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Cassiano LMG, de Oliveira DB, Candiani TMS, Campi-Azevedo AC, Martins-Filho OA, Kroon EG, Kohlhoff M, Coimbra RS. The neurotoxic branch of the kynurenine pathway is highly activated in the central nervous system of patients with pneumococcal meningitis. Cytokine 2023; 168:156237. [PMID: 37257305 DOI: 10.1016/j.cyto.2023.156237] [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: 12/29/2022] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Acute bacterial meningitis (ABM) causes excessive activation of N-methyl-D-aspartate receptors (NMDAr), leading to cortical and hippocampal neuron death. As opposite, enteroviral meningitis is more frequently benign. The kynurenine (KYN) pathway is the major catabolic route of tryptophan (TRP) and some of its metabolites are agonists or antagonists of NMDAr. METHODS In order to investigate the pathogen-specific patterns of KYN pathway modulation in the central nervous system of children with acute meningococcal (MM), pneumococcal (PM) or enteroviral (VM) meningitis, the cerebrospinal fluid (CSF) concentrations of TRP, KYN, kynurenic acid (KYNA) and quinolinic acid (QUINA) were evaluated by ultra-high performance liquid chromatography (uHPLC) coupled to mass spectrometry. In addition, CSF levels of IL-6, IL-10 and TNF-α were quantified by multi-analyte flow assay. The data was mined and integrated using statistical and machine learning methods. RESULTS The three forms of meningitis investigated herein up-regulated the neurotoxic branch of the KYN pathway within the intrathecal space. However, this response, represented by the concentration of QUINA, was six and nine times higher in PM patients compared to MM or VM, respectively. CSF levels of IL-6, TNF-α, and IL-10 were increased in MM and PM patients when compared to controls. In VM, CSF IL-6 and IL-10, but not TNF-α were increased compared to controls, although not reaching the high levels found in bacterial meningitis. No correlation was found between the concentrations or the ratios of any pair of KYN metabolites and any cytokine or standard cytochemical parameter tested. CONCLUSIONS CNS infection with meningococci, pneumococci, and enteroviruses intrathecally activate the KYN pathway, favoring its neurotoxic branch. However, in PM, higher CSF levels of QUINA, compared to MM and VM, may contribute to its poorer neurologic outcome.
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Affiliation(s)
- Larissa M Gomes Cassiano
- Neurogenômica, Imunopatologia, Instituto René Rachou, Fiocruz, Belo Horizonte, MG 30190-002, Brazil; Programa de Pós-Graduação em Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Danilo Bretas de Oliveira
- Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG 39100-000, Brazil
| | | | - Ana Carolina Campi-Azevedo
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz, Belo Horizonte, MG 30190-002, Brazil
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz, Belo Horizonte, MG 30190-002, Brazil
| | - Erna Geessien Kroon
- Laboratório de Virologia, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Markus Kohlhoff
- Química de Produtos Naturais Bioativos, Instituto René Rachou, Fiocruz, Belo Horizonte, MG 30190-002, Brazil
| | - Roney Santos Coimbra
- Neurogenômica, Imunopatologia, Instituto René Rachou, Fiocruz, Belo Horizonte, MG 30190-002, Brazil.
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Zhu Y, Xu M, Ding C, Peng Z, Wang W, Sun B, Cheng J, Chen C, Chen W, Wei H, Hu Z. Metagenomic Next-Generation Sequencing vs. Traditional Microbiological Tests for Diagnosing Varicella-Zoster Virus Central Nervous System Infection. Front Public Health 2022; 9:738412. [PMID: 35127608 PMCID: PMC8814106 DOI: 10.3389/fpubh.2021.738412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background Unbiased metagenomic next-generation sequencing (mNGS) detects pathogens in a target-independent manner. It is not well-understood whether mNGS has comparable sensitivity to target-dependent nucleic acid test for pathogen identification. Methods This study included 31 patients with chickenpox and neurological symptoms for screening of possible varicella-zoster virus (VZV) central nervous system (CNS) infection. Microbiological diagnosing of VZV cerebrospinal fluid (CSF) infection was performed on stored CSF samples using mNGS, quantitative and qualitative VZV-specific PCR assays, and VZV IgM antibodies test. Results The median age was 30.0 [interquartile range (IQR), 24.3–33.3] years. 51.6% of the patients were men. About 80.6% of the patients had normal CSF white blood cell counts (≤ 5 × 106/L). VZV IgM antibodies presented in 16.1% of the CSF samples, and nucleic acids were detectable in 16.1 and 9.7% using two different VZV-specific real-time PCR protocols. Intriguingly, maximal identification of VZV elements was achieved by CSF mNGS (p = 0.001 and p = 007; compared with qualitative PCR and VZV IgM antibody test, respectively), with sequence reads of VZV being reported in 51.6% (16/31) of the CSF samples. All VZV PCR positive samples were positive when analyzed by mNGS. Of note, human betaherpesvirus 6A with clinical significance was unexpectedly detected in one CSF sample. Conclusions Our study suggests that CSF mNGS may have higher sensitivity for VZV detection than CSF VZV PCR and antibody tests, and has the advantage of identifying unexpected pathogens.
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Affiliation(s)
- Yunqi Zhu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Miaomiao Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chengyuan Ding
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhihang Peng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Weixiao Wang
- Department of Clinical Research Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Binghu Sun
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Chen
- Department of Clinical Research Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
- Hongxia Wei
| | - Zhiliang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Zhiliang Hu
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Kulaga SS, Miller CWT. Viral respiratory infections and psychosis: A review of the literature and the implications of COVID-19. Neurosci Biobehav Rev 2021; 127:520-530. [PMID: 33992695 PMCID: PMC9616688 DOI: 10.1016/j.neubiorev.2021.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 01/08/2023]
Abstract
The historical association between respiratory infections and neuropsychiatric symptoms dates back centuries, with more recent literature highlighting a link between viral infections and schizophrenia. Maternal influenza infection during pregnancy has been associated with the development of schizophrenia in offspring. Viral infections in neonates, children, and adolescents have also been associated with later development of schizophrenia. Neuroinvasive and/or systemic infections are thought to increase risk for psychopathology via inflammatory mechanisms, particularly when exposure occurs during critical neurodevelopmental windows. Several human coronaviruses (HCoVs) have been associated with psychotic disorders and increasing reports of the neuropsychiatric manifestations of COVID-19 suggest it has neuroinvasive properties similar to those of other HCoVs. These properties, in conjunction with its ability to generate a massive inflammatory response, suggest that COVID-19 may also contribute to future psychopathology. This review will summarize the psychopathogenic mechanisms of viral infections and discuss the neuroinvasive and inflammatory properties of COVID-19 that could contribute to the development of psychotic disorders, with a focus on in utero, neonatal, and childhood exposure.
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Affiliation(s)
- Stephanie S Kulaga
- University of Maryland School of Medicine, 701 W. Pratt St., 4th Floor, Baltimore, MD 21201, United States.
| | - Christopher W T Miller
- University of Maryland School of Medicine, 701 W. Pratt St., 4th Floor, Baltimore, MD 21201, United States
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Philip SS, Dutton GN. Identifying and characterising cerebral visual impairment in children: a review. Clin Exp Optom 2021; 97:196-208. [PMID: 24766507 DOI: 10.1111/cxo.12155] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Swetha Sara Philip
- Dept of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, South India
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, United Kingdom
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Kovtunov EA, Shkodenko LA, Goncharova EA, Nedorezova DD, Sidorenko SV, Koshel EI, Kolpashchikov DM. Towards Point of Care Diagnostics: Visual Detection of Meningitis Pathogens Directly from Cerebrospinal Fluid. ChemistrySelect 2020. [DOI: 10.1002/slct.202003869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Evgeny A. Kovtunov
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
| | - Liubov A. Shkodenko
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
| | - Ekaterina A. Goncharova
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
- Saint-Petersburg Pasteur Institute Mira st.14, St. Petersburg 197101 Russian Federation
| | - Daria D. Nedorezova
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
| | - Sergey V. Sidorenko
- Department of Medical Microbiology and Molecular Epidemiology Pediatric Research and Clinical Center for Infectious Diseases Saint Petersburg 197022 Russian Federation
- North Western State Medical University named after I.I. Mechnikov Kirochnaya Str. 41, St. Petersburg Russia 191015
| | - Elena I. Koshel
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
| | - Dmitry M. Kolpashchikov
- Laboratory of Molecular Robotics and Biosensor Materials Chemistry Department SCAMT Institute ITMO University 9 Lomonosova Str. Saint Petersburg 191002 Russian Federation
- University of Central Florida Chemistry Department 4111 Libra Drive, Physical Sciences 255 Orlando FL USA 32816-2366
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TLR9 Rs352140 polymorphism contributes to a decreased risk of bacterial meningitis: evidence from a meta-analysis. Epidemiol Infect 2020; 148:e294. [PMID: 33143777 PMCID: PMC7770465 DOI: 10.1017/s0950268820002666] [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: 11/07/2022] Open
Abstract
Some studies have suggested that the Toll-like receptor 9 polymorphism (TLR9 rs352140) is closely related to the risk of bacterial meningitis (BM), but this is subject to controversy. This study set out to estimate whether the TLR9 rs352140 polymorphism confers an increased risk of BM. Relevant literature databases were searched including PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure (CNKI) up to August 2020. Seven case-control studies from four publications were enrolled in the present meta-analysis. Odds ratios (OR) and confidence intervals (95% CI) were calculated to estimate associations between BM risk and the target polymorphism. Significant associations identified were allele contrast (A vs. G: OR 0.66, 95% CI 0.59–0.75, P = 0.000), homozygote comparison (AA vs. AG/GG: OR 0.62, 95% CI 0.49–0.78, P = 0.000), heterozygote comparison (A vs. G: OR 0.74, 95% CI 0.61–0.91, P = 0.005), recessive genetic model (AA vs. AG/GG: OR 0.78, 95% CI 0.65–0.93, P = 0.006) and dominant genetic model (AA vs. AG/GG: OR 0.70, 95% CI 0.57–0.85, P = 0.000). The findings indicate that, in contrast to some studies, the TLR9 rs352140 polymorphism is associated with a decreased risk for BM.
