{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:09:20Z","timestamp":1792714160723,"version":"4.5.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T00:00:00Z","timestamp":1574467200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T00:00:00Z","timestamp":1574467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Until today, classic human astroviruses have not been associated with central nervous system infections in immunocompetent patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>A 16-month-old Caucasian girl presented with repetitive generalized seizures with a 4-day history of watery diarrhea, which had already gradually improved. Initially, the prolonged seizures ceased after systemic midazolam treatment and were thought to be fever associated. However, her mental status remained altered, and after seizure recurrence, she was transferred to our pediatric intensive care unit. Seizure control was achieved by a combination of high-dose levetiracetam and phenobarbital, but she remained unconscious. An electroencephalogram at this time revealed generalized high voltage theta activity. All laboratory analyses, including extended blood and cerebrospinal fluid analyses, and a brain magnetic resonance imaging were normal.<\/jats:p>\n<jats:p>On day 4, the child gradually became conscious, but was very agitated and not able to walk. Since an electroencephalogram at this time still revealed generalized high voltage theta activity, although she had not received sedative medications for 72\u2009hours, she was diagnosed as having encephalopathy. At that time, results of diagnostic testing of the stool sample were positive for classic astrovirus infection, and we decided to analyze the initially obtained cerebrospinal fluid for astrovirus as well. Cerebrospinal fluid was also found positive for human astrovirus. Sequencing analysis revealed a classic astrovirus genotype 1 with exactly the same nucleotide sequence as in the feces. Clinically, the child gradually improved and was discharged on day 9.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Whereas the new human astrovirus subtypes have been recently associated with central nervous system infection, this is the first case of encephalitis in an immunocompetent child due to classic human astrovirus. Considering that classic human astroviruses are the third most common etiological agents of viral gastroenteritis in children, we believe that human astroviruses as causative agents for central nervous system infections should be considered more often, especially in children and infants with preceding gastroenteritis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-019-2302-6","type":"journal-article","created":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T01:02:17Z","timestamp":1574470937000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Human astrovirus infection associated with encephalitis in an immunocompetent child: a case report"],"prefix":"10.1186","volume":"13","author":[{"given":"Georgia","family":"Koukou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Niendorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"Hornei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-U","family":"Schlump","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-7185","authenticated-orcid":false,"given":"Andreas C.","family":"Jenke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Jacobsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,23]]},"reference":[{"key":"2302_CR1","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1111\/tid.12607","volume":"18","author":"SH Lum","year":"2016","unstructured":"Lum SH, et al. An emerging opportunistic infection: fatal astrovirus (VA1\/HMO-C) encephalitis in a pediatric stem cell transplant recipient. Transplant Infect Dis. 2016;18:960\u20134. https:\/\/doi.org\/10.1111\/tid.12607.","journal-title":"Transplant Infect Dis"},{"key":"2302_CR2","doi-asserted-by":"publisher","unstructured":"Reuter G, Pankovics P, Boros A. Nonsuppurative (Aseptic) Meningoencephalomyelitis Associated with Neurovirulent Astrovirus Infections in Humans and Animals. Clin Microbiol Rev. 2018;31 https:\/\/doi.org\/10.1128\/CMR.00040-18.","DOI":"10.1128\/CMR.00040-18"},{"key":"2302_CR3","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1128\/CMR.00013-14","volume":"27","author":"A Bosch","year":"2014","unstructured":"Bosch A, Pinto RM, Guix S. Human astroviruses. Clin Microbiol Rev. 2014;27:1048\u201374. https:\/\/doi.org\/10.1128\/CMR.00013-14.","journal-title":"Clin Microbiol Rev"},{"key":"2302_CR4","doi-asserted-by":"publisher","first-page":"846","DOI":"10.3201\/eid2205.151807","volume":"22","author":"S Cordey","year":"2016","unstructured":"Cordey S, et al. Astrovirus MLB2, a New Gastroenteric Virus Associated with Meningitis and Disseminated Infection. Emerg Infect Dis. 2016;22:846\u201353. https:\/\/doi.org\/10.3201\/eid2205.151807.","journal-title":"Emerg Infect Dis"},{"key":"2302_CR5","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1093\/cid\/ciu940","volume":"60","author":"JR Brown","year":"2015","unstructured":"Brown JR, et al. Astrovirus VA1\/HMO-C: an increasingly recognized neurotropic pathogen in immunocompromised patients. Clin Infect Dis. 2015;60:881\u20138. https:\/\/doi.org\/10.1093\/cid\/ciu940.","journal-title":"Clin Infect Dis"},{"key":"2302_CR6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/(SICI)1096-9071(199702)51:2<101::AID-JMV3>3.0.CO;2-B","volume":"51","author":"G Belliot","year":"1997","unstructured":"Belliot G, Laveran H, Monroe SS. Outbreak of gastroenteritis in military recruits associated with serotype three astrovirus infection. J Med Virol. 1997;51:101\u20136.","journal-title":"J Med Virol"},{"key":"2302_CR7","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1093\/cid\/ciu912","volume":"60","author":"SN Naccache","year":"2015","unstructured":"Naccache SN, et al. Diagnosis of neuroinvasive astrovirus infection in an immunocompromised adult with encephalitis by unbiased next-generation sequencing. Clin Infect Dis. 2015;60:919\u201323. https:\/\/doi.org\/10.1093\/cid\/ciu912.","journal-title":"Clin Infect Dis"},{"key":"2302_CR8","doi-asserted-by":"publisher","unstructured":"Janowski AB, Bauer IK, Holtz LR, Wang D. Propagation of astrovirus VA1, a neurotropic human astrovirus, in cell culture. J Virol. 2017; https:\/\/doi.org\/10.1128\/JVI.00740-17.","DOI":"10.1128\/JVI.00740-17"},{"key":"2302_CR9","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.3201\/eid2312.170703","volume":"23","author":"B Arruda","year":"2017","unstructured":"Arruda B, et al. Porcine Astrovirus Type 3 in the Central Nervous System of Swine with Polioencephalomyelitis. Emerg Infect Dis. 2017;23:2097\u2013100. https:\/\/doi.org\/10.3201\/eid2312.170703.","journal-title":"Emerg Infect Dis"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2302-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13256-019-2302-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2302-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T00:08:22Z","timestamp":1606003702000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-019-2302-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,23]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["2302"],"URL":"https:\/\/doi.org\/10.1186\/s13256-019-2302-6","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,23]]},"assertion":[{"value":"4 April 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The author(s) declare no conflict of interest. There was no funding in this study. The study was approved by the Ethics committee of Witten\/Herdecke University and performed in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent from the legal parents on behalf of their child for the publication of this manuscript and any accompanying medical data was obtained. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"341"}}