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Cergole-Novella MC, Matsuda EM, de Souza MB, Colpas DR, Carmo AMDS, Daros VDSMG, Campos IB. Recurrent community-acquired pneumococcal meningitis in adults with and without identified predisposing factors. Braz J Microbiol 2024; 55:1339-1348. [PMID: 38438832 PMCID: PMC11153432 DOI: 10.1007/s42770-024-01292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Bacterial meningitis is still a significant public health concern, with high morbidity and mortality rates. Despite this, it is still a rare event that requires the bacterial invasion of the meninges. However, some predisposing factors can trigger recurrent episodes of meningitis. This study is aimed at determining the clinical characteristics and the molecular epidemiology of episodes of recurrent community-acquired meningitis with and without predisposing factors. For this purpose, we performed a retrospective study of our laboratory database during the period of 2010 to 2020. Additionally, using molecular tools developed in our previous works, the epidemiology of the pathogens causing these episodes was analyzed using cerebrospinal fluid samples, especially in the absence of isolated strains. We observed a total of 1,779 meningitis cases and 230 were caused by Streptococcus pneumoniae. Of those, 16 were recurrent meningitis episodes (16/1,779; 0.9%) from seven patients. Pneumococcus was the main agent responsible in these recurrent episodes and only two episodes were caused by Haemophilus influenzae. The mean age of these patients was 20 years old and three had predisposing factors which could have led to contracting meningitis. The samples presented different pneumococcal serotypes. Most of them were non-vaccine-covered serotypes and antibiotic susceptible strains. Therefore, it was demonstrated how the practical employment of molecular tools, developed for research, when applied in the routine of diagnosis, can provide important information for epidemiological surveillance. Furthermore, it was shown how pneumococcus was the leading cause of recurrent community-acquired meningitis without predisposing factors, suggesting that pneumococcal vaccination may be necessary, even in those groups of individuals considered to be less susceptible.
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Affiliation(s)
- Maria Cecilia Cergole-Novella
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Elaine Monteiro Matsuda
- City Hall of Santo André, Santo André Health Secretary, Rua Primeiro de Maio, 133 - Centro, Santo André, SP, 09015-030, Brazil
| | - Mariana Brena de Souza
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Daniela Rodrigues Colpas
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Andréia Moreira Dos Santos Carmo
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | | | - Ivana Barros Campos
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil.
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2
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Xu X, Pu R, Zhao L. Benign Recurrent Aseptic Meningitis Complicated by Pseudohypoparathyroidism: A Case Report. Clin Pediatr (Phila) 2024; 63:187-190. [PMID: 37924257 DOI: 10.1177/00099228231209022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Xiaoya Xu
- Department of Neurology, Zigong First People's Hospital, Zigong, China
| | - Rongmei Pu
- Department of Neurology, Zigong First People's Hospital, Zigong, China
| | - Ling Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, NanChong, China
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3
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Wu J, Song X, Hu Y, Chen J, Jiang L. High-risk factors associated with refractory childhood bacterial meningitis in Southwest China. BMC Pediatr 2023; 23:220. [PMID: 37147568 PMCID: PMC10163699 DOI: 10.1186/s12887-023-04007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Refractory bacterial meningitis is acute, develops rapidly, and has higher mortality and morbidity than common bacterial meningitis. This study was undertaken to investigate the high-risk factors related to refractory bacterial meningitis in children with positive pathogens. METHODS We retrospectively analyzed the clinical data of 109 patients who had bacterial meningitis. The patients were divided into a refractory group (96 patients) and nonrefractory group (13 patients) based on the classification criteria. Seventeen clinical variables on risk factors were extracted and evaluated by univariate and multivariate logistic regression analyses. RESULTS There were 64 males and 45 females. The onset age ranged from 1 month old to 12 years old, and the median age was 181 days old. The pathogenic bacteria included 67 cases of gram-positive (G+) bacteria (61.5%) and 42 cases of gram-negative (G-) bacteria. In patients who were 1 to 3 months old, E. coli was the most common (47.5%), followed by Streptococcus agalactiae and Staphylococcus hemolyticus (10.0%); in patients > 3 months old, S. pneumoniae was the most common (55.1%), followed by E. coli (8.7%). The multivariate analysis indicated that consciousness disorder (odds ratio [OR] = 13.050), peripheral blood C-reactive protein (CRP) ≥ 50 mg/L (OR = 29.436), and the isolate bacteria being gram-positive bacteria (OR = 8.227) were independent risk factors for predicting who would progress to refractory bacterial meningitis in this group. CONCLUSION For patients who have pathogenic positive bacterial meningitis along with consciousness disorder, CRP ≥ 50 mg/L, and/or have an isolate bacteria that is a G + bacteria, it is important to be alert to the potential for progression to refractory bacterial meningitis, which demands the physicians' significant attention.
