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Ramón-Cuellar JF, Mejía-Cordovez JA, Quiñones-Ossa GA, Leal-Isaza JP, Vargas-Osorio MP, Ramirez-Muñoz JD, Ordóñez-Rubiano EG, Ramirez AP, Amarillo DG, Hakim-Daccach F. Cerebral Myiasis, An Unexpected Intraoperative Finding - A Case Report and Systematic Review. World Neurosurg 2024; 186:138-144. [PMID: 38503402 DOI: 10.1016/j.wneu.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Postoperative complications, exemplified by surgical site infections, are commonplace in the realm of daily surgical interventions. Conversely, certain infectious entities, such as cerebral myiasis (CM), are distinctly rare. This report elucidates the clinical presentation of a 74-year-old female afflicted with a CSF fistula, within the context of a preceding surgical microvascular decompression employing a suboccipital craniotomy approach. Notably, the course of evaluation and treatment unveiled an intraoperative manifestation of severe CM. This case report underscores the critical significance of prompt identification, precise diagnostic elucidation, and comprehensive multidisciplinary management to optimize patient outcomes in instances of CM. Furthermore, a systematic literature review on CM supplements this report, contributing to the understanding of this infrequent complication.
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Affiliation(s)
| | | | - Gabriel Alexander Quiñones-Ossa
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Juan Pablo Leal-Isaza
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan Daniel Ramirez-Muñoz
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Edgar G Ordóñez-Rubiano
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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Alabaz D, Çay Ü. Tuberculous meningitis during infancy: 26 cases in South Turkey among 20 years. Childs Nerv Syst 2022; 38:611-618. [PMID: 34841468 DOI: 10.1007/s00381-021-05417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the lack of a standard case definifion and the diffuculty in estabilishing a definitive diagnsos, TB in children needs increasing attention by physicians caring for pediatric patients. Tuberculous meningitis (TBM) is the most serious form of extrapulmonary tuberculosis that is associated with significant morbidity and mortality rate in the pediatric age group, especially in infants. This descriptive study was conducted in an University hospital, at the South of Turkey, from May 1999 to May 2019. METHODS The hospital records of 26 TBM infant that was diagnosed at our hospital were retrospectively evaluated. The epidemiological findings (age, gender, family history of TB, tuberculin skin test results, status of BCG scaring), stage of TBM at admission and clinical, laboratory and radiological features were collected. RESULTS Of the 26 infants, 61.5% were male and mean age of the patients was 7,65±2,6 (range, 3-12 months). The history of close contact with an infected adult was encountered in 73.1% (19 infant) of the cases. Only 69.2% of the patients (18 case) had a BCG scar. The prodromal stage (period between the onset of symptoms to hospital admission) ranged from 4 days to 180 days (39±51.3). 2 cases were defined as stage I, 10 cases as stage II and 14 cases as stage III TBM. Only two patients were initially positive for PPD test. While no neurological findings were found in 2 patients (diagnosed as stage I), neurologic findings at the time of admission included increased intracranial pressure; alteration in consciousness (92.3%), seizures (88.4%), vomiting (61.5%) cranial nerve palsy (23%), irritability 19.2%, hemiplegia 15.3% and meningeal signs (7%, only 2 patients). The presence of hepatomegaly 26.9 % and/or splenomegaly 11.5 % and/or extrapulmonary lymphadenopathy 3.8 % in nearly half of the cases suggested that totally 42,2% of cases had disseminated of tuberculosis. On admission, 46.1% of the patients were noted to have hyponatremia. Microbiologic confirmation was established in eleven (42.3%) of the 26 infant. A positive CSF culture for Mtb and/or smear for AFB and/or PCR was obtained in only 5 (19.2%) patients, whereas 3 of the cases had accompaining gastric aspirate examination positivity. Pulmonary consolidation in 14 (53.8%) patients, miliary patern in 10 (41.6%) and pulmonary hilar lymphadenopathy in only 5 (20.8%) patients. 23 (88.4 %) had hydrocephalus, 15 (57.6 %) infarction, 10 (38.4 %) basilar meningitis and 9 (34.6%) tuberculomas. Empiric anti-tuberculosis treatment was instituted in all, at a median of 3 days (range 1-15 days) following admission. 8 (30.7%) died, 3 (11.5%) recovered completely, and 15 (57.6%) recovered with sequelae. 12 case (2 died) of the infants had required ventriculoperitoneal shunting. CONCLUSION As early diagnosis and specific treatment appears to prevent serious complications and reduce mortality, a high index of suspicion among pediatricians is especially required in an infant with an atypical picture suggestive of tuberculosis infection.
