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Lakhani DA, Deng F, Lin DDM. Infectious Diseases of the Brain and Spine: Fungal Diseases. Magn Reson Imaging Clin N Am 2024; 32:335-346. [PMID: 38555144 DOI: 10.1016/j.mric.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Advances in treatments of autoimmune diseases, acquired immunodeficiency syndrome, organ transplantation, and the use of long-term devices have increased the rates of atypical infections due to prolonged immune suppression. There is a significant overlap in imaging findings of various fungal infections affecting the central nervous system (CNS), often mimicking those seen in neoplastic and noninfectious inflammatory conditions. Nonetheless, there are imaging characteristics that can aid in distinguishing certain atypical infections. Hence, familiarity with a wide range of infectious agents is an important part of diagnostic neuroradiology. In this article, an in-depth review of fungal diseases of the CNS is provided.
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Affiliation(s)
- Dhairya A Lakhani
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps B-100 Baltimore, MD 21287, USA
| | - Francis Deng
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps B-100 Baltimore, MD 21287, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps B-100 Baltimore, MD 21287, USA.
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2
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Jiang W, Zhou M, Chen S, Xie J, Chen M, Zhang H, Wu Y, Chen X, Liu R. Peptide-Mimicking Poly(2-oxazoline)s Possessing Potent Antifungal Activity and BBB Penetrating Property to Treat Invasive Infections and Meningitis. J Am Chem Soc 2023; 145:25753-25765. [PMID: 37966432 DOI: 10.1021/jacs.3c09240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Invasive fungal infections, including meningitis, cause a high mortality rate due to few available antifungal drugs and frequently associated side effects and quick emergence of drug-resistant fungi. The restrictive permeability of the blood-brain barrier (BBB) further limits the efficacy of antifungal agents substantially in treating meningitis. Hereby, we design and synthesize guanidinium-functionalized poly(2-oxazoline)s by mimicking cell-penetrating peptides. The optimal polymer, PGMeOx10 bearing a methylene spacer arm, displays potent activities against the drug-resistant fungi and biofilm, negligible toxicity, and insusceptibility to antimicrobial resistance. Moreover, PGMeOx10 can break BBB retractions to exert promising antifungal functions in the brain. PGMeOx10 demonstrates potent in vivo antifungal therapeutic efficacy in mouse models including skin infection, systemic infections, and meningitis. PGMeOx10 effectively rescues infected mice and reduces fungal burden and inflammation in the brain. These results and the excellent biosafety of poly(2-oxazoline)s indicate the effectiveness and potential of our strategy to design promising antifungal agents in treating systemic infections and meningitis.
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Affiliation(s)
- Weinan Jiang
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Min Zhou
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Sheng Chen
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Jiayang Xie
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Minzhang Chen
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Haodong Zhang
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Yueming Wu
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Xin Chen
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Runhui Liu
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
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Singh A, Goyal A, Singh M, Garg S, Moudgil S, Gupta V. Cerebral Fungal Infections as a Cause of Stroke in Cardiac Surgery Patients: Be Cautious!! J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00225-2. [PMID: 37121843 DOI: 10.1053/j.jvca.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Avneet Singh
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
| | - Arushi Goyal
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Manpreet Singh
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sidharth Garg
- Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Sandeep Moudgil
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Vipin Gupta
- Department of Neurosurgery, Government Medical College and Hospital, Chandigarh, India
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Takoutsing BD, Ooi SZY, Egu CB, Gillespie CS, Bandyopadhyay S, Dada OE, Dokponou YCH, Dalle DU, Ciuculete AC, Awad AK, Khan M, Erhabor J, Ikwuegbuenyi CA, Kesici Ö, Bankole NDA. Management and outcomes of intracranial fungal infections in children and adults in Africa: a scoping review protocol. BMJ Open 2023; 13:e065943. [PMID: 36731932 PMCID: PMC9896247 DOI: 10.1136/bmjopen-2022-065943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa. METHODS AND ANALYSIS The scoping review will be conducted in accordance with the Arksey and O'Malley's framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description. ETHICS AND DISSEMINATION This study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.
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Affiliation(s)
| | | | - Chinedu Brian Egu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Conor S Gillespie
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Ahmed K Awad
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Mehdi Khan
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Özgür Kesici
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Li YC, Tseng CC, Chien SC, Huang SH, Chang TW, Chen CT, Tu PH, Liu ZH, Huang YC. Middle cerebral artery infarction, A rare complication of intracranial cryptococcoma in an immunocompetent patient: A case report and literature review. Front Surg 2023; 10:1083833. [PMID: 36874457 PMCID: PMC9975338 DOI: 10.3389/fsurg.2023.1083833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Background This report presents the first case of intracranial cryptococcoma arising from the right frontal lobe causing right middle cerebral artery infarction. Intracranial cryptococcomas usually occur in the cerebral parenchyma, basal ganglia, cerebellum, pons, thalamus, and choroid plexus; they may mimic intracranial tumors, but seldom cause infarction. Of the 15 cases of pathology-confirmed intracranial cryptococcomas in the literature, no case has been complicated by middle cerebral artery (MCA) infarction. Here, we discuss a case of intracranial cryptococcoma with an ipsilateral middle cerebral artery infarction. Case Description A 40-year-old man was referred to our emergency room due to progressive headaches and acute left hemiplegia. The patient was a construction worker with no history of avian contact, recent travel, or human immunodeficiency virus (HIV) infection. Brain computed tomography (CT) showed an intra-axial mass, and subsequent magnetic resonance imaging (MRI) delineated a large mass of 53 mm in the right middle frontal lobe and a small lesion of 18 mm in the right caudate head, with marginal enhancement and central necrosis. A neurosurgeon was consulted in view of the intracranial lesion, and the patient underwent en-bloc excision of the solid mass. The pathology report later identified a Cryptococcus infection rather than malignancy. The patient underwent 4 weeks of postoperative treatment with amphotericin B plus flucytosine; he then received subsequent oral antifungal treatment for 6 months, and had neurologic sequelae that manifested as left side hemiplegia. Conclusion Diagnosis of fungal infections in the CNS remains challenging. This is especially true of Cryptococcus CNS infections that present as a space-occupying lesion in an immunocompetent patient. A Cryptococcus infection should be considered in the differential diagnoses in patients with brain mass lesions, as this infection can be misdiagnosed as a brain tumor.
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Affiliation(s)
- Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chun-Chia Tseng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Shuo-Chi Chien
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Tin-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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Hounchonou FH, Runge J, Ganser A, Hartmann C, Raab P, Krauss JK. Stereotactic biopsy of a brain lesion caused by hormographiella aspergillata. Surg Neurol Int 2022; 13:596. [PMID: 36761261 PMCID: PMC9899447 DOI: 10.25259/sni_576_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background Invasive fungal infections are an increasing problem in immunosuppressed patients. In patients with the central nervous system involvement, there is a high case fatality rate. There is a very limited experience with infections caused by Hormographiella aspergillata (HA) in such cases and most often diagnosis is only confirmed postmortem. Case Description We report the case of a 53-year-old woman with acute myeloid leukemia. After primary therapy with daunorubicin, cytarabine, and gemtuzumab ozogamicin, the patient developed pneumonia and later neurological symptoms caused by multiple gadolinium-enhancing brain lesions in magnetic resonance imaging (MRI). Stereotactic biopsy of a frontal precentral lesion was performed and revealed HA infection. The patient died in the further course secondary to cardiopulmonary problems. Conclusion Stereotactic biopsy is a safe way to establish the diagnosis of unclear lesions such as HA infection. We recommend to perform stereotactic biopsy early in immunocompromised patients with brain lesions to guide further treatment.
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Affiliation(s)
- F. H. Hounchonou
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Corresponding author: F. H. Hounchonou, Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | - Joachim Runge
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Department of Haematology, Haemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Department of Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Caria J, Leal E, Dias A, Pinheiro H, Póvoas D, Maltez F. A case of central nervous system infection by Candida famata in an immunosuppressed patient with HIV-1 infection. Med Mycol Case Rep 2022; 38:21-24. [PMID: 36203541 PMCID: PMC9530402 DOI: 10.1016/j.mmcr.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022] Open
Abstract
Invasive fungal infections caused by Candida species are increasingly observed in immunosuppressed patients. Candida albicans is the more often identified species and neurocandidiasis is associated with high mortality rates. Diagnosis and treatment of these infections are frequently challenging. We report a case of central nervous system infection caused by Candida famata in an HIV-1 infected patient. To our best knowledge this is just the second published case of neural infection by this agent.
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8
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Elevated lumbar puncture opening pressure in aseptic meningitis. J Clin Neurosci 2022; 106:55-60. [DOI: 10.1016/j.jocn.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
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Karaman S, Kebudi R, Kizilocak H, Karakas Z, Demirag B, Evim MS, Yarali N, Kaya Z, Karagun BS, Aydogdu S, Caliskan U, Ayhan AC, Bahadir A, Cakir B, Guner BT, Albayrak C, Karapinar DY, Kazanci EG, Unal E, Turkkan E, Akici F, Bor O, Vural S, Yilmaz S, Apak H, Baytan B, Tahta NM, Güzelkucuk Z, Kocak U, Antmen B, Tokgöz H, Fisgin T, Özdemir N, Gunes AM, Vergin C, Unuvar A, Ozbek N, Tugcu D, Bay SB, Tanyildiz HG, Celkan T. Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Study. J Pediatr Hematol Oncol 2022; 44:e1039-e1045. [PMID: 36036521 DOI: 10.1097/mph.0000000000002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines. MATERIALS AND METHODS In this multicenter retrospective study, 51 pediatric patients with leukemia, 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combination with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links.lww.com/JPHO/A541 ). RESULTS Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus . Sixteen patients received single-agent, 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died, 29 of the CNSFI episodes recovered with a 20% neurological sequelae. CONCLUSION CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes.
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Affiliation(s)
- Serap Karaman
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute
| | - Hande Kizilocak
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
| | - Zeynep Karakas
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Bengu Demirag
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Melike S Evim
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Nese Yarali
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Zuhre Kaya
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara
| | - Barbaros S Karagun
- Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana
| | - Selime Aydogdu
- Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital
| | - Umran Caliskan
- Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya
| | - Aylin C Ayhan
- Division of Pediatric Hematology-Oncology, Medeniyet University, Faculty of Medicine
| | - Aysenur Bahadir
- Division of Pediatric Hematology-Oncology, Karadeniz Technical University, Faculty of Medicine, Trabzon
| | - Betul Cakir
- Division of Pediatric Hematology-Oncology, Bezmiâlem Vakif University
| | - Burcak T Guner
- Division of Pediatric Hematology-Oncology, Izmir University of Health Sciences Tepecik Training and Research Hospital
| | - Canan Albayrak
- Division of Pediatric Hematology-Oncology, Ondokuz Mayis University, Faculty of Medicine, Samsun
| | - Deniz Y Karapinar
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Ege University
| | - Elif G Kazanci
- Division of Pediatric Hematology-Oncology, Health Sciences University Bursa High Specialist Training and Research Hospital, Bursa
| | - Ekrem Unal
- Division of Pediatric Hematology-Oncology, Erciyes University Faculty of Medicine, Kayseri
| | - Emine Turkkan
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Okmeydani Training and Research Hospital
| | - Ferhan Akici
- Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital
| | - Ozcan Bor
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sema Vural
- Division of Pediatric Hematology-Oncology, Health Sciences University Istanbul Sariyer Hamidiye Etfal Health Practice and Research Center, Istanbul
| | - Sebnem Yilmaz
- Division of Pediatric Hematology-Oncology, Dokuz Eylul University Faculty of Medicine, Izmir
| | - Hilmi Apak
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
| | - Birol Baytan
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Neryal M Tahta
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Zeliha Güzelkucuk
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Ulker Kocak
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara
| | - Bulent Antmen
- Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana
| | - Huseyin Tokgöz
- Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya
| | - Tunc Fisgin
- Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital
| | - Nihal Özdemir
- Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital
| | - Adalet M Gunes
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Canan Vergin
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Aysegul Unuvar
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Namik Ozbek
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Deniz Tugcu
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Sema B Bay
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute
| | - Hikmet G Tanyildiz
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Tiraje Celkan
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
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Pathogenesis of Fungal Infections in the Central Nervous System: Host and Pathogen Factors in Neurotropism. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-022-00444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tran VTA, Lee LP, Cho H. Neuroinflammation in neurodegeneration via microbial infections. Front Immunol 2022; 13:907804. [PMID: 36052093 PMCID: PMC9425114 DOI: 10.3389/fimmu.2022.907804] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Recent epidemiological studies show a noticeable correlation between chronic microbial infections and neurological disorders. However, the underlying mechanisms are still not clear due to the biological complexity of multicellular and multiorgan interactions upon microbial infections. In this review, we show the infection leading to neurodegeneration mediated by multiorgan interconnections and neuroinflammation. Firstly, we highlight three inter-organ communications as possible routes from infection sites to the brain: nose-brain axis, lung-brain axis, and gut-brain axis. Next, we described the biological crosstalk between microglia and astrocytes upon pathogenic infection. Finally, our study indicates how neuroinflammation is a critical player in pathogen-mediated neurodegeneration. Taken together, we envision that antibiotics targeting neuro-pathogens could be a potential therapeutic strategy for neurodegeneration.
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Affiliation(s)
- Van Thi Ai Tran
- Department of Biophysics, Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, South Korea
| | - Luke P. Lee
- Department of Biophysics, Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, South Korea
- Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Harvard Institute of Medicine, Harvard University, Boston, MA, United States
- *Correspondence: Hansang Cho, ; Luke P. Lee,
| | - Hansang Cho
- Department of Biophysics, Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
- *Correspondence: Hansang Cho, ; Luke P. Lee,
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Neth BJ, Cohen Cohen S, Trejo-Lopez J, Brinjikji W, Braksick SA, Fugate JE, Rabinstein AA, Wijdicks EFM. Mycotic aneurysm. Pract Neurol 2022; 22:407-409. [PMID: 35470248 DOI: 10.1136/practneurol-2021-003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/03/2022]
Abstract
Angioinvasive fungal infections of the cerebral vasculature often lead to significant morbidity and mortality. High clinical suspicion and early antifungal therapy could improve outcomes. We describe the fatal case of a patient with a rapidly enlarging cavernous carotid aneurysm due to angioinvasive fungus. This case highlights the challenges in diagnosis and management of this condition.
