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Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam

Nga Thi Phan 1 Meriadeg Ar Gouilh 2, 3 Juliette Paireau 4 Loan Phuong 1 Justine Cheval 5 Nghia Duy Ngu 1 Charles Hébert 6 Tuan Hai Ngu 1 Olivier Lortholary 7 Laura Tondeur 4 Jean-Claude Manuguerra 8 Robert Barouki 9 Johannes Sander 10 Nils Janzen 10 Hien Tran Nguyen 1 Paul Brey 11 Arnaud Fontanet 12, 4 Marc Eloit 13
1 NIHE - National Institute of Hygiene and Epidemiology [Hanoi, Vietnam]
2 GRAM 2.0 - Groupe de Recherche sur l'Adaptation Microbienne
3 CIBU - Cellule d'Intervention Biologique d'Urgence - Laboratory for Urgent Response to Biological Threats
4 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
5 PathoQuest
6 REG - Régulation de l'expression génétique
7 Centre d'infectiologie Necker-Pasteur [CHU Necker]
8 Génétique Moléculaire des Virus Respiratoires
9 T3S - UMR_S 1124 - Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire
10 MHH - Hannover Medical School [Hannover]
11 Institut Pasteur du Laos
12 CNAM - Conservatoire National des Arts et Métiers [CNAM]
13 Découverte de Pathogènes - Pathogen Discovery
Biologie des Infections - Biology of Infection
Abstract : We investigated the cause of seasonal outbreaks of pediatric acute encephalitis-like syndrome associated with litchi harvests (May-July) in northern Vietnam since 2008. Nineteen cerebrospinal fluid samples were positive for human enterovirus B, and 8 blood samples were positive for hypoglycemic toxins present in litchi fruits. Patients who were positive for hypoglycemic toxins had shorter median times between disease onset and admission, more reports of seizures, more reports of hypoglycemia (glucose level <3 mmol/L), lower median numbers of leukocytes in cerebrospinal fluid, and higher median serum levels of alanine aminotransferase and aspartate transaminase than did patients who were positive for enteroviruses. We suggest that children with rapidly progressing acute encephalitis-like syndrome at the time of the litchi harvest have intoxication caused by hypoglycemic toxins, rather than viral encephalitis, as previously suspected. These children should be urgently treated for life-threatening hypoglycemia.
Keywords : hypoglycemic toxins litchi cultivation viruses children encephalitis acute encephalitis syndrome Vietnam methylenecyclopropylglycine outbreaks Bac Giang Province enteroviruses meningitis/encephalitis hypoglycemia acute encephalitis-like syndrome litchi hypoglycins
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COMUE-NORMANDIE | CNRS | UNIV-PARIS5 | GRAM | USPC | UNIV-HESAM | INSERM | CNAM | RIIP_LAOS | UNIV-PARIS7 | UNICAEN | UNIROUEN | ENS-PARIS | RIIP | PASTEUR | UNIV-PARIS | UP-SCIENCES | PSL

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Nga Thi Phan, Meriadeg Ar Gouilh, Juliette Paireau, Loan Phuong, Justine Cheval, et al.. Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerging Infectious Diseases, Centers for Disease Control and Prevention, 2018, 24 (8), pp.1435-1443. ⟨10.3201/eid2408.171004⟩. ⟨hal-02146362⟩

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