1
|
Jiang ZJ, Hong JC, Tang QX, Lin BW, Zhang WQ, Xia H, Yao XP. Streptococcus suis meningoencephalitis diagnosed with metagenomic next-generation sequencing: A case report with literature review. J Infect Chemother 2024; 30:544-547. [PMID: 37992864 DOI: 10.1016/j.jiac.2023.11.017] [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] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Streptococcus suis is a pathogen of emerging zoonotic diseases and meningoencephalitis is the most frequent clinical symptom of S. suis infection in humans. Rapid diagnosis of S. suis meningoencephalitis is critical for the treatment of the disease. While the current routine microbiological tests including bacterial culture and gram staining are poorly sensitive, diagnosis of S. suis meningoencephalitis by metagenomic next-generation sequencing (mNGS) has been rarely reported. Here, we report a 52-year-old female pork food producer with a broken finger developed S. suis meningoencephalitis. After her admission, no pathogenic bacteria were detected through bacterial culture and Gram staining microscopy in the cerebrospinal fluid obtained via lumbar puncture. However, mNGS identified the presence of S. suis in the sample. mNGS is a promising diagnostic tool for rapid diagnosis of rare infectious diseases in the central nervous system.
Collapse
Affiliation(s)
- Zai-Jie Jiang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Jian-Chen Hong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Qing-Xi Tang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Bi-Wei Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Wei-Qing Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Han Xia
- Hugobiotech Co., Ltd, Beijing, China
| | - Xiang-Ping Yao
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| |
Collapse
|
2
|
Wang C, Pan M, Lin Q, Mofatteh M, Chen Y, Baizabal-Carvallo JF, Su F, Wang Z. Metagenomic next-generation sequencing assistance in identifying Mycobacterium avium meningoencephalitis: A case report and literature review. Heliyon 2024; 10:e28630. [PMID: 38596092 PMCID: PMC11002592 DOI: 10.1016/j.heliyon.2024.e28630] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Nontuberculous mycobacteria associated intracranial infection is a rare disease that mainly occurs in HIV-infected patients. The disease has a poor prognosis. The authors report a case of non-tuberculous mycobacterial meningoencephalitis in a non-AIDS patient, but long history of poorly controlled type 2 diabetes mellitus. A 55-year-old, right-handed, male patient presented with an 8-day history of fever, episodes of severe headache with signs of meningeal irritation. MRI showed hyperintensities/contrast enhancement in the visual pathways, basal ganglia sellar region and leptomeninges. No etiological diagnosis was reached until metagenomic next-generation sequencing (mNGS) was used, showing the presence of Mycobacterium avium. The patient was cured with aggressive antimycobacterial therapy. The authors discuss the clinical manifestations and drug therapy of nontuberculous mycobacteria-related intracranial infections by reviewing relevant literature. As meningoencephalitis by Mycobacterium avium has a high mortality an early diagnosis and appropriate therapeutic interventions are warranted. For this reason, the use of mNGS can be helpful to avoid therapeutic delay.
Collapse
Affiliation(s)
- Changsheng Wang
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Mengqiu Pan
- Department of Neurology, GuangDong Sanjiu Brain Hospital, Guangzhou, China
| | - Qinjian Lin
- Department of Pharmacy, GuangDong Sanjiu Brain Hospital, Guangzhou, China
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, 528100, China
| | - José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Department of Sciences and Engineering, University of Guanajuato, León, Mexico
| | - Fanghua Su
- Department of Pharmacy, GuangDong Sanjiu Brain Hospital, Guangzhou, China
| | - Zhanhang Wang
- Department of Neurology, GuangDong Sanjiu Brain Hospital, Guangzhou, China
| |
Collapse
|
3
|
Ahn SH, Ahn SJ, Kim SA, Lee HS, Chu K. Eosinophilic meningoencephalitis successfully treated with glucocorticoids and intravenous immunoglobulin: a case report. Encephalitis 2024; 4:40-46. [PMID: 38545640 PMCID: PMC11007548 DOI: 10.47936/encephalitis.2024.00010] [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: 03/04/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024] Open
Abstract
Eosinophilic meningoencephalitis is a rare inflammatory condition of the central nervous system. As a limited number of cases has been reported, debate remains on the optimal treatment. We present a case of idiopathic eosinophilic meningoencephalitis successfully treated with glucocorticoids and intravenous immunoglobulin (IVIG). After extensive evaluation to rule out other possible causes, the patient was treated with intravenous (IV) dexamethasone and showed significant improvement within a few days. However, neurologic impairment persisted, and follow-up lumbar puncture results showed only a mild decrease in pleocytosis. Even after an additional 5 days of IV methylprednisolone, cerebrospinal fluid (CSF) pleocytosis persisted, and brain magnetic resonance imaging (MRI) showed an increase in enhanced lesions, implying persistent neuroinflammation. The patient was maintained on high-dose oral prednisolone for 2 months, and additional immune-modulatory effects were treated with IVIG. Follow-up MRI at 2 months showed a significant decrease in the extent of multiple enhanced lesions and a normalized CSF profile. The patient was maintained on regular maintenance doses of IVIG for an additional 6 months without any neurologic signs or symptoms. Inflammation is the key pathophysiology underlying neurological damage in eosinophilic meningoencephalitis. A literature review revealed that corticosteroid treatment is the only anti-inflammatory treatment used in cases of idiopathic meningoencephalitis, resulting in sufficient response in most patients but only partial response or death in a few cases. This is the first case report of IVIG use in idiopathic eosinophilic meningoencephalitis, suggesting the possibility of a new treatment modality for refractory cases.
Collapse
Affiliation(s)
- Soo Hyun Ahn
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seon-Jae Ahn
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Ae Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
4
|
Pietrasanta C, Ronchi A, Bassi L, De Carli A, Caschera L, Lo Russo FM, Crippa BL, Pisoni S, Crimi R, Artieri G, Pellegrinelli L, Dilena R, Conte G, Mosca F, Fumagalli M, Pugni L. Enterovirus and parechovirus meningoencephalitis in infants: A ten-year prospective observational study in a neonatal intensive care unit. J Clin Virol 2024; 173:105664. [PMID: 38493709 DOI: 10.1016/j.jcv.2024.105664] [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: 10/03/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Non-polio enteroviruses (EV) and human parechoviruses (HPeV) are known etiological agents of meningoencephalitis in neonates. However, reports of neuroradiological findings and neurodevelopmental outcomes in this population are scarce. OBJECTIVES to describe clinical characteristics, neuroradiological findings and, in a subset of patients, neurodevelopmental outcomes in a cohort of infants with EV or HPeV meningoencephalitis within 60 days of life. STUDY DESIGN clinical/laboratory data, neuroradiological findings (cranial ultrasound, cUS, brain magnetic resonance imaging, MRI), and neurodevelopmental outcomes assessed by Ages and Stages Questionnaires - third edition were prospectively collected. RESULTS overall, 32 infants with EV (21, 67.8 %) or HPeV (11, 28.2 %) meningoencephalitis were enrolled. Infants with HPeV (73 %: type 3 HPeV) presented more frequently with seizures (18.2 % vs. 0, p value=0.03), lymphopenia (1120 vs. 2170 cells/mm3, p = 0.02), focal anomalies at electroencephalography (EEG) (63.6 vs. 23.8 %, p = 0.03), and pathological findings at MRI (72.7 % vs. 15.8 %, p value=0.004) compared to those affected by EV. cUS was not significantly altered in any of the enrolled infants. All infants with EV meningoencephalitis evaluated at 12-24 months and at 30-48 months were normal. Two out of the 7 infants with HPeV meningoencephalitis showed some concerns in gross motor (1/7, 14.3 %) or in problem solving (1/7, 14.3 %) function at 30-48 months of age. CONCLUSIONS In our cohort, neonates infected by HPeV had more severe clinical manifestations, more alterations at brain MRI, and some signs of long-term neurodevelopmental delay. Our data highlight the heterogeneity of manifestations in infants with EV or HPeV meningoencephalitis, and the need for long-term follow-up of those infected by HPeV in the neonatal period.
Collapse
Affiliation(s)
- Carlo Pietrasanta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan. Department of Clinical Sciences and Community Health, Milan, Italy.
| | - Andrea Ronchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Laura Bassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Luca Caschera
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Silvia Pisoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Riccardo Crimi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Giacomo Artieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Laura Pellegrinelli
- University of Milan. Department of Biomedical Sciences of Health, Milan, Italy
| | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Neurophysiology Unit, Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; University of Milan. Department of Pathophysiology and Transplantation, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan. Department of Clinical Sciences and Community Health, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan. Department of Clinical Sciences and Community Health, Milan, Italy
| | - Lorenza Pugni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| |
Collapse
|
5
|
Ikenouchi H, Suzuki K, Sato A, Yamamoto N, Miyamoto T, Endo K. A case of meningoencephalitis caused by multisystem inflammatory syndrome in adult SARS-CoV-2 infection. J Infect Chemother 2024; 30:263-265. [PMID: 37863259 DOI: 10.1016/j.jiac.2023.10.013] [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] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
A 37-year-old woman was hospitalized with fever and consciousness disturbance. She showed systemic inflammation with stress cardiomyopathy. Brain computed tomography showed diffuse brain edema. Cerebrospinal fluid (CSF) findings revealed markedly elevated cerebrospinal fluid pressure with pleocytosis, elevated protein, and elevated interleukin 6. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nicking enzyme amplification reaction test using a nasopharyngeal swab was positive, and the patient was diagnosed with SARS-CoV-2 infection. From the negative result of the CSF SARS-CoV-2 polymerase chain reaction test and no findings of bacterial or viral infection, we diagnosed meningoencephalitis by multisystem inflammation syndrome in adults (MIS-A). Intravenous methylprednisolone pulse therapy improved her symptoms and brain edema. There have been no cases of MIS-A with meningoencephalitis, and no initial treatment strategy has been established, especially in emergency cases of suspected MIS-A. The present case suggested Early intravenous methylprednisolone pulse with anti-coronaviral therapies after the exclusion of bacterial infection would be useful in suspected MIS-A with emergent meningoencephalitis cases.
Collapse
Affiliation(s)
- Hajime Ikenouchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan.
| | - Keisuke Suzuki
- Division of Cardiology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan
| | - Ayumi Sato
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan
| | - Naoki Yamamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan
| | - Tatsuo Miyamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan
| |
Collapse
|
6
|
López N, Cuesta G, Rodríguez-Vega S, Rosas E, Chumbita M, Casals-Pascual C, Morata L, Vergara A, Bodro M, Bosch J, Herrera S, Martínez JA, Mensa J, Garcia-Vidal C, Marcos MÁ, Vila J, Soriano A, Puerta-Alcalde P. Multiplex real-time PCR FilmArray performance in the diagnosis of meningoencephalitis: lights and shadows. Infection 2024; 52:165-172. [PMID: 37515691 PMCID: PMC10810907 DOI: 10.1007/s15010-023-02076-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.
Collapse
Affiliation(s)
- Néstor López
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Genoveva Cuesta
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | | | - Enric Rosas
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Climent Casals-Pascual
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Vila
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain.