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Affiliation(s)
- JinFeng Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - XiaoJie Song
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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4
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Grinney M, Mohseni MM. Recurrent benign lymphocytic (Mollaret’s) meningitis due to herpes simplex virus type 2. Proc AMIA Symp 2022; 35:820-821. [DOI: 10.1080/08998280.2022.2108991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Michael Grinney
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida
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5
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Al-Qahtani SM, Shati AA, Alqahtani YA, Ali AS. Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review. Front Pediatr 2022; 10:923125. [PMID: 35783317 PMCID: PMC9249085 DOI: 10.3389/fped.2022.923125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.
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Affiliation(s)
- Saleh M. Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdelwahid Saeed Ali
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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6
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Li X, Liu HZ, Pang LY, Wen X, Sun SZ. A Retrospective Study of Recurrent Bacterial Meningitis in Children: Etiology, Clinical Course, and Treatment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3681871. [PMID: 35309833 PMCID: PMC8930234 DOI: 10.1155/2022/3681871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022]
Abstract
Objectives Recurrent bacterial meningitis (RBM) is a rare but life-threatening disease. This study aims to analyze the clinical features, potential causes, and therapeutic outcomes of RBM in children. Methods This article retrospectively reviews the clinical characteristics, etiologies, and treatments in children with RBM hospitalized in Hebei children's hospital from 2012 to 2020. Results A total of 10 children with RBM, five males and five females, were included in this study. The age of RBM in children spans from the neonatal stage to the childhood stage. The underlying illnesses were identified and classified as cerebrospinal fluid rhinorrhea (1 case), humoral immunodeficiency with Mondini dysplasia (1 case), common cavity deformity with cerebrospinal fluid ear leakage (1 case), Mondini malformations (2 cases), incomplete cochlear separation type I with a vestibular enlargement (2 cases), local inflammation of the sphenoid bone caused by cellulitis (1 case), congenital skull base defects (1 case), and congenital dermal sinus with intraspinal abscess (1 case). 6 patients chose targeted therapy for potential reasons. Conclusions Congenital abnormalities or acquired injuries lead to intracranial communication with the outside world, which can quickly become a portal for bacterial invasion of the central nervous system, resulting in repeated infections.
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Affiliation(s)
- Xin Li
- Department of Neurology, Children's Hospital of Hebei, Shijiazhuang 050031, China
| | - Hua-Zhang Liu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan, Jinan 250014, China
| | - Ling-yu Pang
- Department of Neurology, Children's Hospital of Hebei, Shijiazhuang 050031, China
| | - Xin Wen
- Department of Otolaryngology, Children's Hospital of Hebei, Shijiazhuang 050031, China
| | - Su-Zhen Sun
- Department of Neurology, Children's Hospital of Hebei, Shijiazhuang 050031, China
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7
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Neuro-Ophthalmic Manifestations of Mollaret Meningitis. J Neuroophthalmol 2021; 41:e407-e409. [PMID: 33417418 DOI: 10.1097/wno.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Mollaret meningitis (MM) refers to benign recurrent aseptic meningitis usually following herpes simplex virus 2 (HSV-2) infection. Neuro-ophthalmic manifestations associated with MM are rarely reported. We present a case of recurrent HSV-2 meningitis with the neuro-ophthalmic presentation of papilledema and sixth nerve palsy. To our knowledge, this is the first such description in the English language ophthalmic literature.
