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Solela G, Tenaw AA, Fisseha H, Argaw AM, Petros T, Mengistu B. Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature. J Med Case Rep 2024; 18:206. [PMID: 38658977 PMCID: PMC11044381 DOI: 10.1186/s13256-024-04519-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: 09/24/2023] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Headache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for persistent headaches. CASE PRESENTATION A 45-year-old black man presented with dyspnea, cough, fever and headache for 05 days followed by blurring of vision associated with worsening of the headache. Physical examination was significant for tachypnea and oxygen desaturation and there were no abnormal neurologic findings. He tested positive for SARS-CoV-2 with nasopharyngeal swab PCR. His CSF opening pressure appeared high with normal CSF analysis and brain magnetic resonance imaging (MRI) revealed prominent subarachnoid space around the optic nerves and bilateral papilledema. He had significant improvement with medical therapy alone. CONCLUSION Idiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be considered when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.
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Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
| | - Addis A Tenaw
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Henok Fisseha
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abel M Argaw
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tamirat Petros
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelhem Mengistu
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
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Fernández-de-Las-Peñas C, Cuadrado ML, Gómez-Mayordomo V, García-Azorín D, Arendt-Nielsen L. Headache as a COVID-19 onset symptom or Post-COVID symptom according to the SARS-CoV-2 Variant. Expert Rev Neurother 2023; 23:179-186. [PMID: 36857191 DOI: 10.1080/14737175.2023.2185138] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION COVID19 associated headaches are highly common and there is currently an unmet need to better understand their association with SARSCoV2 variants. Headaches are a prevalent symptom in the acute phase of COVID19 and are associated with a better prognosis and better immune response. They are also a relevant post-COVID symptom. AREAS COVERED This article analyses the differences in the prevalence of headache as an onset symptom and in post-COVID headache among the different SARS-CoV-2 variants: the historical strain, Alpha, Delta and Omicron. The different pathophysiological mechanisms by which SARS-CoV-2 infection may cause headache are also discussed. EXPERT OPINION The presence of headache at the acute phase is a risk factor for post-COVID headache, whereas a history of primary headache does not appear to be associated with post-COVID headache. The prevalence of headache as an onset symptom appears to be variable for the different SARS-CoV-2 variants, but current data are inconclusive. However, the current evidence also suggests that headache represents a prevalent symptom in the acute and post-infection COVID-19 phase, regardless of SARS-CoV-2 variant.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Victor Gómez-Mayordomo
- Department of Neurology, Institute of Neurosciences, Vithas Madrid La Milagrosa University Hospital. Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, AMech-Sense, alborg University Hospital, Aalborg, Denmark
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Nehme M, Braillard O, Chappuis F, Courvoisier DS, Guessous I. Prevalence of Symptoms More Than Seven Months After Diagnosis of Symptomatic COVID-19 in an Outpatient Setting. Ann Intern Med 2021; 174:1252-1260. [PMID: 34224254 PMCID: PMC8280535 DOI: 10.7326/m21-0878] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With millions of SARS-CoV-2 infections worldwide, increasing numbers of patients are coming forward with long-term clinical effects of the disease lasting several weeks to months. OBJECTIVE To characterize symptoms 7 to 9 months after diagnosis of COVID-19. DESIGN Self-reported surveys and semistructured telephone interviews at enrollment and 30 to 45 days and 7 to 9 months from diagnosis. SETTING From 18 March to 15 May 2020, symptomatic persons who tested positive for SARS-CoV-2 at the Geneva University Hospitals were followed by CoviCare, a virtual, clinical, outpatient follow-up program. Persons were contacted again at 30 to 45 days and 7 to 9 months from diagnosis. PARTICIPANTS Persons who were a part of the CoviCare program from 18 March to 15 May 2020. MEASUREMENTS A standardized interview of symptoms consistent with COVID-19, with grading of intensity. RESULTS Of the 629 participants in the study who completed the baseline interviews, 410 completed follow-up at 7 to 9 months after COVID-19 diagnosis; 39.0% reported residual symptoms. Fatigue (20.7%) was the most common symptom reported, followed by loss of taste or smell (16.8%), dyspnea (11.7%), and headache (10.0%). LIMITATION Limitations include generalizability and missing data for 34.8% of participants. CONCLUSION Residual symptoms after SARS-CoV-2 infection are common among otherwise young and healthy persons followed in an outpatient setting. These findings contribute to the recognition of long-term effects in a disease mostly counted by its death toll to date by promoting communication on postacute sequelae of SARS-CoV-2 and encouraging physicians to continue long-term monitoring of their patients. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Mayssam Nehme
- Geneva University Hospitals, Geneva, Switzerland (M.N., O.B.)
| | | | - François Chappuis
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland (F.C., I.G.)
| | | | - Idris Guessous
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland (F.C., I.G.)
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of the recent pandemic of coronavirus disease 19 (COVID-19). As the infection spreads, there is increasing evidence of neurological and psychiatric involvement in COVID-19. Headache, impaired consciousness, and olfactory and gustatory dysfunctions are common neurological manifestations described in the literature. Studies demonstrating more specific and more severe neurological involvement such as cerebrovascular insults, encephalitis and Guillain-Barre syndrome are also emerging. Respiratory failure, a significant condition that leads to mortality in COVID-19, is hypothesized to be partly due to brainstem impairment. Notably, some of these neurological complications seem to persist long after infection. This review aims to provide an update on what is currently known about neurological involvement in patients with COVID-19 due to SARS-CoV-2 infection. In this review, we demonstrate invasion routes of SARS-CoV-2, provide evidence to support the neurotropism hypothesis of the virus, and investigate the pathological mechanisms that underlie neurological complications associated with SARS-CoV-2.
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Affiliation(s)
- Yidan Xu
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yu Zhuang
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Lumei Kang
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Department of Animal Science, Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China
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Osikomaiya B, Erinoso O, Wright KO, Odusola AO, Thomas B, Adeyemi O, Bowale A, Adejumo O, Falana A, Abdus-Salam I, Ogboye O, Osibogun A, Abayomi A. 'Long COVID': persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria. BMC Infect Dis 2021; 21:304. [PMID: 33765941 PMCID: PMC7993075 DOI: 10.1186/s12879-020-05716-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 08/14/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease once thought to be a respiratory infection is now recognised as a multi-system disease affecting the respiratory, cardiovascular, gastrointestinal, neurological, immune, and hematopoietic systems. An emerging body of evidence suggests the persistence of COVID-19 symptoms of varying patterns among some survivors. This study aimed to describe persistent symptoms in COVID-19 survivors and investigate possible risk factors for these persistent symptoms. METHODS The study used a retrospective study design. The study population comprised of discharged COVID-19 patients. Demographic information, days since discharge, comorbidities, and persistent COVID-19 like symptoms were assessed in patients attending the COVID-19 outpatient clinic in Lagos State. Statistical analysis was done using STATA 15.0 software (StataCorp Texas) with significance placed at p-value < 0.05. RESULTS A total of 274 patients were enrolled in the study. A majority were within the age group > 35 to ≤49 years (38.3%), and male (66.1%). More than one-third (40.9%) had persistent COVID-19 symptoms after discharge, and 19.7% had more than three persistent COVID-like symptoms. The most persistent COVID-like symptoms experienced were easy fatigability (12.8%), headaches (12.8%), and chest pain (9.8%). Symptomatic COVID-19 disease with moderate severity compared to mild severity was a predictor of persistent COVID-like symptoms after discharge (p < 0.05). CONCLUSION Findings from this study suggests that patients who recovered from COVID-19 disease may still experience COVID-19 like symptoms, particularly fatigue and headaches. Therefore, careful monitoring should be in place after discharge to help mitigate the effects of these symptoms and improve the quality of life of COVID-19 survivors.
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Affiliation(s)
| | - Olufemi Erinoso
- Lagos State University Teaching Hospital, Lagos, Lagos State, Nigeria.
| | | | | | | | | | | | | | | | | | | | - Akin Osibogun
- College of Medicine, University of Lagos, Lagos, Nigeria
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Romero-Gameros CA, Colin-Martínez T, Waizel-Haiat S, Vargas-Ortega G, Ferat-Osorio E, Guerrero-Paz JA, Intriago-Alor M, López-Moreno MA, Cuevas-García CF, Mendoza-Zubieta V, Martínez-Ordaz JL, González-Virla B. Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients. BMC Infect Dis 2021; 21:255. [PMID: 33706707 PMCID: PMC7947944 DOI: 10.1186/s12879-021-05930-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/17/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. METHODS An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. RESULTS A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28). CONCLUSION The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. TRIAL REGISTRATION Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .
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Affiliation(s)
- Carlos Alfonso Romero-Gameros
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Tania Colin-Martínez
- Emergency Department. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Salomón Waizel-Haiat
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Guadalupe Vargas-Ortega
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, 330 Cuauhtémoc Avenue, 06720, Mexico City, Mexico
| | - Eduardo Ferat-Osorio
- Education and Research Division. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - José Alberto Guerrero-Paz
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Marielle Intriago-Alor
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mayra Alejandra López-Moreno
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Carlos Fredy Cuevas-García
- General Director of the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Victoria Mendoza-Zubieta
- Education and Research Division. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jose Luis Martínez-Ordaz
- Education and Research Division. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Baldomero González-Virla
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, 330 Cuauhtémoc Avenue, 06720, Mexico City, Mexico.
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Abstract
SUMMARY Neurological manifestations of coronavirus disease 2019 most commonly present in severe cases and range from mild complications, such as headache and dizziness, to severe complications, such as encephalopathy and acute cerebrovascular disease. Seizures, however, are an underreported neurological manifestation of this disease. We present three critically ill coronavirus disease 2019 patients with EEG monitoring who developed new-onset seizures and encephalopathy up to three-and-a-half weeks after symptom onset. There are several speculated etiologies for the development of new-onset seizures; however, the pathogenic mechanism remains unknown. Testing of coronavirus disease 2019 in the cerebrospinal fluid in addition to extensive research on neurological manifestations is warranted.
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Affiliation(s)
- Farhan Mithani
- Texas A&M Health Science Center College of Medicine, Bryan, Texas, U.S.A
| | - Meryim Poursheykhi
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Brandy Ma
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
- Weill Cornell Medical College, New York City, New York, U.S.A
| | - Robert G Smith
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Steven H Hsu
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
| | - Deepa Gotur
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
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King JA, Whitten TA, Bakal JA, McAlister FA. Symptômes associés au frottis SRAS-CoV-2-positif chez des enfants de l’Alberta. CMAJ 2021; 193:E177-E185. [PMID: 33526549 PMCID: PMC7954568 DOI: 10.1503/cmaj.202065-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/15/2022] Open
Abstract
CONTEXTE: La recherche sur les enfants atteints d’une infection à coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) a principalement porté sur les enfants amenés aux services des urgences. Nous avons voulu identifier les symptômes plus souvent associés à un frottis SRAS-CoV-2-positif chez les enfants non hospitalisés. MÉTHODES: Nous avons procédé à une étude observationnelle chez des enfants soumis au dépistage et suivis pour une infection à SRAS-CoV-2 confirmée sur des prélèvements de sécrétions nasales, nasopharyngées, de la gorge et autres (p. ex., aspiration nasopharyngée, sécrétions trachéales ou non spécifiées) entre le 13 avril et le 30 septembre 2020 en Alberta. Nous avons calculé les rapports de vraisemblance (RV) positifs entre les symptômes autodéclarés et les frottis SRAS-CoV-2-positifs dans la cohorte entière et dans 3 analyses de sensibilité : tous les enfants présentant au moins 1 symptôme, tous les enfants, symptomatiques ou non, soumis au dépistage par suite d’une recherche de contacts, et tous les enfants de 5 ans et plus. RÉSULTATS: Nous avons analysé les résultats chez 2463 enfants soumis au dépistage de l’infection à SRAS-CoV-2; 1987 enfants se sont révélés positifs et 476 négatifs. Parmi les enfants SRAS-CoV-2-positifs, 714 (35,9 %) n’ont déclaré aucun symptôme. Même si la toux (24,5 %) et la rhinorrhée (19,3 %) étaient les 2 symptômes les plus fréquents chez les enfants ayant contracté le SRAS-CoV-2, elles étaient fréquentes également chez ceux dont les résultats étaient négatifs et ne permettaient pas de prédire un résultat positif (RV positif 0,96, intervalle de confiance [IC] à 95 % 0,81–1,14 et 0,87, IC à 95 % 0,72–1,06, respectivement). L’anosmie/agueusie (RV positif 7,33, IC à 95 % 3,03–17,76), les nausées et vomissements (RV positif 5,51, IC à 95 % 1,74–17,43), les céphalées (RV positif 2,49, IC à 95 % 1,74–3,57) et la fièvre (RV positif 1,68, IC à 95 % 1,34–2,11) ont été les symptômes les plus prédictifs d’un résultat SRAS-CoV-2-positif. Le RV positif pour la combinaison anosmie et agueusie, nausées et vomissements, et céphalées était de 65,92 (IC à 95 % 49,48–91,92). INTERPRÉTATION: Environ les deux tiers des enfants déclarés SRAS-CoV-2-positifs ont manifesté des symptômes, et les symptômes les plus étroitement associés à un frottis SRAS-CoV-2-positif étaient l’anosmie/agueusie, les nausées et les vomissements, les céphalées et la fièvre.
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Affiliation(s)
- James A King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform et Provincial Research Data Services (King, Whitten), Services de santé de l'Alberta, Calgary, Alb.; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (Bakal, McAlister) et Provincial Research Data Services (Bakal), Services de santé de l'Alberta, Edmonton, Alb.; Division de médecine interne générale (McAlister), Université de l'Alberta, Edmonton, Alb
| | - Tara A Whitten
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform et Provincial Research Data Services (King, Whitten), Services de santé de l'Alberta, Calgary, Alb.; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (Bakal, McAlister) et Provincial Research Data Services (Bakal), Services de santé de l'Alberta, Edmonton, Alb.; Division de médecine interne générale (McAlister), Université de l'Alberta, Edmonton, Alb
| | - Jeffrey A Bakal
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform et Provincial Research Data Services (King, Whitten), Services de santé de l'Alberta, Calgary, Alb.; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (Bakal, McAlister) et Provincial Research Data Services (Bakal), Services de santé de l'Alberta, Edmonton, Alb.; Division de médecine interne générale (McAlister), Université de l'Alberta, Edmonton, Alb
| | - Finlay A McAlister
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform et Provincial Research Data Services (King, Whitten), Services de santé de l'Alberta, Calgary, Alb.; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (Bakal, McAlister) et Provincial Research Data Services (Bakal), Services de santé de l'Alberta, Edmonton, Alb.; Division de médecine interne générale (McAlister), Université de l'Alberta, Edmonton, Alb.
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Mubaraki AA, Alrbaiai GT, Sibyani AK, Alhulayfi RM, Alzaidi RS, Almalki HS. Prevalence of anosmia among COVID-19 patients in Taif City, Kingdom of Saudi Arabia. Saudi Med J 2021; 42:38-43. [PMID: 33399169 PMCID: PMC7989313 DOI: 10.15537/smj.2021.1.25588] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: To assess the prevalence of anosmia in coronavirus-19 (COVID-19) patients. Coronavirus-19-related anosmia and hyposmia is a new emerging concept in the medical literature. Methods: A retrospective study on COVID-19 patients with anosmia and hyposmia was performed during the period between May-July, 2020. The inclusion criteria were all clinically stable COVID-19 patients >15 years old with positive reverse transcription-polymerase chain reaction (RT-PCR). Patients who refused to participate or leave incomplete questions were excluded. In this study, we investigated 1022 patients who met our criteria. Results: Olfactory dysfunction (OD) was reported by 53% of our COVID-19 patients, of which 32.7% were anosmic and 20.3% were hyposmic. Other neurological symptoms included ageusia (51.4%), fatigue (63%), myalgia (59.2%), and headache (50.9%), all of which showed significant association with OD. In addition, anosmia had a significant association with young age and female gender. However, there was no association between OD and pre-existing neurological disease. Conclusion: Half of our COVID-19 patients presented OD (anosmia/hyposmia), which often associated with ageusia and many neurological symptoms.
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Affiliation(s)
- Adnan A Mubaraki
- Department of Medicine, Taif University, Taif, Kingdom of Saudi Arabia. E-mail.
