RESUMO
Objective To establish an epidemiological surveillance of viral herpes encephalitis in major hospitals of Monteria, Cordoba. Methods From September 2009 to December 2011, a descriptive study of cases of viral encephalitis was made in three hospitals in the city of Monteria. Cerebrospinal fluid (CSF) samples from 118 patients were included in the study. Clinical aspects, as well as cytochemical and microbiological analysis (Gram stain and culture) of CSF, were used for selecting the patients. Virus detection was performed by using multiplex nested PCR for Herpes simplex virus 1 and 2, Epstein Barr virus, Cytomegalovirus and Varicella zoster virus. Results Viral DNA of herpesvirus was detected in the CSFs of 30 (25.4 %) participants, as follows: 22 (18.6 %) Herpes simplex 1 and 2 viruses, 4 (3.3 %) Cytomegalovirus and 1 (0.8 %) Varicella zoster virus. Co-infections were observed in 3 patients (2.5 %), 1 case by HSV-VZV and 2 cases by CMV/HSV. The clinical manifestations of the patients included: headache (18.6 %), fever (14.4 %), asthenia (10.1 %), seizures (9.3 %), vomiting (8.4 %), and stiff neck (5.9 %). Thirty percent of the patients also had HIV-AIDS. A case fatality rate of 20 % was observed for the patients. Conclusions This paper shows that herpesvirus is a cause of infection of the CNS in patients from Cordoba. This study contributes to the epidemiology of encephalitis, as well as to patient management.
Assuntos
Encefalite Viral/epidemiologia , Infecções por Herpesviridae/epidemiologia , Vigilância da População , Coinfecção/líquido cefalorraquidiano , Coinfecção/epidemiologia , Coinfecção/virologia , Colômbia/epidemiologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/líquido cefalorraquidiano , Infecções por Citomegalovirus/epidemiologia , Encefalite por Herpes Simples/líquido cefalorraquidiano , Encefalite por Herpes Simples/epidemiologia , Encefalite por Varicela Zoster/líquido cefalorraquidiano , Encefalite por Varicela Zoster/epidemiologia , Encefalite Viral/líquido cefalorraquidiano , Infecções por Herpesviridae/líquido cefalorraquidiano , Herpesvirus Humano 3 , HumanosRESUMO
BACKGROUND: Meningoencephalitis is one of the most common disorders of the central nervous system (CNS) worldwide. Viral meningoencephalitis differs from bacterial meningitis in several aspects. In some developing countries, bacterial meningitis has appropriate clinical management and chemotherapy is available. Virus-associated and virus not detected meningoencephalitis are treatable, however, they may cause death in a few cases. The knowledge of how mediators of inflammation can induce disease would contribute for the design of affordable therapeutic strategies, as well as to the diagnosis of virus not detected and viral meningoencephalitis. Cytokine-induced inflammation to CNS requires several factors that are not fully understood yet. METHODS: Considering this, several cytokines were measured in the cerebrospinal fluid (CSF) of patients with undiagnosed and viral meningoencephalitis, and these were correlated with cellularity in the CSF. RESULTS: The results demonstrate that an altered biochemical profile alongside increased cellularity in the cerebrospinal fluid is a feature of patients with meningoencephalitis that are not associated with the detection of virus in the CNS (P < 0.05). Moreover, HIV-positive patients (n = 10) that evolve with meningoencephalitis display a distinct biochemical/cytological profile (P < 0.05) in the cerebrospinal fluid. Meningoencephalitis brings about a prominent intrathecal cytokine storm regardless of the detection of virus as presumable etiological agent. In the case of Enterovirus infection (n = 13), meningoencephalitis elicits robust intrathecal pro-inflammatory cytokine pattern and elevated cellularity when compared to herpesvirus (n = 15) and Arbovirus (n = 5) viral infections (P < 0.05). CONCLUSION: Differences in the cytokine profile of the CSF may be unique if distinct, viral or presumably non-viral pathways initially trigger the inflammatory response in the CNS.
Assuntos
Infecções por Arbovirus/líquido cefalorraquidiano , Citocinas/líquido cefalorraquidiano , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por HIV/líquido cefalorraquidiano , Infecções por Herpesviridae/líquido cefalorraquidiano , Infecções por Lentivirus/líquido cefalorraquidiano , Meningoencefalite/líquido cefalorraquidiano , Infecções por Arbovirus/diagnóstico , Infecções por Arbovirus/imunologia , Viroses do Sistema Nervoso Central/líquido cefalorraquidiano , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/imunologia , Coinfecção/líquido cefalorraquidiano , Coinfecção/imunologia , Estudos Transversais , Citocinas/imunologia , DNA Viral/líquido cefalorraquidiano , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/imunologia , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/imunologia , Humanos , Inflamação , Interferon gama/líquido cefalorraquidiano , Interferon gama/imunologia , Interleucina-10/líquido cefalorraquidiano , Interleucina-10/imunologia , Interleucina-12/líquido cefalorraquidiano , Interleucina-12/imunologia , Interleucina-17/líquido cefalorraquidiano , Interleucina-17/imunologia , Interleucina-6/líquido cefalorraquidiano , Interleucina-6/imunologia , Infecções por Lentivirus/imunologia , Meningoencefalite/diagnóstico , Meningoencefalite/imunologia , RNA Viral/líquido cefalorraquidiano , Fator de Necrose Tumoral alfa/líquido cefalorraquidiano , Fator de Necrose Tumoral alfa/imunologiaRESUMO
Acute infections of the central nervous system (CNS) can be caused by various pathogens. In this study, the presence of herpesviruses (HHV), enteroviruses (EVs), and arboviruses were investigated in CSF samples from 165 patients with suspected CNS viral infection through polymerase chain reaction (PCR) and reverse transcriptase PCR. The genomes of one or more viral agents were detected in 29.7% (49/165) of the CSF samples. EVs were predominant (16/49; 32.6%) followed by Epstein-Barr virus (EBV) (22.4%), Varicella-Zoster virus (VZV) (20.4%), Cytomegalovirus (CMV) (18.4%), herpes simplex virus (HSV-1) (4.1%), (HSV-2) (4.1%), and the arboviruses (14.3%). Four of the arboviruses were of dengue virus (DENV) and three of oropouche virus (OROV). The detection of different viruses in the CNS of patients with meningitis or encephalitis highlight the importance of maintaining an active laboratory monitoring diagnostics with rapid methodology of high sensitivity in areas of viral hyperendemicity that may assist in clinical decisions and in the choice of antiviral therapy.
Assuntos
Infecções por Arbovirus/diagnóstico , Infecções do Sistema Nervoso Central/diagnóstico , Infecções por Enterovirus/diagnóstico , Infecções por Herpesviridae/diagnóstico , Adolescente , Adulto , Idoso , Infecções por Arbovirus/líquido cefalorraquidiano , Infecções por Arbovirus/epidemiologia , Brasil/epidemiologia , Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/epidemiologia , Infecções do Sistema Nervoso Central/virologia , Criança , Pré-Escolar , DNA Viral/líquido cefalorraquidiano , DNA Viral/genética , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/epidemiologia , Feminino , Infecções por Herpesviridae/líquido cefalorraquidiano , Infecções por Herpesviridae/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , RNA Viral/líquido cefalorraquidiano , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto JovemRESUMO
The reactivation of human herpesvirus 6 (HHV-6) in patients with AIDS can result in an acute and severe diffuse meningoencephalitis. We describe the epidemiological, clinical and outcome findings of five patients with diagnosis of HIV/AIDS and central nervous system involvement (CNS) due to HHV-6. Fever was present in all the patients. Meningeal compromise, seizures and encephalitis were present in some of the patients. Polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) specimens was positive for HHV-6 in all the patients. HHV-6 should be included among opportunistic and emerging pathogens that involve the CNS in patients with AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/virologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Herpesviridae/virologia , Herpesvirus Humano 6/genética , Meningoencefalite/virologia , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Adulto , Doenças Transmissíveis Emergentes/líquido cefalorraquidiano , Feminino , Infecções por Herpesviridae/líquido cefalorraquidiano , Humanos , Masculino , Meningoencefalite/líquido cefalorraquidiano , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
The reactivation of human herpesvirus 6 (HHV-6) in patients with AIDS can result in an acute and severe diffuse meningoencephalitis. We describe the epidemiological, clinical and outcome findings of five patients with diagnosis of HIV/AIDS and central nervous system involvement (CNS) due to HHV-6. Fever was present in all the patients. Meningeal compromise, seizures and encephalitis were present in some of the patients. Polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) specimens was positive for HHV-6 in all the patients. HHV-6 should be included among opportunistic and emerging pathogens that involve the CNS in patients with AIDS.