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Affiliation(s)
- Bryan J Neth
- Mayo Clinic Rochester, Rochester, Minnesota, USA
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Khaba MC, Ngale TC, Makhado NA. Fungal infection of the central nervous system: Autopsy analysis of six cases. SAGE Open Med Case Rep 2022; 10:2050313X221122419. [PMID: 36105784 PMCID: PMC9465580 DOI: 10.1177/2050313x221122419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Fungal infections of the central nervous system are fatal and rare clinical
entities observable in immunosuppressed patients from varying causes. They carry
higher risks of morbidities and mortality as compared to viral, bacterial or
parasitic central nervous system infections. This study describes
clinicopathological description of the central nervous system fungal infections
with antemortem diagnostic challenges. This is a 9-year retrospective study of
six cases composed of three females and three males with a mean age of
29.3 years. All six decedents presented with signs of meningeal irritation. They
all suffered from immunodeficiency of varying causes. The gross and microscopic
features revealed cryptococcosis, candidiasis and mucormycosis as the cause of
the central nervous system infection. Early diagnosis and appropriate medical
treatment are of paramount importance in improving the overall survival of
patients with central nervous system mycosis. A few autopsy cases with fungal
infection of the central nervous system have been described; therefore, more
autopsies studies are needed to re-enforce on the existing epidemiology of these
fatal infections. Moreover, this will assist in further elucidating the varying
gross features and tissue reaction patterns associated with them.
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14
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Pujol R, Tessier C, Manneveau G, De Fourmestraux C. Suspected primary mycotic rhinitis and paranasal sinusitis in seven horses (2013–2019). EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. Pujol
- Department of Surgery Equine Clinic ONIRIS National College of Veterinary Medicine Food Science and Engineering Nantes France
| | - C. Tessier
- Department of Surgery Equine Clinic ONIRIS National College of Veterinary Medicine Food Science and Engineering Nantes France
| | - G. Manneveau
- Department of Surgery Equine Clinic ONIRIS National College of Veterinary Medicine Food Science and Engineering Nantes France
- Clinique Équine de Provence Saint‐Cannat France
| | - C. De Fourmestraux
- Department of Surgery Equine Clinic ONIRIS National College of Veterinary Medicine Food Science and Engineering Nantes France
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15
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Chishimba L, Chomba M, Zimba S, Mwansa T, Sinyangwe W, Kunda H, Hachaambwa L, Saylor D. Clinical Reasoning: An Unexpected Response to Therapy in a Patient With HIV and Focal Seizures. Neurology 2021; 97:1084-1089. [PMID: 34312302 DOI: 10.1212/wnl.0000000000012536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present the case of a 23-year-old right-handed man who presented to an emergency department in Lusaka, Zambia with new-onset headaches and focal seizures. He was on combination antiretroviral therapy (cART) for HIV and had been started on anti-tuberculous therapy at his local clinic two weeks prior to presentation based on chest x-ray findings. On examination, he had subtle weakness and hyperreflexia in his left upper extremity. The remainder of the neurological examination was normal. Brain computed tomography (CT) scan revealed a single, ring-enhancing heterogenous mass in the right posterior parietal lobe with marked vasogenic edema. His lab results revealed severe virologic and immunologic failure, and CSF analysis was unremarkable. He was empirically managed as CNS TB. Two months later, his symptoms worsened and he developed new neurologic deficits despite adherence to cART and TB treatment. Repeat imaging subsequently revealed progression of his underlying CNS process with multiple brain abscesses present, and subsequent investigations revealed an unusual cause of these lesions. In this case, we review the differential diagnosis for space-occupying lesions in the context of poorly controlled HIV infection. In particular, we highlight the approach to these patients in resource-limited settings in the context of diagnostic limitations and highlight the importance of considering the local epidemiology of neurological infections. Finally, this case demonstrates the need to maintain a wide differential diagnosis and a close monitoring plan for prompt re-evaluation of empiric diagnoses when response to empiric therapy is unexpected.
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Affiliation(s)
- Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Tilele Mwansa
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Wilmot Sinyangwe
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Humphrey Kunda
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Lottie Hachaambwa
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Division of Infectious Disease, Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia .,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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P K, Raj P, Jabeen S, Bn N, Hb V, Kvl NR, M S, Maher G, B B, Chandrashekar N. Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess. J Mycol Med 2021; 31:101156. [PMID: 34280711 DOI: 10.1016/j.mycmed.2021.101156] [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: 07/16/2019] [Revised: 03/05/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Brain abscesses (BA) form approximately 8% of intracranial masses in developing and 1-2% in western countries. Fungal BA (FBA) are aggressive and represent a catastrophic manifestation compared to protozoan and bacterial BA. Diagnosis of FBA is rare and usually done postmortem. OBJECTIVES The present retrospective study analyses the clinico-mycological aspects of FBA presented to our neurosurgical services over a period of 38 years, from January 1979 to April 2017. MATERIALS AND METHODS Patients diagnosed as definitive cases of FBA were included in the study. Clinico- demographic and microbiological data were collected from medical records. BA pus was examined for fungal etiology using standard microbiological procedures. RESULTS During the period of 38 years out of total 2,916 brain abscesses, 29 cases of FBA were diagnosed with an overall incidence rate of 0.99% per year. Cladophialophora bantiana (44%) was the most predominant isolate followed by Aspergillus spp and others. Male preponderance was seen with a male:female ratio of 4.8:1. There was no predilection for any age group. Headache, limb weakness and fever were the most common presentations. Amphotericin B was given in 44.8% of cases. Craniotomy with excision (48.2%) was the predominant surgical management. Outcome was fatal in 62% of the cases. CONCLUSION Neurotropic C. bantiana is the predominant isolate causing fungal brain abscess. The incidence and trends of fungi causing brain abscess do not show significant change. Young immunocompetent outdoor working males were predominantly susceptible to fungal infection. Advance in the diagnostic modalities show promising in diagnosis of FBA. High index of suspicion with early diagnosis, prompt antifungal therapy and aggressive surgical management is required as FBA are associated with high mortality rate.
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Affiliation(s)
- Kruthika P
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Prabhu Raj
- Department of Neurosurgery, NIMHANS, Bangalore 560029, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and interventional radiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Nandeesh Bn
- Department of Neuropathology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Veenakumari Hb
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Narasinga Rao Kvl
- Department of Neurosurgery, NIMHANS, Bangalore 560029, Karnataka, India
| | - Sandhya M
- Department of Neuroimaging and interventional radiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Ganesh Maher
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Binukumar B
- Department of Biostatistics, NIMHANS, Bangalore 560029, Karnataka, India
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17
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Abstract
In the setting of both globalization and increasing use of immunosuppressive therapy, infectious myelopathies are an important cause of morbidity worldwide. Clinical spinal cord syndromes related to infection are varied, including transverse myelitis, acute flaccid paralysis related to anterior horn cell involvement, spinal cord compression, chronic spastic paraparesis, and myeloradiculitis. Causative pathogens include viruses, parasites, pyogenic and atypical bacteria, and fungi. The epidemiology, clinical characteristics, diagnosis, and treatment of selected organisms will be discussed in this article.
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Affiliation(s)
- Pria Anand
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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18
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Retrospective assessment of fungal pathogens isolated from various clinical samples in a tertiary care hospital in Turkey: A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.910783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Nathan CL, Emmert BE, Nelson E, Berger JR. CNS fungal infections: A review. J Neurol Sci 2021; 422:117325. [PMID: 33516057 DOI: 10.1016/j.jns.2021.117325] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Cody L Nathan
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian E Emmert
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ernest Nelson
- Departments of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph R Berger
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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20
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Kulkarni R, Pujari S, Gupta D, Advani S, Soni A, Duberkar D, Dhonde P, Batra D, Bilala S, Agrawal P, Aurangabadkar K, Jain N, Shetty K, Dhamne M, Bolegave V, Patidar Y, More A, Nirhale S, Rao P, Pande A, Doshi S, Chauvhan A, Palasdeokar N, Valzade P, Jagtap S, Deshpande R, Patwardhan S, Purandare B, Prayag P. Rhino-orbito-cerebral mycosis and COVID-19: From bad to worse? Ann Indian Acad Neurol 2021; 25:68-75. [PMID: 35342244 PMCID: PMC8954311 DOI: 10.4103/aian.aian_463_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave. Aims: Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era. Methodology: Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis. Results: There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%. Conclusion: Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.
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21
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An Antivirulence Approach for Preventing Cryptococcus neoformans from Crossing the Blood-Brain Barrier via Novel Natural Product Inhibitors of a Fungal Metalloprotease. mBio 2020; 11:mBio.01249-20. [PMID: 32694141 PMCID: PMC7374060 DOI: 10.1128/mbio.01249-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Fungal infections like cryptococcal meningitis are difficult to resolve because of the limited therapies available. The small arsenal of antifungal drugs reflect the difficulty in finding available targets in fungi because like mammalian cells, fungi are eukaryotes. The limited efficacy, toxicity, and rising resistance of antifungals contribute to the high morbidity and mortality of fungal infections and further underscore the dire but unmet need for new antifungal drugs. The traditional approach in antifungal drug development has been to target fungal growth, but an attractive alternative is to target mechanisms of pathogenesis. An important attribute of Cryptococcus neoformans (Cn) pathogenesis is its ability to enter the central nervous system. Here, we describe a large-scale screen that identified three natural products that prevented Cn from crossing the blood-brain barrier by inhibiting the virulence factor Mpr1 without affecting the growth of Cn. We propose that compounds identified here could be further developed as antivirulence therapy that would be administered preemptively or serve as a prophylactic in patients at high risk for developing cryptococcal meningitis. Cryptococcus neoformans (Cn) is the leading cause of fungal meningitis, a deadly disease with limited therapeutic options. Dissemination to the central nervous system hinges on the ability of Cn to breach the blood-brain barrier (BBB) and is considered an attribute of Cn virulence. Targeting virulence instead of growth for antifungal drug development has not been fully exploited despite the benefits of this approach. Mpr1 is a secreted fungal metalloprotease not required for fungal growth, but rather, it functions as a virulence factor by facilitating Cn migration across the BBB. This central role for Mpr1, its extracellular location, and lack of expression in mammalian cells make Mpr1 a high-value target for an antivirulence approach aimed at developing therapeutics for cryptococcal meningitis. To test this notion, we devised a large-scale screen to identify compounds that prohibited Cn from crossing the BBB by selectively blocking Mpr1 proteolytic activity, without inhibiting the growth of Cn. A phytochemical natural product-derived library was screened to identify new molecular scaffolds of prototypes unique to a Cn microecosystem. Of the 240 pure natural products examined, 3 lead compounds, abietic acid, diosgenin, and lupinine inhibited Mpr1 proteolytic activity with 50% inhibitory concentration (IC50) values of <10 μM, displayed little to no mammalian cell toxicity, and did not affect Cn growth. Notably, the lead compounds blocked Cn from crossing the BBB, without damaging the barrier integrity, suggesting the bioactive molecules had no off-target effects. We propose that these new drug scaffolds are promising candidates for the development of antivirulence therapy against cryptococcal meningitis.
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22
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Abstract
Candida meningitis in neurosurgical patients is relatively unusual but is associated with a high mortality rate. We present our experience with this infection and discuss the clinical characteristics, treatment options and outcomes. We retrospectively reviewed neurosurgical patients with multiple positive cerebrospinal fluid (CSF) culture results in our hospital from January 2013 to December 2019. Nine patients were available for review according to our inclusion and exclusion criteria. Four species of Candida were isolated from the CSF samples and Candida albicans accounted for half of all infections. Eight infections were associated with ventricle peritoneal shunt, lumbar cistern peritoneal shunt or external ventricular drain. All of these foreign intracranial materials were removed or changed and all the patients received antifungal treatment, including fluconazole and/or voriconazole. It is associated with severe long-term outcomes in survivors and a mortality rate that reaches 11.1%. Prior treatments with broad-spectrum and high-grade antibiotics and anaemia are possible risk factors for Candida meningitis. We advise that foreign intracranial material should be removed or changed as early as possible and the timing of re-shunt operation can be 1 month after control of Candida meningitis has been achieved, with several negative CSF culture results.
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23
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Lavrin T, Konte T, Kostanjšek R, Sitar S, Sepčič K, Prpar Mihevc S, Žagar E, Župunski V, Lenassi M, Rogelj B, Gunde Cimerman N. The Neurotropic Black Yeast Exophiala dermatitidis Induces Neurocytotoxicity in Neuroblastoma Cells and Progressive Cell Death. Cells 2020; 9:cells9040963. [PMID: 32295162 PMCID: PMC7226985 DOI: 10.3390/cells9040963] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/13/2022] Open
Abstract
The neurotropic and extremophilic black yeast Exophiala dermatitidis (Herpotrichellaceae) inhabits diverse indoor environments, in particular bathrooms, steam baths, and dishwashers. Here, we show that the selected strain, EXF-10123, is polymorphic, can grow at 37 °C, is able to assimilate aromatic hydrocarbons (toluene, mineral oil, n-hexadecane), and shows abundant growth with selected neurotransmitters (acetylcholine, gamma-aminobutyric acid, glycine, glutamate, and dopamine) as sole carbon sources. We have for the first time demonstrated the effect of E. dermatitidis on neuroblastoma cell model SH-SY5Y. Aqueous and organic extracts of E. dermatitidis biomass reduced SH-SY5Y viability by 51% and 37%, respectively. Melanized extracellular vesicles (EVs) prepared from this strain reduced viability of the SH-SY5Y to 21%, while non-melanized EVs were considerably less neurotoxic (79% viability). We also demonstrated direct interactions of E. dermatitidis with SH-SY5Y by scanning electron and confocal fluorescence microscopy. The observed invasion and penetration of neuroblastoma cells by E. dermatitidis hyphae presumably causes the degradation of most neuroblastoma cells in only three days. This may represent a so far unknown indirect or direct cause for the development of some neurodegenerative diseases such as Alzheimer’s.
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Affiliation(s)
- Teja Lavrin
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (R.K.); (K.S.)
- Correspondence: (T.L.); (N.G.C.); Tel.: +386-(0)1-543-7652 (T.L.); +386-(0)1-320-3400 (N.G.C.)
| | - Tilen Konte
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.K.); (M.L.)
| | - Rok Kostanjšek
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (R.K.); (K.S.)
| | - Simona Sitar
- Laboratory for Polymer Chemistry and Technology, National Institute of Chemistry, 1000 Ljubljana, Slovenia; (S.S.); (E.Ž.)
| | - Kristina Sepčič
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (R.K.); (K.S.)
| | | | - Ema Žagar
- Laboratory for Polymer Chemistry and Technology, National Institute of Chemistry, 1000 Ljubljana, Slovenia; (S.S.); (E.Ž.)
| | - Vera Župunski
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, 1000 Ljubljana, Slovenia; (V.Ž.); (B.R.)
| | - Metka Lenassi
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.K.); (M.L.)
| | - Boris Rogelj
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, 1000 Ljubljana, Slovenia; (V.Ž.); (B.R.)
- Department of Biotechnology, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Biomedical Research Institute, 1000 Ljubljana, Slovenia
| | - Nina Gunde Cimerman
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (R.K.); (K.S.)
- Correspondence: (T.L.); (N.G.C.); Tel.: +386-(0)1-543-7652 (T.L.); +386-(0)1-320-3400 (N.G.C.)