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Kumar D, Pannu AK, Dhibar DP, Singh R, Kumari S. The epidemiology and clinical spectrum of infections of the central nervous system in adults in north India. Trop Doct 2020; 51:48-57. [PMID: 33019910 DOI: 10.1177/0049475520959905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infections of the central nervous system (CNS) are a leading cause of mortality in low- and middle-income countries. We studied the spectrum, aetiology and outcome of CNS infections in 401 consecutive patients aged ≥12 years admitted at the medical emergency centre of PGIMER, Chandigarh, India. An aetiological diagnosis was made in 365 (91.0%) patients, with 149 (40.8%) microbiologically confirmed cases. CNS tuberculosis was the most prevalent cause (51.5%), followed by viral meningoencephalitis (13.9%), community-acquired bacterial meningitis (9.7%), cryptococcal meningitis (6.2%), scrub typhus meningoencephalitis (1.7%), neurocysticercosis (1.7%) and fungal brain abscess (1.7%). Human immunodeficiency virus (11.0%) and diabetes mellitus (6.2%) remained the usual predisposing conditions. We found a mortality rate of 27.9%, highest in cases without an aetiology (64.5%). Tuberculosis remained the most common cause; however, an increasing number of scrub typhus, dengue, fungal infections and non-classical bacterial pathogens may indicate a change in the epidemiology of community-acquired CNS infections in India.
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Affiliation(s)
- Devender Kumar
- Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Ashok Kumar Pannu
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Deba Prasad Dhibar
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Rajveer Singh
- Assistant Professor, Department of Neurology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Savita Kumari
- Professor and Head, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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Malekmohammad K, Rafieian-Kopaei M, Sardari S, Sewell RDE. Effective Antiviral Medicinal Plants and Biological Compounds Against Central Nervous System Infections: A Mechanistic Review. Curr Drug Discov Technol 2020; 17:469-483. [PMID: 31309894 DOI: 10.2174/1570163816666190715114741] [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: 12/20/2018] [Revised: 03/26/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Infectious diseases are amongst the leading causes of death in the world and central nervous system infections produced by viruses may either be fatal or generate a wide range of symptoms that affect global human health. Most antiviral plants contain active phytoconstituents such as alkaloids, flavonoids, and polyphenols, some of which play an important antiviral role. Herein, we present a background to viral central nervous system (CNS) infections, followed by a review of medicinal plants and bioactive compounds that are effective against viral pathogens in CNS infections. METHODS A comprehensive literature search was conducted on scientific databases including: PubMed, Scopus, Google Scholar, and Web of Science. The relevant keywords used as search terms were: "myelitis", "encephalitis", "meningitis", "meningoencephalitis", "encephalomyelitis", "central nervous system", "brain", "spinal cord", "infection", "virus", "medicinal plants", and "biological compounds". RESULTS The most significant viruses involved in central nervous system infections are: Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV), West Nile Virus (WNV), Enterovirus 71 (EV71), Japanese Encephalitis Virus (JEV), and Dengue Virus (DENV). The inhibitory activity of medicinal plants against CNS viruses is mostly active through prevention of viral binding to cell membranes, blocking viral genome replication, prevention of viral protein expression, scavenging reactive Oxygen Species (ROS), and reduction of plaque formation. CONCLUSION Due to the increased resistance of microorganisms (bacteria, viruses, and parasites) to antimicrobial therapies, alternative treatments, especially using plant sources and their bioactive constituents, appear to be more fruitful.
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Affiliation(s)
- Khojasteh Malekmohammad
- Department of Animal Sciences, Faculty of Basic Sciences, Shahrekord University, Shahrekord, Iran
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sardari
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Robert D E Sewell
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, United Kingdom
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Akram M, Riaz M, Munir N, Rasul A, Daniyal M, Ali Shah SM, Shariati MA, Shaheen G, Akhtar N, Parveen F, Akhter N, Owais Ghauri A, Chishti AW, Usman Sarwar M, Said Khan F. Progress and prospects in the management of bacterial infections and developments in Phytotherapeutic modalities. Clin Exp Pharmacol Physiol 2020; 47:1107-1119. [PMID: 32064656 DOI: 10.1111/1440-1681.13282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/28/2022]
Abstract
The advent of antibiotics revolutionized medical care resulting in significantly reduced mortality and morbidity caused by infectious diseases. However, excessive use of antibiotics has led to the development of antibiotic resistance and indeed, the incidence of multidrug-resistant pathogens is considered as a major disadvantage in medication strategy, which has led the scholar's attention towards innovative antibiotic sources in recent years. Medicinal plants contain a variety of secondary metabolites with a wide range of therapeutic potential against the resistant microbes. Therefore, the aim of this review is to explore the antibacterial potential of traditional herbal medicine against bacterial infections. More than 200 published research articles reporting the therapeutic potential of medicinal plants against drug-resistant microbial infections were searched using different databases such as Google Scholar, Science Direct, PubMed and the Directory of Open Access Journals (DOAJ), etc., with various keywords like medicinal plants having antibacterial activities, antimicrobial potentials, phytotherapy of bacterial infection, etc. Articles were selected related to the efficacious herbs easily available to local populations addressing common pathogens. Various plants such as Artocarpus communis, Rheum emodi, Gentiana lutea L., Cassia fistula L., Rosemarinus officinalis, Argemone maxicana L, Hydrastis canadensis, Citrus aurantifolia, Cymbopogon citrates, Carica papaya, Euphorbia hirta, etc, were found to have significant antibacterial activities. Although herbal preparations have promising potential in the treatment of multidrug-resistant bacterial infection, still more research is required to isolate phytoconstituents, their mechanism of action as well as to find their impacts on the human body.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
| | - Naveed Munir
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Akhtar Rasul
- Department of Allied Health Sciences, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
| | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Syed Muhammad Ali Shah
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Mohammad Ali Shariati
- Kazakh Research Institute of Processing and Food Industry (Semey branch), Semey, Kazakhstan
| | - Ghazala Shaheen
- Department of Eastern Medicine, Faculty of Pharmacy and Alternative Medicine, College of Conventional Medicine, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Naheed Akhtar
- Department of Pharmacy, University of Poonch, Rawalakot, Azad Jammu and Kashmir, Pakistan
| | - Farzana Parveen
- Department of Pharmacy, Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Naheed Akhter
- College of Allied Health Professional, Government College University Faisalabad, Faisalabad, Pakistan
| | - Aymen Owais Ghauri
- Faculty of Pharmacy, Rayaz College of Eastern Medicine, Jinnah University for Women, Karachi, Pakistan
| | - Abdul Wadood Chishti
- Faculty of Pharmacy and Alternative Medicine, University College of Conventional Medicine, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Usman Sarwar
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Fahad Said Khan
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
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Matthews E, Diaz-Arias LA, Beekmann SE, Polgreen P, Waldrop G, Yang V, Rimmer K, Venkatesan A, Thakur KT. Prevalence and Characteristics of Neuroinfectious Disease Inquiries Within the Emerging Infections Network: A 22-Year Retrospective Study. Open Forum Infect Dis 2020; 7:ofaa163. [PMID: 32550236 PMCID: PMC7292246 DOI: 10.1093/ofid/ofaa163] [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: 03/19/2020] [Accepted: 05/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background To monitor emerging infectious diseases, the Centers for Disease Control and Prevention and the Infectious Disease Society of America established the Emerging Infections Network (EIN), allowing infectious disease specialists to post inquiries about clinical cases. We describe the frequency and characteristics of neuroinfectious disease-related inquiries. Methods The EIN listserv was retrospectively reviewed from February 1997 to December 2019 using search terms associated with neurologic diseases. We recorded case summaries, disease type (ie, meningitis, encephalitis), inquiry type (diagnostic approach, result interpretation, management decisions), unique patient populations, exposures, pathogens, ultimate diagnosis, and change in clinical care based on responses. Results Of 2348 total inquiries, 285 (12.1%) related to neuroinfectious diseases. The majority involved meningitis (99, 34.7%) or encephalitis (56, 19.6%). One hundred fifteen inquiries (40%) related to management, 34 (12%) related to diagnostic workup, and 22 (8%) related to result interpretation. Eight (2.8%) specifically involved results of cerebrospinal fluid polymerase chain reaction testing. Sixty-three (22.1%) involved immunosuppressed patients (29 human immunodeficiency virus-positive cases [46%]). The most common pathogens were Treponema pallidum (19, 6.7%) and Cryptococcus neoformans (18, 6.3%). In 74 (25%) inquiries, patients had neurologic symptoms without a clear infection, 38 (51.3%) of which included noninfectious neurologic etiologies in the differential diagnosis. Conclusions This study demonstrates the significant challenges of diagnosis and management of neuroinfectious diseases within the field of infectious diseases. It also highlights the importance of curated forums to guide the approach of difficult cases, in particular instances that mimic infectious diseases. Finally, the EIN listserv may assist in identifying areas for research and training to address these complexities.
