Childhood chorea-encephalopathy associated with recent parvovirus B19 infection in two Jamaican children

Chambers, R. H. Melbourne; Gooden, Michael A.; Gilbert, Thomas D.; Jackson, Sandra

doi:10.1179/146532810x12858955921438

Cited by 6 publications

(2 citation statements)

References 12 publications

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“…On the other hand, immune-related pathogenic mechanisms cannot be ruled out, supported by complete resolution of symptoms in cases treated with steroids. In addition, recent reports suggest that some cases of anti-N-methyl-D-aspartate receptor encephalitis could be triggered by B19 [35,36,101]. Vascular injury, particularly in the cerebellum, could also be involved in the pathogenesis.…”

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confidence: 99%

Neurological aspects of human parvovirus B19 infection: a systematic review

Barah

Whiteside

Batista

et al. 2014

Reviews in Medical Virology

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Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required. © 2014 The Authors. Reviews in Medical Virology published by John Wiley & Sons, Ltd.

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confidence: 99%

Neurological aspects of human parvovirus B19 infection: a systematic review

Barah

Whiteside

Batista

et al. 2014

Reviews in Medical Virology

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“…There is one case of tick-born encephalitis presenting with chorea that improved with haloperidol, dexamethasone, pentoxifylline, nitrazepam, and midazolam [ 14 ]. Cases of influenza A, parvovirus B19 encephalitis, and West Nile virus encephalitis presenting with chorea that slowly improved with supportive care over several weeks [ 15 16 17 ]. When syphilis was the cause, symptoms responded to standard treatment with benzathine penicillin 2.4 million units IM followed by penicillin G 2.4 million units IM for 14 days [ 18 19 ].…”

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confidence: 99%

Treatment of Secondary Chorea: A Review of the Current Literature

Feinstein

Walker

2020

Tremor and Other Hyperkinetic Movements

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Background: Chorea consists of involuntary movements affecting the limbs, trunk, neck or face, that can move from one body part to another. Chorea is conceptualized as being "primary" when it is attributed to Huntington's disease (HD) or other genetic etiologies, or "secondary" when it is related to infectious, pharmacologic, metabolic, autoimmune disorders, or paraneoplastic syndromes. The mainstay of the secondary chorea management is treating the underlying causative disorder; here we review the literature regarding secondary chorea. We also discuss the management of several non-HD genetic diseases in which chorea can be a feature, where metabolic targets may be amenable to intervention and chorea reduction. Methods: A PubMed literature search was performed for articles relating to chorea and its medical and surgical management. We reviewed the articles and cross-references of pertinent articles to assess the current clinical practice, expert opinion, and evidence-based medicine to synthesize recommendations for the management of secondary chorea. Results: There are very few double-blind randomized controlled trials assessing chorea treatments regardless of etiology. Most recommendations are based on small open-label studies, case reports, and expert opinion. Discussion: Treatment of secondary chorea is currently based on expert opinion, clinical experience, and small case studies, with limited evidence-based medical data. When chorea is secondary to an underlying infection, medication, metabolic abnormality, autoimmune process, or paraneoplastic illness, the movements typically resolve following treatment of the underlying disease. Tardive dyskinesia is most rigorously studied secondary chorea with the best evidence-based medicine treatment guidelines recommending the use of pre-synaptic dopamine-depleting agents. Even though there is an insufficient pool of EBM, small clinical trials, case reports, and expert opinion are valuable for guiding treatment and improving the quality of life for patients with chorea. Highlights: There is a dearth of well-controlled studies regarding the treatment of chorea. Expert opinion and clinical experiences are fundamental in guiding chorea management and determining successful treatment. In general, secondary chorea improves with treating the underlying medical abnormality; treatments include antibiotics, antivirals, immunosuppression, dopamine depleting agents, chelation, and supportive care.

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