Browsing by Author "Ziemele, Inga"

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    Acute human bocavirus 1 infection in child with life-threatening bilateral bronchiolitis and right-sided pneumonia : a case report
    (2019-09-14) Ziemele, Inga; Xu, Man; Vilmane, Anda; Rasa-Dzelzkaleja, Santa; Hedman, Lea; Hedman, Klaus; Söderlund-Venermo, Maria; Nora-Krukle, Zaiga; Murovska, Modra; Gardovska, Dace; Department of Paediatrics; Institute of Microbiology and Virology
    BACKGROUND: Human bocavirus 1 is a commonly detected human parvovirus. Many studies have shown human bocavirus 1 as a pathogen in association with acute respiratory tract infections in children. However, because human bocavirus 1 persists in the upper airways for extensive time periods after acute infection, the definition and diagnostics of acute human bocavirus 1 infection is challenging. Until now, detection of human bocavirus 1 exclusively, high viral load in respiratory samples, and viremia have been associated with a clinical picture of acute respiratory illness. There are no studies showing detection of human bocavirus 1 messenger ribonucleic acid in the peripheral blood mononuclear cells as a diagnostic marker for acute lower respiratory tract infection. CASE PRESENTATION: We report the case of a 17-month-old Latvian boy who presented in intensive care unit with acute bilateral bronchiolitis, with a history of rhinorrhea and cough for 6 days and fever for the last 2 days prior to admission, followed by severe respiratory distress and tracheal intubation. Human bocavirus 1 was the only respiratory virus detected by a qualitative multiplex polymerase chain reaction panel. For the diagnosis of acute human bocavirus 1 infection, both molecular and serological approaches were used. Human bocavirus 1 deoxyribonucleic acid (DNA) was detected simultaneously in nasopharyngeal aspirate, stool, and blood, as well as in the corresponding cell-free blood plasma by qualitative and quantitative polymerase chain reaction, revealing high DNA-copy numbers in nasopharyngeal aspirate and stool. Despite a low-load viremia, human bocavirus 1 messenger ribonucleic acid was found in the peripheral blood mononuclear cells. For detection of human bocavirus 1-specific antibodies, non-competitive immunoglobulin M and competitive immunoglobulin G enzyme immunoassays were used. The plasma was positive for both human bocavirus 1-specific immunoglobulin M and immunoglobulin G antibodies. CONCLUSIONS: The presence of human bocavirus 1 genomic DNA in blood plasma and human bocavirus 1 messenger ribonucleic acid in peripheral blood mononuclear cells together with human bocavirus 1-specific immunoglobulin M are markers of acute human bocavirus 1 infection that may cause life-threatening acute bronchiolitis.
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    Cilvēka imūndeficīta vīrusa vertikālā transmisija un tā klīniskās izpausmes bērnam pirmajā dzīves gadā - klīniskā gadījuma analīze
    (Rīgas Stradiņa universitāte, 2023) Kramiņa, Agija; Ziemele, Inga; Rezidentūras studiju fakultāte; Faculty of Residency
