Case report: Detection of rotavirus RNA in the cerebrospinal fluid of a child with rotavirus gastroenteritis and meningism

Abstract

Although case reports have described detection of rotavirus (RV) in extraintestinal sites such as the liver, kidney, and central nervous system (CNS) of children with RV gastroenteritis, CNS localization in RV infection seems to be rare. RT‐PCR and nucleotide sequencing detected a G1P[8] strain in the stool and cerebrospinal fluid (CSF) samples of a patient with concurrent RV‐associated enteritis and CNS signs. Upon sequence analysis, the viruses detected in the CSF was identical to the virus detected in the stools. In the VP7‐ and VP4‐based phylogenetic dendograms the strain clustered within the G1‐Ic sub‐lineage and the P[8]‐III lineage. This study supports the hypothesis that RV infection was able to spread from the intestinal tract to the CNS, and likely played a role in the onset of neurological disease. J. Med. Virol. 83:1637–1640, 2011. © 2011 Wiley‐Liss, Inc.

Analysis of prognostic factors for infantile rotavirus infection

“…Moreover, in this study, some infants presented convulsions, for which aseptic meningitis cannot be excluded (Tang et al, 2010). The existence of RV in the cerebrospinal fluid in infants with RV enteritis complicated by meningitis suggests that RV can lead to viremia (Medici et al, 2011), which can lead to CNS damage (Kawano et al, 2007). However, it has been suggested that both RV-caused viremia and brain damage lack a reliable theoretical basis (Fang, 2011).…”

“…All children were confirmed to have RV infection and met the diagnostic criteria of RV enteritis (Medici et al, 2011). They were all confirmed to have no histories of congenital heart disease, myocarditis, toxic encephalopathy, hepatorenal diseases, and various muscle diseases.…”

Changes in the cytokine expression of peripheral Treg and Th17 cells in children with rotavirus enteritis

“…The majority of the intestinal epithelium is a collection of T lymphocytes in lymph nodes; thus, investigating the role of antiviral cell-mediated immunity in the gut is particularly important (4). With the increasing number of studies investigating the abnormal immune response and the mechanism underlying RV infection in the body, a variety of cellular immune responses associated with RV cells and cytokines have been demonstrated to be involved in the inflammatory response (5,6). An imbalance in the proportion of regulatory T cells (Treg)/T helper 17 cells (Th17), and the subsequent expression of cytokines, has become the theoretical basis for the study of various autoimmune disorders and other diseases (7)(8)(9).…”

Evidences and consequences of extra-intestinal spread of rotaviruses in humans and animals

“…In one study, RV antigen was diagnosed in 30 of 70 serum samples, and levels of antigen in the sera were significantly increased at the acute phase of the RV infections [21]. Acute sera from children with RV associated encephalopathy were identified to be positive with RV antigen, demonstrating antigenemia; however, the antigen was not detected in the cerebro-spinal fluid [39]. Most of the findings concerning antigenemia were observed during the early phase of infection, where the RV antigen levels in the sera peaked at 2 days post-inoculation (dpi), and no antigen was detected at 6 dpi [48,56].…”

“…It may seem that RV can move to these organs via viremia, but there is still no indication whether it can replicate efficiently outside the intestine. Increasing reports presented detection of RV antigen or RNA in the cerebrospinal fluid of diarrheic children [23,30,37,39,45]. Previously, reported cases showed the presence of RV nucleic acid in cerebrospinal fluid of children with acute cerebellitis which was attributed to cerebellar seizures [14,47].…”