Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review

OBJECTIVES

To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections.

METHODS

Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted.

RESULTS

52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001).

CONCLUSIONS

CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.

Immunoglobulin and CD8⁺ T-cell distribution in histologically distinctive tonsils of individuals with tonsillar focal infection

CONCLUSION

This study demonstrated that the common immunological mechanism, which involves aberration of immunoglobulin and T-cell distribution in histologically distinctive tonsils, may be associated with the pathogenesis of tonsillar focal infection.

OBJECTIVES

Tonsillar focal infection comprises a group of relatively common diseases combined with chronic tonsillar infection, is associated with unusual immune responses in tonsils, and may cause lesions in another distant target organ. This study aimed to investigate the distribution of inflammatory T cells and T-cell regulatory elements, such as programmed cell death-1 (PD-1) and Fork head box protein 3 (Foxp3), immunoglobulin production, and histological characteristics in tonsils from patients with tonsillar focal infection.

METHODS

Immunohistochemistry and reverse transcription-polymerase chain reaction (PCR) were used to compare the expression of CD8(+) T cells, immunoglobulins, and cytokines associated with immunoglobulin production in the tonsils of patients with IgA nephropathy (IgAN), palmoplantar pustulosis (PPP), rheumatoid arthritis (RA), and chronic tonsillitis.

RESULTS

The overexpression of CD8(+) T cells combined with decreased expression of Foxp3 and PD-1 and the aberration of immunoglobulin production, which may be due to the elevated expression of activation-induced deaminase (AID), B-cell-activating factor of the TNF family (BAFF), supporting isotype switching, and B-cell survival in the histologically distinctive tonsils.

[The molecular biological characteristics of the pathogen of tuberculosis and the pathoanatomic aspects of its fatal outcomes in Irkutsk in 2008-2011]

The paper gives the results of examining 163 autopsy cases of tuberculosis in Irkutsk. The forms of the disease are characterized, by identifying generalized large focal necrotic focal tuberculosis. MIRU-VNTR genotyping defined M. tuberculosis genotypes and established the leading role of the Beijing genotype (65%) in the development of the most severe generalized alterative and exudative changes. 48% of all generalized large focal tuberculosis cases were shown to be HIV-infected. A DS-SIGN gene polymorphism at the -336 A/G position was studied; the most unfavorable combination of AG or GG polymorphism (in 84% of cases) was shown in a patient with the M. tuberculosis Beijing genotype. Not only the patient's immune status, but also the genotypes of mycobacteria and the host affect the most unfavorable course of tuberculosis with the development of generalized alterative and exudative lesions.

Acute focal nephritis: its true sonographic face

BACKGROUND

Acute focal nephritis is an inflammatory process of the renal parenchyma affecting principally the cortex of the kidney. It is considered a midpoint in the spectrum of upper urinary tract infections, ranging from uncomplicated pyelonephritis to intrarenal abscesses. Until recently the hyperechoic sonographic appearance of this lesion was considered uncommon.

OBJECTIVES

To determine the relative prevalence of hyperechoic and hypoechoic sonographic appearance of focal renal lesions in patients with the clinical diagnosis of acute pyelonephritis and to correlate the findings with those of the color Doppler examinations.

METHODS

We reviewed the sonograms of 367 patients hospitalized with the clinical diagnosis of acute pyelonephritis. The sonograms were reviewed for acute renal inflammatory changes. When a focal lesion was detected, we noted the echogenicity, side, form, location and color Doppler characteristics.

RESULTS

Abnormal sonographic findings related to the infection were found in 78 cases. In 52 patients a focal lesion was diagnosed. Forty-seven focal lesions appeared hyperechoic related to the adjacent parenchyma. These lesions were more frequently located at the upper pole and were wedge-shaped in most of the cases. The areas appeared hypo/avascular on the color Doppler examination.

CONCLUSIONS

Our data suggest that the most common appearance of acute focal nephritis is an area of increased echogenicity in the parenchyma of the affected kidney.