    Klīniskajā gadījumā prezentēts piecus mēnešus vecs pacients, kas piektajā slimības dienā tika stacionēts Bērnu klīniskās universitātes slimnīcā (BKUS) ar sūdzībām par paaugstinātu ķermeņa temperatūru, klepu un petehiāliem izsitumiem kakla rajonā, kas parādījušies četras dienas pirms stacionēšanas. Klīniski pacienta stāvoklis bija grūts, pacients bija miegains, apātisks, ar tahikardiju, tahipnoju un skābekļa (O2) saturāciju asinīs 88%. Fizikālajā izmeklēšanā bija redzami petehiāli izsitumi uz kakla, krūšu kurvja, rokām, kājām un cirkšņiem. Mutes gļotādā un uz mēles balts aplikums, autiņu dermatīts. Pozitīvs sprandas stīvums, auskultatīvi dzirdami mitri trokšņi un palpējama palielināta akna. Sākotnēji, laboratoriski konstatēta anēmija, paaugstināti iekaisuma rādītāji – C reaktīvais proteīns (CRO) 55,17mg/L, interleikīns 6 (IL-6) – 146 pg/ml , cerebrospinālajā šķidrumā (CSŠ) - pleocitoze ar 69,1% mononukleārajām šūnām. Diagnostiskajos izmeklējumos konstatēta abpusēja pneimonija, hepatomegālija, splenomegālija. Pacienta CSŠ tika konstatēts pozitīvs citomegalovīrusa (CMV) dezoksiribonukleīnskābe (DNS), ko apstiprināja arī asins un urīna paraugā. Trīspadsmitajā stacionēšanas dienā laboratoriskajos izmeklējumos konstatētas pozitīvas cilvēka imūndeficīta vīrusa (HIV) 1/2 antivielas un HIV1 antigēns (Ag). HIV diagnosticēšanas brīdī pacients bija dziļā imūnsupresijā ar T limfocītu (CD4) skaitu 22,75%, iegūta imūndeficīta sindroma (AIDS) stadijā. Dinamikā pacientam attīstījās tādas oportūnistiskās infekcijas (OI) kā Pneumocystis carinii pneimonija (PCP), ko apstiprināja pozitīvs Pneumocystis carinii DNS nazofaringeālajā uztriepē, kandidoze, konstatējot Candida albicans uzsējumā no mutes dobuma, fēcēm un pozitīvu Candida albicans antigēnu asinīs. Uzsējumā no auss izdalījumiem izauga Pseudomona aeruginosa baktērija. Klīniski Bacillus Calmette-Guerin (BCG) vakcinācijas vietā attīstījās lokāla tuberkuloze (TB). Atbilstoši infekcijas etioloģiskajam izsaucējam, pacients saņēma ārstēšanu ar antiretrovirālo terapiju (ART), Valgancikloviru, Gancikloviru, Foscarnet, Trimetoprimu/Sulfametaksozolu, Flukanazolu, Ceftazidimu, Izoniazīdu, Etambutolu un Rifabutīnu. Kopumā pacienta ārstēšana stacionārā ilga septiņus mēnešus, tā ārstēšanā iesaistījās multidisciplikāra ārstu komanda.
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    Hemorrhagic Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With Acute Lymphoblastic Leukemia : A Case Report
    (2024-03-29) Kalēja, Kristīne; Sokolovskis, Artūrs; Ziemele, Inga; Department of Paediatrics
    Posterior reversible encephalopathy syndrome (PRES) is an uncommon yet severe neurological disorder characterized by a combination of clinical and radiological features. Common clinical presentations of PRES include headaches, seizures, altered mental status ranging from lethargy to coma, visual disturbances, and behavior changes. This case report outlines the occurrence of hemorrhagic PRES in an 11-year-old girl with B-cell acute lymphoblastic leukemia (ALL) relapse. Hospitalized for ALL relapse, the patient underwent reinduction chemotherapy. On the ninth day of admission, she had a generalized tonic-clonic seizure with a blood pressure peak of 170/120 mmHg. Magnetic resonance imaging (MRI) and a seizure episode suggested PRES. Initially, after the first tonic-clonic seizure, the neurological examination was normal, but after the second seizure, the meningeal symptoms were negative, and gaze palsy and right-sided homonymous hemianopsia were observed; muscle strength was symmetrically reduced in the upper and lower extremitiesand reflexes were symmetrical and diminished. A bilateral Babinski reflex was observed at the time of examination; the patient had mild motor aphasia, and she opened her eyes only in response to tactile stimulation. A follow-up MRI four days after the second seizure episode showed extensive PRES damage with hemorrhagic changes. Over two weeks, the patient's neurological status and blood pressure gradually improved, with persistent changes in the visual field. Subsequent MRI revealed a significant reduction in PRES lesions, but residual hemorrhage measuring 6x4 cm remained evident.