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8
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Gombolay GY, Gadde JA. Aseptic meningitis and leptomeningeal enhancement associated with anti-MOG antibodies: A review. J Neuroimmunol 2021; 358:577653. [PMID: 34229204 DOI: 10.1016/j.jneuroim.2021.577653] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/31/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aseptic meningitis can be caused by autoimmune diseases, such as lupus and sarcoidosis. Aseptic meningitis with leptomeningeal enhancement can be the initial presentation of a neuroinflammatory syndrome associated with antibodies to myelin oligodendrocyte glycoprotein (MOG-abs). MOG-abs is a serum biomarker for MOG-associated disorder (MOG-AD), an acquired demyelinating syndrome that includes features of neuromyelitis optica, multiple sclerosis, optic neuritis, and acute disseminated encephalomyelitis. The purpose of this study is to review cases of aseptic meningitis and leptomeningeal enhancement associated with MOG-abs. METHODS Systematic review using PubMed, Embase, Ovid MEDLINE, Web of Science Core Collection, and Google Scholar up to December 2020 was performed. Cases of MOG-AD were included if they met the following criteria: 1) Initial clinical presentation of aseptic meningitis; 2) positive leptomeningeal enhancement and 3) MOG-Ab seropositivity. Descriptive statistics were used. This analysis was limited to the cases available in the literature. RESULTS 11 total cases of aseptic meningitis and leptomeningeal enhancement in setting of MOG-ab were identified. Demyelinating type T2 lesions were also present at time of presentation in 6/11; however, 5/11 of patients had leptomeningeal enhancement alone without demyelinating lesions. All 5 patients required immunotherapy for improvement, including one patient with symptoms for 28 days, with 4/5 receiving steroids and 1/5 receiving intravenous immunoglobulin (IVIG). CONCLUSIONS Aseptic meningitis with leptomeningeal enhancement can be the initial presenting symptom of MOG-AD. MOG-ab testing should be considered in a patient presenting with aseptic meningitis and leptomeningeal enhancement of unknown etiology.
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Affiliation(s)
- Grace Y Gombolay
- Emory University, Children's Healthcare of Atlanta: Pediatrics Institute, United States of America.
| | - Judith A Gadde
- Emory University School of Medicine, Department of Radiology and Imaging Sciences & Pediatrics, United States of America; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, United States of America
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9
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Sekiguchi S, Yamamoto Y, Hatakeyama S, Matsumura M. Recurrent Aseptic Meningitis Associated with Kikuchi's Disease (Histiocytic Necrotizing Lymphadenitis): A Case Report and Literature Review. Intern Med 2021; 60:1779-1784. [PMID: 33431735 PMCID: PMC8222115 DOI: 10.2169/internalmedicine.6494-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We herein report a 31-year-old man with recurrent aseptic meningitis associated with Kikuchi's disease. Although aseptic meningitis is the most common neurological complication of Kikuchi's disease, its characteristics remain unclear, especially in recurrent cases. A literature review revealed that aseptic meningitis associated with Kikuchi's disease was more likely to occur in men and was associated with a low cerebrospinal fluid (CSF)/serum glucose ratio. Lymphadenopathy tended to occur simultaneously or after the onset of meningitis. When encountering a patient with aseptic meningitis of unknown etiology, it may be worthwhile to focus on the CSF/serum glucose ratio and lymphadenopathy with a careful examination.
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Affiliation(s)
- Shiori Sekiguchi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Shuji Hatakeyama
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
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10
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Sobczak T, Alleman L, Wille H, Menard F, Benard Y, Perard B, Vareil MO. [Recurrent meningitis revealing a Bing-Neel syndrome]. Rev Med Interne 2021; 42:359-362. [PMID: 33663872 DOI: 10.1016/j.revmed.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/12/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bing-Neel syndrome is a rare complication of Waldenström macroglobulinemia, defined by monoclonal lymphoplasmocytic cells in the cerebrospinal fluid or in central nervous system biopsy. CASE REPORT We report a 47-year-old man, with no prior history, who presented a recurrent aseptic lymphocytic meningitis with central nervous manifestations. The presence of a monoclonal lymphoplasmacytic proliferation in cerebrospinal fluid, blood and bone marrow biopsy results was compatible with a diagnosis of Bing-Neel syndrome. Despite the absence of any specific treatment, there was no recurrence of symptoms at 4-month follow-up, and the MRI lesions remained stable. CONCLUSION We report a case of Bing-Neel syndrome revealed by a recurrent meningitis. Outcome without treatment was favorable at 4-month follow-up.
