title: Co-infection with coxsackievirus A5 and norovirus GII.4 could have been the trigger of the first episode of severe acute encephalopathy in a six-year-old child with the intermittent form of maple syrup urine disease (MSUD).
abstract: In this case study, a co-infection with coxsackievirus A5 (family Picornaviridae) and norovirus GII.4 (family Caliciviridae) was detected by RT-PCR in a faecal sample from a six-year-old girl with symptoms of severe acute encephalopathy subsequently diagnosed as the intermittent form of maple syrup urine disease (MSUD). The two co-infecting viruses, which had been detected previously, appeared to have triggered the underlying metabolic disorder. Here, we describe the genotyping of the viruses, as well as the chronological course, laboratory test results, and clinical presentation of this case, which included recurrent vomiting without diarrhoea, metabolic acidosis, unconsciousness, seizure and circulatory collapse, but with a positive final outcome.
authors.affiliation: Regional Laboratory of Virology, National Reference Laboratory of Gastroenteric Viruses, ÁNTSZ Regional Institute of State Public Health Service, Pecs, Hungary.|Department of Medical Microbiology and Immunology, University of Pécs, Szigeti út 12, Pecs, 7624, Hungary.
authors.forename: Ákos
authors.initials: Á
authors.lastname: Boros
authors.affiliation: Regional Laboratory of Virology, National Reference Laboratory of Gastroenteric Viruses, ÁNTSZ Regional Institute of State Public Health Service, Pecs, Hungary.|Department of Medical Microbiology and Immunology, University of Pécs, Szigeti út 12, Pecs, 7624, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Pankovics
authors.affiliation: Szent István and Szent László Hospital, Budapest, Hungary.
authors.forename: Sándor
authors.initials: S
authors.lastname: Kőmíves
authors.affiliation: Szent István and Szent László Hospital, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Liptai
authors.affiliation: Szent István and Szent László Hospital, Budapest, Hungary.
authors.forename: Sarolta
authors.initials: S
authors.lastname: Dobner
authors.affiliation: Szent István and Szent László Hospital, Budapest, Hungary.
authors.forename: Enikő
authors.initials: E
authors.lastname: Ujhelyi
authors.affiliation: MR Research Centre, Semmelweis University, Budapest, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Várallyay
authors.affiliation: 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
authors.forename: Petra
authors.initials: P
authors.lastname: Zsidegh
authors.affiliation: Regional Laboratory of Virology, National Reference Laboratory of Gastroenteric Viruses, ÁNTSZ Regional Institute of State Public Health Service, Pecs, Hungary.|Department of Medical Microbiology and Immunology, University of Pécs, Szigeti út 12, Pecs, 7624, Hungary.
authors.forename: Nóra
authors.initials: N
authors.lastname: Bolba
authors.affiliation: Regional Laboratory of Virology, National Reference Laboratory of Gastroenteric Viruses, ÁNTSZ Regional Institute of State Public Health Service, Pecs, Hungary. reuter.gabor@gmail.com.|Department of Medical Microbiology and Immunology, University of Pécs, Szigeti út 12, Pecs, 7624, Hungary. reuter.gabor@gmail.com.
authors.forename: Gábor
authors.initials: G
authors.lastname: Reuter
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis / Q000821:virology*; D002648:Child; D060085:Coinfection; D029821:Enterovirus A, Human / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D005243:Feces / Q000821:virology; D005260:Female; D005838:Genotype; D006801:Humans; D008375:Maple Syrup Urine Disease / Q000175:diagnosis / Q000821:virology*; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology