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Clinical aspects of exotic viruses

At the Viroscience department of Erasmus Medical Centre, EVI is the research group that engages in the study of Exotic Viral Infectious diseases. It consists of talented researchers from various clinical and basic scientific disciplines.
Figuur 2 exotic virus
The main clinical symptoms caused by exotic viral infections are encephalitis, infection of the brain tissue, and haemorrhagic fever. The EVI Study Group for Exotic Viral Infections therefore focusses mainly  on these two important clinical manifestations.

The research within the study group Exotic Viral Infections is characterized by its translational nature, a patient-oriented question is translated into a basic research question and vice versa: the translation from the laboratory back to the patient, in other words: 'from bench to bedside and vice versa'. The research focusses on the relationship between the different viruses and the inflammatory and coagulation cascade; a relationship which is important in the development of disease.

Infectious diseases still - and increasingly - form a major health risk, not only in less developed countries but also to an increasing extent in developed countries, including the Netherlands. The illusion that infectious diseases have practically been banned from the world was abandoned by us more than thirty years ago. That illusion was created because of an underestimation of the complex dynamics between infectious diseases, man and the environment, in combination with an overestimation of the power of our knowledge, knowledge acquired from science.

Until now, we have considered exotic virus infections in the Netherlands to be imported diseases caused by viruses which are able to reach our country from far-away tropical countries. But this view seems to have been outmoded now as exotic infectious diseases have also recently occurred on the European continent. The outbreak of the Cikungunya virus in northern Italy in 2007 and the spreading of the West Nile virus in Europe are examples of this.

Ongoing research projects

The Exotic Viral Infections group of the department of Virology has four ongoing research projects:

  • Semester studies
  • Trevi studies
  • COVA study
  • Hi Temp study

Get to know these research projects and studies by scrolling down.

Semester studies

SEMESTER studies; studies on the epidemiology, clinical aspects and pathogenesis of Meningo-Encefalitis- Guillain Barré in Suriname and in Indonesia.

Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, and encephalitis is inflammation of the brain itself. This inflammation can be caused by viruses, bacteria, or other microorganisms. Meningitis and encephalitis can be life-threatening diseases and prompt initiating of treatment is warranted. Despite availability of antibiotics, antiviral medication and adjunctive dexamethasone mortality and morbidity rates are still substantial.

The SEMESTER-study is an extension of a fruitful, long existing collaboration between Indonesian, Surinamese and Dutch research institutes. With our joint experience in recognizing new and emerging diseases the ultimate objective is to create adequate diagnostic facilities and procedures in Surabaya and Paramaribo with the aim to facilitate the Java region as a diagnostic reference center for tropical viruses. An important task for a reference center is to continuously monitor the epidemiology of emerging pathogens by surveillance, for which validated diagnostic procedures are conditional. One of the most important requirements of adequate diagnostics is the knowledge of circulating pathogens and their associated clinical symptoms. Therefore a prospective clinical surveillance study, like the SEMESTER study, is required.

Research team:

  • Prof. Eric C.M. van Gorp
  • Dr. Marco Goeijenbier MD Msc
  • Wesley De Jong MD
  • Thomas Langerak MD
  • Laura Doornekamp MD
  • Dr. Kirsten Adriani MD PhD
         

Trevi studies

TREVI studies; HIV infection manifests itself differently in different populations, in different 'shades' as it were. These shade differences can be seen particularly in the various long-term effects of HIV infection in general and vascular damage in particular.

This first study instigated a follow-up study in which Lennert van den Dries is currently involved. Lennert is studying the link between the HIV virus and the brain in both adults and in children. Based on the findings that I have just shared with you, the hypothesis is that the increased risk of thrombosis with HIV infection could also be the cause of vascular damage and possibly microinfarction, small blood clots, in the brain. The brain forms a reservoir where the HIV virus can hide. Because of this, chronic HIV infection can potentially affect the brain, which, in clinical practice, may lead to cognitive functional disorders such as loss of concentration. This may lead to problematic functioning in social and work situations and may have serious consequences for the quality of life of HIV patients. Obviously, loss of capacity for work may also have negative economic effects. The TREVI study investigates all of these aspects. The study has been set up by various departments of Erasmus Medical Centre in collaboration with the Chronic Disease and Labour knowledge centre of the Rotterdam University of Applied Sciences, the Institute for Policy and Management in Health Care, and Sophia Children's Hospital in Rotterdam. Lennert van den Dries, Marlies Wagener and Stefanie van Opstal are the PhD's who are working together in this project. The TREVI study is an outstanding example of translational research, from bench to bedside to society.

Research team:

  • Prof. Eric C.M. van Gorp
  • Lennert van den Dries MD
  • Rob Gruters
  • Marlies wagener
  • Stefanie van Opstal
         

COVA study

Individuals with immune deficiencies are at increased risk for infectious diseases compared to general population. In addition, the responsiveness after immunization can be diminished due to impaired function of monocytes, B cells and/or T cells as well as other co-morbidity, certain drugs and age. Exposure to infectious pathogens sharply increases during travel, with heterogeneity and frequency depending on geographic location. We aim to increase our knowledge of cellular and humoral responses after vaccination in the setting of immune compromised hosts and investigate travel related infections in general.

  1. study on effectiveness of vaccination in immunocompromised subjects
  2. study on improvement of vaccination strategies for immunocompromised patients and the development of a patient pathway

Research team:

  • Prof. Eric C.M. van Gorp
  • Dr. M. Goeijenbier MD Phd Msc
  • W. De Jong MD
  • L. Doornekamp MD
  • R Gruters

Figuur 1 exotic virus

Hi Temp study

Despite much technological progress , this seemingly simple question still remains difficult to answer for the attending physician. HI TEMP is a collaboration between the Erasmus University departments of Viroscience, Internal Medicine and Clinical Chemistry together with the Institute of Health Policy & Management (iBMG), which is also part of the Erasmus university. Within the setting of the emergency department, Yuri van der Does, as a PhD, is studying the added value of Procalcitonin, a new biomarker, as a predictor of infection and especially as a marker for distinguishing between infections caused by a bacteria or a different pathogen, for example a virus. Previous studies in primary and intensive care settings have already shown that Procalcitonin is a reliable marker as an instrument for making a safe choice as to whether antibiotics should be prescribed or not. Earlier, Martijn de Kruif and Maarten Limper studied the role of different biomarkers including Procalcitonin in various patient populations and in various infections in the Netherlands, Indonesia and the Caribbean. In addition to the importance of Procalcitonin, the HI TEMP study also includes innovative research into possible new biomarkers for the future.

If the results of this biomarker study advocate the introduction of Procalcitonin, it is expected that this will lead to more efficient diagnostics and fewer unnecessary antibiotics being prescribed. This will reduce cost reduction and prevent large-scale antibiotic insensitivity

Research team:

  • Prof. Eric C.M. van Gorp
  • Dr. Maarten Limper MD PhD
  • Yuri van der Does MD
  • Prof. Peter Patka
  • Dr. Pleunie Rood
      

Selection of publications: