53 results on '"Enterovirus Infections complications"'
Search Results
2. Acute flaccid myelitis: cause, diagnosis, and management.
- Author
-
Murphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, Dean J, DeBiasi R, Desai J, Elrick MJ, Farias-Moeller R, Gombolay GY, Greenberg B, Harmelink M, Hong S, Hopkins SE, Oleszek J, Otten C, Sadowsky CL, Schreiner TL, Thakur KT, Van Haren K, Carballo CM, Chong PF, Fall A, Gowda VK, Helfferich J, Kira R, Lim M, Lopez EL, Wells EM, Yeh EA, and Pardo CA
- Subjects
- Central Nervous System Viral Diseases cerebrospinal fluid, Central Nervous System Viral Diseases virology, Child, Enterovirus Infections cerebrospinal fluid, Enterovirus Infections complications, Global Health, Humans, Magnetic Resonance Imaging, Myelitis cerebrospinal fluid, Myelitis virology, Neuromuscular Diseases cerebrospinal fluid, Neuromuscular Diseases virology, Patient Outcome Assessment, Central Nervous System Viral Diseases diagnostic imaging, Central Nervous System Viral Diseases rehabilitation, Enterovirus Infections epidemiology, Muscle Hypotonia etiology, Muscle Weakness etiology, Myelitis diagnostic imaging, Myelitis rehabilitation, Neuromuscular Diseases diagnostic imaging, Neuromuscular Diseases rehabilitation
- Abstract
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
3. Vaccination management in an asymptomatic child with a novel SCN1A variant and family history of status epilepticus following vaccination: A case report on a potential new direction in personalised medicine.
- Author
-
Deng L, Ma A, Wood N, and Ardern-Holmes S
- Subjects
- Clobazam therapeutic use, Enterovirus A, Human pathogenicity, Fatal Outcome, Female, Humans, Infant, Male, Pedigree, Precision Medicine, Valproic Acid therapeutic use, Anticonvulsants therapeutic use, Enterovirus Infections complications, Epilepsy genetics, Epilepsy prevention & control, Hypoxia-Ischemia, Brain etiology, NAV1.1 Voltage-Gated Sodium Channel genetics, Status Epilepticus etiology, Vaccination adverse effects
- Abstract
Purpose: SCN1A variants cause a spectrum of epilepsy syndromes from Dravet Syndrome, a severe epileptic encephalopathy of early infancy to the milder disorder of genetic epilepsy with febrile seizures plus (GEFS+). These genetic epilepsies are associated with increased risk of poor outcome including complications of status epilepticus and early mortality. Individualised management of young children known to be at increased risk should be considered, such as around vaccination management., Methods: We describe two siblings with a novel pathogenic SCN1A variant, their management and clinical outcomes following routine childhood vaccinations., Results: The index case who had a family history of epilepsy of unknown genetic aetiology, died from hypoxic ischemic encephalopathy following his 12-month vaccinations, in the context of status epilepticus and enterovirus 71 infection. The sibling of the index case with the same SCN1A variant was subsequently managed with prophylactic regular sodium valproate and additional clobazam post vaccination to reduce the risk of seizure. She has successfully completed the childhood immunisations to 18 months with no seizures and normal neurodevelopmental progress., Conclusion: As the aetiology of genetic epilepsies is increasingly known in early childhood, opportunities to personalise care, minimise risks and optimise outcomes are changing. Further research is needed on the risks and benefits of symptomatic and preventative management of seizures around vaccinations in young children with genetic epilepsies., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
4. Respiratory presentation of patients infected with enterovirus D68 in Taiwan.
- Author
-
Pan HH, Tsai CR, Ting PJ, Huang FL, Wang LC, Lin CF, Ko JL, Lue KH, and Chen PY
- Subjects
- Adolescent, Asthma etiology, Child, Child, Preschool, Dyspnea etiology, Enterovirus Infections complications, Enterovirus Infections diagnosis, Female, Humans, Infant, Male, Retrospective Studies, Young Adult, Enterovirus D, Human, Enterovirus Infections therapy
- Abstract
Background: Enterovirus-D68 (EV-D68) has been endemic in Taiwan for some years with a small number of positive cases. Detailed information about respiratory presentation is lacking. This study characterized the clinical course in children admitted to the medical center and regional hospital in Taichung during 2015., Methods: Retrospective chart review of patients with confirmed EV-D68 infection admitted to the medical center and regional hospital in Taichung with respiratory symptoms in the second half of 2015. Past medical history, clinical presentation, management, and course in hospital were collected and analyzed. Simple demographic data and clinical symptoms were also collected from patients confirmed with EV-D68 infection who visited clinics in Taichung., Results: Six children were included. Two patients had a prior history of asthma or recurrent dyspnea, and one had other preexisting medical comorbidities. One child was admitted to the pediatric intensive care unit. All the patients were cured. Cough, rhinorrhea, tachypnea and fever were the most common clinical symptoms among inpatients, while influenza-like illness (ILI) was prevalent in outpatients., Conclusion: EV-D68 infection resulted in respiratory presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of asthma or recurrent dyspnea appear to be more severely affected., (Copyright © 2019. Published by Elsevier B.V.)
- Published
- 2020
- Full Text
- View/download PDF
5. Chromogranin A provides additional prognostic information in children with severe hand, foot, and mouth disease: A prospective observational study.
- Author
-
Dang H, Li J, Liu C, and Xu F
- Subjects
- Biomarkers blood, Blood Glucose metabolism, Child, Preschool, Enterovirus Infections complications, Female, Hand, Foot and Mouth Disease blood, Hand, Foot and Mouth Disease complications, Hospitalization, Humans, Infant, Intensive Care Units, Pediatric, Leukocyte Count, Male, Odds Ratio, Prognosis, Prospective Studies, Risk Factors, Chromogranin A blood, Hand, Foot and Mouth Disease diagnosis
- Abstract
Objective: Severe hand, foot, and mouth disease (HFMD) is associated with high mortality in children, and persistent sympathetic activation is a common presentation. The aim of this study was to prospectively investigate serum chromogranin A (CHGA) levels and their prognostic role in this condition., Methods: Serum CHGA, creatine kinase myocardial band (CK-MB), serum D-dimer, norepinephrine, blood glucose, lactate, and C-reactive protein levels, white blood cell (WBC) counts, usage of vasopressors, pediatric risk of mortality Ⅲ (PRISM-Ⅲ) scores, and viral etiology were measured upon pediatric intensive care unit (PICU) admission. The correlation between clinical outcomes and the indicators listed above were analyzed, and the ability of CHGA as a biomarker to predict mortality was evaluated., Results: Serum CHGA levels were higher in the non-survivors group than in the survivors group (median (interquartile range): 434.8 (374.3-502.4) vs 183.3 (131.9-246.9) μg/l; p < 0.001) and were correlated with norepinephrine (r = 0.37. p < 0.001), blood glucose (r = 0.32, p = 0.001), lactate (r = 0.25, p = 0.009), WBC (r = 0.20, p = 0.039), and PRISM-Ⅲ scores (r = 0.748, p < 0.0001). Patients suffering neurogenic pulmonary edema, those infected with enterovirus A71, and those requiring more vasopressors had higher serum CHGA levels (median (interquartile range): 385 (239.9-488.8) vs 161 (115.6-222.9), 340.6 (190.6-436.0) vs 150.5 (112.1-210.0), 395.6 (209.1-487.0) vs 167.7 (110.5-240.5) μg/l, respectively; p < 0.0001). The CHGA level upon PICU admission in severe HFMD could be an independent risk factor for mortality (adjusted odds ratio 2.459, 95% confidence interval 1.054-5.906, p = 0.038) with high specificity (87.5%) and sensitivity (82.6%) (cut-off value at 339.6 μg/l)., Conclusions: The CHGA level in severe HFMD was found to be associated with cardiopulmonary failure. If measured upon PICU admission, CHGA may provide additional prognostic information in this disease., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
6. Current status of enterovirus D68 worldwide and in Taiwan.
- Author
-
Hu YL and Chang LY
- Subjects
- Central Nervous System Viral Diseases therapy, Disease Outbreaks, Enterovirus Infections complications, Enterovirus Infections therapy, Female, Humans, Male, Myelitis therapy, Neuromuscular Diseases therapy, Seroepidemiologic Studies, Taiwan epidemiology, Enterovirus D, Human, Enterovirus Infections epidemiology
- Abstract
Enterovirus D68 was first identified in 1962 and caused a worldwide outbreak starting from the North America in 2014. Enterovirus D68 has been in continuous circulation among many countries recently, including Taiwan. Reports also reveal high seroprevalence, which indicates that the disease burden of enterovirus D68 may be underestimated via viral culture or polymerase chain reaction results. Although most infected cases have mild respiratory illness, severe complications including acute flaccid myelitis and acute respiratory distress syndrome have also been reported. In the position of an emerging pathogen, enterovirus D68 poses a threat to public health and may cause devastating diseases. Diverse severity of neurological sequelae remains inevitable among acute flaccid myelitis patients, but no curable treatment is available currently. According to the management suggestions of the American Centers of Disease Control, uses of corticosteroids and plasmapheresis are either preferred or avoided and intravenous immunoglobulin also has no clear indication in the treatment for acute flaccid myelitis. In this review article, we provide information about the epidemiology, clinical recognition and treatment strategy of enterovirus D68. Better understanding of this disease is the foothold for advanced investigation and monitoring in the future., (Copyright © 2019. Published by Elsevier B.V.)
