#CFR and #Risk factors for #Nipah Virus #Encephalitis: a systematic review and meta-analysis (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 21 May 2019 / In Press, Accepted Manuscript

Case fatality rate and Risk factors for Nipah Virus Encephalitis: a systematic review and meta-analysis

Sebastien Kenmoe a, Maurice Demanou a, Jean Joel Bigna b, Cyprien Nde Kengne c, Abdou Fatawou Modiyinji a,d, Fredy Brice N. Simo a,e, Sara Eyangoh f, Serge  Alain Sadeuh-Mba a, Richard Njouom a

{a} Department of Virology, Centre Pasteur of Cameroon, 451 Rue 2005, P.O. Box 1274 Yaoundé, Cameroon; {b} Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon; {c} National AIDS Control Committee, Cameroon; {d} Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon; {e} Department of Biochemistry, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroun; {f} Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon

Received 12 March 2019, Revised 28 April 2019, Accepted 17 May 2019, Available online 21 May 2019. DOI: https://doi.org/10.1016/j.jcv.2019.05.009

 

Highlights

  • A substantial number of deaths are registered among patients with Nipah virus encephalitis.
  • Our meta-analysis shows that exposure to pigs, exposure to date palm sap, tree climbing and travel outside his sub-district are associated with an increased risk of NiV infection.
  • The combined probability of fruit consumption was higher in healthy controls compared to NiV infected cases.

 

Abstract

Background

A wide range of Nipah virus (NiV) encephalitis case fatality rates (CFR) have been reported. Data on the involvement of several potential risk factors in Nipah virus transmission remain controversial. We performed a systematic review and meta-analysis to estimate the pooled CFR of NiV encephalitis and to assess the risk factors for NiV infection.

Methods

Articles published up to the 27th of November 2018 in MedLine, Embase and Web of knowledge databases were considered for this study. We included cross-sectional, cohort, and case-control studies that have reported NiV CFR and/or risk factors. Data were pooled with random-effects model. This review was registered in the PROSPERO, CRD42018116242.

Findings

This global review included 22 citations (25 studies) including 2156, 1682, and 474 suspected, probable, and confirmed cases of NiV encephalitis, respectively. We determined a pooled CFR for NiV encephalitis at 61.0% (95% CI, 45.7-75.4; I² = 96.8%). Climbing trees (OR = 1.4; 95% CI; 1.0 to 1.9), male gender (OR = 1.5; 95% CI; 1.1 to 2.0), travel outside their own sub-district (OR = 2.0; 95% CI; 1.4 to 2.9), and exposure to date palm sap (DPS) (OR = 5.7; 95% CI; 3.8 to 8.6) or pigs (OR = 7.6; 95% CI; 1.2 to 45.4) were significantly associated with NiV infection.

Conclusion

Findings from this study suggest that NiV Encephalitis is associated with a high CFR and that male gender, travel outside their sub-district, climbing trees, and exposure to pigs and DPS are associated with an increased risk of NiV encephalitis.

Keywords: Case fatality rate – Risk factors – Nipah virus – Encephalitis

© 2019 Published by Elsevier B.V.

Keywords: Nipah virus; Encephalitis.

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#Bacteroides fragilis #polysaccharide A induces IL-10 secreting B and T cells that prevent #viral #encephalitis (Nat Commun., abstract)

[Source: Nature Communications, full page: (LINK). Abstract, edited.]

Article | OPEN | Published: 14 May 2019

Bacteroides fragilis polysaccharide A induces IL-10 secreting B and T cells that prevent viral encephalitis

Chandran Ramakrishna, Maciej Kujawski, Hiutung Chu, Lin Li, Sarkis K. Mazmanian & Edouard M. Cantin

Nature Communications, volume 10, Article number: 2153 (2019)

 

Abstract

The gut commensal Bacteroides fragilis or its capsular polysaccharide A (PSA) can prevent various peripheral and CNS sterile inflammatory disorders. Fatal herpes simplex encephalitis (HSE) results from immune pathology caused by uncontrolled invasion of the brainstem by inflammatory monocytes and neutrophils. Here we assess the immunomodulatory potential of PSA in HSE by infecting PSA or PBS treated 129S6 mice with HSV1, followed by delayed Acyclovir (ACV) treatment as often occurs in the clinical setting. Only PSA-treated mice survived, with dramatically reduced brainstem inflammation and altered cytokine and chemokine profiles. Importantly, PSA binding by B cells is essential for induction of regulatory CD4+ and CD8+ T cells secreting IL-10 to control innate inflammatory responses, consistent with the lack of PSA mediated protection in Rag−/−, B cell- and IL-10-deficient mice. Our data reveal the translational potential of PSA as an immunomodulatory symbiosis factor to orchestrate robust protective anti-inflammatory responses during viral infections.

