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Wegener A, Lima KO, Holm AE, Gomes LC, Matos LO, Vieira IVM, Souza RM, Marinho CRF, Vestergaard LS, Biering-Sørensen T, Silvestre OM, Brainin P. Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin. Malar J 2021; 20:330. [PMID: 34321001 PMCID: PMC8316880 DOI: 10.1186/s12936-021-03861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described. CASE PRESENTATION A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized. CONCLUSIONS This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms.
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Affiliation(s)
- Alma Wegener
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil. .,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark.
| | - Karine O Lima
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Anna E Holm
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark
| | - Laura C Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luan O Matos
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros Souza
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Lasse S Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark.,Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark
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Phrenic nerve palsy in Japanese encephalitis: a rare association. Acta Neurol Belg 2021; 121:575-576. [PMID: 32638271 DOI: 10.1007/s13760-020-01433-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
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Ghosh R, Dubey S, Chatterjee S, Kanti Ray B, Benito-León J. Mixed Upper and Lower Motor Neuron Damage in Japanese Encephalitis Virus Infection. Case Rep Neurol 2020; 12:482-488. [PMID: 33568983 PMCID: PMC7841720 DOI: 10.1159/000510711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Cerebral manifestations in Japanese B encephalitis are well known. However, there are very few studies focusing on extra-cerebral manifestations, among which focal anterior horn cell involvement is exceedingly rare. We herein report a case of Japanese B encephalitis with focal anterior horn cell involvement and unfurl how stepwise clinical approach and targeted investigations helped to solve the diagnostic conundrum. A 27-year-old female was admitted with fever, headache, altered sensorium, and convulsions. She tested positive for Japanese B encephalitis-IgM. Following conservative management, she regained consciousness after 5 days when neurological examination revealed marked cognitive impairment, medial convergence of eyeballs, upward gaze restriction, upper limbs dystonia with brisk tendon jerks, and flaccid paraparesis. A repeat neurological examination, on day 15 of admission, showed marked wasting and intermittent fasciculation in both lower limbs. Brain magnetic resonance imaging showed asymmetrical (right > left) bilateral thalamic and midbrain lesions, hyperintense on T2 and T2-fluid-attenuated inversion recovery (FLAIR)-weighted imaging with mild diffusion restriction on diffusion-weighted imaging and apparent diffusion coefficient map, suggestive of encephalitis. Nerve conduction study revealed decreased compound muscle action potentials exclusively in lower limbs with intact sensory nerve action potentials. Electromyogram showed chronic denervation potentials and presence of spontaneous activity in lower limbs, but not in upper limbs, indicative of focal anterior horn cell involvement. Prognosis of Japanese B encephalitis does not only depend on cerebral sequelae. Anterior horn cell involvement can dictate poor outcome and can easily be missed if not carefully dealt with.
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur institute of Neurosciences, Kolkata, India
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur institute of Neurosciences, Kolkata, India
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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Calderón-Peláez MA, Velandia-Romero ML, Bastidas-Legarda LY, Beltrán EO, Camacho-Ortega SJ, Castellanos JE. Dengue Virus Infection of Blood-Brain Barrier Cells: Consequences of Severe Disease. Front Microbiol 2019; 10:1435. [PMID: 31293558 PMCID: PMC6606788 DOI: 10.3389/fmicb.2019.01435] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/06/2019] [Indexed: 01/10/2023] Open
Abstract
More than 500 million people worldwide are infected each year by any of the four-dengue virus (DENV) serotypes. The clinical spectrum caused during these infections is wide and some patients may develop neurological alterations during or after the infection, which could be explained by the cryptic neurotropic and neurovirulent features of flaviviruses like DENV. Using in vivo and in vitro models, researchers have demonstrated that DENV can affect the cells from the blood-brain barrier (BBB) in several ways, which could result in brain tissue damage, neuronal loss, glial activation, tissue inflammation and hemorrhages. The latter suggests that BBB may be compromised during infection; however, it is not clear whether the damage is due to the infection per se or to the local and/or systemic inflammatory response established or activated by the BBB cells. Similarly, the kinetics and cascade of events that trigger tissue damage, and the cells that initiate it, are unknown. This review presents evidence of the BBB cell infection with DENV and the response established toward it by these cells; it also describes the consequences of this response on the nervous tissue, compares these evidence with the one reported with neurotropic viruses of the Flaviviridae family, and shows the complexity and unpredictability of dengue and the neurological alterations induced by it. Clinical evidence and in vitro and in vivo models suggest that this virus uses the bloodstream to enter nerve tissue where it infects the different cells of the neurovascular unit. Each of the cell populations respond individually and collectively and control infection and inflammation, in other cases this response exacerbates the damage leaving irreversible sequelae or causing death. This information will allow us to understand more about the complex disease known as dengue, and its impact on a specialized and delicate tissue like is the nervous tissue.
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Tandon R, Kumar A, Kumar A. Long-Segment Myelitis, Meningoencephalitis, and Axonal Polyneuropathy in a Case of Scrub Typhus. Ann Indian Acad Neurol 2019; 22:237-240. [PMID: 31007446 PMCID: PMC6472236 DOI: 10.4103/aian.aian_66_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection.
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Affiliation(s)
- Ruchika Tandon
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Malerba P, Kaminstein D, Brunetti E, Manciulli T. Is there a role for bedside ultrasound in malaria? A survey of the literature. J Ultrasound 2019; 23:13-21. [PMID: 30852774 DOI: 10.1007/s40477-019-00371-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/27/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) has proven utility in the evaluation and treatment of many tropical diseases. Its role in malaria has been studied, but its value for the clinician at the bedside is unclear. Our review aimed at summarizing the existing studies to assess the usefulness, if any, of POCUS in treating malaria. METHODS We used Boolean operators using keywords "malaria", "acoustic", "ultrasound", "echography", and "ultrasonography" to search PubMed, Scopus, and Science Direct in three languages (Italian, French, and English). RESULTS We found 22 eligible references. Organs explored include the liver, spleen, heart, optic nerve sheath diameter (ONSD), kidney, lungs, and cerebral vasculature. Multiple pathologic findings by ultrasound are reported, but few demonstrate clinical utility. Current studies involve small numbers of patients, and a few trends emerge when studies are compared. The ability to combine study results is limited due to the significant heterogeneity that exists between studies in regards to both methods of evaluation and the reporting of organ pathology and malaria severity. CONCLUSIONS AND ASSESSMENT A review of the current literature indicates that the use of ultrasound by clinicians adds little to the diagnostic evaluation of patients with malaria. Our review did find that measurements of the spleen, lungs, optic nerve sheath diameter, and cerebral blood flow have potential utility in specific patient populations. Further studies are needed to evaluate whether this utility persists when a larger sample size is used.
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Affiliation(s)
- Paolo Malerba
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, PV, Italy
| | - Daniel Kaminstein
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Enrico Brunetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, PV, Italy
- Department of Infectious Diseases, IRCCS Policlinico San Matteo Hospital Fundation, Pavia, Italy
| | - Tommaso Manciulli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, PV, Italy.
- PhD School of Experimental Medicine, University of Pavia, Pavia, Italy.
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