileira, medidas sanitárias no rebanho infectado (teste e abate) devem ser adotadas.