- Published
- 2020
- Full Text
- View/download PDF
7. Seasonal distribution of febrile seizure and the relationship with respiratory and enteric viruses in Korean children based on nationwide registry data.
- Author
-
Han DH, Kim SY, Lee NM, Yi DY, Yun SW, Lim IS, and Chae SA
- Subjects
- Child, Preschool, Enterovirus Infections epidemiology, Female, Humans, Incidence, Infant, Influenza, Human epidemiology, Male, Registries, Republic of Korea, Enterovirus Infections complications, Influenza, Human complications, Seasons, Seizures, Febrile epidemiology, Seizures, Febrile virology
- Abstract
Purpose: The seasonal distribution patterns of febrile seizures and of respiratory and enteric viral pathogens are similar. In this study, we analyzed trends in febrile seizures and viral infection in Korean children, using big data from the Korean Health Insurance Review and Assessment Service (HIRA)., Methods: We analyzed children younger than 6 years who visited the hospital and were diagnosed with febrile seizures from 2009 to 2016, using medical records in the HIRA database. A total of 666,136 medical records of children with a main or subdiagnosis of febrile seizure from 2008 to 2016 were included. Of these records, patients younger than 1 month and records before 2009 were excluded. Finally, 558,130 records were extracted., Results: The medical records included 315,774 male children and 242,356 (43.4%) female children, with a mean age of 2.31 ± 1.31 years. The annual incidence of febrile seizure was 25.4 per 1000 person-years (27.9 for boys and 22.7 for girls). The ratio of male to female children was 1.30: 1, and records of 1-year-old children comprised the highest proportion (n = 210,400, 33.70%). The total monthly number of patients was highest in May (n = 64,969, 11.6%), and peaks were formed from April to July. The fewest patients were seen in October (n = 34,424, 6.17%). The most common viral pathogens were influenza in April and enterovirus during May-July., Conclusion: The seasonal distribution of febrile seizures was high from late spring to summer, and influenza virus and enterovirus were most frequently associated., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
8. Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan.
- Author
-
Okumura A, Mori H, Fee Chong P, Kira R, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, and Tanaka-Taya K
- Subjects
- Acute Disease, Child, Child, Preschool, Disease Outbreaks, Female, Gray Matter pathology, Humans, Infant, Japan, Magnetic Resonance Imaging, Male, White Matter pathology, Enterovirus D, Human pathogenicity, Enterovirus Infections complications, Gray Matter diagnostic imaging, Myelitis diagnostic imaging, Myelitis etiology, Myelitis pathology, Myelitis physiopathology, Paralysis diagnostic imaging, Paralysis etiology, Paralysis pathology, Paralysis physiopathology, White Matter diagnostic imaging
- Abstract
Objecive: To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection., Methods: We performed a detailed review of the spinal and cranial MRI results of 54 children with acute flaccid myelitis. We focused on the range of longitudinal lesions, the localization and appearance of lesions within a horizontal section, Gadolinium-enhancement, and changes over time., Results: All children had longitudinal spinal lesions involving central gray matter. Twenty-six children had lesions spanning the entire spine. Six of them had weakness in all limbs, whereas seven had weakness of only one limb. Thirty-eight children had lesions in both gray and white matter and limb weakness tended to be more severe in these children. During the acute period, spinal lesions showed bilateral ill-defined widespread T2 hyperintensity. During the subacute period, lesions were well defined and confined to the anterior horn. The distribution of limb weakness was correlated with the appearance of lesions during the subacute period. Gadolinium enhancement was performed in 37 children, and enhancement was seen in the cauda equina in 29 children. Enhancement was infrequent within 2 days after onset but was seen in almost all children thereafter. Twenty-two children had brainstem lesions continuous with spinal lesions., Conclusion: Extensive longitudinal spinal lesions were characteristic in children with acute flaccid myelitis. Lesions were usually bilateral and widespread during the acute period, whereas localization to the anterior horn could become obvious. Although enhancement of the cauda equina was often observed, its appearance was sometimes delayed., (Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
9. Transient posterior cerebral arteriopathy: An unusual case enterovirus-related.
- Author
-
Piccolo B, Barsacchi M, Greco F, Cerasti D, Ormitti F, and Pisani F
- Subjects
- Brain blood supply, Brain diagnostic imaging, Brain virology, Brain Ischemia diagnostic imaging, Cerebral Arterial Diseases diagnostic imaging, Child, Preschool, Humans, Magnetic Resonance Imaging, Male, Stroke diagnostic imaging, Brain Ischemia virology, Cerebral Arterial Diseases virology, Enterovirus Infections complications, Posterior Cerebral Artery diagnostic imaging, Stroke virology
- Abstract
Transient Cerebral Arteriopathy (TCA) is one of the main causes of childhood stroke. Here we present an unusual case of Arterial Ischemic Stroke (AIS) caused by a TCA of posterior flow and originally located in the right thalamus. The detection of enterovirus in the cerebrospinal fluid allowed us to suppose a probable post infectious etiology. The course of symptoms was self-limited and the child had a complete clinical recovery after five days. A new ischemic lesion on the antero-inferior paravermian region of the left cerebellum was revealed by a following brain Magnetic Resonance Imaging (MRI) three months later and these findings were reported by further brain MRI control performed after 15 months. Comparing follow up Magnetic Resonance Angiography (MRA) with previous High Resolution Vessel Wall Magnetic Resonance Imaging (HRMI), we found a vessel narrowing at the level of the Posterior Inferior Cerebellar Artery that might explain the arteriopathy process. In conclusion, clinical and radiological course allow us to speculate that this multifocal cerebral arteriopathy might be a transient lesion due to enterovirus infection. To our knowledge, there are only three articles describing TCA enterovirus-related, and brain MRA was performed in only one case; in addition, no one with the involvement of the posterior circulation., (Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
10. A neonatal mouse model of Enterovirus D68 infection induces both interstitial pneumonia and acute flaccid myelitis.
- Author
-
Sun S, Bian L, Gao F, Du R, Hu Y, Fu Y, Su Y, Wu X, Mao Q, and Liang Z
- Subjects
- Animals, Animals, Newborn, Disease Models, Animal, Enterovirus D, Human pathogenicity, Enterovirus Infections immunology, Female, Lethal Dose 50, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, Viral Load, Viral Tropism, Antibodies, Viral therapeutic use, Central Nervous System Viral Diseases virology, Enterovirus Infections complications, Immunization, Passive, Lung Diseases, Interstitial virology, Myelitis virology, Neuromuscular Diseases virology
- Abstract
Enterovirus D68 (EV-D68) is a causative agent of recent outbreaks of severe respiratory illness, pneumonia and acute flaccid myelitis (AFM) worldwide. The study of the pathogenesis, vaccines and anti-viral drugs for EV-D68 infection has been reported. Given the previously described mouse model of EV-D68, we sought to establish a neonatal mice model inducing both pneumonia and AFM. The neonatal BALB/c mice were inoculated intraperitoneally with the EV-D68 strain (named15296-virus) which was produced by the reverse genetics method. The infected mice displayed limb paralysis, tachypnea and even death, which were similar to the clinical symptoms of human infections. Moreover, the results of histopathologic examination and immunohistochemical staining showed acidophilic necrosis in the muscle, the spinal cord and alveolar wall thickening in the lung, indicating that EV-D68 exhibited strong tropism to the muscles, spinal cord and lung. Furthermore, the results of real-time PCR also suggested that the viral loads in the blood, spinal cord, muscles and lung were higher than those in other tissues at different time points post-infection. Additionally, the neonatal mouse model was used for evaluating the EV-D68 infection. The results of the anti-serum passive and maternal antibody protection indicated that the neonatal mice could be protected against the EV-D68 challenge, and displayed that both the serum of 15296-virus and prototype-virus (Fermon) were performing a certain cross-protective activity against the 15296-virus challenge. In summary, the above results proved that our neonatal mouse model possessed not only the interstitial pneumonia and AFM simultaneously but also a potentiality to evaluate the protective effects of EV-D68 vaccines and anti-viral drugs in the future., (Copyright © 2018. Published by Elsevier B.V.)
