Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia

Casas‐Alba, Dídac; Sevilla, Mariona Fernández de; Valero-Rello, Ana; Fortuny, Clàudia; García-García, Juan-José; Ortez, C.; Muchart, Jordi; Armangué, Thaís; Jordán, Iolanda; Luaces, Carles; Barrabeig, Irene; González-Sanz, Rubén; Cabrerizo, María; Muñoz-Almagro, Carmen; Launes, Cristian

doi:10.1016/j.cmi.2017.03.016

Cited by 68 publications

(54 citation statements)

References 36 publications

(46 reference statements)

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“…Otherwise, the second most predominant EV was EV-A71, mostly detected in specimens of cases involved in the 2016 rhombencephalitis outbreak occurred in Catalonia and other Spanish regions [1,7,10]. Neurologic manifestations of EV-A71 mainly occurred in children < 5 years old and rhombencephalitis was the most common neurologic presentation, but the EV-A71 detection at hospital level might be underestimated because of the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

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Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Andrés

Vila

Gimferrer

et al. 2019

Journal of Clinical Virology

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A B S T R A C TBackground: Enterovirus (EV) infections are usually asymptomatic or mild, but symptomatic infections can evolve to severe complications. Outbreaks of EV-A71 and EV-D68 have been recently reported worldwide, sometimes related to severe clinical outcomes. Objective: To describe EV genetic diversity and the clinical outcomes from paediatric patients attended at a tertiary university hospital in Barcelona (Catalonia, Spain) from 2014 to 2017. Study design: Specimens were collected from paediatric (< 17 years old) cases with suspicion of respiratory tract infection or EV infection. EV laboratory-confirmation was performed by specific real-time multiplex RT-PCR assay. Partial viral VP1 protein was sequenced for genetic characterisation by phylogenetic analyses. Results: A total of 376 (7%) from 5703 cases were EV laboratory-confirmed. Phylogenetic analyses of VP1 (210; 81%) sequences distinguished up to 27 different EV types distributed within EV-A (82; 40%), EV-B (90; 42%), EV-C (5; 2%), and EV-D (33; 15%), in addition to 50 (19%) rhinoviruses. The most predominant were EV-A71 (37; 45%) and EV-D68 (32; 99%). EV-A71 was highly related to neurological complications (25/39, 63%), of which 20/39 were rhombencephalitis, and most EV-D68 (28/32, 88%) were associated with lower respiratory tract infections (LRTI), and exceptionally one (3%) with acute flaccid paralysis. Conclusions: EV-A71 and EV-D68 were the most detected EV in respiratory specimens. EV-A71 was highly related to neurological disease and EV-D68 was often associated with LRTI. However, both potential relatedness to neurological diseases makes the monitoring of EV circulation obligatory.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, while in some regions an EV might be endemic, in others it might be the aetiological agent of limited sporadic outbreaks [8]. The EV surveillance has been reinforced from 2014 and on due to EV-D68 and EV-A71 outbreaks in North America and Europe, respectively [9,10].…”

Section: Introductionmentioning

confidence: 99%

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Andrés

Vila

Gimferrer

et al. 2019

Journal of Clinical Virology

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“…EV typing in previously reported case series has revealed both D68 and A71 strains in cases of AFM, and anecdotally, children with EV A71 neuroinvasive disease have been reported to have better outcomes than those associated with EV D68. 2,15 Although only one of the children in our case series was positive for EV A71, that child had a good outcome compared with the other children. The 6 children who tested positive for EV D68 had overall poorer outcomes than those who tested negative or were not tested, but it is unclear if other factors may have confounded this association.…”

Section: Discussionmentioning

confidence: 71%

Acute Flaccid Myelitis: Characteristics and Outcomes of 2014 and 2016 Cases at a Single Center

Matesanz

McGuire

Hopkins

2019

The Journal of Pediatrics

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Acute flaccid myelitis (AFM) is a rare condition associated with spinal cord gray matter abnormalities and frequent persistent motor deficits in the limbs. We present our experience with the diagnosis, management, and outcomes of affected children in 2014 and 2016, emphasizing features that should trigger early consideration of AFM. Early viral testing may increase the rate of detecting associated viruses. (J Pediatr 2019;215:272-6).

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“…58 In one study that examined 57 patients who presented with both neurological symptoms and positive EV71 detection during this Catalonia outbreak, 41 (72%) had brainstem encephalitis, 7 (12%) had aseptic meningitis, 6 (11%) had encephalitis, and 3 (5%) had encephalomyelitis. 67 A pediatric prospective study was performed during the 2013 outbreak in Sydney, Australia, and examined 61 infected individuals. 68 Out of the 57 survivors, 23 (40%) had encephalomyelitis, 20 (35%) had brainstem encephalitis, 6 (11%) had encephalitis, 4 (7%) had acute flaccid paralysis, and 4 (7%) had autonomic dysregulation with neurogenic pulmonary edema.…”

Section: Enterovirus 71mentioning

confidence: 99%

“…64 Despite the majority of outbreaks occurring in this Asia-Pacific region, travelers should be aware of cases in other regions, with a recent 2016 outbreak in Catalonia, Spain, raising concern for sporadic outbreaks worldwide. 67 More than 100 pediatric patients suffered from an EV71 outbreak in Catalonia between April and June 2016. 67 RT-PCR is typically used for diagnosing enteroviruses as it is both rapid and sensitive, although culture techniques may be used when serotype identification is needed.…”

Section: Enterovirus 71mentioning

confidence: 99%

Nervous System Infections and the Global Traveler

2018

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Neurological complications of infectious diseases are associated with high rates of morbidity and mortality. It is imperative that neurologists be up-to-date on current developments including typical and atypical presentations of neurological infections in travelers, diagnostic and treatment recommendations, and emerging pathogen resistance patterns to avoid fatal outcomes and long-term sequelae. This article will address concepts of emerging and reemerging infectious diseases, and will provide updates on the neurological manifestations of select emerging and reemerging infections, including Ebola virus, bacterial meningitis, enterovirus 71, Zika virus, cerebral malaria, and Japanese encephalitis. Emerging and reemerging neurotropic infectious diseases, including Zika virus, have recently been major global health threats. Factors contributing to the emergence of infectious diseases include closer contact with zoonoses, population growth in cities, globalization, environmental changes, and the rise in antibiotic resistance. Serotype replacement of bacterial meningitis, the possibility of viral persistence in the central nervous system in Ebola virus, antibiotic resistance of malaria, and the evolution of neurovirulent strains of Zika virus display some of the developing challenges that accompany various neurotropic infectious diseases. Neurologists should be aware of the factors contributing to the emergence and reemergence of neurotropic infectious diseases. As emerging and reemerging neurotropic infectious continue to be a major global health security threat, clinicians should be aware of the risks to travelers and current guidelines on prevention and management.

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Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia

Abstract: 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.

Cited by 68 publications

References 36 publications

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Acute Flaccid Myelitis: Characteristics and Outcomes of 2014 and 2016 Cases at a Single Center

Nervous System Infections and the Global Traveler

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