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Legouy C, Cervantes A, Sonneville R, Thakur KT. Autoimmune and inflammatory neurological disorders in the intensive care unit. Curr Opin Crit Care 2024; 30:142-150. [PMID: 38441114 DOI: 10.1097/mcc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW The present review summarizes the diagnostic approach to autoimmune encephalitis (AE) in the intensive care unit (ICU) and provides practical guidance on therapeutic management. RECENT FINDINGS Autoimmune encephalitis represents a group of immune-mediated brain diseases associated with antibodies that are pathogenic against central nervous system proteins. Recent findings suggests that the diagnosis of AE requires a multidisciplinary approach including appropriate recognition of common clinical syndromes, brain imaging and electroencephalography to confirm focal pathology, and cerebrospinal fluid and serum tests to rule out common brain infections, and to detect autoantibodies. ICU admission may be necessary at AE onset because of altered mental status, refractory seizures, and/or dysautonomia. Early management in ICU includes prompt initiation of immunotherapy, detection and treatment of seizures, and supportive care with neuromonitoring. In parallel, screening for neoplasm should be systematically performed. Despite severe presentation, epidemiological studies suggest that functional recovery is likely under appropriate therapy, even after prolonged ICU stays. CONCLUSION AE and related disorders are increasingly recognized in the ICU population. Critical care physicians should be aware of these conditions and consider them early in the differential diagnosis of patients presenting with unexplained encephalopathy. A multidisciplinary approach is mandatory for diagnosis, ICU management, specific therapy, and prognostication.
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Affiliation(s)
- Camille Legouy
- GHU Paris Psychiatrie & Neurosciences, Department of Intensive Care Medicine, Paris, France
| | - Anna Cervantes
- Divisions of Neurocritical Care and Neuroinfectious Disease, Boston Medical Center, Boston, Massachusetts, USA
| | - Romain Sonneville
- Université Paris Cité, IAME, INSERM UMR1137
- AP-HP, Hôpital Bichat - Claude Bernard, Department of Intensive Care Medicine, Paris, France
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
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Zhang Z, Tan J, Li Y, Zhou X, Niu J, Chen J, Sheng H, Wu X, Yuan Y. Bibliometric analysis of publication trends and topics of influenza-related encephalopathy from 2000 to 2022. Immun Inflamm Dis 2023; 11:e1013. [PMID: 37773718 PMCID: PMC10510462 DOI: 10.1002/iid3.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Influenza-related encephalopathy is a rapidly progressive encephalopathy that usually presents during the early phase of influenza infection and primarily manifests as central nervous system dysfunction. This study aimed to analyze the current research status and hotspots of influenza-related encephalopathy since 2000 through bibliometrics analysis. METHODS The Web of Science Core Collection (WOSCC) was used to extract global papers on influenza-related encephalopathy from 2000 to 2022. Meanwhile, the VOSviewer and CiteSpace software were used for data processing and result visualization. RESULTS A total of 561 published articles were included in the study. Japan was the country that published the most articles, with 205 articles, followed by the United States and China. Okayama University and Tokyo Medical University published the most articles, followed by Nagoya University, Tokyo University, and Juntendo University. Based on the analysis of keywords, four clusters with different research directions were identified: "Prevalence of H1N1 virus and the occurrence of neurological complications in different age groups," "mechanism of brain and central nervous system response after influenza virus infection," "various acute encephalopathy" and "diagnostic indicators of influenza-related encephalopathy." CONCLUSIONS The research progress, hotspots, and frontiers on influenza-related encephalopathy after 2000 were described through the visualization of bibliometrics. The findings will lay the groundwork for future studies and provide a reference for influenza-related encephalopathy. Research on influenza-related encephalopathy is basically at a stable stage, and the number of research results is related to outbreaks of the influenza virus.