Keywords: Bacteroides fragilis; Immunomodulation; Encephalitis.

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#Neurological manifestations of #pediatric #arboviral #infections in the #Americas (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 8 May 2019 / In Press, Accepted Manuscript

Neurological manifestations of pediatric arboviral infections in the Americas

Aline Almeida Bentes a,c,d, Erna Geessien Kroon b,d, Roberta Maiade Castro Romanelli a,d

{a} Faculdade de Medicina, Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190- Santa Efigênia, CEP 30130-100, Belo Horizonte, MG, Brazil; {b} Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; {c} Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil; {d} Faculty of Medicine of José do Rosário Vellano Univesity, Brazil

Received 8 February 2019, Revised 21 April 2019, Accepted 23 April 2019, Available online 8 May 2019. DOI: https://doi.org/10.1016/j.jcv.2019.04.006

 

Highlights

  • The neurological complications caused by DENV are based on three possible neuropathogenic mechanisms: invasion of the central (CNS) and peripheral (PNS) nervous systems; metabolic and vascular disorders and immune-mediated with different manifestations and sequelae.
  • Neurological manifestations of Zika acquired in children were remarkable and included hemiparesis, myelitis, Guillain-Barre syndrome, cortical infarction and behavioral changes.
  • The most common neurological manifestations found in children with Chikungunya infection were seizures, encephalitis, meningism and behavioral changes. Of these children, 5.6% died and 8.5% developed neuronal sequelae.

 

Abstract

Dengue, Zika, Chikungunya and yellow fever viruses are arboviruses transmitted by the mosquito Aedes aegypti. These viruses exhibit marked neurotropism but have rarely been studied. Here, we conduct an integrative review of the neurological manifestations caused by these arboviruses in the pediatric population. Data on patients under 18 years of age were extracted from literature databases. The most frequently reported neurological manifestations were encephalitis, meningitis, seizures, hypotonia, paresis, and behavioral changes. This review highlights the importance of accurately diagnosing these arboviral infections in children and adolescents with neurological manifestations.

Keywords: neurological manifestations – Dengue virus – Zika virus – Chikungunya virus – Yellow fever virus

© 2019 Elsevier B.V. All rights reserved.

Keywords: Arbovirus; Neurology; Zika virus; Chikungunya fever; Dengue Fever; Pediatrics; Encephalitis; Meningitis.

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Multi- #recombinant #Enterovirus A71 Subgenogroup C1 Isolates Associated with #Neurologic Disease, #France, 2016–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 6—June 2019 / Dispatch

Multirecombinant Enterovirus A71 Subgenogroup C1 Isolates Associated with Neurologic Disease, France, 2016–2017

Stéphanie Tomba Ngangas, Alexander Lukashev, Gwendoline Jugie, Olga Ivanova, Jean-Michel Mansuy, Catherine Mengelle, Jacques Izopet, Anne-Sophie L’honneur, Flore Rozenberg, David Leyssene, Denise Hecquet, Stéphanie Marque-Juillet, David Boutolleau, Sonia Burrel, Hélène Peigue-Lafeuille, Christine Archimbaud, Kimberley Benschop, Cécile Henquell, Audrey Mirand, and Jean-Luc Bailly

Author affiliations: Université Clermont Auvergne, Clermont-Ferrand, France (S. Tomba Ngangas, G. Jugie, H. Peigue-Lafeuille, C. Archimbaud, C. Henquell, A. Mirand, J.-L. Bailly); Sechenov University, Moscow, Russia (A. Lukashev); Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Moscow (O. Ivanova); Centre Hospitalier Universitaire de Toulouse, Toulouse, France (J.-M. Mansuy, C. Mengelle, J. Izopet); Assistance Publique-Hôspitaux de Paris Cochin, Paris, France (A.-S. L’honneur, F. Rozenberg); Centre Hospitalier de la Côte Basque, Bayonne, France (D. Leyssene); Centre Hospitalier Universitaire Amiens, Amiens, France (D. Hecquet); Centre Hospitalier de Versailles, Le Chesnay, France (S. Marque-Juillet); Assistance Publique-Hôspitaux de Paris Pitié-Salpêtrière-Charles Foix, Paris (D. Boutolleau, S. Burrel); CHU Clermont-Ferrand, Clermont-Ferrand (H. Peigue-Lafeuille, C. Archimbaud, C. Henquell, A. Mirand, J.-L. Bailly); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (K. Benschop)

 

Abstract

In 2016, an upsurge of neurologic disease associated with infection with multirecombinant enterovirus A71 subgenogroup C1 lineage viruses was reported in France. These viruses emerged in the 2000s; 1 recombinant is widespread. This virus lineage has the potential to be associated with a long-term risk for severe disease among children.

