Aseptic Meningitis Syndrome Research Articles

Surgical Outcomes in Chiari 1 and Chiari 1.5 Malformation Treated by Posterior Fossa Reconstruction: A Comprehensive Analysis of 110 Pediatric Cases and Literature Review.

Background/Objectives: The management of Chiari malformations (CMs) remains a clinical challenge and a topic of great controversy. Results may vary between children and adults. The purpose of the current single-center study is to critically assess the one-year surgical outcomes of a cohort of 110 children with CM-1 or CM-1.5 who were treated using "posterior fossa reconstruction" (PFR), a surgical technique described in 1994 that has since been used in both adults and children. We also review the literature and discuss the possible causes of the drawbacks and pitfalls in children in whom PFR was ineffective in controlling the disease. Methods: The present cohort was selected from a prospective registry of adults and children with CMs collected since 2006. Patients included in this study were selected from a group of children with CMs who were operated on in our Pediatric Neurosurgical Unit between 1 January 2007 and 31 November 2023. Surgical outcome was defined based on clinical and neuroradiological results as very good, good, or bad. Results: The mean age of our child cohort was 9.9 ± 4.7 years, with 54 girls (49%) and 56 boys (51%). Sixty-six children had CM-1 (60%) while forty-four had CM-1.5 (40%). Following surgery, there was no neurological worsening or death among the children. Most children (70%) had an uneventful recovery and were discharged home on average one week after surgery. However, in 33 children (30%), we recorded at least one postoperative adverse event. Aseptic meningitis syndrome was the most frequent adverse event (n = 25, 22.7%). The final surgical outcome was evaluated one year after PFR by using both clinical and neuroradiological results. The one-year surgical outcome was excellent in 101 children (91.9%), good in 5 (4.5%), and bad in 4 (3.6%). Conclusions: PFR significantly enlarges the volume of the posterior fossa and recreates a CSF environment that generates buoyancy of the cerebellum, with a high percentage of excellent and good clinical results evaluated one year post-surgery.

Kawasaki Disease Associated Acute Abdomen: Most Require No Surgery.

To summarize the clinical features and treatment experiences of patients with Kawasaki disease (KD)-associated acute abdomen (KD-AA). We conducted a retrospective case-control study of patients with KD-AA treated at our hospital between January 2006 and November 2022. Of the 917 children with KD, 43 (4.7%) presented with AA. Of these, 33 with complete information were included in the KD-AA group. Patients with KD-AA were significantly older, with higher neutrophil rate, C-reactive protein, procalcitonin, and alanine transaminase levels and lower hemoglobin, albumin, and serum sodium levels. Additionally, more patients with KD-AA presented with aseptic meningitis and KD shock syndrome than those with KD alone (all p<0.05). The two groups did not differ in the incidence of intravenous immunoglobulin (IVIG) resistance, incomplete KD, or coronary artery abnormalities. All patients received aspirin and IVIG therapy, with nine receiving a second dose of IVIG and 11 receiving corticosteroids. Only two patients with KD-AA underwent surgery, and the prognosis of all patients with KD-AA was good. KD-AA should be suspected in febrile children with abdominal symptoms. Prompt diagnosis of KD-AA is important for early effective treatment to avoid unnecessary surgical harm. KD, complicated by acute abdomen, has a good prognosis.

Анализ эффективности иммунотерапии раннего и позднего нейроборрелиоза у детей

Immunostimulants are drugs that increase the effectiveness of antimicrobial therapy, improve outcomes, and participate in the process of repairing damaged tissues. Objective. To evaluate the effectiveness of the inclusion of immunostimulants in the therapy of early and late neuroborreliosis (NB) in children: glucosaminylmuramyldipeptide (Licopid), recombinant interferon α-2b in combination with antioxidants vitamins E and C (Viferon®) and recombinant interleukin-2 (Roncoleukin). Patients and methods. Forty-two patients with NB aged 2–17 years were examined and received therapy. The diagnosis included clinical-epidemiological and laboratory-etiological methods (enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR)) for Borrelia burgdorferi s.l. (Bb). Electroneuromyography was performed in early NB, and magnetic resonance imaging (MRI) of the brain and spinal cord was performed in late NB. The main group included children with early NB (n = 13) who received 1 mg of Licopid orally and Viferon® rectal suppositories 150,000 or 500,000 IU (depending on age) twice a day for 10 days. In late NB, children in the main group (n =1 2) received drip intravenous injection of Roncoleukin №3 at a dosage of 0.5 mg for 3 days. The comparison groups included 9 children with early NB and 8 children with late NB who received antimicrobial and pathogenetic therapy without immunostimulants. Results. In early NB (n = 22), children with aseptic meningitis and Bannwarth syndrome were observed, and in late NB (n = 20) – children with leukoencephalitis and disseminated encephalomyelitis. The prescription of Licopid and Viferon® ensured the eradication of Bb in the cerebrospinal fluid (CSF) by PCR results and led to the complete recovery of facial and peripheral nerve function in all cases, whereas in the comparison group, in 11.1% (n = 1), Bb remained in CSF on day 15, and after 6 months, a neurological deficit was detected in 2 (40%) of 5 children with Bannwarth syndrome: in the form of facial muscle contraction (n = 1) and polyneuropathy (n = 1). In late NB, the presription of Roncoleukin reduced the duration of bed days (by an average of 13 days) and mean neurological deficit on the EDSS scale after 1, 6 and 12 months. After 1 year, ¼ of children had complete regression of foci on MRI, and 41.6% (n = 5) had regression of both foci and clinical symptoms. During the year, there were no exacerbations, and CSF PCR was negative. In the comparison group, 3 (37.5%) children had clinical and/or radiation exacerbation. Conclusion. The inclusion of immunostimulants (Licopid, Viferon®) in therapy in early NB and the drug Roncoleukin in late NB accelerates the eradication of Borrelia, reduces neurological deficit, avoids exacerbations, progression of infection and repeated courses of antibiotics. Key words: neuroborreliosis, immunotherapy, Licopid, Viferon, Roncoleukin, children

4. Post-marketing safety study to evaluate the occurrence of aseptic meningitis syndrome (AMS) in an adult population (⩾18 years) treated with doses of ⩾1 g/kg INTRAGAM10®

4. Post-marketing safety study to evaluate the occurrence of aseptic meningitis syndrome (AMS) in an adult population (⩾18 years) treated with doses of ⩾1 g/kg INTRAGAM10®

Posterior Reversible Encephalopathy in a Patient with Severe Leptospirosis Complicated with Pulmonary Haemorrhage, Myocarditis, and Acute Kidney Injury

Severe leptospirosis (Weil's disease) can give rise to multiorgan failure such as acute renal failure, liver dysfunction, coagulopathy, acute respiratory distress syndrome, pulmonary haemorrhage, and myocarditis. Leptospirosis is a biphasic disease characterised by leptospiraemic phase and immunological phase. Although neurological manifestations are rare in leptospirosis, aseptic meningitis, myeloradiculopathy, transverse myelitis, and cerebellar syndrome are well recognised. We report a rare case of posterior reversible encephalopathy syndrome (PRES) in a patient with severe leptospirosis during recovery phase of the illness.

Interventions for necrotizing soft tissue infections in adults

Interventions for necrotizing soft tissue infections in adults

Клініко-діагностичні та лікувально-профілактичні особливості синдрому асептичного менінгіту у хворих з кістозними менінгіомами головного мозку

