title: Viral isolation from cases of epidemic neuropathy in Cuba.
abstract: OBJECTIVE
  To investigate the possibility of a viral agent in the central nervous system of patients with epidemic neuropathy.
  
  
  METHODS
  Virus isolation attempts, in cell cultures and suckling mice, from cerebrospinal fluid (CSF) of neuropathy patients and controls undergoing lumbar puncture for unrelated reasons. Serologic studies in patients, contacts, and controls.
  
  
  METHODS
  An epidemic of optic and peripheral neuropathy affected more than 50,000 people in Cuba in 1991 through 1993. Illness was associated with dietary limitations and increased physical demands accompanying the shortages of food and fuel experienced in Cuba since 1989. Most patients responded to parenteral vitamin therapy, and the epidemic began to subside when oral vitamin supplementation was begun for the entire Cuban population.
  
  
  RESULTS
  Coxsackievirus A9 (five isolates) and a similar, less cytopathic virus (100 isolates) were recovered from 105 (84%) of 125 CSF specimens from neuropathy patients. The strains with light cytopathic effect were antigenically related to Coxsackieviruses A9 and B4 by cross-neutralization and immunoblotting assays. Virus persisted in CSF of some patients for 1 to 12 months. Cerebrospinal fluid from patients and both types of virus from cell culture produced illness, including complete posterior flaccid paralysis, in newborn mice, and virus was reisolated from the mice. Mouse tissues and sural nerve biopsy specimens from patients were stained by immunoperoxidase and colloidal gold techniques using hyperimmune rabbit antisera against the virus with light cytopathic effect.
  
  
  CONCLUSIONS
  Coxsackievirus A9 or an antigenically related agent with a light cytopathic effect was present in CSF of 84% of 125 patients with epidemic neuropathy. The role of these agents, probably in combination with nutritional factors, in the pathophysiology of the disease requires further investigation.
authors.affiliation: Institute of Tropical Medicine Pedro Kourí, Ministry of Public Health, Havana, Cuba.
authors.forename: P
authors.initials: P
authors.lastname: Más
authors.forename: J L
authors.initials: JL
authors.lastname: Pelegrino
authors.forename: M G
authors.initials: MG
authors.lastname: Guzmán
authors.forename: M M
authors.initials: MM
authors.lastname: Comellas
authors.forename: S
authors.initials: S
authors.lastname: Resik
authors.forename: M
authors.initials: M
authors.lastname: Alvarez
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez
authors.forename: M
authors.initials: M
authors.lastname: Muné
authors.forename: V
authors.initials: V
authors.lastname: Capó
authors.forename: A
authors.initials: A
authors.lastname: Balmaseda
authors.forename: L
authors.initials: L
authors.lastname: Rodríguez
authors.forename: M P
authors.initials: MP
authors.lastname: Rodríguez
authors.forename: J
authors.initials: J
authors.lastname: Handy
authors.forename: G
authors.initials: G
authors.lastname: Kourí
authors.forename: A
authors.initials: A
authors.lastname: Llop
mesh_terms: D000328:Adult; D000818:Animals; D000833:Animals, Suckling / Q000821:virology; D000914:Antibodies, Viral / Q000032:analysis; D000956:Antigens, Viral / Q000032:analysis; D018929:Cell Culture Techniques; D002555:Cerebrospinal Fluid / Q000821:virology; D002522:Chlorocebus aethiops; D003384:Coxsackievirus Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003462:Cuba / Q000453:epidemiology; D003588:Cytopathogenic Effect, Viral; D004196:Disease Outbreaks; D004770:Enterovirus / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D009902:Optic Neuritis / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D017933:Peripheral Nervous System / Q000473:pathology / Q000821:virology; D010523:Peripheral Nervous System Diseases / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D011817:Rabbits; D014709:Vero Cells / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral