Acute cerebellitis associated with rotavirus infection

Background

Rotavirus infection is occasionally associated with central nervous system involvement, including cerebellitis. However, the precise clinical sequelae of central nervous system disorders and the usefulness of neuroradiological examination for clinical therapies, such as steroid pulse therapy, have not been clarified.

Methods

We present a case of rotavirus cerebellitis examined by magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and single photon emission computed tomography.

Results

MRI demonstrated abnormal intensities in the right cerebellum on fluid attenuated inversion recovery images and, much more obviously, on diffusion-weighted images, but not on T1- or T2-weighted images. Single photon emission computed tomography showed only mild hypoperfusion in the right cerebellum on the 15th day, while 4 weeks later the image showed remarkably low perfusion in the right cerebellum.

Conclusion

The findings of the reported case suggest the importance of performing radiological examinations at early phases of the disease, especially by new modalities such as diffusion weighted imaging, to make timely and appropriate therapeutic decisions.     

轮状病毒全身性感染一例分析

为了探讨轮状病毒（ＲＶ）肠道外感染问题，对１９９６年１月初广州地区ＲＶ腹泻高峰期间死亡１例婴儿做了尸体解剖，同时采用反转录聚合酶链反应（ＲＴ－ＰＣＲ）技术对有关组织和体液检测了ＲＶ抗原。结果显示，光镜下，患儿肠组织呈典型ＲＶ胃肠炎改变，肺和脑组织显示间质性肺炎、脑膜脑炎提示病毒感染所致，在脑脊液、腹水、肺组织和粪便中均可检出ＲＶ，血与胆汁中未检出。提示患儿在疾病早期可能存在一过性病毒血症，导致ＲＶ全身播散。ＲＶ是否对呼吸系统与中枢神经系统亦为易受侵犯的脏器与组织，成为致死的主要原因尚待进一步深入地研究与探讨     

Acute infantile gastroenteritis caused by rotavirus in Japan

We had an outbreak of acute infantile gastroenteritis accompanied by milky-white stool (called Hakuri in Japanese) during the winters of 1976 and 1977. Stool specimens collected from 72 cases of Hakuri were studied by negative-staining electron microscopy. Rotavirus was detected with a very high frequency (89%).Rotavirus obtained from one of the patients was isolated and passaged in cultures of primary human embryonic kidney cells. Viral antigens could be detected in the cytoplasm of the cells by indirect immuno-fluorescence. The fluorescence-positive cells increased in number with repeated passage.Serum anti-viral activities in 11 patients were titrated by indirect immuno-fluorescence, using the cells infected with the passaged rotavirus. All 11 patients developed IgM responses in the convalescent phase. However, in 4 of the 11 patients, no IgG responses were detected even 2–3 weeks after the onset of illness. The reinfection which has occasionally be seen in our country may be related to these poor IgG responses.     

Detection of rotavirus infection chains by electropherotyping

518 fecal specimens were examined by SDS-PAGE after rotavirus had been detected by an ELISA. The material was collected from 239 patients in three children's hospitals in Bremen over a period of one year. Seventy-two percent of the children had a nosocomial infection. Eight electropherotypes could be distinguished by electrophoresis, one of which (type C) dominated (61.1%). In the neonatal wards of the children's hospitals one main electropherotype (type C) was detected throughout the year. In contrast, different electropherotypes could be detected simultaneously in the isolation wards. Some other electropherotypes were found only in certain hospitals. Our examinations demonstrate that by these additional electrophoretic investigations infection chains within children's hospitals can be detected and that the endemic occurrence of rotavirus in neonatal wards is less dependent on those types circulating in the general population.     

重症轮状病毒感染

自1973年发现轮状病毒(rotavirus,RV)以来,研究不断深入。RV是世界范围内儿童急性腹泻病最重要的病原之一,全球每年约有87万儿童死于RV感染,并且主要是在发展中国家。人类RV分为A、B、C 3组,分子流行病学研究显示,世界范围内广泛流行的主要为A组,但B、C组也有报道。在我国流行的A组轮状病毒一直以G1型为主,G2型次之,G3型、G4型再次之。然而近年来,全国分离出的G3型毒株明显增多。B组轮状病毒,是我国分离鉴定的新轮状病毒,仅在我国大陆流行。C组轮状病毒感染在世界各地有局部的发病和流行,但感染率不如A组。英格兰和威尔士的血清学…     

Adenovirus infection in families.

Eighteen families were followed up for four to six weeks after one member of each family was diagnosed as having an adenovirus infection. In 17 of 18 index cases the diagnosis was based on the rapid detection of adenovirus hexon antigen in the nasopharyngeal mucus specimens and in one case (the only adult index case) on isolation of the virus. All index cases had high temperatures associated most commonly with tonsillitis, acute otitis media, gastroenteritis, or febrile convulsions. In 14 of the 16 families with symptomatic contacts the index case was the first symptomatic case, or one of the first symptomatic cases, in that family. Fifteen (94%) of the siblings and 20 (56%) of the parents had signs and symptoms of acute infection during the follow up period. In 10 (63%) and eight (20%) of these cases, respectively, adenovirus was confirmed. The mean (SD) incubation period of confirmed adenovirus infections was 10 (3) days. The observations show that adenovirus infection spreads actively to other siblings in the family. Rapid diagnosis permits parents to be informed prospectively about the expected spread and clinical picture of the illness in the family.     

