1
|
Klevor R, Jarti M, Chraa M, Louhab N, Krati K, Kissani N. Metronidazole-Induced Encephalopathy With Probable Crohn Encephalitis: A Case Report. Clin Neuropharmacol 2024; 47:104-107. [PMID: 38743605 DOI: 10.1097/wnf.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Metronidazole central nervous system toxicity is a rare finding in patients receiving the medication. We report a peculiar case of metronidazole central nervous system toxicity in which both the underlying condition (Crohn disease) and the drugs used to treat it are potential causes of encephalopathy. METHODS A 26-year-old female with 6-year history of Crohn's disease for 6 years presented acute-onset encephalopathy. We provide bibliographic evidence to support metronidazole toxicity and potential Crohn disease-associated neurologic involvement. RESULTS The patient presented dystonia, cerebellar ataxia, and altered mental status. Magnetic resonance imaging of the brain revealed typical findings of metronidazole toxicity and white matter involvement of the centrum semiovale. Immunoelectrophoresis and immunofixation of serum and cerebrospinal fluid proteins were consistent with a systemic inflammatory process. We concluded on an association between drug toxicity and probable Crohn-associated neurologic involvement. Metronidazole was stopped and the patient was placed on vitamin therapy and diazepam to control dystonia. She deteriorated and was transferred to the intensive care unit where she expired. CONCLUSIONS Acute behavioral changes in a young patient constitute an emergency and differential diagnoses should include infective, inflammatory, metabolic, and toxic causes. Metronidazole is a potential toxic etiology.
Collapse
Affiliation(s)
| | - Mariama Jarti
- Gastro-entero-hepatology, Mohammed VI University Medical Center, Marrakesh, Morocco
| | | | | | - Khadija Krati
- Gastro-entero-hepatology, Mohammed VI University Medical Center, Marrakesh, Morocco
| | | |
Collapse
|
2
|
Jackson C, Furnes M, Rød‐Eriksen L, Yap KN, Davey M, Fossøy F, Flagstad Ø, Eide NE, Mjøen T, Ulvund K. Subclinical thiamine deficiency results in failed reproduction in Arctic foxes. Vet Med Sci 2024; 10:e1358. [PMID: 38356320 PMCID: PMC10867461 DOI: 10.1002/vms3.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Thiamine deficiency can result in life-threatening physiological and neurological complications. While a thiamine-deficient diet may result in the onset of such symptoms, the presence of thiaminase - an enzyme that breaks down thiamine - is very often the cause. In such instances, thiaminase counteracts the bioavailability and uptake of thiamine, even when food-thiamine levels are adequate. Here, we report on a case of failed reproduction in seven Arctic fox (Vulpes lagopus) breeding pairs kept at a captive breeding facility, including the presentation of severe thiamine deficiency symptoms in two male foxes. Symptoms included ataxia, obtundation, truncal sway, star-gazing and visual impairment. Blood tests were inconclusive, yet symptoms resolved following treatment with a series of thiamine hydrochloride injections, thereby verifying the diagnosis. A fish-dominated feed, which for the first time had been frozen for a prolonged period, was identified as the likely source of thiaminase and subsequent deterioration in the animals' health. Symptoms in the two males arose during the annual mating period. All seven breeding pairs at the captive breeding station failed to reproduce - a phenomenon never recorded during the captive breeding facility's preceding 17-year operation. Relating our findings to peer-reviewed literature, the second part of this case report assesses how thiamine deficiency (due to thiaminase activity) likely resulted in subclinical effects that impaired the production of reproduction hormones, and thereby led to a complete breeding failure. While previous work has highlighted the potentially lethal effects of thiamine deficiency in farmed foxes, this is, to our knowledge the first study showing how subclinical effects in both males and females may inhibit reproduction in foxes in general, but specifically Arctic foxes. The findings from our case report are not only relevant for captive breeding facilities, but for the welfare and management of captive carnivorous animals in general.