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Affiliation(s)
- Zhengyu Zhang
- Medical Records Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Juntao Tan
- Operation Management OfficeAffiliated Banan Hospital of Chongqing Medical UniversityChongqingChina
| | - Ying Li
- Department of Medical Administration, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiumei Zhou
- Department of Infectious DiseasesPeople's Hospital of Pujiang CountyZhejiangChina
- PuJiang branch of the First Affiliated HospitalZhejiang University School of MedicineJinhuaChina
| | - Jianhua Niu
- Intensive Care Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jun Chen
- Lung Transplant Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Hongfeng Sheng
- Department of OrthopedicsTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Infectious DiseasesHangzhouZhejiangChina
| | - Yuan Yuan
- Medical Records DepartmentWomen and Children's Hospital of Chongqing Medical UniversityChongqingChina
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Huang W, Niu W, Chen H, Jiang W, Fu Y, Li X, Li M, Hua J, Hu C. Development of a nomogram for severe influenza in previously healthy children: a retrospective cohort study. J Int Med Res 2023; 51:3000605231153768. [PMID: 36802862 PMCID: PMC9941605 DOI: 10.1177/03000605231153768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE We aimed to develop a nomogram to predict the risk of severe influenza in previously healthy children. METHODS In this retrospective cohort study, we reviewed the clinical data of 1135 previously healthy children infected with influenza who were hospitalized in the Children's Hospital of Soochow University between 1 January 2017 and 30 June 2021. Children were randomly assigned in a 7:3 ratio to a training or validation cohort. In the training cohort, univariate and multivariate logistic regression analyses were used to identify risk factors, and a nomogram was established. The validation cohort was used to evaluate the predictive ability of the model. RESULT Wheezing rales, neutrophils, procalcitonin > 0.25 ng/mL, Mycoplasma pneumoniae infection, fever, and albumin were selected as predictors. The areas under the curve were 0.725 (95% CI: 0.686-0.765) and 0.721 (95% CI: 0.659-0.784) for the training and validation cohorts, respectively. The calibration curve showed that the nomogram was well calibrated. CONCLUSION The nomogram may predict the risk of severe influenza in previously healthy children.
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Affiliation(s)
- Wenyun Huang
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Wensi Niu
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Hongmei Chen
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Wujun Jiang
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Yanbing Fu
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Xiuxiu Li
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Minglei Li
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Jun Hua
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China,Jun Hua, Children’s Hospital of Soochow University, No. 92 Zhongnan Street, Suzhou Industrial Park, Suzhou, Jiangsu 215025, China.
| | - Chunxia Hu
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
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Fakhri S, Mohammadi Pour P, Piri S, Farzaei MH, Echeverría J. Modulating Neurological Complications of Emerging Infectious Diseases: Mechanistic Approaches to Candidate Phytochemicals. Front Pharmacol 2021; 12:742146. [PMID: 34764869 PMCID: PMC8576094 DOI: 10.3389/fphar.2021.742146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Growing studies are revealing the critical manifestations of influenza, dengue virus (DENV) infection, Zika virus (ZIKV) disease, and Ebola virus disease (EVD) as emerging infectious diseases. However, their corresponding mechanisms of major complications headed for neuronal dysfunction are not entirely understood. From the mechanistic point of view, inflammatory/oxidative mediators are activated during emerging infectious diseases towards less cell migration, neurogenesis impairment, and neuronal death. Accordingly, the virus life cycle and associated enzymes, as well as host receptors, cytokine storm, and multiple signaling mediators, are the leading players of emerging infectious diseases. Consequently, chemokines, interleukins, interferons, carbohydrate molecules, toll-like receptors (TLRs), and tyrosine kinases are leading orchestrates of peripheral and central complications which are in near interconnections. Some of the resulting neuronal manifestations have attracted much attention, including inflammatory polyneuropathy, encephalopathy, meningitis, myelitis, stroke, Guillain-Barré syndrome (GBS), radiculomyelitis, meningoencephalitis, memory loss, headaches, cranial nerve abnormalities, tremor, and seizure. The complex pathophysiological mechanism behind the aforementioned complications urges the need for finding multi-target agents with higher efficacy and lower side effects. In recent decades, the natural kingdom has been highlighted as promising neuroprotective natural products in modulating several dysregulated signaling pathways/mediators. The present study provides neuronal manifestations of some emerging infectious diseases and underlying pathophysiological mechanisms. Besides, a mechanistic-based strategy is developed to introduce candidate natural products as promising multi-target agents in combating major dysregulated pathways towards neuroprotection in influenza, DENV infection, ZIKV disease, and EVD.
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Affiliation(s)
- Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pardis Mohammadi Pour
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sana Piri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javier Echeverría
- Departamento de Ciencias del Ambiente, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
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Jain A, Lodha R. Influenza Associated Neurological Diseases in Children. Indian J Pediatr 2020; 87:889-890. [PMID: 33006119 DOI: 10.1007/s12098-020-03511-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Agam Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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