RESUMO
We report here a case of a 17-year-old boy with viral encephalitis associated with human parvovirus B19 who presented consciousness disturbance, left hemiparesis, and focal neurologic signs. The diagnosis was based on the specific sequence reads corresponding to human parvovirus B19 (PVB19) in a CSF sample as analyzed by metagenomic next-generation sequencing (mNGS). Thus, PVB19 should be considered in the differential diagnosis of encephalitis and encephalopathy of unknown etiology. The introduction of mNGS into the diagnostic protocol of neuropathies, especially for those undiagnosed, could interrogate all genetic information in a biologic sample and facilitate the identification of the etiological agent.
Assuntos
DNA Viral/genética , Encefalite Viral/virologia , Metagenômica/métodos , Paresia/virologia , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/genética , Adolescente , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/patologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Paresia/líquido cefalorraquidiano , Paresia/diagnóstico por imagem , Paresia/patologia , Infecções por Parvoviridae/líquido cefalorraquidiano , Infecções por Parvoviridae/diagnóstico por imagem , Infecções por Parvoviridae/patologia , Parvovirus B19 Humano/isolamento & purificação , Parvovirus B19 Humano/patogenicidadeRESUMO
Seasonal outbreaks of acute encephalitis syndrome (AES) at Gorakhpur, India have been recognized since 2006. So far, the causative agent has not been identified. Use of next generation sequencing identified human parvovirus 4 (HPARV4) sequences in a CSF/plasma pool. These sequences showed highest identity with sequences earlier identified in similar patients from south India. Real-time PCR detected HPARV4 DNA in 20/78 (25.6%) CSF and 6/31 (19.3%) plasma of AES patients. Phylogenetic analysis classified three almost complete genomes and 24 partial NS1 sequences as genotype 2A. The observed association of HPARV4 with AES needs further evaluation. ELISAs for the detection of IgM and IgG antibodies against scrub typhus (Orientia tsutsugamushi, OT) showed â¼70% IgM/IgG positivity suggestive of etiologic association. Prospective, comprehensive studies are needed to confirm association of these agents, singly or in combination with AES in Gorakhpur region.
Assuntos
Encefalopatia Aguda Febril/virologia , Surtos de Doenças , Infecções por Parvoviridae/epidemiologia , Parvovirus/isolamento & purificação , Análise de Sequência de DNA/métodos , Encefalopatia Aguda Febril/sangue , Encefalopatia Aguda Febril/líquido cefalorraquidiano , Encefalopatia Aguda Febril/epidemiologia , Criança , Pré-Escolar , DNA Viral/genética , Feminino , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Índia/epidemiologia , Lactente , Masculino , Infecções por Parvoviridae/sangue , Infecções por Parvoviridae/líquido cefalorraquidiano , Infecções por Parvoviridae/diagnóstico , Parvovirus/genética , Parvovirus/imunologia , FilogeniaRESUMO
OBJECTIVE: The study aimed to describe the prevalence of HSV DNA, VZV DNA, Enterovirus RNA, Parechovirus RNA, CMV DNA, EBV DNA, adenovirus DNA, HHV-6 DNA, HHV-7 DNA, HHV-8 DNA and Parvovirus B19DNA in children aged less 14 years with a suspected viral infection of the central nervous system in a clinical practice setting. METHODS: Between January 2012 and May 2015, cerebrospinal fluids from 304 children were tested with an in-house real-time PCR method. RESULTS: A positive PCR was detected in 64 subjects (21%): the mean number of tests performed in patients who showed a viral infection was 7.5, significantly higher (p = 0.001) with respect to that reported in negative samples (6.4). Enterovirus is the leading virus detected: 12 out of the 37 positive children reported were newborns (85.7% of all the newborns with a positive result). The second most frequently identified virus was HHV-7 (5 positive PCR out of 105 samples tested, 4.8%, if we excluded a child with a concomitant S. pneumoniae isolated), a prevalence significantly higher with respect to VZV (p = 0.02) and to CMV (p = 0.04). HHV-6 was the third most commonly identified aetiology (4.2%). All children were immunocompetent. SIGNIFICANCE: Only a minority of children had a specific viral aetiology identified: the rate of HHV-7 positivity suggests a routine testing of these viruses within the diagnostic algorithm in immunocompetent paediatric patients. This approach could help to define the clinical role of this herpesvirus.