- Published
- 2019
- Full Text
- View/download PDF
11. [Infection outbreak due to an enterovirus causing severe neurological complications in a tertiary hospital].
- Author
-
Leal Barceló AM, Carrascosa García P, Rincón López EM, Miranda Herrero MC, and Navarro ML
- Subjects
- Child, Preschool, Enterovirus Infections virology, Female, Humans, Infant, Male, Prospective Studies, Severity of Illness Index, Tertiary Care Centers, Disease Outbreaks, Enterovirus Infections complications, Nervous System Diseases virology
- Published
- 2018
- Full Text
- View/download PDF
12. [Acute neurological disease due to enterovirus: A review of clinical cases in a tertiary hospital in Andalusia after an outbreak in Catalonia].
- Author
-
Valdivielso Martínez AI, Carazo Gallego B, Cubiles Arilo Z, Moreno-Pérez D, and Urda Cardona A
- Subjects
- Acute Disease, Child, Disease Outbreaks, Enterovirus Infections diagnosis, Enterovirus Infections epidemiology, Enterovirus Infections therapy, Humans, Infant, Nervous System Diseases diagnosis, Nervous System Diseases therapy, Spain epidemiology, Tertiary Care Centers, Enterovirus Infections complications, Nervous System Diseases virology
- Published
- 2018
- Full Text
- View/download PDF
13. Pediatric Acute Flaccid Paralysis: Enterovirus D68-Associated Anterior Myelitis.
- Author
-
Yoder JA, Lloyd M, Zabrocki L, and Auten J
- Subjects
- Anti-Inflammatory Agents pharmacology, Anti-Inflammatory Agents therapeutic use, Child, Enterovirus D, Human pathogenicity, Enterovirus Infections virology, Humans, Immunoglobulins, Intravenous pharmacology, Immunoglobulins, Intravenous therapeutic use, Immunologic Factors pharmacology, Immunologic Factors therapeutic use, Magnetic Resonance Imaging methods, Male, Methylprednisolone pharmacology, Methylprednisolone therapeutic use, Muscle Hypotonia virology, Myelitis virology, Polymerase Chain Reaction methods, United States, Enterovirus Infections complications, Muscle Hypotonia etiology, Myelitis etiology
- Abstract
Background: Enteroviral infections can cause acute flaccid paralysis secondary to anterior myelitis. Magnetic resonance imaging (MRI) is important in the diagnosis of this potentially devastating pediatric disease. Before the 2014 outbreak of Enterovirus D68 (EV-D68), the virus was considered a relatively benign disease., Case Report: A fully immunized 8-year-old boy was brought to the emergency department complaining of a cough, headache, neck pain, and right arm pain and weakness. Deep tendon reflexes in the weak arm could not be elicited. MRI of the brain and cervical spine revealed anterior myelitis of the cervical spine. The patient was given intravenous antibiotics, acyclovir, and methylprednisolone with no initial improvement. He was then given intravenous immunoglobulin over 3 days with improvement in symptoms. Nasal swab polymerase chain reaction revealed EV-D68. Despite medical management, the child was left with long-term motor disability in the effected extremity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute flaccid paralysis is a potential devastating complication of enteroviral infections. Extremity complaints in the clinical setting of central nervous system infection should raise concern for encephalomyelitis. MRI is extremely helpful in establishing this diagnosis. Prevalence of non-polio enteroviral paralytic events is increasing in the United States. Potential EV-D68 cases should be reported to local health departments. Emergency medicine providers should consider this complication in the child with acute, unexplained significant respiratory illness with new neurologic complaints., (Published by Elsevier Inc.)
- Published
- 2017
- Full Text
- View/download PDF
14. Acute Hypotonia in an Infant.
- Author
-
Sierakowski J, Arthur J, and Wylie T
- Subjects
- Emergency Service, Hospital organization & administration, Enterovirus Infections physiopathology, Female, Humans, Immunoglobulins pharmacology, Immunoglobulins therapeutic use, Immunologic Factors pharmacology, Immunologic Factors therapeutic use, Infant, Magnetic Resonance Imaging methods, Methylprednisolone Hemisuccinate pharmacology, Methylprednisolone Hemisuccinate therapeutic use, Muscle Hypotonia diagnosis, Steroids pharmacology, Steroids therapeutic use, Enterovirus Infections complications, Muscle Hypotonia etiology, Muscle Hypotonia physiopathology
- Abstract
Background: Acute flaccid myelitis (AFM) is increasing in incidence in the United States and presenting to emergency departments (EDs) across the country. This clinical entity presents as acute paralysis, with magnetic resonance imaging changes in the gray matter only in children younger than 21 years of age. The etiology is unknown, although preceding viral illnesses are common. There are no consensus guidelines regarding treatment., Case Report: A 4-month-old girl presented with decreased bilateral arm movement. The history consisted of a recent upper respiratory illness and abrupt decline in movement. She was found to have truncal and peripheral hypotonia, while maintaining her airway. Magnetic resonance imaging found gray matter hyperintensity at C2-C6, with no white matter changes. The patient was positive for enterovirus. Intravenous steroids and intravenous immunoglobulin were given, with slight improvement prior to discharge to an inpatient rehabilitation center. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: AFM was largely nonexistent in the United States after implementation of the polio vaccine, but the incidence has recently increased. Pediatric patients are now presenting to EDs with acute hypotonia, and emergency physicians must recognize how to differentiate this emerging diagnosis from other causes of acute flaccid paralysis. The clinical course of AFM does not seem to change acutely, in stark contrast to disease entities like botulism, which can change in hours. Patients with AFM do not need aggressive ED diagnostic evaluation, but rather transfer to a pediatric hospital for further care. Therefore, discerning the etiology of pediatric hypotonia with history and physical examination alone is important., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
15. Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging Infection?
- Author
-
Wali RK, Lee AH, Kam JC, Jonsson J, Thatcher A, Poretz D, Ambardar S, Piper J, Lynch C, Kulkarni S, Cochran J, and Djurkovic S
- Subjects
- Acute Disease, Adult, Enterovirus Infections complications, Graft Rejection, Graft Survival, Humans, Kidney Failure, Chronic virology, Magnetic Resonance Imaging, Male, Middle Aged, Neuroimaging, Prognosis, Risk Factors, Transplant Recipients, Brain Diseases etiology, Enterovirus D, Human pathogenicity, Enterovirus Infections virology, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Paraplegia etiology, Postoperative Complications
- Abstract
We report the first case of enterovirus-D68 infection in an adult living-donor kidney transplant recipient who developed rapidly progressive bulbar weakness and acute flaccid limb paralysis following an upper respiratory infection. We present a 45-year-old gentleman who underwent pre-emptive living-donor kidney transplantation for IgA nephropathy. Eight weeks following transplantation, he developed an acute respiratory illness from enterovirus/rhinovirus that was detectable in nasopharyngeal (NP) swabs. Within 24 h of onset of respiratory symptoms, the patient developed binocular diplopia which rapidly progressed to multiple cranial nerve dysfunctions (acute bulbar syndrome) over the next 24 h. Within the next 48 h, asymmetric flaccid paralysis of the left arm and urinary retention developed. While his neurological symptoms were evolving, the Centers for Disease Control reported that the enterovirus strain from the NP swabs was, in fact, Enterovirus-D68 (EV-D68). Magnetic resonance imaging of the brain demonstrated unique gray matter and anterior horn cell changes in the midbrain and spinal cord, respectively. Constellation of these neurological symptoms and signs was suggestive for postinfectious encephalomyelitis (acute disseminated encephalomyelitis [ADEM]) from EV-D68. Treatment based on the principles of ADEM included intensive physical therapy and other supportive measures, which resulted in a steady albeit slow improvement in his left arm and bulbar weakness, while maintaining stable allograft function., (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2015
- Full Text
- View/download PDF
16. Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigation.