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24
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George P, Ramiro JI, Gomes JA, Newey CR, Bhimraj A. Central Nervous System Fungal Infection-Related Stroke: A Descriptive Study of Mold and Yeast-Associated Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104759. [PMID: 32265138 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Central nervous system (CNS) ischemic events caused by fungal infections are rare, and clinical characteristics of these ischemic events are largely unknown. The objective of this manuscript is to highlight characteristics of fungal-related strokes and describe possible mechanistic differences between CNS mold and yeast infection-related strokes. METHODS We report a single-center retrospective case series of all adult patients who presented with concurrent CNS fungal infection and stroke between 2010 and 2018. Patients believed to have a stroke etiology due to cardioembolic, atheroembolic, or strokes nontemporally associated with a CNS fungal infection and those with incomplete stroke workups were excluded from analysis. RESULTS Fourteen patients were identified with ischemic stroke and concurrent CNS fungal infection without other known ischemic stroke etiology. Eight patients had a CNS yeast infection, and 6 had a CNS mold infection. All patients presented with recurrent or progressive stroke symptoms. Six patients were immune-compromised. Four patients admitted to intravenous drug use. All yeast infections were identified by cerebrospinal fluid culture or immunologic studies while all but one of the mold infections required identification by tissue biopsy. Leptomeningeal enhancement was only associated with CNS yeast infections, while basal ganglia stroke was only associated with CNS mold infections. CONCLUSION Ischemic stroke secondary to CNS fungal infections should be considered in patients with recurrent or progressive cryptogenic stroke, regardless of immune status and cerebrospinal fluid profile. CNS yeast and mold infections have slightly different stroke and laboratory characteristics and should have a distinct diagnostic method. Depending on clinical suspicion, a thorough diagnostic approach including spinal fluid analysis and biopsy should be considered.
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Affiliation(s)
- Pravin George
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
| | | | - Joao A Gomes
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | | | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
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25
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Abstract
Infections of the central nervous system cause significant morbidity and mortality in immunocompetent and immunocompromised individuals. A wide variety of microorganisms can cause infections, including bacteria, mycobacteria, fungi, viruses, and parasites. Although less invasive testing is preferred, surgical biopsy may be necessary to collect diagnostic tissue. Histologic findings, including special stains and immunohistochemistry, can provide a morphologic diagnosis in many cases, which can be further classified by molecular testing. Correlation of molecular, culture, and other laboratory results with histologic findings is essential for an accurate diagnosis, and to minimize false positives from microbial contamination.
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Affiliation(s)
- Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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26
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Bot JCJ, Mazzai L, Hagenbeek RE, Ingala S, van Oosten B, Sanchez-Aliaga E, Barkhof F. Brain miliary enhancement. Neuroradiology 2020; 62:283-300. [PMID: 31925469 PMCID: PMC7044143 DOI: 10.1007/s00234-019-02335-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.
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Affiliation(s)
- Joseph C J Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Linda Mazzai
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.,Institute of Radiology, Department of Medicine (DiMED), University of Padua, Padua, Italy
| | | | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Bob van Oosten
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Esther Sanchez-Aliaga
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.,Institute of Neurology and Healthcare Engineering, UCL, London, UK
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27
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Weidauer S, Wagner M, Enkirch SJ, Hattingen E. CNS Infections in Immunoincompetent Patients : Neuroradiological and Clinical Features. Clin Neuroradiol 2019; 30:9-25. [PMID: 31538219 DOI: 10.1007/s00062-019-00837-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/28/2019] [Indexed: 12/15/2022]
Abstract
In patients with immunodeficiency the pathogen spectrum of central nervous system (CNS) infections is broader and different from that of immunocompetent patients. Numerous opportunistic infections are characterized by a high prevalence of viral, bacterial and parasitic pathogens, and depend on the type of impaired immune defense, for example impaired T‑cell or monocyte function, monoclonal antibody treatment, and impaired granulocyte function. Neuroradiological features as well as laboratory findings are often different and versatile in comparison to immunocompetent individuals and pathognomonic imaging findings do not exist; however, knowledge of possible pathways of pathogens in the CNS and preferred tissue affection may help in narrowing down differential diagnoses. Therefore, knowledge of the type of patient and the performed immunomodulatory therapy is essential for the neuroradiological assessment and the differential diagnostic considerations. Moreover, parenchymal reactions in the sense of an immune reconstitution inflammatory syndrome (IRIS) can occur when immunocompetence is restored. This review focus on the most common pathologies in immunocompromised patients, and an overview of imaging features but also of pathology and clinical aspects is given. The synopsis of anamnestic information, clinical findings and structured analysis of the lesion pattern, its spread and short-term follow-up may increase the correct diagnostic classification; however, the gold standard is still determination of the pathogen in the cerebrospinal fluid (CSF), blood cultures or biopsies.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital, Goethe University, Seckbacher Landstraße 65, 60389, Frankfurt/Main, Germany.
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
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28
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Abstract
PURPOSE OF REVIEW This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or parainfectious autoimmune-mediated mechanisms; this article focuses primarily on the former. RECENT FINDINGS Some microorganisms exhibit neurotropism for the spinal cord (eg, enteroviruses such as poliovirus and flaviviruses such as West Nile virus), while others are more protean in neurologic manifestations (eg, herpesviruses such as varicella-zoster virus), and others are only rarely reported to cause myelopathy (eg, certain fungal and parasitic infections). Individuals who are immunocompromised are at increased risk of disseminated infection to the central nervous system. Within the last few years, an enterovirus D68 outbreak has been associated with cases of acute flaccid paralysis in children, and emerging Zika virus infection has been concurrent with cases of acute flaccid paralysis due to Guillain-Barré syndrome, although cases of myelitis have also been reported. Associated pathogens differ by geographic distribution, with myelopathies related to Borrelia burgdorferi (Lyme disease) and West Nile virus more commonly seen in the United States and parasitic infections encountered more often in Latin America, Southeast Asia, and Africa. Characteristic CSF and MRI patterns have been identified with many of these infections. SUMMARY A myriad of pathogens are associated with infectious myelopathies. Host factors, geographic distribution, clinical features, CSF profiles, and MRI findings can assist in formulating the differential diagnosis and ultimately guide management.
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Gerhart JG, Watt KM, Edginton A, Wade KC, Salerno SN, Benjamin DK, Smith PB, Hornik CP, Cohen-Wolkowiez M, Duara S, Ross A, Shattuck K, Stewart DL, Neu N, Gonzalez D. Physiologically-Based Pharmacokinetic Modeling of Fluconazole Using Plasma and Cerebrospinal Fluid Samples From Preterm and Term Infants. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2019; 8:500-510. [PMID: 31087536 PMCID: PMC6656941 DOI: 10.1002/psp4.12414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
Abstract
Fluconazole is used to treat hematogenous Candida meningoencephalitis in preterm and term infants. To characterize plasma and central nervous system exposure, an adult fluconazole physiologically‐based pharmacokinetic (PBPK) model was scaled to infants, accounting for age dependencies in glomerular filtration and metabolism. The model was optimized using 760 plasma samples from 166 infants (median postmenstrual age (range) 28 weeks (24–50)) and 27 cerebrospinal fluid (CSF) samples from 22 infants (postmenstrual age 28 weeks (24–33)). Simulations evaluated achievement of the surrogate efficacy target of area under the unbound concentration‐time curve ≥ 400 mg • hour/L over the dosing interval in plasma and CSF using dosing guidelines. Average fold error of predicted concentrations was 0.73 and 1.14 for plasma and CSF, respectively. Target attainment in plasma and CSF was reached faster after incorporating a loading dose of 25 mg/kg. PBPK modeling can be useful in exploring CNS kinetics of drugs in children.