Collapse
Affiliation(s)
- Craig Jackson
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Marianne Furnes
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Lars Rød‐Eriksen
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Kang Nian Yap
- Department of BiologyNorwegian University of Science and TechnologyTrondheimNorway
| | - Marie Davey
- Department of Terrestrial BiodiversityNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Frode Fossøy
- Department of Aquatic BiodiversityNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Øystein Flagstad
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Nina E. Eide
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Toralf Mjøen
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| | - Kristine Ulvund
- Department of Terrestrial EcologyNorwegian Institute for Nature Research (NINA)TrondheimNorway
| |
Collapse
|
3
|
Wang M, Li Y, Yang X, Liu Z, Wang K, Gong D, Li J. Effects of metronidazole on colorectal cancer occurrence and colorectal cancer liver metastases by regulating Fusobacterium nucleatum in mice. Immun Inflamm Dis 2023; 11:e1067. [PMID: 38018574 PMCID: PMC10683560 DOI: 10.1002/iid3.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Colorectal cancer (CRC) represents a leading cause of cancer-related deaths. Metronidazole (MNZ) is exceedingly implicated in CRC. This study explored the roles of MNZ in mouse CRC occurrence and liver metastasis (CRLM). METHODS Male BALB/c nude mice were subjected to CRC and CRLM modeling, orally administration with MNZ (1 g/L) 1 week before modeling, and disease activity index (DAI) evaluation. Fresh stool and anal swab samples were collected on the morning of the 28th day after modeling. The relative expression of Fusobacterium nucleatum (F. nucleatum) DNA was assessed by quantitative polymerase chain reaction. After euthanasia, tumor tissues and liver tissues were separated and the tumor volume and weight change were measured. The liver tissues were stained with hematoxylin-eosin to quantitatively analyze the metastatic liver nodules. Malignant tumor biomarker Ki67 protein levels in liver tissues/DNA from stool samples were detected by immunohistochemistry/high-throughput 16S rRNA gene sequencing. Bioinformatics analysis was performed on the raw sequence data to analyze microbial community richness (Chao1 index, ACE index) and microbial community diversity (Shannon index). RESULTS The DAI and F. nucleatum DNA relative expression in feces and anal swabs of the CRC and CRLM groups were raised and repressed after MNZ intervention. MNZ repressed tumor occurrence and growth in mice to a certain extent, alleviated CRLM malignant degree (reduced liver metastases and Ki67-positive cell density/number), and suppressed CRC liver metastasis by regulating intestinal flora structure, which affected the intestinal characteristic flora of CRC and CRLM mice. CONCLUSION MNZ suppressed CRC occurrence and CRLM in mice by regulating intestinal F. nucleatum.
Collapse
Affiliation(s)
- Maijian Wang
- Department of General Surgery, Digestive Disease HospitalAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Yong Li
- Department of OncologyGuizhou Provincial People's HospitalGuiyangChina
| | - Xuefeng Yang
- Department of General Surgery, Digestive Disease HospitalAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Zhenxing Liu
- Department of General Surgery, Digestive Disease HospitalAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Kai Wang
- Department of PathologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Dengmei Gong
- Institute of Zoonoses, College of Public HealthZunyi Medical UniversityZunyiChina
| | - Jida Li
- Institute of Zoonoses, College of Public HealthZunyi Medical UniversityZunyiChina
| |
Collapse
|
4
|
El-Moslemany AM, Abd-Elfatah MH, Tahoon NA, Bahnasy RM, Alotaibi BS, Ghamry HI, Shukry M. Mechanistic Assessment of Anise Seeds and Clove Buds against the Neurotoxicity Caused by Metronidazole in Rats: Possible Role of Antioxidants, Neurotransmitters, and Cytokines. TOXICS 2023; 11:724. [PMID: 37755735 PMCID: PMC10538152 DOI: 10.3390/toxics11090724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
Long-term use of the nitroimidazole-derived antibiotic metronidazole has been associated with neuronal damage due to its ability to cross the blood-brain barrier. Polyphenol-rich plants, such as anise seeds and clove buds, are suggested to have neuroprotective effects. However, their intracellular protective pathway against metronidazole-induced neurotoxicity remains unexplored. This study aims to evaluate the potential neuroprotective benefits of anise seeds and clove buds and elucidate the proposed metronidazole-induced neurotoxicity mechanism. This study divided rats into six groups, each containing six rats. In Group I, the control group, rats were administered saline orally. Group II rats received 200 mg/kg of metronidazole orally. Group III rats received 250 mg/kg b.w. of anise seed extract and metronidazole. Group IV rats received 500 mg/kg b.w. of anise seed extract (administered orally) and metronidazole. Group V rats received 250 mg/kg b.w. of clove bud extract (administered orally) and metronidazole. Group VI rats were administered 500 mg/kg b.w. of clove bud extract and metronidazole daily for 30 consecutive days. The study evaluated the phenolic compounds of anise seeds and clove buds. Moreover, it assessed the inflammatory and antioxidant indicators and neurotransmitter activity in brain tissues. A histological examination of the brain tissues was conducted to identify neuronal degeneration, brain antioxidants, and apoptotic mRNA expression. The study found that metronidazole treatment significantly altered antioxidant levels, inflammatory mediators, and structural changes in brain tissue. Metronidazole also induced apoptosis in brain tissue and escalated the levels of inflammatory cytokines. Oral administration of metronidazole resulted in a decrease in GABA, dopamine, and serotonin and an increase in ACHE in brain tissue. Conversely, oral administration of anise and clove extracts mitigated the harmful effects of metronidazole. The neurotoxic effects of metronidazole appear to stem from its ability to reduce antioxidants in brain tissue and increase nitric oxide production and apoptosis. The study concludes that neuronal damage caused by metronidazole is significantly mitigated by treatment with anise and clove extracts.