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Affiliation(s)
- Elizabeth Matthews
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Luisa A Diaz-Arias
- Johns Hopkins Encephalitis Center, Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan E Beekmann
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip Polgreen
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Greer Waldrop
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Yang
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathryn Rimmer
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Arun Venkatesan
- Johns Hopkins Encephalitis Center, Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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Brown BL, Fidell A, Ingolia G, Murad E, Beckham JD. Infectious causes and outcomes in patients presenting with cerebral spinal fluid pleocytosis. J Neurovirol 2019; 25:448-456. [PMID: 30850974 DOI: 10.1007/s13365-019-00739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/27/2018] [Accepted: 02/21/2019] [Indexed: 11/24/2022]
Abstract
To evaluate the infectious etiologies, clinical features, and outcomes of patients with CNS infections at a tertiary care center. Patients that present with a pleocytosis in the cerebral spinal fluid (CSF), defined as a CSF WBC count > 5 cells/mm3, from July 2015 to June 2016 at a tertiary care hospital were analyzed for this report. Data from patients with confirmed (n = 43) and presumed (n = 51) CNS infections were analyzed. CNS infection was the leading known cause of CSF pleocytosis (n = 43, 18% of all patients with a pleocytosis in the CSF), and HSV-2 was identified as the leading causative pathogen (n = 10) followed by varicella zoster virus (n = 5). Fifty-three percent of patients with a pleocytosis in the CSF did not receive a diagnosis. In the patients that did not receive a diagnosis, CNS infection was presumed to be the cause in 51 patients (21% of patients with CSF pleocytosis). The mean time to diagnosis for patients with confirmed CNS infection was 16 days, but time to diagnosis was highly variable depending on the causative pathogen. There was a significant overlap in CSF parameters and peripheral white blood cell counts in patients diagnosed with a viral, bacterial, or fungal infection. Neuroimaging changes were present in only 44% of CNS infections. The overall mortality was 7% for CNS infections, and 17% of patients with a CNS infection had a severe neurologic deficit at presentation while only 3% had a severe deficit at the last neurologic assessment. This study provides new insights into the infectious causes of disease in a cohort of patients with pleocytosis in the CSF. The study provides new insights into the time to diagnosis and outcomes in patients that present with pleocytosis in the CSF.
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Affiliation(s)
- Bethany L Brown
- Clinical Science Graduate Program, University of Colorado Graduate School, Aurora, CO, USA
| | - Andrea Fidell
- Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Gregory Ingolia
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL, USA
| | - Eias Murad
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - J David Beckham
- Clinical Science Graduate Program, University of Colorado Graduate School, Aurora, CO, USA.
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.
- Veterans Administration, Eastern Colorado Health System, Denver, CO, USA.
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, University of Colorado School of Medicine, Research Building 2, Rm 11015, 12700 East 19th Ave, B168, Aurora, CO, 80045, USA.
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Rizvi SMD, Hussain T, Ahmed ABF, Alshammari TM, Moin A, Ahmed MQ, Barreto GE, Kamal MA, Ashraf GM. Gold nanoparticles: A plausible tool to combat neurological bacterial infections in humans. Biomed Pharmacother 2018; 107:7-18. [PMID: 30075371 DOI: 10.1016/j.biopha.2018.07.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Management of bacterial infections of central nervous system is a major challenge for the scientists all over the world. Despite the development of various potential drugs, the issue of central nervous system infections persists in the society. The main constraint is the delivery of drugs across the blood brain barrier and only a few drugs after meeting the stringent criteria could cross the blood brain barrier. On the other hand, certain bacterial pathogens could easily enter the brain by using several factors and mechanisms by crossing the blood brain barriers. Interestingly, in the recent past, gold nanoparticles have shown immense potential to overcome the issues associated with the treatment of central nervous system infections, especially due to their inherent ability to cross the blood brain barrier. Initially, the present review summarized the recent updates on the pathogenesis and factors involved in neurological bacterial infections, including the mechanism used by bacterial pathogens to cross the blood brain barriers. Thereafter, the emphasis of the review was on providing current information on gold nanoparticles pertinent to their applicability for the treatment of neurological infections. After discussing the background of neurological bacterial infections, the characteristic features, antibacterial properties, mechanisms of antibacterial action and ability to cross the blood brain barrier of gold nanoparticles have been summarized. Some of the features of gold nanoparticles that make them an ideal candidate for brain delivery are biocompatibity, stability, ability to get synthesized in different sizes with facile methods, surface affinity towards various functional groups, spontaneous crossing of blood brain barrier without applying any external field and most importantly, easy non-invasive tracing by CT imaging. The current updates on the development of gold nanoparticles based therapeutic strategies for the prevention and treatment of central nervous system infections have been discussed in the present study. However, further investigation would be required to translate these preclinical outcomes into clinical applications. Nevertheless, we could safely state that the information gathered and discussed in the present review would benefit the scientists working in the field of neuro-nanotechnology.
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Affiliation(s)
- Syed Mohd Danish Rizvi
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia.
| | - Talib Hussain
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Abo Bakr Fathy Ahmed
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Thamir M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Mohammed Qumani Ahmed
- Department of Pharmacology, College of Medicine,University of Hail, Hail, Saudi Arabia
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C, Colombia; Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Mohammad Ajmal Kamal
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770, Sydney, Australia; Novel Global Community Educational Foundation, Australia; King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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Brown B, Fidell A, Ingolia G, Murad E, Beckham JD. Defining diagnostic approaches and outcomes in patients with inflammatory CSF: A retrospective cohort study. Clin Neurol Neurosurg 2018; 172:105-111. [PMID: 29986194 DOI: 10.1016/j.clineuro.2018.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/07/2018] [Accepted: 06/30/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Define the etiologies, clinical features, time to diagnosis, and outcomes of patients that present with cerebral spinal fluid (CSF) pleocytosis. PATIENTS AND METHODS This is retrospective cohort study of patients with CSF pleocytosis, defined as WBC count >5 cells/mm3 in the CSF, from July 2015 to June 2016 at a large tertiary care hospital. The proportion of patients within specific diagnostic categories were analyzed for differences in diagnostic testing and outcomes. RESULTS 53% of patients had CSF pleocytosis due to an unknown etiology. The leading known cause of neuroinflammation was CNS infection (n = 43/244, 18%), followed by malignancy (n = 28/244, 11%). Mean time to diagnosis was 125 days in patients with autoimmune neuroinflammation and was 16 days in patients with an infection or malignancy. CSF parameters and peripheral white blood cell counts did not distinguish between categories of disease. The presence of CSF oligoclonal bands or a positive biopsy result most commonly supported a diagnosis of an autoimmune disease or malignancy, respectively. Neuroimaging changes were present in only 44% of infections but were found in 80-90% of other categories of neuroinflammation. Patients presenting with a severe neurologic deficit had 22.29 higher odds of a severe deficit at the last neurologic assessment, and mortality was highest (29%) in patients with malignancy-associated neuroinflammation. CONCLUSIONS This study to defines general diagnostic categories of neuroinflammatory disease in patients and provides new insight on the value of specific diagnostic testing, time to diagnosis, and outcomes in these patient populations.
