Clinically severe Epstein-Barr virus encephalitis with mild cerebrospinal fluid abnormalities in an immunocompetent adolescent: a case report

A 15-year-old boy developed Epstein-Barr virus (EBV) encephalitis, a rare complication of infectious mononucleosis. The severe clinical picture and the marked neuroimaging changes were in contrast with mild cerebrospinal fluid abnormalities: leukocyte count was normal and protein level was only slightly elevated. EBV DNA was detected in cerebrospinal fluid by polymerase chain reaction.     

CSF beta-amyloid 1-42 and tau in Tunisian patients with Alzheimer's disease: the effect of APOE epsilon4 allele

Alzheimer's disease (AD) is the leading cause of dementia. Currently, no definitive diagnostic test for AD exists. An accurate, convenient and objective test to detect AD is urgently needed for efficient drug development and effective clinical use of emerging therapies. The aim of the present work is to investigate the usefulness of cerebrospinal fluid (CSF) beta-amyloid protein (Abeta1-42) and total tau protein (t-tau) analyses in the diagnosis of AD and whether apolipoprotein E (ApoE) epsilon4 allele is a factor for AD affecting Tunisian people. Abeta1-42 and t-tau levels were measured in CSF from AD patients (n=73), non-Alzheimer dementia (nAD, n=35) and healthy controls (HC, n=38) by sandwich enzyme-linked immunosorbent assay. Abeta1-42 levels were decreased and t-tau increased in AD patients. The combination of Abeta1-42 and t-tau at baseline yielded a sensitivity of 87.4% for detection of AD. The specificities were 97.3% for controls and 82.7% for other dementia. The ApoE epsilon4 allele frequency (29.5%) was significantly higher in the AD patients than in the nAD patients (17.1%) or in the control groups (9.5%). AD patients carrying ApoE epsilon4 allele had lower Abeta1-42 (p<0.001) levels than those without a epsilon4 allele. The combination of t-tau and Abeta1-42 is a robust and reliable assay that may be useful in discriminating cases at risk for AD such as ApoE epsilon4 allele carriers from nAD patients or from age-matched control subjects.     

Prevalence of Bordetella pertussis and Bordetella parapertussis infections in Tunisian hospitalized infants: results of a 4-year prospective study

The prevalence of pertussis in Tunisia remains undetermined essentially because of the unavailability of a basic laboratory diagnostic service. Specific diagnostic tools were applied for the first time in a Tunisian prospective study in order to get a first estimation of the prevalence of Bordetella pertussis/parapertussis infections and to evaluate their use to determine the epidemiologic characteristics of these infections in Tunisian infants. Between 2007 and 2011, a total of 626 samples from 599 infants aged <1 year with and without pertussoid cough were investigated for the presence of B. pertussis/parapertussis using culture and real-time polymerase chain reaction (PCR). The real-time PCR (RT-PCR) targets include IS481 commonly found in B. pertussis, B. bronchiseptica, and B. holmesii; IS1001 specific of B. parapertussis, in combination with the pertussis toxin promoter region gene (ptx) of B. pertussis; and the recA gene specific of B. holmesii. When possible, patients' household contacts provided nasopharyngeal aspirates (NPAs) for RT-PCR detection of B. pertussis/parapertussis or single-serum samples for anti-PT IgG quantification. All except 1 NPAs were negative by conventional culture, whereas PCR gave positive signals for 126 specimens (21%): B. pertussis, B. parapertussis, and Bordetella spp. were detected in 82%, 6%, and 4% of the samples, respectively. The simultaneous presence of B. pertussis and B. parapertussis was noted in 8% of the cases. Pertussis was reported throughout the year with a peak during the summer of the year 2009. The prevalence of Bordetella infection was 20% between 2007 and 2011. Most of these cases corresponded to patients younger than 6 months who received <3 doses of pertussis vaccine. Among the household contacts enrolled in the study, mothers seemed to be the likely source of infection. This study showed that pertussis is still prevalent in Tunisia and that the disease remains a public health problem affecting not only infants but also adults. Given this situation, sensitive and specific laboratory tests are needed to improve the accuracy of pertussis diagnosis.     