- Universitat de Barcelona (UB), Barcelona, Spain.
| |
Collapse
|
7
|
Andrade HB, da Silva IRF, Espinoza R, Ferreira MT, da Silva MST, Theodoro PHN, Detepo PJT, Varela MC, Ramos GV, da Silva AR, Soares J, Belay ED, Sejvar JJ, Bozza FA, Cerbino-Neto J, Japiassú AM. Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area. J Crit Care 2024; 79:154451. [PMID: 37871403 DOI: 10.1016/j.jcrc.2023.154451] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates. MATERIALS AND METHODS We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality. RESULTS In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression. CONCLUSIONS Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.
Collapse
Affiliation(s)
- Hugo Boechat Andrade
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil; Sexually Transmitted Diseases Sector, Biomedical Institute, Federal Fluminense University (UFF), Niterói, RJ, Brazil.
| | | | - Rodolfo Espinoza
- Surgical Intensive Care Unit, Hospital Copa Star, Rio de Janeiro, RJ, Brazil; Intensive Care Unit II, Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | - Marcel Treptow Ferreira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Mayara Secco Torres da Silva
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Pedro Henrique Nascimento Theodoro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Paula João Tomás Detepo
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Margareth Catoia Varela
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Immunization and Health Surveillance Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Grazielle Viana Ramos
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Aline Reis da Silva
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Jesus Soares
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ermias D Belay
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Fernando Augusto Bozza
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil; Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - José Cerbino-Neto
- Immunization and Health Surveillance Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - André Miguel Japiassú
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| |
Collapse
|
8
|
Hall AD, Kumar JE, Golba CE, Luckett KM, Bryant WK. Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases. Parasitol Res 2024; 123:84. [PMID: 38182931 DOI: 10.1007/s00436-023-08094-w] [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] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri, a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95-98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri. PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient's history of freshwater exposure and the physician's high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae.
Collapse
Affiliation(s)
- Ashton D Hall
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia E Kumar
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Claire E Golba
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Keith M Luckett
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Whitney K Bryant
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
9
|
Sellali S, Lafri I, Ayhan N, Medrouh B, Messahel NE, Lafri M, Charrel R, Bitam I. Neutralizing based seroprevalence study of Toscana virus in livestock from Algeria. Comp Immunol Microbiol Infect Dis 2023; 103:102075. [PMID: 37922744 DOI: 10.1016/j.cimid.2023.102075] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Toscana virus is a sandfly-borne human pathogen belonging to Phlebovirus genus into Phenuiviridae family. It is emerging in north Africa posing a complex threat to public health. TOSV is heavily affecting sandfly-exposed people in northern Algeria. A larger distribution has recently been stated in Algeria by using dog sera. Dog exposure to TOSV was repeatedly identified in north Algeria, with 4.56% lately detected to possess respective neutralizing antibodies. However, evidence for TOSV has only been observed in dogs among various species of domestic animals. Therefore, we attempted to assess sera from 221 livestock comprising cattle, sheep, goats, rabbits and horses, to identify the presence of TOSV neutralizing antibodies. The study was conducted during 2017, in 11 areas from the governorates of Blida, Medea, Algiers, Tipaza, Ain Defla, Tissemsilt in the north center, and Setif, Mila, Tizi Ouzou, Jijel in the northeast of Algeria. Positive results were obtained in 14.6% (12/82) cattle, 17.18% (11/64) sheep, 15% (3/20) horses and 3.33% (1/30) goats, whereas rabbits remained negative. Positive samples originated mainly from the north centre, with new areas being first-ever detected. The seroprevalence was noticed to be very strongly related to sample origin (p < 0.01). Females (OR=4.09) were observed to be more likely infected. Our findings represent a further proof of TOSV circulation in Algeria. Moreover, they revealed a potential role of livestock (p = 0.00731) in its natural cycle. This fact emphasize how important is to elucidate the exact contribution of livestock to the epidemiology of sandfly-borne phleboviruses, and their impact on public health.
Collapse
Affiliation(s)
- Sabrina Sellali
- Institut des Sciences Vétérinaires, Université Blida 1, Blida, Algeria; Laboraoire des Biotechnologies Liées à la Reproduction Animale (LBRA), Institut des Sciences Vétérinaires Université Blida 1, Blida, Algeria
| | - Ismail Lafri
- Institut des Sciences Vétérinaires, Université Blida 1, Blida, Algeria; Laboraoire des Biotechnologies Liées à la Reproduction Animale (LBRA), Institut des Sciences Vétérinaires Université Blida 1, Blida, Algeria
| | - Nazli Ayhan
- Unité des Virus Emergents (UVE: Aix Marseille Université, IRD 190, Inserm 1207, AP-HM Hôpitaux Universitaires de Marseille, Marseille, France
| | - Bachir Medrouh
- Center of Research in Agro-pastoralism, Djelfa 17000, Algeria
| | | | - Mohamed Lafri
- Institut des Sciences Vétérinaires, Université Blida 1, Blida, Algeria; Laboraoire des Biotechnologies Liées à la Reproduction Animale (LBRA), Institut des Sciences Vétérinaires Université Blida 1, Blida, Algeria
| | - Remi Charrel
- Unité des Virus Emergents (UVE: Aix Marseille Université, IRD 190, Inserm 1207, AP-HM Hôpitaux Universitaires de Marseille, Marseille, France
| | - Idir Bitam
- Center of Research in Agro-pastoralism, Djelfa 17000, Algeria.
| |
Collapse
|
10
|
Kim HS, Kim SH, Song HS, Kwon YK, Park CK, Kim HR. Application of metagenomics for diagnosis of broilers displaying neurological symptoms. BMC Vet Res 2023; 19:190. [PMID: 37798783 PMCID: PMC10552438 DOI: 10.1186/s12917-023-03732-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Thirty-two-day-old broiler chickens at a farm located in northwestern South Korea displayed adverse neurological symptoms including limping, lying down, and head shaking. Approximately 2.1% of chickens died or were culled due to severe symptoms. Five carcasses were submitted to the Avian Disease Division of the Animal and Plant Quarantine Agency (APQA) for disease diagnosis. RESULTS Broilers displayed severe pericarditis and perihepatitis associated with gross lesions. Broilers also displayed microscopic lesions in the cerebrum and in the granular layer of the cerebellum, which were associated with multifocal perivascular cuffing and purulent necrosis in the cerebrum, and severe meningitis with heterophil and lymphocyte infiltration. Staphylococcus spp. were identified in the liver and heart using bacteriological culture. PCR/RT-PCR assays revealed that broilers were negative for avian Clostridium botulinum, Newcastle disease virus, and avian encephalomyelitis virus. Bacterial and viral metagenomic analysis of brain sample further revealed the presence of Pseudomonas spp. and Marek's disease virus, which are known etiological agents of chicken meningoencephalitis. CONCLUSIONS This study reports a diagnostic analysis of gross and histopathological lesions from 32-day-old broilers displaying unique neurological symptoms that revealed the presence of the several neurological diseases including meningoencephalitis. The causative agents associated with meningoencephalitis of broilers that had not been identified by routine diagnostic methods could be diagnosed by metagenomics, which proves the usefulness of metagenomics as a diagnostic tool for unknown neurological diseases in broilers.
Collapse
Grants
- M-1543084-2023-25-01 Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, the Republic of Korea.
- M-1543084-2023-25-01 Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, the Republic of Korea.
- M-1543084-2023-25-01 Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, the Republic of Korea.
- M-1543084-2023-25-01 Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, the Republic of Korea.
- M-1543084-2023-25-01 Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, the Republic of Korea.
Collapse
Affiliation(s)
- Hyeon-Su Kim
- Avian Disease Division, Animal and Plant Quarantine Agency, 177 Hyeoksin 8-ro, Gimcheon-si, 39660 Korea
- College of Veterinary Medicine & Animal Disease Intervention Center, Kyungpook National University, Daegu, 41566 Korea
| | - Si-Hyeon Kim
- Avian Disease Division, Animal and Plant Quarantine Agency, 177 Hyeoksin 8-ro, Gimcheon-si, 39660 Korea
- College of Veterinary Medicine & Animal Disease Intervention Center, Kyungpook National University, Daegu, 41566 Korea
| | - Hye-Soon Song
- Avian Disease Division, Animal and Plant Quarantine Agency, 177 Hyeoksin 8-ro, Gimcheon-si, 39660 Korea
| | - Yong-Kuk Kwon
- Avian Disease Division, Animal and Plant Quarantine Agency, 177 Hyeoksin 8-ro, Gimcheon-si, 39660 Korea
| | - Choi-Kyu Park
- College of Veterinary Medicine & Animal Disease Intervention Center, Kyungpook National University, Daegu, 41566 Korea
| | - Hye-Ryoung Kim
- Avian Disease Division, Animal and Plant Quarantine Agency, 177 Hyeoksin 8-ro, Gimcheon-si, 39660 Korea
| |
Collapse
|
11
|
Mostel Z, Nguyen BA, Costanzo L, Bankhead S, Ayat P, Taluru H, Puskoor A, Ahmed Z, Chiu E, El Sehamy A, Smith DN. Thrombotic Thrombocytopenic Purpura due to Varicella-Zoster Virus Meningoencephalitis in an Immunocompetent Patient. J Glob Infect Dis 2023; 15:172-174. [PMID: 38292692 PMCID: PMC10824231 DOI: 10.4103/jgid.jgid_241_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 02/01/2024] Open
Abstract
Varicella-zoster virus (VZV) can cause variable disease states in individuals with intact and compromised immune systems. Both meningoencephalitis and thrombotic thrombocytopenic purpura (TTP) are uncommon, life-threatening entities associated with VZV. There are few reported cases of TTP due to VZV and this may be the first case of TTP due to VZV meningoencephalitis confirmed through lumbar puncture. The literature tends to emphasize that this pathology mostly occurs in immunocompromised hosts. Here, we present a unique case of TTP due to VZV meningoencephalitis in a patient that was immunocompetent.
Collapse
Affiliation(s)
- Zachary Mostel
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Ben Anthony Nguyen
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Louis Costanzo
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Sarah Bankhead
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Parinaz Ayat
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Harsha Taluru
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Anoop Puskoor
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Zahra Ahmed
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Edwin Chiu
- Department of Medicine, Division of Hematology and Oncology, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Adam El Sehamy
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - David Nathaniel Smith
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| |
Collapse
|
12
|
Lan J, Lv L, Ye L, Wang T, Wu Z, Wu S, Peng C, Lu W, Lu T. Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature. J Med Case Rep 2023; 17:332. [PMID: 37542340 PMCID: PMC10403845 DOI: 10.1186/s13256-023-04066-x] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/04/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. CASE PRESENTATION A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. CONCLUSION There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.
