D Casas-Alba1, M F de Sevilla2, A Valero-Rello3, C Fortuny2, J-J García-García2, C Ortez4, J Muchart5, T Armangué4, I Jordan6, C Luaces7, I Barrabeig8, R González-Sanz9, M Cabrerizo9, C Muñoz-Almagro10, C Launes11. 1. Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain. 2. Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain. 3. Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Department of Molecular Microbiology, Hospital Sant Joan de Deu, Spain. 4. Department of Paediatric Neurology, Hospital Sant Joan de Deu (University of Barcelona), Spain. 5. Department of Diagnostic Imaging, Hospital Sant Joan de Deu (University of Barcelona), Spain. 6. Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Paediatric Intensive Care Unit, Hospital Sant Joan de Deu (University of Barcelona), Spain. 7. Emergency Department, Hospital Sant Joan de Deu (University of Barcelona), Spain. 8. Epidemiological Surveillance Unit of Health Region, Barcelona-South, Public Health Agency of Catalonia, Hospitalet de Llobregat, Spain. 9. Enterovirus Unit, National Centre for Microbiology, Institute of Public Health "Carlos III", Madrid, Spain. 10. Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Emergency Department, Hospital Sant Joan de Deu (University of Barcelona), Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain. 11. Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain. Electronic address: claunes@sjdhospitalbarcelona.org.
Abstract
OBJECTIVES: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.
OBJECTIVES: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.
Authors: Olwen C Murphy; Kevin Messacar; Leslie Benson; Riley Bove; Jessica L Carpenter; Thomas Crawford; Janet Dean; Roberta DeBiasi; Jay Desai; Matthew J Elrick; Raquel Farias-Moeller; Grace Y Gombolay; Benjamin Greenberg; Matthew Harmelink; Sue Hong; Sarah E Hopkins; Joyce Oleszek; Catherine Otten; Cristina L Sadowsky; Teri L Schreiner; Kiran T Thakur; Keith Van Haren; Carolina M Carballo; Pin Fee Chong; Amary Fall; Vykuntaraju K Gowda; Jelte Helfferich; Ryutaro Kira; Ming Lim; Eduardo L Lopez; Elizabeth M Wells; E Ann Yeh; Carlos A Pardo Journal: Lancet Date: 2020-12-23 Impact factor: 79.321
Authors: Elba Pascual-Goñi; Maria Josa; Cristian Launes; Luis Querol; Marga Del Cuerpo; M Alba Bosch; Iolanda Jordan; Eulàlia Turón-Viñas Journal: Front Neurol Date: 2019-05-24 Impact factor: 4.003
Authors: Rubén González-Sanz; Didac Casas-Alba; Cristian Launes; Carmen Muñoz-Almagro; María Montserrat Ruiz-García; Mercedes Alonso; María José González-Abad; Gregoria Megías; Nuria Rabella; Margarita Del Cuerpo; Mónica Gozalo-Margüello; Alejandro González-Praetorius; Ana Martínez-Sapiña; María José Goyanes-Galán; María Pilar Romero; Cristina Calvo; Andrés Antón; Manuel Imaz; Maitane Aranzamendi; Águeda Hernández-Rodríguez; Antonio Moreno-Docón; Sonia Rey-Cao; Ana Navascués; Almudena Otero; María Cabrerizo Journal: Euro Surveill Date: 2019-02
Authors: Josefa Masa-Calles; Nuria Torner; Noemí López-Perea; María de Viarce Torres de Mier; Beatriz Fernández-Martínez; María Cabrerizo; Virtudes Gallardo-García; Carmen Malo; Mario Margolles; Margarita Portell; Natividad Abadía; Aniceto Blasco; Sara García-Hernández; Henar Marcos; Núria Rabella; Celia Marín; Amelia Fuentes; Isabel Losada; Juan García Gutiérrez; Alba Nieto; Visitación García Ortúzar; Manuel García Cenoz; José María Arteagoitia; Ángela Blanco Martínez; Ana Rivas; Daniel Castrillejo Journal: Euro Surveill Date: 2018-11