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    Human bocavirus infection markers in peripheral blood and stool samples of children with acute gastroenteritis
    (2018-11-15) Nora-Krukle, Zaiga; Vilmane, Anda; Xu, Man; Rasa, Santa; Ziemele, Inga; Silina, Elina; Söderlund-Venermo, Maria; Gardovska, Dace; Murovska, Modra; Institute of Microbiology and Virology; Department of Paediatrics
    Human bocaviruses (HBoVs) 1–4 belong to the Parvoviridae family, and they infect the respiratory or gastrointestinal tracts in children. We investigated the prevalence of HBoV1–4 DNAs in the blood and stool samples, and of HBoV1–4 IgG and IgM in the plasma samples, of children presenting with acute gastroenteritis (AGE). In addition, we identified HBoV co-infections with the five most frequent gastrointestinal pathogens. A total of 83 paired blood and stool samples were collected from children aged five years or less. Infection markers of HBoV1, 2, or 3 (viral DNA in blood and/or stool and/or antibodies) were detected in 61 out of 83 (73.5%) patients. HBoV1, 2, or 3 DNA as a monoinfection was revealed in 18.1%, 2.4%, and 1.2%, respectively, and 21.7% in totalIn 56.1% of the HBoV DNA-positive patients, the presence in stool of another virus—most frequently norovirus or rotavirus—was observed. In conclusion, this study, for the first time, illustrates the prevalence and genetic diversity of HBoVs in Latvian children with gastroenteritis, and shows a widespread distribution of these viruses in the community. HBoV1 and 2 are commonly found as single infectious agents in children with AGE, suggesting that the viruses can be as pathogenic by themselves as other enteric agents are.
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    Latent infection of human bocavirus accompanied by flare of chronic cough, fatigue and episodes of viral replication in an immunocompetent adult patient, cologne, Germany
    (2016-07-11) Windisch, Wolfram; Pieper, Monika; Ziemele, Inga; Rockstroh, Jürgen; Brockmann, Michael; Schildgen, Oliver; Schildgen, Verena; Rīga Stradiņš University
    Introduction: The human bocavirus (HBoV) is a parvovirus and is associated with mild to lifethreatening acute or persisting respiratory infections, frequently accompanied by further pathogens. So far, there is limited knowledge on the mechanisms of persistence, and no reports on chronic infections or latency have been published so far. Case presentation: An immunocompetent male patient suffers from a chronic HBoV1 infection, i.e. viral DNA was detected in both serum and bronchoalveolar lavage (BAL) for >5 months without co-infections and with respiratory symptoms resolved spontaneously while receiving symptomatic treatment with montelukast and corticosteroids. Following the symptomatic medication of a chronic infection with HBoV1 viraemia indicating active viral replication lasting over 5 months, the patient cleared the viraemia and no further viral DNA was detectable in the BAL. However, by fluorescence in situ hybridization analyses of mucosal biopsies, it was shown that the virus genome still persisted in the absence of viral shedding but in a more compact manner possibly representing a supercoiled episomal form of this otherwise linear singlestranded DNA genome. This indicated the entry into a latency phase. Moreover, the cytokine profile and the IP-10/TARC ratio, a marker for fibrotization, seem to have been altered by HBoV1 replication. Although specific IgG antibodies were detectable during the whole observation period, they showed an apparently insufficient neutralising activity. Conclusion: On the one hand, these findings suggest that the symptomatic medication may have led to clearance of the virus from blood and airways and, moreover, that the viral DNA persists in the tissue as an altered episomal form favoured by lacking neutralising antibodies. This appears to be important in order to reduce possible long-term effects such as lung fibrosis.
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    Presence of human bocavirus 1 and other respiratory viruses in children with lower respiratory tract infection in Latvia
    (2019-05-01) Vilmane, Anda; Ziemele, Inga; Rasa, Santa; Terentjeva, Anna; Murovska, Modra; Gardovska, Dace; Lin, Yung Cheng; Nora-Krukle, Zaiga; Institute of Microbiology and Virology; Department of Paediatrics; Faculty of Medicine
    Lower respiratory tract infection (LRTI) is the major cause of morbidity and mortality of children in the world. In addition to respiratory syncytial virus, influenza virus types A and B, parainfluenza types 1, 2 and 3, and adenoviruses, several new respiratory viruses associated with LRTI were discovered in the 21 st century. These are metapneumovirus, coronaviruses NL63 and HKU1, parainfluenza virus type four and human bocavirus one (HBoV1). HBoV1 was discovered in 2005 and is considered as the fourth most prevalent respiratory virus worldwide. However, the high frequency of co-infections detected together with HBoV1 raises doubt about whether HBoV1 is a true pathogen or just a bystander. This is the first study aimed to determine the presence of HBoV1 and 18 other respiratory viruses in nasopharyngeal aspirates (NPA) of children with LRTI in Latvia. Using multiplex real-time polymerase chain reaction method, the HBoV1 genomic sequence was detected in 60.0% of NPA samples, showing that HBoV1 prevalence is high among children with LRTI in Latvia. HBoV1 mono-infection was revealed in 6.67%. The most common co-infections associated with HBoV1 were rhinovirus, adenovirus, respiratory syncytial virus A and B, metapneumovirus, and enterovirus.