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Ghaffari M, Ansari H, Beladimoghadam N, Aghamiri SH, Haghighi M, Nabavi M, Mansouri B, Mehrpour M, Assarzadegan F, Hesami O, Sedaghat M, Farahbakhsh M, Lima BS. Neurological features and outcome in COVID-19: dementia can predict severe disease. J Neurovirol 2021; 27:86-93. [PMID: 33417193 PMCID: PMC7792552 DOI: 10.1007/s13365-020-00918-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.
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Affiliation(s)
- Mehran Ghaffari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Headache and Facial Pain Clinic, Kaizen Brain Center, San Diego, USA
- Department of Neurology, University of California, San Diego, USA
| | - Nahid Beladimoghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehrdad Haghighi
- Department of Infectious Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Nabavi
- Department of Infectious Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Mansouri
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Assarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meghdad Sedaghat
- Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Farahbakhsh
- Department of Infectious Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Safarpour Lima
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Imam Hossein Medical and Educational Center , Madani Street, Tehran, Iran.
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11
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Owoo C, Oliver-Commey JA, Calys-Tagoe BNL, Oduro-Mensah E, Ofori-Boadu L, Adjei-Mensah E, Kenu E, Samba A, Yawson AE, Lartey M. Sociodemographic and clinical characteristics of the first cohort of COVID-19 recoveries at two national treatment centres in Accra, Ghana. Ghana Med J 2020; 54:16-22. [PMID: 33976437 PMCID: PMC8087372 DOI: 10.4314/gmj.v54i4s.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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana. METHODS We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics. RESULTS Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%). CONCLUSION COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolves. FUNDING None declared.
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Affiliation(s)
- Christian Owoo
- National COVID-19 Treatment Centre, University of Ghana Medical Centre (UGMC), Accra
- Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ghana
| | - Joseph A Oliver-Commey
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- LEKMA Hospital, Ghana Health Service
- National COVID-19 Case Management Team, Ghana
| | - Benedict N L Calys-Tagoe
- Department of Community Health, University of Ghana Medical School (UGMS), College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ebenezer Oduro-Mensah
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ghana
| | - Lawrence Ofori-Boadu
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ghana
- Institutional Care Division, Ghana Health Service
| | - Evelyn Adjei-Mensah
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- Department of Community Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana
| | - Ali Samba
- National COVID-19 Case Management Team, Ghana
- Department of Obstetrics & Gynaecology Department, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School (UGMS), College of Health Sciences, University of Ghana, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
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12
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Oduro-Mensah E, Tetteh J, Adomako I, Adjei-Mensah E, Owoo C, Yawson AO, Oliver-Commey JA, Puplampu P, Samba A, Yawson AE, Lartey M. Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases. Ghana Med J 2020; 54:23-32. [PMID: 33976438 PMCID: PMC8087366 DOI: 10.4314/gmj.v54i4s.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana. METHODS Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16. RESULTS Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD's count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)]. CONCLUSION The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients. FUNDING None declared.
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Affiliation(s)
- Ebenezer Oduro-Mensah
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Isaac Adomako
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Evelyn Adjei-Mensah
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Christian Owoo
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- National COVID-19 Treatment Centre, University of Ghana Medical Centre, Accra, Ghana
- Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Anita O Yawson
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Joseph A Oliver-Commey
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- LEKMA Hospital, La Dadekotopon Municipality, Ghana Health Service, Accra, Ghana
| | - Peter Puplampu
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Pentecost Convention Centre- National CoOVID-19 Treatment Centre, Central Region, Ghana
| | - Ali Samba
- Department of Obstetrics & Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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13
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Szôts M, Péterfi A, Geröly J, Nagy F. [Covid-19 associated neurological disorders]. Ideggyogy Sz 2020; 73:427-430. [PMID: 33264532 DOI: 10.18071/isz.73.0427] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The clinical signs of SARS-CoV-2 infection has become more recognisable in recent times. In addition to common symptoms such as fever, cough, dyspnea, pneumonia and ageusia, less common complications can be identified, including many neurological manifestations. In this paper, we discuss three Covid-19 associated neurological disorders (Case 1: Covid-19 encephalitis, Case 2: Covid-19 organic headache, Case 3: SARS-CoV-2-infection and ischaemic stroke). We emphasize in our multiple case study that during the present pandemic, it is especially important for neurologists to be aware of the nervous system complications of the virus infection, thus saving unnecessary examinations and reducing the frequency of patients' contact with health care personnel.
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Affiliation(s)
- Mónika Szôts
- Somogy Megyei Kaposi Mór Oktató Kórház, Neurológiai Osztály, Kaposvár
| | - Anna Péterfi
- Somogy Megyei Kaposi Mór Oktató Kórház, Neurológiai Osztály, Kaposvár
| | - Júlia Geröly
- Somogy Megyei Kaposi Mór Oktató Kórház, Neurológiai Osztály, Kaposvár
| | - Ferenc Nagy
- Somogy Megyei Kaposi Mór Oktató Kórház, Neurológiai Osztály, Kaposvár
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14
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Hou X, Zhang X, Wu X, Lu M, Wang D, Xu M, Wang H, Liang T, Dai J, Duan H, Xu Y, Yu X, Li Y. Serum Protein Profiling Reveals a Landscape of Inflammation and Immune Signaling in Early-stage COVID-19 Infection. Mol Cell Proteomics 2020; 19:1749-1759. [PMID: 32788344 PMCID: PMC7664125 DOI: 10.1074/mcp.rp120.002128] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious infection and threating the human lives in the world. The elevation of cytokines in blood is crucial to induce cytokine storm and immunosuppression in the transition of severity in COVID-19 patients. However, the comprehensive changes of serum proteins in COVID-19 patients throughout the SARS-CoV-2 infection is unknown. In this work, we developed a high-density antibody microarray and performed an in-depth proteomics analysis of serum samples collected from early COVID-19 (n = 15) and influenza (n = 13) patients. We identified a large set of differentially expressed proteins (n = 132) that participate in a landscape of inflammation and immune signaling related to the SARS-CoV-2 infection. Furthermore, the significant correlations of neutrophil and lymphocyte with the CCL2 and CXCL10 mediated cytokine signaling pathways was identified. These information are valuable for the understanding of COVID-19 pathogenesis, identification of biomarkers and development of the optimal anti-inflammation therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Betacoronavirus/pathogenicity
- Blood Proteins/genetics
- Blood Proteins/immunology
- COVID-19
- Child
- Coronavirus Infections/genetics
- Coronavirus Infections/immunology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/virology
- Cough/genetics
- Cough/immunology
- Cough/physiopathology
- Cough/virology
- Cytokine Release Syndrome/genetics
- Cytokine Release Syndrome/immunology
- Cytokine Release Syndrome/physiopathology
- Cytokine Release Syndrome/virology
- Cytokines/genetics
- Cytokines/immunology
- Female
- Fever/genetics
- Fever/immunology
- Fever/physiopathology
- Fever/virology
- Gene Expression Profiling
- Gene Expression Regulation
- Headache/genetics
- Headache/immunology
- Headache/physiopathology
- Headache/virology
- Humans
- Influenza, Human/genetics
- Influenza, Human/immunology
- Influenza, Human/physiopathology
- Influenza, Human/virology
- Male
- Middle Aged
- Myalgia/genetics
- Myalgia/immunology
- Myalgia/physiopathology
- Myalgia/virology
- Orthomyxoviridae/pathogenicity
- Pandemics
- Pneumonia, Viral/genetics
- Pneumonia, Viral/immunology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/virology
- Protein Array Analysis
- Proteome/genetics
- Proteome/immunology
- Receptors, Cytokine/genetics
- Receptors, Cytokine/immunology
- SARS-CoV-2
- Signal Transduction/immunology
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Affiliation(s)
- Xin Hou
- Department of Clinical Laboratory & Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaomei Zhang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Xian Wu
- Department of Clinical Laboratory & Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Minya Lu
- Department of Clinical Laboratory & Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Dan Wang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Meng Xu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Hongye Wang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Te Liang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Jiayu Dai
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Hu Duan
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China
| | - Yingchun Xu
- Department of Clinical Laboratory & Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| | - Xiaobo Yu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing, China.
| | - Yongzhe Li
- Department of Clinical Laboratory & Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
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15
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Caronna E, Ballvé A, Llauradó A, Gallardo VJ, Ariton DM, Lallana S, López Maza S, Olivé Gadea M, Quibus L, Restrepo JL, Rodrigo-Gisbert M, Vilaseca A, Hernandez Gonzalez M, Martinez Gallo M, Alpuente A, Torres-Ferrus M, Pujol Borrell R, Alvarez-Sabin J, Pozo-Rosich P. Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia 2020; 40:1410-1421. [PMID: 33146036 PMCID: PMC7645597 DOI: 10.1177/0333102420965157] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. METHODS This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. RESULTS Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). CONCLUSIONS Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.