Collapse
Affiliation(s)
- Jianhua Lan
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Luyi Lv
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Ling Ye
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Tao Wang
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Zhiyu Wu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Shugen Wu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Chunxian Peng
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Weili Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Tao Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China.
| |
Collapse
|
13
|
Wang HY, Hu Z, Han J, Wang D, Wu Q. Remote cerebellar hemorrhage following repeated lumbar punctures. BMC Neurol 2023; 23:220. [PMID: 37291540 DOI: 10.1186/s12883-023-03276-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Remote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery. No case of RCH secondary to repeated lumbar punctures (LPs) has been previously reported. CASE PRESENTATION A 49-year-old man presented with impaired consciousness following persistent fever. Cerebrospinal fluid examination showed high opening pressure, elevated white blood cells, increased protein level, and decreased glucose level, resulting in a diagnosis of bacterial meningoencephalitis. Treatment with repeated LPs and intrathecal injection of ceftriaxone resulted in an improvement in neurological symptoms. However, on day 31 of treatment, brain magnetic resonance image (MRI) showed streaky bleeding in bilateral cerebellum (zebra sign), leading to a diagnosis of RCH. Close observation and repeated brain MRI imaging without specific treatments led to the absorption of bilateral cerebellar hemorrhage, and the patient was discharged with improved neurological symptoms. Repeated brain MRI scans one month after discharge showed that bilateral cerebellar hemorrhage had improved, and had disappeared one year after discharge. CONCLUSION We reported a rare occurrence of LPs-induced RCH presenting as isolated bilateral inferior cerebellar hemorrhage. Clinicians should be vigilant of the risk factors for RCH, closely monitoring patients' clinical symptoms and neuroimaging findings to determine the need for specialized treatment. Furthermore, this case highlights the importance of ensuring the safety of LPs and managing any potential complications appropriately.
Collapse
Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No.1 People's Hospital, Jining, 272000, Shandong Province, China
| | - Zerui Hu
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, 272000, China
| | - Jinming Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Dongsen Wang
- Clinical Medical College of Jining Medical University, Jining, Shandong Province, 272067, China
| | - Qingjian Wu
- Department of Emergency, Jining No.1 People's Hospital, No. 6, Jiankang Road, Jining, 272011, Shandong Province, China.
| |
Collapse
|
14
|
Cottu A, Kante A, Megherbi A, Lhomme S, Maisonneuve L, Santoli F. A frantic confusion: beyond rabies and anti-N-methyl-D-aspartate encephalitis. J Neurovirol 2023; 29:358-363. [PMID: 37171751 DOI: 10.1007/s13365-023-01146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/12/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
Hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide. In rare cases, HEV may generate neurologic lesions such as neuralgic amyotrophy, Guillain-Barré syndrome, and meningoencephalitis. Thirteen cases of HEV meningoencephalitis have been reported over 20 years. The clinical landscape varied from mild symptoms to coma and seizures. Most of patients were immunocompetent adults and spontaneously recovered. We report here the case of a 44-year-old immunocompetent adult with HEV meningoencephalitis presenting with aggressiveness and then coma. The evolution was spontaneously favorable without any specific treatment. This clinical case aims to draw attention on this emerging and probably under-recognized cause of meningoencephalitis.
Collapse
Affiliation(s)
- Adrien Cottu
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire Robert Ballanger, Aulnay-Sous-Bois, France.
- Université Pierre et Marie Curie, Sorbonne Universités, Paris 6, Paris, France.
| | - Aïcha Kante
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire Robert Ballanger, Aulnay-Sous-Bois, France
- Université Pierre et Marie Curie, Sorbonne Universités, Paris 6, Paris, France
| | - Alexandre Megherbi
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire Robert Ballanger, Aulnay-Sous-Bois, France
- Université Pierre et Marie Curie, Sorbonne Universités, Paris 6, Paris, France
| | - Sébastien Lhomme
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, 31300, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), UMR1291-CNRS UMR5051, INSERM, 31300, Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062, Toulouse, France
| | - Lydia Maisonneuve
- Service de Biologie Médicale, Centre Hospitalo-Universitaire Robert Ballanger, Aulnay-Sous-Bois, France
| | - Francesco Santoli
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire Robert Ballanger, Aulnay-Sous-Bois, France
| |
Collapse
|
15
|
Araujo IL, Piraine REA, Fischer G, Leite FPL. Recombinant BoHV-5 glycoprotein (rgD5) elicits long-lasting protective immunity in cattle. Virology 2023; 584:44-52. [PMID: 37244054 DOI: 10.1016/j.virol.2023.04.004] [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: 07/02/2022] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/29/2023]
Abstract
BoHV-5 is a worldwide distributed pathogen usually associated with a lethal neurological disease in dairy and beef cattle resulting in important economic losses due to the cattle industry. Using recombinant gD5, we evaluated the long-duration humoral immunity of the recombinant vaccines in a cattle model. Here we report that two doses of intramuscular immunization, particularly with the rgD5ISA vaccine, induce long-lasting antibody responses. Recombinant gD5 antigen elicited tightly mRNA transcription of the Bcl6 and the chemokine receptor CXCR5 which mediate memory B cells and long-lived plasma cells in germinal centers. In addition, using an in-house indirect ELISA we observed higher and earlier responses of rgD5-specific IgG antibody and the upregulation of mRNA transcription of IL2, IL4, IL10, IL15, and IFN-γ in rgD5 vaccinated cattle, indicating a mixed immune response. We further show that rgD5 immunization protects against both BoHV -1 and -5. Our findings indicate that the rgD5-based vaccine represents an effective vaccine strategy to induce an efficient control of herpesviruses.
Collapse
Affiliation(s)
- Itauá L Araujo
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, Brazil.
| | - Renan E A Piraine
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, Brazil.
| | - Geferson Fischer
- Laboratory of Virology and Immunology, Federal University of Federal de Pelotas, Pelotas, RS, Brazil.
| | - Fábio P L Leite
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, Brazil; Laboratory of Virology and Immunology, Federal University of Federal de Pelotas, Pelotas, RS, Brazil.
| |
Collapse
|
16
|
Sonneville R, de Montmollin E, Contou D, Ferrer R, Gurjar M, Klouche K, Sarton B, Demeret S, Bailly P, da Silva D, Escudier E, Le Guennec L, Chabanne R, Argaud L, Ben Hadj Salem O, Thyrault M, Frerou A, Louis G, De Pascale G, Horn J, Helbok R, Geri G, Bruneel F, Martin-Loeches I, Taccone FS, De Waele JJ, Ruckly S, Staiquly Q, Citerio G, Timsit JF. Clinical features, etiologies, and outcomes in adult patients with meningoencephalitis requiring intensive care (EURECA): an international prospective multicenter cohort study. Intensive Care Med 2023; 49:517-529. [PMID: 37022378 DOI: 10.1007/s00134-023-07032-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE We aimed to characterize the outcomes of patients with severe meningoencephalitis requiring intensive care. METHODS We conducted a prospective multicenter international cohort study (2017-2020) in 68 centers across 7 countries. Eligible patients were adults admitted to the intensive care unit (ICU) with meningoencephalitis, defined by an acute onset of encephalopathy (Glasgow coma scale (GCS) score [Formula: see text] 13), a cerebrospinal fluid pleocytosis [Formula: see text] 5 cells/mm3, and at least two of the following criteria: fever, seizures, focal neurological deficit, abnormal neuroimaging, and/or electroencephalogram. The primary endpoint was poor functional outcome at 3 months, defined by a score of three to six on the modified Rankin scale. Multivariable analyses stratified on centers investigated ICU admission variables associated with the primary endpoint. RESULTS Among 599 patients enrolled, 589 (98.3%) completed the 3-month follow-up and were included. Overall, 591 etiologies were identified in those patients which were categorized into five groups: acute bacterial meningitis (n = 247, 41.9%); infectious encephalitis of viral, subacute bacterial, or fungal/parasitic origin (n = 140, 23.7%); autoimmune encephalitis (n = 38, 6.4%); neoplastic/toxic encephalitis (n = 11, 1.9%); and encephalitis of unknown origin (n = 155, 26.2%). Overall, 298 patients (50.5%, 95% CI 46.6-54.6%) had a poor functional outcome, including 152 deaths (25.8%). Variables independently associated with a poor functional outcome were age > 60 years (OR 1.75, 95% CI 1.22-2.51), immunodepression (OR 1.98, 95% CI 1.27-3.08), time between hospital and ICU admission > 1 day (OR 2.02, 95% CI 1.44-2.99), a motor component on the GCS [Formula: see text] 3 (OR 2.23, 95% CI 1.49-3.45), hemiparesis/hemiplegia (OR 2.48, 95% CI 1.47-4.18), respiratory failure (OR 1.76, 95% CI 1.05-2.94), and cardiovascular failure (OR 1.72, 95% CI 1.07-2.75). In contrast, administration of a third-generation cephalosporin (OR 0.54, 95% CI 0.37-0.78) and acyclovir (OR 0.55, 95% CI 0.38-0.80) on ICU admission were protective. CONCLUSION Meningoencephalitis is a severe neurologic syndrome associated with high mortality and disability rates at 3 months. Actionable factors for which improvement could be made include time from hospital to ICU admission, early antimicrobial therapy, and detection of respiratory and cardiovascular complications at admission.
Collapse
Affiliation(s)
- Romain Sonneville
- Université Paris Cité, INSERM UMR 1137, 75018, Paris, France.
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 75018, Paris, France.
- Service de Médecine Intensive-Réanimation, Hôpital Bichat-Claude Bernard, 46 Rue Henri Huchard, 75877, Paris Cedex, France.
| | - Etienne de Montmollin
- Université Paris Cité, INSERM UMR 1137, 75018, Paris, France
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Damien Contou
- Department of Intensive Care Medicine, Victor Dupouy Hospital, Argenteuil, France
| | - Ricard Ferrer
- Department of Intensive Care Medicine, Val d'Hebron University Hospital, Barcelona, Spain
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Kada Klouche
- Department of Intensive Care Medicine, Montpellier University Hospital, Montpellier, France
| | - Benjamine Sarton
- Department of Intensive Care Medicine, Purpan University Hospital, Toulouse, France
| | - Sophie Demeret
- Sorbonne University, AP-HP, Neurology Department, Neurological Intensive Care Unit, Pitié Salpêtrière Hospital, Paris, France
| | - Pierre Bailly
- Department of Intensive Care Medicine, Brest University Hospital, Brest, France
| | - Daniel da Silva
- Department of Intensive Care Medicine, Saint Denis University Hospital, Saint Denis, France
| | - Etienne Escudier
- Department of Intensive Care Medicine, Annecy Hospital, Annecy, France
| | - Loic Le Guennec
- Department of Intensive Care Medicine, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Russel Chabanne
- Department of Anesthesia and Intensive Care Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Argaud
- Department of Intensive Care Medicine, Lyon University Hospital, Lyon, France
| | - Omar Ben Hadj Salem
- Department of Intensive Care Medicine, Poissy-Saint Germain Hospital, Poissy, France
| | - Martial Thyrault
- Department of Intensive Care Medicine, Longjumeau hospital, Longjumeau, France
| | - Aurélien Frerou
- Department of Intensive Care Medicine, Pontchaillou Hospital, Rennes, France
| | - Guillaume Louis
- Department of Intensive Care Medicine, Metz Hospital, Metz, France
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Janneke Horn
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Guillaume Geri
- Department of Intensive Care Medicine, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Fabrice Bruneel
- Department of Intensive Care Medicine, Versailles Hospital, Le Chesnay, France
| | | | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | - Giuseppe Citerio
- School of Medicine and Surgery, University Milano Bicocca, Milan, Italy
- NeuroIntensive Care Unit, Department of Neuroscience, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Jean-François Timsit
- Université Paris Cité, INSERM UMR 1137, 75018, Paris, France
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| |
Collapse
|
17
|
Dagra A, Lyerly M, Lucke-Wold B. Encephalitis and Meningitis: Indications for Intervention. Clin Res (Westerville) 2023; 4:8. [PMID: 37229501 PMCID: PMC10207635] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Meningitis and encephalitis are characterized by inflammation of the meninges and brain parenchyma, respectively. The blood-brain barrier normally acts as a protective barrier against inflammation in the central nervous system (CNS), but its compromise requires prompt diagnosis and treatment to prevent morbidity and mortality. Optimizing therapy for meningitis and encephalitis can expedite resolution of symptoms, mitigating the risk of neuronal injury and minimizing potential long-term neurological sequelae. This paper aims to provide a comprehensive overview of the etiology and pathophysiology of meningitis and encephalitis, discussing the diagnostic criteria, and emphasizing the clinical indications for treatments, including current treatment strategies, and emerging therapeutic approaches.
Collapse
Affiliation(s)
- Abeer Dagra
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mac Lyerly
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | |
Collapse
|
18
|
Yang RX, Chen B, Zhang Y, Yang Y, Xie S, He L, Shi J. Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report. World J Clin Cases 2023; 11:2315-2320. [PMID: 37122516 PMCID: PMC10131016 DOI: 10.12998/wjcc.v11.i10.2315] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae.
CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment.
CONCLUSION Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.
Collapse
Affiliation(s)
- Rui-Xi Yang
- Department of Infectious Diseases, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Bei Chen
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yun Zhang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yao Yang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Shu Xie
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Lin He
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Jian Shi
- Department of Psychosomatic Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| |
Collapse
|
19
|
Di Rubbo V, Morelli L, Zangrandi A, Lauda L, Piras G, Sanna M. Late complications of cochlear implant: a case report of necrotizing meningoencephalitis similar to a CPA tumor. Eur Arch Otorhinolaryngol 2023; 280:3485-3488. [PMID: 37020047 DOI: 10.1007/s00405-023-07956-4] [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: 01/27/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Report a case of localized necrotizing meningoencephalitis as the cause of functional hearing loss after cochlear implant (CI) surgery. CASE REPORT A 12-year-old with bilateral CI presented to our quaternary center due to severe functional hearing loss after 11 years since left ear CI surgery. CT with contrast was conducted showing a CPA tumor-like mass. Pre-operative computed tomography (CT) scans and magnetic resonance imaging (MRI) performed at the age of 1 year showed no inner ear abnormalities and in particular no evidence of a tumor in the cerebellopontine angle (CPA). CONCLUSION Following removal of the CI and the mass, histopathological, immunohistochemical and cultural examinations revealed a necrotizing meningoencephalitis, with the CI electrode as the focus.
Collapse
Affiliation(s)
- Vittoria Di Rubbo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Luca Morelli
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Italy.
| | - Adriano Zangrandi
- Department of Oncohematology, Pathological Anatomy, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| |
Collapse
|
20
|
Li K, Wu J, Chen J, You Y. Glial fibrillary acidic protein astrocytopathy and tuberculous meningoencephalitis occurring in a patient with Legionella pneumonia: a case report. BMC Neurol 2023; 23:69. [PMID: 36782173 PMCID: PMC9923896 DOI: 10.1186/s12883-023-03113-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a recently identified recurrent meningoencephalomyelitis with GFAP immunoglobulin G presence in the serum or cerebrospinal fluid (CSF) as a specific biomarker. GFAP astrocytopathy is closely associated with the occurrence of some tumors and often coexists with other antibodies, such as the N-methyl-D-aspartate receptor and aquaporin-4 antibodies. However, GFAP astrocytopathy complicated by central nervous system infection is rare. CASE PRESENTATION Here, we present the case of a patient admitted to a local hospital due to a prominent fever and cough. The patient had a 1-month history of headaches before admission that were not considered serious at the time. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid revealed a high sequence number of Legionella pneumophila and a few mycobacteria. His cough and fever improved significantly after antibiotic treatment. Still, a slight headache remained. Subsequently, his condition worsened, and he visited our hospital with a disturbance of consciousness. Mycobacterium tuberculosis was detected with mNGS of the CSF, while the CSF and serum were also positive for GFAP antibodies. Following anti-tuberculosis and steroid therapy, the patient's symptoms improved, and he tested negative for the GFAP antibody. CONCLUSION This is the first reported case of GFAP astrocytopathy complicated by tuberculous meningoencephalitis. Due to overlaps in the clinical manifestations of the two diseases, GFAP astrocytopathy is sometimes misdiagnosed as tuberculous meningoencephalitis. Therefore, in addition to ensuring careful identification of the two diseases, clinicians need to be aware of their possible co-existence.
Collapse
Affiliation(s)
- Ke Li
- grid.443397.e0000 0004 0368 7493Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, 570013 Haikou, China
| | - Jingwei Wu
- grid.443397.e0000 0004 0368 7493Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, 570013 Haikou, China
| | - Junwu Chen
- Department of Internal Medicine, Changjiang County Medical Group, Changjiang, China
| | - Yong You
- Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, 570013, Haikou, China.
| |
Collapse
|
21
|
Etemadifar M, Fereidan-Esfahani M, Sedaghat N, Kargaran PK, Mansouri AR, Abhari AP, Aghababaei A, Jannesari A, Salari M, Ganjalikhani-Hakemi M, Nouri H. Non-infectious meningitis and CNS demyelinating diseases: A conceptual review. Rev Neurol (Paris) 2023:S0035-3787(23)00756-7. [PMID: 36781321 DOI: 10.1016/j.neurol.2022.10.006] [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: 06/12/2022] [Revised: 09/11/2022] [Accepted: 10/17/2022] [Indexed: 02/13/2023]
Abstract
Many cases of aseptic meningitis or meningoencephalitis, unresponsive to antimicrobial treatments, have been reported recently in patients with established/new-onset central nervous system (CNS) inflammatory demyelinating diseases (CNSIDDs). Given the higher probability of infectious etiologies, CNSIDDs are rarely considered among the differentials in meningitis or meningoencephalitis cases. We gathered and tabulated cases of non-infectious, steroid-responsive meningitis or meningoencephalitis associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). This conceptual review highlights the need to bolster routine infectious workups with immunological workups in cases of meningoencephalitis or meningitis where potential autoimmune etiologies can be suspected. Although differentiating CNSIDDs with meningeal involvement from infectious meningitis may not substantially affect acute treatment strategies, long-term management and follow-up of the two are entirely different. We also discuss future research directions and hypotheses on how CNSIDDs may be associated with meningitis-like presentations, e.g. overlapping glial fibrillary acidic protein astrocytopathy or autoimmune encephalitis, alterations in regulatory T-helper cells function, and undetected viral agents.
Collapse
Affiliation(s)
- M Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Fereidan-Esfahani
- Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, MN, USA
| | - N Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - P K Kargaran
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, Rochester, MN, USA
| | - A R Mansouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A P Abhari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - A Aghababaei
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Jannesari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Ganjalikhani-Hakemi
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H Nouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
| |
Collapse
|
22
|
Zeng X, Shen J, Li D, Liu S, Feng Y, Yuan D, Wang L, Wu Z. CEBPα/miR-101b-3p promotes meningoencephalitis in mice infected with Angiostrongylus cantonensis by promoting microglial pyroptosis. Cell Commun Signal 2023; 21:31. [PMID: 36747241 PMCID: PMC9903543 DOI: 10.1186/s12964-023-01038-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Angiostrongylus cantonensis (A. cantonensis) infection can induce acute inflammation, which causes meningoencephalitis and tissue mechanical injury to the brain. Parasite infection-induced microRNAs play important roles in anti-parasite immunity in non-permissive hosts. miR-101b-3p is highly expressed after A. cantonensis infection; however, the role of miR-101b-3p and the transcription regulation of miR-101b-3p in A. cantonensis infection remain poorly characterized. RESULTS In the present study, we found that miR-101b-3p inhibition alleviated inflammation infiltration and pyroptosis in A. cantonensis infection. In addition, we found that CCAAT/enhancer-binding protein alpha (CEBPα) directly bound to the - 6-k to - 3.5-k region upstream of miR-101b, and CEBPα activated miR-101b-3p expression in microglia. These data suggest the existence of a novel CEBPα/miR-101b-3p/pyroptosis pathway in A. cantonensis infection. Further investigation verified that CEBPα promotes pyroptosis by activating miR-101b-3p expression in microglia, and microglial pyroptosis further promoted inflammation. CONCLUSIONS Our results suggest that a CEBPα/miR-101b-3p/pyroptosis pathway may contribute to A. cantonensis infection-induced inflammation and highlight the pro-inflammatory effect of miR-101b-3p. Video Abstract.
Collapse
Affiliation(s)
- Xingda Zeng
- grid.12981.330000 0001 2360 039XDepartment of Parasitology of Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XKey Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, 510080 China ,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080 China
| | - Jia Shen
- grid.12981.330000 0001 2360 039XDepartment of Parasitology of Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XKey Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, 510080 China ,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080 China
| | - Dinghao Li
- grid.12981.330000 0001 2360 039XDepartment of Parasitology of Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XKey Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, 510080 China ,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080 China
| | - Shurui Liu
- grid.12981.330000 0001 2360 039XDepartment of Parasitology of Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XKey Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, 510080 China ,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080 China
| | - Ying Feng
- grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, 510006 China
| | - Dongjuan Yuan
- grid.20561.300000 0000 9546 5767College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642 China
| | - Lifu Wang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, 510180, China.
| | - Zhongdao Wu
- Department of Parasitology of Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, China. .,Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, 510080, China. .,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080, China.
| |
Collapse
|
23
|
De Grado A, Cencini F, Priori A. Neurology of cancer immunotherapy. Neurol Sci 2023; 44:137-48. [PMID: 36112276 DOI: 10.1007/s10072-022-06297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Immunotherapy is nowadays considered a mainstay of cancer treatment, dramatically affecting the disease-free survival rate in several aggressive malignancies. Unfortunately, cancer immunotherapy can also trigger life-threatening autoimmune neurological complications named "neurological adverse effects" (NAEs). NAEs can affect both the central nervous system (CNS), as in ipilimumab-related aseptic meningitis, and the peripheral nervous system (PNS), as in nivolumab-induced myasthenia gravis. CURRENT EVIDENCE The incidence of NAEs is highly variable, ranging from 2 to 4% using checkpoint inhibitors to 50% using blinatumomab. Looking at these numbers, it appears clear that neurologists will soon be called more and more frequently to decide upon the best therapeutic strategy for a patient receiving immunotherapy and experiencing a NAE. Most of them can be treated or reverted withholding the offending drug and adding IVIg, plasmapheresis, or steroids to the therapy. Sometimes, however, for oncological reasons, immunotherapy cannot be stopped so the neurologist needs to know what countermeasures have proven most effective. Moreover, patients with a pre-existing autoimmune neurological disease (AID), such as myasthenia gravis or multiple sclerosis, might need immunotherapy during their life, risking a severe worsening of their symptoms. In that setting, the neurologist needs to properly counsel patients about the risk of a therapy-related relapse. CONCLUSION In this article, we describe the most frequently reported NAEs and aim to give neurologists a practical overview on how to deal with them.
Collapse
|
24
|
de Oliveira RVM, Corrêa-Moreira D, Mendes TV, da Costa GL, Vieira RDM, Buchele CMN, Lins RS, Ferreira ABTBC, Veira DB, Pedroso RSDA, de Faria VTDP, Oliveira MME. First report of fungal meningoencephalitis by Penicillium chrysogenum in Brazil. Int J Infect Dis 2023; 126:94-97. [PMID: 36427702 DOI: 10.1016/j.ijid.2022.11.015] [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: 07/28/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Fungal infections of the central nervous system present a variety of clinical syndromes, such as meningitis, encephalitis, raised intracranial pressure with a nonspecific presentation, and, in the last two decades, have increased the incidence of these fungal infections. Fungal meningoencephalitis is frequently associated with Cryptococcus, but this report stands out for presenting one species of Penicillium genus. OBJECTIVES Here, we present the first case of meningoencephalitis associated with brain injury caused by Penicillium chrysogenum, in a patient who is immunocompetent and was admitted to Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil. METHODS To identify the fungal species, we performed phenotypic and genotypic methodologies, from the culture to the sequencing of internal transcribed spacer region, and β-tubulin gene, a rare fungus in cerebrospinal fluid cultures, belonging to the genus Penicillium, was identified. CONCLUSION We highlight the importance of the first report of meningoencephalitis caused by P. chrysogenum in a patient who is immunocompetent, registered in Brazil. We also emphasize the need for further studies to determine an effective treatment with the least possible side effects for patients infected by fungi that are rarely related to the most severe forms of invasive infections.
Collapse
Affiliation(s)
| | - Danielly Corrêa-Moreira
- Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil; Laboratory of Taxonomy, Biochemistry and Bioprospecting of Fungi, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Túlio Vieira Mendes
- Infectious Diseases Department, Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil; Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Gisela Lara da Costa
- Laboratory of Taxonomy, Biochemistry and Bioprospecting of Fungi, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | | | | | - Rodrigo Schrage Lins
- Infectious Diseases Department, Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil
| | | | - Daniela Barbosa Veira
- Infectious Diseases Department, Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
25
|
Lu KH, Wu TC, Yeh PS. Cytotoxic Lesions beyond the Corpus Callosum Following Acute Meningoencephalitis and Mycoplasma Pneumoniae Infection: A Case Report and Literature Review. Case Rep Neurol 2023; 15:113-119. [PMID: 37497263 PMCID: PMC10368104 DOI: 10.1159/000530944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/04/2023] [Accepted: 04/24/2023] [Indexed: 07/28/2023] Open
Abstract
Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with a variety of clinical causes. The presence of a small and reversible lesion in the splenium of corpus callosum with restricted diffusion on cranial magnetic resonance imaging is the defining feature. The clinical-radiological manifestations have been documented as mild and reversible. Severer presentations were scarcely reported. In this report, we described a 25-year-old man with preceding fever, worsening somnolence, and convulsions. He was diagnosed with acute meningoencephalitis and Mycoplasma pneumoniae infection after workups. After medical treatments, he had neurological deterioration and progressing CLOCCs from a small oval lesion in the center of splenium extending to the whole corpus callosum and bilaterally adjacent white matter. The patient received intravenous methylprednisolone and immunoglobulin successively, and his neurological conditions improved. The CLOCCs, not always mild and reversible, could present with severe clinicoradiological features.
Collapse
Affiliation(s)
- Kuan-Hsien Lu
- Department of Neurology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Te-Chang Wu
- Division of Neuroradiology, Department of Radiology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Poh-Shiow Yeh
- Department of Neurology, Chi-Mei Medical Center, Tainan City, Taiwan
| |
Collapse
|
26
|
Naderi H, Sheybani F, Parsa A, Haddad M, Khoroushi F. Neurobrucellosis: report of 54 cases. Trop Med Health 2022; 50:77. [PMID: 36242068 PMCID: PMC9569038 DOI: 10.1186/s41182-022-00472-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brucellosis is among the most widespread zoonotic diseases worldwide. Although rare, nervous system involvement due to Brucella infection is a major diagnostic challenge in endemic regions. PATIENTS AND METHODS This study was a cross-sectional investigation of hospitalized adults with neurobrucellosis from March 2007 to February 2017. We described the clinical characteristics, radiographical and laboratory features, and clinical outcomes of patients with neurobrucellosis. RESULTS Fifty-four patients with neurobrucellosis were included. The median age was 35 (interquartile range, 25-50) years, and 32 (59%) cases were male. Thirty-four (63%) patients were stockmen or shepherds. The most common clinical manifestations were fever in 49 (91%) cases, headache in 47 (87%), decreased consciousness in 12 (22%), and seizures in 6 (11%). Meningeal signs were detected in 36 (67%) cases. Brucella species were isolated in five cases from blood or cerebrospinal fluid (CSF). The median of CSF leukocytes was 75 per µL, CSF protein 83 mg/dL, and CSF glucose 39 mg/dL. Only two cases had severe hypoglycorrhachia and one CSF protein ≥ 500 mg/dL. No patient died during hospitalization. CONCLUSIONS The symptoms of neurobrucellosis could be mild and nonspecific and the classic triad of meningitis is uncommon. Mild CSF pleocytosis of fewer than 50 leukocytes per microliter of CSF was common but severe hyperproteinorrhachia and severe hypoglycorrhachia were rare in neurobrucellosis. Differentiation between neurobrucellosis and systemic brucellosis is important, because more prolonged treatment is indicated for neurobrucellosis, and it could be associated with a broad spectrum of complications that require close follow-up.
Collapse
Affiliation(s)
- HamidReza Naderi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ashkan Parsa
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Haddad
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
27
|
Quek AM, Tang D, Chin A, Ng KW, Lin H, Seet RC. Autoimmune Glial Fibrillary Acidic Protein (GFAP) Astrocytopathy Masquerading as Tuberculosis of the Central Nervous System: A Case Series. Int J Infect Dis 2022; 124:164-167. [PMID: 36162739 DOI: 10.1016/j.ijid.2022.09.029] [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: 07/02/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 10/31/2022] Open
Abstract
We describe the case history of 3 patients with meningoencephalitis who were initially treated for presumed tuberculous meningoencephalitis before being diagnosed with autoimmune GFAP astrocytopathy. We highlight overlapping clinical features between autoimmune GFAP astrocytopathy and tuberculous meningoencephalitis and challenges in early diagnosis, as both entities respond to an initial course of steroids accompanying anti-tuberculous medications. Early evaluation of GFAP-IgG in cerebrospinal fluid of patients who present with aseptic meningoencephalitis could reveal autoimmune GFAP astrocytopathy which responds favorably to immunotherapy.
Collapse
Affiliation(s)
- Amy Ml Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - David Tang
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Amanda Chin
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Kay Wp Ng
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hazel Lin
- Department of Ophthalmology, National University Hospital, Singapore
| | - Raymond Cs Seet
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
28
|
Vaughn JA, Goncalves LF, Cornejo P. Intrauterine and Perinatal Infections. Clin Perinatol 2022; 49:751-770. [PMID: 36113933 DOI: 10.1016/j.clp.2022.05.008] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging plays an important role in evaluating patients with suspected intrauterine and perinatal infections. Advances in fetal imaging including both ultrasound and MRI allow for increasingly more specific diagnosis if the radiologist is familiar with specific imaging features and patterns. Early imaging of neonates with suspected central nervous system infection is valuable to enable prompt treatment and differentiate infection from other conditions which can clinically present similarly. Ultrasound is a useful initial modality to screen for abnormalities however MRI with and without contrast remains the optimal examination to characterize infection, evaluate for potential surgical targets, and provide prognostic information.
Collapse
Affiliation(s)
- Jennifer A Vaughn
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA.
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
29
|
Jindal AK, Chaudhary H, Tyagi R, Rawat A, Suri D, Patra PK, Arora K, Chawla S, Vyas S, Arora M, Aggarwal R, Basu S, Bansal R, Sachdeva MUS, Gupta A, Pandiarajan V, Sankhyan N, Suthar R, Sahu JK, Singh M, Mani R, Sharma R, Saka R, Imai K, Ohara O, Nonoyama S, Hammarström L, Chan KW, Lau YL, Singh S. Meningoencephalitis in primary antibody deficiency: Our experience from northwest India. J Neuroimmunol 2022; 371:577952. [PMID: 36030644 DOI: 10.1016/j.jneuroim.2022.577952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVES Patients with primary antibody deficiency (PAD) are predisposed to develop meningoencephalitis, often considered to be enteroviral. However, there is a paucity of literature on this subject, and there are no studies from developing countries. METHODS We analyzed our cohort of children with PAD who developed meningoencephalitis. RESULTS This complication was observed in 13/135 (10.4%) patients with PAD - 5 patients had X-linked agammaglobulinemia (XLA), 7 had common variable immunodeficiency (CVID) and 1 had suspected nuclear factor kappa B essential modulator (NEMO) defect. Mean age at onset of neurological illness was 9.3 years. Presenting features included seizures (n=8), neurodevelopmental delay (n=2), regression of milestones (n=2), and acute flaccid paralysis (n=1). Trough IgG levels were found to be low in 12/13 patients at the time of development of neurological symptoms. Herpes simplex virus (HSV), cytomegalovirus (CMV), and Streptococcus pneumoniae were isolated in 1 each. Eight (72.7%) patients had altered signal hyperintensities in gray matter and deep white matter on magnetic resonance imaging (MRI), while 4 patients showed global cerebral atrophy. All patients were treated with high-dose intravenous immunoglobulin (IVIg). Fluoxetine was given to 3 patients. Eight patients in the present series have died, 3 have recovered with varying degrees of neurological sequelae and 2 patients are showing gradual recovery. CONCLUSIONS To conclude, meningoencephalitis is an uncommon complication in patients with PAD and is associated with high morbidity and mortality. Early diagnosis of immune deficiency and initiation of replacement immunoglobulin therapy may prevent the development of neurological complications.
Collapse
Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Himanshi Chaudhary
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratap Kumar Patra
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Arora
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanchi Chawla
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Munish Arora
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ridhima Aggarwal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suprit Basu
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Advanced Eye Centre Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Pandiarajan
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reeta Mani
- Department of Neurovirology, NIMHANS, Bangalore, India
| | - Rajni Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchi Saka
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Kisarazu, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Lennart Hammarström
- Dept. of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Koon Wing Chan
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
30
|
Trabelsi I, Ali MB, Romdhane MB, Smaoui H, Hadj IB, Boussetta K. [ Haemophilus influenzae type B (Hib) meningitis in older children: about a case]. Pan Afr Med J 2022; 42:220. [PMID: 36845237 PMCID: PMC9949271 DOI: 10.11604/pamj.2022.42.220.35804] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 02/28/2023] Open
Abstract
Since widespread vaccination, invasive Haemophilus influenzae type b (Hib) has become a rare infection. We here report the case of a 9-year-old boy admitted with seizures associated with fever and impaired general condition. First examination showed comatose child, Glasgow score 9/15, fever 38.2, deep tendon reflexes without frank meningeal syndrome. Laboratory tests showed polymorphonuclear neutrophils (PNN) with CRP 45.8. Cerebrospinal fluid (CSF) analysis revealed a cloudy appearance, pleiocytosis (6760 white blood cell count/ mm3) with neutrophil predominance (PNN = 90%, lymphocytes = 10%). Direct examination showed polymorphic bacilli, soluble antigen of Haemophilus influenzae type b, decreased glycorachy 0.04 mmol/L and hyper proteinorachie 4.097 g/L. MRI of the cerebellomedullary fissure revealed subtentorial and supratentorial encephalitis with bilateral parieto-occipital and cerebellar cortical and subcortical signal anomalies. The patient was treated with cefotaxime with favorable outcome. The patient had not been vaccinated against Hib in early childhood. After a 3-year follow-up, the patient was asymptomatic with no neurosensory sequelae. In subjects with severe Hib infection proof of vaccination or testing for underlying immunodeficiency are required.