Keywords: EV-A71; Encephalitis; Neurology; Pediatrics; France.

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#Immunopathology of #Fatal #Human Variegated #Squirrel #Bornavirus 1 #Encephalitis, #Germany, 2011–2013 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 6—June 2019 / Synopsis

Immunopathology of Fatal Human Variegated Squirrel Bornavirus 1 Encephalitis, Germany, 2011–2013

Dennis Tappe  , Jonas Schmidt-Chanasit, Jessica Rauch, Petra Allartz, and Christiane Herden

Author affiliations: Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (D. Tappe, J. Schmidt-Chanasit, J. Rauch, P. Allartz); German Centre for Infection Research, Hamburg (J. Schmidt-Chanasit); University of Giessen, Giessen, Germany (C. Herden)

 

Abstract

Variegated squirrel bornavirus 1 (VSBV-1) is a zoonotic virus that causes fatal encephalitis in humans who are infected after contact with exotic squirrels. We analyzed the brain lesions and the immune responses in all 4 known human cases that showed panencephalitis. Inflammatory infiltrates in areas positive for VSBV-1 RNA and antigen consisted of CD4+ and CD8+ T cells, with perivascular B-cell accumulation. Strong microglial response and bizarre astroglial expansion were present. Areas of malacia contained neutrophils and foamy microglia and macrophages. Immunopathologic examination during infection showed cleavage of caspase 3 in brain cells adjacent to CD8+ cells and widespread p53 expression, hallmarks of apoptosis. Cerebrospinal fluid analyses over time demonstrated increasing protein concentrations and cell counts, paralleled by pathologic lactate elevations in all patients. The most severe cerebrospinal fluid and histologic changes occurred in the patient with the highest viral load, shortest duration of disease, and most medical preconditions.

Keywords: Variegated squirrel bornavirus 1; Encephalitis; Human; Germany; Immunopathology.

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Long-term #outcome in #neuroZika: When #biological #diagnosis matters (Neurology, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Neurology. 2019 Apr 26. pii: 10.1212/WNL.0000000000007536. doi: 10.1212/WNL.0000000000007536. [Epub ahead of print]

Long-term outcome in neuroZika: When biological diagnosis matters.

Lannuzel A1, Fergé JL2, Lobjois Q2, Signate A2, Rozé B2, Tressières B2, Madec Y2, Poullain P2, Herrmann C2, Najioullah F2, McGovern E2, Savidan AC2, Valentino R2, Breurec S2, Césaire R2, Hirsch E2, Lledo PM2, Thiery G2, Cabié A2, Lazarini F2, Roze E2.

Author information: 1 From the Service de Neurologie (A.L., Q.L.), Service de Radiologie (P.P.), Laboratoire de Microbiologie Clinique et Environnementale (C.H., S.B.), and Service de Réanimation (G.T.), Centre Hospitalier Universitaire de la Guadeloupe, Institut Pasteur de Guadeloupe (S.B.), Faculté de Médecine (A.L., Q.L., R.C., G.T., S.B., A.C.), Equipe d’accueil 4537 (F.N., R.C., A.C.), Université des Antilles; Faculté de Médecine de Sorbonne Université (A.L., E.H., E.R.), Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moelle Épinière, ICM, Paris; Service de Réanimation (J.-L.F., A.-C.S., R.V.), Service de Neurologie (A.S.), Service de Maladies Infectieuses et Tropicales (A.C., B.R.), and Laboratoire de Virologie (R.C., F.N.), Centre Hospitalier Universitaire de la Martinique (A.C.); Inserm CIC 1424 (B.T., A.C.), Centre d’Investigation Clinique Antilles Guyane; Emerging Diseases Epidemiology Unit (Y.M.), Institut Pasteur; Département de Neurologie (E.M., E.R.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Institut Pasteur, Perception and Memory Unit (P.-M.L., F.L.), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France. annie.lannuzel@chu-guadeloupe.fr. 2 From the Service de Neurologie (A.L., Q.L.), Service de Radiologie (P.P.), Laboratoire de Microbiologie Clinique et Environnementale (C.H., S.B.), and Service de Réanimation (G.T.), Centre Hospitalier Universitaire de la Guadeloupe, Institut Pasteur de Guadeloupe (S.B.), Faculté de Médecine (A.L., Q.L., R.C., G.T., S.B., A.C.), Equipe d’accueil 4537 (F.N., R.C., A.C.), Université des Antilles; Faculté de Médecine de Sorbonne Université (A.L., E.H., E.R.), Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moelle Épinière, ICM, Paris; Service de Réanimation (J.-L.F., A.-C.S., R.V.), Service de Neurologie (A.S.), Service de Maladies Infectieuses et Tropicales (A.C., B.R.), and Laboratoire de Virologie (R.C., F.N.), Centre Hospitalier Universitaire de la Martinique (A.C.); Inserm CIC 1424 (B.T., A.C.), Centre d’Investigation Clinique Antilles Guyane; Emerging Diseases Epidemiology Unit (Y.M.), Institut Pasteur; Département de Neurologie (E.M., E.R.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Institut Pasteur, Perception and Memory Unit (P.-M.L., F.L.), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France.