Assuntos
Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , DNA Viral/líquido cefalorraquidiano , RNA Viral/líquido cefalorraquidiano , Viroses/líquido cefalorraquidiano , Adenoviridae/genética , Infecções por Adenoviridae/líquido cefalorraquidiano , Infecções por Adenoviridae/epidemiologia , Infecções do Sistema Nervoso Central/epidemiologia , Infecções do Sistema Nervoso Central/virologia , Criança , Pré-Escolar , Citomegalovirus/genética , Infecções por Citomegalovirus/líquido cefalorraquidiano , Infecções por Citomegalovirus/epidemiologia , Encefalite por Herpes Simples/líquido cefalorraquidiano , Encefalite por Herpes Simples/epidemiologia , Encefalite por Varicela Zoster/líquido cefalorraquidiano , Encefalite por Varicela Zoster/epidemiologia , Enterovirus/genética , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/epidemiologia , Infecções por Vírus Epstein-Barr/líquido cefalorraquidiano , Infecções por Vírus Epstein-Barr/epidemiologia , Feminino , Herpes Simples/genética , Infecções por Herpesviridae/líquido cefalorraquidiano , Infecções por Herpesviridae/epidemiologia , Herpesvirus Humano 3/genética , Herpesvirus Humano 4/genética , Herpesvirus Humano 6/genética , Herpesvirus Humano 7/genética , Herpesvirus Humano 8/genética , Humanos , Recém-Nascido , Itália/epidemiologia , Masculino , Parechovirus/genética , Infecções por Parvoviridae/líquido cefalorraquidiano , Infecções por Parvoviridae/epidemiologia , Parvovirus B19 Humano/genética , Infecções por Picornaviridae/líquido cefalorraquidiano , Infecções por Picornaviridae/epidemiologia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Infecções por Roseolovirus/líquido cefalorraquidiano , Infecções por Roseolovirus/epidemiologia , Viroses/epidemiologia , Viroses/virologiaRESUMO
A case of meningoencephalitis, associated with persistent parvovirus B19 infection, is described in a 36-year-old immunocompetent woman. Parvovirus B19 DNA was detected in samples of cerebrospinal fluid and serum; no parvovirus B19-specific clinical symptoms were seen, but neurological episodes were observed in the presence of parvovirus B19 infection and despite the onset of a specific immune response.
Assuntos
Anemia/virologia , Meningoencefalite/diagnóstico , Infecções por Parvoviridae/diagnóstico , Parvovirus B19 Humano/isolamento & purificação , Adulto , Feminino , Humanos , Meningoencefalite/líquido cefalorraquidiano , Parestesia/virologia , Infecções por Parvoviridae/líquido cefalorraquidianoRESUMO
To find out the incidence and clinical presentation of parvovirus B19 meningoencephalitis, we tested samples of cerebrospinal fluid from 162 patients (one from each patient) with undiagnosed meningoencephalitis, who presented between March, 1997, and March, 1998 (an outbreak period) using nested PCR for B19 genes. Seven patients were positive; an incidence of 4.3%. Five additional cases of meningoencephalitis were detected from other years. Three patients with underlying disorders (haemophagocytic lymphohistiocytosis, Cockayne's syndrome, and Turner's syndrome) died. Neurological sequelae were observed in three surviving patients, all of whom had had striking abnormalities detected on brain scans done during the acute phase.
Assuntos
Surtos de Doenças , Meningoencefalite/virologia , Parvovirus B19 Humano/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningoencefalite/epidemiologia , Meningoencefalite/fisiopatologia , Infecções por Parvoviridae/líquido cefalorraquidiano , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/fisiopatologia , Parvovirus B19 Humano/genética , Reação em Cadeia da Polimerase , Reino Unido/epidemiologiaAssuntos
Doenças do Sistema Nervoso Central/virologia , DNA Viral/análise , Infecções por Parvoviridae/líquido cefalorraquidiano , Parvovirus B19 Humano/isolamento & purificação , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Pré-Escolar , Humanos , Masculino , Infecções por Parvoviridae/diagnósticoRESUMO
A case in which parvovirus B19 infection persisted over a prolonged period of time in the blood of an immunocompetent patient following an acute infection with meningitis is reported. Using a nested polymerase chain reaction assay the viral genome was detected in cerebrospinal fluid as well as in blood at the time of overt disease and in consecutive blood samples collected for up to nine months.
