1
|
McCarter SK, Shen KR, Wylam ME. Occult Lung Cancer-Associated Autoimmune Encephalitis Presenting as Acute Psychosis. Mil Med 2024; 189:e1813-e1818. [PMID: 38554268 DOI: 10.1093/milmed/usae116] [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] [Received: 01/16/2024] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
During deployment, a 52-year-old male developed acute behavioral changes. Though initially considered to have PTSD and related agitation and confusional state, his evaluation was consistent with acute encephalopathy. Magnetic resonance imaging of the brain showed T2 hyperintensities, and CSF analysis was positive for anti-N-methyl-D-aspartate receptor antibody. A nuclear protein in testis carcinoma midline carcinoma was discovered in the lung. Immunotherapy and surgical resection led to steady improvement prior to adjuvant chemotherapy. Autoimmune encephalitis due to anti-N-methyl-D-aspartate receptor antibodies is increasingly being recognized as causal of acute behavioral change.
Collapse
Affiliation(s)
- Shelly K McCarter
- Department of Surgical Services, Naval Hospital Pensacola, Pensacola, FL 32412, USA
| | - K Robert Shen
- Division of Thoracic Surgery, Department of Surgery, May Mayo Clinic Alix College of Medicine, Rochester, MN 55905, USA
| | - Mark E Wylam
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic Alix College of Medicine, Rochester, MN 55905, USA
| |
Collapse
|
2
|
Bode CM, Kristensen SB, Olsen HT, Cornwall CD, Roberg L, Monsson O, Krøigård T, Toft P, Beier CP. Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors. Neurocrit Care 2024; 40:1025-1035. [PMID: 37940836 PMCID: PMC11147838 DOI: 10.1007/s12028-023-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Postictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge. METHODS This retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records. RESULTS Of all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade. DISCUSSION In this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.
Collapse
Affiliation(s)
- Clara Marie Bode
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Simon Bruun Kristensen
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | | | - Camilla Dyremose Cornwall
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Roberg
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Olav Monsson
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurophysiology, Odense University Hospital, Odense, Denmark
| | - Palle Toft
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
3
|
Kim JH, Kim T, Kim W, Kim SH, Hong YJ, Lim E, Bae DW, Noh SM, Lee J. The incidence and predictors of antibiotic-associated encephalopathy: a multicenter hospital-based study. Sci Rep 2024; 14:8747. [PMID: 38627483 PMCID: PMC11021399 DOI: 10.1038/s41598-024-59555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
This study aimed to evaluate the incidence and likelihood of antibiotic-associated encephalopathy (AAE), comparing rates among the classes of antibiotics in monotherapy or in combination therapy. We also investigated the associations between the incidence of AAE and the glomerular filtration rate (GFR) and electroencephalogram features. Consecutive admissions that used any kind of antibiotics to treat infectious diseases were identified from six hospitals. We classified antibiotics according to three distinct pathophysiologic mechanisms and clinical subtypes. We searched for the incidence of AAE as the primary outcome. A total of 97,433 admission cases among 56,038 patients was identified. Cases that received type 1 antibiotics had significantly more frequent AAE compared to those that received type 2 antibiotics (adjusted odds ratio [OR], 2.62; 95% confidence interval [CI] 1.15-5.95; P = 0.021). Combined use of type 1 + 2 antibiotics was associated with a significantly higher incidence of AAE compared to the use of type 2 antibiotics alone (adjusted OR, 3.44; 95% CI 1.49-7.93; P = 0.004). Groups with GFR < 60 mL/min/1.73 m2 had significantly higher incidence rates of AAE compared to those with GFRs ≥ 90 mL/min/1.73 m2 among cases that received type 1 + 2 antibiotics. Detection of spike-and-wave or sharp-and-wave patterns on electroencephalogram was significantly more common in the combination therapy group. Combination use of antibiotics was associated with a higher incidence of AAE compared to monotherapy. The incidence of AAE significantly increased as renal function decreased, and epileptiform discharges were more likely to be detected in cases receiving combined antibiotics.
Collapse
Affiliation(s)
- Jean Hee Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Taewon Kim
- Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-Ro, Bupyeong-Gu, Incheon, 21431, South Korea.
| | - Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Seong-Hoon Kim
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yun Jeong Hong
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eunyae Lim
- Department of Neurology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dae Woong Bae
- Department of Neurology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Mi Noh
- Department of Neurology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jieun Lee
- Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
4
|
Carrara M, Aubertin G, Khirani S, Massenavette B, Bierme P, Griffon L, Ioan I, Schweitzer C, Binoche A, Lampin ME, Mordacq C, Rubinsztajn R, Debeilleix S, Galode F, Bui S, Hullo E, Becourt A, Lubrano M, Moreau J, Renoux MC, Matecki S, Stremler N, Baravalle-Einaudi M, Mazenq J, Sigur E, Labouret G, Genevois AL, Heyman R, Pomedio M, Masson A, Hangard P, Menetrey C, Le Clainche L, Bokov P, Dudoignon B, Fleurence E, Bergounioux J, Mbieleu B, Breining A, Giovannin-Chami L, Fina A, Ollivier M, Gachelin E, Perisson C, Pervillé A, Barzic A, Cros P, Jokic M, Labbé G, Diaz V, Coutier L, Fauroux B, Taytard J. Pediatric long-term noninvasive respiratory support in children with central nervous system disorders. Pediatr Pulmonol 2024; 59:642-651. [PMID: 38088209 DOI: 10.1002/ppul.26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024]
Abstract
RATIONALE The use of long-term noninvasive respiratory support is increasing in children along with an extension of indications, in particular in children with central nervous system (CNS) disorders. OBJECTIVE The aim of this study was to describe the characteristics of children with CNS disorders treated with long-term noninvasive respiratory support in France. METHODS Data were collected from 27 French pediatric university centers through an anonymous questionnaire filled for every child treated with noninvasive ventilatory support ≥3 months on 1st June 2019. MAIN RESULTS The data of 182 patients (55% boys, median age: 10.2 [5.4;14.8] years old [range: 0.3-25]) were collected: 35 (19%) patients had nontumoral spinal cord injury, 22 (12%) CNS tumors, 63 (35%) multiple disabilities, 26 (14%) central alveolar hypoventilation and 36 (20%) other CNS disorders. Seventy five percent of the patients were treated with noninvasive ventilation (NIV) and 25% with continuous positive airway pressure (CPAP). The main investigations performed before CPAP/NIV initiation were nocturnal gas exchange recordings, alone or coupled with poly(somno)graphy (in 29% and 34% of the patients, respectively). CPAP/NIV was started in an acute setting in 10% of the patients. Median adherence was 8 [6;10] hours/night, with 12% of patients using treatment <4 h/day. Nasal mask was the most common interface (70%). Airway clearance techniques were used by 31% of patients. CONCLUSION CPAP/NIV may be a therapeutic option in children with CNS disorders. Future studies should assess treatment efficacy and patient reported outcome measures.
Collapse
Affiliation(s)
- Marion Carrara
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Guillaume Aubertin
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
- Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
- ASV Santé, Gennevilliers, France
| | - Bruno Massenavette
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Priscille Bierme
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Iulia Ioan
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Marie-Emilie Lampin
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Clémence Mordacq
- Pediatic Pulmonology and Allergology Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Robert Rubinsztajn
- Department of Pediatric orthopedic surgery, Hôpital Necker-Enfants malades, Paris, France
| | | | - François Galode
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Stéphanie Bui
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Eglantine Hullo
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, Grenoble, France
| | - Arnaud Becourt
- Pediatric Pulmonology Department, CHU Amiens Picardie, Amiens, France
| | - Marc Lubrano
- Respiratory Diseases, Allergy and CF Unit, Department of Pediatric, University Hospital Charles Nicolle, Rouen, France
| | - Johan Moreau
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - Marie-Catherine Renoux
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Functional Exploration Laboratory, University Hospital, Montpellier, France
| | - Nathalie Stremler
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | | | - Julie Mazenq
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | - Elodie Sigur
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Anne-Laure Genevois
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Rachel Heyman
- Pediatric Unit, Department of Physical Medicine and Rehabilitation, Hôpital Pontchaillou, Rennes, France
| | - Michael Pomedio
- Pediatric Intensive Care Unit, American Memorial Hospital, CHU Reims, Reims, France
| | - Alexandra Masson
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Pauline Hangard
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Céline Menetrey
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Laurence Le Clainche
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | - Plamen Bokov
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
| | - Benjamin Dudoignon
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Jean Bergounioux
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | | | - Lisa Giovannin-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Agnes Fina
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | | | - Elsa Gachelin
- Department of Pediatric, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Caroline Perisson
- Department of Pediatric, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Anne Pervillé
- Department of Pédiatrics, Hôpital d'Enfants-ASFA, Saint Denis, La Réunion, France
| | | | | | - Mickaël Jokic
- Pediatric Intensive Care Unit, CHU de Caen Normandie, Caen, France
| | - Guillaume Labbé
- Pediatric Pulmonology and Allergology Unit, CHU d'Estaing, Clermont-Ferrand, France
| | - Véronique Diaz
- Department of Respiratory Physiology, CHU Poitiers, Poitiers, France
| | - Laurianne Coutier
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- INSERM UMR-S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Sorbonne Université, Paris, France, Paris, France
| |
Collapse
|
5
|
Swatzyna RJ, Morrow LM, Collins DM, Barr EA, Roark AJ, Turner RP. Evidentiary Significance of Routine EEG in Refractory Cases: A Paradigm Shift in Psychiatry. Clin EEG Neurosci 2024:15500594231221313. [PMID: 38238932 DOI: 10.1177/15500594231221313] [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] [Indexed: 02/29/2024]
Abstract
Over the past decade, the Diagnostic and Statistical Manual's method of prescribing medications based on presenting symptoms has been challenged. The shift toward precision medicine began with the National Institute of Mental Health and culminated with the World Psychiatric Association's posit that a paradigm shift is needed. This study supports that shift by providing evidence explaining the high rate of psychiatric medication failure and suggests a possible first step toward precision medicine. A large psychiatric practice began collecting electroencephalograms (EEGs) for this study in 2012. The EEGs were analyzed by the same neurophysiologist (board certified in electroencephalography) on 1,233 patients. This study identified 4 EEG biomarkers accounting for medication failure in refractory patients: focal slowing, spindling excessive beta, encephalopathy, and isolated epileptiform discharges. Each EEG biomarker suggests underlying brain dysregulation, which may explain why prior medication attempts have failed. The EEG biomarkers cannot be identified based on current psychiatric assessment methods, and depending upon the localization, intensity, and duration, can all present as complex behavioral or psychiatric issues. The study highlights that the EEG biomarker identification approach can be a positive step toward personalized medicine in psychiatry, furthering the clinical thinking of "testing the organ we are trying to treat."
Collapse
Affiliation(s)
| | | | - Diana M Collins
- Child, Adolescent, and Adult Psychiatry, Sugar Land, TX, USA
| | - Emma A Barr
- Houston Neuroscience Brain Center, Houston, TX, USA
| | | | - Robert P Turner
- Network Neurology, LLC, University of South Carolina School of Medicine, Charleston, SC, USA
| |
Collapse
|
6
|
Ni J, Fang B, Xu H, Liu Y, Fang K, Li S. Case report: Influenza A virus and Human herpesvirus 1 infection-associated acute encephalopathy in children with the mutations in the SLC25A19 and TICAM1 gene, respectively. IDCases 2023; 34:e01910. [PMID: 37867568 PMCID: PMC10587721 DOI: 10.1016/j.idcr.2023.e01910] [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: 09/18/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background Infection-associated acute encephalopathy (AE) is a clinical condition caused by a variety of pathogens, particularly common viruses. In some cases, this condition could be characterized by a sudden onset and a rapid progression, leading to severe neurological sequelae, including acute encephalopathy with biphasic seizures and late reduced diffusion, hemorrhagic shock and encephalopathy syndrome, etc. Case presentation In this study, it was reported that three previously healthy children developed acute encephalopathy/encephalitis symptoms with different neurological sequelae after either Influenza A Virus or Human Herpesvirus 1 infection, presenting with fever and convulsions. What's more, after performing the gene exon detection for these three children, it was found that there are abnormal genes corresponding to their neurological sequelae, including SLC25A19 and TICAM1. Conclusions Therefore, comparing to children with common encephalitis, for children with encephalitis whose progression is rapid and clinical manifestations such as recurrent fever and frequent convulsions is difficult to improve, whole-exome sequencing can be a valuable tool for identifying encephalitis-associated genetic variants and providing strong evidence for prognostic prediction.
Collapse
Affiliation(s)
- Jingwen Ni
- Pediatric intensive care unit, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Boliang Fang
- Pediatric intensive care unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Huan Xu
- Vison Medicals for Infection Diseases, Guangzhou, China
| | - Yahui Liu
- Department of biomedical imaging and radiology, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Kenan Fang
- Pediatric intensive care unit, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Shujun Li
- Pediatric intensive care unit, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Okada Y, Nakasone H, Yoshimura K, Tamaki M, Kusuda M, Nakamura Y, Kawamura M, Kawamura S, Takeshita J, Yoshino N, Misaki Y, Gomyo A, Tanihara A, Kimura SI, Kako S, Kanda Y. Plasma ubiquitin C-terminal hydrolase-L1 (UCH-L1) level as a blood biomarker of neurological damage after allogeneic hematopoietic cell transplantation. Int J Hematol 2023; 118:340-346. [PMID: 37480445 DOI: 10.1007/s12185-023-03642-7] [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: 03/10/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
Several biofluid-based biomarkers for traumatic brain injury show promise for use in diagnosis and outcome prediction. In contrast, few studies have investigated biomarkers for non-traumatic brain injury. We focused on ubiquitin C-terminal hydrolase-L1 (UCH-L1), which has been proposed as a screening tool for traumatic brain injury, and investigated whether the plasma UCH-L1 level could also be a useful biomarker in patients with non-traumatic brain injury. We measured UCH-L1 in 25 patients who had experienced neurological complications after allogeneic hematopoietic cell transplantation (HCT) and 22 control patients without any complications or graft-versus-host disease. Although UCH-L1 levels before HCT did not differ significantly (P = 0.053), levels after HCT were higher in patients with neurological complications compared with the control group (P < 0.001). At a UCH-L1 cutoff value of 0.072 ng/ml, sensitivity was 68.0% and specificity was 100%. The statistical power of UCH-L1 for neurological complications seemed to be higher than that of CT and comparable to that of MRI. Thus, increased levels of UCH-L1 might reflect the presence of neurological damage even in patients with non-traumatic brain injury. Further large cohort investigations are warranted.
Collapse
Affiliation(s)
- Yosuke Okada
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan.
| |
Collapse
|
9
|
Villalba N, Ma Y, Gahan SA, Joly-Amado A, Spence S, Yang X, Nash KR, Yuan SY. Lung infection by Pseudomonas aeruginosa induces neuroinflammation and blood-brain barrier dysfunction in mice. J Neuroinflammation 2023; 20:127. [PMID: 37245027 PMCID: PMC10223932 DOI: 10.1186/s12974-023-02817-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Severe lung infection can lead to brain dysfunction and neurobehavioral disorders. The mechanisms that regulate the lung-brain axis of inflammatory response to respiratory infection are incompletely understood. This study examined the effects of lung infection causing systemic and neuroinflammation as a potential mechanism contributing to blood-brain barrier (BBB) leakage and behavioral impairment. METHODS Lung infection in mice was induced by instilling Pseudomonas aeruginosa (PA) intratracheally. We determined bacterial colonization in tissue, microvascular leakage, expression of cytokines and leukocyte infiltration into the brain. RESULTS Lung infection caused alveolar-capillary barrier injury as indicated by leakage of plasma proteins across pulmonary microvessels and histopathological characteristics of pulmonary edema (alveolar wall thickening, microvessel congestion, and neutrophil infiltration). PA also caused significant BBB dysfunction characterized by leakage of different sized molecules across cerebral microvessels and a decreased expression of cell-cell junctions (VE-cadherin, claudin-5) in the brain. BBB leakage peaked at 24 h and lasted for 7 days post-inoculation. Additionally, mice with lung infection displayed hyperlocomotion and anxiety-like behaviors. To test whether cerebral dysfunction was caused by PA directly or indirectly, we measured bacterial load in multiple organs. While PA loads were detected in the lungs up to 7 days post-inoculation, bacteria were not detected in the brain as evidenced by negative cerebral spinal fluid (CSF) cultures and lack of distribution in different brain regions or isolated cerebral microvessels. However, mice with PA lung infection demonstrated increased mRNA expression in the brain of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), chemokines (CXCL-1, CXCL-2) and adhesion molecules (VCAM-1 and ICAM-1) along with CD11b + CD45+ cell recruitment, corresponding to their increased blood levels of white cells (polymorphonuclear cells) and cytokines. To confirm the direct effect of cytokines on endothelial permeability, we measured cell-cell adhesive barrier resistance and junction morphology in mouse brain microvascular endothelial cell monolayers, where administration of IL-1β induced a significant reduction of barrier function coupled with tight junction (TJ) and adherens junction (AJ) diffusion and disorganization. Combined treatment with IL-1β and TNFα augmented the barrier injury. CONCLUSIONS Lung bacterial infection is associated with BBB disruption and behavioral changes, which are mediated by systemic cytokine release.