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Affiliation(s)
- Jacqueline G Gerhart
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin M Watt
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly C Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara N Salerno
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Shahnaz Duara
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ashley Ross
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Karen Shattuck
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dan L Stewart
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Natalie Neu
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Elzein F, Kalam K, Mohammed N, Elzein A, Alotaibi FZ, Khan M, Albadani A. Treatment of cerebral mucormycosis with drug therapy alone: A case report. Med Mycol Case Rep 2019; 23:4-7. [PMID: 30425919 PMCID: PMC6222173 DOI: 10.1016/j.mmcr.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/26/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023] Open
Abstract
We report on an elderly male patient with headache and right-side weakness. Imaging studies revealed multiple space-occupying lesions in the parietal and occipital cerebral regions. Biopsy revealed broad aseptate ribbon-like structures branching at right angles, suggestive of mucormycosis. Improvement was observed after medical therapy with 20 weeks of liposomal amphotericin B (5 mg/kg/day) combined with posaconazole, followed by posaconazole (400 mg twice a day) alone for 1 month. The patient recovered without neurological deficits; however, multidrug-resistant bacteraemia and hospital-acquired pneumonia occurred, resulting in death. Nevertheless, our report shows that this lethal fungal infection can sometimes show favourable progress with drug therapy alone.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Kiran Kalam
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Nazik Mohammed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Ahmed Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Mujtaba Khan
- Department of Radiology, PSMMC, Riyadh, Saudi Arabia
| | - Abeer Albadani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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Sanches MD, Mimura LAN, Oliveira LRC, Ishikawa LLW, Garces HG, Bagagli E, Sartori A, Kurokawa CS, Fraga-Silva TFC. Differential Behavior of Non- albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice. Front Microbiol 2019; 9:2968. [PMID: 30671026 PMCID: PMC6332706 DOI: 10.3389/fmicb.2018.02968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/18/2018] [Indexed: 12/16/2022] Open
Abstract
The genus Candida includes commensal fungi that can cause local and systemic infections, frequently involving vital organs as the central nervous system (CNS). Candida spp. occupy the fourth place among infections that affect the CNS. Although the incidence of Candida albicans is decreasing among patients under immunosuppressive therapies, the incidence of non-albicans Candida is increasing. In this context, the objective of this work was to evaluate the ability of non-albicans Candida species to spread to the CNS of immunocompetent and immunosuppressed mice. Adult female C57BL/6 mice were treated with prednisolone, intravenously infected with Candida glabrata, Candida krusei and Candida parapsilosis yeasts and then evaluated at the 3rd and 14th days after infection. All Candida species disseminated to the brain from immunocompetent animals and induced local inflammation at the third day post-infection. The immunosuppression resulted in body weight loss, leukopenia and reduced IL-2 production by spleen cell cultures. Higher fungal loads were recovered from the CNS of immunosuppressed mice. Inflammatory infiltration associated to a Th1 subset profile was higher in brain samples from C. krusei immunosuppressed mice compared with immunocompetent ones. Additionally, C. krusei was able to transform into pseudohypha inside microglia in vitro infected cells and also to induce elevated nitric oxide production. Altogether, these results indicate that C. glabrata, C. krusei and C. parapsilosis are able to disseminate to the CNS and promote local inflammation in both immunocompetent and immunosuppressed mice. C. krusei displayed a distinct behavior at the CNS triggering a local Th1 profile. The possible contribution of these non-albicans Candida species to other CNS pathologies as multiple sclerosis, Parkinson’s and Alzheimer’s diseases deserves further attention.
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Affiliation(s)
| | - Luiza A N Mimura
- Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Hans G Garces
- Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Eduardo Bagagli
- Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Alexandrina Sartori
- Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
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McHugh KE, Gersey M, Rhoads DD, Procop GW, Zhang Y, Booth CN, Sturgis CD. Sensitivity of Cerebrospinal Fluid Cytology for the Diagnosis of Cryptococcal Infections: A 21-Year Single-Institution Retrospective Review. Am J Clin Pathol 2019; 151:198-204. [PMID: 30321269 DOI: 10.1093/ajcp/aqy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Cryptococcal meningoencephalitis is the most common fungal infection of the central nervous system diagnosed by cerebrospinal fluid cytology (CSF) studies. Existing literature suggests that routine CSF cytomorphologic evaluations are exquisitely specific; however, less is known about their sensitivity. Methods An electronic record review of the cytopathology and microbiology files was conducted for the 21-year interval from January 1, 1995, through December 31, 2015. Results In 21 years, 12,584 CSF samples were processed in the laboratory. Of these, 24 (0.2%) were reported positive for cryptococcal organisms by light microscopy, and 129 CSF fungal cultures were positive for Cryptococcus species. All cotested specimens with positive cytology results were positive on culture (15 specimens, 100% specificity). Twenty-four samples with positive culture results were negative by CSF cytology (sensitivity 39%). Conclusions When culture is used as a gold standard, CSF cytology is 100% specific and 39% sensitive, with a positive predictive value of 100% and a negative predictive value of 99.8%.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Melanie Gersey
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Yaxia Zhang
- Department of Pathology, Hospital for Special Surgery, New York, NY
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Turgut M, Challa S, Akhaddar A. Histopathology. FUNGAL INFECTIONS OF THE CENTRAL NERVOUS SYSTEM 2019. [PMCID: PMC7123394 DOI: 10.1007/978-3-030-06088-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
During the last 30 years, advances in intensive and critical care units, organ transplantation, concomitant use of immunosuppressive drugs, and increasing prevalence of chronic diseases, malnutrition, and other debilitating conditions, as well as the human immunodeficiency virus pandemic, have increased the incidence of systemic mycotic diseases, the most serious form of fungal diseases are the ones that comprise the central nervous system, representing the most dangerous clinical situations. In those cases, starting an adequate therapy through a rapid and assertive diagnosis is absolutely necessary. Considering the fastidious microbiological nature of some fungi (longtime requirement, specific culture conditions, and biohazard issues), as well as the lack of alternative testing availability, a rapid diagnosis is always challenging. When a tissue or liquid specimen is available, its pathological analysis constitutes a rapid and cost-effective way to provide a presumptive or definitive diagnosis of an invasive fungal infection; however, microbiologists, pathologists, and clinicians need to be aware of the limitations of microscopical diagnosis. In this chapter, we review the usual histological presentation of the most frequent central nervous system fungal infections.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University, School of Medicine, Aydın, Turkey
| | - Sundaram Challa
- Department of Pathology, Basavatarakam Indo-American Hospital & Research Institute, Hyderabad, Telangana India
| | - Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital, Mohammed V University in Rabat, Marrakech, Morocco
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Goico A, Henao J, Tejada K. Disseminated blastomycosis in a 36-year-old immunocompetent male from Chicago, IL. Oxf Med Case Reports 2018; 2018:omy071. [PMID: 30263127 PMCID: PMC6151315 DOI: 10.1093/omcr/omy071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022] Open
Abstract
Blastomycosis is a fungal infection caused by Blastomyces species. This infection is endemic to North America particularly states bordering the Mississippi, Ohio and St Lawrence Rivers, and the Great Lakes but also occurs worldwide. While the most common site of infection is the lung, it can also manifest in the bones, skin and central nervous system. Blastomycosis is a great masquerader and it can present in a manner difficult to distinguish from bacterial pneumonia, tuberculosis (TB), histoplasmosis or carcinoma. Here, we describe a 36-year-old male with disseminated blactomycosis infection who presented with right arm weakness. Initial diagnostic evaluation was cofounded by a previous concern for TB; however, broncho-alveolar lavage confirmed Blastomyces spp. Pulmonary and brain lesions markedly improved after Amphotericin and Itraconazole.