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    Presence of Human Bocavirus 1 in Hospitalised Children with Acute Respiratory Tract Infections in Latvia and Lithuania
    (2016-08-01) Nora-Krūkle, Zaiga; Rasa, Santa; Vilmane, Anda; Grāvelsiņa, Sabīne; Kālis, Mārtiņš; Ziemele, Inga; Naciute, Milda; Petraitiene, Sigita; Mieliauskaite, Diana; Klimantaviciene, Migle; Girkontaite, Irute; Liu, Hsin Fu; Lin, Jih Hui; Lin, Yung Cheng; Chan, Hsiu Chuan; Gardovska, Dace; Murovska, Modra; Institute of Microbiology and Virology; Rīga Stradiņš University
    Human bocavirus 1 (HBoV1) is a parvovirus recently found to be a possible aetiologic agent of acute respiratory disease in children. We conducted the first clinical and molecular study on this virus in Latvia (LV) and Lithuania (LT). The aim of the study was to determine the occurrence of HBoV1 in respiratory tract samples taken from hospitalised children with acute respiratory tract infections in LV and LT. In total 186 children with age one to 50 months, and who fulfilled criteria of acute respiratory tract infection, including lower respiratory tract infections, with or without fever, were included in this study. A nasopharyngeal aspirate was obtained from each patient on admission. DNA was isolated and polimerase chain reaction (PCR) performed targeting the HBoV1 NS1sequence. HBoV1 positive samples were sequenced and phylogenetic analysis was performed. HBoV1 sequence was detected in 42 (32%) of 130 LV and in 8 (14%) of 56 LT samples. In LV the majority of patients with HBoV1 infection were observed in February while in LT in October. The phylogenetic tree for HBoV1 indicated that isolates of HBoV1 cluster closely and include almost all of the isolates in this study. HBoV1 is common in Latvia and Lithuania and might be a significant pathogen that contributes to acute respiratory tract infections in children.
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    Serodiagnosis of human bocavirus 1 infection among hospitalised children with lower respiratory tract infection in Latvia
    (2019-08-01) Ziemele, Inga; Xu, Man; Vilmane, Anda; Rasa-Dzelzkaleja, Santa; Hedman, Klaus; Söderlund-Venermo, Maria; Gardovska, Dace; Nora-Krukle, Zaiga; Murovska, Modra; Department of Paediatrics; Institute of Microbiology and Virology
    Since its discovery in 2005, human bocavirus 1 (HBoV1) has globally been one of the most common respiratory viruses. It is currently accepted that HBoV1 is a pathogen, causing upper and lower respiratory tract infections (LRTIs) in children. However, due to the prolonged HBoV1 DNA shedding from the upper airways and the subsequent high rate of co-detections with other respiratory viruses, the interpretation of positive polymerase chain reaction results is challenging. The aim of this study was to identify acute HBoV1 infections by the presence of HBoV1-specific IgM and IgG measured by competition enzyme immunoassay, to elucidate the induction of Th1/Th2 cytokines, and to describe the clinical characteristics associated with acute HBoV1 infection in hospitalised children less than five years of age with LRTI. HBoV1 IgM was detected in 19/102 (18.6%) and IgG in 66/102 (64.7%) patients. HBoV1 IgM was most frequently found in patients aged 13 to 24 months. Pneumonia and acute wheezing were the most common clinical diagnoses among HBoV1 IgM positive patients. The seroprevalence of HBoV1-specific IgG increased with age, reaching 85% by the age of five years. INF-γ, IL-4, IL-5, and IL-10 were observed to be higher in patients with acute HBoV1 infection.