Collapse
Affiliation(s)
- Nuria Villalba
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Yonggang Ma
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Sarah A. Gahan
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Aurelie Joly-Amado
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Sam Spence
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Xiaoyuan Yang
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Kevin R. Nash
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Sarah Y. Yuan
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| |
Collapse
|
10
|
Vengalil A, Nizamutdinov D, Su M, Huang JH. Mechanisms of SARS-CoV-2-induced Encephalopathy and Encephalitis in COVID-19 Cases. Neurosci Insights 2023; 18:26331055231172522. [PMID: 37255742 PMCID: PMC10225804 DOI: 10.1177/26331055231172522] [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: 12/27/2022] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
The SARS-CoV-2 virus caused an unprecedented pandemic around the globe, infecting 36.5 million people and causing the death of over 1 million in the United States of America alone. COVID-19 patients demonstrated respiratory symptoms, cardiovascular complications, and neurologic symptoms, which in most severe cases included encephalopathy and encephalitis. Hypoxia and the uncontrolled proliferation of cytokines are commonly recognized to cause encephalopathy, while the retrograde trans-synaptic spread of the virus is thought to cause encephalitis in SARS-CoV-2-induced pathogenesis. Although recent research revealed some mechanisms explaining the development of neurologic symptoms, it still remains unclear whether interactions between these mechanisms exist. This review focuses on the discussion and analysis of previously reported hypotheses of SARS-CoV-2-induced encephalopathy and encephalitis and looks into possible overlaps between the pathogenesis of both neurological outcomes of the disease. Promising therapeutic approaches to prevent and treat SARS-CoV-2-induced neurological complications are also covered. More studies are needed to further investigate the dominant mechanism of pathogenesis for developing more effective preventative measures in COVID-19 cases with the neurologic presentation.
Collapse
Affiliation(s)
- Aaron Vengalil
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
| | - Damir Nizamutdinov
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
- Neurosurgery, Baylor Scott and White
Health, Neuroscience Institute, Temple, TX, USA
| | - Matthew Su
- Department of BioSciences, Rice
University, Houston, TX, USA
| | - Jason H Huang
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
- Neurosurgery, Baylor Scott and White
Health, Neuroscience Institute, Temple, TX, USA
| |
Collapse
|
11
|
Huq MR, Kawnayn G, Kabir H, Chowdhury MI, Anwar MB. Acute Vaccine-Related Encephalopathy and Acute Disseminated Encephalomyelitis (ADEM) After COVID-19 Vaccination: A Case Series From Bangladesh. Cureus 2023; 15:e39724. [PMID: 37398807 PMCID: PMC10310056 DOI: 10.7759/cureus.39724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 07/04/2023] Open
Abstract
There are several reported cases of various neurological adverse effects following the COVID-19 vaccination globally. Acute vaccine-related encephalopathy and acute disseminated encephalomyelitis (ADEM) are included among them. Here we are reporting three cases of ADEM and one case of acute vaccine-related encephalopathy from Bangladesh, which have a possible association with COVID-19 vaccines. All three ADEM cases were elderly; two cases developed symptoms after receiving the second dose of the Sinopharm vaccine, and another case after receiving the second dose of the Sinovac vaccine. We have treated another case of acute vaccine-related encephalopathy following receiving the Moderna vaccine. The patients had features of encephalopathy, including altered consciousness and convulsions. The ADEM cases had MRI (magnetic resonance imaging) brain findings suggestive of ADEM. The other case had normal MRI findings. All the cases were treated with intravenous corticosteroids with full recovery, except for one ADEM patient, who developed aspiration pneumonia and died. Though it is not possible to conclude that COVID-19 vaccination is the causative agent behind these cases, this case series will help to increase awareness regarding the early detection and treatment of these serious adverse effects.
