Chronic progressive mumps virus encephalitis in a child

Breast cancer immune microenvironment: from pre-clinical models to clinical therapies

The breast cancer tumour microenvironment (BC-TME) is characterized by significant cellular and spatial heterogeneity that has important clinical implications and can affect response to therapy. There is a growing need to develop methods that reliably quantify and characterize the BC-TME and model its composition and functions in experimental systems, in the hope of developing new treatments for patients. In this review, we examine the role of immune-activating cells (including tumour-infiltrating lymphocytes and natural killer cells) and immune inhibitory cells (including T regulatory cells, tumour-associated macrophages and myeloid-derived suppressor cells) in the BC-TME. We summarize methods being used to characterize the microenvironment, with specific attention to pre-clinical models including co-cultures, organoids, and genetically modified and humanized mouse models. Finally, we explore the implications and applications of existing preclinical data for drug development and highlight several drugs designed to alter the BC-TME in order to improve treatment outcomes for patients.

Deep sequencing reveals persistence of cell-associated mumps vaccine virus in chronic encephalitis

Routine childhood vaccination against measles, mumps and rubella has virtually abolished virus-related morbidity and mortality. Notwithstanding this, we describe here devastating neurological complications associated with the detection of live-attenuated mumps virus Jeryl Lynn (MuV^JL5) in the brain of a child who had undergone successful allogeneic transplantation for severe combined immunodeficiency (SCID). This is the first confirmed report of MuV^JL5 associated with chronic encephalitis and highlights the need to exclude immunodeficient individuals from immunisation with live-attenuated vaccines. The diagnosis was only possible by deep sequencing of the brain biopsy. Sequence comparison of the vaccine batch to the MuV^JL5 isolated from brain identified biased hypermutation, particularly in the matrix gene, similar to those found in measles from cases of SSPE. The findings provide unique insights into the pathogenesis of paramyxovirus brain infections.

The EEG of tropical encephalopathies

In addition to encountering most of the conditions treated by clinicians in the West, clinicians in the tropics are faced with unique tropical encephalopathies. These are largely but not entirely infectious in nature. Despite the relatively low cost of EEG technology, it remains unavailable in many low-income tropical settings even at the tertiary care level. Where available, the EEG recordings and interpretation are often of unacceptable quality. Nonetheless, there are existing data on the EEG patterns seen in malaria and a number of tropical viral, bacterial, and parasitic infestations.

Brainstem encephalitis and acute disseminated encephalomyelitis following mumps

A previously healthy female, aged 4 years 3 months, developed brainstem encephalitis with clinical manifestations of fever, decreased level of consciousness, and left facial and abducens paralysis 1 week after bilateral parotitis. Twenty days after remission of encephalitis, she manifested new symptoms of ataxia, dysarthria, and fever. Magnetic resonance imaging revealed multiple hyperintense lesions which were increased in size when compared with the first magnetic resonance imaging. She was treated with glucocorticoids and intravenous immunoglobulin. Forty-eight days after therapy, she was able to walk with support and recovered completely on follow-up. Brainstem encephalitis and acute disseminating encephalomyelitis are discussed as rare complications of mumps.