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Affiliation(s)
- Ana Goico
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Jose Henao
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Karla Tejada
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Mhlwatika Z, Aderibigbe BA. Application of Dendrimers for the Treatment of Infectious Diseases. Molecules 2018; 23:E2205. [PMID: 30200314 PMCID: PMC6225509 DOI: 10.3390/molecules23092205] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/14/2023] Open
Abstract
Dendrimers are drug delivery systems that are characterized by a three-dimensional, star-shaped, branched macromolecular network. They possess ideal properties such as low polydispersity index, biocompatibility and good water solubility. They are made up of the interior and the exterior layers. The exterior layer consists of functional groups that are useful for conjugation of drugs and targeting moieties. The interior layer exhibits improved drug encapsulation efficiency, reduced drug toxicity, and controlled release mechanisms. These unique properties make them useful for drug delivery. Dendrimers have attracted considerable attention as drug delivery system for the treatment of infectious diseases. The treatment of infectious diseases is hampered severely by drug resistance. Several properties of dendrimers such as their ability to overcome drug resistance, toxicity and control the release mechanism of the encapsulated drugs make them ideal systems for the treatment of infectious disease. The aim of this review is to discuss the potentials of dendrimers for the treatment of viral and parasitic infections.
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Affiliation(s)
- Zandile Mhlwatika
- Department of Chemistry, University of Fort Hare, Alice Campus, Eastern Cape 5700, South Africa.
| | - Blessing Atim Aderibigbe
- Department of Chemistry, University of Fort Hare, Alice Campus, Eastern Cape 5700, South Africa.
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Abstract
BACKGROUND Fungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences. METHODS One hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: "fungi and CNS mycoses", CNS fungal infections", "fungal brain infections", " fungal cerebritis", fungal meningitis", "diagnostics of fungal infections", and "treatment of CNS fungal infections". All were published in English with the majority in the period 2000-2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS. RESULTS The FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS. CONCLUSION Although the number of fungal species causing CNS mycosis is increasing, only some possess well-defined treatment standards (e.g., cryptococcal meningitis and CNS aspergillosis). The early diagnosis of fungal infection, accompanied by identification of the etiological factor, is needed to allow the selection of effective therapy in patients with FIs-CNS and limit their high mortality.
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Affiliation(s)
- Katarzyna Góralska
- Department of Biomedicine and Genetics, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland.
| | - Joanna Blaszkowska
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
| | - Magdalena Dzikowiec
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
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Zhu Z, Huang Z, Li Z, Li X, Du C, Tian Y. Multiple brain abscesses caused by infection with Candida glabrata: A case report. Exp Ther Med 2018; 15:2374-2380. [PMID: 29456643 PMCID: PMC5795773 DOI: 10.3892/etm.2018.5692] [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: 11/28/2016] [Accepted: 06/29/2017] [Indexed: 12/25/2022] Open
Abstract
The present case report described the initial diagnosis of a 25-year old female with a brain abscess consisting of two lesions 0.2 and 2.9 cm3 in volume. The patient was initially treated with antibiotics; however, 2 months following initial treatment, the patient's condition deteriorated and she became vegetative. Following transfer to the China-Japan Union Hospital of Jilin University (Jilin, China) the two lesions had grown in volume to 9.0 and 13.0 cm3, respectively. The results of magnetic resonance spectroscopy and plasma 1–3-β-D-glucan activity suggested a possible fungal infection. Subsequently, a stereotactic biopsy was conducted, fluid was cultured and itraconazole treatment was initiated. Analysis of cultures confirmed a Candida glabrata infection and antifungal treatment was continued. Shortly following surgery, the patient regained consciousness and the ability to eat and speak. A follow-up MRI 8 months following biopsy confirmed disappearance of all lesions and no recurrence. To the best of our knowledge, this is the first English-language report of a brain abscess caused primarily by Candida glabrata.
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Affiliation(s)
- Zifeng Zhu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhehao Huang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenshengnan Li
- Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xianglan Li
- Laboratory of Fungus, Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Chao Du
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Yu Tian
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Martínez-Girón R, Pantanowitz L. Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders. Diagn Cytopathol 2017; 45:1020-1029. [PMID: 28816034 DOI: 10.1002/dc.23797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/21/2017] [Accepted: 08/03/2017] [Indexed: 12/16/2022]
Abstract
Cerebrospinal fluid cytology examination is a common and reliable primary and/or complementary procedure for the diagnosis of central nervous system (CNS) disorders. This review provides an update of aseptic meningeal disorders that may be encountered in cytopathology practice. The article covers the cytological findings and helpful ancillary studies needed of nonmalignant aseptic CNS disorders such as viral, bacterial, fungal and parasitic infections, and other noninfectious diseases, such as Mollaret's meningitis (recurrent benign lymphocytic meningitis), Guillain-Barré syndrome, multiple Sclerosis, subarachnoid haemorrhage, and drug-induced disorders.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, Oviedo, 33007, Spain
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside, UPMC Cancer Pavilion Suite 201, 5150 Centre Ave, Pittsburgh, Pennsylvania, 15232
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Increased Intracranial Pressure in the Setting of Enterovirus and Other Viral Meningitides. Neurol Res Int 2017; 2017:2854043. [PMID: 28491476 PMCID: PMC5405393 DOI: 10.1155/2017/2854043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Increased intracranial pressure due to viral meningitis has not been widely discussed in the literature, although associations with Varicella and rarely Enterovirus have been described. Patients with increased intracranial pressure and cerebrospinal fluid analysis suggestive of a viral process are sometimes classified as having atypical idiopathic intracranial hypertension (IIH). However, a diagnosis of IIH requires normal cerebrospinal fluid, and therefore in these cases an infection with secondary intracranial hypertension may be a more likely diagnosis. Here seven patients are presented with elevated intracranial pressure and cerebrospinal fluid suggestive of viral or aseptic meningitis. Of these, 1 had Enterovirus and the remainder were diagnosed with nonspecific viral meningitis. These data suggest that viral meningitis may be associated with elevated intracranial pressure more often than is commonly recognized. Enterovirus has previously been associated with increased intracranial pressure only in rare case reports.
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COLOMBO ANACAROLINE, RODRIGUES MARCIOL. Fungal colonization of the brain: anatomopathological aspects of neurological cryptococcosis. ACTA ACUST UNITED AC 2015; 87:1293-309. [DOI: 10.1590/0001-3765201520140704] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Brain infection by the fungus Cryptococcus neoformans results in an estimated 500,000 human deaths per annum. Colonization of the central nervous system (CNS) by C. neoformans causes different clinical syndromes that involve interaction of a number of fungal components with distinct brain cells. In this manuscript, our literature review confirmed the notion that the Cryptococcus field is expanding rapidly, but also suggested that studies on neuropathogenesis still represent a small fraction of basic research activity in the field. We therefore discussed anatomical and physiological aspects of the brain during infection by C. neoformans, in addition to mechanisms by which brain resident cells interact with the fungus. This review suggests that multiple efforts are necessary to improve the knowledge on how C. neoformans affects brain cells, in order to enable the generation of new therapeutic tools in a near future.
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Affiliation(s)
- ANA CAROLINE COLOMBO
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | - MARCIO L. RODRIGUES
- Universidade Federal do Rio de Janeiro, Brazil; Fundação Oswaldo Cruz, Brazil
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Haßler A, Porto L, Lehrnbecher T. Cerebral Fungal Infection in Pediatric Cancer Patients. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-014-0213-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Infektionen. NEUROINTENSIV 2015. [PMCID: PMC7175474 DOI: 10.1007/978-3-662-46500-4_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In diesem Kapitel werden zunächst die für die Neurointensivmedizin wesentlichen bakteriellen Infektionen (Meningitis, spinale und Hirnabszesse, Spondylodiszitis, septisch-embolische Herdenzephalitis) abgehandelt, die trotz gezielt eingesetzter Antibiotika und neurochirurgischer Therapieoptionen noch mit einer erheblichen Morbidität und Mortalität behaftet sind. Besonderheiten wie neurovaskuläre Komplikationen, die Tuberkulose des Nervensystems, Neuroborreliose, Neurosyphilis und opportunistische Infektionen bei Immunsuppressionszuständen finden hierbei besondere Berücksichtigung. Der zweite Teil dieses Kapitels behandelt akute und chronische Virusinfektionen des ZNS sowie in einem gesonderten Abschnitt die HIVInfektion und HIV-assoziierte Krankheitsbilder sowie Parasitosen und Pilzinfektionen, die in Industrieländern seit Einführung der HAART bei HIV zwar eher seltener, aber mit zunehmender Globalisierung auch in unseren Breiten immer noch anzutreffen sind.