Therapy of focal viral encephalitis in children with aciclovir and recombinant beta-interferon - results of a placebo-controlled multicenter study

Focal viral encephalitis in childhood is a rare but life-threatening disease. Animal experiments and case reports suggest a positive effect of an additional therapy with interferon-beta on the course of the disease. Therefore, we initiated a prospective, double-blind placebo-controlled study to investigate the benefit of a combination therapy of Aciclovir (ACV) and recombinant interferon-beta (rIFN-beta) in juvenile focal viral encephalitis. - Initial inclusion criterium was suspicion of focal viral encephalitis. Diagnosis was proven by demonstration of characteristic focal lesions in cerebral imaging or virological evidence of HSV in cerebrospinal fluid. Patients were treated with ACV plus rIFN-beta or ACV plus placebo. Neurological outcome was determined 21 days and 3 months after onset of the disease. - Initially 59 patients were enrolled in the study. Encephalitis was proven in 14 patients (7 ACV + rIFN-beta, 7 ACV + placebo). The study groups were balanced in terms of important prognostic criteria. 10 patients (5 ACV + rIFN-beta, 5 ACV + placebo) were cured or had slight defects, 4 patients (2 ACV + rIFN-beta, 2 ACV + placebo) showed moderate to severe defects. There was no significant difference in favour of the additive therapy with rIFN-beta.

[Lethal complication of an odontogenic infection developing after tooth extraction in a patient with untreated diabetes. Case report]

The extraction of a tooth led to the acute exacerbation of existing chronic osteomyelitis then phlegmon, and sepsis as a result. Persisting coma developed after three reanimations of the patient, on account of septic shock. Finally, in more than two weeks following the extraction the patient died due to multiorgan failure. This case description wishes to call attention to the risks of complications of diabetes, to summarize the relevant documents of diagnosis and treatment of osteomyelitis and phlegmon and the data of mortality. Hopefully we offer some useful advice to the general dentist about patients with immunosuppressive diseases.

Focal bacterial nephritis (lobar nephronia) presenting as renal mass

A focal infection of the kidney can cause a diagnostic dilemma by mimicking a neoplasm. We describe a case of focal bacterial nephritis (acute lobar nephronia) caused by Escherichia coli in which the diagnosis was confirmed only after surgical exploration. Although the patient had fever on admission, urine and blood cultures were negative and fine needle aspiration of the kidney could not rule out a well-differentiated carcinoma.

Herpes simplex replication and dissemination is not increased by corticosteroid treatment in a rat model of focal Herpes encephalitis

Neurological damage in Herpes simplex type 1 encephalitis results from neuronal cell death secondary to viral invasion, and from inflammatory changes and cerebral oedema secondary to the immune response to the virus. Corticosteroids could have an important role in the management of Herpes simplex encephalitis because their anti-inflammatory action reduces cerebral oedema. However their use has been limited by concerns that their immunosuppressive actions could increase viral replication and spread. The present study examined this issue in a rat model in which injection of HSV-1 into the cervical vagus nerve produced a well-defined focal encephalitis, characterised by an orderly progression of the virus through central neural pathways connected with vagal afferent termination sites in the medulla oblongata. After injection of HSV-1, rats were treated twice a day, either with vehicle (saline, 400 microl i.p.), with acyclovir (30 mg/kg i.p.), with dexamethasone (5 mg/kg i.p.), or with both acyclovir and dexamethasone. Animals were sacrificed after 72 h, and viral load in different brain regions was quantified by computer-assisted measurement of the area occupied by immunohistochemical reaction product. Treatment with acyclovir reduced viral load to 17 +/- 5% of the saline value (P < 0.01). After dexamethasone treatment, the viral load (63 +/- 13% of the saline value) was also reduced (P < 0.05). Treatment with both acyclovir and dexamethasone reduced viral load to 26 +/- 8% of the saline value (P < 0.01 compared with saline, and P > 0.05 compared to acyclovir alone). Our results confirm the effectiveness of acyclovir in a new model of HSV-1 infection, and provide evidence that corticosteroids do not inhibit the antiviral action of acyclovir. In addition corticosteroids may decrease the extent of infection in their own right. The acute time course studied in our model parallels the time course of acute Herpes simplex encephalitis in humans. Our data suggests that corticosteroids are not detrimental when combined with acyclovir in the management of this condition.

[The effect of antibodies to microorganisms in a focus of purulent inflammation]

The rats were infected with a suspension of dissociated or agglutinated Pseudomonas aeruginosa [correction of B. pynocyaneus]. Infection with the agglutinated agent drastically improved the clinical course, lowered the indices of the process generalization (mortality, metastatic foci, spread in the internal organs); no hemorrhages, necrosis or abscesses were noted. A rapid (within the first day) death of almost all agglutinated bacteria in the primary focus was observed, this not being due to phagocytosis or complement-dependent lysis.

[The efficacy of the combined antibacterial treatment of patients with colonic cancer complicated by perifocal inflammation]

In patients with colonic cancer complicated by inflammation since 1989 we have been using irrigations of tumor area with antibacterial drugs (dioxidin, betadin) side by side with conventional antibacterial and detoxicating therapy. The complex antibacterial therapy having been applied in 47 patients eliminated clinical manifestation of inflammatory process. Histological and morphometrical biopsy of tumor tissue and surrounding mucosa gives a reason to conclude that the complex therapy has proved to be effective.

Hepatic candidiasis: persistent pyrexia in a patient with acute myeloid leukaemia after recovery from consolidation therapy-induced neutropenia

Fever, a frequent manifestation in acute leukaemia patients who develop treatment-induced neutropenia, usually resolves when the neutrophil count returns to normal irrespective of whether an infective agent is isolated or not. A persistent pyrexia following neutrophil recovery and associated with multiple negative microbiological cultures should signal a careful search for a deep-seated fungal infection in any leukaemic patient who is complete remission. We report here a 39-year-old Chinese man with acute myeloid leukaemia in first complete remission whose unresolved fever after recovery from consolidation therapy-induced neutropenia was ultimately confirmed to be caused by focal hepatic candidal microabscesses by an open liver biopsy.

Urinary growth hormone in growth-impaired children with chronic inflammatory bowel disease

Growth impairment of undefined aetiology occurs in approximately 30% of children with chronic inflammatory bowel disease. We measured urinary growth hormone concentrations in 36 children with chronic inflammatory bowel disease and 51 normal controls. The median urinary concentration of growth hormone in the stunted children with chronic inflammatory bowel disease was 15.8 ng/g creatinine (range 4.3-32.6), compared with 11.7 ng/g creatinine (range 4.1-35.9) in those with normal growth. The difference was statistically not significant (p = 0.15). Moreover, there was no significant difference between the patients and the control group. One stunted patient had a urinary growth hormone (UGH) concentration below the normal range, whereas four patients with normal height were also below the normal range. Four of these five patients (80%) were on corticosteroid treatment at the time of urinary collection, whereas only 26% of the patients with normal UGH were also on corticosteroid treatment. We conclude that growth retardation in children with chronic inflammatory bowel disease is probably not related to growth hormone deficiency but must involve other mechanisms.

The effect of neonatal treatment with capsaicin on focal arteriolar insudation

There is evidence that peptide neurotransmitters (e.g., substance P, neurokinin A, vasoactive intestinal peptide, calcitonin gene-related peptide) from sensory nerves play a part in vasoregulation. We examined the effect of neonatal treatment with capsaicin, a procedure that causes permanent impairment of primary sensory neurons, on a recently described arteriolar response to inflammation, focal arteriolar insudation (FAI). FAI occurs at a distance from the site of injury, in arterioles supplying that area, and is first observed 6 hr after onset of inflammation and maximally at 24 hr; the affected arterioles show dilation, with increased endothelial permeability and occasional smooth muscle cell damage. In our model, inflammation is induced by implanting a sterile plastic disk in the connective tissue superficial to the rat cremaster muscle. When carbon black is injected intravenously 24 hr later, FAI in the cremaster arterioles can be detected on light microscopy as areas of carbon extravasation; and the length of affected segments is morphometrically measured. The capsaicin-pretreated group showed a marked decrease in FAI compared to the controls. Mean FAI in the capsaicin group (12 animals) was 1.8 +/- 2.4 (SD) mm/cremaster compared to 5.6 +/- 5.1 for the control group (12 animals). P less than 0.003. These results provide evidence that this arteriolar response to inflammation is modulated in part by capsaicin-sensitive neurons.

[The role of a local infectious focus in the development of Pseudomonas aeruginosa sepsis (experimental research)]

The dynamics of sepsis development and the formation of metastatic foci have been studied using an experimental model. It has been established, that at the initial stages, the process manifests itself by bacteremia and endotoxemic shock, as well as by the complex of vascular disorders. The dependence of the formation of metastatic abscesses on the terms of the primary focus excision as well as the irreversibility of sepsis at the definite stage of infectious process have been studied. It is supposed, that the primary focus initiates the cascade activation mechanism of the factors, that determine the transition of bacteremia to the stage of septicopyemia.

[The immunomorphological characteristics of a focal staphylococcal infection against a background of long-term exposure to low doses of simazine]

State of immunologic and nonspecific resistance of the organism, ultra- and histostructure of the thymus, histopathology of the wall of experimental staph abscess reproduced in animals given low doses of the herbicide simazine for a long time have been studied. It is established that simazine induced the immunodeficiency state underlain by pathologic changes in the thymus. Against this background experimental abscesses developed more rapidly, alterative and exudative processes in their wall proceeding more intensively and proliferative ones--attenuating. This provides prolongation of the abscesses healing phase for an indefinite time and chronization of the process.