- Author
-
Midgley CM, Watson JT, Nix WA, Curns AT, Rogers SL, Brown BA, Conover C, Dominguez SR, Feikin DR, Gray S, Hassan F, Hoferka S, Jackson MA, Johnson D, Leshem E, Miller L, Nichols JB, Nyquist AC, Obringer E, Patel A, Patel M, Rha B, Schneider E, Schuster JE, Selvarangan R, Seward JF, Turabelidze G, Oberste MS, Pallansch MA, and Gerber SI
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Asthma complications, Asthma virology, Child, Child, Preschool, Colorado epidemiology, Cough epidemiology, Cough virology, Critical Care statistics & numerical data, Dyspnea epidemiology, Dyspnea virology, Enterovirus Infections complications, Enterovirus Infections virology, Female, Fever epidemiology, Fever virology, Hospitalization statistics & numerical data, Humans, Illinois epidemiology, Infant, Infant, Newborn, Male, Middle Aged, Missouri epidemiology, Respiration, Artificial statistics & numerical data, Respiratory Sounds, Respiratory Tract Infections complications, Respiratory Tract Infections virology, United States epidemiology, Young Adult, Disease Outbreaks statistics & numerical data, Enterovirus D, Human, Enterovirus Infections epidemiology, Respiratory Tract Infections epidemiology
- Abstract
Background: Enterovirus D68 (EV-D68) has been infrequently reported historically, and is typically associated with isolated cases or small clusters of respiratory illness. Beginning in August, 2014, increases in severe respiratory illness associated with EV-D68 were reported across the USA. We aimed to describe the clinical, epidemiological, and laboratory features of this outbreak, and to better understand the role of EV-D68 in severe respiratory illness., Methods: We collected regional syndromic surveillance data for epidemiological weeks 23 to 44, 2014, (June 1 to Nov 1, 2014) and hospital admissions data for epidemiological weeks 27 to 44, 2014, (June 29 to Nov 1, 2014) from three states: Missouri, Illinois and Colorado. Data were also collected for the same time period of 2013 and 2012. Respiratory specimens from severely ill patients nationwide, who were rhinovirus-positive or enterovirus-positive in hospital testing, were submitted between Aug 1, and Oct 31, 2014, and typed by molecular sequencing. We collected basic clinical and epidemiological characteristics of EV-D68 cases with a standard data collection form submitted with each specimen. We compared patients requiring intensive care with those who did not, and patients requiring ventilator support with those who did not. Mantel-Haenszel χ(2) tests were used to test for statistical significance., Findings: Regional and hospital-level data from Missouri, Illinois, and Colorado showed increases in respiratory illness between August and September, 2014, compared with in 2013 and 2012. Nationwide, 699 (46%) of 1529 patients tested were confirmed as EV-D68. Among the 614 EV-D68-positive patients admitted to hospital, age ranged from 3 days to 92 years (median 5 years). Common symptoms included dyspnoea (n=513 [84%]), cough (n=500 [81%]), and wheezing (n=427 [70%]); 294 (48%) patients had fever. 338 [59%] of 574 were admitted to intensive care units, and 145 (28%) of 511 received ventilator support; 322 (52%) of 614 had a history of asthma or reactive airway disease; 200 (66%) of 304 patients with a history of asthma or reactive airway disease required intensive care compared with 138 (51%) of 270 with no history of asthma or reactive airway disease (p=0·0004). Similarly, 89 (32%) of 276 patients with a history of asthma or reactive airway disease required ventilator support compared with 56 (24%) of 235 patients with no history of asthma or reactive airway disease (p=0·039)., Interpretation: In 2014, EV-D68 caused widespread severe respiratory illness across the USA, disproportionately affecting those with asthma. This unexpected event underscores the need for robust surveillance of enterovirus types, enabling improved understanding of virus circulation and disease burden., Funding: None., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
17. Elevated cerebrospinal fluid endothelin 1 associated with neurogenic pulmonary edema in children with enterovirus 71 encephalitis.
- Author
-
Tu YF, Lin CH, Lee HT, Yan JJ, Sze CI, Chou YP, Ho CJ, and Huang CC
- Subjects
- Animals, Brain Stem metabolism, Child, Preschool, Endothelin-1 metabolism, Female, Humans, Infant, Male, Meningitis, Aseptic cerebrospinal fluid, Rats, Encephalitis, Viral complications, Endothelin-1 cerebrospinal fluid, Enterovirus A, Human isolation & purification, Enterovirus Infections complications, Pulmonary Edema cerebrospinal fluid, Pulmonary Edema virology
- Abstract
Objectives: Neurogenic pulmonary edema (NPE) is a fatal complication in children with enterovirus 71 (EV71) encephalitis. Endothelin 1 (ET-1), a potent vasoconstrictor, can induce pulmonary edema in rats via intrathecal injections. Thus, it was hypothesized that ET-1 in the central nervous system may correlate with NPE in children with EV71 encephalitis., Methods: Clinical data and ET-1 in the cerebrospinal fluid (CSF) were compared between three groups: (1) EV71 encephalitis with NPE; (2) EV71 encephalitis without NPE; and (3) non-EV71 aseptic meningitis. ET-1 immunostaining was performed on the brainstem of autopsy patients., Results: The EV71 with NPE group showed significantly increased CSF levels of ET-1 compared to the EV71 without NPE and the non-EV71 aseptic meningitis groups (both p<0.01). The optimum cut-off point of ET-1 to predict NPE in EV71 patients, based on the receiver operating characteristic curve, was 0.5 pg/ml (sensitivity 83%, specificity 100%). Immunostaining in the brainstem showed increased ET-1 expression, mainly in the oligodendrocytes, in EV71 with NPE patients compared with control patients., Conclusion: ET-1 in the central nervous system may play a role in the development of NPE in children with EV71 infection and could be used as a biomarker or therapeutic target for NPE in EV71 encephalitis., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
18. Treatment of refractory enterovirus effusive-constrictive pericarditis with corticosteroids.
- Author
-
Howard FM and Patel AY
- Subjects
- Adrenal Cortex Hormones pharmacology, Adult, Enterovirus Infections complications, Enterovirus Infections diagnosis, Humans, Male, Pericarditis, Constrictive complications, Pericarditis, Constrictive diagnosis, Treatment Outcome, Adrenal Cortex Hormones therapeutic use, Enterovirus drug effects, Enterovirus Infections drug therapy, Pericarditis, Constrictive drug therapy
- Published
- 2015
- Full Text
- View/download PDF
19. Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients.
- Author
-
Waghmare A, Pergam SA, Jerome KR, Englund JA, Boeckh M, and Kuypers J
- Subjects
- Adult, Aged, Base Sequence, DNA, Viral genetics, Female, Humans, Immunocompromised Host, Male, Middle Aged, Rhinovirus genetics, Rhinovirus isolation & purification, Young Adult, Enterovirus D, Human genetics, Enterovirus D, Human isolation & purification, Enterovirus D, Human pathogenicity, Enterovirus Infections complications, Enterovirus Infections diagnosis, Hematologic Neoplasms complications, Hematopoietic Stem Cell Transplantation adverse effects, Respiratory Tract Infections complications, Respiratory Tract Infections diagnosis
- Abstract
The United States Centers for Disease Control and Prevention reported over 1000 cases of severe respiratory disease in pediatric patients associated with enterovirus D68 (EV-D68) in the fall of 2014. We sought to identify and define the clinical burden of disease due to EV-D68 in adult patients with hematologic malignancy or undergoing hematopoietic cell transplant (HCT). Real-time reverse-transcriptase polymerase chain reaction (PCR) for EV-D68 was performed on all respiratory samples positive for human rhinovirus (HRV) or negative for all respiratory viruses by a laboratory-developed respiratory viral PCR panel from August 11, 2014, to November 7, 2014. Presumptive cases were defined as those with an EV-D68 PCR cycle threshold (CT) at least 4 cycles lower than the HRV CT for HRV-positive samples or any EV-D68 CT value for HRV-negative samples. Sequencing of a 150-bp fragment of the 5' noncoding region confirmed EV-D68 in 16 of 506 respiratory samples. Eight patients had a history of hematologic malignancy, and 6 of these had undergone HCT. Presentation ranged from mild upper respiratory symptoms to respiratory failure. EV-D68 can infect adult patients with hematologic malignancy and HCT recipients and may be associated with severe respiratory disease. Current commercial diagnostic assays cannot differentiate EV-D68 from other enteroviruses or HRV, and improved rapid diagnostic tools are needed., (© 2015 by The American Society of Hematology.)