Objective – to investigate the frequency of aseptic meningitis syndrome (AMS), to describe the peculiarities of diagnostics, clinical signs of AMS and its differential diagnostic criteria, as well as features of immune parameters for patients with cystic meningiomas with normal postoperation recovery and with AMS progression. Materials and methods. To describe the symptoms and determine the frequency of AMS there had been analyzed the medical records of 54 patients with cystic meningiomas of various localization and histological structure, being operated at Extracerebral Tumor Department of the SI Romodanov Neurosurgery Institute NAMS of Ukraine during 2012-2016. Immunity was estimated for 18 patients with brain tumors of different histostructures and postoperative AMS (meningiomas – in 13, gliomas of low degree anaplasia – in 2, gliomas of high degree anaplasia – in 3) in comparison with normal postoperative recovery for 7 patients with tumors of the brain without occuring of AMS (meningiomas – in 3, glioblastoma – in 1, metastasis of cancer – in 1). Studies were conducted in dynamics (weekly): at the 1st-7th, 8th-14th and 15th day or further after the surgery. The phenotype of peripheral blood lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+) was determined using monoclonal antibodies (IMK Plus, Becton Dickinson, USA) by means of flow cytometry (FASCalibur E2085), IgA, IgM and IgG, serum immunoglobulin level – by means of simple radial immunodiffusion in gel (Mancini method). The functional activity of neutrophils was estimated by the phagocytosis test according to phagocytic activity and phagocytic number, as well as by nitro blue tetrazolium reduction test. Ten patients with stable compression of the roots of lumbar spine were considered as the control group. Results. AMS occurred for 8 (14.81 %) patients. The clinical picture of AMS developed quickly on the 3rd-7th day after the operation. In the clinical blood count, leukocytosis was noted without significant fluctuations, high ESR. The analysis of the peripheral blood immunity parameters of patients with AMS showed no signs of infectious or autoimmune inflammation. The changes were indolent, atypical and short-term. The rates returned to normal ones within 3 weeks. In our opinion, the following laboratory indicators can show the risk of AMS developing in the preoperative period: a decrease in the number of lymphocytes and eosinophils, an increase in the number of monocytes of the peripheral blood. It is possible to assume, that a greater risk of AMS developing arises in special areas of localization (convextic-associated with the liquoronal pathways, the ventricles of the cerebrum and the posterior cranial fossa) and tumors of individual histological variants (anaplastic cystic meningiomas and glial tumors with cystic component, with necrosis and sarcolysis of the tumor itself). Conclusions. Eradication of cystic meningioma of the brain, the prevention of cystic fluid entering the cerebrospinal fluid, the rational use of glucocorticoids within 5-10 days after the operation can significantly reduce the frequency of ASM occurrence. When evidence of meningitis appear, it is mandatory to differentiate between it and bacterial meningitis and to extract cystic components from the cerebrospinal fluid and reduce the inflammatory response of the cerebral meninges by means of glucocorticoids.

Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011

BackgroundCoxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9.MethodsWe analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree.ResultsOf the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of fever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome (n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar.ConclusionsThe most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.

Study of adverse events reported to the center of health surveillance related to the use of intravenous immunoglobulin (IVIG)

Event Abstract Back to Event Study of adverse events reported to the center of health surveillance related to the use of intravenous immunoglobulin (IVIG) Ida C. Gubert1*, Marcia Marques De Azevedo Dos Santos2 and Vera C. Zanetti2 1 UNIVERSIDADE FEDERAL DO PARANA, Brazil 2 Secretaria de Estado da Saude, Brazil Antibody replacement therapy was first introduced for clinical use in the 1950s mainly for the treatment of primary immunodeficiency conditions, usually used subcutaneously or intramuscularly, either as an adjunctive or first line therapy. Due to the recognition of its modulator effects, subsequently suitable preparations for intravenous use have been developed. Intravenous immunoglobulin has been, since then, increasingly used in many inflammatory and autoimmune conditions, although only a few have received approval by FDA and EMEA and unlabeled use is now common. Clinical preparations consist of IgG antibodies and all four subclasses, obtained from a pool of thousands of healthy donors, comprising the entire repertoire of antigen binding sites expectedly found in normal human serum. Intravenous immunoglobulin mechanisms of action are complex and include anti-infective, immunoregulatory, and anti-inflammatory properties. However, adverse events due to the use of this immunobiological have been reported. It is the purpose of this study to identify the adverse events most commonly reported to the center of health surveillance related to the use of intravenous immunoglobulin. Notification forms, spreadsheets and database files have been analyzed and data were organized and systematized in order to provide easy access to the information for health professionals and surveillance center. Hypersensitivity reactions, thrombotic events, acute renal failure and aseptic meningitis syndrome, chills, fever during infusion, artralgia, mialgia, abdominal pain and headache are some of the adverse events commonly reported. High cost, supplies and safety of the product are some of the concerns related to the use of intravenous immunoglobulin. Keywords: Immunotherapy, immunodeficiency, immunoglubulin, intravenous, adverse events Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Translational immunology and immune intervention Citation: Gubert IC, Marques De Azevedo Dos Santos M and Zanetti VC (2013). Study of adverse events reported to the center of health surveillance related to the use of intravenous immunoglobulin (IVIG). Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00383 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 16 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Ida C Gubert, UNIVERSIDADE FEDERAL DO PARANA, CURITIBA, Brazil, gubert@ufpr.br Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Ida C Gubert Marcia Marques De Azevedo Dos Santos Vera C Zanetti Google Ida C Gubert Marcia Marques De Azevedo Dos Santos Vera C Zanetti Google Scholar Ida C Gubert Marcia Marques De Azevedo Dos Santos Vera C Zanetti PubMed Ida C Gubert Marcia Marques De Azevedo Dos Santos Vera C Zanetti Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Aseptic meningitis and adult respiratory distress syndrome caused by Borrelia persica