−1154G/A and −2578C/A polymorphisms of the vascular endothelial growth factor gene in Tunisian Alzheimer patients in relation to β-amyloid (1–42) and total tau protein

Recent evidences indicate that polymorphisms within the promoter region of the vascular endothelial growth factor (VEGF) gene may elevate the risk for Alzheimer's disease (AD). To further investigate, we have analyzed association between promoter polymorphisms of the VEGF gene in 93 AD patients and age and sex matched 113 controls from Tunisian population. The distribution of genotype and allele frequencies of the VEGF (−2578C/A) and (−1154G/A) polymorphisms did not differ significantly between AD and control groups (p > 0.05). In the subgroup of ApoE ?4 carriers, the −2578A was observed to be significantly higher in the AD patients than in the control individuals. After adjusting the data by gender, age and the ApoE ?4 status using logistic regression, the −2578A allele was found to increase the risk for sporadic AD by 1.7-fold. The present study provides the evidence that the −2578A allele may be associated with the development of AD in the individuals with ApoE ?4 allele. In addition, AD patients carrying the −2578A allele had lower Aβ42 (p = 0.029) levels than those without this allele, particularly in subjects with ApoE ?4 allele.     

Interest of CSF beta-amyloid1-42 and t-tau protein level determinations for the diagnosis of Alzheimer's disease

Early diagnosis of Alzheimer's disease remains a tactful poser. In order to clarify the importance of beta amyloid protein dosage (Abeta1-42) and protein tau (t-tau) in such pathology, we have rigorously studied three well recruited populations that match in age: healthy controls (n = 32), Alzheimer patients (n = 87) and non Alzheimer dementia (n = 31) patients. The combination of Abeta1-42 and t-tau at baseline yielded a sensitivity of 85.29 % for detection of Alzheimer's disease and the specificity was by 96.77 % to differentiate controls. So the combination of these tow markers helps in the diagnosis of Alzheimer because of the high specificity and sensibility of this method.     

Analysis of association between bleomycin hydrolase and apolipoprotein E polymorphism in Alzheimer’s disease

Alzheimer’s disease (AD) is the leading cause of dementia. Several studies indicate a possible relationship between different genes and Alzheimer’s disease. To further investigate, we have analyzed the association between the bleomycin hydrolase (BLMH) and apolipoprotein E (ApoE) polymorphisms in 93 AD patients and age- and sex-matched 113 controls from the Tunisian population. The frequency of ApoE epsilon 4 allele was found to differ significantly in AD patients compared to the control [29.5% vs. 8.8 (χ ² = 26, df = 1, p < 0.001)] leading to an increased risk of AD in subjects with this allele (OR = 3.29, 95% CI = 1.7–6.5; p = 0.001]. This risk was found to decrease from OR = 8.4, CI = 3.3–23; p < 0.001 in subjects less than 75 years old to OR = 1.2, CI = 1.031–14; p = 0.0297 in subjects 75 years and older. No association was observed between carrying the BLMH-G genotype and AD in ε4 negative or positive subjects.     

Predicting manual wheelchair initiation movement with EMG activity during over ground propulsion

Context/Objective: This is a preliminary study of movement finalities prediction in manual wheelchairs (MWCs) from electromyography (EMG) data. MWC users suffer from musculoskeletal disorders and need assistance while moving. The purpose of this work is to predict the direction and speed of movement in MWCs from EMG data prior to movement initiation. This prediction could be used by MWC to assist users in their displacement by doing a smart electrical assistance based on displacement prediction.Design: Experimental study.Setting: Trained Subject LAMIH Laboratory.Participants: Eight healthy subjects trained to move in manual wheelchairs.Interventions: Subjects initiated the movement in three directions (front, right and left) and with two speeds (maximum speed and spontaneous speed) from two hand positions (on the thighs or on the handrim). A total of 96 movements was studied. Activation of 14 muscles was recorded bilaterally at the deltoid anterior, deltoid posterior, biceps brachii, pectoralis major, rectus abdominis, obliquus externus and erector spinae.Outcome Measures: Prior amplitude, prior time and anticipatory postural adjustments were measured. A hierarchical multi-class classification using logistic regression was used to create a cascade of prediction models. We performed a stepwise (forward–backward) selection of variables using the Bayesian information criterion. Percentages of well-classified movements have been measured through the means of a cross-validation.Results: Prediction is possible using the EMG parameters and allows to discriminate the direction / speed combination with 95% correct classification on the 6 possible classes (3 directions * 2 speeds).Conclusion: Action planning in the static position showed significant adaptability to the forthcoming parameters displacement. The percentages of prediction presented in this work make it possible to envision an intuitive assistance to the initiation of the MWC displacement adapted to the user''s intentions.