Collapse
|
12
|
Li L, Huang D, Xu J, Li M, Zhao J, Shi Q, Guo Q. The assessment in patients with acute fatty liver of pregnancy (AFLP) treated with plasma exchange: a cohort study of 298 patients. BMC Pregnancy Childbirth 2023; 23:171. [PMID: 36915067 PMCID: PMC10012504 DOI: 10.1186/s12884-023-05503-x] [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: 09/19/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND To assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE). METHODS We retrospectively reviewed the AFLP patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University and Xijing Hospital of Air Force Medical University from January 2012 to May 2022. Final prediction model for death among AFLP by means of stepwise backward elimination with p value < 0.05. Patients treated with and without PE were compared by propensity-matched cohort study. RESULTS Two hundred ninety eight patients with the diagnosis of AFLP, and finally 290 patients were enrolled in the cohort study, 50 of whom (17.2%) were dead. Compared with AFLP patients alive, the dead of patients were more likely to be combined encephalopathy (p < 0.01), postpartum hemorrhage (p < 0.01), and found significantly higher frequency of fetal distress (p = 0.04), fetal death (p < 0.01). we developed a predicted probability value and with an area under the receiver operating characteristics (ROC) curve of 0.94 (95%CI 0.87 to 1.00), indicating AFLP patients' death. The patients treated with PE had a significantly lower 60-day mortality rate (OR 0.42, 95% CI 0.29 to 2.64, p = 0.04), and significantly shorter duration of hospital-free days at day 28 (p = 0.01). CONCLUSIONS In conclusion, our study indicated that liver function were risk factors for maternal mortality, and PE was a protective factor for maternal 60-day mortality and hospital-free days at day 28 in AFLP patients.
Collapse
Affiliation(s)
- Lingxia Li
- Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Dengchao Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Jing Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Miaojing Li
- Department of Hematopathology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Juan Zhao
- Department of Hematopathology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Qindong Shi
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Qinyue Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
13
|
Bartels HC, Meltzer EC. 30-Year-Old Immunocompromised Man With Fever, Headache, and History of Encephalopathy. Mayo Clin Proc 2023; 98:610-614. [PMID: 36870860 DOI: 10.1016/j.mayocp.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 03/06/2023]
Affiliation(s)
- Helen C Bartels
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Phoenix, AZ
| | - Ellen C Meltzer
- Advisor to resident and Consultant in General Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| |
Collapse
|
14
|
Rivers D, Gunnell S, Clark J, Lenehan R, Phenis R, Shan Y, Castro E. Clinical Reasoning: A 66-Year-Old Woman With Progressive Encephalopathy and Bilateral Hearing Loss. Neurology 2023; 100:254-258. [PMID: 36332986 DOI: 10.1212/wnl.0000000000201536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dustin Rivers
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX.
| | - Spencer Gunnell
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Jeffrey Clark
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Richard Lenehan
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Richard Phenis
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Yuan Shan
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Eduardo Castro
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| |
Collapse
|
15
|
Villalba N, Ma Y, Gahan SA, Joly-Amado A, Spence S, Yang X, Nash K, Yuan SY. Lung infection by P. aeruginosa induces neuroinflammation and blood-brain barrier dysfunction in mice. RESEARCH SQUARE 2023:rs.3.rs-2511441. [PMID: 36778380 PMCID: PMC9915779 DOI: 10.21203/rs.3.rs-2511441/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Severe lung infection can lead to brain dysfunction and neurobehavioral disorders. The mechanisms that regulate the lung-brain axis of inflammatory response to respiratory infection are incompletely understood. This study examined the effects of lung infection causing systemic and neuroinflammation as a potential mechanism contributing to blood-brain barrier (BBB) leakage and behavioral impairment. Methods Pneumonia was induced in adult C57BL/6 mice by intratracheal inoculation of Pseudomonas aeruginosa (PA). Solute extravasation, histology, immunofluorescence, RT-PCR, multiphoton imaging and neurological testing were performed in this study. Results Lung infection caused alveolar-capillary barrier injury as indicated by leakage of plasma proteins across pulmonary microvessels and histopathological characteristics of pulmonary edema (alveolar wall thickening, microvessel congestion, and neutrophil infiltration). PA also caused significant BBB dysfunction characterized by leakage of different sized molecules across cerebral microvessels and a decreased expression of cell-cell junctions (VE-cadherin, claudin-5) in the brain. BBB leakage peaked at 24 hours and lasted for 7 days post-inoculation. Additionally, mice with lung infection displayed hyperlocomotion and anxiety-like behaviors. To test whether cerebral dysfunction was caused by PA directly or indirectly, we measured bacterial load in multiple organs. While PA loads were detected in the lungs up to 7 days post-inoculation, bacteria were not detected in the brain as evidenced by negative cerebral spinal fluid (CSF) cultures and lack of distribution in different brain regions or isolated cerebral microvessels. However, mice with PA lung infection demonstrated increased mRNA expression in the brain of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), chemokines (CXCL-1, CXCL-2) and adhesion molecules (VCAM-1 and ICAM-1) along with CD11b + cell recruitment, corresponding to their increased blood levels of white cells (polymorphonuclear cells) and cytokines. To confirm the direct effect of cytokines on endothelial permeability, we measured cell-cell adhesive barrier resistance and junction morphology in mouse brain microvascular endothelial cell monolayers, where administration of IL-1β induced a significant reduction of barrier function coupled with tight junction (TJ) diffusion and disorganization. Combined treatment with IL-1β and TNFα augmented the barrier injury. Conclusions These results suggest that lung bacterial infection causes cerebral microvascular leakage and neuroinflammation via a mechanism involving cytokine-induced BBB injury.