The occurrence of some of the clinical complications of tickborne relapsing fever varies with Borrelia species. For example, adult respiratory distress syndrome (ARDS), a newly reported complication, was described so far only with B. hermsii infection. A previously healthy young Israeli man was admitted for fever and headache and was diagnosed as aseptic meningitis. Shortly before the lumbar puncture was performed he started to experience shortness of breath and developed acute respiratory insufficiency necessitating mechanical ventilation. Radiography, which was normal on admission, demonstrated bilateral lung infiltrates consistent with ARDS. Spirochetes suggestive of Borrelia were seen on a thick blood smear preparation, and polymerase chain reaction was positive for B. persica. This is the first reported case of ARDS in association with Borrelia spp. occurring outside the U.S.A. and the first one due to B. persica infection.

Index of Suspicion in the Nursery

A 2.94-kg male infant is born at 39 weeks to a 19-year-old G1P0 woman. The pregnancy was complicated by gestational diabetes. The woman had no significant past medical history, including sexually transmitted diseases, and no significant family history. Prenatal screening for group B Streptococcus, Chlamydia, gonorrhea, syphilis, and human immunodeficiency virus were negative. Delivery is complicated by prolonged rupture of membranes for 18 hours, maternal fever (temperature of 38.9°C), and failure to progress. The baby is delivered in good condition by cesarean section. Apgar scores are 8 at 1 minute and 9 at 5 minutes. Vital signs are within normal limits, and physical examination at birth shows no abnormal findings of note. The infant is admitted to the newborn nursery for observation. Blood culture is drawn and empiric antibiotics are started. Hematologic parameters are within normal limits and C-reactive protein measures 0.5 mg/dL. Antibiotics are continued for suspected chorioamnionitis. He is otherwise feeding well, euthermic, and looking well, and his blood culture remains negative. On postnatal day 7, the nurse notices two vesicular skin lesions: one on the right side of the forehead (Fig. 1) and the other on the vertex of the scalp (Fig. 2). Both comprise groups of clustered tiny vesicles that have minimal erythema at their bases. Vital signs and physical examination findings are within normal limits. The result of a simple test supports the diagnosis, and further laboratory investigations confirm the cause. Figure 1. Vesicular lesions on the right side of the forehead. Figure 2. Vesicular lesions on the vertex of the scalp. # Case: Blister in a Baby: Benign or Bothersome? {#article-title-2} ### Differential Diagnosis Vesiculobullous lesions in neonates should never be ignored because the cause could range from benign, self-limited conditions to serious fatal diseases. Early diagnosis and management are crucial …

Spontaneous Rupture, Disappearance, and Reaccumulation of a Rathke's Cleft Cyst

Rathke's cleft cysts (RCCs) are benign epithelium-lined intrasellar cysts containing mucoid material and are believed to originate from the remnants of Rathke's pouch. Most are asymptomatic but may cause symptoms secondary to compression of adjacent structures such as visual disturbances and endocrinopathies, especially hypopituitary. Furthermore, inflammation such as an aseptic meningitis syndrome may be associated with these tumors, presumably resulting from leakage of cyst material into the subarachnoid space. We present a unique case of spontaneous rupture and complete disappearance of a known sella-suprasellar cyst associated with a severe headache syndrome, followed by cyst reaccumulation requiring surgery. Although this phenomenon is well accepted, to our knowledge, this is the first report of the complete disappearance of a Rathke's cyst presenting with the classic syndrome. Furthermore, it was remarkable how quickly it recurred and became symptomatic, providing evidence that an “empty sella syndrome” may indeed need clinical follow-up.

The neuropsychiatric aspects of influenza/swine flu: A selective review

The world witnessed the influenza virus during the seasonal epidemics and pandemics. The current strain of H1N1 (swine flu) pandemic is believed to be the legacy of the influenza pandemic (1918-19). The influenza virus has been implicated in many neuropsychiatric disorders. In view of the recent pandemic, it would be interesting to review the neuropsychiatric aspects of influenza, specifically swine flu. Author used popular search engine ‘PUBMED’ to search for published articles with different MeSH terms using Boolean operator (AND). Among these, a selective review of the published literature was done. Acute manifestations of swine flu varied from behavioral changes, fear of misdiagnosis during outbreak, neurological features like seizures, encephalopathy, encephalitis, transverse myelitis, aseptic meningitis, multiple sclerosis, and Guillian-Barre Syndrome. Among the chronic manifestations, schizophrenia, Parkinson's disease, mood disorder, dementia, and mental retardation have been hypothesized. Further research is required to understand the etiological hypothesis of the chronic manifestations of influenza. The author urges neuroscientists around the world to make use of the current swine flu pandemic as an opportunity for further research.

