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BRIEF COMMUNICATIONS: M. A. Verboon-Maciolek, F. Groenendaal, F. Cowan, P. Govaert, A. M. van Loon, and L. S. de Vries White matter damage in neonatal enterovirus meningoencephalitis Neurology 2006; 66: 1267-1269 [Abstract] [Full text] [PDF]

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Update on article: White matter damage in neonatal enterovirus meningoencephalitis

M. Verboon-Maciolek, F. Groenendaal, F. Cowan, P. Govaert, A.M. vanLoon, L.S. deVries   (10 March 2008)

Update

M. Verboon-Maciolek, F. Groenendaal, F. Cowan, P. Govaert, A.M. vanLoon, L.S. deVries   (10 March 2008)

Update on article: White matter damage in neonatal enterovirus meningoencephalitis 10 March 2008
M. Verboon-Maciolek, University Medical Center Lundlaan 6, 3584 EA , Utrecht, The Netherlands, F. Groenendaal, F. Cowan, P. Govaert, A.M. vanLoon, L.S. deVries Send Correspondence to journal: Re: Update on article: White matter damage in neonatal enterovirus meningoencephalitis M.Verboon-Maciolek{at}umcutrecht.nl M. Verboon-Maciolek, et al.	We recently reported six patients who suffered a severe infection of the central nervous system (CNS) caused by enterovirus (EV) in the neonatal period. [1] The diagnosis of EV infection was made by positive reverse transcription polymerase chain reaction (RT-PCR) from: cerebrospinal fluid (CSF) or blood; or a viral culture from different specimens (e.g., CSF, nasopharynx, stool). Specimens submitted for viral culture were inoculated into different tissue cultures and observed for development of a cytopathic (CPE) effect. Viral isolates with a CPE suggestive of EV were typed using pools of neutralizing antisera according to standard techniques. It is not always possible to type the viral isolate as was the case in three of the infants. [2] A year after our Neurology® report was published, we treated several infants with encephalitis who presented with signs and symptoms suggestive of EV infection (i.e., fever, seizures and rash) but in whom EV could not be detected in different clinical samples. These children were diagnosed with human parechovirus (HPeV) CNS infection. They were diagnosed using RT-PCR for HPeV which had recently become available in our hospital. With this new diagnostic tool available, we also performed RT PCR on HPeV on the previously stored CSF of case 1 of our published article. [1] This neonate had previously had an untypable EVstrain cultured from the nasopharynx. This patient turned out to have a HPeV type 3 cerebral infection and not an EV infection. HPeV and EV belong to the same family Picornaviridae. On the basis of sequence analysis the viruses belonging to the genus Enterovirus were reclassified and the serotypes previously known as echovirus 22 and 23 were reclassified as HPeV 1 and 2, respectively, in the new genus Parechovirus. [3] In 2005, the new HPeV 3 was described as an important pathogen in the neonatal period. [4] Recently, four new members of this genus have been identified: HPeV 4-6. The clinical presentation and cerebral MRI of HPeV infection in the neonatal period are not distinguishable from an EV infection. [5] At the time of publication in Neurology, it was not yet possible to perform RT-PCR for HPeV in our hospital. Due to new diagnostic possibilities, the diagnosis of case [1] has been changed to HPeV infection. References 1.Verboon-Maciolek MA, Groenendaal F, Cowan F et al. White matter damage in neonatal enterovirus meningoencephalitis. Neurology 2006;8:1267-1269. 2. Oberste MS, Maher K, Flemister MR et al. Comparison of classic and molecular approaches for the identification of untypeable enteroviruses. J Clin Microbiol. 2000; 38:1170-1174. 3. Joki-Korpela P, Hyypia T. Parechoviruses, a novel group of human picornaviruses. Ann Med. 2001; 33:466-471. 4. Boivin G, Abed Y, Boucher FD. Human parechovirus 3 and neonatal infections. Emerg Infect Dis. 2005; 11:103-105. 5. Verboon-Maciolek MA, Krediet TG, Gerards LJ, de Vries LS, Groenendaal F, van Loon AM. Severe neonatal parechovirus infection and similarity with enterovirus infection. Pediatr Infect Dis J 2008 in press. An Update of this article is available on page XXX of this issue of Neurology. Disclosure: The authors report no conflicts of interest.
Update 10 March 2008
M. Verboon-Maciolek, University Medical Center Lundlaan 6, 3584 EA , UIrecht, The Netherlands, F. Groenendaal, F. Cowan, P. Govaert, A.M. vanLoon, L.S. deVries Send Correspondence to journal: Re: Update M.Verboon-Maciolek{at}umcutrecht.nl M. Verboon-Maciolek, et al.	Update White matter damage in neonatal enterovirus meningoencephalitis In the Brief Communication “White matter damage in neonatal enterovirus meningoencephalitis by M. A. Verboon-Maciolek, MD, PhD, et al (NEUROLOGY 2006;66:1267-1269) the authors reported six patients who had an infection of the central nervous system (CNS) caused by enterovirus (EV) in the neonatal period. The diagnosis of EV infection was made by positive reverse transcription polymerase chain reaction (RT-PCR) from: cerebrospinal fluid (CSF) or blood; or a viral culture from different specimens (e.g., CSF, nasopharynx, stool). About one year after publication of the article, RT-PCR for HPeV became available as a diagnostic tool in the authors’ institution. The authors then performed RT PCR on HPeV on the previously stored CSF of published case 1. This neonate had previously had an untypable EVstrain cultured from the nasopharynx. This patient was newly diagnosed as having HPeV type 3 cerebral infection. A correspondence from the authors detailing the updated diagnosis is above. This Update and Correspondence will also appear in a future print issue.