Collapse
Affiliation(s)
- Ines Trabelsi
- Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie,,Corresponding author: Ines Trabelsi, Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie.
| | - Mouadh Ben Ali
- Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie
| | - Manel Ben Romdhane
- Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie
| | - Hanen Smaoui
- Service de Microbiologie, Hôpital d´Enfants de Tunis, Tunis, Tunisie
| | - Imen Bel Hadj
- Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie
| | - Khadija Boussetta
- Service de Médecine Infantile B, Hôpital d’Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie
| |
Collapse
|
31
|
Alavi Darazam I, Sharifi G, Jamali E, Khodavaisy S, Javandoust Gharehbagh F, Hakamifard A. Meningoencephalitis caused by Fusarium proliferatum: an unusual case. Infection 2022; 50:1023-1027. [PMID: 35112322 DOI: 10.1007/s15010-022-01761-7] [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: 10/16/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
Meningoencephalitis can be a diagnostic dilemma and one of its etiology are infectious causes including fungal agents. Fusarium species have attracted much attention as one of the invasive fungal infections. Major clinical manifestations of infections due to Fusarium spp. are broad such as keratitis, endophthalmitis, sino-pulmonary and central nervous system (CNS) infections. However, CNS fusariosis is rare and often happens due to hematogenous dissemination from other sites. Herein, we describe an unusual case of meningoencephalitis caused by Fusarium proliferatum, in a patient with rheumatoid arthritis.
Collapse
Affiliation(s)
- Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Jamali
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Division of Molecular Biology and Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
32
|
Erhart DK, Bracknies V, Lutz-Schuhbauer S, Wigand S, Tumani H. The special role of CXCL13 in Lyme neuroborreliosis: a case report. Neurol Res Pract 2022; 4:3. [PMID: 35034645 PMCID: PMC8762870 DOI: 10.1186/s42466-022-00167-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/22/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of chronic lyme neuroborreliosis can be a challenge even for experienced neurologists. The clinical picture may be multifaceted, including polyradiculitis to cranial nerve palsies, meningitis, encephalomyelitis, encephalopathy and peripheral neuropathy. We report on a patient presenting with basal leptomeningoencephalitis associated with vasculopathy where the chemokine CXCL13 in cerebrospinal fluid played an important diagnostic role.
Collapse
Affiliation(s)
- Deborah K Erhart
- Specialty Hospital of Neurology Dietenbronn, Dietenbronn 7, 88466, Schwendi, Germany. .,Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Vera Bracknies
- Specialty Hospital of Neurology Dietenbronn, Dietenbronn 7, 88466, Schwendi, Germany
| | | | - Sonja Wigand
- Specialty Hospital of Neurology Dietenbronn, Dietenbronn 7, 88466, Schwendi, Germany
| | - Hayrettin Tumani
- Specialty Hospital of Neurology Dietenbronn, Dietenbronn 7, 88466, Schwendi, Germany.,Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| |
Collapse
|
33
|
Karnik K, Wu Y, Ruddy S, Quijano-Rondan B, Urban C, Turett G, Yung L, Prasad N, Yoon J, Segal-Maurer S. Fatal case of disseminated cryptococcal infection and meningoencephalitis in the setting of prolonged glucocorticoid use in a Covid-19 positive patient. IDCases 2022; 27:e01380. [PMID: 35013707 PMCID: PMC8734083 DOI: 10.1016/j.idcr.2022.e01380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/15/2022] Open
Abstract
Based on the RECOVERY trial, glucocorticoids have become the mainstay of treatment for COVID-19, thus increasing the risk of opportunistic infections. We report a case of disseminated Cryptococcus neoformans with documented meningoencephalitis in a patient with severe COVID-19 in the setting of prolonged glucocorticoid administration with poor outcome likely due to adrenal involvement.
Collapse
Affiliation(s)
- Krupa Karnik
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Yuexiu Wu
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Samantha Ruddy
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Bladimir Quijano-Rondan
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Carl Urban
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,Weill Cornell Medicine, Cornell University, New York, New York 10065, United States
| | - Glenn Turett
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Lok Yung
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Nishant Prasad
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - James Yoon
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Sorana Segal-Maurer
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,Weill Cornell Medicine, Cornell University, New York, New York 10065, United States
| |
Collapse
|
34
|
Epstein S, Thakkar R, Fong KT, Ng J, Bearden DR, Mishra N, Thakur KT, Riley CS. Compassionate-use pocapavir and immunoglobulin therapy for treatment of rituximab-associated enterovirus meningoencephalitis. J Neurovirol 2022. [PMID: 34981437 DOI: 10.1007/s13365-021-01038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
A 71-year-old woman previously on rituximab treatment for rheumatoid arthritis presented with 2 years of progressive neurologic symptoms. She was found to have persistent hypogammaglobulinemia and B cell depletion despite rituximab discontinuation a year prior. MRI revealed diffuse meningeal enhancement along the entire neuroaxis. LP showed a CSF lymphocytic pleocytosis, elevated protein, and presence of enterovirus by PCR. The patient was hospitalized several times for progressive clinical and radiologic decline, though she had transient improvements following treatment with immunoglobulin therapy. Her CSF remained positive for enterovirus PCR for at least 12 months. Though two brain biopsies were non-diagnostic, pan-Enterovirus was ultimately identified using a high-throughput next-generation sequencing technique. She was treated with compassionate-use pocapavir with clinical stabilization at 4-month follow-up; however, she expired 8 months later from a bacterial pneumonia.
Collapse
|
35
|
Chen KM, Lan KP, Lai SC. Heme oxygenase-1 modulates brain inflammation and apoptosis in mice with angiostrongyliasis. Parasitol Int 2021; 87:102528. [PMID: 34942361 DOI: 10.1016/j.parint.2021.102528] [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: 05/07/2020] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
The rat nematode lungworm Angiostrongylus cantonensis undergoes obligatory intracerebral migration in its hosts and causes eosinophilic meningitis or meningoencephalitis. Heme oxygenase 1 (HO-1) has several cytoprotective properties such as anti-oxidative, anti-inflammatory, and anti-apoptotic effects. HO-1 in brain tissues was induced in A. cantonensis-infected group and showed positive modulation in cobalt protoporphyrin (CoPP)-treated groups. Assay methods for the therapeutic effect include western blot analysis, enzyme-linked immunosorbent assay, gelatin zymography, blood-brain barrier permeability evaluation and eosinophil count in cerebrospinal fluid. The combination of albendazole (ABZ) and CoPP significantly decreased pro-inflammatory cytokines, tumor necrosis factor-α, interleukin (IL)-1β, IL-5, and IL-33 but significantly increased anti-inflammatory cytokines IL-10 and transforming growth factor-β. In addition, worm recovery, matrix metalloproteinase-9, BBB permeability, and eosinophil counts were decreased in the ABZ and CoPP co-treated groups. Induction of HO-1 with CoPP strongly inhibited the protein levels of caspase-3 and increased the induction of annexin-V and B-cell leukemia 2. Thus, co-treatment with ABZ and CoPP prevented A. cantonensis-induced eosinophilic meningoencephalitis and its anti-apoptotic effect by promoting HO-1 signaling prior to BBB dysfunction. HO-1 induction might be a therapeutic modality for eosinophilic meningoencephalitis.
Collapse
Affiliation(s)
- Ke-Min Chen
- Department of Parasitology, Chung Shan Medical University, Taichung 402, Taiwan
| | - Kuang-Ping Lan
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Taiwan
| | - Shih-Chan Lai
- Department of Parasitology, Chung Shan Medical University, Taichung 402, Taiwan; Clinical Laboratory, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
| |
Collapse
|
36
|
Ungureanu A, van der Meer J, Bicvic A, Abbuehl L, Chiffi G, Jaques L, Suter-Riniker F, Leib SL, Bassetti CLA, Dietmann A. Meningitis, meningoencephalitis and encephalitis in Bern: an observational study of 258 patients. BMC Neurol 2021; 21:474. [PMID: 34872509 PMCID: PMC8647376 DOI: 10.1186/s12883-021-02502-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/19/2021] [Accepted: 11/25/2021] [Indexed: 12/05/2022] Open
Abstract
Background Depending on geographic location, causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify the most frequent causes, clinical presentation and long-term outcome of encephalitis, meningoencephalitis and meningitis cases treated in the Inselspital University Hospital Bern, Switzerland. Methods In this monocentric, observational study, we performed a retrospective review of clinical patient records for all patients treated within a 3-year period. Patients were contacted for a telephone follow-up interview and to fill out questionnaires, especially related to disturbances of sleep and wakefulness. Results We included 258 patients with the following conditions: encephalitis (18%), nonbacterial meningoencephalitis (42%), nonbacterial meningitis (27%) and bacterial meningoencephalitis/meningitis (13%). Herpes simplex virus (HSV) was the most common cause of encephalitis (18%); tick-borne encephalitis virus (TBEV) was the most common cause of nonbacterial meningoencephalitis (46%), enterovirus was the most common cause of nonbacterial meningitis (21%) and Streptococcus pneumoniae was the most common cause of bacterial meningoencephalitis/meningitis (49%). Overall, 35% patients remained without a known cause. After a median time of 16 months, 162 patients participated in the follow-up interview; 56% reported suffering from neurological long-term sequelae such as fatigue and/or excessive daytime sleepiness (34%), cognitive impairment and memory deficits (22%), headache (14%) and epileptic seizures (11%). Conclusions In the Bern region, Switzerland, TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequelae, most importantly cognitive impairment, fatigue and headache, were frequently self-reported not only in encephalitis and meningoencephalitis survivors but also in viral meningitis survivors up to 40 months after acute infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02502-3.
Collapse
Affiliation(s)
- Anamaria Ungureanu
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Antonela Bicvic
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Lena Abbuehl
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Gabriele Chiffi
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
| | - Léonore Jaques
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | | | - Stephen L Leib
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland.
| |
Collapse
|
37
|
Casella SW, Salazar-Austin N, Charnaya O. Rare neurological complication in an adolescent with kidney failure secondary to systemic lupus erythematosus: Answers. Pediatr Nephrol 2021; 36:4093-5. [PMID: 34355261 DOI: 10.1007/s00467-021-05200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
|
38
|
Ananthegowda DC, Khatib MY, Ali HS, Al wraidat M, Imam Y. Cytomegalovirus meningoencephalitis in a case of severe COVID-19 Pneumonia. A case report. IDCases 2021; 26:e01346. [PMID: 34840957 PMCID: PMC8608663 DOI: 10.1016/j.idcr.2021.e01346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 01/07/2023] Open
Abstract
The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. Cytomegalovirus (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.
