First case of confirmed rotavirus meningoencephalitis in Germany

Kehle, Johannes; Metzger-Boddien, Christoph; Tewald, Friedemann; Wald, Martin; Schüürmann, Joachim; Enders, Gisela

doi:10.1097/01.inf.0000066193.54453.7a

Cited by 14 publications

(13 citation statements)

References 15 publications

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“…Of note, in 2003 Blutt et al demonstrated that rotavirus antigenemia was, in fact, a common event in infant mice, adult mice, rabbits, rats, calves, and young children during acute infection (2). A variety of recent studies in children and primates have confirmed these observations (6,11,16,18,20,32). These studies clearly demonstrated that the spread of rotavirus to the bloodstream occurs frequently, but the quantity of viremia relative to the amount of virus in the gut has not been investigated, nor has it been determined whether extraintestinal replication accompanies the viremia.…”

Section: Discussionsupporting

confidence: 53%

Extraintestinal Spread and Replication of a Homologous EC Rotavirus Strain and a Heterologous Rhesus Rotavirus in BALB/c Mice

Fenaux

Cuadras

Feng

et al. 2006

J Virol

110

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Although rotavirus infection has generally been felt to be restricted to the gastrointestinal tract, over the last two decades there have been sporadic reports of children with acute or fatal cases of rotavirus gastroenteritis testing positive for rotavirus antigen and/or nucleic acid in various extraintestinal locations such as serum, liver, kidney, bladder, testes, nasal secretions, cerebrospinal fluid, and the central nervous system. Recently, studies in animals and people have demonstrated that rotavirus antigenemia is a common event during natural infection. In this study, we extend these observations and compare the intestinal and extraintestinal spread of wild-type homologous murine rotavirus EC and a heterologous strain, rhesus rotavirus (RRV), in newborn mice. A strand-specific quantitative reverse transcription-PCR (ssQRT-PCR) assay was used to quantify the ability of different rotavirus strains to spread and replicate extraintestinally. Both strain EC and RRV were detected extraintestinally in the mesenteric lymph nodes (MLN), livers, lungs, blood, and kidneys. Extraintestinal replication, as measured by ssQRT-PCR, was most prominent in the MLN and occurred to a lesser degree in the livers, kidneys, and lungs. In the MLN, strain EC and RRV had similar (P < 0.05) RNA copy numbers, although EC was present at a 10,000-fold excess over RRV in the small intestine. Rotavirus nonstructural protein 4 (NSP4) and/or assembled triple-layered particles, indicated by immunostaining with the VP7 conformation-dependent monoclonal antibody 159, were detected in the MLN, lungs, and livers of ECand RRV-inoculated mice, confirming the ssQRT-PCR findings. Infectious RRV was detected in the MLN in quantities exceeding the amount present in the small intestines or blood. The cells in the MLN that supported rotavirus replication included dendritic cells and potentially B cells and macrophages. These data indicate that extraintestinal spread and replication occurs commonly during homologous and some heterologous rotaviral infections; that the substantial host range restrictions for rhesus rotavirus, a heterologous strain present in the intestine, are not necessarily apparent at systemic sites; that the level and location of extraintestinal replication varies between strains; that replication can occur in several leukocytes subsets; and that extraintestinal replication is likely a part of the normal pathogenic sequence of homologous rotavirus infection.Rotavirus-associated gastroenteritis affects an estimated 111 million children worldwide and is responsible for at least 440,000 deaths annually (25). Although in some reports rotavirus antigen and/or RNA was detected in the central nervous systems, lungs, kidneys, spleens, heart, testes, bladders, and pancreases of selected severely ill children (19,20), homologous rotavirus replication has generally been considered to be restricted to the terminally differentiated epithelial cells of the small intestinal villi. The sporadically reported findings of extraintestinal virus have ...

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Section: Discussionsupporting

confidence: 53%

Extraintestinal Spread and Replication of a Homologous EC Rotavirus Strain and a Heterologous Rhesus Rotavirus in BALB/c Mice

Fenaux

Cuadras

Feng

et al. 2006

J Virol

110

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“…It is important to elucidate the possibility that NoV can be one of the causative pathogens of neurological disease, as recently hypothesized for rotavirus. [17][18][19][20] Takanashi et al 10 found no genetic differences between strains revealed in blood samples and those deposited in GenBank, suggesting that no unique strains are associated with detection in the blood stream. However, more studies will be necessary to clarify the presence of genetic determinants favoring the NoV extra-intestinal spread during gastroenteritis and to elucidate if any host susceptibility factors are involved.…”

Section: Discussionmentioning

confidence: 96%

Norovirus RNA in the blood of a child with gastroenteritis and convulsions—A case report

Medici

Abelli

Dodi

et al. 2010

Journal of Clinical Virology

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“…For instance, evidence suggests neurotropism of rotavirus, as rotavirus gastroenteritis has been associated with aseptic meningitis (9) and encephalitis (10–12). The cerebrospinal fluid in a number of these cases has yielded rotavirus particles by electron microscopy (9,10) and rotavirus RNA by polymerase chain reaction (PCR) (8,11,12). Norwalk‐like viruses also have been implicated as a cause of nonfebrile seizures (13).…”

Section: Discussionmentioning

confidence: 99%

Nonfebrile Illness Seizures: A Unique Seizure Category?

Zerr

Blume

Berg³

et al. 2005

Epilepsia

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Summary:Purpose. To describe the clinical characteristics of children with a first-time nonfebrile seizure in the setting of mild illness and to test the hypothesis that these seizures are associated with illness characterized by diarrhea.Methods. This retrospective cohort study was performed in a pediatric emergency department. Patients ages 6 months to 6 years who were evaluated with first-time seizures were eligible for inclusion. Subjects were divided into three groups on the basis of symptoms accompanying their seizure: febrile (temperature, >38.0• C with seizure), unprovoked (no symptoms of illness), and nonfebrile illness (no fever at the time of seizure, but other symptoms of illness present).Results. Of the 323 children with first-time seizures, 247 (76%) had febrile seizure, 37 (12%) had unprovoked seizures, and 39 (12%) had nonfebrile illness seizures. Children with nonfebrile illness seizures were more likely than children with febrile seizures to have diarrheal illnesses accompanying their seizure (44 vs. 16%; p = 0.001). Frequency of cough, rhinorrhea, and rash did not differ significantly between children with febrile and nonfebrile illness seizures. Diagnostic testing for infectious etiologies was not performed frequently in either group.Conclusions. Nonfebrile illness seizures may represent a distinct group of seizures with unique epidemiology. Further study to define this seizure group better is warranted.The distinction between febrile seizures and unprovoked seizures has led to major changes in the clinical management of young children with a first seizure. By definition, a febrile seizure must be accompanied with a temperature of ≥100.4• F (38 • C), whereas children with unprovoked seizures are afebrile and have no significant signs of illness (1,2). Children having illnesses with minimal to no elevation of temperature are in a grey area and traditionally have not been thought to belong in either of the aforementioned groups; accordingly, they have been largely excluded from prognostic studies of first-time seizures. As a result, little descriptive information about these patients is available, and virtually no information exists that would inform clinical management and parent counseling.Recently, Lee and Ong (3) published the first controlled study of nonfebrile seizures occurring in the setting of illness. This study was performed in Singapore and demonstrated that diarrhea occurred more frequently in the setting of first-time nonfebrile illness seizures than in firsttime febrile seizures. In addition, several case reports have been published of nonfebrile seizures occurring with mild gastroenteritis where medically significant electrolyte abnormalities and dehydration were absent (4-7). These studies raise intriguing questions about the epidemiology and etiology of first-time nonfebrile seizures occurring in the setting of mild illness.We performed a retrospective pilot study with two aims: (a) to compare the clinical features of children with a firsttime nonfebrile seizure in the settin...

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First case of confirmed rotavirus meningoencephalitis in Germany

Cited by 14 publications

References 15 publications

Extraintestinal Spread and Replication of a Homologous EC Rotavirus Strain and a Heterologous Rhesus Rotavirus in BALB/c Mice

Extraintestinal Spread and Replication of a Homologous EC Rotavirus Strain and a Heterologous Rhesus Rotavirus in BALB/c Mice

Norovirus RNA in the blood of a child with gastroenteritis and convulsions—A case report

Nonfebrile Illness Seizures: A Unique Seizure Category?

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