Correlation of gross and microscopic appearance of skin buttons in total artificial heart animals

Pneumatic artificial hearts are powered by compressed air that is delivered through percutaneous tubes. A stress relief device, termed a skin button, surrounds these tubes as they exit from the recipient's tissues. The skin button is designed to protect the tissues from damage and provide a secure material-tissue interface. Prevention of superficial and invasive infection is the primary goal of the skin button. Eight calves were studied prospectively to identify gross or microscopic infection with the skin button. All animals who survived more than sixty days (62-136) had both gross and microscopic evidence of infection. All animals surviving less than 60 days (13-43) had no gross evidence of infection but one had subcutaneous microscopic abscess formation. No animal died secondary to a skin button infection. Skin buttons cannot prevent infection but they can contain the pathologic process in the superficial tissues with no evidence of systemic effects.

[The interaction of neutrophilic granulocytes with Candida albicans fungi in the formation of mycotic foci under conditions of immunodepression]

In the electron-microscopic study of the interaction of neutrophil granulocytes with the fungal species C. albicans in the process of the formation of mycotic foci in mice under the conditions of cyclophosphamide-induced immunosuppression, mouse leukocytes have been found to retain their capacity for migration to the focus of inflammation and for the phagocytosis of fungal cells. At the same time the fungicidal activity of leukocytes is decreased, which is manifested by the prevalence of viable fungal cells with the partially digested cell wall in the cytoplasm of leukocytes.

[An immunological and morphological study of focal staphylococcal infection against a background of long-term exposure to the herbicide linuron]

Small doses of long-term injection of herbicide linuron causes the appearance of secondary immunodeficiency. It is manifested in histological and ultrastructural determination of thymus, severe suppression of immunological indices. Epithelial nurse-cells damage takes place in thymus, the contacts between epithelial cells are destroyed, the reforming of microvessels (their endothelium) occurs which causes the deterioration of vessels penetration and the growth of connective tissue. Against this background a more rapid development of experimental staphylococcus abscesses is observed in animals, the reparation phase being absent.

Migratory lobar nephronia

Lobar nephronia or focal bacterial nephritis is a pre-abscess stage of localized cellulitis and has been shown to represent a focal imaging manifestation of what is frequently a diffuse renal process. To the best of our knowledge, although multi-focal bacterial nephritis has been described, a migratory pattern has not been observed. This report describes a previously healthy 32-year-old woman with pathologically proven lobar nephronia that exhibited a migratory pattern on serial computed tomography (CT) and a prolonged course on antibiotic therapy. Possible etiologies for this unusual course, along with the CT, sonographic and needle biopsy features of this disease are discussed.

Immunohistological studies on tonsils of recurrent tonsillitis and tonsils with focal infections

In this study, two experiments were made to investigate the immunological pathogenesis of PPP, a skin disease of so-called focal infections. One was the immunohistological study on tonsils with PPP and recurrent tonsillitis. In the investigation, monoclonal antibodies against T lymphocytes and anti-immunoglobulin antibodies were used to reveal the distribution of T and B cell subsets on frozen sections of tonsils. But no difference between tonsils with focal infection and recurrent tonsillitis was observed in the distribution of T and B cell subsets. The other was the identification of a common antigen between tonsillar epithelium of PPP and hand-sole skin by use of one monoclonal antibody against PPP-tonsillar epithelium, which was made in our laboratory. Monoclonal antibody ATE-3 was in IgM, and recognized about 35 kilo dalton molecular weight protein of a tonsillar epithelium of PPP. This antibody reacted with the basal layer cells of the tonsillar epithelium and the suprabasilar cells of plantar skins of PPP. But ATE-3 did not react with normal tonsillar epithelium and normal plantar skin.

Distribution and morphology of macrophages in palatine tonsils

The distribution and morphology of macrophages were studied by immunohistochemical and electronmicroscopic methods in three diseases of the palatine tonsils: tonsillar hypertrophy, recurrent tonsillitis and tonsils with focal infection. We confirmed the presence of two types of macrophages in the tonsils, a monocyte-macrophage cell line and dendritic cells with subtypes, Langerhans' and interdigitating reticulum cells. In the lymphoepithelial symbiosis area and in the subepithelial area, the monocyte-macrophage cells and the dendritic cells had similar distributions and densities. Since these two types of cells were sometimes in contact with each other, they may function in close cooperation. In tonsils with focal infection, there were fewer dendritic cells in the lymphoepithelial symbiosis area, and the germinal centers were less well developed than in the other tonsillar diseases. These findings suggest that in tonsils with focal infection, insufficient amounts of antigen may be presented by the dendritic cells to helper T-lymphocytes.