Collapse
Affiliation(s)
- Dore C. Ananthegowda
- Medical Intensive Care Unit, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Y. Khatib
- Medical Intensive Care Unit, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Husain S. Ali
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
| | - Mohamed Al wraidat
- Medical Intensive Care Unit, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
39
|
Ahmad SA, Salih BK, Hama Hussein KF, Mikael TM, Kakamad FH, Salih AM. Aseptic meningoencephalitis after COVID-19 vaccination: A case report. Ann Med Surg (Lond) 2021; 71:103028. [PMID: 34777795 PMCID: PMC8570436 DOI: 10.1016/j.amsu.2021.103028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Several types of vaccine have been shown to significantly reduce the risk of severe coronavirus disease 2019 (COVID-19). This study aims to report the first case of meningoencephalitis after receiving the second dose of Pfizer COVID-19 vaccine. Case report A 62-year-old lady presented with headache, fever and rigor for 4 days. She had acute confessional state and inability to talk. She was conscious, disoriented, not obeying commands. Acyclovir vial IV 750 mg three times a day for 14 days were prescribed. She responded very well. Discussion Concern has been raised about the safety of vaccinations. The most common side effects of COVID-19 vaccinations are local responses at the injection site, followed by non-specific systemic symptoms such as headache, tiredness, myalgia, and fever. These may appear shortly after immunization and disappear in a short period of time. Conclusion Although extremely rare, aseptic meningoencephalitis could occur after COVID-19 vaccination. The patient could be managed conservatively with a good clinical outcome. COVID-19 mostly causes respiratory disease. Vaccinations have been shown to significantly reduce the risk of severe COVID-19 infection. A suspicious cluster of significant neurological complications following vaccination have been established. Development of meningoencephalitis after COVID-19 vaccination is an extremely rare condition.
Collapse
Affiliation(s)
- Shwan A Ahmad
- Smart Health Tower, Francios Metterrand Street, Sulaimani, Kurdistan, Iraq
| | - Bestoon Kh Salih
- Smart Health Tower, Francios Metterrand Street, Sulaimani, Kurdistan, Iraq
| | | | - Tomas M Mikael
- Smart Health Tower, Francios Metterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Francios Metterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Francios Metterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Sulaimani, Iraq
| |
Collapse
|
40
|
Carbo EC, Blankenspoor I, Goeman JJ, Kroes ACM, Claas ECJ, De Vries JJC. Viral metagenomic sequencing in the diagnosis of meningoencephalitis: a review of technical advances and diagnostic yield. Expert Rev Mol Diagn 2021; 21:1139-1146. [PMID: 34607520 DOI: 10.1080/14737159.2021.1985467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Meningoencephalitis patients are often severely impaired and benefit from early etiological diagnosis, though many cases remain without identified cause. Metagenomics as pathogen agnostic approach can result in additional etiological findings; however, the exact diagnostic yield when used as a secondary test remains unknown. AREAS COVERED This review aims to highlight recent advances with regard to wet and dry lab methodologies of metagenomic testing and technical milestones that have been achieved. A selection of procedures currently applied in accredited diagnostic laboratories is described in more detail to illustrate best practices. Furthermore, a meta-analysis was performed to assess the additional diagnostic yield utilizing metagenomic sequencing in meningoencephalitis patients. Finally, the remaining challenges for successful widespread implementation of metagenomic sequencing for the diagnosis of meningoencephalitis are addressed in a future perspective. EXPERT OPINION The last decade has shown major advances in technical possibilities for using mNGS in diagnostic settings including cloud-based analysis. An additional advance may be the current established infrastructure of platforms for bioinformatic analysis of SARS-CoV-2, which may assist to pave the way for global use of clinical metagenomics.
Collapse
Affiliation(s)
- Ellen C Carbo
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ivar Blankenspoor
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Aloys C M Kroes
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric C J Claas
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jutte J C De Vries
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
41
|
Dhawan SR, Sahu JK, Singhi P, Sankhyan N, Jayashree M. Comparison of 4 weeks versus 12 weeks antiseizure medication for acute symptomatic seizures in children with Acute Encephalitis Syndrome: An open-label, randomized controlled trial. Seizure 2021; 92:182-188. [PMID: 34543779 DOI: 10.1016/j.seizure.2021.09.005] [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: 05/02/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To compare the proportion of children with seizure recurrence/s during 6-18 months of follow-up among children with acute symptomatic seizures underlying acute encephalitis syndrome (AES) treated with either 4 weeks or 12 weeks of antiseizure medication (ASM). METHODS Eligible children aged 3 months to 12 years with acute symptomatic seizures underlying AES, receiving a single ASM at 4 weeks of illness, and without seizure recurrence from day 7-28 of illness were included in this comparative, parallel-group assignment, open-label, randomized control study (either 4 weeks or 12 weeks duration). The primary outcome was to compare proportions of children developing seizure recurrence over six months of follow-up. The secondary outcomes were to study seizure recurrence over 12-18 months follow-up and factor(s) associated with seizure recurrence. RESULTS Of 232 children with AES screened, 60 eligible children were randomized in two groups. Baseline demographics were comparable (except the duration of illness) between the groups. Seizure recurrences at 6, 12 and 18 months were none, two (one in each group, relative risk 1.0, 95% CI 0.06-16.76; p-value >0.99), and six (one and five children in 4 and 12 weeks groups respectively, relative risk 0.17, 95% CI 0.01-1.62; p-value 0.19) respectively. There was no association of seizure recurrences with seizure characteristics, abnormal electroencephalography and neuroradiology. Children with disabilities at randomization had a higher risk of seizure recurrence at 18 months of follow-up (relative risk 7.16, 95% CI 1.1-43.9; p-value 0.049). SIGNIFICANCE With limitations of the study design, this study provides Class I evidence that a shorter duration (4 weeks) of ASM is comparable with 12 weeks therapy for preventing seizure recurrences in children with AES. TRIAL REGISTRATION Clinical Trials.gov identifier: NCT03181945; Clinical Trial Registry of India identifier: CTRI/2017/06/008783.
Collapse
Affiliation(s)
- Sumeet Rajendra Dhawan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pratibha Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Intensive and Emergency Care, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
42
|
Minami S, Okada H, Ihara S, Tsuji H, Yamadera M, Yasuoka H. Pembrolizumab-Induced Meningoencephalitis: A Brain Autopsy Case. J Med Cases 2021; 12:359-365. [PMID: 34527106 PMCID: PMC8425809 DOI: 10.14740/jmc3748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/18/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Encephalitis is very rare, but often fatal immune-related adverse event (irAE) of immune checkpoint inhibitors (ICIs). A 65-year-old Japanese woman was admitted to our hospital because of general fatigue, chillness and high-grade fever for 4 days, 8 months after the initiation of the first-line pembrolizumab monotherapy for metastatic pulmonary adenocarcinoma. On the hospital day 3, she suddenly presented delirium and uncontrollable impaired consciousness. Although the magnetic resonance imaging (MRI) did not suggest a diagnosis of encephalitis and meningitis, the spinal fluid showed abnormally elevated levels of protein (317.6 mg/L) and cell count (197 cells/µL) with increased mononuclear cells (93%). An empirical and intravenous administration of acyclovir in doses of 10 mg/kg body weight every 8 h and steroid pulse therapy in dose of 1 g/body/day from the hospital day 5 until her death failed to improve her conditions. She died on the hospital day 8. The postmortem autopsy showed viable cancer cells in the metastatic tumor in the left occipital lobe and in the spinal fluids. However, many inflammatory cells infiltration in the meninges and perivascular cuffing were prominent especially in the brain stem and medial part of the temporal lobe. Infiltrating lymphocytes in the meninges and parenchyma of the brain stem were mainly composed of cluster of differentiation (CD)8-positive lymphocytes. For irAE encephalitis, early recognition of early signs and symptoms and subsequent early therapeutic intervention are necessary. It is important for oncologists to keep in mind of the possible adverse effects of immunotherapies on the nervous system.
Collapse
Affiliation(s)
- Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan
| | - Hideyasu Okada
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan
| | - Shoichi Ihara
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan
| | - Hiromi Tsuji
- Department of Pathology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan
| | - Misaki Yamadera
- Department of Pathology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Hironao Yasuoka
- Department of Pathology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan
| |
Collapse
|
43
|
Ji S, Liu C, Bi Z, Gao H, Sun J, Bu B. Overlapping syndrome mimicking infectious meningoencephalitis in a patient with MOG and GFAP IgG. BMC Neurol 2021; 21:348. [PMID: 34507542 PMCID: PMC8431933 DOI: 10.1186/s12883-021-02381-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/02/2020] [Accepted: 09/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background Central nervous system overlapping autoimmune syndromes are uncommon, especially with the coexistence of MOG-IgG and GFAP-IgG. Case presentation A 23-year-old woman presented with transient convulsions, a loss of consciousness, persistent fever, headache, and vomiting. Cerebrospinal fluid (CSF) analysis revealed elevated cellularity, and magnetic resonance imaging (MRI) showed diffuse leptomeningeal enhancement. She had fever and headache with antiviral and antibiotic treatment for 2 weeks, and she had empirical anti-tuberculosis treatment and oral prednisolone therapy. She was followed for 3 months after presentation with improved symptoms and normal CSF analysis. A 3-month follow-up MRI showed asymmetric lesions in the cerebellum, corona radiata, and white matter with enhancement. The anti-tuberculosis treatment was continued, and steroid therapy was discontinued. After she stopped taking prednisolone, an interrupted headache gradually appeared. MRI at 4 months after presentation revealed a partial reduction in lesions but enlarged areas in the left cerebellum and right parietal white matter and a new lesion in the region of the right ependyma with linear enhancement. Her CSF was positive for anti-myelin oligodendrocyte glycoprotein (MOG) and anti-glial fibrillary acidic protein (GFAP) antibodies using a transfected cell-based assay. She was diagnosed with overlapping syndrome of MOG‑IgG‑associated disease and GFAP astrocytopathy. She received steroid pulse therapy (methylprednisolone, 1 g for 5 days), followed by a gradual tapering of oral prednisolone and the addition of an immunosuppressant (tacrolimus, 3 mg per day). Six months after the initial presentation, she had no symptoms. An MRI showed that the lesions had diminished, and no enhancement was found. Conclusions We report a case that was positive for double antibodies, which was initially misdiagnosed as infectious meningoencephalitis. This case broadens the clinical and phenotypic presentation of the overlapping syndrome spectrum.