Clinical and virological features of an aseptic meningitis outbreak in North-Eastern France, 2005

Background Enteroviruses (EVs) are considered as a major viral etiological cause of aseptic meningitis in children. Objectives We assessed the clinical and virological features of an aseptic meningitis outbreak in North-East of France, 2005. Study design Classical bacteriological analysis, Herpesviridae and EV PCR assays had been prospectively performed on cerebrospinal fluid (CSF) samples taken from 80 children hospitalized for aseptic meningitis. For each EV strain identified as etiological agent, a phylogenetic comparison of partial EV VP1 capsid protein coding gene was performed. Results The children older than 12 months ( n = 75) presented a typical aseptic meningitis syndrome, whereas the children aged less than 1 year ( n = 5) demonstrated only fever and hypotonia. Among the 80 studied children, EV was identified as the etiological cause of aseptic meningitis in 73 (91%) cases. Echovirus 30 (E30) was the most common isolated serotype (84% of 51 EV strains). VP1 phylogenetic analysis revealed that E30 strains were genetically closer to those isolated during 2000 aseptic meningitis outbreak comparatively to those identified during 2003 and 2006 non-epidemic years. Moreover, the genetic study demonstrated the co-circulation of four distinct lineages without any difference in temporal distribution or clinical features during the 2005 outbreak. Conclusions The present report demonstrates the co-circulation of distinct E30 lineages during the same aseptic meningitis outbreak season. This E30 genetic diversity may be a prerequisite for the emergence of new strains potentially responsible for further aseptic meningitis outbreaks.

Clinical validation of a new real-time PCR assay for detection of enteroviruses and parechoviruses, and implications for diagnostic procedures

BackgroundEnteroviruses (EV) and parechoviruses (HPeV) are the most common causes of aseptic meningitis, encephalitis and sepsis-like syndrome in neonates. Detection by nucleic acid amplification methods improves patient management. ObjectiveDevelopment of a real-time PCR assay on a LightCycler for simultaneous detection of EV, HPeV and an internal control to monitor inhibition. Study designWe investigated the value of the new assay, prospectively, in a variety of samples from patients suspected of having viral meningitis or sepsis-like syndrome. ResultsThe assay detected 64 EV serotypes and HPeV types 1–4. Of 186 patients, 63 (33.9%) were EV positive and 18 (9.7%) HPeV positive in one or more samples. In 43 of 159 feces and 6 of 57 throat samples viral culture and PCR were positive. With real-time PCR 27 extra EV and 19 HPeV positives were found.Blood and CSF were present from 33 patients. In 19 patients blood and CSF were positive, one was only positive in CSF, two were only positive in blood, 11 were negative.From 96 patients CSF and/or blood samples were tested and compared to results in throat and/or feces samples. Forty patients were EV-PCR and 14 HPeV-PCR positive in blood and/or CSF. All of these were confirmed by a positive PCR for the respective virus in feces and/or throat. ConclusionsSimultaneous detection of EV and HPeV with this two-step real-time PCR is specific, faster and more sensitive than viral culture. All systemic infections (blood or CSF positive) were confirmed in feces. Culture is no longer necessary for clinical diagnosis and should only be performed on PCR-positive samples to obtain isolates for typing purposes. Application of this assay is an important improvement for patient management since the outcome of the analysis is available within the time frame of clinical decision-making.

Pesquisa de enterovírus em casos de síndrome de meningite asséptica de Belém, PA

With the objective of isolating and identifying enteroviral serotypes, which are the most frequent etiologic agents of aseptic meningitis syndrome, cerebrospinal fluid samples were studied from patients referred to the health unit in the City of Belém (State of Pará, Brazil), from March 2002 to March 2003. The samples were inoculated in RD and HEp-2 cells line, and the positive were identified by neutralization test or indirect immunofluorescence. Out of 249 samples, 33 (13.2%) were positive 57.6% (n = 19) in patients under 11 years of age (p < 0.03) and predominantly (72.7%) in males (p < 0.008). The serotypes isolated were: Echovirus 30 (n = 31), Coxsackievirus B5 (n = 1) and Echovirus 30 and 4. In conclusion, this type of study also serves to determine the national picture, which is still little defined, regarding the most prevalent viral agents in AMS cases.

