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Cecco BS, Henker LC, Lorenzett MP, Molossi FA, Schwertz CI, Baumbach LF, Weber MN, Canal CW, Driemeier D, Pavarini SP, Langohr IM, Carossino M, Balasuriya UBR, Sonne L. An outbreak of visna-maedi in a flock of sheep in Southern Brazil. Braz J Microbiol 2022; 53:1723-1730. [PMID: 35478313 PMCID: PMC9433499 DOI: 10.1007/s42770-022-00763-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Visna-maedi is a multisystemic and progressive inflammatory disease caused by a non-oncogenic retrovirus (Visna-maedi virus, VMV). An outbreak of visna-maedi occurred in Southern Brazil in sheep with clinical signs of blindness and stumbling gait. At post-mortem examination, all animals had similar lesions, including heavy non-collapsed lungs and multifocal yellow areas in the cerebral white matter, affecting mainly the periventricular region. These lesions corresponded histologically to lymphocytic interstitial pneumonia and histiocytic periventricular encephalitis surrounding areas of necrosis, in addition to significant demyelination in the brain. Serology was performed in all the sheep from the flock and 14% were seropositive for VMV. The presence of VMV was confirmed through PCR and partial sequencing of the 5'LTR. Sequencing demonstrated that the virus had 89.7 to 90.0% of nucleotide identity with VMV strains reported in the USA. This is the first description of clinical disease related to VMV in Brazil leading to economic losses. This study calls for the need to implement control measures to prevent the spread of small ruminant lentiviruses in Brazil.
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Affiliation(s)
- Bianca S Cecco
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Luan C Henker
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marina P Lorenzett
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Franciéli A Molossi
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Claiton I Schwertz
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Letícia F Baumbach
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Matheus N Weber
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Cláudio W Canal
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - David Driemeier
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Saulo P Pavarini
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ingeborg M Langohr
- Department of Pathobiological Sciences and Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Medicine, Louisiana State University (LSU), Baton Rouge, LA, USA
| | - Mariano Carossino
- Department of Pathobiological Sciences and Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Medicine, Louisiana State University (LSU), Baton Rouge, LA, USA
| | - Udeni B R Balasuriya
- Department of Pathobiological Sciences and Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Medicine, Louisiana State University (LSU), Baton Rouge, LA, USA
| | - Luciana Sonne
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Equiza J, Rodríguez-Antigüedad J, Campo-Caballero D, Iruzubieta P, Prada Á, Roncancio A, Fernández E, Ganzarain Oyarbide M, Arruti M, Urtasun MA, Castillo-Triviño T. Autoimmune GFAP astrocytopathy presenting with remarkable CNS hyperexcitability and oculogyric crises. J Neuroimmunol 2021; 359:577695. [PMID: 34416409 DOI: 10.1016/j.jneuroim.2021.577695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
The autoimmune GFAP astrocytopathy has been associated with meningoencephalomyelitis that usually responds to glucocorticoids. We report a 20-year-old man that developed an acute and severe meningoencephalomyelitis with remarkable CNS hyperexcitability and oculogyric crises. CSF analysis showed hypoglycorrhachia, pleocytosis, elevated ADA, and CSF-immunofluorescence characteristic of autoimmune GFAP astrocytopathy. MRI showed lesions at thalamus, corpus-callosum, dorsal pons and dentate nucleus with associated myelitis. Immunotherapy led to a full recovery, although MRI activity was observed at follow-up. CNS hyperexcitability, typically seen in other immune-mediated syndromes, represents a novel presenting form to be included as part of the clinical spectrum of this entity.
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Affiliation(s)
- Jon Equiza
- Deparment of Neurology, Donostia University Hospital, Spain.
| | | | | | | | - Álvaro Prada
- Deparment of Immunology, Donostia University Hospital, Spain
| | | | - Esther Fernández
- Deparment of Magnetic Resonance, OSATEK, Donostia University Hospital, Spain
| | | | - Maialen Arruti
- Deparment of Neurology, Donostia University Hospital, Spain; Multiple Sclerosis & Demyelinating Diseases Unit, Deparment of Neurology, Donostia University Hospital, Spain
| | | | - Tamara Castillo-Triviño
- Deparment of Neurology, Donostia University Hospital, Spain; Multiple Sclerosis & Demyelinating Diseases Unit, Deparment of Neurology, Donostia University Hospital, Spain
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Alnefelt Y, Van Meervenne S, Varjonen K, Tidholm A, Rohdin C. Evaluation of antibodies in cerebrospinal fluid for the diagnosis of tick-borne encephalitis in dogs. Acta Vet Scand 2021; 63:32. [PMID: 34446031 PMCID: PMC8396403 DOI: 10.1186/s13028-021-00597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Tick-borne encephalitis (TBE) is caused by the neurotropic tick-borne encephalitis virus (TBEV). In dogs, this virus may affect the central nervous system (CNS), causing meningoencephalitis, meningomyelitis, radiculitis or any combination of these. Diagnosis of TBE relies on a combination of clinical signs of CNS disease and laboratory findings, including CSF pleocytosis and serum TBEV antibody titers. Exposure to TBEV does not necessarily cause clinical disease, and seroprevalence has been reported as high as 40% in endemic areas. This causes concerns of over-diagnosing TBE in dogs with CNS disease. By examining TBEV antibodies in dogs with and without neurological disease in a TBEV endemic area, this study aimed to evaluate the diagnostic value of TBEV antibodies in the cerebrospinal fluid (CSF) in dogs. Eighty-nine dogs were included in the study, 56 with neurological disease and 33 neurologically normal control dogs. A positive TBEV CSF and serum IgG antibody titer (> 126 U/mL) was found in 3/89 dogs (3.4%). A positive serum TBEV antibody titer was found in 11 of the 89 dogs (12.4%). None of the control dogs showed a positive CSF antibody titer, whilst two showed positive serum concentrations. A positive CSF IgG antibody titer supports a clinical diagnosis of TBE in patients with acute onset of CNS disease and may help reduce the risk of over-diagnosis.