轮状病毒肠道外感染的研究进展

近年来,不断有轮状病毒肠炎患儿在病程中出现各种肠道外脏器损伤的报道,主要见于肺、心、肝胆、肾以及神经系统的损伤,并且在部分受累器官中已找到明确的证据,提示轮状病毒可能存在新的发病机制和感染途径,但目前仍未完全清楚.     

轮状病毒感染机制新进展

轮状病毒(rotavirus,RV)是世界范围内引起婴幼儿重症腹泻的最主要病原,而对于RV腹泻至今尚无特效治疗药物.目前对于RV感染的致病机制有多种说法,但尚无确切结论.在RV感染过程中,RV病原体必须克服宿主抗病毒先天免疫反应才能在宿主细胞中成功复制,而在此过程中RV编码的蛋白起到了重要作用.该文对RV编码蛋白在RV感染机制中的作用的研究进展加以综述.     

Nosocomial transmission of rotavirus infection

Children admitted to the infant ward between November 30, 1983, and May 5, 1984, were sampled for rotavirus antigen at admission and at 4-day intervals during subsequent hospitalization. Rotavirus was detected in 51 of 315 infants, 24 at the initial sampling and 27 after 72 hours of hospitalization (nosocomial cases). Forty-one of the cases were symptomatic and 10 were asymptomatic. Nosocomial rotavirus was detected in 5, 13 and 24% of children in the hospital for 4 to 8, 9 to 13 and greater than 13 days, respectively. Attending physicians clinically entertained the diagnosis of rotavirus infection in 58% of community-acquired cases but in only 22% of nosocomial cases. Subgrouping of 24 of the rotavirus isolates with monoclonal antibodies indicated that two-thirds of the isolates were Subgroup II, and the remainder were a mixed subgroup, with similar prevalences in the nosocomial and community-acquired cases. Only 11 of 27 instances of nosocomial rotavirus acquisition were epidemiologically associated with a rotazyme-positive roommate and in 4 of these instances different subgroups were present in the 2 roommates. These data suggest that infected roommates appear not to be a major source for direct transmission of nosocomial rotavirus infection.     

Chronic rotavirus infection in immunodeficiency

The characteristics of rotavirus infection in 23 children with a variety of primary immunodeficiency diseases were studied. Stools and sera were tested for rotavirus by means of the enzyme-linked immunosorbent assay and the enzyme-linked fluorescent assay, respectively. Four immunodeficient patients had diarrhea during the study period and all had rotavirus infection; rotavirus was not detected in the stools of the 19 asymptomatic immunodeficient patients. Forty-six control children with diarrhea were tested and 22 had rotavirus infection; rotavirus was not detected in 39 asymptomatic control children. One immunodeficient patient with X-linked agammaglobulinemia and one with severe combined immunodeficiency had chronic, symptomatic rotavirus infection with rotavirus excretion lasting more than six weeks. The other two immunodeficient patients and eight control children eliminated the rotavirus from their stools in periods ranging from two to 12 days. Rotavirus antigen was detected in the sera of three of the four immunodeficient patients; none of the 14 control infants tested had rotavirus antigen detected in their sera. This study indicates that rotavirus may produce a chronic infection in immunodeficient children.     

Adenovirus infection in hospitalized immunocompetent children

This study investigated the clinical features of immunocompetent children with adenovirus infection requiring hospitalization. The files of 78 children (mean age 17 +/- 10 months) with community-acquired adenovirus infection admitted over a 2-year period were reviewed. The children were referred after 5.7 +/- 3.4 days of illness, all with fever (mean peak 39.8 +/- 0.8 degrees C). Temperature normalized after 3.5 +/- 2 days. Duration of hospitalization (mean, 7.0 +/- 3.9 days) correlated with lethargy, lung crackles, cracked lips, hypoxia, impaired liver tests, and high serum lactic dehydrogenase (LDH) concentration at admission. Serum LDH concentrations and hypoxemia predicted 70% of the variance in hospital stay. All patients recovered. Adenovirus infection may cause considerable morbidity, even in immunocompetent children. Disease severity, defined by duration of hospitalization, correlates with serum LDH concentrations and oxygen saturation at admission.     

Adenovirus infection and childhood intussusception.

OBJECTIVE--To investigate the possible relationship between enteric adenovirus types 40 and 41 and intestinal intussusception in children. DESIGN--Prospective, case-control patient study. PATIENTS--Sixty-three consecutive children suspected clinically of having intestinal intussusception were enrolled in this study. Of these, 25 children (mean age, 1.4 years; range, 3 months to 5 years) had barium enema examination-proved intussusception. Age-matched normal controls (24) and controls with diarrhea (21) were obtained within 1 month of the index case. MEASUREMENTS AND RESULTS--Stools were tested for the presence of nonenteric adenovirus and enteric adenovirus using a monoclonal antibody-based enzyme immunoassay. Five (20%) of 25 children with intussusception had nonenteric adenovirus in their stools compared with one (4%) of 24 normal controls, none (0%) of 21 of the controls with diarrhea, and none (0%) of 37 patients suspected of having intussusception who had negative results on barium enema examination. However, no stool samples were positive for enteric adenovirus. CONCLUSIONS--Nonenteric adenovirus infection and intestinal intussusception may be associated. However, because enteric adenovirus was not found in any of the groups studied, no conclusions can be made regarding their possible influence on the risk for developing intussusception.