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Volume 17, Number 12—December 2011

Dispatch

Human Cardioviruses, Meningitis, and Sudden Infant Death Syndrome in Children

Jan Felix Drexler, Sigrid Baumgarte, Monika Eschbach-Bludau, Arne Simon, Christoph Kemen, Udo Bode, Anna-Maria Eis-Hübinger, Burkhard Madea, and Christian DrostenComments to Author 
Author affiliations: University of Bonn Medical Centre, Bonn, Germany (J.F. Drexler, M. Eschbach-Bludau, A. Simon, U. Bode, A.-M. Eis-Hübinger, B. Madea, C. Drosten); Institute of Hygiene and the Environment, Hamburg, Germany (S. Baumgarte); Catholic Children's Hospital Wilhelmstift, Hamburg (C. Kemen)

Main Article

Table A1

Characteristics of patients with positive human cardiovirus test results, Germany*

Sample ID Sampling location/ date/cohort Clinical diagnosis Patient age/ sex Leading symptoms Body temperature, °C Recent history General medical history Symptomatic contact person Altered serum laboratory parameters Lumbar puncture results Clinical course Virus concentration, RNA copies per mL/g specimen Co-infections† Main pathologic autopsy finding
07/03981 Bonn/Feb 2007/ virologic routine diagnostics Meningitis 9 y/F Severe frontal headache, fatigue, meningism, photosensitivity 38.2 Sore throat 1 wk earlier Uneventful None C-reactive protein (2.1 mg/L) Cells 582/µL (lymphocytes 368/µL, neutrophils 162/µL, monocytes 50/µL), protein 434 mg/L, glucose 58 mg/dL Antibiosis (cefotaxime/ ceftazidime) for 14 d, improvement after 5 d, discharged healthy after 14 d 1.14 × 104/mL CSF, 9.50 × 102/g feces None NA
VI1607 Hamburg/ Jul 2007/ virologic routine diagnostics Meningitis 3 y/F Reduced general condition, meningism, emesis 38.1/39.6 (d 1) Family vacation at German seaside Uneventful None C-reactive protein (13 mg/L) Cells 16/µL, protein 237 mg/L Antibiosis (ceftriaxone) for 3 d, discharged healthy after 5 d 9.63 × 102/mL CSF Enterovirus ECHO30 NA
347/10 Bonn/2010/ forensic routine diagnostics SIDS‡ 9 mo/M Rigor mortis, paleness 39.2 (rectal) Obstructive bronchitis, gastroenteritis (rotavirus), skin infection (Staphylococcus aureus) Preterm birth (wk 31 of pregnancy), birth weight 1,400 g, partial trisomy 6, partial monosomy 20, hypothyreosis, albinism, retrognathia, dystrophy NA NA NA NA Below assay detection limit Rhinovirus Unclear cause of death, aspiration of gastric contents

*CSF, cerebrospinal fluid; NA, not applicable; SIDS, sudden infant death syndrome.
†Fecal specimens were tested for norovirus and enteroviruses by real-time reverse transcription PCR (RT-PCR) and for rotavirus, adenovirus, and astroviruses by ELISA; CSF specimens were tested by real-time RT-PCR/PCR/nested RT-PCR for enterovirus, influenza virus, parechovirus, rhinovirus, tick-borne encephalitis virus, coronavirus, adenovirus, parvovirus, mumps, measles, and all other human paramyxoviruses and the human herpesviruses HSV1/2, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, and human herpesvirus 6. Initial and follow-up serum specimens were tested for lymphocytic choriomeningitis virus by complement binding reaction. Diagnostics of bacterial pathogens included ELISA, Western blot, and PCR for Borrelia burgdorferi sensu lato and Treponoma pallidum, complement binding reaction for Leptospira spp., and standard microbiologic culture methods.
‡Because of partial trisomy 6 and monosomy 20, also classifiable as sudden unexpected death in infancy.

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