Fast duplex one-step RT-PCR for rapid differential diagnosis of entero- or toscana virus meningitis

Acute meningitis is the most common neurologic disease that involves the central nervous system. The spectrum of infectious agents that cause neurologic infection is remarkably broad and numerous viruses are the most frequent cause of the aseptic meningitis syndrome. We applied a multiplex one-step method for the rapid detection of the genomic RNA of different neurotropic viruses: particles in the genus Enterovirus and Toscana virus, which are the most representative aetiologic agents in our country during the spring-summer period. We have evaluated the sensitivity and the specificity of the multiplex one-step test on positive controls and on RNA extracted from clinical samples harvested from 475 patients with meningitis hospitalized during the 1996–2001 period. The multiplex one-step RT-nPCR protocol allows for the detection of enterovirus and Toscana virus RNA in a single sample, by using, at the same time, a very small clinical sample volume. In our study we were able to diagnose 192 cases of meningitis by Toscana virus and 31 cases by enteroviruses out of 475 cases of meningitis utilizing the described one-step multiplex method.

Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia

For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia. In 44.6% (n=50), the etiologic agent for the diagnosis was laboratory-confirmed: enterovirus was identified in 37.7% (n=42) of the cases by the PCR Amplicor diagnostic kit, cerebrospinal fluid or fecal culture isolation; Leptospira sp. in 7.12% (n=8) by the microagglutination test; and arbovirus in non of the cases by inhibition of passive hemagglutination. In 14 of the 22 enteroviral isolates that were evaluated, 6 different serotypes were identified with Echovirus-4 being the major serotype (27.2%; 6/22) among all found (Coxsackie B2, B3, B6 and B9; Enterovirus 71). In conclusion, enteroviruses were the most frequent etiologic agent of AMS and that leptospirosis should be included in the differential diagnosis. In addition, patients with and without laboratory-confirmed identification of the etiologic agent had similar demographic and clinical characteristics and cerebrospinal fluid findings (p >0.05), therefore suggesting that patients without a confirmed diagnosis had enteroviral or leptospiral etiologies.

Benefits of management strategy adjustments during an outbreak of enterovirus meningitis in adults.

Enteroviruses (EVs) are the most common identifiable cause of the aseptic meningitis syndrome. Widespread seasonal outbreaks of EV meningitis result in a high financial cost to the community, in part because of the difficulty of discriminating between viral and bacterial meningitis. During a nationwide outbreak of EV meningitis due to echovirus 30 in France we tested the hypothesis that a management strategy including early testing of cerebrospinal fluid (CSF) by means of EV PCR in all adult patients with acute aseptic meningitis on admission might reduce the duration of hospitalization and thus the expenditure on health resources. We compared the characteristics of adult patients with acute aseptic meningitis seen in our institution before (n = 21) and after (n = 27) implementation of this strategy. The strategy was cost-effective in that it significantly reduced (i) the mean duration of hospital stay (from 103 to 80 h; p = 0.04); and (ii) the mean duration of antibacterial treatment (from 115 to 69 h; p = 0.02). Systematic testing of CSF in adult patients with aseptic meningitis by means of EV PCR may be cost-effective during an outbreak of EV meningitis.

Detection of enteroviruses in cases of neurological disorders in the State of Pará, Brazil.

Eighty-one cerebrospinal fluid (CSF) samples mainly from cases of aseptic meningitis and motor deficiency syndrome were sent to the Virology Section of Evandro Chagas Institute, Belém Pará, in the period of January 1995 to January 1996 in order to isolate viruses. All samples were inoculated onto HEp-2 cell culture and newborn mice, with negative results. The probability of isolating viruses by these methods is reduced because of the low concentration of viral particles in these specimens. In order to obtain more information about the etiology of these cases, a group of 23 samples were selected to be tested by a more sensitive technique than the virus isolation - the reverse transcription polymerase chain reaction (RT-PCR). Specific primers directed to conserved regions in the enterovirus genome were used, considering that this group of viruses is frequently associated with these neurological disorder. The age of the patients ranged from 1 to 55 years and nearly all of them lived in Belém, State of Pará, North of Brazil. Of 15 samples analyzed by RT PCR nine (60%) were positive; of these, 6 (66.6%) had motor deficiency and 3 (33.3%) developed aseptic meningitis. These results show that it is important to investigate enterovirus as cause of these syndromes.