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Affiliation(s)
- Derya Alabaz
- Department of Pediatrics, Pediatric Infectious Diseases, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ümmühan Çay
- Department of Pediatrics, Pediatric Infectious Diseases, Faculty of Medicine, Cukurova University, Adana, Turkey
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Fiorindi A, Marton E, Gioffrè G, Biroli A, Basaldella L, Fontanella MM, Longatti P. New perspectives in the endoscopic treatment of brain purulent collections: targets, techniques, results in a case series, and overview of the literature. Acta Neurochir (Wien) 2020; 162:2867-2874. [PMID: 32358657 DOI: 10.1007/s00701-020-04301-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Purulent intracranial infections are threatening conditions. Different surgical approaches have been described, respecting the rationale of evacuating the fluid component of the purulent collection. Emerging evidence supports the use of the endoscope for the treatment of cerebral abscesses and subdural empyemas; especially the peculiarities of flexible endoscopes could potentially offer a more effective and conclusive management as compared with the drainage through catheters. We describe our experience in the treatment of intracranial purulent collections with flexible endoscopy, comparing it with the most recent literature. METHODS Ten patients affected by intracranial suppuration were treated with endoscopy at our institution. The neurosurgical technique is thoroughly described. The related literature is reviewed, providing a comprehensive overview on the endoscopic treatment of intracranial suppuration so far. RESULTS All the patients had a good clinical outcome, with no peri-operative complications. The postoperative scans showed significant radiological improvement, with important reduction of the pus volume. In all cases, the microbiological cultures showed positivity. CONCLUSIONS In our experience, the use of the flexible scope proved feasible and effective in the treatment of intracranial purulent collections. Visual awareness of the internal capsule is not limited to a direct inspection of the fluid pus; it rather allows an active removal of the more solid (and perhaps more microbiologically significant) fibrinoid component, and also assists in final bleeding control and in assessing the extent of the evacuation. The steering capabilities of the fiberscope are particularly suitable for such purposes, allowing sampling the solid internal layer of the pyogenic membrane, and potentially shedding light on the actual clinical significance of this component of the abscess.
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Fehr M, Cathomas G, Graber A, Makert E, Gaus E, Boggian K. Multi-fungal sepsis and mucormycosis of the central nervous system in a patient treated with ibrutinib, a case report and review of the literature. Med Mycol Case Rep 2020; 27:14-6. [PMID: 31890489 DOI: 10.1016/j.mmcr.2019.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022] Open
Abstract
We report the case of a 71 years old patient with chronic lymphocytic leukemia (CLL), who developed a rapidly progressing multi-fungal infection including mucormycosis of the central nervous system (CNS) during treatment with ibrutinib. On autopsy mucorales species were demonstrated intravascularly by histomorphology of several organs and lymph nodes and were characterized as Rhizomucor pusillus by polymerase-chain reaction (PCR) - analysis. In addition, invasive pulmonary Aspergillus fumigatus was found and also confirmed by PCR. To the best of our knowledge, this is the first confirmation of a multi-fungal sepsis and invasive CNS-infection with mucorales species under ibrutinib. Knowing the risk for invasive fungal disease in patients under ibrutinib, identifying the pathogen and early initiation of specific treatment is crucial for a good clinical outcome especially in mucormycosis.