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Affiliation(s)
- Yvonne Alnefelt
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
| | | | | | - Anna Tidholm
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
| | - Cecilia Rohdin
- Anicura Albano Small Animal Hospital, 182 36 Danderyd, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
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Gharsallah H, Tritar A, Naija H, Batikh R, Ferjani M. Severe meningoencephalomyelitis due to toscana virus: A diagnostic challenge. Travel Med Infect Dis 2021; 43:102131. [PMID: 34197927 DOI: 10.1016/j.tmaid.2021.102131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
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Heide ES, Chaudhari A, Pirverdian A, Lai S, Courtney A. Failure of IVIG in steroid-responsive autoimmune glial fibrillary acidic protein astrocytopathy: A case report. Mult Scler Relat Disord 2021; 51:102933. [PMID: 33866078 DOI: 10.1016/j.msard.2021.102933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To advocate for high-dose steroids, not intravenous immunoglobulins (IVIG), as first-line treatment for Anti-glial fibrillary acidic protein (GFAP) associated meningoencephalomyelitis. BACKGROUND A novel IgG antibody against GFAP was associated with relapsing autoimmune meningoencephalomyelitis. DESIGN/METHODS Here, we present an investigational case report to highlight continuing challenges in diagnosing and managing Anti-GFAP associated meningoencephalomyelitis. RESULTS Our 45-year-old Asian female presented to the emergency department with an acute onset low-grade fever and back pain associated with headaches, intermittent confusion, vision changes, and hand tremors. A review of systems identified no inciting factors. Past medical history was significant only for chronic Hepatitis B without significant viral load. Neurological exam was significant for decreased visual acuity, high-frequency hand tremor, and gait imbalance. Serum labs were within normal limits. Video electroencephalogram captured tremors without electrographical correlates. Cerebrospinal fluid analysis revealed lymphocytic leukocytosis, elevated protein, and reduced glucose. A wide range of infectious studies including bacterial, viral, and fungal cultures were negative. MRI brain and spine showed leptomeningeal enhancement. CT chest abdomen pelvis were negative. Patient continued to decline clinically, working diagnosis was possible paraneoplastic syndrome with pending laboratory results. She was given a five-day course of intravenous immunoglobulin as a therapeutic trial,hh however, her symptoms did not improve. A broader investigation with repeat lumbar puncture, imaging and serum laboratory failed to provide any additional information. She was treated symptomatically with minimal benefit. A trial of steroids was given with clinical improvement and continued stability. Paraneoplastic panels returned positive for high levels of Anti-GFAP antibody for confirmation of diagnosis. CONCLUSIONS Autoimmune GFAP astrocytopathy is a rare cause of meningoencephalomyelitis that remains difficult to diagnose despite emerging laboratory studies. Our case adds to the limited literature by proposing that high-dose steroids, not IVIG, should be the first-line treatment. Further investigations are underway to assess implications of this finding in disease pathophysiology and management.
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Affiliation(s)
- Elena S Heide
- University of California Irvine (UCI), Department of Neurology, Irvine CA, United States.