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Affiliation(s)
- Edoardo Caronna
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Ballvé
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Llauradó
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor José Gallardo
- Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana María Ariton
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sofia Lallana
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López Maza
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Olivé Gadea
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Quibus
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Luis Restrepo
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreu Vilaseca
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Hernandez Gonzalez
- Immunology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Monica Martinez Gallo
- Immunology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Alicia Alpuente
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ricard Pujol Borrell
- Immunology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Barcelona, Spain
| | - José Alvarez-Sabin
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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16
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Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia 2020; 40:1443-1451. [PMID: 33146035 PMCID: PMC7645592 DOI: 10.1177/0333102420966770] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/05/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the frequency and characteristics of headache in patients with COVID-19 and whether there is an association between headache and anosmia and ageusia. METHODS This was a cross-sectional study. Consecutive patients admitted to hospital with COVID-19, confirmed by reverse transcription polymerase chain reaction (RT-PCR) technique, were assessed by neurologists. RESULTS Seventy-three patients were included in the study, 63% were male; the median age was 58 years (IQR: 47-66). Forty-seven patients (64.4%) reported headaches, which had most frequently begun on the first day of symptoms, were bilateral (94%), presenting severe intensity (53%) and a migraine phenotype (51%). Twelve patients (16.4%) presented with headache triggered by coughing. Eleven (15%) patients reported a continuous headache. Twenty-eight patients (38.4%) presented with anosmia and 29 (39.7%) with ageusia. Patients who reported hyposmia/anosmia and/or hypogeusia/ageusia experienced headache more frequently than those without these symptoms (OR: 5.39; 95% CI:1.66-17.45; logistic regression). Patients with anosmia and ageusia presented headache associated with phonophobia more often compared to those with headache without these complaints (Chi-square test; p < 0.05). Headache associated with COVID-19 presented a migraine phenotype more frequently in those experiencing previous migraine (p < 0.05). CONCLUSION Headaches associated with COVID-19 are frequent, are generally severe, diffuse, present a migraine phenotype and are associated with anosmia and ageusia.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, Brazil
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17
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Águila-Gordo D, Manuel Flores-Barragán J, Ferragut-Lloret F, Portela-Gutierrez J, LaRosa-Salas B, Porras-Leal L, Carlos Villa Guzmán J. Acute myelitis and SARS-CoV-2 infection. A new etiology of myelitis? J Clin Neurosci 2020; 80:280-281. [PMID: 33099361 PMCID: PMC7525324 DOI: 10.1016/j.jocn.2020.07.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022]
Abstract
The etiological agent of coronavirus disease-19 (COVID-19), SARS-coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and quickly spread worldwide leading the World Health Organization (WHO) to recognize it not only as a pandemic but also as an important thread to public health. Beyond respiratory symptoms, new neurological manifestations are being identified such as headache, ageusia, anosmia, encephalitis or acute cerebrovascular disease. Here we report the case of an acute transverse myelitis (TM) in a patient with SARS-CoV-2 infection detected by the nasopharyngeal swab technique but not in cerebrospinal fluid (CSF) analysis. Anti-herpes simplex virus (HSV) 1 and varicella-zoster IgM antibodies were not detected in serum samples and spinal and brain magnetic resonance imaging (MRI) showed no abnormal findings. This case remarks that COVID-19 nervous system damage could be caused by immune-mediated mechanisms.
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Affiliation(s)
- Daniel Águila-Gordo
- Cardiology Department, University Hospital of Ciudad Real, Obispo Torija s/n, 13005, Ciudad Real, Spain.
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18
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Zayet S, Kadiane-Oussou NJ, Lepiller Q, Zahra H, Royer PY, Toko L, Gendrin V, Klopfenstein T. Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect 2020; 22:481-488. [PMID: 32561409 PMCID: PMC7297177 DOI: 10.1016/j.micinf.2020.05.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
Clinical descriptions about influenza-like illnesses (ILI) in COVID-19 seem non-specific. We aimed to compare the clinical features of COVID-19 and influenza. We retrospectively investigated the clinical features and outcomes of confirmed cases of COVID-19 and influenza in Nord Franche-Comté Hospital between February 26th and March 14th 2020. We used SARS-CoV-2 RT-PCR and influenza virus A/B RT-PCR in respiratory samples to confirm the diagnosis. We included 124 patients. The mean age was 59 (±19 [19-98]) years with 69% female. 70 patients with COVID-19 and 54 patients with influenza A/B. Regarding age, sex and comorbidities, no differences were found between the two groups except a lower Charlson index in COVID-19 group (2 [±2.5] vs 3 [±2.4],p = 0.003). Anosmia (53% vs 17%,p < 0.001), dysgeusia (49% vs 20%,p = 0.001), diarrhea (40% vs 20%,p = 0.021), frontal headache (26% vs 9%,p = 0.021) and bilateral cracklings sounds (24% vs 9%,p = 0.034) were statistically more frequent in COVID-19. Sputum production (52% vs 29%,p = 0.010), dyspnea (59% vs 34%,p = 0.007), sore throat (44% vs 20%,p = 0.006), conjunctival hyperhemia (30% vs 4%,p < 0.001), tearing (24% vs 6%,p = 0.004), vomiting (22% vs 3%,p = 0.001) and rhonchi sounds (17% vs 1%,p = 0.002) were more frequent with influenza infection. We described several clinical differences which can help the clinicians during the co-circulation of influenza and SARS-CoV-2.
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Affiliation(s)
- Souheil Zayet
- Infectious Disease Department, Nord Franche-Comté Hospital, France.
| | | | - Quentin Lepiller
- Virology Department, Centre-Hospitalier Universitaire de Besançon, France
| | - Hajer Zahra
- Diabetology Department Nord Franche-Comté Hospital, France
| | | | - Lynda Toko
- Infectious Disease Department, Nord Franche-Comté Hospital, France
| | - Vincent Gendrin
- Infectious Disease Department, Nord Franche-Comté Hospital, France
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19
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Lahiri D, Mondal R, Deb S, Bandyopadhyay D, Shome G, Sarkar S, Biswas SC. Neuroinvasive potential of a primary respiratory pathogen SARS- CoV2: Summarizing the evidences. Diabetes Metab Syndr 2020; 14:1053-1060. [PMID: 32640417 PMCID: PMC7331527 DOI: 10.1016/j.dsx.2020.06.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/29/2022]
Abstract
BACKROUND AND AIMS After the emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the last two decades, the world is facing its new challenge in SARS-CoV-2 pandemic with unfathomable global responses. The characteristic clinical symptoms for Coronavirus (COVID-19) affected patients are high fever, dry-cough, dyspnoea, lethal pneumonia whereas some patients also show additional neurological signs such as headache, nausea, vomiting etc. The accumulative evidences suggest that SARS-CoV-2 is not only confined within the respiratory tract but may also invade the central nervous system (CNS) and peripheral nervous system (PNS) inducing some fatal neurological diseases. Here, we analyze the phylogenetic perspective of SARS-CoV-2 with other strains of β-Coronaviridae from a standpoint of neurological spectrum disorders. METHODOLOGY A Pubmed/Medline, NIH Lit Covid, Cochrane library and some open data bases (BioRxiv, MedRxiv,preprint.org and others) search were carried out by using keywords relevant to our topic of discussion. The extracted literatures are scrutinized by the authors. RESULTS 58 literatures including original articles, case reports and case series were selected by the authors to analyze the differential distribution of neurological impairments in COVID-19 positive patients along with angiotensin-converting enzyme-2 (ACE2) expression dynamics in neuronal and non-neuronal tissue in CNS and PNS with neuroinvasive potential of SARS-CoV2. CONCLUSION We discuss the need for modulations in clinical approach from a neurological point of view, as a measure towards reducing disease transmission, morbidity and mortality in SARS-CoV2 positive patients.