Collapse
Affiliation(s)
- Suqiong Ji
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Zhuajin Bi
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Huajie Gao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Jian Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
| |
Collapse
|
44
|
Alnefelt Y, Van Meervenne S, Varjonen K, Tidholm A, Rohdin C. Evaluation of antibodies in cerebrospinal fluid for the diagnosis of tick-borne encephalitis in dogs. Acta Vet Scand 2021; 63:32. [PMID: 34446031 PMCID: PMC8396403 DOI: 10.1186/s13028-021-00597-9] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Tick-borne encephalitis (TBE) is caused by the neurotropic tick-borne encephalitis virus (TBEV). In dogs, this virus may affect the central nervous system (CNS), causing meningoencephalitis, meningomyelitis, radiculitis or any combination of these. Diagnosis of TBE relies on a combination of clinical signs of CNS disease and laboratory findings, including CSF pleocytosis and serum TBEV antibody titers. Exposure to TBEV does not necessarily cause clinical disease, and seroprevalence has been reported as high as 40% in endemic areas. This causes concerns of over-diagnosing TBE in dogs with CNS disease. By examining TBEV antibodies in dogs with and without neurological disease in a TBEV endemic area, this study aimed to evaluate the diagnostic value of TBEV antibodies in the cerebrospinal fluid (CSF) in dogs. Eighty-nine dogs were included in the study, 56 with neurological disease and 33 neurologically normal control dogs. A positive TBEV CSF and serum IgG antibody titer (> 126 U/mL) was found in 3/89 dogs (3.4%). A positive serum TBEV antibody titer was found in 11 of the 89 dogs (12.4%). None of the control dogs showed a positive CSF antibody titer, whilst two showed positive serum concentrations. A positive CSF IgG antibody titer supports a clinical diagnosis of TBE in patients with acute onset of CNS disease and may help reduce the risk of over-diagnosis.
Collapse
Affiliation(s)
- Yvonne Alnefelt
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
| | | | | | - Anna Tidholm
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
| | - Cecilia Rohdin
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
| |
Collapse
|
45
|
Watson AL, Rice G, Hieu Vo T, Kangaharan N. Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-aneurysms in a remote Aboriginal healthcare setting in Australia: a case report. Eur Heart J Case Rep 2021; 5:ytab265. [PMID: 34423241 PMCID: PMC8374982 DOI: 10.1093/ehjcr/ytab265] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/14/2021] [Accepted: 04/27/2021] [Indexed: 12/03/2022]
Abstract
Background The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis. Case summary A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement. Discussion Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.
Collapse
Affiliation(s)
- Anna Louise Watson
- Royal Darwin Hospital, 105 Rockland Drive, Tiwi, Northern Territory 0810, Australia
| | - Gregory Rice
- Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Tony Hieu Vo
- Royal Darwin Hospital, 105 Rockland Drive, Tiwi, Northern Territory 0810, Australia.,Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland 4215, Australia
| | - Nadarajah Kangaharan
- Royal Darwin Hospital, 105 Rockland Drive, Tiwi, Northern Territory 0810, Australia.,Menzies School of Health Research, 58 Rocklands Drive, Tiwi, Northern Territory 0810, Australia.,Flinders University, Nightingale Road, Tiwi, Northern Territory 0810, Australia For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
| |
Collapse
|
46
|
Tu A, Byard RW. Cryptococcosis and unexpected death. Forensic Sci Med Pathol 2021. [PMID: 34324155 DOI: 10.1007/s12024-021-00400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 06/03/2021] [Indexed: 12/04/2022]
Abstract
Cryptococcosis is a fungal disease caused predominantly by Cryptococcus neoformans and Cryptococcus gatti. It is most often found in immunocompromised individuals and has quite protean and chronic manifestations affecting all body systems. The unexpected death of a 22-year-old man with cryptococcal meningoencephalitis demonstrates, however, that it may have a fulminant course in previously well individuals. Also present at autopsy was a toruloma of the upper lobe of the right lung. Delays in clinical diagnoses, confusion with tuberculosis and precipitate clinical deterioration may mean that cases will be encountered unexpectedly during medicolegal autopsies.
Collapse
|
47
|
Grose C, Shaban A, Fullerton HJ. Common Features Between Stroke Following Varicella in Children and Stroke Following Herpes Zoster in Adults : Varicella-Zoster Virus in Trigeminal Ganglion. Curr Top Microbiol Immunol 2021; 438:247-272. [PMID: 34224015 DOI: 10.1007/82_2021_236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The cerebral arteries are innervated by afferent fibers from the trigeminal ganglia. Varicella-zoster virus (VZV) frequently resides in the trigeminal ganglion. Reports of arterial ischemic stroke due to VZV cerebral vasculopathy in adults after herpes zoster have been described for decades. Reports of arterial ischemic stroke due to post-varicella cerebral arteriopathy in children have also been described for decades. One rationale for this review has been post-licensure studies that have shown an apparent protective effect from stroke in both adults who have received live zoster vaccine and children who have received live varicella vaccine. In this review, we define common features between stroke following varicella in children and stroke following herpes zoster in adults. The trigeminal ganglion and to a lesser extent the superior cervical ganglion are central to the stroke pathogenesis pathway because afferent fibers from these two ganglia provide the circuitry by which the virus can travel to the anterior and posterior circulations of the brain. Based on studies in pseudorabies virus (PRV) models, it is likely that VZV is carried to the cerebral arteries on a kinesin motor via gE, gI and the homolog of PRV US9. The gE product is an essential VZV protein.
Collapse
Affiliation(s)
- Charles Grose
- Division of Infectious Diseases and Virology Laboratory, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
- University Hospital/Room BT2001, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Amir Shaban
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Heather J Fullerton
- Division of Child Neurology and Pediatric Brain Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
48
|
Shields LBE, Alsorogi MS, Mar N, Rezazadeh Kalebasty A. Immune-Related Meningoencephalitis following Nivolumab in Metastatic Renal Cell Carcinoma. Case Rep Oncol 2021; 14:1051-1058. [PMID: 34326741 PMCID: PMC8299396 DOI: 10.1159/000513001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022] Open
Abstract
While immunotherapy with nivolumab is promising for patients with renal cell carcinoma (RCC), overactivation of the immune system can lead to serious side effects. Immune-related meningoencephalitis without a viral or microbial etiology is a rare complication that may occur in patients treated with checkpoint inhibitors (CPI). Herein, we report a 66-year-old man who underwent a partial nephrectomy which revealed a papillary RCC with clear cell component. Three years later, an abdomen and pelvic CT revealed metastatic lesions in the left psoas muscle and in the left 12th rib. The patient was treated with pazopanib which was discontinued after 2 weeks due to significant hepatic and renal toxicity. He subsequently started sunitinib. Two months later, a chest, abdomen, and pelvic CT demonstrated progressive metastatic RCC in the retroperitoneal mass of the left psoas muscle and paraspinal musculature as well as a left renal mass. The patient was treated with 7 cycles of the CPI nivolumab. He was subsequently hospitalized for 3 weeks after experiencing bilateral lower extremity weakness, lethargy, several falls, hyperthermia, confusion, and gait abnormalities. A CSF analysis demonstrated a lymphocyte pleocytosis with elevated protein and no bacterial or viral growth. The patient was treated with high-dose steroids after which his symptoms resolved. Chest, abdomen, and pelvic CT scans over the next 3 years revealed no evidence of metastatic disease, reflecting a progression-free survival of 40 months. We highlight the unique case of a patient with metastatic RCC who experienced immune-related meningoencephalitis following immunotherapy with nivolumab. Medical oncologists should be alert to the potential development of immune-related encephalitis in patients treated with nivolumab and should promptly diagnose and treat this concerning condition. The excellent oncologic outcome of this case emphasizes the need for continued aggressive measures for management of CNS toxicity resulting from CPI therapy.
Collapse
Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | | | - Nataliya Mar
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, California, USA
| | | |
Collapse
|
49
|
Wanamaker MW, Vernau KM, Taylor SL, Cissell DD, Abdelhafez YG, Zwingenberger AL. Classification of neoplastic and inflammatory brain disease using MRI texture analysis in 119 dogs. Vet Radiol Ultrasound 2021; 62:445-454. [PMID: 33634942 PMCID: PMC9970026 DOI: 10.1111/vru.12962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/24/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 01/06/2023] Open
Abstract
Magnetic resonance imaging is the primary method used to diagnose canine glial cell neoplasia and noninfectious inflammatory meningoencephalitis. Subjective differentiation of these diseases can be difficult due to overlapping imaging characteristics. This study utilizes texture analysis (TA) of intra-axial lesions both as a means to quantitatively differentiate these broad categories of disease and to help identify glial tumor grade/cell type and specific meningoencephalitis subtype in a group of 119 dogs with histologically confirmed diagnoses. Fifty-nine dogs with gliomas and 60 dogs with noninfectious inflammatory meningoencephalitis were retrospectively recruited and randomly split into training (n = 80) and test (n = 39) cohorts. Forty-five of 120 texture metrics differed significantly between cohorts after correcting for multiple testing (false discovery rate < 0.05). After training the random forest algorithm, the classification accuracy for the test set was 85% (sensitivity 89%, specificity 81%). TA was only partially able to differentiate the inflammatory subtypes (granulomatous meningoencephalitis [GME], necrotizing meningoencephalitis [NME], and necrotizing leukoencephalitis [NLE]) (out-of-bag error rate of 35.0%) and was unable to identify metrics that could correctly classify glioma grade or cell type (out-of-bag error rate of 59.6% and 47.5%, respectively). Multiple demographic differences, such as patient age, sex, weight, and breed were identified between disease cohorts and subtypes which may be useful in prioritizing differential diagnoses. TA of MR images with a random forest algorithm provided classification accuracy of inflammatory and neoplastic brain disease approaching the accuracy of previously reported subjective radiologist evaluation.
Collapse
Affiliation(s)
- Mason W. Wanamaker
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis 95616, CA
| | - Karen M. Vernau
- Department of Surgical and Radiological Sciences, University of California, Davis 95616, CA
| | | | - Derek D. Cissell
- Department of Surgical and Radiological Sciences, University of California, Davis 95616, CA
| | - Yasser G. Abdelhafez
- Department of Radiology University of California Davis School of Medicine, Sacramento 95817, CA
| | | |
Collapse
|
50
|
Kapadia RK, Gill CM, Baca C, McMenamin C, Kannappan A, Niehaus WN, Tyler KL, Pastula DM, Piquet AL. Enterovirus A71 causing meningoencephalitis and acute flaccid myelitis in a patient receiving rituximab. J Neuroimmunol 2021; 358:577639. [PMID: 34214953 DOI: 10.1016/j.jneuroim.2021.577639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
We present the case of a young woman being treated with rituximab for rheumatoid arthritis who developed a severe enteroviral meningoencephalitis and acute flaccid myelitis (AFM). Cerebrospinal fluid (CSF) and stool reverse transcription-polymerase chain reaction (RT-PCR) testing confirmed the diagnosis and additional sequencing studies performed at the CDC further characterized the enterovirus as enterovirus A71 (EV-A71). After treatment with intravenous immunoglobulin (IVIg) and fluoxetine (based on previous reports of possible efficacy) the patient experienced a remarkable improvement over time. This case highlights the importance of considering enteroviral infection in patients treated with rituximab, depicts a possible clinical course of enteroviral meningoencephalitis and AFM, and illustrates the importance of testing multiple sites for enterovirus infection (CSF, stool, nasopharyngeal swab, blood). Here we present the case with a brief review of the literature pertaining to EV-A71.
Collapse
|