| | - Amit Chaudhari
- University of California Irvine (UCI), Department of Neurology, Irvine CA, United States
| | - Ateena Pirverdian
- University of California Irvine (UCI), Department of Neurology, Irvine CA, United States
| | - Samuel Lai
- University of California Irvine (UCI), Department of Neurology, Irvine CA, United States
| | - Ardith Courtney
- University of California Irvine (UCI), Department of Neurology, Irvine CA, United States
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Andersson E, Kendall A, Url A, Auer A, Leschnik M. The first RT-qPCR confirmed case of tick-borne encephalitis in a dog in Scandinavia. Acta Vet Scand 2020; 62:51. [PMID: 32912238 PMCID: PMC7488111 DOI: 10.1186/s13028-020-00550-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background Tick-borne encephalitis (TBE) is a zoonotic neurological disease caused by tick-borne encephalitis virus (TBEV), a flavivirus endemic in parts of Europe and Asia. Seroconversion without signs of clinical disease is common in dogs and most of the cases previously described have been tentatively diagnosed by combining neurologic signs with serum antibody titres. Here, the first Scandinavian RT-qPCR-confirmed clinical case of TBE in a dog is reported. Case presentation A 4-year old castrated male Pointer Labrador cross was presented with acute-onset ataxia. During hospitalisation, the dog developed seizures. Despite aggressive treatment with steroids, antimicrobials and sedation/anaesthesia, there was continued deterioration during the following 24 h after admission and the dog was euthanised and submitted for necropsy. Histopathological changes in the brain were consistent with lymphoplasmacytic and histiocytic meningoencephalomyelitis. RT-qPCR examination of the brain was positive for TBEV, confirming infection. Conclusions Meningoencephalomyelitis caused by TBEV should be a diagnostic consideration in dogs presenting with clinical signs of central nervous system disease such as acute-onset ataxia and seizures in areas where TBEV-positive ticks are endemic. Clinical TBE may be underdiagnosed in dogs due to lack of specific testing.
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Garcia CA, El-Ali A, Rath TJ, Contis LC, Gorantla V, Drappatz J, Davar D. Neurologic immune-related adverse events associated with adjuvant ipilimumab: report of two cases. J Immunother Cancer 2018; 6:83. [PMID: 30170622 DOI: 10.1186/s40425-018-0393-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background PD-1 and CTLA-4 inhibitors are associated with several adverse events including a spectrum of immune-related adverse effects (irAEs). Neurologic irAEs are uncommon occurrences with varied presentations. We describe two separate cases of ipilimumab associated meningoencephalomyelitis and demyelinating polyneuropathy with unusual presentations. Case presentation Two melanoma patients were treated with ipilimumab in the adjuvant setting. The first patient developed a meningoencephalitis following 3 doses of ipilimumab. MRI imaging of the brain confirmed leptomeningeal enhancement although cerebrospinal fluid (CSF) analyses were negative for malignant cells consistent with meningoencephalomyelitis. Although she initially improved following treatment with steroids and intravenous immunoglobulin, she subsequently relapsed. She was successfully treated with infliximab and made a complete neurological recovery. A second patient developed progressive lower extremity weakness following two doses of ipilimumab. MRI imaging of the spine confirmed diffuse nerve root enhancement consistent with acute inflammatory demyelinating polyneuropathy (AIDP). He was treated with high dose steroids with resolution of neurological symptoms. Both patients remain disease free. Conclusions Neurological irAEs are uncommon adverse events in the context of CTLA-4 and/or PD-1 inhibitor therapy. Care must be taken to distinguish these from leptomeningeal disease. Early recognition of neurological irAEs is critical for the initiation of specific anti-inflammatory agents to prevent and potentially reverse neurological sequelae.
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Enemark HL, Hansen MS, Jensen TK, Larsen G, Al-Sabi MNS. An outbreak of bovine meningoencephalomyelitis with identification of Halicephalobus gingivalis. Vet Parasitol 2016; 218:82-6. [PMID: 26872932 DOI: 10.1016/j.vetpar.2016.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/06/2016] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
Abstract
Halicephalobus gingivalis is an opportunistic parasite which is known to cause fatal meningoencephalomyelitis primarily in equines but sporadically also in humans. In April 2014, laboratory examination of the head of a young dairy calf, euthanized due to severe central nervous system symptoms, revealed the presence of granulomatous to necrotizing encephalitis and myriads of nematodes in the brain lesion. Morphologically the parasites were identified as H. gingivalis. The diagnosis was confirmed by molecular analysis of the large subunit (LSU) rRNA and the small subunit (SSU) rRNA genes, revealing genetic variations of 0.5-4.4% and 0.7-8.6%, respectively, between the H. gingivalis isolated from the Danish calf and published isolates, collected worldwide from free-living and parasitic stages of the nematode. Clinical symptoms and histological changes indicated infection with H. gingivalis from another three calves in the herd. This is the first scientific publication of H. gingivalis induced meningoencephalomyelitis in ruminants. As ante mortem diagnosis is a major challenge, the infection may easily remain undiagnosed in cattle.
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Affiliation(s)
- Heidi Larsen Enemark
- National Veterinary Institute, Technical University of Denmark, DK-1870 Frederiksberg C, Denmark; Norwegian Veterinary Institute, P.O. Box 750 Sentrum, N-0106 Oslo, Norway.
| | - Mette Sif Hansen
- National Veterinary Institute, Technical University of Denmark, DK-1870 Frederiksberg C, Denmark
| | - Tim Kåre Jensen
- National Veterinary Institute, Technical University of Denmark, DK-1870 Frederiksberg C, Denmark
| | - Gitte Larsen
- National Veterinary Institute, Technical University of Denmark, DK-1870 Frederiksberg C, Denmark
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