A reativação do herpesvírus humano 6 (HHV-6), em um hospedeiro com AIDS, pode resultar em meningoencefalite aguda difusa. Nós descrevemos a epidemiologia, a clínica e resultados encontrados em cinco pacientes com diagnóstico de HIV/AIDS e comprometimento do sistema nervoso central (SNC) devido ao HHV-6. Todos os pacientes apresentaram febre. Sinais e sintomas de comprometimento meníngeo, convulsões e encefalite podem ser encontrados. A reação em cadeia da polimerase (PCR) de amostras do líquor foi positiva para HHV-6 em todos os pacientes. O HHV-6 deve ser incluído entre os patógenos emergentes oportunistas que comprometem o SNC de pacientes com AIDS.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas Relacionadas com a AIDS/virologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Herpesviridae/virologia , /genética , Meningoencefalite/virologia , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Doenças Transmissíveis Emergentes/líquido cefalorraquidiano , Infecções por Herpesviridae/líquido cefalorraquidiano , Meningoencefalite/líquido cefalorraquidiano , Reação em Cadeia da PolimeraseRESUMO
Bovine herpesvirus type 5 (BHV-5) infection in calves causes meningoencephalitis, a fatal disease highly prevalent in South America. To study the pathogenesis of BHV-5 infection in cattle, 12 calves (group 1: acute infection) and 11 calves (group 2: latent infection) were intranasally inoculated with an Argentinean BHV-5 isolate at 10(8) and 10(4.7) tissue culture infective doses, respectively; six calves (control group) were mock infected. At 3 months postinoculation, all of the calves in group 2 and three calves in group 3 were given dexamethasone to reactivate the virus. The animals were euthanatized between days 6 and 17 postinoculation (group 1) and between days 6 and 16 postreactivation (group 2). Seventy-five percent and 91% of animals in groups 1 and 2, respectively, excreted BHV-5 in nasal and ocular discharges. Following dexamethasone administration, 45% of calves shed virus in both types of secretions. Spontaneous virus reactivation and shedding was observed in one calf. Neurologic signs consisting of circling, teeth grinding, ptyalism, jaw chomping, tongue protrusion, and apathy were observed in two animals in group 1 and, during the reactivation period, in four animals in group 2. Macroscopic findings consisted of softening of the cerebral tissue, meningeal hemorrhages and swelling, and edema and hemorrhages of prescapular, retropharyngeal and submandibular lymph nodes. Histologic lesions consisted of meningitis, mononuclear perivascular cuffing, neuronophagia, satellitosis, gliosis, hemorrhage, and necrosis and edema. Lesions in anterior cerebral cortex, medulla, and pons were consistently seen in all the animals of group 1. In the acutely infected animals, lesions in the diencephalon appeared at day 10 postinoculation, whereas in the latently infected calves these lesions were observed as early as at day 6 postreactivation. Latently infected animals developed lesions simultaneously in anterior cortex, medulla, pons, and diencephalon, showing a remarkable difference from the acutely infected group. Trigeminal ganglionitis appeared relatively early in animals of both groups (day 7 postinoculation in group 1 and day 8 postreactivation in group 2).
Assuntos
Doenças dos Bovinos/virologia , Encefalite Viral/veterinária , Infecções por Herpesviridae/veterinária , Herpesvirus Bovino 5/patogenicidade , Meningoencefalite/veterinária , Animais , Anti-Inflamatórios não Esteroides/metabolismo , Anticorpos Antivirais/sangue , Argentina , Bovinos , Doenças dos Bovinos/patologia , Córtex Cerebral/patologia , Córtex Cerebral/virologia , Efeito Citopatogênico Viral , Dexametasona/metabolismo , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/patologia , Encefalite Viral/virologia , Infecções por Herpesviridae/líquido cefalorraquidiano , Infecções por Herpesviridae/patologia , Infecções por Herpesviridae/virologia , Meningoencefalite/líquido cefalorraquidiano , Meningoencefalite/patologia , Meningoencefalite/virologia , Mucosa Nasal/virologia , Testes de Neutralização/veterinária , Distribuição Aleatória , Gânglio Trigeminal/patologia , Gânglio Trigeminal/virologia , Ativação Viral , Latência Viral , Eliminação de Partículas ViraisRESUMO
Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5% in AIDS patients and CMV was the virus most frequently detected (13.7%). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.
Assuntos
Infecções por Herpesviridae , Meningoencefalite/virologia , Adulto , Criança , Cuba , Feminino , Infecções por Herpesviridae/líquido cefalorraquidiano , Humanos , Masculino , Meningoencefalite/líquido cefalorraquidianoRESUMO
Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5 in AIDS patients and CMV was the virus most frequently detected (13.7). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.