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Affiliation(s)
- Durjoy Lahiri
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, Kolkata, India.
| | - Ritwick Mondal
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, Kolkata, India
| | - Shramana Deb
- S. N. Pradhan Centre for Neuroscience, University of Calcutta, India
| | - Deebya Bandyopadhyay
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, Kolkata, India
| | - Gourav Shome
- Department of Microbiology, University of Calcutta, India
| | - Sukanya Sarkar
- Department of Cell Biology and Physiology, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Subhas C Biswas
- Department of Cell Biology and Physiology, CSIR-Indian Institute of Chemical Biology, Kolkata, India
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20
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Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol 2020; 26:619-630. [PMID: 32839951 PMCID: PMC7444681 DOI: 10.1007/s13365-020-00895-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 01/01/2023]
Abstract
The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.
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Affiliation(s)
- Fatima Khatoon
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Kartikay Prasad
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Vijay Kumar
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India.
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21
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Abstract
BACKGROUND Reports on neurologic manifestations of coronavirus disease 2019 (COVID-19) have attracted broad attention. We present an unusual case of COVID-19-associated encephalitis mimicking a glial tumor. CASE DESCRIPTION A 35-year-old woman presented with headache and seizures. T2 fluid-attenuated inverse recovery imaging showed hyperintensities in the left temporal lobe. Magnetic resonance spectroscopy showed an elevated choline peak. Imaging findings were suggestive of high-grade glioma. Antiepileptic medication failed to achieve seizure control. A left anterior temporal lobectomy was performed. The patient had no postoperative deficits, and her symptoms completely improved. Histologic examination revealed encephalitis. Postoperatively, our patient tested positive for COVID-19. CONCLUSIONS Our case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors. For prompt diagnosis and prevention of transmission, clinicians should consider COVID-19 in patients with similar presentation.
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Affiliation(s)
- Ibrahim E Efe
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Orhun Utku Aydin
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alper Alabulut
- Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Ozgur Celik
- Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Kerameddin Aydin
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey.
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22
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Abstract
A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient's mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.
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Affiliation(s)
- Jamie A Mawhinney
- Academic Department of Vascular Surgery, King's College London, London, UK
| | - Catherine Wilcock
- Department of Ageing and Health, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Hasan Haboubi
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Shahbaz Roshanzamir
- Department of Ageing and Health, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
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23
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Abstract
Chikungunya and Zika virus infections are emerging diseases in the Americas, and dengue continues to be the most prevalent arthropod-borne virus in the world. These arbovirus diseases may spread by endemic transmission or as travel-related infections and have rapidly expanded their geographic distribution secondary to vector spread. All 3 share a similar clinical picture that includes a maculopapular rash. Zika is characterized by pruritic rash, low-grade fever, and arthralgia. Congenital nervous system malformations are a growing public-health concern. Chikungunya distinctive dermatologic manifestations include facial melanosis and bullous eruption. Dengue bleeding complications may be life-threatening and require inpatient management.
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Affiliation(s)
- Jose Dario Martinez
- Department of Internal Medicine, University Hospital "Dr. José E. González", UANL, Mitras Centro, Avenida Gonzalitos y Madero S/N, Monterrey 64460, Mexico.
| | - Jesus Alberto Cardenas-de la Garza
- Department of Dermatology, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Mitras Centro, Avenida Gonzalitos y Madero S/N, Monterrey 64460, Mexico
| | - Adrian Cuellar-Barboza
- Department of Dermatology, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Mitras Centro, Avenida Gonzalitos y Madero S/N, Monterrey 64460, Mexico
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24
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Bongard E, van der Velden AW, Cook J, Saville B, Beutels P, Munck Aabenhus R, Brugman C, Chlabicz S, Coenen S, Colliers A, Davies M, De Paor M, De Sutter A, Francis NA, Glinz D, Godycki-ćwirko M, Goossens H, Holmes J, Ieven M, de Jong M, Lindbaek M, Little P, Martinón-Torres F, Moragas A, Pauer J, Pfeiferová M, Radzeviciene-Jurgute R, Sundvall PD, Torres A, Touboul P, Varthalis D, Verheij T, Butler CC. Antivirals for influenza-Like Illness? A randomised Controlled trial of Clinical and Cost effectiveness in primary CarE (ALIC 4 E): the ALIC 4 E protocol. BMJ Open 2018; 8:e021032. [PMID: 30002007 PMCID: PMC6089276 DOI: 10.1136/bmjopen-2017-021032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/01/2018] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Effective management of seasonal and pandemic influenza is a high priority internationally. Guidelines in many countries recommend antiviral treatment for older people and individuals with comorbidity at increased risk of complications. However, antivirals are not often prescribed in primary care in Europe, partly because its clinical and cost effectiveness has been insufficiently demonstrated by non-industry funded and pragmatic studies. METHODS AND ANALYSIS Antivirals for influenza-Like Illness? An rCt of Clinical and Cost effectiveness in primary CarE is a European multinational, multicentre, open-labelled, non-industry funded, pragmatic, adaptive-platform, randomised controlled trial. Initial trial arms will be best usual primary care and best usual primary care plus treatment with oseltamivir for 5 days. We aim to recruit at least 2500 participants ≥1 year presenting with influenza-like illness (ILI), with symptom duration ≤72 hours in primary care over three consecutive periods of confirmed high influenza incidence. Participant outcomes will be followed up to 28 days by diary and telephone. The primary objective is to determine whether adding antiviral treatment to best usual primary care is effective in reducing time to return to usual daily activity with fever, headache and muscle ache reduced to minor severity or less. Secondary objectives include estimating cost-effectiveness, benefits in subgroups according to age (<12, 12-64 and >64 years), severity of symptoms at presentation (low, medium and high), comorbidity (yes/no), duration of symptoms (≤48 hours/>48-72 hours), complications (hospital admission and pneumonia), use of additional prescribed medication including antibiotics, use of over-the-counter medicines and self-management of ILI symptoms. ETHICS AND DISSEMINATION Research ethics committee (REC) approval was granted by the NRES Committee South Central (Oxford B) and Clinical Trial Authority (CTA) approval by The Medicines and Healthcare products Regulatory Agency. All participating countries gained national REC and CTA approval as required. Dissemination of results will be through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN27908921; Pre-results.
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Affiliation(s)
- Emily Bongard
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alike W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna Cook
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Saville
- Berry Consultants, Austin, Texas, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | - Curt Brugman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Slawomir Chlabicz
- Department of Family Medicine and Community Nursing, Medical University of Bialystok, Bialystok, Poland
| | - Samuel Coenen
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Annelies Colliers
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | | | - Muireann De Paor
- Department of General Practice, Royal College of Surgeons in Ireland School of Medicine, Dublin, Ireland
| | - An De Sutter
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Nick A Francis
- Department of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Dominik Glinz
- University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Maciek Godycki-ćwirko
- Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Jane Holmes
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Menno de Jong
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Morten Lindbaek
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Paul Little
- Primary Care and Population Science, University of Southampton, Southampton, UK
| | | | - Ana Moragas
- Primary Healthcare Centre Jaume I, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | | | - Markéta Pfeiferová
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Pär-Daniel Sundvall
- Närhälsan, Research and Development Primary Health Care, Region Västra Götaland, Research and Development Center Södra Älvsborg, Borås, Sweden
- Department of Public Health and Community Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Antoni Torres
- Department of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, Barcelona, Spain
| | - Pia Touboul
- Department of Public Health, University Hospital of Nice, Nice, France
- Department of Teaching and Research in General Practice, University of Côte d’Azur, Nice, France
| | | | - Theo Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christopher C Butler
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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25
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Abstract
RATIONALE Ramsay Hunt syndrome in conjunction with cranial polyneuritis is not extensively documented, and is very easily misdiagnosed. PATIENT CONCERNS A case of a 53-year-old male with Ramsay Hunt syndrome in conjunction with cranial polyneuritis is presented with early symptoms of vertigo, cephalalgia, and facial palsy, followed by zoster oticus 10 days later. DIAGNOSES Diagnosis was challenging as this condition presents with multiple neuropathies, and attempting to diagnose based on clinical symptoms was often misleading. Polymerase chain reaction can be used to test for presence of the virus in the cerebrospinal fluid, followed by targeted drug therapy. INTERVENTIONS Acupuncture, in conjunction with fire cupping, bloodletting around the afflicted region on the face, as well as oral consumption of herbal medicine and vitamins for nerve nourishment was given to treat this disease. OUTCOMES Due to misdiagnosis resulting in delayed treatment, peripheral facial paralysis was left as the main sequelae, while other symptoms responded quickly to treatment. After a 6-month follow-up, facial palsy was still present. LESSONS Considering that targeted antiviral therapy can be used to increase the effectiveness of treatment, early diagnosis, and timely use of medication is critical.