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Yoganathan S, Chakrabarty B, Gulati S, Kumar A, Kumar A, Singh M, Xess I. Candida tropicalis brain abscess in a neonate: An emerging nosocomial menace. Ann Indian Acad Neurol 2014; 17:448-50. [PMID: 25506171 PMCID: PMC4251023 DOI: 10.4103/0972-2327.144036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/05/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022] Open
Abstract
Fungi are a relatively uncommon cause of brain abscess in neonates and early infancy. They are usually associated with predisposing factors like prematurity, low birth weight, use of broad-spectrum antibiotics, and prolonged stay in the intensive care unit. Candida tropicalis (C. tropicalis) is rapidly emerging as a nosocomial threat in the neonatal intensive care settings. This case report describes a neonate with C. tropicalis brain abscess who was diagnosed early and managed aggressively with a favorable outcome. Inadvertent use of intravenous antibiotics can have serious complications such as invasive fungal infection. Correct microbiological diagnosis is the key to successful treatment of deep-seated pyogenic infection. Fungal etiology should always be studied in relevant clinical settings.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Bassiri-Jahromi S, Iravani K. Fungal brain abscess: report of three cases and review of literature. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60745-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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45
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Thoracic spinal cord intramedullary aspergillus invasion and abscess. J Clin Neurosci 2014; 22:404-6. [PMID: 25088481 DOI: 10.1016/j.jocn.2014.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/31/2014] [Accepted: 04/21/2014] [Indexed: 12/11/2022]
Abstract
Invasive central nervous system aspergillosis is a rare form of fungal infection that presents most commonly in immunocompromised individuals. There have been multiple previous reports of aspergillus vertebral osteomyelitis and spinal epidural aspergillus abscess; however to our knowledge there are no reports of intramedullary aspergillus infection. We present a 19-year-old woman with active acute lymphoblastic leukemia who presented with several weeks of fevers and bilateral lower extremity weakness. She was found to have an intramedullary aspergillus abscess at T12-L1 resulting from adjacent vertebral osteomyelitis and underwent surgical debridement with ultra-sound guided aspiration and aggressive intravenous voriconazole therapy. To our knowledge this is the first reported case of spinal aspergillosis invading the intramedullary cavity. Though rare, this entity should be included in the differential for immunocompromised patients presenting with fevers and neurologic deficit. Early recognition with aggressive neurosurgical intervention and antifungal therapy may improve outcomes in future cases.
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Weidauer S, Nichtweiss M, Hattingen E. Differential diagnosis of white matter lesions: Nonvascular causes-Part II. Clin Neuroradiol 2014; 24:93-110. [PMID: 24519493 DOI: 10.1007/s00062-013-0267-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/17/2013] [Indexed: 12/29/2022]
Abstract
The knowledge of characteristic lesion patterns is important in daily practice imaging, as the radiologist increasingly is required to provide precise differential diagnosis despite unspecific clinical symptoms like cognitive impairment and missed elaborated neurological workup. This part II dealing with nonvascular white matter changes of proven cause and diagnostic significance aimed to assist the evaluation of diseases exhibiting lesions exclusively or predominantly located in the white matter. The etiologies commented on are classified as follows: (a) toxic-metabolic, (b) leukodystrophies and mitochondriopathies, (c) infectious, (d) neoplastic, and (e) immune mediated. The respective mode of lesion formation is characterized, and typical radiological findings are displayed. More or less symmetrical lesion patterns on the one hand as well as focal and multifocal ones on the other are to be analyzed with reference to clinical data and knowledge of predilection sites characterizing major disease categories. Complementing spinal cord imaging may be useful not only in acute and relapsing demyelinating diseases but in certain leukodystrophies as well. In neuromyelitis optica (NMO), the detection of a specific antibody and some recently published observations may lead to a new understanding of certain deep white matter lesions occasionally complicating systemic autoimmune disease.
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Affiliation(s)
- S Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe University, Seckbacher Landstraße 65, 60389, Frankfurt am Main, Germany,
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Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR. Brain abscess: Current management. J Neurosci Rural Pract 2013; 4:S67-81. [PMID: 24174804 PMCID: PMC3808066 DOI: 10.4103/0976-3147.116472] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.
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Affiliation(s)
| | | | - Mohammed Awad Elzain
- Department of Neurosurgery, National Center for Neurological Sciences, Shaab Hospital, Khartoum, Sudan
| | - Luis Rafael Moscote-Salazar
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Hospital Ángeles de Pedregal, Mexico City, Colombia
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Galgóczy L, Tóth L, Virágh M, Papp T, Vágvölgyi CS. In vitro interactions of amantadine hydrochloride, R-(-)-deprenyl hydrochloride and valproic acid sodium salt with antifungal agents against filamentous fungal species causing central nervous system infection. ACTA BIOLOGICA HUNGARICA 2012; 63:490-500. [PMID: 23134606 DOI: 10.1556/abiol.63.2012.4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The mortality rates of fungal infections that affect the central nervous system are high in consequence of the absence of effective antifungal drugs with good penetration across the blood-brain barrier and the blood-cerebrospinal fluid barrier. In the present work in vitro antifungal activities of three good penetrating non-antifungal drugs (amantadine hydrochloride, R-(-)-deprenyl hydrochloride, valproic acid sodium salt) and their combinations with three antifungal agents (amphotericin B, itraconazole, terbinafine) were tested with broth microdilution method against eight fungal isolates belonging to Zygomycetes (Lichtheimia corymbifera, Rhizomucor miehei, Rhizopus microsporus var. rhizopodiformis, Saksenaeavasiformis) and Aspergillus genus (A. flavus, A. fumigatus, A. nidulans, A. terreus). These are known to be possible agents of central nervous fungal infections (CNFI). When used alone, the investigated nonantifungal drugs exerted slight antifungal effects. In their combinations with antifungal agents they acted antagonistically, additively and synergistically against zygomyceteous isolates. Primarily antagonistic interactions were revealed between the investigated drugs in case of Aspergilli, but additive and synergistic interactions were also observed. The additive and synergistic combinations allowed the usage of reduced concentrations of antifungal agents to inhibit the fungal growth in our study. These combinations would be a basis of an effective, less toxic therapy for treatment of CNFI.
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Affiliation(s)
- L Galgóczy
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
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Infektionen. NEUROINTENSIV 2012. [PMCID: PMC7123678 DOI: 10.1007/978-3-642-16911-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trotz Weiterentwicklung moderner Antibiotika in den letzten Jahren sind die Letalitätszahlen der bakteriellen (eitrigen) Meningitis weiterhin hoch; Überlebende haben häufig neurologische Residuen. Die ungünstigen klinischen Verläufe der bakteriellen Meningitis sind meist Folge intrakranieller Komplikationen, wie z. B. eines generalisierten Hirnödems, einer zerebrovaskulären arteriellen oder venösen Beteiligung oder eines Hydrozephalus.
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