Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause.

A wide range of etiologies can cause hemifacial spasm (HFS), including infection. In this case report, a 44-year-old woman developed HFS and was explored surgically 7 years later. No abnormalities were found. Afterward, treatment of a surgical wound infection with an oral cephalosporin resulted in a temporary HFS remission that had never occurred previously. This antibiotic experience prompted further workup for an underlying infection, which ultimately led to diagnosis of Lyme disease. Presentation of HFS due to Lyme disease has not been reported. Because its diagnosis can be occult and antibiotic therapy can be both diagnostic and therapeutic, Lyme disease should be a consideration for cases of HFS.

Brote de meningitis por echovirus serotipo 30 en la Comunidad Valenciana / Meningitis outbreak caused by Echovirus serotype 30 in the Valencian Community

Fundamento y objetivo: Las meningitis asépticas pueden estar causadas por distintos agentes, si bien en muchos casos no se llega a conocer la etiología. El objetivo del presente estudio ha sido analizar las características clínicas y epidemiológicas de un brote de meningitis detectado en el Departamento de Salud 11 de la Comunidad Valenciana. Material y método: Se realizó un estudio de los niños hospitalizados entre noviembre y diciembre de 2006 con clínica de meningitis, pleocitosis en el líquido cefalorraquídeo (LCR) y cultivos bacterianos de LCR negativos. Se realizó una encuesta epidemiológica entre casos y familiares. Mediante técnica de biología molecular se realizó la detección y el análisis filogenético de virus. Resultados: El brote implicó al menos a 44 pacientes pediátricos. La media de edad ± desviación estándar fue de 5,5±2,9 años. La estancia media de hospitalización fue de 3,1 días y todos los pacientes evolucionaron de forma favorable. En 24 pacientes se dispuso de muestra suficiente de LCR para la detección de virus por técnica de reacción en cadena de la polimerasa; en 12 de ellos (50%) se obtuvo un resultado positivo para enterovirus, que fue finalmente tipificado como echovirus 30. Este serotipo se detectó recientemente en otras zonas geográficas de España. Conclusiones: La detección de echovirus 30 en LCR junto con la presentación epidémica ha permitido determinar la etiología del brote. Este hallazgo coincide en el tiempo con otros brotes de echovirus serotipo 30 detectados en España, lo que puede explicar la situación epidémica ocurrida durante el año 2006 en la Comunidad Valenciana. La existencia de una red nacional de vigilancia de infecciones sistémicas por enterovirus permitiría conocer sus patrones de circulación y detectar los nuevos serotipos emergentes (AU)

Background and objective: Aseptic meningitis can be caused by several agents, and in many cases the etiology remains unknown. The aim of this study to analyze the clinical and epidemiological characteristics of a meningitis outbreak detected in Health Department 11 of the Valencian Community (Spain). Material and methods: The study was performed in children hospitalized between November and December 2006 with meningitis symptoms, CSF pleocytosis, and negative CSF bacteriological culture. An epidemiological survey was conducted among cases and family members. Virus detection and phylogenetic analysis were performed with molecular biology techniques. Results: The outbreak affected at least 44 children, with a mean age (standard deviation) of 5.5 years (2.9). The average hospital stay was 3.1 days and outcome was favorable in all cases. In 24 patients the CSF specimen sufficed for viral detection by PCR; enteroviruses ultimately serotyped as echovirus 30 were detected in 12 of them (50%). This serotype has been recently found in other parts of our country. Conclusions: Detection of echovirus 30 in CSF and the epidemiological presentation of cases enabled determination of the etiology of the outbreak. This finding coincided in time with other outbreaks of (..) (AU)

[Study on an outbreak of echovirus type 6 of meningitis in Liu'an city, Anhui province].

OBJECTIVE: To understand the epidemiological, clinical and etiological characteristics of an Echovirus type 6 meningitis outbreak in Jinzhai county, Liu'an city in Anhui, and to find out the proper way in controlling the aseptic meningitis outbreak. METHODS: A surveillance system for aseptic meningitis was established in Jinzhai to confirm the case definition. Stool or cerebrospinal fluid (CSF) specimens from some cases were collected for entero-viruses isolation and identification. Case-control study was conducted. The case group involved patients while the controls would include: patients' classmate with same gender and the age difference was not over one year. Neutralization antibody in serum specimens were collected and tested in cases and in healthy people. RESULTS: 105 cases were distributed in 17 of the 30 towns in Jinzhai county while 41.0% of the cases were in Banzhuyuan town with an incidence rate of 203/10(5). Cases were clustered by school and classroom with age ranging from 3 to 15 years old and the highest as 10.9/10(5) in the 6 to 10 group. The incidence in males was 24.2/10(5) compared to 8.4/10(5) in females. The main clinic characteristics of cases were: fever, headache and vomiting. Echovirus type 6 from 25 of the 72 CSF samples (35%) was isolated. When comparing the cases group with control group, the OR of drinking home-made beverages was 4.1 (95% CI: 1.4-12.0), especially the beverages sacked by plastic bag: 3.3 (95% CI: 1.3-8.8). 6 out of 7 workers engaging in producing home-made beverages were detected to have carried Echovirus type 6 from their stool specimens. The Echovirus type 6 neutralization antibody positive rate in cases (73.5%) was significantly higher than that in 100 healthy people (46.0%) (X2 = 12. 526, P = 0.000). CONCLUSION: This episode of meningitis outbreak was caused by Echovirus type 6. The proportion of drinking home-made beverages, especially the beverages sacked by plastic bag in cases group was higher than in control group.