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Affiliation(s)
- Ru-Wen Zheng
- Department of Acupuncture and Moxibustion, Dongfang Hospital, The Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Di Liu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, The Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Tay E. Eric
- Singapore Chung Hwa Medical Institution, Singapore
| | - Yan-Zhe Ning
- Beijing Anding Hospital, Affiliated to Capital Medical University
| | - Lu-Lu Chen
- Department of Acupuncture and Moxibustion, Dongfang Hospital, The Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hui Hu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, The Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yi Ren
- Department of Neurology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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26
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Le Borgne P, Brunhuber C, Bilbault P. Febrile headache and leg weakness as the initial symptoms of tickborne encephalitis. BMJ Case Rep 2017; 2017:bcr-2017-220841. [PMID: 28663270 PMCID: PMC5535206 DOI: 10.1136/bcr-2017-220841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Claudia Brunhuber
- Radiology, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Baden-Wurttemberg, Germany
| | - Pascal Bilbault
- Emergency Department, Hopitaux Universitaires de Strasbourg, Strasbourg, France
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27
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Abstract
Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey of the symptoms of all survivors from the Ebola treatment unit (ETU) at 34th Regimental Military Hospital, Freetown, Sierra Leone (MH34), was conducted after discharge at their initial follow-up appointment within 3 weeks after their second negative PCR result. From its opening on December 1, 2014, through March 31, 2015, the MH34 ETU treated 84 persons (8-70 years of age) with PCR-confirmed Ebola virus disease, of whom 44 survived. Survivors reported musculoskeletal pain (70%), headache (48%), and ocular problems (14%). Those who reported headache had had lower admission cycle threshold Ebola PCR than did those who did not (p<0.03). This complete survivor cohort from 1 ETU enables analysis of the proportion of symptoms of post-Ebola syndrome. The Ebola epidemic is waning, but the effects of the disease will remain.
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28
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de Laval F, Matheus S, Maquart M, Yvrard E, Barthes N, Combes C, Rousset D, Leparc-Goffart I, Briolant S. Prospective Zika virus disease cohort: systematic screening. Lancet 2016; 388:868. [PMID: 27597462 DOI: 10.1016/s0140-6736(16)31429-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/05/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Franck de Laval
- Military Centre for Epidemiology and Public Health, Camp Militaire de Sainte Marthe, Marseille, France; French Armed Forces Health Service in French Guiana, Quartier La Madeleine, BP 6019, 97306 Cayenne Cedex, French Guiana
| | - Séverine Matheus
- Institut Pasteur of French Guiana, Laboratory of Virology, National Reference Centre for Arboviruses, Cayenne, French Guiana
| | - Marianne Maquart
- French Armed Forces Biomedical Research Institute, National Reference Centre for Arboviruses, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Emmanuel Yvrard
- French Armed Forces Biomedical Research Institute, National Reference Centre for Arboviruses, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Nicolas Barthes
- French Armed Forces Health Service in French Guiana, Quartier La Madeleine, BP 6019, 97306 Cayenne Cedex, French Guiana
| | - Cédric Combes
- French Armed Forces Health Service in French Guiana, Quartier La Madeleine, BP 6019, 97306 Cayenne Cedex, French Guiana
| | - Dominique Rousset
- Institut Pasteur of French Guiana, Laboratory of Virology, National Reference Centre for Arboviruses, Cayenne, French Guiana
| | - Isabelle Leparc-Goffart
- French Armed Forces Biomedical Research Institute, National Reference Centre for Arboviruses, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Sébastien Briolant
- French Armed Forces Health Service in French Guiana, Quartier La Madeleine, BP 6019, 97306 Cayenne Cedex, French Guiana; Unit of Medical Entomology, Cayenne, French Guiana; Unit of Parasitology and Medical Entomology, Hôpital d'Instruction des Armées Laveran, Marseille, France; Research Unit in Emerging Infectious and Tropical Diseases, UM 63, CNRS 7278, IRD 198, Aix-Marseille Université, Marseille, France; INSERM 1095, Faculté de Médecine La Timone, Aix-Marseille Université, Marseille, France.
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29
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Abstract
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.
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Affiliation(s)
- Bridgette Jeanne Billioux
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Bryan Smith
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA.
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30
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Dicker F, Walsh R, May IC. Young Man with Sore Throat, Headache, and Rash. J Emerg Med 2016; 50:e99-e101. [PMID: 26443642 DOI: 10.1016/j.jemermed.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/14/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Frank Dicker
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ryan Walsh
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Ian C May
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington
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31
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Vâţă A, Luca CM, Duca E, Irina T, Manciuc C, Vâţă LG, Dorobăţ C. Viral meningitis admitted to an infectious diseases hospital: a retrospective case series. Rev Med Chir Soc Med Nat Iasi 2013; 117:476-482. [PMID: 24340533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Given its epidemic potential and development of severe forms of disease, viral meningitis (VM) is a serious public health problem. AIM to characterize the main clinical, epidemiologic features, the etiology and treatment of VM cases admitted to the Iasi Infectious Diseases Hospital, in 2012. MATERIAL AND METHODS We retrospectively analyzed the medical records of the patients admitted for viral meningitis at the Iasi "St. Parascheva" Infectious Diseases Hospital in the interval January 1- December 31, 2012 (98 cases). The etiologic diagnosis was made by determining the IgM/IgG antibodies against Coxsackie virus and/or West Nile virus in blood/CSF. RESULTS There was a fourfold increase in the number of cases as compared to the average for the years 2009-2011. Most cases (73.5%) were children aged 1 to 14 years. 61.8% of patients were males, 51.7% from urban areas. The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases. In43.5% of the 39 patients serologically investigated a Coxsackie virus infection was confirmed and 1/20 was positive for West Nile virus; three varicella-zoster virus infections and one mumps infection were diagnosed clinically. 68.3% of the patients received first-line antibiotic treatment. CONCLUSIONS The illness mainly affected children, fever and neck stiffness being sometimes absent. The etiology was known in 22.4% of cases; enter viruses being the most frequent causative agent. Most patients received antibiotic therapy. The course was favorable in all cases.
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Affiliation(s)
- A Vâţă
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa" - Iaşi
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32
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Affiliation(s)
- Neelam Kumar
- Clinical Infection Unit, St George's Hospital, London SW17 0QT, UK.
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33
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Mykyteĭ OM. [Diagnostics and complex treatment of head pain related to acute herpes zoster infection]. Lik Sprava 2012:102-105. [PMID: 23373386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Classification (on a nosotropic mechanism) on which distinguish head pain is in-process resulted: vascular, head pain of tension, likvorodinamicheskaya, neuralgic, mixed type, and also facial pains and pains in area of ear. Duration--from a few clock to a few days. Such state can be at hypertensive illness, allergic reaction, fervescence. When GB appears in set time during a few days, large authenticity that it is a vascular type. It is expedient to apply the holiatry of head pain, related to the sharp infection of girdle herpes (Nerpes zoster), antiviral, kortikosteroidnimi, nesteroidnymi protivovospalitel'nymi preparations, antidepressants, methods of refleksoterapii.
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34
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Abstract
Dejerine-Roussy syndrome, also known as the thalamic pain syndrome is a condition in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. Association of this syndrome with HIV is rare with few case reports described in adults. We report a 10 year old male child who was HIV positive and had developed this syndrome due to cytomegalovirus vasculitis.
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Affiliation(s)
- Syed Ahmed Zaki
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
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35
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Javed S. Autumn blues. J Miss State Med Assoc 2007; 48:170-173. [PMID: 17941244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Shazia Javed
- Department of Family Medicine, University of Mississippi Medical Center, Jackson, USA
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36
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Affiliation(s)
- Ki-Young Jung
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Anam-Dong, Seongbuk-Gu, Seoul, Korea.