Acute lobular nephronia

Acute lobular nephronia is an unusual form of localized renal infection, which has a characteristic computerized tomographic and ultrasonographic appearance, and should be distinguished from abscess or other renal masses. Treatment is nonoperative, consisting of intensive antibiotic therapy.

[Structural bases for the invasion of the causative agents of experimental Pseudomonas aeruginosa sepsis into the bloodstream from the primary septic focus]

The soft tissues around the implant with a suspension of P. aeruginosa were studied by light and electron microscopy. Severe damages to structures of the histohematic barrier, phagocytes were revealed as was the bacterial invasion into thrombosed vessels of the microcirculatory bed. The mechanism of the micrometabolism as playing the key role in the bacterial penetration from the primary septic focus into the common bloodstream is discussed.

Focal inflammatory myopathy

We report three patients with inflammatory myopathy who presented clinically with weakness and wasting of only one limb. The myopathy progressed over 6 months and 5 years, respectively, in two patients and was stable after 8 years in the third patient. One patient had a skin rash. Serum CK was elevated in the two patients with progressive disease. Electromyography showed brief duration, small amplitude motor unit potentials and fibrillations in the affected limbs. Muscle biopsy revealed variable fiber size, degenerating and regenerating fibers, and inflammatory foci. Vasculitis was seen in the patient with skin lesions and marked fibroblastic proliferation in the patient with the most chronic course. Immunosuppressive therapy has arrested the progression in the two patients treated; both have regained strength.

[Ultrastructural characteristics of a focus of recurrent infection in genital herpes patients (clinical and electron microscopy studies)]

In patients with recurrent genital herpes in the active stage of herpetic infection, herpes simplex virus (HSV) is located both extra- and intracellularly in keratinocytes of the pricky and glandular layers of the epidermis as well as in macrophages and neutrophilic leukocytes. The observed incompleted phagocytosis of HSV by macrophages may be one of the causes of insufficient local resistance to the virus.

Focal giant papillary conjunctivitis from retained contact lenses

Three cases of retained contact lenses leading to focal papillary conjunctivitis of the upper lids reminiscent of the more diffuse changes of lens or suture-induced giant papillary conjunctivitis are reported. One silicone and two cabufocon lenses were responsible. Corneal changes occurred in two of the three cases. Secondary infection with Staphylococcus aureus was found in one patient. In two, conjunctival cytology suggested a hypersensitivity mechanism. In all three patients the simple removal of the retained lens was sufficient to reverse pathology. The focal nature of the papillary changes observed in these patients as well as in those cases occurring post-operatively from exposed suture edges would point towards an important direct mechanical etiologic factor in addition to the proposed hypersensitivity basis for the similar diffuse upper lid papillary hypertrophy characteristic of giant papillary conjunctivitis.

Focal epithelial hyperplasia of the oral mucosa. A case report from the United Kingdom

A case of focal epithelial hyperplasia of the oral mucosa (Heck's disease) is presented, which appears to be the first to be described in the United Kingdom. Virus particles were found in tissue from the lesions studied by electron microscopy, and identified as belonging to the papilloma virus sub-group of the family of papovaviruses.

[Primary pyelonephritis (the focal problem)]

On different experimental models of pyelonephritis in dogs and rabbits an experiment for the classification of the pathogenesis of this disease with the special questioning of the possible development of the so-called primary pyelonephritis was performed. A series of experiments consisted of 3 groups: 1. Injection of an E.-coli-suspension into the musculature of the urinary bladder of dogs and rabbits. 2. Injection of an E.-coli-suspension into the testicles of rabbits. 3. Injection of an E.-coli-suspension into the seminal bladders of rats. The experiments lasted 2 to 15 days and 16 to 110 days, respectively. In the second series of experiment in rats and rabbits an E.-coli-suspension was injected into the gall-bladder of rats and rabbits. Bacteriologic blood cultures and histologic investigations of the kidneys, the ureters, the wall of the urinary bladder and the adjacent lymphatic and fatty tissue as well as of the gall-bladders were performed. The results showed that the pyelonephritis developed secondarily after the infection of the other infected organs by haematogenic or interstitial dissemination of the pathogenic agents. Conclusions are drawn: 1. Every pyelonephritis, also the haematogenic, is a secondary process. 2. Therefore all must be done to find out the primary inflammatory change in the organism and to cure it. 3. Severe forms of the pyelonephritis may, on the other hand, effect as focus and evoke in inflammation of other organs on lymphogenic and haematogenic way. 4. Taking into consideration the facts mentioned perhaps the great number of pyelonephritiides having become latent might be reduced.