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Udayakumaran S, Onyia CU, Kumar RK. Forgotten? Not Yet. Cardiogenic Brain Abscess in Children: A Case Series-Based Review. World Neurosurg 2017; 107:124-129. [PMID: 28780403 DOI: 10.1016/j.wneu.2017.07.144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Brain abscess is a significant cause of morbidity in patients with uncorrected or partially palliated congenital cyanotic heart disease (CCHD). Unfortunately, in the developing world, the majority of patients with CCHD remain either uncorrected or only partially palliated. Furthermore, a risk of this feared complication also exists even among those undergoing staged corrective operations in the interval in between operations. There have been no recent articles in the literature on the outcomes of surgical management of cardiogenic brain abscess in children. In this study, we aimed to describe the clinical and demographic profile of patients with cardiogenic cerebral abscess and to highlight the fact that uncorrected or palliated CCHD continue to be at risk for brain abscess. METHODS This study was a retrospective analysis of 26 children (age <19 years) being managed for CCHD who were diagnosed with cerebral abscess managed surgically (26 of 39 of cases cerebral abscess in children), at Amrita Institute of Medical Sciences and Research Centre, Kochi, India between December 2000 and January 2014. Data collected retrospectively included demographic information, modes of presentation, diagnosis, location of abscess, details of the underlying heart disease, management of the cerebral abscess, and outcomes of management. RESULTS The patient cohort comprised 26 patients (16 males and 10 females), with a mean age of 7.19 years (range, 1.5-19 years). Ten of the 26 patients (38%) required reaspiration after the initial surgery. On follow-up, all the patients had improved symptomatically and demonstrated no signs of cerebral abscess. CONCLUSIONS Cardiogenic origin of cerebral abscess is the most common cause of cerebral abscess in children. Unresolved CCHD is a risk factor for the occurrence, persistence, and recurrence of cerebral abscess.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Chiazor U Onyia
- Neurosurgery Division, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Müller J, Aguado A, Laleu B, Balmer V, Ritler D, Hemphill A. In vitro screening of the open source Pathogen Box identifies novel compounds with profound activities against Neospora caninum. Int J Parasitol 2017; 47:801-809. [PMID: 28751177 DOI: 10.1016/j.ijpara.2017.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 11/25/2022]
Abstract
Neospora caninum is a major cause of abortion in cattle and represents an important veterinary health problem of great economic significance. The Medicines for Malaria Venture (MMV) Pathogen Box, an open-source collection of 400 compounds with proven anti-infective properties against a wide range of pathogens, was screened against a N. caninum beta-galactosidase reporter strain grown in human foreskin fibroblasts. A primary screening carried out at 1µM yielded 40 compounds that were effective against N. caninum tachyzoites. However, 30 of these compounds also affected the viability of the host cells. The 10 remaining compounds exhibited IC50 values between 4 and 43nM. Three compounds with IC50 values below 10nM, namely MMV676602, MMV688762 and MMV671636, were further characterized in vitro in more detail with respect to inhibition of invasion versus intracellular proliferation, and only MMV671636 had an impact on intracellular proliferation of tachyzoites. This was confirmed by transmission electron microscopy, showing that the primary target of MMV671636 was the mitochondrion. MMV671636 treatment of experimentally infected mice significantly reduced the number of animals with lung and brain infection, and these mice also exhibited a significantly reduced titer of antibodies directed against N. caninum antigens. Thus, MMV671636 is a promising starting point for the development of a future neosporosis therapy.
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Affiliation(s)
- Joachim Müller
- Institute for Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Adriana Aguado
- Institute for Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Benoît Laleu
- Medicines for Malaria Venture (MMV), PO Box 1826, 20, Route de Pré-Bois, 1215 Geneva 15, Switzerland
| | - Vreni Balmer
- Institute for Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Dominic Ritler
- Institute for Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Andrew Hemphill
- Institute for Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