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37
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Abstract
Hypertrophic pachymeningitis is a condition characterized by significant chronic inflammatory thickening of the cranial dura mater, frequently presenting with symptoms such as headache and cranial neuropathy. In this report, we describe a very rare case of hypertrophic pachymeningitis, considered to be attributable to Epstein-Barr virus (EBV), which was diagnosed in a patient who visited our hospital with a complaint of ongoing severe headaches. The diagnosis was based on positive specific serum EBV antibody titers, with VCA-IgM levels of less than 1:10, VCA-IgG levels of 1:160, and EBNA levels of 1:40, as well as on the results of magnetic resonance imaging of the head with contrast media.
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Affiliation(s)
- Hirohisa Okuma
- Department of Neurology, Tokai University Tokyo Hospital, Tokyo, Japan
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38
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Desmond RA, Accortt NA, Talley L, Villano SA, Soong SJ, Whitley RJ. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother 2006; 50:2409-14. [PMID: 16801419 PMCID: PMC1489762 DOI: 10.1128/aac.00227-06] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enteroviral meningitis causes appreciable morbidity in adults, including hospitalization, decreased activity, and headache. Limited data define the natural history of disease. No antiviral therapeutic agent has demonstrated improved outcome in controlled clinical trials. Pleconaril, an inhibitor of enterovirus replication, was tested in two placebo-controlled clinical trials. Of 607 randomized patients in a multicenter, double-blind placebo-controlled study of pleconaril (200 mg three times daily versus an identical-appearing placebo), 240 patients were confirmed to have enterovirus infection. The time to headache resolution was evaluated by using Kaplan-Meier survival methodology. A Cox regression model evaluated multivariate factors associated with disease resolution. Resolution of headache in patients with concomitant moderate to severe nausea at baseline occurred at a median of 9.5 days in the absence of therapy and was reduced to 7.0 days for pleconaril recipients (P = 0.009). For a headache score of > 5 alone, treated patients resolved headache significantly more rapidly (P = 0.005). Males resolved headache 50% faster than females. Regardless of randomization group, patients with a baseline headache score of 5 or greater resolved headache 50% more slowly than patients with a baseline headache score of 4. No differences in either clinical or laboratory adverse events were noted. Over 50% of untreated patients had a persistent headache that was greater than 1 week in duration. Pleconaril shortened the course of illness compared to placebo recipients, especially in the early disease course. However, the benefit was achieved only modestly in a subgroup analysis of patients with more severe disease after adjusting for confounding variables.
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Affiliation(s)
- R A Desmond
- Department of Biostatistics and Bioinformatics, Medical Statistics Section, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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39
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Taşdemir HA, Dilber C, Totan M, Onder A. Pseudotumor cerebri complicating measles: a case report and literature review. Brain Dev 2006; 28:395-7. [PMID: 16504441 DOI: 10.1016/j.braindev.2005.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 09/05/2005] [Accepted: 10/19/2005] [Indexed: 11/22/2022]
Abstract
A previously healthy 8-year-old girl patient was referred with the complaints of severe headache associated with nausea and vomiting. Three weeks prior to her admission, she had measles manifested with fever and typical skin eruptions. Fundoscopic examination revealed bilateral swollen optic discs with tortuous blood vessels. Other physical examinations were unremarkable, except for photophobia. Lumbar puncture demonstrated a cerebrospinal fluid opening pressure of 30 cm H(2)O, no cells, normal levels of glucose and protein. Serum measles immunoglobulin M level was elevated (183 AU). Our further investigations revealed that the patient had pseudotumor cerebri (PTC) following measles infection.
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Affiliation(s)
- Haydar Ali Taşdemir
- Division of Neurology, Department of Paediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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40
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Abstract
BACKGROUND In 2003, West Nile virus (WNV) nucleic acid amplification testing (NAT) was implemented to detect potentially infected donors. Of more than 5.3 million donations screened prospectively by the American Red Cross during the epidemic periods of 2003 and 2004, 974 were NAT-reactive and 519 confirmed-positive. A subset of both the confirmed-positive and the false-positive groups was assessed for demographic characteristics, symptoms, and symptom reporting relative to date of donation. STUDY DESIGN AND METHODS All donors with initial WNV NAT-reactive results were invited to participate in a study that included a demographic, symptom, and date-of-symptom questionnaire. WNV confirmed-positive cases were compared to false-positive controls for comparison of frequency of symptom reporting before, on the day of, and after donation. RESULTS Enrolled cases and controls were similar in all characteristics except cases were more likely to live in rural areas. Symptoms were reported by 61 percent of cases versus 20 percent of controls, with 74 percent of symptoms reported by cases within the 14 days after donation. The frequency of headache and fever reported together in the 7 days before donation was not significantly different between cases and controls; only the individual frequencies of headache, eye pain, and new rash during this time were significantly different. The most commonly reported symptoms, after adjustment for symptom reporting by controls, were headache, new rash, and generalized weakness; these symptoms were reported by 25 percent of cases. CONCLUSIONS The demographic characteristics of infected donors reflected the rural nature of the 2003 to 2004 WNV epidemics. This study suggests that asking donors about predonation headache and fever had no detectable contribution to blood safety.
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Affiliation(s)
- S L Orton
- Division of Blood Applications, FDA, CBER, OBRR, Rockville, Maryland, USA
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41
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Pancewicz SA, Hermanowska-Szpakowicz T, Kondrusik M, Zajkowska J, Grygorczuk S, Swierzbińska R, Zielenkiewicz-Madejska E. [Complications of tick-borne encephalitis in 15-year long experience of the Department of Infectious Diseases and Neuroinfections]. Przegl Epidemiol 2006; 60 Suppl 1:92-101. [PMID: 16909785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The clinical features of tick-borne encephalitis (tbe) were analyzed in the group of 477 patients hospitalized in the Department of the Infectious Disease and Neuroinfections of the Medical Academy in Białystok. The group included 31.4% women and 68.6% men, aged from 15 to 76 years. Persistent neurological sequelae were noted in 10.9% of patients: paresis or plegia in 5.66%, spinal dysfunction with lower limbs paraparesis in 1.68%, significant paresis of upper extremities in 0.63%, brachial plexus paresis in 2.31%. Cranial nerves involvement was present in 2.93%, including uni- or bilateral facial nerve palsy in 2.73% and trigeminal nerve involvement in 0.21%. Cerebellar dysfunction was present in 2,09% of patients. No fatal cases of tbe occured.
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42
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Ostrowska JD, Zajkowska J, Krupa W, Pancewicz S, Kondrusik M, Grygorczuk S. [Severe course of tick-borne encephalitis (Encephalomeningomyelitis): a case report]. Med Pr 2006; 57:25-8. [PMID: 16780172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
A 19-year-old male student was admitted to the Department of Infectious Diseases and Neuroinfections with suspected encephalomeningitis. Three weeks before admission the patient was bitten by a tick. The first symptoms were manifested by mild consciousness disorders, headache, vomiting, and fever with the presence of meningeal syndrome. In the course of the disease, the signs of focal lesions in the central nervous system developed: horizontal nystagmus, bilateral ptosis, paresis of cranial nerves: peripheral damage to nerve VII on the right and nerve XI, weakness of proximal muscles of upper and lower extremities. Examination of the cerebrospinal fluid showed lymphocytic pleocytosis with the presence of antibodies against TBE virus. CT and MRI scans did not show any pathology. The applied treatment reduced neurological abnormalities. In the course of the disease, generalized convulsions were twice observed. On the day of discharge, slight nystagmus, bilateral ptosis with normal movement of eyeballs, slight peripheral paresis of nerve VII on the right and nerve XI, massive paresis of the shoulder girdle muscles as a result of their atrophy were found. Mental status was normal. Residual signs of peripheral paresis of peripheral nerve VII, slight nystagmus as well as paresis and atrophy of the shoulder girdle muscles are still present.
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Sobolewski P. [Mixed aphasia as a dominating symptom of encephalitis]. Przegl Epidemiol 2006; 60 Suppl 1:146-7. [PMID: 16909792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Encephalitis has typically a severe course, with psychotic disorders, consciousness disorders, epileptic seizures and meningal signs. The author describes a case of a young male, in whom dominant symptoms of encephalities were aphasia and headache. These symptoms were accompanied by considerable inflammatory changes in cerebral fluid. The outcome of illness was favourable.
