Enterovirus serotypes in patients with central nervous system and respiratory infections in Viet Nam 1997-2010.

BACKGROUND: Enteroviruses are the most common causative agents of human illness. Enteroviruses have been associated with regional and global epidemics, recently, including with severe disease (Enterovirus A71 and D68), and are of interest as emerging viruses. Here, we typed Enterovirus A-D (EV) from central nervous system (CNS) and respiratory infections in Viet Nam. METHODS: Data and specimens from prospective observational clinical studies conducted between 1997 and 2010 were used. Species and serotypes were determined using type-specific RT-PCR and viral protein 1 or 4 (VP1, VP4) sequencing. RESULTS: Samples from patients with CNS infection (51 children - 10 CSF and 41 respiratory/rectal swabs) and 28 adults (28 CSF) and respiratory infection (124 children - 124 respiratory swabs) were analysed. Twenty-six different serotypes of the four Enterovirus species (A-D) were identified, including EV-A71 and EV-D68. Enterovirus B was associated with viral meningitis in children and adults. Hand, foot and mouth disease associated Enteroviruses A (EV-A71 and Coxsackievirus [CV] A10) were detected in children with encephalitis. Diverse serotypes of all four Enterovirus species were found in respiratory samples, including 2 polio-vaccine viruses, but also 8 CV-A24 and 8 EV-D68. With the exception of EV-D68, the relevance of these viruses in respiratory infection remains unknown. CONCLUSION: We describe the diverse spectrum of enteroviruses from patients with CNS and respiratory infections in Viet Nam between 1997 and 2010. These data confirm the global circulation of Enterovirus genera and their associations and are important for clinical diagnostics, patient management, and outbreak response.

Reprint of-Differential diagnosis: Trepanation.

Trepanation is the scraping, cutting, or drilling of an opening (or openings) into the neurocranium. World surveys reveal that a number of ancient cultures experimented with cranial surgery, and that in some areas these practices continued into modern times. Archaeological discoveries of possible trepanations continue to be made, often from geographic areas or time periods from which the practice was not previously known. Unfortunately, most of these reports describe single crania with healed defects interpreted as trepanations. When evaluating a possible trepanation in a skull that lacks medical history or comes from an archaeological context where there is no other evidence that such operations were performed, a thorough differential diagnosis is essential. Identification of unhealed trepanations is a relatively straightforward exercise, since tool marks provide direct evidence of surgical intervention. A confident diagnosis is more difficult in healed defects of the skull, where the mechanism that produced an opening may be obscured by bone remodeling. There are many possible causes of defects of the skull vault, including congenital and developmental anomalies, trauma, infection, neoplasm, and taphonomic damage. For this reason, a careful differential diagnosis is essential for identifying surgical intervention and distinguishing it from cranial defects caused by other mechanisms.

Management of brain abscesses. I: Drainage and antiseptics.

Listerian antisepsis opened the way to surgical treatment of brain abscesses, at a time when advances in neurology made it possible to localize many of these lethal infections. William Macewen, a pupil of Joseph Lister, published in 1893 a remarkable monograph on pyogenic diseases of the brain and spinal cord. He recognized that these were caused by bacterial infection, and reported a series of 20 cerebral and cerebellar abscesses, treated by surgical drainage with antiseptic precautions. His mortality was amazingly low, but later surgeons were less successful. The causes of failure included inability to control microbial infection of the brain. Various chemical antiseptics and also serotherapy were tried, but mortality remained very high.

Management of brain abscesses. II: Antibiotics and computed tomography.

The discovery of the sulphonamides in 1935 was followed by the dramatic introduction of penicillin, first used in the management of a brain abscess in 1942 by J.B. Pennybacker of Oxford. He integrated antimicrobial drugs in a system of diagnosis, local and systemic antibiotics, and operative treatment, which was widely accepted. However, the mortality from brain abscess remained high until the advent of computerized tomography in 1973 made diagnosis safe and easy. During the next two decades, Pennybacker's system of management was modified, and applied with better results to all forms of brain abscess, including opportunistic infections associated with impaired immunity. These modifications have been studied historically in the management of 140 patients with brain abscesses treated in South Australia in the years 1955-95.

Everything to gain: Sir Hugh Cairns' treatment of central nervous system infection at Oxford and abroad.

Antibiotics have revolutionized survival from central nervous system (CNS) infections. Sixty years after the death of Sir Hugh Cairns, we present archive material of historical interest from the Radcliffe Infirmary in Oxford from the time of his first trials of penicillin for CNS infection. We discuss Cairns' important wartime and subsequent contributions to antibiosis in CNS infection and include drawings by Audrey Arnott illustrating the surgical techniques used to treat abscesses at the time.

Recurrent cerebral fever in the seventeenth and twenty first centuries.

The development of modern neuroscience away from the concepts of Hippocrates and Galen can be traced to the writings of some 17th century clinicians, especially Thomas Willis. His exceptional skills in observation and description allow a window into the experiences of our medical forebears. His approach to the management of infection-related coma in a child is amenable to modern interpretation and comparison with modern management because of the clarity of his clinical descriptions. Modern clinicians may benefit from this historical perspective into influences on the origins of neuroscience. The different outcome for a child presenting in the 17th and 21st century encourage grateful reflection on our current privileged position.

Behavioral consequences of infections of the central nervous system: with emphasis on viral infections.

Infections of the central nervous system can damage the brain and cause abnormal behavior. In this article, the authors examine how behavior is affected by damage to different parts of the brain. They then focus on damage caused by specific infections of the brain and how these can result in abnormal behavior with legal consequences. Examples of such infections include neurosyphilis, encephalitis lethargica, herpes simplex encephalitis, and various other viral encephalitides, both acute and chronic. The AIDS dementia complex, which results from HIV infection of the brain, causes behavioral abnormalities in addition to motor and cognitive impairments. In some cases of violence and other criminal behavior, this can be a consequence of central nervous system infection, and the authors suggest that criminal sanctions in such events are inappropriate in the absence of volitional criminal intent.