 

Abstract

OBJECTIVE:

To characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection.

METHODS:

We conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak.

RESULTS:

Eighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13-17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12-75.22; p = 0.039).

CONCLUSIONS:

NeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients.

© 2019 American Academy of Neurology.

PMID: 31028126 DOI: 10.1212/WNL.0000000000007536

Keywords: Zika Virus; Neuroinvasion; Encephalitis; Meningoencephalitis; GBS; Neurology.

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#Picornavirus #etiology of acute #infections among hospitalized #infants (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 25 April 2019 / In Press, Accepted Manuscript

Picornavirus etiology of acute infections among hospitalized infants

Glen R.Abedi a, Kevin Messacar b, William Luong c, W. Allan Nix a, Shannon Rogers a, Krista Queen a, Suxiang Tong a, M. Steven Oberste a, James Watt c, Gretchen Rothrock c, Samuel Dominguez b, Susan I. Gerber a, John T. Watson a

{a} Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, United States; {b}
Colorado Emerging Infections Program, Denver, Colo., United States; {c} California Emerging Infections Program, Richmond, Calif., United States

Received 4 December 2018, Revised 17 April 2019, Accepted 23 April 2019, Available online 25 April 2019. DOI: https://doi.org/10.1016/j.jcv.2019.04.005

 

Highlights

  • Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.
  • Of 319 patients aged <1 year, CSF specimens from 13 (4.1%) were positive for EV and from 11 (3.4%) for PeV.
  • Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.
  • Clinicians should consider EV and PeV infections in infants presenting with febrile illness.

 

Abstract

Background

Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.

Objectives

We describe EV and PeV infections among children from 2 US study sites aged <1 year and hospitalized with acute infections. For EV- and PeV-negative case-patients, we explored other viral etiologies.

Methods

Participants were aged <1 year, hospitalized during 2016, and had cerebrospinal fluid (CSF) collected for routine diagnostic testing. Demographic and clinical data were abstracted from medical charts, and residual specimens were sent to CDC for confirmatory testing and typing.

Results

Of 472 eligible case-patients, CSF specimen was available for 319 (67.6%). Among those, 13 (4.1%) were positive for EV and 11 (3.4%) for PeV. Most case-patients (86.8%, n = 277) were aged <2 months, as were all EV- or PeV-positive case-patients. None of the positive case-patients had underlying conditions, and the chief complaint for 91.7% (n = 22) was fever. Twelve positive case-patients were admitted to intensive care (ICU) and had brief hospital stays (median 2 days). Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.

Conclusions

A range of EVs and PeVs were associated with acute febrile illnesses leading to hospitalization in children aged <2 months. Approximately half of EV and PeV case-patients were admitted to ICU, but length of hospital stay was brief and illnesses were generally self-limiting. Clinicians should consider EV and PeV infections in infants presenting with febrile illness.

Keywords: enterovirus – parechovirus – infants – fever – sepsis – encephalitis – meningitis

{☆} The conclusions, findings, and opinions expressed by the authors do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

© 2019 Published by Elsevier B.V.

Keywords: Enterovirus; Picornavirus; Parechovirus; Encephalitis; Meningitis; Sepsis; Pediatrics.

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