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Affiliation(s)
- Piotr Sobolewski
- Oddział Neurologii z Pododdziałem Udarowym S.P.Z.Z.O.Z. w Sandomierzu
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44
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Abstract
A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.
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Affiliation(s)
- Sean W Taylor
- Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
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45
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Abstract
OBJECTIVE The objective of this study was to analyze the characteristics of a series of acute aseptic meningitis (AAM) (defined by sterile cerebrospinal fluid (CSF) with more than 10 leucocytes per mm3 and a neutrophilic polynuclear-rich formula). We analysed the initial management, the reasons for antibiotic and/or antiviral treatment, the aetiologies, the need for lumbar puncture and the progression... METHOD We retrospectively analyzed 32 cases of AAM (out of a total of 130 cases of meningitis) from two departments of internal medicine in Lyon, diagnosed between January 1996 and January 2003. Only the files fulfilling the AAM criteria were retained, selecting those with a minimum neutrophilic polynuclear level of 30% in the CSF. RESULTS The mean age was 32.6 years (range: 18-75) and predominantly male patients (59%). On admission, 87% of the patients exhibited fever, but only 9% remaining so for 72 hours. Viral syndrome before admission was noted in 59% of cases, with seasonal predilection (summer: 39%, winter: 35%). The motivation for lumbar puncture (LP) was meningeal syndrome (44%), headache (94%) and vomiting (47%). The average rate of neutrophils in the CSF on admission was 63% (range: 30-96). A control LP on Day 3 was performed 16 times (50%): mean PNN rate at 18% (range: 0-80), lymphocyte rate=68% (range: 20-95). Most of the patients (77.4%) had a C reactive protein (CRP) lower than 50 mg/l on admission (range: 5-320). A cerebral scan was performed 10 times (31%) and was abnormal 2 times (multiple cerebral abscesses, possible intracranial hypertension). An antibiotic (84%) and/or antiviral (34%) treatment was initiated. The evolution on Day 3 was favourable (87.5%): no fever, regression of the meningeal syndrome, with a mean duration of hospitalisation of 8.3 days (range: 1-60). Search for Herpes simplex virus and Enterovirus was made with PCR analysis in 20 cases (62.5%): no positivity for the herpes, but 9 for the Enterovirus. The systematic blood cultures were positive only once (staphylococcal infective endocarditis with cerebral abscesses). The diagnosis of bacterial meningitis was evoked 3 times (prior antibiotic treatment). DISCUSSION The frequency of Enterovirus AAM should encourage this type of investigation in order to withdraw the often initiated anti-infectious treatment rapidly, and hence avoid a second lumbar puncture.
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Affiliation(s)
- M Pavic
- Service de médecine interne, HIA Desgenettes, Lyon.
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46
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Schattner A, Halperin D, Wolf D, Zimhony O. Enteroviruses and sudden deafness. CMAJ 2003; 168:1421-3. [PMID: 12771071 PMCID: PMC155958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
A young, healthy man presented with sudden severe sensorineural hearing loss and tinnitus. The results of the workup and neuroimaging were normal, as were the auditory brain stem responses. Methylprednisolone pulse therapy was associated with significant hearing improvement within 10 days. A history of a short self-limited febrile illness preceding admission (with headache, photophobia, myalgia and fatigue), a raised serum C-reactive protein level and transient leukopenia suggested an infectious cause. Lumbar puncture revealed a mononuclear pleocytosis of the cerebrospinal fluid, with negative cultures but positive polymerase chain reaction test results for enterovirus, which was later cultured from the patient's stool. The patient's wife and baby had had a similar febrile illness without hearing loss 10 days earlier, and an outbreak of enterovirus meningitis was identified in the area, which was associated with familial clustering and echovirus serotype 4 infection. The varied causes of sudden sensorineural hearing loss, which should include enterovirus, are reviewed here.
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Affiliation(s)
- Ami Schattner
- Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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47
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Thakare JP, Rao TLG, Padbidri VS. Prevalence of West Nile virus infection in India. Southeast Asian J Trop Med Public Health 2002; 33:801-5. [PMID: 12757229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
During the course of the virological investigation of cases of suspected viral fevers carried out at the National Institute of Virology (NIV), Pune, India, evidence of recent infection with West Nile (WN) virus was detected in 88 cases. Fever, general aches, headache, nausea and vomiting were the principal clinical features in 92% (81/88) of the cases; there were seven cases of encephalitis, in which WN virus-specific IgM class antibodies were detected in CSF samples. These cases of encephalitis were from Japanese encephalitis (JE) nonendemic areas, like Maharashtra and Rajasthan, as well as from JE endemic areas, like Goa and Orissa. Interestingly, neutralizing antibodies predominantly to WN virus were detected in CSF samples by the 50% cytopathic effect inhibition method; the titers ranged from 5 to 375. Cases of WN virus infection associated with both encephalitis and classic features have been reported for the first time in recent years in India. Reports of unique urban West Nile virus encephalitis epidemics in New York, Romania, and Algeria in recent years have signaled the emergence of neurological infection due to West Nile virus as a novel public health threat. This study is important because it records evidence of WN virus infection in India.
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Affiliation(s)
- J P Thakare
- National Institute of Virology, Pune, Maharashtra, India.
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48
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Lohse N, Obel N. [Meningitis caused by herpes simplex virus type 2]. Ugeskr Laeger 2002; 164:4190-2. [PMID: 12362835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Herpes simplex virus type 1 (HSV-1) is well-known as a cause of orolabial ulcers, whereas HSV-2 predominantly causes genital infections. Furthermore, HSV can lead to severe infections in the central nervous system (CNS). In adults, HSV encephalitis is predominantly caused by HSV-1, whereas HSV-2 mainly leads to aseptic meningitis, the symptoms of which are seen with or without concurrent genital ulcers. We describe four cases of HSV-2-associated aseptic meningitis. One of the patients had a primary HSV infection, and another had recurrent aseptic meningitis. All the patients recovered without neurological sequelae.
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Affiliation(s)
- Nicolai Lohse
- Infektionsmedicinsk afdeling Q, Skejby Sygehus, Braendstrupgårdsvej 100, DK-8240 Arhus N.
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49
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Ogunseyinde AO, Familusi JB. HIV-assocated lymphoma: a case report. Afr J Med Med Sci 2002; 31:283-5. [PMID: 12751575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
We report the case of a 3(1/2) year old boy who presented with sudden onset of headache. Fever and swelling of the left eye. He had complete opthalmoplegia of the left eye and 6th cranial nerve paralysis in the right eye. He was thought to have cavenous sinus thrombosis but CT findings suggestive of lymphoma led to the correct diagnosis of HIV associated Lymphoma It view of the rising incidence of HIV infection and the protein clinical manifestations, it is advised that all patients with disseminated tumour masses should be screened for the HIV virus, and CT examination should be made available to patients.
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Affiliation(s)
- A O Ogunseyinde
- Department of Radiology, University College Hospital, Ibadan, Nigeria
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50
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Abstract
A 30-year-old man without previous attacks of migraine, despite a family history of migraine, presented with moderate headache and temporary focal neurological signs and symptoms. The patient had had, two weeks previously, a prodromic flu-like illness. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and increased total protein. Extensive microbiological determinations were negative. Routine hematological, immunological, blood and urine tests were normal. Electroencephalography showed a focal slowing in the right temporal area. Brain SPECT, performed during a symptom-free period, revealed decreased tracer uptake in the left temporal and insula cortices,topographicallyconsistent with abnormalities on brainstem auditory evoked potentials. Computed tomography and magnetic resonance imaging of the brain were normal. A cardiovascular examination provided normal results. The patient completely recovered within 2 days. This condition is suggestive of "headache with neurologic deficits and CSF lymphocytosis" (HaNDL syndrome). I hypothesize that this syndrome could be produced by the direct action of a virus.
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Affiliation(s)
- F Chalaupka Devetag
- Department of Neurology and Clinical Neurophysiology, S. Maria del Prato Hospital, ULSS2, Via Bagnols sur Cèze 3, I-32032 Feltre (BL), Italy
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