Blood-CSF-barrier dysfunction is a marker for encephalitic involvement in patients with aseptic meningitis/meningoencephalitis

The usefulness of hematological parameters and cerebrospinal fluid indexes in the differential diagnosis of acute bacterial from viral meningitis

Central nervous system (CNS) infection is a medical emergency with an important cause of mortality worldwide. The 79 patients with confirmed acute CNS infection (48 bacterial and 31 viral meningitis) were evaluated. Bacterial meningitis score, cerebrospinal fluid (CSF)/serum glucose ratio, and CSF/serum albumin ratio had the highest area under the curves (0.873, 0.843, 0.810, respectively) for discriminating bacterial meningitis. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR) and CSF lactate dehydrogenase have a good ability for the differential diagnosis of bacterial meningitis. CSF/serum glucose ratio, NLR (with a cut-off value> 8.87), large unstained cell, total protein, albumin, and procalcitonin levels were found to be predictors for mortality. NLR can be used as a biomarker to differentiate bacterial meningitis from viral meningitis and to predict the prognosis of CNS infection. CSF/serum albumin ratio and CSF lactate dehydrogenase can be used to predict bacterial meningitis as well as CSF/serum glucose ratio.

Tacrolimus induced optic neuropathy in post-lung transplant patients: A series of 3 patients

Purpose

Tacrolimus is a commonly used immunosuppressant medication after lung transplantation. In rare cases, tacrolimus causes a medication-induced optic neuropathy (TON) that can lead to significant vision loss.

Observations

In this series, we describe three cases of TON, 1-10 years after medication use. Two patients were young (22yr and 33yr) females with cystic fibrosis. The last case was a 65yr male with idiopathic pulmonary fibrosis. In 2/3 cases tacrolimus serum levels were normal. Visual acuity ranged from 20/20 to 20/300, and vision loss occurred acutely to sub-acutely, over a span of 2-3 months.

Conclusions and importance

As presented here, TON can be highly variable. MRI findings are often non-specific, from normal brain findings to extensive white matter changes. There remains an unclear association with graft-versus-host disease and reduced kidney function. Visual findings are often subtle, including color vision aberration and peripheral visual field deficits, both of which usually require an ophthalmologic evaluation. When diagnosed in a timely fashion, TON is at least partially reversible in up to half of all cases. While rare, the cases described here support post-lung transplant ophthalmologic evaluation in those taking high-risk medications.

Human intracerebroventricular (ICV) injection of autologous, non-engineered, adipose-derived stromal vascular fraction (ADSVF) for neurodegenerative disorders: results of a 3-year phase 1 study of 113 injections in 31 patients

We have chosen to test the safety of human intracerebroventricular (ICV) brain injections of autologous non-genetically-modified adipose-derived stromal vascular fraction (ADSVF). In this IRB-approved trial, 24 patients received ICV ADSVF via an implanted reservoir between 5/22/14 and 5/22/17. Seven others were injected via their ventriculo-peritoneal shunts. Ten patients had Alzheimer's disease (AD), 6 had amyotrophic lateral sclerosis (ALS), 6 had progressive multiple sclerosis (MS-P), 6 had Parkinson's "Plus" (PD+), 1 had spinal cord injury, 1 had traumatic brain injury, and 1 had stroke. Median age was 74 (range 41-83). Injections were planned every 2-3 months. Thirty-one patients had 113 injections. Patients received SVF injection volumes of 3.5-20 cc (median:4 cc) containing 4.05 × 10⁵ to 6.2 × 10⁷ cells/cc, which contained an average of 8% hematopoietic and 7.5% adipose stem cells. Follow-up ranged from 0 to 36 months (median: 9.2 months). MRIs post injection(s) were unchanged, except for one AD patient whose hippocampal volume increased from < 5th percentile to 48th percentile (NeuroQuant^® volumetric MRI). Of the 10 AD patients, 8 were stable or improved in tests of cognition. Two showed improvement in P-tau and ß-amyloid levels. Of the 6 MS-P patients all are stable or improved. Four of 6 ALS patients died of disease progression. Twelve of 111 injections (11%) led to 1-4 days of transient meningismus, and mild temperature elevation, which resolved with acetaminophen and/or dexamethasone. Two (1.8% of injections) required hospitalization for these symptoms. One patient (0.9% of injections) had his reservoir removed and later replaced for presumed infection. In this Phase 1 safety trial, ADSVF was safely injected into the human brain ventricular system in patients with no other treatment options. Secondary endpoints of clinical improvement or stability were particularly promising in the AD and MS-P groups. These results will be submitted for a Phase 2 FDA-approved trial.

Diagnostic Value of Procalcitonin for Bacterial Meningitis in Children: A Comparison Analysis Between Serum and Cerebrospinal Fluid Procalcitonin Levels

The aim of this study was to analyze and compare procalcitonin (PCT) levels in serum and cerebrospinal fluid (CSF) as tools for detecting bacterial meningitis (BM) in children. Serum and CSF PCT levels as well as albumin index (AI = CSF albumin/serum albumin × 1000) were measured from 29 BM, 25 viral meningitis (VM), and 47 non-meningitis patients. Differences between groups only for CSF PCT were significant. A stronger positive correlation between CSF PCT level and AI was observed in the BM patients ( R = 0.68, P < .001). As a predictor of BM, the area under the receiver operating characteristics curve for CSF PCT was greater than that of serum PCT (0.76 vs 0.67, P < .05) and a cutoff of ⩾0.085 ng/mL achieved 55.17% sensitivity and 95.83% specificity. High levels of CSF PCT may indicate loss of integrity of the blood-brain barrier; only CSF PCT has a diagnostic value for BM in children suspected meningitis.