Collapse
Affiliation(s)
| | - Yonggang Ma
- University of South Florida Morsani College of Medicine
| | - Sarah A Gahan
- University of South Florida Morsani College of Medicine
| | | | - Sam Spence
- University of South Florida Morsani College of Medicine
| | - Xiaoyuan Yang
- University of South Florida Morsani College of Medicine
| | - Kevin Nash
- University of South Florida Morsani College of Medicine
| | - Sarah Y Yuan
- University of South Florida Morsani College of Medicine
| |
Collapse
|
16
|
Villalba N, Ma Y, Gahan SA, Joly-Amado A, Spence S, Yang X, Nash K, Yuan SY. Lung infection by P. aeruginosa induces neuroinflammation and blood-brain barrier dysfunction in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.23.524949. [PMID: 36747856 PMCID: PMC9900744 DOI: 10.1101/2023.01.23.524949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Severe lung infection can lead to brain dysfunction and neurobehavioral disorders. The mechanisms that regulate the lung-brain axis of inflammatory response to respiratory infection are incompletely understood. This study examined the effects of lung infection causing systemic and neuroinflammation as a potential mechanism contributing to blood-brain barrier (BBB) leakage and behavioral impairment. Methods Pneumonia was induced in adult C57BL/6 mice by intratracheal inoculation of Pseudomonas aeruginosa (PA). Solute extravasation, histology, immunofluorescence, RT-PCR, multiphoton imaging and neurological testing were performed in this study. Results Lung infection caused alveolar-capillary barrier injury as indicated by leakage of plasma proteins across pulmonary microvessels and histopathological characteristics of pulmonary edema (alveolar wall thickening, microvessel congestion, and neutrophil infiltration). PA also caused significant BBB dysfunction characterized by leakage of different sized molecules across cerebral microvessels and a decreased expression of cell-cell junctions (VE-cadherin, claudin-5) in the brain. BBB leakage peaked at 24 hours and lasted for 7 days post-inoculation. Additionally, mice with lung infection displayed hyperlocomotion and anxiety-like behaviors. To test whether cerebral dysfunction was caused by PA directly or indirectly, we measured bacterial load in multiple organs. While PA loads were detected in the lungs up to 7 days post-inoculation, bacteria were not detected in the brain as evidenced by negative cerebral spinal fluid (CSF) cultures and lack of distribution in different brain regions or isolated cerebral microvessels. However, mice with PA lung infection demonstrated increased mRNA expression in the brain of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), chemokines (CXCL-1, CXCL-2) and adhesion molecules (VCAM-1 and ICAM-1) along with CD11b+ cell recruitment, corresponding to their increased blood levels of white cells (polymorphonuclear cells) and cytokines. To confirm the direct effect of cytokines on endothelial permeability, we measured cell-cell adhesive barrier resistance and junction morphology in mouse brain microvascular endothelial cell monolayers, where administration of IL-1β induced a significant reduction of barrier function coupled with tight junction (TJ) diffusion and disorganization. Combined treatment with IL-1β and TNFα augmented the barrier injury. Conclusions These results suggest that lung bacterial infection causes cerebral microvascular leakage and neuroinflammation via a mechanism involving cytokine-induced BBB injury.
Collapse
|
17
|
Duve K, Svitlana S, Tkachenko O. POLYMORPHISM OF ACE AND AT2R1 GENES AS A GENETIC BACKGROUND FOR DIFFERENT TYPES OF ENCEPHALOPATHIES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2460-2468. [PMID: 38112365 DOI: 10.36740/wlek202311119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim: To study the prevalence of ACE I/D and AT2R1 A1166C gene polymorphisms in patients with CTE, SVD, AIE, and PIE and to assess the influence of the presence of a particular genotype of the studied genes on the occurrence and/or progression of encephalopathies. PATIENTS AND METHODS Materials and methods: A total of 96 patients with encephalopathies of various genesis (chronic traumatic encephalopathy (CTE) n=26; chronic alcohol-induced encephalopathy (AIE) n=26; microvascular ischemic disease of the brain (or cerebral small vessel disease, (SVD)) n=18; post-infectious encephalopathy (PIE) n=26) were involved in the study. The molecular genetic study was performed in the molecular genetics laboratory of the State Institution «Reference Center for Molecular Diagnostics of the Ministry of Health of Ukraine», Kyiv. Statistical processing of the results was performed using the STATISTICA 10.0 program. RESULTS Results: In patients with various types of encephalopathies, probable changes in the frequency distribution of genotypes of polymorphic variants I/D of the ACE gene were established (11.11% vs. 33.33% - carriers of the I/I genotype, 27.78% vs. 50.00% - carriers of the I/D genotype and 61.11% vs. 16.67% - carriers of the D/D genotype) and A1166C of the AT2R1 gene (22.22% vs. 66.67% - carriers of the A/A genotype, 50.00% vs. 25.00% - carriers A/C genotype, 27.78% versus 8.33% - carriers of the C/C genotype) compared to individuals of the control group only in patients with SVD. The presence of the D allele and the D/D genotype of the ACE gene is associated with a statistically significant increase in the risk of SVD development and progression (respectively, 4.2 times (95% CI (1.39-12.72)) and 7.9 (95% CI ( 1.31-47.05)) times). A similar trend was established for the carrier of the C allele of the A1166C polymorphic variant of the AT2R1 gene in patients with SVD: a 4.3-fold increase in the risk of development and progression (95% CI (1.30-13.86). In addition, there is a probable dependence between carrier genotype A/C of the AT2R1 gene and increased risk of PIE and AIE by 4.8 and 5.7 times, respectively. CONCLUSION Conclusions: Therefore, results suggest the reasonability to include the I/D of the ACE gene polymorphism investigation in the genetic panel of encephalopathies.
Collapse
Affiliation(s)
- Khrystyna Duve
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE, TERNOPIL, UKRAINE
| | - Shkrobot Svitlana
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE, TERNOPIL, UKRAINE
| | - Olena Tkachenko
- THE SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| |
Collapse
|
18
|
Yin H, Yang R, Xin Y, Jiang T, Zhong D. In-hospital mortality and SpO2 incritical care patients with cerebral injury: data from the MIMIC‑IV Database. BMC Anesthesiol 2022; 22:386. [PMID: 36510130 PMCID: PMC9743499 DOI: 10.1186/s12871-022-01933-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence regarding the relationship between in-hospital mortality and SpO2 was low oxygen saturations are often thought to be harmful, new research in patients with brain damage has found that high oxygen saturation actually enhances mortality. However, there is currently no clear study to point out the appropriate range for oxygen saturation in patients with craniocerebral diseases. METHODS: By screening all patients in the MIMIC IV database, 3823 patients with craniocerebral diseases (according to ICD-9 codes and ICD-10) were selected, and non-linear regression was used to analyze the relationship between in-hospital mortality and oxygen saturation. Covariates for all patients included age, weight, diagnosis, duration of ICU stay, duration of oxygen therapy, etc. RESULTS: In-hospital mortality in patients with TBI and SAH was kept to a minimum when oxygen saturation was in the 94-96 range. And in all patients, the relationship between oxygen saturation and in-hospital mortality was U-shaped. Subgroup analysis of the relationship between oxygen saturation and mortality in patients with metabolic encephalopathy and other encephalopathy also draws similar conclusions In-hospital mortality and oxygen saturation were all U-shaped in patients with subarachnoid hemorrhage, metabolic and toxic encephalopathy, cerebral infarction, and other encephalopathy, but the nonlinear regression was statistically significant only in patients with cerebral infarction (p for nonlinearity = 0.002). CONCLUSION Focusing too much on the lower limit of oxygen saturation and ignoring too high oxygen saturation can also lead to increase in-hospital mortality. For patients with TBI and SAH, maintaining oxygen saturation at 94-96% will minimize the in-hospital mortality of patients.
Collapse
Affiliation(s)
- Haoyang Yin
- grid.452206.70000 0004 1758 417XDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yang
- grid.452206.70000 0004 1758 417XDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Xin
- grid.452206.70000 0004 1758 417XDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Jiang
- grid.452206.70000 0004 1758 417XDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Zhong
- grid.452206.70000 0004 1758 417XDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
19
|
Lewis SL, Chizmar LR, Liotta S. COVID-19 and Micronutrient Deficiency symptoms – is there some overlap? Clin Nutr ESPEN 2022; 48:275-281. [PMID: 35331502 PMCID: PMC8809666 DOI: 10.1016/j.clnesp.2022.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Background & aims COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports. Methods We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive. Results The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive. Conclusion Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.
Collapse
|
20
|
Lima MN, Barbosa-Silva MC, Maron-Gutierrez T. New perspectives for mesenchymal stromal cells as an adjuvant therapy for infectious disease-associated encephalopathies. Neural Regen Res 2022; 17:48-52. [PMID: 34100426 PMCID: PMC8451575 DOI: 10.4103/1673-5374.314292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Knowledge of the mechanisms that trigger infection-related encephalopathies is still very limited and cell therapies are one of the most promising alternatives for neurodegenerative diseases, and its application in infectious diseases can be of great relevance. Mesenchymal stromal cells are cells with great immunomodulatory potential; therefore, their use in clinical and preclinical studies in a variety of diseases, including central nervous system diseases, increased in the last decade. Mesenchymal stromal cells can exert their beneficial effects through several mechanisms, such as direct cell contact, through surface receptors, and also through paracrine or endocrine mechanisms. The paracrine mechanism is widely accepted by the scientific community and involves the release of soluble factors, which include cytokines, chemokines and trophic factors, and extracellular vesicles. This mini review discusses mesenchymal stromal cells mechanisms of action in neurological disorders, the neuroinflammatory process that takes place in the brain as a result of peripheral inflammation and changes in the brain’s cellular scenario as a common factor in central nervous system diseases, and mesenchymal stromal cells therapy in encephalopathies. Mesenchymal stromal cells have been shown to act in neuroinflammation processes, leading to improved survival and mitigating behavioral damage. More recently, these cells have been tested in preclinical models of infectious diseases-associated encephalopathies (e.g., cerebral malaria and sepsis associated encephalopathy) and have shown satisfactory results.
Collapse
Affiliation(s)
- Maiara N Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Maria C Barbosa-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Tatiana Maron-Gutierrez
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz; National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Brazil
| |
Collapse
|
21
|
Salinas V, Martínez N, Maturo JP, Rodriguez-Quiroga SA, Zavala L, Medina N, Amartino H, Sfaello I, Agosta G, Serafín EM, Morón DG, Kauffman MA, Vega P. Clinical next generation sequencing in developmental and epileptic encephalopathies: Diagnostic relevance of data re-analysis and variants re-interpretation. Eur J Med Genet 2021; 64:104363. [PMID: 34673242 DOI: 10.1016/j.ejmg.2021.104363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
Developmental and epileptic encephalopathies (DEE) are complex pediatric epilepsies, in which heterogeneous pathogenic factors play an important role. Next-generation-sequencing based tools have shown excellent effectiveness. The constant increase in the number of new genotype-phenotype associations suggests the periodic need for re-interpretation and re-analysis of genetic studies without positive results. In this study, we report the diagnostic utility of targeted gene panel sequencing and whole exome sequencing in 55 Argentine subjects with DEE, focusing on the utility of re-interpretation and re-analysis of undetermined and negative genetic diagnoses. The new information in biomedical literature and databases was used for the re-interpretation. For re-analysis, sequencing data processing was repeated using updated bioinformatics tools. Initially, pathogenic variants were detected in 21 subjects (38%). After an average time of 29 months, 25% of the subjects without a genetic diagnosis were re-categorized as diagnosed. Finally, the overall diagnostic yield increased to 53% (29 subjects). In consequence of the re-interpretation and re-analysis, we identified novel variants in the genes: CHD2, COL4A1, FOXG1, GABRA1, GRIN2B, HNRNPU, KCNQ2, MECP2, PCDH19, SCN1A, SCN2A, SCN8A, SLC6A1, STXBP1 and WWOX. Our results expand the diagnostic yield of this subgroup of infantile and childhood seizures and demonstrate the importance of re-evaluation of genetic tests in subjects without an identified causative etiology.
