Positive PCR for enterovirus in the cerebrospinal fluid of a child with acute disseminated encephalomyelitis

Mariotti, Paolo; Batocchi, Anna Paola; Colosimo, Cesare; Cattani, Paola; Stefanini, Maria Cristina; Colitto, Francesca; Tonali, P.; Guzzetta, Andrea

doi:10.1007/s00415-004-0492-2

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…ADEM is the most common manifestation in the pediatric population and often occurs after infection with EBV, measles, influenza, enterovirus, coronavirus, herpes simplex and, rarely, Mycoplasma pneumoniae [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 ]. Recently, it has been observed that previous infection is more common during the monophasic course of the disease [ 191 ].…”

Section: Mogadmentioning

confidence: 99%

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The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases

Frau¹,

Coghe²,

Lorefice³

et al. 2023

Life

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Multiple sclerosis (MS), neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are inflammatory diseases of the central nervous system (CNS) with a multifactorial aetiology. Environmental factors are important for their development and microorganisms could play a determining role. They can directly damage the CNS, but their interaction with the immune system is even more important. The possible mechanisms involved include molecular mimicry, epitope spreading, bystander activation and the dual cell receptor theory. The role of Epstein–Barr virus (EBV) in MS has been definitely established, since being seropositive is a necessary condition for the onset of MS. EBV interacts with genetic and environmental factors, such as low levels of vitamin D and human endogenous retrovirus (HERV), another microorganism implicated in the disease. Many cases of onset or exacerbation of neuromyelitis optica spectrum disorder (NMOSD) have been described after infection with Mycobacterium tuberculosis, EBV and human immunodeficiency virus; however, no definite association with a virus has been found. A possible role has been suggested for Helicobacter pylori, in particular in individuals with aquaporin 4 antibodies. The onset of MOGAD could occur after an infection, mainly in the monophasic course of the disease. A role for the HERV in MOGAD has been hypothesized. In this review, we examined the current understanding of the involvement of infectious factors in MS, NMO and MOGAD. Our objective was to elucidate the roles of each microorganism in initiating the diseases and influencing their clinical progression. We aimed to discuss both the infectious factors that have a well-established role and those that have yielded conflicting results across various studies.

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Section: Mogadmentioning

confidence: 99%

“…Case report: ADEM with detection of coronavirus in CNS [186] Enterovirus Case report: ADEM with positive PCR for enterovirus in the CSF [185] Mycoplasma pneumoniae Description of cases reporting MOGAD following Mycoplasma pneumoniae infection [189,190] Jamestown Canyon virus…”

Section: Coronavirusmentioning

confidence: 99%

The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases

Frau¹,

Coghe²,

Lorefice³

et al. 2023

Life

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“…The most frequent infections involved are viral and related to the upper respiratory tract, such as measles [14,16], mumps [2,[17][18][19], rubella [2], varicella [2,14], influenza [5,20], and infectious mononucleosis [21,22]. Also enterovirus [23], coronavirus [24], human immunodeficiency virus [2], herpes simplex virus [25], cytomegalovirus [22], and hepatitis A virus [26,27] have been associated with ADEM. Other pathogens anecdotally involved in ADEM have been Toxoplasma gondii [3], Plasmodium falciparum [28], Cryptococcus neoformans [29], Haemophilus influenzae type b [30], Leptospira sp.…”

Section: A Complex Bind Of Infection-triggered Autoimmune Phenomena Amentioning

confidence: 99%

A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children

Esposito

Pietro

Madini

et al. 2015

Autoimmunity Reviews

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Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that involves multifocal areas of the white matter, rarely the gray matter and spinal cord, mainly affecting children and mostly occurring 1-2weeks after infections or more rarely after vaccinations. Though a specific etiologic agent is not constantly identified, to evaluate carefully patient's clinical history and obtain adequate samples for the search of a potential ADEM causal agent is crucial. In the case of a prompt diagnosis and adequate treatment, most children with ADEM have a favorable outcome with full recovery, but in the case of diagnostic delays or inappropriate treatment some patients might display neurological sequelae and persistent deficits or even show an evolution to multiple sclerosis. The suspicion of ADEM rises on a clinical basis and derives from systemic and neurologic signs combined with magnetic resonance imaging of the central nervous system. Other advanced imaging techniques may help an appropriate differential diagnosis and definition of exact disease extension. Although there is no standardized protocol or management for ADEM, corticosteroids, intravenous immunoglobulin, and plasmapheresis have been successfully used. There is no marker that permits to identify the subset of children with worse prognosis and future studies should try to detect any biological clue for prevision of neurologic damage as well as should optimize treatment strategies using an approach based on the effective risk of negative evolution.

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“…In contrast to aseptic meningitis, encephalitis due to EV can cause focal gray matter lesions in infants and may be responsible for neurological impairment (4, 7). Rare cases of encephalitis with white matter lesions have been reported in infants with documented EV central nervous system (CNS) infections (1,5,6,8). EV-related leukoencephalitis has been previously reported by David et al, who described a potential case of acute disseminated encephalomyelitis (ADEM) after coxsackievirus B infection, and more recently by Mariotti et al and Saitoh et al, who described positive detection of EV by PCR in the CSF of children with radiological features of ADEM (1,6,8).…”

mentioning

confidence: 99%

“…Rare cases of encephalitis with white matter lesions have been reported in infants with documented EV central nervous system (CNS) infections (1,5,6,8). EV-related leukoencephalitis has been previously reported by David et al, who described a potential case of acute disseminated encephalomyelitis (ADEM) after coxsackievirus B infection, and more recently by Mariotti et al and Saitoh et al, who described positive detection of EV by PCR in the CSF of children with radiological features of ADEM (1,6,8). In the present case report, the radiological findings on the patient and detection of EV genomic RNA are highly suggestive of infective meningoencephalitis (8).…”

mentioning

confidence: 99%

Fatal Echovirus 18 Leukoencephalitis in a Child

Brunel¹,

Jacques²,

Motté

2007

J Clin Microbiol

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Rare cases of leukoencephalitis have been reported in infants with documented enterovirus (EV) central nervous system (CNS) infections. A case of fatal encephalitis with white matter lesions caused by echovirus 18 is described, and it highlights the role of EV CNS infection as a potential cause of leukoencephalitis in infants. CASE REPORTThe patient described herein was an 18-month-old male infant who was the eldest child in a three-child family and had no particular medical history. Twelve hours before his hospital admission, his parents reported fever, vomiting, and a general tonic and clonic seizure. On hospital admission, he was afebrile (36.5°C), conscious, feverish, and without any particular symptoms on physical and neurological examination. Lumbar puncture revealed the presence of 184 white cells per l of cerebrospinal fluid (CSF) with 98% lymphocytes. CSF protein and glucose concentrations were 2.08 g/liter and 3.77 mmol/liter, respectively, and the blood concentration was 5.74 mmol/liter. No bacterial counts were observed after classical staining of CSF. Moreover, electroencephalogram findings revealed diffuse and excessive slow-wave activity. Initial treatment included ceftriaxone (100 mg/kg/day), amoxicillin (100 mg/kg/ day), and acyclovir (250 mg/m 2 ). Following a new episode of febrile general seizure, the infant was transferred to the pediatric department of the regional university hospital (Champagne Ardenne, France). On admission, his child-modified Glasgow score was 13/15, with eyes opening in response to a voice and consolable crying; he was afebrile, tachycardic, and normotensive. A second lumbar puncture revealed the presence of 81 white cells per l of CSF with 100% mononuclear cells. CSF protein and glucose concentrations were 3.2 g/liter and 3.1 mmol/liter, respectively, associated with an alpha interferon (IFN-␣) level of 12 IU/ml (the IFN-␣ level was Ͻ2 IU/ml of blood plasma). Three days after the beginning of febrile illness, the Glasgow score remained the same (13/15) and was not associated with high levels of C-reactive protein (Ͻ3 mg/liter). Classical biochemical parameters reflecting metabolic disorders were examined and found to be normal, indicating the absence of an inborn metabolic disorder.Two days after the admission of this infant to the university hospital, brain magnetic resonance imaging (MRI) studies with and without gadolinium revealed a diffuse hyperintense signal in the white matter. MRI T2 showed modifications, symmetrically involving the white matter of both cerebral hemispheres, that were predominantly located in the periventricular and subcortical white matter ( Fig. 1A and C). Seven days after his initial admission to the university hospital, a second brain MRI study revealed an extensive and diffuse hyperintense signal in the subcortical and deep white matter of both cerebral hemispheres ( Fig. 1B and D). At that time, several images showed extension of the hyperintense signal into the cortical gray matter (not shown).Testing of CSF, peripheral blood, throat, an...

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Positive PCR for enterovirus in the cerebrospinal fluid of a child with acute disseminated encephalomyelitis

Cited by 4 publications

References 14 publications

The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases

The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases

A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children

Fatal Echovirus 18 Leukoencephalitis in a Child

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