Prospective assessment of clinical symptoms associated with enterovirus and parechovirus genotypes in a multicenter study in Dutch children.

BACKGROUND: Human non-polio enterovirus (EV) and human parechovirus (HPeV) are important pathogens of viral infection and aseptic meningitis in children. The aim of this study is to prospectively compare the incidence, clinical signs, blood and cerebrospinal fluid in EV and HPeV infected children. OBJECTIVES: To compare the clinical symptoms and laboratory data of children with different EV and HPeV genotypes. STUDY DESIGN: This study is part of a multicenter prospective cohort study. Children were included in 3 different hospitals in The Netherlands from 2008 to 2011. RESULTS: Of 285 included patients, 140 (49%) had EV and 44 (15%) HPeV infection. Of children with EV infection 9 (6%) had EV-A, 109 (78%) EV-B, 12 (9%) had a non-type able EV and in 10 (7%) no genotyping was performed. Of children with HPeV infection, 24 (55%) had HPeV-3, 6 (14%) HPeV-1, 2 (5%) HPeV-4 and 1 (2%) HPeV-6. Meningitis was more frequent in EV than in HPeV infected children (54% vs. 36%, p=0.046), and in EV-B than EV-A infected children (60 vs. 33%). In contrast gastroenteritis was more frequent in HPeV than EV infected children (30% vs. 15%, p=0.030), and significantly more in HPeV-1 than HPeV-3 infected children (p<0.001). CONCLUSIONS: EV infection is more often associated with meningitis and HPeV infection more often with a gastro-enteritis. EV genotype B infection is more often associated with meningitis than EV genotype A infection. HPeV-1 infection was more often associated with gastroenteritis than HPeV-3 infection.

Prospective comparison of the detection rates of human enterovirus and parechovirus RT-qPCR and viral culture in different pediatric specimens.

BACKGROUND: Reverse-transcriptase quantitative real-time polymerase chain reaction (RT-qPCR) has become the gold standard for the diagnosis of human enterovirus (EV) and parechovirus (HPeV) infections. The detection rate of RT-qPCR in different pediatric body specimens has not been compared prospectively in a multicentre study. OBJECTIVES: This study compared the diagnostic detection rates of EV and HPeV RT-qPCR and viral culture in different specimens (feces, nasopharynx, blood, urine and cerebrospinal fluid (CSF)) of pediatric patients. STUDY DESIGN: This prospective, multicenter study performed an EV and HPeV RT-qPCR on nasopharynx, blood, urine, feces and CSF specimens and a viral culture on nasopharynx, feces and CSF specimens in symptomatic children<16 years. RESULTS: Of 285 included children EV was detected in 140 (49%) and HPeV in 44 (15%) children. Both EV and HPeV RT-qPCR had a higher sensitivity and negative predictive value than EV and HPeV viral culture, respectively. EV and HPeV RT-qPCR in feces specimen had the highest sensitivity (99.2% and 95.1%) of all specimens. Pooling results of specimens increased the detection rate for both viruses. CONCLUSION: Of all specimens, RT-qPCR in feces had the highest detection rate for both EV and HPeV in symptomatic pediatric patients. An EV was detected in all EV positive patients if a RT-qPCR was performed on both feces and CSF specimens or in both feces and urine specimens. HPeV was detected in all HPeV positive patients if a RT-qPCR was performed on both feces and CSF specimens, feces and nasopharynx specimens or CSF and nasopharynx specimens.

Iron autointoxication in a 16-year-old girl: a protective role for hepcidin?