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Affiliation(s)
- T Sobczak
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne.
| | - L Alleman
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
| | - H Wille
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
| | - F Menard
- Laboratoire d'Hématologie, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
| | - Y Benard
- Laboratoire d'Hématologie, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
| | - B Perard
- Service d'Hématologie, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
| | - M O Vareil
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de la Côte Basque, 13, avenue de l'Interne Jacques Loeb, 64100 Bayonne
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11
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Andreu S, Ripa I, Bello-Morales R, López-Guerrero JA. Valproic Acid and Its Amidic Derivatives as New Antivirals against Alphaherpesviruses. Viruses 2020; 12:v12121356. [PMID: 33256172 PMCID: PMC7760627 DOI: 10.3390/v12121356] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
Herpes simplex viruses (HSVs) are neurotropic viruses with broad host range whose infections cause considerable health problems in both animals and humans. In fact, 67% of the global population under the age of 50 are infected with HSV-1 and 13% have clinically recurrent HSV-2 infections. The most prescribed antiherpetics are nucleoside analogues such as acyclovir, but the emergence of mutants resistant to these drugs and the lack of available vaccines against human HSVs has led to an imminent need for new antivirals. Valproic acid (VPA) is a branched short-chain fatty acid clinically used as a broad-spectrum antiepileptic drug in the treatment of neurological disorders, which has shown promising antiviral activity against some herpesviruses. Moreover, its amidic derivatives valpromide and valnoctamide also share this antiherpetic activity. This review summarizes the current research on the use of VPA and its amidic derivatives as alternatives to traditional antiherpetics in the fight against HSV infections.
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Affiliation(s)
- Sabina Andreu
- Departamento de Biología Molecular, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid, Spain; (I.R.); (R.B.-M.); (J.A.L.-G.)
- Centro de Biología Molecular Severo Ochoa, Spanish National Research Council—Universidad Autónoma de Madrid (CSIC-UAM), Cantoblanco, 28049 Madrid, Spain
- Correspondence:
| | - Inés Ripa
- Departamento de Biología Molecular, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid, Spain; (I.R.); (R.B.-M.); (J.A.L.-G.)
- Centro de Biología Molecular Severo Ochoa, Spanish National Research Council—Universidad Autónoma de Madrid (CSIC-UAM), Cantoblanco, 28049 Madrid, Spain
| | - Raquel Bello-Morales
- Departamento de Biología Molecular, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid, Spain; (I.R.); (R.B.-M.); (J.A.L.-G.)
- Centro de Biología Molecular Severo Ochoa, Spanish National Research Council—Universidad Autónoma de Madrid (CSIC-UAM), Cantoblanco, 28049 Madrid, Spain
| | - José Antonio López-Guerrero
- Departamento de Biología Molecular, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid, Spain; (I.R.); (R.B.-M.); (J.A.L.-G.)
- Centro de Biología Molecular Severo Ochoa, Spanish National Research Council—Universidad Autónoma de Madrid (CSIC-UAM), Cantoblanco, 28049 Madrid, Spain
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12
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Hait AS, Thomsen MM, Larsen SM, Helleberg M, Mardahl M, Barfod TS, Christiansen M, Brandt C, Mogensen TH. Whole-Exome Sequencing of Patients With Recurrent HSV-2 Lymphocytic Mollaret Meningitis. J Infect Dis 2020; 223:1776-1786. [PMID: 32946550 DOI: 10.1093/infdis/jiaa589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
Recurrent lymphocytic meningitis, also referred to as Mollaret meningitis, is a rare neurological disease characterized mainly by reactivation of herpes simplex virus 2 (HSV-2) from sensory ganglia. However, the underlying host immune determinants and viral factors rendering some individuals unable to maintain HSV-2 latency are largely unknown. We collected a cohort of 15 patients diagnosed with Mollaret meningitis. By whole-exome sequencing we identified rare host genetic variants predicted to be deleterious in molecules involved in (1) ubiquitin-proteasome pathways, (2) the autophagy machinery, and (3) cell proliferation/apoptosis. Moreover, infection of patient cells with HSV-2 or stimulation by virus-derived double-stranded DNA ligands revealed reduced antiviral interferon responses in most patients. These findings may contribute to a better understanding of disease pathogenesis and protective immunity to HSV in the central nervous system, and may ultimately be of importance for identification of targets for development of improved prophylaxis and treatment of this disease.