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Affiliation(s)
- Bethany Brown
- Clinical Science Graduate Program, University of Colorado Graduate School, Aurora, CO, United States
| | - Andrea Fidell
- Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Gregory Ingolia
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL, United States
| | - Eias Murad
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
| | - J David Beckham
- Clinical Science Graduate Program, University of Colorado Graduate School, Aurora, CO, United States; Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States; Veterans Administration, Eastern Colorado Health System, Denver, CO, United States; Department of Neurology, Division of NeuroImmunology and Neurological Infections, University of Colorado School of Medicine, Aurora, CO, United States.
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Etiological identification of viral agents in acute encephalitis in Guadalajara, México, 2011-2015. BIOMEDICA 2018; 38:216-223. [PMID: 30184350 DOI: 10.7705/biomedica.v38i0.3730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 08/07/2017] [Indexed: 11/21/2022]
Abstract
Introduction: Viral encephalitis is a well-known inflammatory process associated with neurological dysfunction that might derive into severe brain damage or a fatal outcome. In México there is no epidemiological data that describes the prevalence of viral agents responsible for acute encephalitis.
Objective: To identify the main viral agents by real time PCR involved in acute encephalitis in Mexico.
Materials and methods: We obtained cerebral spinal fluid (CSF) samples from all patients with suspected viral encephalitis admitted to the emergency service of the Hospital Civil de Guadalajara “Fray Antonio Alcalde”. To identify pathogens, we performed nucleic acid extraction using real-time PCR and RT-PCR.
Results: Sixty-six patients were diagnosed with acute encephalitis from 2011 to 2014. A definitive viral etiological diagnosis was established in 16 patients (24%); the main causative agents were enteroviruses in 50% of the 16 positive samples, followed by herpes simplex virus (37%) and cytomegaloviruses (12.5%). Patients with encephalitis were predominantly male (63.3%) and a seasonal predominance was observed during autumn (37.5%). The main clinical characteristics in the acute encephalitis phase were fever (48.45) and cephalea (36.3), followed by seizures, disorientation, and muscular weakness (30.3%). Kerning sign was present in two cases (3%) and other two cases presented Brudzinski’s sign (3%).
Conclusions: CSF PCR is a suitable diagnostic technique for the identification of viral encephalitis caused by viral infections that allows an appropriate antiviral therapeutic treatment.
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Jin X, Yin S, Zhang Y, Chen X. Association between TLR2 + 2477G/A polymorphism and bacterial meningitis: a meta-analysis. Epidemiol Infect 2018; 146:642-647. [PMID: 29457581 PMCID: PMC9134541 DOI: 10.1017/s0950268818000298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/27/2023] Open
Abstract
Toll-like receptor 2 (TLR2) is a key member of TLRs, which is crucial in the initial inflammatory response against bacteria. TLR2, is also the initial barrier against bacterial infection and plays an important role in recognising a variety of bacterial lipoproteins. Several studies have been performed to investigate the TLR2 + 2477G/A polymorphism and bacterial meningitis susceptibility. Unfortunately, the results of previous studies were controversial. Therefore, we performed a meta-analysis to derive a more precise estimation of the association. The association between the TLR2 + 2477G/A polymorphism and bacterial meningitis susceptibility was assessed by odds ratios together with their 95% confidence intervals (CI). Six studies were enrolled in the present meta-analysis. Overall, no significant association between TLR2 + 2477G/A polymorphism and bacterial meningitis risk were found under allele contrast (A vs. G: OR = 1.15, 95% CI = 0.93-1.43, P = 0.202), recessive genetic model (AA vs. AG/GG: OR = 1.12, 95% CI = 0.90-1.41, P = 0.313). The significant association was found between TLR2 + 2477G/A polymorphism and pneumococcal meningitis risk under allele contrast (A vs. G: OR = 1.54, 95% CI = 1.01-2.36, P = 0.046), recessive genetic model (AA vs. AG/GG: OR = 1.63, 95% CI = 1.03-2.57, P = 0.035). We conclude that TLR2 + 2477G/A polymorphism is not associated with meningococcal meningitis risk but contributes an increased risk of pneumococcal meningitis.
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Affiliation(s)
- Xiaochun Jin
- Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028, People's Republic of China
| | - Shuzhou Yin
- Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028, People's Republic of China
| | - Youtao Zhang
- Department of Clinical Laboratory, First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Xu Chen
- Department of Clinical Laboratory, First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
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Monticelli J, Geremia N, D'Agaro P, Petix V, Luzzati R. Aseptic central nervous system infections in adults: what predictor for unknown etiological diagnosis? Neurol Sci 2018; 39:863-870. [PMID: 29455403 DOI: 10.1007/s10072-018-3274-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
Despite the availability of nucleic acid amplification tests (NAATs), most of aseptic acute meningitides, encephalitides, and meningoencephalitides (AAMEMs) in adults remain of unknown etiology so far. To shed light on such topic, we aimed to evaluate potential predictors for AAMEMs of unknown origin. We collected retrospectively data from all consecutive cases of AAMEMs in adults discharged from an Italian referral hospital, from January 2004 to December 2016. Laboratory analysis included common immunometric methods and NAATs. Potential predictors for unknown etiology (age, seasonality, serum C-reactive protein value, antibiotic use before lumbar puncture, immunodeficiency conditions, clinical symptoms and signs) were evaluated by a logistic regression analysis model. A p value ≤ 0.05 was considered to indicate statistical significance. The study included 92 patients (median age 39 years; 54.3% males) affected by meningitis (n = 57), encephalitis (n = 25), and meningoencephalitis (n = 10). The identified agents that cause AAMEMs were herpesviruses (20.7%), enteroviruses (5.4%), tick-borne encephalitis virus (3.3%), influenza virus A (2.2%), West Nile virus (1.1%), and parvovirus B19 (1.1%), while 66.3% of cases were of unknown etiology. No predictor was found to be significantly associated with AAMEMs of unknown etiology. We suggest that potential infectious agents causing undiagnosed cases should be investigated among non-bacterial, non-opportunistic, and non-seasonal organisms.
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Affiliation(s)
- Jacopo Monticelli
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy.
| | - Nicholas Geremia
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Pierlanfranco D'Agaro
- Department of Reproductive, Developmental and Public Health Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, Via dell'Istria 65, 34137, Trieste, Italy
| | - Vincenzo Petix
- Department of Reproductive, Developmental and Public Health Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, Via dell'Istria 65, 34137, Trieste, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy
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Marinho PES, Bretas de Oliveira D, Candiani TMS, Crispim APC, Alvarenga PPM, Castro FCDS, Abrahão JS, Rios M, Coimbra RS, Kroon EG. Meningitis Associated with Simultaneous Infection by Multiple Dengue Virus Serotypes in Children, Brazil. Emerg Infect Dis 2018; 23:115-118. [PMID: 27983492 PMCID: PMC5176234 DOI: 10.3201/eid2301.160817] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the causes of viral meningitis, we analyzed 22 cerebrospinal fluid samples collected during the 2014–2015 dengue epidemics in Brazil. We identified 3 serotypes of dengue virus (DENV-1, -2, and -3), as well as co-infection with 2 or 3 serotypes. We also detected the Asian II genotype of DENV-2.
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Implications of Neuroinvasive Bacterial Peptides on Rodents Behaviour and Neurotransmission. Pathogens 2017; 6:pathogens6030027. [PMID: 28671588 PMCID: PMC5617984 DOI: 10.3390/pathogens6030027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 01/09/2023] Open
Abstract
Neuroinvasive microbes are capable of applying their influences on the autonomic nervous system (ANS) of the host followed by the involvement of central nervous system (CNS) by releasing extracellular metabolites that may cause alterations in the biochemical and neurophysiological environment. Consequently synaptic, neuroendocrine, peripheral immune, neuro-immune, and behavioural responses of the host facilitate the progression of infection. The present study was designed to extrapolate the effects of crude and purified extracellular peptides of neuropathogenic bacteria on behavioural responses and neurotransmission of Sprague Dawley (SD) models. Listeria monocytogenes (Lm) and Neisseria meningitides (Nm) were isolated from the 92 cerebrospinal fluid (CSF) samples collected from mentally compromised patients. Bacillus cereus (Bc) and Clostridium tetani (Ct) were also included in the study. All bacterial strains were identified by the standard biochemical procedures. Filter sterilized cell free cultural broths (SCFBs) were prepared of different culture media. Behavioural study and neurotransmitter analysis were performed by giving an intraperitoneal (i.p.) injection of each bacterial SCFB to four groups (Test; n = 7) of SD rats, whereas two groups each (Control; n = 7) received a nutrient broth (NB) control and sterile physiological saline control, respectively. Extracellular bioactive peptides of these bacteria were screened and purified. All experiments were repeated using purified bacterial peptides on SD rat cohorts. Our study indicated promising behavioural changes, including fever, swelling, and hind paw paralysis, in SD rat cohorts. Purified bacterial peptides of all bacteria used in the present study elicited marked changes in behaviour through the involvement of the autonomic nervous system. Furthermore, these peptides of meningitis bacteria were found to potently affect the dopaminergic neurotransmission in CNS.
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de Oliveira DB, Candiani TM, Franco-Luiz APM, Almeida GMF, Abrahão JS, Rios M, Coimbra RS, Kroon EG. Etiological agents of viral meningitis in children from a dengue-endemic area, Southeast region of Brazil. J Neurol Sci 2017; 375:390-394. [PMID: 28320174 DOI: 10.1016/j.jns.2017.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/19/2022]
Abstract
Meningitis is a disease with a global distribution that constitutes a worldwide burden, with viruses as the primary etiologic agents. The range of viral meningitis severity depends mainly on age, immune status and etiological agent. The aim of this work was to investigate the suspected cases of viral meningitis using molecular techniques to confirm the viral infection. The diagnosed virus was correlated with clinical findings and cytochemical parameters in cerebrospinal liquid (CSF) of patients. CSF of 70 children with the presumptive diagnosis of viral meningitis was analyzed by real time PCR (qPCR). Viruses were identified by qPCR in 44 CSF samples (62.9%). Among them, 31 were identified as Enterovirus (ENTV) (70.4%), six as Human herpes virus 3 (HHV-3) (13.6%), five as Dengue virus (DENV) (11.7%), one as Human herpes virus 1-2 (2.3%) and one as Human herpes virus 5 (2.3%). Patients in the HHV-positive groups had increased percentage of polymorphonuclear neutrophils (PMN) (mean of 81%) while the groups of patients with DENV and ENTV had a mean of 30.9%. This study contributes to the knowledge of the epidemiological distribution of viral agents in CNS infections in children. In addition, it raises the relevance of DENV as an agent of CNS infection, and reinforces the importance for molecular in the cases of CNV infection.
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Affiliation(s)
- Danilo B de Oliveira
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; Faculdade de Medicina de Diamantina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina 39100-000, Brazil
| | - Talitah M Candiani
- Hospital Infantil João Paulo II, FHEMIG, Belo Horizonte 30130-110, Brazil
| | - Ana Paula M Franco-Luiz
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Gabriel M F Almeida
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Jônatas S Abrahão
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Maria Rios
- Center for Biologics Research and Review, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Roney S Coimbra
- Neurogenômica, Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte 30190-002, Brazil
| | - Erna G Kroon
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
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Olevianingrum M, Yulistiani Y, Saharso D, Zairina N. C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS. FOLIA MEDICA INDONESIANA 2016. [DOI: 10.20473/fmi.v51i3.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.
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Mutale W, Sahay KM, Hartley J, Thompson D, Ratnasinghe D, Hudson L, Hulse E, Fellows G. Community acquired Panton-Valentine Leukocidin (PVL) positive Methicilin Resistant Staphylococcal aureus cerebral abscess in an 11-month old boy: a case study. BMC Res Notes 2014; 7:862. [PMID: 25435087 PMCID: PMC4265436 DOI: 10.1186/1756-0500-7-862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Background Brain abscess are uncommon childhood infection. Brain abscess caused by Panton-Valentine Leukocidin positive Community acquired Methicillin Resistant Staphylococcal aureus have never been reported in the United Kingdom. Case presentation We report a case of a previously well 11-month old boy of Indian origin who developed a parietal lobe abscess from PVL positive CA-MRSA. Conclusion This case is one of the few described cases of brain abscess caused by PVL CA-MRSA in children. The unusual (insidious) presentation, the absence of a clear staphylococcal focus and the unexpected finding of a CA-MRSA in this patient highlight the challenges of managing such cases in clinical settings and the potential future risk to public health.
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Affiliation(s)
- Wilbroad Mutale
- London School of Hygiene and Tropical Medicine, Clinical Research Unit, London, UK.
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Coimbra RS, Calegare BFA, Candiani TMS, D'Almeida V. A putative role for homocysteine in the pathophysiology of acute bacterial meningitis in children. BMC Clin Pathol 2014; 14:43. [PMID: 25477764 PMCID: PMC4255930 DOI: 10.1186/1472-6890-14-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background Acute bacterial meningitis frequently causes cortical and hippocampal neuron loss leading to permanent neurological sequelae. Neuron death in acute bacterial meningitis involves the excessive activation of NMDA receptors and p53-mediated apoptosis, and the latter is triggered by the depletion of NAD + and ATP cellular stores by the DNA repair enzyme poly(ADP-ribose) polymerase. This enzyme is activated during acute bacterial meningitis in response to DNA damage induced, on its turn, by reactive oxygen and nitrogen species. An excess of homocysteine can also induce this cascade of events in hippocampal neurons. The present work aimed at investigating the possible involvement of homocysteine in the pathophysiology of meningitis by comparing its concentrations in cerebrospinal fluid (CSF) samples from children with viral or acute bacterial meningitis, and control individuals. Methods Homocysteine and cysteine concentrations were assessed by high-performance liquid chromatography in CSF samples from nine patients with acute bacterial meningitis, 13 patients with viral meningitis and 18 controls (median age: 4 years-old; range: <1 to 13) collected by lumbar puncture at admission at the Children's Hospital Joao Paulo II - FHEMIG, from January 2010 to November 2011. Results We found that homocysteine accumulates up to neurotoxic levels within the central nervous system of patients with acute bacterial meningitis, but not in those with viral meningitis or control individuals. No correlation was found between homocysteine and cysteine concentrations and the cerebrospinal fluid standard cytochemical parameters. Conclusions Our results suggest that HCY is produced intrathecally in response to acute bacterial meningitis and accumulates within the central nervous system reaching potentially neurotoxic levels. This is the first work to propose a role for HCY in the pathophysiology of brain damage associated with acute bacterial meningitis.
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Affiliation(s)
- Roney Santos Coimbra
- Biosystems Informatics, Research Center Rene Rachou, FIOCRUZ, Av. Augusto de Lima 1715, Belo Horizonte, MG Zip Code: 30190-002 Brazil
| | | | | | - Vânia D'Almeida
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP Brazil
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Abstract
This article provides an imaging overview of several of the common central nervous system (CNS) infections. Neurologic clinicians who provide acute care for patients should be familiar with the range of imaging findings for patients with acute neurologic infections, including knowledge of the appropriate study and the best protocol and views to show the disorder, and the ability to properly interpret them. This requirement applies particularly for CNS infections, as in stroke, in which a rapid appreciation of the exact cause of a patient's infection may play a major role in reducing mortality and morbidity.
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Affiliation(s)
- Patrick M Capone
- Virginia Commonwealth University, Richmond, VA, USA; Department of Neurology and Medical Imaging, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA; Winchester Neurological Consultants, Inc, 125-A Medical Circle, Winchester, VA 22601, USA.
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van Nierop GP, Hintzen RQ, Verjans GMGM. Prevalence of human Herpesviridae in cerebrospinal fluid of patients with multiple sclerosis and noninfectious neurological disease in the Netherlands. J Neurovirol 2014; 20:412-8. [PMID: 24671719 DOI: 10.1007/s13365-014-0248-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/20/2014] [Accepted: 03/13/2014] [Indexed: 11/30/2022]
Abstract
Prevalence of eight human herpesviruses (HHV1-8) was determined by real-time PCR in cell-rich cerebrospinal fluid (CSF) samples, obtained early after disease symptoms, of Dutch patients with multiple sclerosis (MS) and other noninfectious central nervous system diseases (NIND). Whereas HHV1-8 DNA was undetectable in CSF samples of MS patients, HHV6 DNA was detected in a plexus neuritis case and HHV7 DNA in an ependymoma and a Behçets' disease patient. However, intrathecal HHV infection was not detected. Data indicate that HHV1-8 are rarely detected in CSF of Dutch NIND patients and do not support the role of intrathecal HHV infection early after onset of disease symptoms in MS.
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Affiliation(s)
- Gijsbert P van Nierop
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Virological diagnosis of central nervous system infections by use of PCR coupled with mass spectrometry analysis of cerebrospinal fluid samples. J Clin Microbiol 2013; 52:212-7. [PMID: 24197874 DOI: 10.1128/jcm.02270-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Viruses are the leading cause of central nervous system (CNS) infections, ahead of bacteria, parasites, and fungal agents. A rapid and comprehensive virologic diagnostic testing method is needed to improve the therapeutic management of hospitalized pediatric or adult patients. In this study, we assessed the clinical performance of PCR amplification coupled with electrospray ionization-time of flight mass spectrometry analysis (PCR-MS) for the diagnosis of viral CNS infections. Three hundred twenty-seven cerebrospinal fluid (CSF) samples prospectively tested by routine PCR assays between 2004 and 2012 in two university hospital centers (Toulouse and Reims, France) were retrospectively analyzed by PCR-MS analysis using primers targeted to adenovirus, human herpesviruses 1 to 8 (HHV-1 to -8), polyomaviruses BK and JC, parvovirus B19, and enteroviruses (EV). PCR-MS detected single or multiple virus infections in 190 (83%) of the 229 samples that tested positive by routine PCR analysis and in 10 (10.2%) of the 98 samples that tested negative. The PCR-MS results correlated well with herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), and EV detection by routine PCR assays (kappa values [95% confidence intervals], 0.80 [0.69 to 0.92], 0.85 [0.71 to 0.98], and 0.84 [0.78 to 0.90], respectively), whereas a weak correlation was observed with Epstein-Barr virus (EBV) (0.34 [0.10 to 0.58]). Twenty-six coinfections and 16 instances of uncommon neurotropic viruses (HHV-7 [n = 13], parvovirus B19 [n = 2], and adenovirus [n = 1]) were identified by the PCR-MS analysis, whereas only 4 coinfections had been prospectively evidenced using routine PCR assays (P < 0.01). In conclusion, our results demonstrated that PCR-MS analysis is a valuable tool to identify common neurotropic viruses in CSF (with, however, limitations that were identified regarding EBV and EV detection) and may be of major interest in better understanding the clinical impact of multiple or neglected viral neurological infections.
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Casaroto E, Marra AR, Coelho FMS, Pinho JRR, Sitnik R, Colombari F, Victor ES, Muto NH, Senne C, dos Santos OFP, Edmond MB. Improving the diagnosis of meningitis due to enterovirus and herpes simplex virus I and II in a tertiary care hospital. BMC Infect Dis 2013; 13:487. [PMID: 24138798 PMCID: PMC3853767 DOI: 10.1186/1471-2334-13-487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enterovirus and herpes simplex viruses are common causes of lymphocytic meningitis. The purpose of this study was to analyse the impact of the use molecular testing for Enteroviruses and Herpes simplex viruses I and II in all suspected cases of viral meningitis. METHODS From November 18, 2008 to November 17, 2009 (phase II, intervention), all patients admitted with suspected viral meningitis (with pleocytosis) had a CSF sample tested using a nucleic acid amplification test (NAAT). Data collected during this period were compared to those from the previous one-year period, i.e. November 18, 2007 to November 17, 2008 (phase I, observational), when such tests were available but not routinely used. RESULTS In total, 2,536 CSF samples were assessed, of which 1,264 were from phase I, and 1,272 from phase II. Of this total, a NAAT for Enterovirus was ordered in 123 cases during phase I (9.7% of the total phase I sample) and in 221 cases in phase II (17.4% of the total phase II sample). From these, Enterovirus was confirmed in 35 (28.5%, 35/123) patients during phase I and 71 (32.1%, 71/221) patients during phase II (p = 0.107). The rate of diagnosis of meningitis by HSV I and II did not differ between the groups (13 patients, 6.5% in phase I and 13, 4.7% in phase II) (p = 1.0), from 200 cases in phase I and 274 cases in phase II. CONCLUSIONS The number of cases diagnosed with enteroviral meningitis increased during the course of this study, leading us to believe that the strategy of performing NAAT for Enterovirus on every CSF sample with pleocytosis is fully justified.
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Affiliation(s)
| | - Alexandre R Marra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Cost-effective diagnostic checklists for meningitis in resource-limited settings. J Acquir Immune Defic Syndr 2013; 63:e101-8. [PMID: 23466647 DOI: 10.1097/qai.0b013e31828e1e56] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Checklists can standardize patient care, reduce errors, and improve health outcomes. For meningitis in resource-limited settings, with high patient loads and limited financial resources, central nervous system diagnostic algorithms may be useful to guide diagnosis and treatment. However, the cost effectiveness of such algorithms is unknown. METHODS We used decision analysis methodology to evaluate the costs, diagnostic yield, and cost effectiveness of diagnostic strategies for adults with suspected meningitis in resource-limited settings with moderate/high HIV prevalence. We considered 3 strategies: (1) comprehensive "shotgun" approach of utilizing all routine tests; (2) "stepwise" strategy with tests performed in a specific order with additional tuberculosis (TB) diagnostics; (3) "minimalist" strategy of sequential ordering of high-yield tests only. Each strategy resulted in 1 of 4 meningitis diagnoses: bacterial (4%), cryptococcal (59%), TB (8%), or other (aseptic) meningitis (29%). In model development, we utilized prevalence data from 2 Ugandan sites and published data on test performance. We validated the strategies with data from Malawi, South Africa, and Zimbabwe. RESULTS The current comprehensive testing strategy resulted in 93.3% correct meningitis diagnoses costing $32.00 per patient. A stepwise strategy had 93.8% correct diagnoses costing an average of $9.72 per patient, and a minimalist strategy had 91.1% correct diagnoses costing an average of $6.17 per patient. The incremental cost-effectiveness ratio was $133 per additional correct diagnosis for the stepwise over minimalist strategy. CONCLUSIONS Through strategically choosing the order and type of testing coupled with disease prevalence rates, algorithms can deliver more care more efficiently. The algorithms presented herein are generalizable to East Africa and Southern Africa.
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Abstract
Bacterial meningitis is an infection of the meninges that can be infected by bacteria, virus, or fungus. The classic triad of bacterial meningitis consists of fever, neck stiffness, and altered mental status; headache is also another common symptom. Interventions for bacterial meningitis include prompt diagnosis, and initiation of antimicrobial therapy to optimize bacterial kill and decrease inflammatory response in the subarachnoid space. Nursing management consists of effective delivery of antibiotic therapy, fluid management, and supportive care.
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Affiliation(s)
- Michelle VanDemark
- Neurocritical Care, Sanford USD Medical Center, Sioux Falls, SD 57117-5039, USA.
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Single nucleotide polymorphisms in pathogen recognition receptor genes are associated with susceptibility to meningococcal meningitis in a pediatric cohort. PLoS One 2013; 8:e64252. [PMID: 23691182 PMCID: PMC3653876 DOI: 10.1371/journal.pone.0064252] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 04/13/2013] [Indexed: 12/11/2022] Open
Abstract
Bacterial meningitis (BM) is a serious infection of the central nervous system, frequently occurring in childhood and often resulting in hearing loss, learning disabilities, and encephalopathy. Previous studies showed that genetic variation in innate immune response genes affects susceptibility, severity, and outcome of BM. The aim of this study is to describe whether single nucleotide polymorphisms (SNPs) in pathogen recognition gene products are associated with susceptibility to develop BM in single genes analysis as well as SNP combinations. Genotype frequencies of seven SNPs, in five immune response genes encoding for Toll-like receptors (TLRs), nucleotide oligomerization domain (NOD) proteins and caspase-1 (CASP1), in 391 children with meningococcal meningitis (MM) and 82 children with pneumococcal meningitis were compared with a large cohort of 1141 ethnically matched healthy controls. Carriage of TLR4 +896 GG mutant predisposed to susceptibility to develop MM (p = 1.2*10−5, OR = 9.4, 95% CI = 3.0–29.2). The NOD2 SNP8 mutant was significantly more frequent in MM patients compared to controls (p = 0.0004, OR = 12.2, 95% CI = 2.6–57.8). Combined carriage of TLR2 +2477 and TLR4 +896 mutants was strongly associated with MM (p = 4.2*10−5, OR = 8.6, 95% CI = 2.7–27.3). A carrier trait of TLR4 +896 and NOD2 SNP8 mutants was also strongly associated with susceptibility to develop MM (p = 4.2*10−5, OR = 10.6, 95% CI = 2.9–38.6). This study associates SNPs in TLR4 and NOD2 with susceptibility to develop MM.