Intentional iron overdose appears to be an increasingly common form of attempted suicide. We present a case of iron overdose in a 16-year-old girl who was found unconscious in her bed and brought to our emergency department. The most remarkable diagnostic findings were the patient's comatose condition, divergent eye position and positive Babinski foot pad reflexes. Laboratory tests showed hyperglycaemia and mild metabolic acidosis. A computed tomography scan of the cerebrum showed no signs of intracerebral haemorrhage or elevated intracerebral pressure. Toxicology screening showed no use of acetaminophen, ethanol or drugs of abuse. The patient was stabilized and monitored on the intensive care ward. When she woke up, she confessed to having taken Fero-Gradumet(®). Retrospectively analysed, the serum iron concentration in the first blood sample (seven hours after ingestion) was 62 µmol/L which corresponds with moderate iron intoxication. The patient received whole bowel irrigation with 2 L polyethyleneglycol solution and de-ironing treatment with intravenous deferoxamine 20 mg/kg in eight hours. She was discharged from the hospital after three days in a good clinical condition. Retrospectively, serum hepcidin concentrations were determined and evaluated in conjunction with serum iron concentrations and the installed treatment. Before medical de-ironing interventions were started, we saw that the serum iron concentration in our patient was already declining. At the same time, we observed a sharp increase in the serum hepcidin concentration. After normalization of serum iron concentrations, hepcidin normalized as well.

Diurnal fluxes and the isotopomer ratios of N(2)O in a temperate grassland following urine amendment.

There is an urgent need to provide an accurate, up-to-date estimate of N(2)O fluxes in order that national policies can be developed to reduce emissions of N(2)O from soils. There are only limited data on temporal and diurnal patterns of N(2)O fluxes to the atmosphere, mainly due to constraints in the measurement techniques. In this paper we present the first terrestrial source values of N(2)O isotopomers and have measured and quantified the temporal and diurnal variability in N(2)O fluxes following urine addition to a grassland system in the UK. The experiment was carried out over a 2-week period on an artificially drained grassland system at the Institute of Grassland and Environmental Research (IGER), North Wyke, UK. Duplicate samples of urine, each of 2 L, were collected from dairy cows and applied to chambers (of area 0.16 m(2)). The N(2)O diurnal fluxes from urine and control (no urine) plots were measured by an automatic closed chamber technique. The isotopomers of N(2)O were obtained by analysing the gas samples collected during a peak emission phase. Soil and meteorological data were also collected. The results showed strong diurnal variations in N(2)O fluxes with minimum fluxes generally occurring between 7:00 and 14:00 hrs. The total cumulative flux of N(2)O for the whole experimental period was higher by a factor of >2 compared with estimates based on the daytime (between 10.00-16.00 hrs) measurements only. Therefore, measurements of N(2)O fluxes based on daily single exposure and expressed on a 24-h basis could impose a considerable bias and inaccuracy to the emission estimates, depending on when it was taken. The measured site preference values (difference between the centre (delta(15)Nalpha) and the end (delta(15)Nbeta) N atom of the N(2)O molecule) for soil-emitted N(2)O measured during our study were always lower than the tropospheric value. This work confirms that the enhanced tropospheric N(2)O site preference value could be the result of the back injection from the stratosphere. The intramolecular isotope ratios of nitrogen (delta(15)N) and oxygen (delta(18)O) and the site preference of the emitted N(2)O indicated that there was a shift of processes during the measurement period.

Effects of dung and urine amendments on the isotopic content of N(2)O released from grasslands.

The temporal and diurnal changes in nitrous oxide (N(2)O) fluxes were measured between 29(th) September and 2(nd) November 1999 from urine and dung patches from cattle deposited on grazed grassland. The delta(15)N and delta(18)O values of the N(2)O emitted from soil from both treatments were examined on four occasions during this period. The diurnal fluxes of N(2)O were measured by a chamber technique that provides hourly measurement of N(2)O fluxes. The (15)N and (18)O analysis of N(2)O were determined by isotope ratio mass spectrometry. N(2)O fluxes from the excreta patches were large, with peak emissions up to 1893 ng N m(-2) s(-1) occurring after heavy precipitation, measured one month after the treatment applications. Emissions from the urine patches were significantly greater than from the dung. The results showed that excretal patches are an important source of atmospheric N(2)O. The flux pattern showed a strong diurnal variation with maximum fluxes generally occurring in late afternoon or early morning, and generally not in phase with the soil temperature changes. The isotopic content of (15)N and (18)O in the N(2)O showed a similar trend to that of the N(2)O flux. The (15)N and (18)O values of the N(2)O emitted from the soil indicated that denitrification was the major process involved. After heavy precipitation on the 6(th) October, the larger delta(15)N and delta(18)O values suggested a consumption of the N(2)O by total denitrification.