Collapse
Affiliation(s)
- Valeria Salinas
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina; Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute-CONICET, Faculty of Biomedical Sciences, Universidad Austral, Buenos Aires, Argentina.
| | - Nerina Martínez
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina.
| | - Josefina Pérez Maturo
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina; Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute-CONICET, Faculty of Biomedical Sciences, Universidad Austral, Buenos Aires, Argentina.
| | | | - Lucia Zavala
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina.
| | - Nancy Medina
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina.
| | - Hernán Amartino
- Paediatric Neurology Unit, Hospital Universitario Austral, Buenos Aires, Argentina.
| | - Ignacio Sfaello
- CETES, Instituto de Neurología Infanto-Juvenil, Córdoba, Argentina.
| | - Guillermo Agosta
- Paediatric Neurology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | | | - Marcelo A Kauffman
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina; Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute-CONICET, Faculty of Biomedical Sciences, Universidad Austral, Buenos Aires, Argentina.
| | - Patricia Vega
- Neurogenetics Unit, Hospital JM Ramos Mejía, Buenos Aires, Argentina.
| |
Collapse
|
22
|
Ding JB, Dongas J, Hu K, Ding M. Autoimmune Limbic Encephalitis: A Review of Clinicoradiological Features and the Challenges of Diagnosis. Cureus 2021; 13:e17529. [PMID: 34603897 PMCID: PMC8476324 DOI: 10.7759/cureus.17529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 12/19/2022] Open
Abstract
Limbic encephalitis is an autoimmune cause of encephalitis. In addition to the usual symptoms of encephalitis such as altered consciousness, fever, and focal neurological deficits, limbic encephalitis can present with neuropsychiatric manifestations and seizures. Making a formal diagnosis involves a difficult and prolonged workup phase. The purpose of this review is to help readers delineate limbic encephalitis from other illnesses. This is done by presenting a spectrum of potential organic differential diagnoses and pertinent findings that distinguish them from limbic encephalitis. Instead of presenting a variety of psychiatric differential diagnoses, the authors present a review of psychiatric manifestations known to be associated with limbic encephalitis, as naturally, any psychiatric disorder could be a potential comorbid disease.
Collapse
Affiliation(s)
- Jack B Ding
- Internal Medicine, Royal Adelaide Hospital, Adelaide, AUS
- Internal Medicine, University of Adelaide, Adelaide, AUS
| | - John Dongas
- Internal Medicine, Royal Adelaide Hospital, Adelaide, AUS
| | - Kevin Hu
- Internal Medicine, Lyell McEwin Hospital, Adelaide, AUS
| | - Mark Ding
- Internal Medicine, University of Adelaide, Adelaide, AUS
| |
Collapse
|
23
|
Barbosa-Silva MC, Lima MN, Battaglini D, Robba C, Pelosi P, Rocco PRM, Maron-Gutierrez T. Infectious disease-associated encephalopathies. Crit Care 2021; 25:236. [PMID: 34229735 PMCID: PMC8259088 DOI: 10.1186/s13054-021-03659-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Infectious diseases may affect brain function and cause encephalopathy even when the pathogen does not directly infect the central nervous system, known as infectious disease-associated encephalopathy. The systemic inflammatory process may result in neuroinflammation, with glial cell activation and increased levels of cytokines, reduced neurotrophic factors, blood-brain barrier dysfunction, neurotransmitter metabolism imbalances, and neurotoxicity, and behavioral and cognitive impairments often occur in the late course. Even though infectious disease-associated encephalopathies may cause devastating neurologic and cognitive deficits, the concept of infectious disease-associated encephalopathies is still under-investigated; knowledge of the underlying mechanisms, which may be distinct from those of encephalopathies of non-infectious cause, is still limited. In this review, we focus on the pathophysiology of encephalopathies associated with peripheral (sepsis, malaria, influenza, and COVID-19), emerging therapeutic strategies, and the role of neuroinflammation.
Collapse
Affiliation(s)
- Maria C Barbosa-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Maiara N Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Tatiana Maron-Gutierrez
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil.
- National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
24
|
Nepal G, Balayar R, Bhatta S, Acharya S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, Ojha R. Neurobrucellosis: A differential not to be missed in patients presenting with neuropsychiatric features. Clin Case Rep 2021; 9:e04190. [PMID: 34194775 PMCID: PMC8222759 DOI: 10.1002/ccr3.4190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
When a patient presents with undulating fever and neuropsychiatric features, neurobrucellosis should be considered as a differential diagnosis. If diagnosed early, neurobrucellosis is a treatable disease with a favorable outcome.
Collapse
Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Ramesh Balayar
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Suraj Bhatta
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Sulav Acharya
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | | | - Ragesh Karn
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Reema Rajbhandari
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Sunanda Paudel
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Ashish Shrestha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| |
Collapse
|