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Abstract
The adequate management of central nervous system (CNS) infections requires that antimicrobial agents penetrate the blood-brain barrier (BBB) and achieve concentrations in the CNS adequate for eradication of the infecting pathogen. This review details the currently available literature on the pharmacokinetics (PK) of antibacterials in the CNS of children. Clinical trials affirm that the physicochemical properties of a drug remain one of the most important factors dictating penetration of antimicrobial agents into the CNS, irrespective of the population being treated (i.e. small, lipophilic drugs with low protein binding exhibit the best translocation across the BBB). These same physicochemical characteristics determine the primary disposition pathways of the drug, and by extension the magnitude and duration of circulating drug concentrations in the plasma, a second major driving force behind achievable CNS drug concentrations. Notably, these disposition pathways can be expected to change during the normal process of growth and development. Finally, CNS drug penetration is influenced by the nature and extent of the infection (i.e. the presence of meningeal inflammation). Aminoglycosides have poor CNS penetration when administered intravenously. Intrathecal gentamicin has been studied in children with more promising results, often exceeding the minimum inhibitory concentration. There are very limited data with intrathecal tobramycin in children. However, in the few patients that have been studied, the CSF concentrations were highly variable. Penicillins generally have good CNS penetration. Aqueous penicillin G reaches greater concentrations than procaine or benzathine penicillin. Concentrations remain detectable for ≥ 12 h. Of the aminopenicillins, both ampicillin and parenteral amoxicillin reach adequate CNS concentrations; however, orally administered amoxicillin resulted in much lower concentrations. Nafcillin and piperacillin are the final two penicillins with pediatric data: their penetration is erratic at best. Cephalosporins vary greatly in regard to their CSF penetration. Few first- and second-generation cephalosporins are able to reach higher CSF concentrations. Cefuroxime is the only exception and is usually avoided due to its adverse effects and slower sterilization of the CSF than third-generation agents. Ceftriaxone, cefotaxime, ceftazidime, cefixime and cefepime have been studied in children and are all able to adequately penetrate the CSF. As with penicillins, concentrations are greatest in the presence of meningeal inflammation. Meropenem and imipenem are the only carbapenems with pediatric data. Imipenem reaches higher CSF concentrations; however, meropenem is preferred due to its lower incidence of seizures. Aztreonam has also demonstrated favorable penetration but only one study has been completed in children. Both chloramphenicol and sulfamethoxazole/trimethoprim (cotrimoxazole) penetrate into the CNS well; however, significant toxicities limit their use. The small size and minimal protein binding of fosfomycin contribute to its favorable CNS PK. Although rarely used, it achieves higher concentrations in the presence of inflammation and accumulation is possible. Linezolid reaches high CSF concentrations; however, more frequent dosing might be required in infants due to their increased elimination. Metronidazole also has very limited information but it demonstrated favorable results similar to adult data; CSF concentrations even exceeded plasma concentrations at certain time points. Rifampin (rifampicin) demonstrated good CNS penetration after oral administration. Vancomycin demonstrates poor CNS penetration after intravenous administration. When combined with intraventricular therapy, CNS concentrations are much greater. Of the antituberculosis agents, isoniazid, pyrazinamide and streptomycin have been studied in children. Isoniazid and pyrazinamide have favorable CSF penetration. Streptomycin appears to produce unpredictable CSF levels. No pediatric-specific data are available for clindamycin, daptomycin, macrolides, tetracyclines, and fluoroquinolones. Daptomycin, fluoroquinolones, and tetracyclines have demonstrated favorable CNS penetration in adults; however, data are limited due to their potential pediatric-specific toxicities and newness within the marketplace. Macrolides and clindamycin have demonstrated poor CNS penetration in adults and thus have not been studied in pediatrics.
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Barichello T, Generoso JS, Milioli G, Elias SG, Teixeira AL. Pathophysiology of Bacterial Infection of the Central Nervous System and its Putative Role in the Pathogenesis of Behavioral Changes. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:81-7. [DOI: 10.1016/j.rbp.2012.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/09/2012] [Indexed: 01/19/2023]
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Parthasarathy G, Philipp MT. Review: apoptotic mechanisms in bacterial infections of the central nervous system. Front Immunol 2012; 3:306. [PMID: 23060884 PMCID: PMC3463897 DOI: 10.3389/fimmu.2012.00306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/15/2012] [Indexed: 01/18/2023] Open
Abstract
In this article we review the apoptotic mechanisms most frequently encountered in bacterial infections of the central nervous system (CNS). We focus specifically on apoptosis of neural cells (neurons and glia), and provide first an overview of the phenomenon of apoptosis itself and its extrinsic and intrinsic pathways. We then describe apoptosis in the context of infectious diseases and inflammation caused by bacteria, and review its role in the pathogenesis of the most relevant bacterial infections of the CNS.
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Affiliation(s)
- Geetha Parthasarathy
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Covington, LA, USA
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34
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Abstract
Glycemic control is an important aspect of patient care in the surgical Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the potential to cause a rapidly deteriorating condition that the physician should be familiar with. Viral encephalitis frequently accompanies viral meningitis, and can produce focal neurologic findings and cognitive difficulties that can mimic other neurologic disorders. Brain abscesses also have the potential to mimic and present like other neurologic disorders, and cause more focal deficits. Finally, other infectious diseases of the central nervous system, such as prion disease and cavernous sinus thrombosis, are explored in this review.
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Affiliation(s)
- Vevek Parikh
- University of California, San Francisco, CA, USA
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Hahn K, Schildmann EK, Baumeister C, Seggern IV, Schielke E. Cognitive Impairment After Acute Encephalitis: An ERP Study. Int J Neurosci 2012; 122:630-6. [DOI: 10.3109/00207454.2012.702819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Rapid virological diagnosis of central nervous system infections by use of a multiplex reverse transcription-PCR DNA microarray. J Clin Microbiol 2011; 49:3874-9. [PMID: 21918017 DOI: 10.1128/jcm.01214-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Viruses are the main etiological cause of central nervous system (CNS) infections. A rapid molecular diagnosis is recommended to improve the therapeutic management of patients. The aim of this study was to evaluate the performances of a DNA microarray, the Clart Entherpex kit (Genomica, Coslada, Spain), allowing the rapid and simultaneous detection of 9 DNA and RNA neurotropic viruses: herpes simplex virus 1 (HSV-1), HSV-2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), HHV-7, HHV-8, and the human enteroviruses (HEVs). This evaluation was performed with 28 samples from the European proficiency panels (Quality Control for Molecular Diagnostics [QCMD]; Glasgow, Scotland) and then with 78 cerebrospinal fluid (CSF) specimens. The majority of the QCMD results obtained by the DNA microarray were similar to those recorded by the overall QCMD participants. The main discrepant results were observed for low concentrations of HSV-2 and HEVs. From the clinical samples, the kit detected 27 of the 28 herpesvirus CNS infections and all of the 30 HEV-positive CSF samples. No false-positive result was observed among the 20 virus-negative CSF samples. The clinical sensitivity, specificity, and negative and positive predictive values of the assay were 98.3, 100, 95.2, and 100%, respectively, when the results were compared to those of commercially available PCR assays. Interestingly, HHV-7 was detected in 11 (37%) of the 30 HEV-positive CSF samples from children suffering from aseptic meningitis causing significantly longer lengths of stay at the hospital than infection with HEVs alone (2.4 versus 1.4 days; P = 0.038). In conclusion, this preliminary study showed that this DNA microarray could be a valuable molecular diagnostic tool for single and mixed DNA and RNA virus infections of the CNS.
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Ravishankar K, Chakravarty A, Chowdhury D, Shukla R, Singh S. Guidelines on the diagnosis and the current management of headache and related disorders. Ann Indian Acad Neurol 2011; 14:S40-59. [PMID: 21847329 PMCID: PMC3152170 DOI: 10.4103/0972-2327.83100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Indexed: 11/04/2022] Open
Affiliation(s)
- K. Ravishankar
- The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India
| | - Ambar Chakravarty
- Department of Neurology, Vivekananda Institute of Medical Science, Kolkata, India
| | | | - Rakesh Shukla
- Department of Neurology, CSM Medical University, Lucknow, India
| | - Sumit Singh
- Department of Neurology, Medanta – The Medicity Gurgaon, Haryana, India
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Abstract
Headache is the most common symptom that humans experience. While the vast majority of headaches are due to benign primary headache disorders, a small but important minority of headaches are due to secondary causes. Whereas significant emphasis is placed on educating physicians regarding prompt recognition of subarachnoid hemorrhage and headaches secondary to brain tumors, attention toward headaches secondary to infectious causes is often neglected. Unfortunately, a missed or delayed diagnosis of a headache secondary to meningitis, encephalitis, brain abscess, subdural empyema, or other infectious etiologies can lead to dire consequences for both the patient and physician. Accordingly, this article provides an overview of headaches attributed to systemic and intracranial infectious causes.
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39
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Muzumdar D. Central nervous system infections and the neurosurgeon: A perspective. Int J Surg 2011; 9:113-6. [DOI: 10.1016/j.ijsu.2010.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/29/2010] [Accepted: 11/01/2010] [Indexed: 01/23/2023]
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40
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Mace SE. Central nervous system infections as a cause of an altered mental status? What is the pathogen growing in your central nervous system? Emerg Med Clin North Am 2010; 28:535-70. [PMID: 20709243 DOI: 10.1016/j.emc.2010.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are several central nervous system (CNS) infections (meningitis, encephalitis, and brain abscess), any of which may present with an altered level of consciousness. Because CNS infections can have a devastating outcome, it is important to recognize the presence of a CNS infection and begin treatment as soon as possible because early appropriate therapy may, in some cases, limit morbidity and mortality.