Bovine lactoferrin peptidic fragments involved in inhibition of Echovirus 6 in vitro infection.

Bovine lactoferrin is a multifunctional glycoprotein folded in two symmetric globular lobes (N- and C-lobes), each being able to bind one ferric ion. We have previously demonstrated that this protein is able to prevent echovirus-induced apoptosis. In the present study, we have investigated both the role of tryptic fragments of bovine lactoferrin and the mechanism of lactoferrin effect on echovirus infection. Results obtained showed that bovine lactoferrin inhibits echovirus-induced cytopathic effect and antigen synthesis in a dose-dependent manner and that this protein is able to prevent viral replication when added not only during the entire cycle of infection but also before, during or after the viral adsorption step. The N-terminal cationic peptide was sufficient to prevent viral binding. Our data suggest that lactoferrin inhibition of echovirus attachment to cell receptors could be mediated by the cluster of positive charges at its N-terminus (lactoferricin).

Nutrition- and virus-induced stress represses the expression of manganese superoxide dismutase in vitro.

The relationship between oxidative stress and neuronal cell death has been suggested for many years. To understand the influence of oxidative stress on neuronal cell death, we investigated the influence of oxidative stress on DEV cells, a human glial cell line. Using enterovirus infection and/or malnutrition to induce oxidative stress, our results demonstrate that those stressors severely influence the antioxidant defense system in DEV cells. Although the expression of mitochondrial manganese superoxide dismutase (MnSOD) in DEV cells was significantly increased in acute infection with viral and nutritional stress, in persistent infection and nutritional stress, the expression of the MnSOD was drastically downregulated. We believe that this downregulation of MnSOD expression in the chronic stress model is due to repression of antioxidant defense. The downregulation of the MnSOD expression may lead to an increase of free-radical production and thus explain why the cells in the chronic stress model were more vulnerable to other oxidative stress influences. The vulnerability of DEV cells to additional stress factors resulted in progressive cell death, which may be analogous to the cell death in neurodegenerative diseases.

Construction of a recombinant cDNA of echovirus 6 that established a persistent in vitro infection.

cDNA clones of lytic acute and nonlytic persistent strains of echovirus 6 were used to construct a recombinant cDNA. The 3' region of the infectious wild-type cDNA genome, which extended from VPg to the end of the noncoding region, was exchanged with the cDNA fragment representing the same region of the persistent viral genome. Sequence analyses indicated that there was one mutation in the 3C protease and eight mutations in the 3D polymerase. Transfection of the recombinant cDNA into WISH cells resulted in cellular survival and synthesis of viral RNA. The viral RNA was retained in the transfected cell line after cultivation for 7 months. Supernates, collected from cell cultures at 1, 3, and 7 months after transfection with the recombinant cDNA, transmitted the viral RNA to uninfected cells. The results indicated that the recombinant cDNA established a persistent echovirus 6 infection that was transmissible by nonlytic virus particles.

Construction of an infectious cDNA clone of echovirus 6.

A complete cDNA copy of the echovirus 6 genome was constructed. Complementary DNA was reversed transcribed from viral RNA. Subgenomic cDNAs were obtained by direct cloning and polymerase chain reactions. Full length cDNA was constructed into the Bluescript II vector (pBSII) using unique, overlapping, restriction sites of four clones. The cDNA was infectious and produced echovirus 6 particles that behaved in the same manner as the parental virus.

Stability of human enteroviruses in estuarine and marine waters.

Studies of the effects of temperature and salinity on the survival of three enteric viruses (poliomyelitis type 1, echovirus-6, and coxsackievirus B-5) under controlled laboratory conditions and in situ indicate that temperature rather than salinity is the critical factor affecting their stability, in that the higher the temperature the more rapid was the loss of viral infectivity. In the laboratory studies, all three viruses were quite stable at 4 degrees C, with infectious virus still detectable after 46 weeks of incubation. In situ studies on virus survival in free-flowing estuarine or marine waters showed that, although the viruses were more labile in natural waters than in the laboratory studies, they persisted for several months, in some cases during the winter months. At all temperatures and salinities, coxsackievirus B-5 was the most stable, echovirus-6 was intermediate, and poliovirus 1 was the least stable of the viruses tested.