- Published
- 2015
- Full Text
- View/download PDF
20. Enterovirus D68: a new threat to hematology patients?
- Author
-
Ljungman P
- Subjects
- Female, Humans, Male, Enterovirus D, Human, Enterovirus Infections complications, Enterovirus Infections diagnosis, Hematologic Neoplasms complications, Hematopoietic Stem Cell Transplantation adverse effects, Respiratory Tract Infections complications, Respiratory Tract Infections diagnosis
- Published
- 2015
- Full Text
- View/download PDF
21. The absence of exanthema is related with death and illness severity in acute enterovirus infection.
- Author
-
Zhou HT, Guo YH, Tang P, Zeng L, Pan YX, Ding XX, Wen K, Tao SH, Chen MJ, Wang B, Yu N, and Che XY
- Subjects
- Acute Disease, Child, Preschool, China, Enterovirus Infections complications, Enterovirus Infections mortality, Exanthema complications, Female, Humans, Infant, Male, Retrospective Studies, Enterovirus Infections diagnosis, Exanthema diagnosis
- Abstract
Objective: To clarify whether exanthema is related to illness severity in acute enterovirus infection in children., Methods: The data of pediatric inpatients at Zhujiang Hospital during 2009-2012 with an acute enterovirus infection were reviewed retrospectively. Enterovirus infection was determined by real-time reverse transcription PCR. Clinical data were summarized and compared between cases with and without exanthema., Results: A total of 780 pediatric inpatients with an acute enterovirus infection were included in this study, of whom 83 (10.6%) presented no exanthema. The percentage of deaths in the group of patients without exanthema was significantly higher than that in the group with exanthema (7.2% vs. 1.1%; p = 0.002). Central nervous system involvement (41.0% vs. 30.0%; p = 0.041), severe central nervous system (CNS) involvement (21.7% vs. 11.0%; p = 0.005), severe CNS involvement with cardiopulmonary failure (9.6% vs. 2.3%; p = 0.002), an altered level of consciousness (15.7% vs. 7.6%; p = 0.013), and convulsions (14.4% vs. 6.3%; p = 0.007) occurred significantly more frequently in the group without exanthema., Conclusions: A considerable proportion of children with an acute enterovirus infection in Guangdong Province, China during 2009-2012 presented no exanthema, and the absence of exanthema was found to be related to death and illness severity for these acute enterovirus infections. Clinicians in China should consider enterovirus as the possible pathogen when treating children with an acute pathogen infection without exanthema.
- Published
- 2014
- Full Text
- View/download PDF
22. Enterovirus/picornavirus infections.
- Author
-
Jubelt B and Lipton HL
- Subjects
- Enterovirus genetics, Enterovirus ultrastructure, Enterovirus Infections epidemiology, Enterovirus Infections history, Enterovirus Infections therapy, History, 19th Century, History, 20th Century, History, 21st Century, History, Ancient, Humans, Nervous System Diseases virology, Enterovirus pathogenicity, Enterovirus Infections complications, Nervous System Diseases etiology
- Published
- 2014
- Full Text
- View/download PDF
23. A case of neonatal human parechovirus encephalitis with a favourable outcome.
- Author
-
Renna S, Bergamino L, Pirlo D, Rossi A, Furione M, Piralla A, Mascaretti M, Cristina E, Marazzi MG, and Di Pietro P
- Subjects
- Child, Humans, Magnetic Resonance Imaging, Male, Parechovirus genetics, Encephalitis, Viral etiology, Enterovirus Infections complications, Parechovirus pathogenicity
- Abstract
Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous system (CNS) infections similar to enterovirus (EVs) meningoencephalitis in the neonatal period, resulting in white matter lesions that can be visualized with cranial ultrasonography and magnetic resonance imaging, and correlated to a large spectrum of neurological outcomes. HPeV should be suspected in neonates with signs and symptoms of sepsis-like illness or CNS disease. We report a case of neonatal HPeV encephalitis, diagnosed on the basis of clinical and radiological findings and HPeV RT-PCR, with a good neurological outcome., (Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
24. Plasma B-type natriuretic peptide study in children with severe enterovirus 71 infection: a pilot study.
- Author
-
Jan SL, Lin SJ, Fu YC, Lin MC, Chan SC, and Hwang B
- Subjects
- Biomarkers blood, Child, Child, Preschool, Echocardiography, Enterovirus A, Human, Enterovirus Infections complications, Enterovirus Infections diagnosis, Female, Heart Diseases diagnosis, Heart Diseases etiology, Heart Diseases physiopathology, Humans, Infant, Male, Pilot Projects, Severity of Illness Index, Stroke Volume, Ventricular Function, Left, Enterovirus Infections blood, Natriuretic Peptide, Brain blood
- Abstract
Objectives: Severe enterovirus 71 (EV71) infections in children can result in acute heart failure. B-type natriuretic peptide (BNP) is a good biomarker of myocardial stress. The purpose of this study was to use plasma BNP for the detection of EV71 infection with cardiac involvement., Methods: Patients with severe EV71 infections and healthy control subjects were studied: group 1 (n=30), normal controls; group 2 (n=20), EV71 infection with central nervous system involvement; and group 3 (n=3), EV71 infection with cardiopulmonary failure. The demographic and laboratory data including plasma BNP levels were analyzed statistically., Results: All group 2 patients recovered completely without neurological sequelae, and all group 3 patients survived without cardiac complications. Group 3 patients had higher troponin I, MB fraction of creatine kinase, and BNP levels than patients of the other groups. The median BNP values were <5 pg/ml in group 1, 9.5 pg/ml in group 2, and 238 pg/ml in group 3. Using a BNP cut-off value of 100 pg/ml to identify cases with severe EV71 infection and acute heart failure, the sensitivity and specificity were both 100%., Conclusions: Children with severe EV71 infections have varying degrees of myocardial stress. Plasma BNP would be a sensitive and reliable biomarker for the detection of cardiac involvement in children with severe EV71 infections., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
25. Hemolytic uremic syndrome caused by enteroviral infection.
- Author
-
Lee MD, Tzen CY, Lin CC, Huang FY, Liu HC, and Tsai JD
- Subjects
- Child, Preschool, Hemolytic-Uremic Syndrome therapy, Humans, Male, Reverse Transcriptase Polymerase Chain Reaction, Enterovirus Infections complications, Hemolytic-Uremic Syndrome etiology
- Abstract
A 4-year-old boy presented with enteroviral infection complicated with atypical hemolytic uremic syndrome (aHUS). Enterovirus RNA was detected by reverse transcription polymerase chain reaction (RT-PCR) of both blood and kidney biopsy specimens. A survey of the complement system did not reveal a specific complement defect. Supportive therapy with blood components transfusion, plasma therapy, and immunosuppressants was administered, however, renal function did not recover. The results of this report demonstrate that the enterovirus is the cause of aHUS., (Copyright © 2012. Published by Elsevier B.V.)
- Published
- 2013
- Full Text
- View/download PDF
26. Acute necrotizing encephalopathy associated with enterovirus infection.
- Author
-
Tabarki B, Thabet F, Al Shafi S, Al Adwani N, Chehab M, and Al Shahwan S
- Subjects
- Child, Preschool, Enterovirus Infections diagnosis, Female, Follow-Up Studies, Humans, Leukoencephalitis, Acute Hemorrhagic diagnosis, Magnetic Resonance Imaging, Enterovirus Infections complications, Leukoencephalitis, Acute Hemorrhagic complications
- Abstract
Acute necrotizing encephalopathy is a rare, clinically distinct entity of acute encephalopathy triggered by acute febrile diseases, mostly viral infections. It is postulated to arise from uncontrolled cytokine release during a febrile illness, and is most often seen in East Asia. We describe a rare Saudi patient of acute necrotizing encephalopathy attributable to enterovirus in a 4 years and 6 months old girl. A work-up revealed elevations in serum and cerebrospinal fluid interleukin-6 and tumor necrosis factor-α. The outcome on intravenous pulse methylprednisolone was good. This case is the first, to the best of our knowledge, of acute necrotizing encephalopathy reported from Saudi Arabia with a good outcome despite severe magnetic resonance imaging findings and delay in the steroid treatment., (Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
27. Enteroviral encephalitis presenting as rapidly progressive aphasia.
- Author
-
Kim KW, Ahn SW, Park KY, Youn YC, and Shin HW
- Subjects
- Enterovirus, Female, Humans, Young Adult, Aphasia virology, Encephalitis, Viral complications, Enterovirus Infections complications, Frontal Lobe virology
- Abstract
Enteroviral CNS infection is common and its clinical course is usually benign. In immunocompromised patients, however, it can cause meningoencephalitis, presenting with altered mentality and seizure. We describe a previously healthy female patient with enteroviral meningoencephalitis who showed rapidly progressive aphasia. Examination of her cerebrospinal fluid (CSF) showed pleocytosis with lymphocyte dominance, elevated protein, and normal glucose, findings compatible with viral encephalitis. Fluid-attenuated inversion recovery (FLAIR) brain MRI showed hyperintensity in the left frontal and parietal cortices. Enterovirus in the CSF was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of the CSF. Although her neurological deficits had progressed to global aphasia, conservative management resulted in complete improvement within 3 months. This case provides unusual clinical manifestations and imaging findings in enteroviral encephalitis., (Copyright © 2012 Elsevier B.V. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