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Affiliation(s)
- Sharon E Mace
- Department of Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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41
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Abstract
The differential diagnosis and empiric management of altered mental status and seizures often overlap. Altered mental status may accompany seizures or simply be the manifestation of a postictal state. This article provides an overview of the numerous causes of altered mental status and seizures: metabolic, toxic, malignant, infectious, and endocrine causes. The article focuses on those agents that should prompt the emergency physician to initiate unique therapy to abate the seizure and correct the underlying cause.
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Affiliation(s)
- David E Slattery
- Department of Emergency Medicine, University of Nevada School of Medicine, 901 Rancho Lane, Suite #135, Las Vegas, NV 89106, USA.
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42
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Clinical Outcome and Life Quality of Patients After Monophasic Encephalitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181e85cec] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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43
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Barichello T, Dos Santos I, Savi GD, Simões LR, Generoso JS, Comim CM, Sachs D, Teixeira AL, Quevedo J. Depressive-like-behavior and proinflamatory interleukine levels in the brain of rats submitted to pneumococcal meningitis. Brain Res Bull 2010; 82:243-6. [PMID: 20450961 DOI: 10.1016/j.brainresbull.2010.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/20/2010] [Accepted: 04/27/2010] [Indexed: 11/19/2022]
Abstract
Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensorymotor deficits, seizures, and impairments of learning and memory. The presence of proliferating bacteria within the subarachnoid and ventricular space compartments triggers an intense inflammatory host response. Proinflammatory mediators released in the process include tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-6, and all of which have been shown to contribute to the development of brain injury in bacterial meningitis. The animals underwent a magna cistern tap receiving either 10muL sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration 5x10(9)cfu/mL. Ten days after induction we evaluated depressive-like behavior by using the forced swimming test and verified the levels of the TNF-alpha, IL-1beta, IL-6 and CINC-1 in the brain of rats induced to pneumococcal meningitis. In the forced swimming test we observed a significant increase in the immobility time in the meningitis group compared to the sham group (p<0.05). The TNFlevels were found increased in the prefrontal cortex (p<0.05, F=4.921), but not hippocampus. The IL-6, CINC-1 and IL-1beta levels presented no alteration in both prefrontal cortex and hippocampus 10 days after meningitis induction by S. pneumoniae. These findings suggest that the meningitis model could be a good research tool for the study of the biological mechanisms involved in the behavioral alterations secondary to pneumococcal meningitis.
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Affiliation(s)
- Tatiana Barichello
- Laboratory of Experimental Microbiology and National Institute for Translational Medicine (INCT-TM), Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, 88806-000 Criciúma, SC, Brazil.
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TNF-α, IL-1β, IL-6, and cinc-1 levels in rat brain after meningitis induced by Streptococcus pneumoniae. J Neuroimmunol 2010; 221:42-5. [DOI: 10.1016/j.jneuroim.2010.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/17/2022]
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Affiliation(s)
- Daniel P Hsu
- Division of Interventional Neuroradiology, Department of Radiology, University Hospitals of Cleveland Case Medical Center, Cleveland, OH 44106, USA.
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46
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Mittal R, Gonzalez-Gomez I, Goth KA, Prasadarao NV. Inhibition of inducible nitric oxide controls pathogen load and brain damage by enhancing phagocytosis of Escherichia coli K1 in neonatal meningitis. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 176:1292-305. [PMID: 20093483 DOI: 10.2353/ajpath.2010.090851] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Escherichia coli K1 is a leading cause of neonatal meningitis in humans. In this study, we sought to determine the pathophysiologic relevance of inducible nitric oxide (iNOS) in experimental E. coli K1 meningitis. By using a newborn mouse model of meningitis, we demonstrate that E. coli infection triggered the expression of iNOS in the brains of mice. Additionally, iNOS-/- mice were resistant to E. coli K1 infection, displaying normal brain histology, no bacteremia, no disruption of the blood-brain barrier, and reduced inflammatory response. Treatment with an iNOS specific inhibitor, aminoguanidine (AG), of wild-type animals before infection prevented the development of bacteremia and the occurrence of meningitis. The infected animals treated with AG after the development of bacteremia also completely cleared the pathogen from circulation and prevented brain damage. Histopathological and micro-CT analysis of brains revealed significant damage in E. coli K1-infected mice, which was completely abrogated by AG administration. Peritoneal macrophages and polymorphonuclear leukocytes isolated from iNOS-/- mice or pretreated with AG demonstrated enhanced uptake and killing of the bacteria compared with macrophages and polymorphonuclear leukocytes from wild-type mice in which E. coli K1 survive and multiply. Thus, NO produced by iNOS may be beneficial for E. coli to survive inside the macrophages, and prevention of iNOS could be a therapeutic strategy to treat neonatal E. coli meningitis.
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Affiliation(s)
- Rahul Mittal
- Division of Infectious Diseases, Department of Pathology, MS #51, Childrens Hospital Los Angeles, and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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Abstract
Three patients with viral infections of the central nervous system (CNS) were evaluated on an inpatient infectious diseases consultation service within a two-week period. These cases, caused by herpes simplex virus, varicella zoster virus and enterovirus, highlight the importance of viral pathogens in causing debilitating infections of the CNS and provide examples of the utility of molecular diagnostics in evaluating patients with encephalitis and meningitis. The importance of antiviral therapy is particularly underscored by these cases, as is the variability in response of patients to such agents.
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Affiliation(s)
- Cecilia Big
- Division of Infectious Diseases and
- Department of Internal Medicine, University of Michigan Health System Ann Arbor, Michigan
| | - Lora A. Reineck
- Department of Internal Medicine, University of Michigan Health System Ann Arbor, Michigan
| | - David M. Aronoff
- Division of Infectious Diseases and
- Department of Internal Medicine, University of Michigan Health System Ann Arbor, Michigan
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48
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Mariani MM, Kielian T. Microglia in infectious diseases of the central nervous system. J Neuroimmune Pharmacol 2009; 4:448-61. [PMID: 19728102 DOI: 10.1007/s11481-009-9170-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/11/2009] [Indexed: 02/06/2023]
Abstract
Microglia are the resident macrophage population in the central nervous system (CNS) parenchyma and, as such, are poised to provide a first line of defense against invading pathogens. Microglia are endowed with a vast repertoire of pattern recognition receptors that include such family members as Toll-like receptors and phagocytic receptors, which collectively function to sense and eliminate microbes invading the CNS parenchyma. In addition, microglial activation elicits a broad range of pro-inflammatory cytokines and chemokines that are involved in the recruitment and subsequent activation of peripheral immune cells infiltrating the infected CNS. Studies from several laboratories have demonstrated the ability of microglia to sense and respond to a wide variety of pathogens capable of colonizing the CNS including bacterial, viral, and fungal species. This review will highlight the role of microglia in microbial recognition and the resultant antipathogen response that ensues in an attempt to clear these infections. Implications as to whether microglial activation is uniformly beneficial to the CNS or in some circumstances may exacerbate pathology will also be discussed.
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Affiliation(s)
- Monica M Mariani
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198-5900, USA
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49
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Naesens R, Ronsyn M, Druwé P, Denis O, Ieven M, Jeurissen A. Central nervous system invasion by community-acquired meticillin-resistant Staphylococcus aureus. J Med Microbiol 2009; 58:1247-1251. [DOI: 10.1099/jmm.0.011130-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) bacteraemia with cavernous sinus thrombosis, meningitis and brain abscess in a previously healthy American, who was employed in Belgium. We consecutively reviewed all published cases of CA-MRSA with central nervous system (CNS) involvement. A total of 12 similar cases were found, of which 11 were published in the last 4 years. Predominantly, young previously healthy subjects were affected (median age 28 years). The cases involved brain abscesses (5/12), disseminated disease (4/12), cavernous sinus thrombosis (2/12) and other (1/12). Infection origins were superficial skin infections (5/12), mostly of the face, sinusitis (1/12), otitis media (1/12), other or unknown (5/12). Although, in our review of the literature patients treated with linezolid had a better outcome compared to patients treated with vancomycin, the latter is still the mainstay of therapy for CNS infections associated with MRSA.
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Affiliation(s)
- Reinout Naesens
- Laboratory of Medical Microbiology, GZA Hospitals, Antwerp, Belgium
| | - Mark Ronsyn
- Intensive Care Unit, GZA Hospitals, Antwerp, Belgium
| | - Patrick Druwé
- Intensive Care Unit, GZA Hospitals, Antwerp, Belgium
| | - Olivier Denis
- Laboratoire de Référence MRSA–Staphylocoques, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, University Hospital Antwerp, Antwerp, Belgium
| | - Axel Jeurissen
- Laboratory of Medical Microbiology, GZA Hospitals, Antwerp, Belgium
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