Collapse
Affiliation(s)
- Amira M. El-Moslemany
- Nutrition and Food Science Department, Faculty of Home Economics, Al-Azhar University, Tanta 31732, Egypt; (A.M.E.-M.); (R.M.B.)
| | - Mai Hussein Abd-Elfatah
- Nutrition and Food Science Department, Faculty of Home Economics, Al-Azhar University, Tanta 31732, Egypt; (A.M.E.-M.); (R.M.B.)
| | - Nawal A. Tahoon
- Department of Home Economics, Faculty of Specific Education, Banha University, Banha 13511, Egypt;
| | - Rasha M. Bahnasy
- Nutrition and Food Science Department, Faculty of Home Economics, Al-Azhar University, Tanta 31732, Egypt; (A.M.E.-M.); (R.M.B.)
| | - Badriyah S. Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Heba I. Ghamry
- Nutrition and Food Sciences, Department of Home Economics, Faculty of Home Economics, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia;
| | - Mustafa Shukry
- Physiology Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| |
Collapse
|
5
|
Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report. BMC Neurol 2022; 22:485. [PMID: 36522715 PMCID: PMC9753291 DOI: 10.1186/s12883-022-03006-4] [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: 03/21/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neurological symptoms and radiographic abnormalities may remain in a small proportion of patients with metronidazole-induced encephalopathy (MIE). Although experimental animal models of MIE have suggested a Wernicke's encephalopathy-like pathology, little is known about the histopathological features of MIE. Here we report the first autopsy case of irreversible MIE. CASE PRESENTATION A 72-year-old Japanese woman with pancreatic neuroendocrine tumour and metastatic tumours in the liver developed intraabdominal bleeding from a hepatic abscess. She was administered metronidazole for 79 days (1.5 g/day), which caused dysarthria followed by hand tremor and altered mental status. Brain magnetic resonance imaging at the time of onset revealed hyperintensities in the deep white matter of the bilateral parietal lobes and splenium of the corpus callosum on diffusion-weighted imaging (DWI) with reduced apparent diffusion coefficient (ADC) values. Despite the improvement of dysarthria and hand tremor, her cognition remained affected even after the withdrawal of metronidazole. She died of pancreatic neuroendocrine tumour at the age of 74 years. Histopathological examinations of the brain confirmed a combination of severe demyelination and moderate axonal degeneration, which corresponded to the regions showing abnormal signal intensities on DWI with reduced ADC values. There were no pathological findings suggestive of Wernicke's encephalopathy in the brain. CONCLUSION We have demonstrated the clinical, radiographic and histopathological aspects of irreversible MIE. Hyperintensities on DWI with reduced ADC values in affected regions may indicate a poor clinical prognosis due to irreversible pathological damage.
Collapse
|
6
|
Saleem TH, Okasha M, Ibrahim HM, Abu El-Hamd M, Fayed HM, Hassan MH. Biochemical Assessments of Seminal Plasma Zinc, Testis-Expressed Sequence 101 and Free Amino Acids and Their Correlations with Reproductive Hormones in Male Infertility. Biol Trace Elem Res 2021; 199:1729-1742. [PMID: 32767245 DOI: 10.1007/s12011-020-02310-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
The role of the male factors in the couple's infertility has been significantly increased in recent years due to a sententious assessment of male reproductive functions and enhanced diagnostic tools. We investigated the correlations among the seminal plasma (SP) levels of each of zinc, testis-expressed sequence 101 (TEX101), and free amino acids levels with reproductive hormones in adult fertile and infertile men. The study included 100 infertile men categorized into 50 non-obstructive azoospermic patients and 50 patients with idiopathic oligoasthenoteratozoospermia (iOAT), in addition to 50 fertile controls. Semen analyses, serum ELISA assays for male reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, and prolactin), colorimetric assays of SP zinc and total proteins, SP free amino acids using high-performance liquid chromatography (HPLC), and ELISA assays of SP TEX101 were performed for all subjects. Infertile men with azoospermia had significantly lower SP median levels of zinc, TEX101, and many SP free amino acids compared to both men with iOAT and fertile controls (P ˂ 0.05 for all). There were lower SP levels of zinc and some free amino acids among men with iOAT compared to the fertile controls (P ˂ 0.05 for all) with non-significant difference regarding to SP TEX101 (P ˃ 0.05). Azoospermic men exhibited negative correlations between FSH, LH, and prolactin with some SP free amino acids (P ˂ 0.05 for all), and a positive correlation between glycine with total testosterone (P ˂ 0.05). Among iOAT patients, LH and FSH were positively correlated with SP zinc, TEX101, and some measured free amino acids (P ˂ 0.05 for all). Total testosterone was positively correlated with some amino acids, while prolactin was negatively correlated with glycine (P ˂ 0.05 for all). iOAT and azoospermic men exhibited low SP zinc and some free amino acids levels that were more pronounced in azoospermic men and were significantly associated with the reproductive hormones. TEX101 could be a helpful confirmatory test for azoospermia.
Collapse
Affiliation(s)
- Tahia H Saleem
- Faculty of Medicine, Department of Medical Biochemistry, Assiut University, Assiut, Egypt
| | - Marwa Okasha
- Faculty of Medicine, Department of Medical Biochemistry, South Valley University, Qena, 83523, Egypt
| | - Hassan M Ibrahim
- Dermatology, Venereology & Andrology, South Valley University, Qena, Egypt
| | | | - Hanan M Fayed
- Clinical Pathology, South Valley University, Qena, Egypt
| | - Mohammed H Hassan
- Faculty of Medicine, Department of Medical Biochemistry, South Valley University, Qena, 83523, Egypt.
| |
Collapse
|