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Affiliation(s)
- Alon Schneider Hait
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Michelle M Thomsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Simon M Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maibritt Mardahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Toke S Barfod
- Department of Internal medicine, Section for Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Mette Christiansen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Brandt
- Department of Internal medicine, Section for Infectious Diseases, Zealand University Hospital, Roskilde, Denmark.,Department of Pulmonology and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Goyal T, Ali I. Recurrent Herpes Simplex Virus 2 Lymphocytic Meningitis in Patient with IgG Subclass 2 Deficiency. Emerg Infect Dis 2020; 26:748-750. [PMID: 32186491 PMCID: PMC7101106 DOI: 10.3201/eid2604.190406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of a patient with a lifetime history of 8 episodes of recurrent lymphocytic meningitis. Our findings suggest that susceptibility to recurrent lymphocytic meningitis might be caused by low serum IgG subclass 2 immunodeficiency.
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14
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Alhazmi A, Lazrek M, Alidjinou EK, Engelmann I, Schuffenecker I, Dubos F, Hober D. Repeated viral meningitis in a newborn. J Neurovirol 2020; 26:449-451. [PMID: 32026339 DOI: 10.1007/s13365-020-00829-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Abstract
Human enteroviruses (EV) are the most common cause of viral meningitis in children. Human parechoviruses (HPeV) are increasingly being recognized as a cause of central nervous system (CNS) infections and sepsis-like disease in children. Both viruses belong to Picornaviridae family. The clinical picture in EV and HPeV infections is usually nonspecific. Therefore, molecular detection of both viruses is needed for etiological diagnosis. In this case report, we describe and discuss clinical and laboratory findings of two consecutive episodes of viral meningitis caused by EV and HPeV, respectively, occurring in the first month of a newborn's life.
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Affiliation(s)
- Abdulaziz Alhazmi
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France.,Univ Jazan, Microbiology Department, Jazan, Saudi Arabia
| | - Mouna Lazrek
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France
| | | | - Ilka Engelmann
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France
| | | | - Francois Dubos
- Univ Lille, CHU Lille, Urgences Pédiatriques et Maladies Infectieuses, F-59037, Lille, France
| | - Didier Hober
- Univ Lille, CHU Lille, Laboratoire de Virologie EA3610, F-59037, Lille, France.
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15
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Hosoi T, Ishii K, Tozaka N, Kishida D, Sekijima Y, Tamaoka A. Familial Mediterranean Fever Is Important in the Differential Diagnosis of Recurrent Aseptic Meningitis in Japan. Intern Med 2020; 59:125-128. [PMID: 31511485 PMCID: PMC6995700 DOI: 10.2169/internalmedicine.3432-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by a recurrent fever and multiple serositis. In the present report, we discuss the case of a 42-year-old man diagnosed with FMF accompanied by recurrent aseptic meningitis (RAM). The patient experienced RAM at intervals of several years without any serositis or synovitis. We detected Mediterranean fever (MEFV) gene mutations (E148Q homozygotes) and diagnosed FMF in perfect accordance with clinical diagnostic criteria. FMF, in which RAM is a major symptom, has also been described in previous reports. Therefore, FMF should be considered in the differential diagnosis of causative diseases for RAM.
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Affiliation(s)
- Takahiro Hosoi
- Department of General Medicine, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazuhiro Ishii
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Naoki Tozaka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
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16
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Abstract
PURPOSE OF REVIEW This article describes the clinical presentation, diagnostic approach (including the use of novel diagnostic platforms), and treatment of select infectious and noninfectious etiologies of chronic meningitis. RECENT FINDINGS Identification of the etiology of chronic meningitis remains challenging, with no cause identified in at least one-third of cases. Often, several serologic, CSF, and neuroimaging studies are indicated, although novel diagnostic platforms including metagenomic deep sequencing may hold promise for identifying organisms. Infectious etiologies are more common in those at risk for disseminated disease, specifically those who are immunocompromised because of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), transplantation, or immunosuppressant medications. An important step in identifying the etiology of chronic meningitis is assembling a multidisciplinary team of individuals, including those with specialized expertise in ophthalmology, dermatology, rheumatology, and infectious diseases, to provide guidance regarding diagnostic procedures. SUMMARY Chronic meningitis is defined as inflammation involving the meninges that lasts at least 4 weeks and is associated with a CSF pleocytosis. Chronic meningitis has numerous possible infectious and noninfectious etiologies, making it challenging to definitively diagnose patients. Therefore, a multifaceted approach that combines history, physical examination, neuroimaging, and laboratory analysis, including novel diagnostic platforms, is needed. This article focuses on key aspects of the evaluation of and approach to patients with chronic meningitis. Specific infectious etiologies and differential diagnoses of subacute and chronic meningitis, including noninfectious etiologies, are addressed.