28. Enterovirus 71 meningoencephalitis complicating rituximab therapy.
- Author
-
Ahmed R, Buckland M, Davies L, Halmagyi GM, Rogers SL, Oberste S, and Barnett MH
- Subjects
- Antineoplastic Agents adverse effects, Enterovirus Infections complications, Fatal Outcome, Humans, Male, Meningoencephalitis physiopathology, Middle Aged, Rituximab, Antibodies, Monoclonal, Murine-Derived adverse effects, Enterovirus A, Human immunology, Enterovirus Infections immunology, Immunosuppressive Agents adverse effects, Meningoencephalitis virology
- Abstract
We describe a fatal case of proven enterovirus 71 meningoencephalitis complicating monoclonal anti-CD20 antibody therapy for non-Hodgkin's lymphoma. B-cell depletion, an effective treatment strategy in an expanding spectrum of hematological and inflammatory disorders, impairs neutralising antibody-mediated clearance of enterovirus. The global threat of emerging neurotropic viruses such as enterovirus 71 is heightened by an increasing pool of susceptible individuals in non-endemic regions., (Copyright © 2011 Elsevier B.V. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
29. Myocarditis in children and detection of viruses in myocardial tissue: implications for immunosuppressive therapy.
- Author
-
Camargo PR, Okay TS, Yamamoto L, Del Negro GM, and Lopes AA
- Subjects
- Adenovirus Infections, Human complications, Adenovirus Infections, Human drug therapy, Adenovirus Infections, Human immunology, Child, Child, Preschool, Cytomegalovirus Infections complications, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections immunology, DNA, Viral isolation & purification, Enterovirus Infections complications, Enterovirus Infections drug therapy, Enterovirus Infections immunology, Genome, Viral, Herpes Simplex complications, Herpes Simplex drug therapy, Herpes Simplex immunology, Humans, Infant, Myocardium immunology, Cardiomyopathy, Dilated drug therapy, Cardiomyopathy, Dilated immunology, Cardiomyopathy, Dilated virology, Immunosuppressive Agents therapeutic use, Myocarditis drug therapy, Myocarditis immunology, Myocarditis virology, Virus Diseases complications, Virus Diseases drug therapy, Virus Diseases immunology
- Abstract
Background: There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression., Methods: Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 ± 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were re-catheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included., Results: Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 ± 2.8% to 45.7 ± 8.6% (versus 20.0 ± 4.0% to 22.0 ± 9.0% in historical controls, p<0.01) and cardiac index from 3.28 ± 0.51 L/min/m(2) to 4.40 ± 0.49 L/min/m(2) (versus 3.50 ± 0.40 L/min/m(2) to 3.70 ± 0.50 L/min/m(2) in controls, p<0.01), regardless of the presence of viral genomes (p=0.98 and p=0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 ± 3.6% to 27.5 ± 10.6%)., Conclusion: Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
30. Neural pathogenesis of enterovirus 71 infection.
- Author
-
Weng KF, Chen LL, Huang PN, and Shih SR
- Subjects
- Apoptosis, Enterovirus Infections complications, Host-Pathogen Interactions, Humans, Nervous System virology, Sepsis complications, Sepsis virology, Enterovirus A, Human pathogenicity, Enterovirus Infections virology, Nervous System Diseases virology
- Abstract
Enterovirus 71 (EV71) is a neurotropic pathogen that can cause severe neural diseases and complications on infected patients. Clinical observations showed that EV71-induced immune responses may be associated with virus induced neurogenic pulmonary edema. Here reviewed studies that discovered several host molecules as potential factors for EV71 virulence.
- Published
- 2010
- Full Text
- View/download PDF
31. Differential interferon responses enhance viral epitope generation by myocardial immunoproteasomes in murine enterovirus myocarditis.
- Author
-
Jäkel S, Kuckelkorn U, Szalay G, Plötz M, Textoris-Taube K, Opitz E, Klingel K, Stevanovic S, Kandolf R, Kotsch K, Stangl K, Kloetzel PM, and Voigt A
- Subjects
- Animals, Disease Models, Animal, Enterovirus Infections complications, Enterovirus Infections pathology, Epitopes, T-Lymphocyte immunology, Humans, Interferon Type I pharmacology, Mice, Mice, Inbred C57BL, Myocarditis pathology, Proteasome Endopeptidase Complex drug effects, Enterovirus immunology, Enterovirus Infections immunology, Interferon Type I immunology, Myocarditis immunology, Myocarditis virology, Proteasome Endopeptidase Complex immunology
- Abstract
Murine models of coxsackievirus B3 (CVB3)-induced myocarditis mimic the divergent human disease course of cardiotropic viral infection, with host-specific outcomes ranging from complete recovery in resistant mice to chronic disease in susceptible hosts. To identify susceptibility factors that modulate the course of viral myocarditis, we show that type-I interferon (IFN) responses are considerably impaired in acute CVB3-induced myocarditis in susceptible mice, which have been linked to immunoproteasome (IP) formation. Here we report that in concurrence with distinctive type-I IFN kinetics, myocardial IP formation peaked early after infection in resistant mice and was postponed with maximum IP expression concomitant to massive inflammation and predominant type-II IFN responses in susceptible mice. IP activity is linked to a strong enhancement of antigenic viral peptide presentation. To investigate the impact of myocardial IPs in CVB3-induced myocarditis, we identified two novel CVB3 T cell epitopes, virus capsid protein 2 [285-293] and polymerase 3D [2170-2177]. Analysis of myocardial IPs in CVB3-induced myocarditis revealed that myocardial IP expression resulted in efficient epitope generation. As opposed to the susceptible host, myocardial IP expression at early stages of disease corresponded to enhanced CVB3 epitope generation in the hearts of resistant mice. We propose that this process may precondition the infected heart for adaptive immune responses. In conclusion, type-I IFN-induced myocardial IP activity at early stages coincides with less severe disease manifestation in CVB3-induced myocarditis.
- Published
- 2009
- Full Text
- View/download PDF
32. Enteroviruses: new findings on the role of enteroviruses in type 1 diabetes.
- Author
-
Roivainen M
- Subjects
- Enterovirus pathogenicity, Humans, Islets of Langerhans virology, Diabetes Mellitus, Type 1 virology, Enterovirus Infections complications
- Abstract
Common enterovirus infections appear to initiate or facilitate the pathogenetic processes leading to type 1 diabetes, and sometimes also precipitate the clinical disease. It is not known in detail how enterovirus infections bring about the loss of insulin-producing beta-cells, a phenomenon characteristic of the disease. Recent results from studies on pancreases from human autopsies and cultured human islets support the idea that during systemic enterovirus infections, the virus may reach pancreatic islets and cause direct beta-cell damage. Although individual enteroviruses (EV) exhibited differences in their beta-cell tropism in the cultured human islets, all serotypes studied contained highly destructive strains. The final confirmation on the role of enteroviruses in type 1 diabetes can only be obtained from intervention studies. If the association holds true then it would be possible to reduce the risk of developing type 1 diabetes by preventing enterovirus infections with a multivalent enterovirus vaccine that could be given to children soon after birth.
- Published
- 2006
- Full Text
- View/download PDF
33. [Neuromeningeal enterovirus infections in Tunisia: epidemiology, clinical presentation, and outcome of 26 pediatric cases].
- Author
-
Jaïdane H, Chouchane C, Gharbi J, Chouchane S, Merchaoui Z, Ben Meriem C, Aouni M, and Guediche MN
- Subjects
- Adolescent, Child, Child, Preschool, DNA, Viral analysis, Enterovirus Infections complications, Female, Humans, Infant, Male, Meningitis, Viral complications, Prognosis, Prospective Studies, Reverse Transcriptase Polymerase Chain Reaction, Treatment Outcome, Tunisia epidemiology, Enterovirus Infections epidemiology, Enterovirus Infections pathology, Meningitis, Viral epidemiology, Meningitis, Viral pathology
- Abstract
Unlabelled: Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines., Objective: The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS., Method and Patients: We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR., Results: This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case)., Conclusion: This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.
- Published
- 2005
- Full Text
- View/download PDF
34. Environmental causes: viral causes.
- Author
-
Hyöty H
- Subjects
- Cytomegalovirus Infections complications, Diabetes Mellitus, Type 1 epidemiology, Enterovirus Infections complications, Humans, Rotavirus Infections complications, Rubella complications, Diabetes Mellitus, Type 1 virology, Virus Diseases complications
- Published
- 2004
- Full Text
- View/download PDF
35. [Successful treatment of Echovirus 27 meningoencephalitis in agammaglobulinaemia with intraventricular injection of gammaglobulin. A case report].
- Author
-
Mellouli F, Arrouji Z, Debre M, and Bejaoui M
- Subjects
- Child, Preschool, Humans, Male, Prognosis, Treatment Outcome, Enterovirus Infections complications, Enterovirus Infections drug therapy, Immunization, Passive, Meningoencephalitis drug therapy, Meningoencephalitis virology, gamma-Globulins pharmacology
- Abstract
Background: Meningoencephalitis due to enteroviruses is particularly serious when occurring in patients with agammaglobulinaemia. This disease is associated with a high mortality and a significant risk for neurological sequelae in such circumstances. We report here a new case treated with intraventricular immunoglobulin, whose evolution was favourable., Case Report: A three-year-old boy with agammaglobulinaemia, while he was treated with gammaglobulin with an IgG residual concentration of 10 g/l, presented neurological symptoms related to Echovirus 27 meningo encephalitis. Under treatment with intraventricular gammaglobulin by means of an Ommaya reservoir, the patient recovered., Conclusion: Favourable evolution is rare in meningo encephalitis in agammaglobulinaemic patients. Prognosis depends on an early diagnosis and on the extent of dissemination of the infection. Intraventricular gammaglobulin administration may contribute to a favourable outcome.
- Published
- 2003
- Full Text
- View/download PDF
36. Unilateral facial paralysis occurring in an infant with enteroviral otitis media and aseptic meningitis.
- Author
-
Hostetler MA, Suara RO, and Denison MR
- Subjects
- Enterovirus B, Human isolation & purification, Enterovirus Infections therapy, Enterovirus Infections virology, Female, Humans, Infant, Meningitis, Aseptic therapy, Meningitis, Aseptic virology, Otitis Media therapy, Otitis Media virology, Enterovirus Infections complications, Facial Paralysis etiology, Meningitis, Aseptic complications, Otitis Media complications
- Abstract
We report the case of a four month old infant presenting to the Emergency Department (ED) with irritability and facial asymmetry following a recent bout of gastroenteritis. Physical examination revealed a unilateral peripheral facial nerve paralysis. Common in older children and adults, facial nerve palsy has rarely been described in infancy. Although historically associated with a variety of inflammatory and infectious causes, the pathogenesis remains unclear. In this infant we were able to successfully identify an underlying acute enteroviral infection. Coxsackie B5 was isolated from the middle ear fluid, cerebrospinal fluid (CSF), nasopharyngeal and rectal swabs. After myringotomy drainage of the middle ear fluid and placement of pneumatic equalization tubes, there was rapid and complete resolution of facial paralysis.
- Published
- 2002
- Full Text
- View/download PDF
37. Non-progressive viral myelitis in X-linked agammaglobulinemia.
- Author
-
Katamura K, Hattori H, Kunishima T, Kanegane H, Miyawaki T, and Nakahata T
- Subjects
- Adolescent, Disease Progression, Enterovirus Infections virology, Humans, Male, Myelitis complications, Agammaglobulinemia complications, Agammaglobulinemia genetics, Enterovirus B, Human, Enterovirus Infections complications, Myelitis virology, X Chromosome
- Abstract
We report a 14-year-old boy with X-linked agammaglobulinemia (XLA) complicated by isolated non-progressive myelitis caused by Coxsackie virus B1. Despite the absence of immunoglobulin supplement and persistence of the virus for the initial 2 years, motor impairment did not show any progression for 3 years. This report shows that the prognosis of central nervous system infection in XLA is not determined by immunoglobulin levels alone, and that it is not always progressive or fatal. The balance between host immunity and the virulence of the causative virus may be involved in the prognosis of meningoencephalitis in XLA.
- Published
- 2002
- Full Text
- View/download PDF
38. [Concomitant Mycoplasma pneumonia, rotavirus and enterovirus infections].
- Author
-
Briard D, Mareau-Dupré C, Napuri S, Peudenier S, and Le Gall E
- Subjects
- Amoxicillin therapeutic use, Anti-Bacterial Agents therapeutic use, Child, Preschool, Follow-Up Studies, Humans, Male, Penicillins therapeutic use, Pneumonia, Mycoplasma diagnosis, Pneumonia, Mycoplasma drug therapy, Radiography, Thoracic, Roxithromycin therapeutic use, Time Factors, Enterovirus Infections complications, Pneumonia, Mycoplasma complications, Rotavirus Infections complications
- Published
- 1999
- Full Text
- View/download PDF
39. [Enteroviruses and dilated cardiomyopathies].
- Author
-
Kopecka H, Bouhour JB, Langlard JM, Petitjean J, and Freymuth F
- Subjects
- Cardiomyopathy, Dilated etiology, Cardiomyopathy, Dilated genetics, Cardiomyopathy, Dilated immunology, Enterovirus Infections complications, Enterovirus Infections genetics, Enterovirus Infections immunology, Humans, In Situ Hybridization, Myocarditis complications, Myocarditis genetics, Myocarditis immunology, Polymerase Chain Reaction, Cardiomyopathy, Dilated microbiology, Enterovirus isolation & purification, Enterovirus Infections microbiology, Myocarditis microbiology
- Published
- 1993
40. Vacuolar neuronal degeneration in the ventral horns of SCID mice in naturally occurring Theiler's encephalomyelitis.
- Author
-
Rozengurt N and Sanchez S
- Subjects
- Animals, Animals, Suckling, Disease Outbreaks veterinary, Encephalomyelitis complications, Encephalomyelitis epidemiology, Encephalomyelitis pathology, Enterovirus Infections complications, Enterovirus Infections epidemiology, Enterovirus Infections pathology, Mice, Neurons pathology, Severe Combined Immunodeficiency complications, Disease Models, Animal, Encephalomyelitis veterinary, Enterovirus Infections veterinary, Maus Elberfeld virus, Mice, SCID, Nerve Degeneration, Poliomyelitis, Severe Combined Immunodeficiency pathology, Spinal Cord pathology, Vacuoles
- Abstract
During a spontaneous outbreak of Theiler's encephalomyelitis severe combined immunodeficient mice developed high morbidity and high mortality. Histological lesions were localized in the ventral horns of the spinal cord and brain stem. The salient features were the severe vacuolar degeneration of neurones and glial cells and the absence of inflammatory cellular infiltrates. The clinical and pathological features of this outbreak indicate that the SCID mouse would be a much improved model for studying the mechanism of poliovirus infection and of virus-induced demyelinating diseases.
- Published
- 1992
- Full Text
- View/download PDF
41. Enterovirus associated placental morphology: a light, virological, electron microscopic and immunohistologic study.
- Author
-
Garcia AG, Basso NG, Fonseca ME, Zuardi JA, and Outanni HN
- Subjects
- Coxsackievirus Infections complications, Coxsackievirus Infections microbiology, Coxsackievirus Infections pathology, Echovirus Infections complications, Echovirus Infections microbiology, Echovirus Infections pathology, Enterovirus Infections microbiology, Enterovirus Infections pathology, Female, Humans, Microscopy, Electron, Placenta Diseases microbiology, Placenta Diseases pathology, Pregnancy, Pregnancy Complications, Infectious pathology, Enterovirus Infections complications, Placenta Diseases complications, Pregnancy Complications, Infectious microbiology
- Abstract
The purpose of this study was to identify the possible effect of enteroviruses on placental tissue. Seventy-eight pregnant women were studied throughout their pregnancy: enteroviral infection was detected by faecal viral isolation and seric neutralization of previously identified virus in cell culture. In 19 cases of confirmed maternal infection, placentae were examined grossly, by optical microscopy, immunohistochemical and electron microscopic methods. Ten term placentae from women included in the study, with no clinical, serological or virological evidence of enteroviral infection, were used as control, and examined by gross and optical microscopy. In 17 specimens (echovirus-coxsackievirus) an haematogenous placentitis was suspected on the basis of gross observation. Microscopic lesions were similar to those found in other viral infections, with specific features. The nature of the inflammatory reaction pointed to the presence of an acute type of haematogenous placentitis, not present in placentae of the control group. The authors (AA) comment on the results and present the hypotheses about the available data: (1) maternal enteroviremia and faecal virus shedding without placental invasion, placentary damage being an unspecific consequence of infection; (2) direct virus-induced injury is not the only possible cause for the lesions: (3) placental enteroviral infection occurred with placental pathology but the virus did not cross the organ as the newborn had no signs of infection.
- Published
- 1991
- Full Text
- View/download PDF
42. Dilated cardiomyopathy and enteroviruses.
- Subjects
- Antibodies, Viral analysis, Autoantibodies analysis, Cardiomyopathy, Dilated diagnosis, Cardiomyopathy, Dilated genetics, Cardiomyopathy, Dilated immunology, Enterovirus genetics, Enterovirus Infections diagnosis, Enterovirus Infections genetics, Enterovirus Infections immunology, Humans, Immunoglobulin M analysis, Prognosis, RNA, Viral analysis, Cardiomyopathy, Dilated etiology, Enterovirus Infections complications
- Published
- 1990
43. Animal models of cardiomyopathy.
- Author
-
Matsumori A and Kawai C
- Subjects
- Animals, Cardiomyopathies pathology, Encephalomyocarditis virus, Enterovirus Infections complications, Heart microbiology, Heart Failure etiology, Heart Failure pathology, Humans, Mice, Mice, Inbred DBA, Cardiomyopathies etiology, Disease Models, Animal, Virus Diseases complications
- Published
- 1983
- Full Text
- View/download PDF
44. Neurological manifestations of acute haemorrhagic conjunctivitis.
- Author
-
Wadia NH, Wadia PN, Katrak SM, and Misra VP
- Subjects
- Hemorrhage complications, Humans, Conjunctivitis complications, Enterovirus Infections complications, Neurologic Manifestations
- Published
- 1981
- Full Text
- View/download PDF
45. Effect of measles, mumps, rubella vaccination on pattern of encephalitis in children.
- Author
-
Koskiniemi M and Vaheri A
- Subjects
- Adolescent, Brain Damage, Chronic etiology, Chickenpox complications, Child, Child, Preschool, Drug Combinations, Encephalitis epidemiology, Encephalitis prevention & control, Enterovirus Infections complications, Female, Finland, Humans, Infant, Male, Measles-Mumps-Rubella Vaccine, Pneumonia, Mycoplasma complications, Encephalitis etiology, Measles Vaccine, Mumps Vaccine, Rubella Vaccine
- Abstract
462 patients (269 males, 193 females, aged from 1 month to 16 years) with encephalitis were treated at the Children's Hospital, University of Helsinki, over a 20-year period. The incidence of encephalitis was 8.3/100,000 child-years (range 19.8 in 1974 to 2.5 in 1985 and 1986). The organisms most commonly associated with encephalitis in children were mumps, measles, and varicella viruses, and Mycoplasma pneumoniae. After the start of the nationwide measles, parotitis, and rubella (MPR) vaccination programme in 1982 in Finland, encephalitides associated with these viruses seem to have totally vanished. Currently the pathogens most often associated with childhood encephalitides are varicella-zoster, M pneumoniae, and enteroviruses. 3% of the 462 patients died from their illness, and 7% became severely damaged, with the poorest outcome occurring after multiple infections, and herpes simplex virus, cytomegalovirus or M pneumoniae infections. The decline in the total number of cases of encephalitis was not accompanied by a decrease in number of patients with a poor outcome. Patients with treatable encephalitides due, for example, to M pneumoniae and herpes viruses, need prompt attention.
- Published
- 1989
- Full Text
- View/download PDF
46. Contrasting features of T-lymphocyte-mediated diabetes in encephalomyocarditis virus-infected Balb/cBy and Balb/cCum mice.
- Author
-
Babu PG, Huber SA, and Craighead JE
- Subjects
- Animals, Diabetes Mellitus, Experimental immunology, Encephalomyocarditis virus, Male, Mice, Mice, Inbred BALB C, Species Specificity, Diabetes Mellitus, Experimental etiology, Enterovirus Infections complications, T-Lymphocytes immunology
- Abstract
Two closely related sublines of the Balb/c strain, Balb/cBy and Balb/cCum mice respond differently when inoculated with the diabetogenic M variant of the encephalomyocarditis (EMCM) virus. Although genetically similar, Balb/cBy mice develop severe hyperglycemia, whereas Balb/cCum animals exhibit only modest alterations in glucose tolerance. Virus concentrations in the pancreases of animals of both sublines are equivalent 3 days after inoculation and decrease rapidly to undetectable levels within 10 days, at a time when hyperglycemia in Balb/cBy mice peaks. These results support two conclusions: 1) direct virus-induced injury to the beta cells probably is not responsible for hyperglycemia in Balb/c mice, and 2) virus replication in the pancreas does not predict diabetes susceptibility. Diabetes in Balb/cBy mice is immunologically mediated. These animals generate cytolytic T lymphocytes specific for beta cells during periods corresponding to glucose intolerance, and anti-thymocyte serum treatment of infected mice prevents the development of hyperglycemia. The pathogenesis of diabetes in Balb/cCum mice is not clear. Although cytolytic T cells appear concomitant with glucose intolerance, anti-thymocyte serum has not consistently prevented the development of the metabolic disease.
- Published
- 1986
47. Neurological manifestation of acute haemorrhagic conjunctivitis due to enterovirus 70.
- Author
-
John TJ, Christopher S, and Abraham J
- Subjects
- Acute Disease, Adult, Conjunctivitis complications, Disease Outbreaks epidemiology, Hemorrhage etiology, Humans, India, Male, Conjunctivitis etiology, Enterovirus Infections complications, Neurologic Manifestations
- Published
- 1981
- Full Text
- View/download PDF
48. Enterovirus infection and cardiomyopathy in Cameroon.
- Author
-
Blackett K
- Subjects
- Acute Disease, Africa, Western, Enterovirus, Humans, Infant, Pericarditis etiology, Cardiomyopathy, Dilated etiology, Enterovirus Infections complications
- Published
- 1989
- Full Text
- View/download PDF
49. Chronic relapsing pericarditis and dilated cardiomyopathy: serological evidence of persistent enterovirus infection.
- Author
-
Muir P, Nicholson F, Tilzey AJ, Signy M, English TA, and Banatvala JE
- Subjects
- Acute Disease, Antibody Specificity, Cardiomyopathy, Dilated etiology, Chronic Disease, Coxsackievirus Infections complications, Coxsackievirus Infections immunology, Enterovirus B, Human immunology, Enterovirus Infections complications, Follow-Up Studies, HLA-A Antigens immunology, HLA-A2 Antigen, HLA-DR Antigens immunology, HLA-DR2 Antigen, Humans, Pericarditis etiology, Prognosis, Recurrence, Time Factors, Antibodies, Viral analysis, Cardiomyopathy, Dilated immunology, Enterovirus Infections immunology, Immunoglobulin A analysis, Immunoglobulin M analysis, Pericarditis immunology
- Abstract
By means of two different IgM-capture assays, enterovirus-specific IgM responses were shown in 9 of 14 (64%) patients with chronic relapsing pericarditis. This finding suggests persistent enterovirus infection, particularly coxsackie B virus infection. IgM responses persisted for at least 1 year and for up to 10 years after onset of symptoms. In contrast, patients with acute enterovirus infections, including acute pericarditis, had transient responses. Among patients with acute pericarditis, the level of IgM antibody was significantly higher in those who subsequently relapsed (mean 1.21, range 0.6-2.0 optical density [OD] units) than in those who did not (0.4, 0.2-0.9 OD units; p less than 0.01). Of 86 patients with dilated cardiomyopathy, 28 (33%) showed enterovirus-specific IgM responses which were present for up to 19 months before transplantation and persisted up to 4 years afterwards. Although the distribution of HLA types in these patients was similar to that in the general population, the frequency of the HLA A2 haplotype was significantly higher in those who were IgM positive. IgM antibody was significantly more common in those who had had symptoms for longer than a year before transplantation than in those with a shorter duration of symptoms (1 of 21 vs 8 of 23; p less than 0.02). Persistent virus-specific serum IgA responses were also shown in patients with chronic cardiac disease.
- Published
- 1989
- Full Text
- View/download PDF
50. Modification of encephalomyocarditis virus-induced diabetes in mice by antiviral agents.
- Author
-
Powers RD, Dotson WM Jr, and Hayden FG
- Subjects
- Animals, Cytopathogenic Effect, Viral, Diabetes Mellitus etiology, Encephalomyocarditis virus, Enterovirus Infections drug therapy, Interferons therapeutic use, Male, Mice, Mice, Inbred Strains, Antiviral Agents therapeutic use, Diabetes Mellitus prevention & control, Enterovirus Infections complications
- Abstract
The current study used a murine model of diabetes induced by the D variant of encephalomyocarditis virus (DEMC) to determine the protective effect of exogenous antiviral agents. Antivirals, which were found to inhibit the development of DEMC virus cytopathic effect in L-929 cell monolayers, were administered intraperitoneally beginning 12 h prior to DEMC virus challenge. Arildone (500 mg/kg per day) or murine interferon (3.2 X 10(6) IU/kg per day) significantly reduced the incidence of hyperglycemia at 4 days after virus challenge. The incidences of hyperglycemia were 96% in untreated, 62% in arildone, and 0% in interferon treated mice. In other experiments we found that interferon (1.6 X 10(6) IU/kg per 12 h X 3) significantly protected mice against diabetes when administered at the time of virus infection or beginning 12 h afterwards. This effect was associated with reductions in average viral titers in the heart and pancreas of infected animals relative to untreated, infected mice. The results of these studies suggest that picornavirus induced diabetes may be prevented or ameliorated by the use of antiviral agents.
- Published
- 1983
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.