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Nguyen HS, Doan N, Gelsomino M, Shabani S, Mueller W. Dilemmas surrounding the diagnosis of deep brain stimulation electrode infection without associated wound complications: A series of two cases. Surg Neurol Int 2016; 7:S121-4. [PMID: 26958428 PMCID: PMC4765243 DOI: 10.4103/2152-7806.176133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background: When wounds are benign, diagnosis of deep brain stimulation (DBS) electrode infection and associated intraparenchymal infection can be challenging. Only a couple, such cases exist in literature. Since infections of the central nervous system can be life-threatening, prompt diagnosis is necessary to prevent neurological injury. Employed within the appropriate context, magnetic resonance imaging (MRI) of the brain, as well as laboratory data and clinical presentation, may help guide diagnosis. Case Descriptions: Case 1 - A 55-year-old male with bilateral DBS electrodes and generators (49 days from last procedure), who presented with confusion and fever. Pertinent positive laboratory was white blood cell 20.5K. MRI of the brain showed edema with enhancement along the right DBS electrode. Wound exploration revealed gross purulence in the subgaleal space. The entire system was removed; cultures from subgaleal space revealed Propionibacterium acnes; cultures from electrode were negative. The patient was sent home on antibiotics. Case 2 - A 68-year-old male with a right DBS electrode (11 days from placement), who presented after an unwitnessed fall, followed by confusion and amnesia. Pertinent laboratory examinations were negative. MRI of the brain showed edema with enhancement along the DBS electrode. Wound exploration revealed no infection. The DBS system was left in place; final cultures were negative; no antibiotics were prescribed. Repeat MRI showed resolving fluid-attenuated inversion recovery (FLAIR) signal and contrast enhancement. Conclusions: Contrast enhancement, T2 FLAIR, and diffusion weighted imaging are influenced by postoperative changes. Caution is stressed regarding dependence on these features for acute diagnosis of infection and indication for electrode removal. Timing of the imaging after surgery must be considered. Other factors, such as systemic signs and abnormal laboratory data, should be evaluated. Based on these guidelines, retrospectively, the patient in Case 2 should not have been rushed for a wound exploration; close observation with serial imaging and laboratory data may have prevented an unnecessary procedure.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Müller J, Aguado-Martinez A, Manser V, Balmer V, Winzer P, Ritler D, Hostettler I, Arranz-Solís D, Ortega-Mora L, Hemphill A. Buparvaquone is active against Neospora caninum in vitro and in experimentally infected mice. Int J Parasitol Drugs Drug Resist 2015; 5:16-25. [PMID: 25941626 PMCID: PMC4412913 DOI: 10.1016/j.ijpddr.2015.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/16/2022]
Abstract
Buparvaquone inhibits proliferation of Neospora caninum at nanomolar concentrations. In vitro, the drug acts mainly parasitostatic. Parasiticidal effects occur at µmolar concentrations after extended periods of time. Buparvaquone acts slowly as evidenced by transmission electron microscopy. Buparvaquone prevents clinical signs of acute neosporosis in mice.
The naphthoquinone buparvaquone is currently the only drug used against theileriosis. Here, the effects of buparvaquone were investigated in vitro and in an experimental mouse model for Neospora caninum infection. In 4-day proliferation assays, buparvaquone efficiently inhibited N. caninum tachyzoite replication (IC50 = 4.9 nM; IC100 = 100 nM). However, in the long term tachyzoites adapted and resumed proliferation in the presence of 100 nM buparvaquone after 20 days of cultivation. Parasiticidal activity was noted after 9 days of culture in 0.5 µM or 6 days in 1 µM buparvaquone. TEM of N. caninum infected fibroblasts treated with 1 µM buparvaquone showed that the drug acted rather slowly, and ultrastructural changes were evident only after 3–5 days of treatment, including severe alterations in the parasite cytoplasm, changes in the composition of the parasitophorous vacuole matrix and a diminished integrity of the vacuole membrane. Treatment of N. caninum infected mice with buparvaquone (100 mg/kg) either by intraperitoneal injection or gavage prevented neosporosis symptoms in 4 out of 6 mice in the intraperitoneally treated group, and in 6 out of 7 mice in the group receiving oral treatment. In the corresponding controls, all 6 mice injected intraperitoneally with corn oil alone died of acute neosporosis, and 4 out of 6 mice died in the orally treated control group. Assessment of infection intensities in the treatment groups showed that, compared to the drug treated groups, the controls showed a significantly higher parasite load in the lungs while cerebral parasite load was higher in the buparvaquone-treated groups. Thus, although buparvaquone did not eliminate the parasites infecting the CNS, the drug represents an interesting lead with the potential to eliminate, or at least diminish, fetal infection during pregnancy.
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Affiliation(s)
- Joachim Müller
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Adriana Aguado-Martinez
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Vera Manser
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Vreni Balmer
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Pablo Winzer
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Dominic Ritler
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - Isabel Hostettler
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
| | - David Arranz-Solís
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Ciudad Universitaria s/n, Madrid 28040, Spain
| | - Luis Ortega-Mora
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Ciudad Universitaria s/n, Madrid 28040, Spain
| | - Andrew Hemphill
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, Bern 3012, Switzerland
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