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17
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Lee DH, Lee SJ. Recurrent aseptic meningitis as an initial clinical presentation of primary Sjögren’s syndrome. JOURNAL OF NEUROCRITICAL CARE 2019. [DOI: 10.18700/jnc.190077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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19
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Kawamoto M, Murakami Y, Kinoshita T, Kohara N. Recurrent aseptic meningitis with PIGT mutations: a novel pathogenesis of recurrent meningitis successfully treated by eculizumab. BMJ Case Rep 2018; 2018:bcr-2018-225910. [PMID: 30262533 PMCID: PMC6169622 DOI: 10.1136/bcr-2018-225910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We report the case of a patient with PIGT mutations who experienced recurrent aseptic meningitis 121 times over 16 years before developing paroxysmal nocturnal haemoglobinuria (PNH). Each episode was preceded by urticaria and arthralgia. After developing PNH, haemolysis occurred prior to meningitis. Flow cytometry revealed deficiency of the glycophosphatidylinositol (GPI)-anchored complement regulatory proteins, CD59 and CD55, and he was diagnosed with PNH. All the symptoms disappeared on administering eculizumab, an anti-C5 antibody. We did not detect mutation in PIGA, which is regarded as the cause of PNH. However, we detected a germ-line mutation and a somatic microdeletion in chromosome 20q including PIGT; PIGT is essential for transferring GPI anchor to the precursors of CD59 and CD55, which play important roles in complement regulation. Loss of these proteins leads to complement overactivation, causing inflammatory symptoms, including recurrent meningitis. PIGT mutations should be considered a novel pathogenesis of recurrent meningitis of unknown aetiology.
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Affiliation(s)
- Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshiko Murakami
- Research Institute for Microbial Disease, Osaka University, Suita, Japan.,WPI Immunology Frontier Research Center, Osaka University, Suita, Japan
| | - Taroh Kinoshita
- Research Institute for Microbial Disease, Osaka University, Suita, Japan.,WPI Immunology Frontier Research Center, Osaka University, Suita, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
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20
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Masri A, Alassaf A, Khuri-Bulos N, Zaq I, Hadidy A, Bakri FG. Recurrent meningitis in children: etiologies, outcome, and lessons to learn. Childs Nerv Syst 2018; 34:1541-1547. [PMID: 29728757 DOI: 10.1007/s00381-018-3815-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Recurrent meningitis in children is a rare condition. However, its early recognition is important in order to prevent serious complications. This study aims to review cases of recurrent meningitis in children. METHODS This is a retrospective study that included children diagnosed with recurrent meningitis and who were followed at child neurology clinic at the Jordan University Hospital from January 2001 to June 2017. RESULTS Thirteen patients were included (nine males and four females). Age of first episode of meningitis ranged from 2 months to 9.5 years. The delay in diagnosis of the underlying cause after the first episode ranged from 6 months to 2.5 years. Underlying causes included inner ear malformation in one patient, skull fractures in two, and dermal sinuses (thoracic spinal and occipital dermal sinus) in two patients. No identifiable cause was found in eight patients. Streptococcus pneumoniae was identified in four (31%) patients, Staphylococcus aureus in two (15%), and no organism was isolated in seven (54%). Three patients (23.1%) developed neurological sequel including developmental delay, limb spasticity, and epilepsy. Two patients had sensorineural hearing loss related to meningitis, and two patients had sensorineural hearing loss mostly related to their original disease. CONCLUSION A detailed history, examination, and thorough investigations are necessary to determine the underlying cause of recurrent meningitis. In addition, in patients with positive CSF bacterial culture, finding the underlying etiology is very likely.
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Affiliation(s)
- Amira Masri
- Department of Pediatric, Division of Child Neurology, School of Medicine, The University of Jordan, PO Box 13046, Amman, 11942, Jordan.
| | - Abeer Alassaf
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
| | - Najwa Khuri-Bulos
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan.,Pediatric Infectious Disease, Vanderbilt University, Nashville, TN, USA
| | - Imad Zaq
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Azmy Hadidy
- Radiology and Nuclear Medicine Department, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Faris G Bakri
- Department of Internal Medicine, Division of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan.,Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
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