1
|
Cytotoxic lesion of the corpus callosum in a case of Q fever. J Clin Neurosci 2022; 104:62-63. [PMID: 35964404 DOI: 10.1016/j.jocn.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 11/21/2022]
|
2
|
Gu M, Mo X, Tang Z, Tang J, Wang W. Case Report: Diagnosis of Acute Q Fever With Aseptic Meningitis in a Patient by Using Metagenomic Next-Generation Sequencing. Front Med (Lausanne) 2022; 9:855020. [PMID: 35665349 PMCID: PMC9157756 DOI: 10.3389/fmed.2022.855020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Query fever (Q fever) is a widespread zoonotic disease caused by the bacterium of Coxiella burnetii (C. burnetii). Its neurological complications are rarely reported. But they may lead to severe consequences. It needs a rapid and accurate detective method to diagnose acute Q fever with neurological presentations in non-epidemic areas urgently. Here, we report an acute Q fever case with aseptic meningitis. The male patient, without any contact history in the epidemic area or with animals, was indicated to exhibit fever and headache symptoms. The cultures of blood, stool, urine, and sputum were all negative. But C. burnetii was repeatedly detected in blood by metagenomic next-generation sequencing (mNGS). He received Doxycycline therapy and quickly returned to normal. Therefore, for the diagnosis and identification of Q fever in non-reporting regions, mNGS has comparative advantages. Secondly, aseptic meningitis may be a direct infection of C. burnetii to central nervous system (CNS) or inflammatory reactions to systemic infection, we recommend detecting mNGS both in blood and cerebrospinal fluid (CSF).
Collapse
Affiliation(s)
- Meifeng Gu
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoqin Mo
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenchu Tang
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Tumor Models and Individualized Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jianguang Tang
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
3
|
Neurotransmitter System-Targeting Drugs Antagonize Growth of the Q Fever Agent, Coxiella burnetii, in Human Cells. mSphere 2021; 6:e0044221. [PMID: 34232075 PMCID: PMC8386451 DOI: 10.1128/msphere.00442-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Coxiella burnetii is a highly infectious, intracellular, Gram-negative bacterial pathogen that causes human Q fever, an acute flu-like illness that can progress to chronic endocarditis. C. burnetii is transmitted to humans via aerosols and has long been considered a potential biological warfare agent. Although antibiotics, such as doxycycline, effectively treat acute Q fever, a recently identified antibiotic-resistant strain demonstrates the ability of C. burnetii to resist traditional antimicrobials, and chronic disease is extremely difficult to treat with current options. These findings highlight the need for new Q fever therapeutics, and repurposed drugs that target eukaryotic functions to prevent bacterial replication are of increasing interest in infectious disease. To identify this class of anti-C. burnetii therapeutics, we screened a library of 727 FDA-approved or late-stage clinical trial compounds using a human macrophage-like cell model of infection. Eighty-eight compounds inhibited bacterial replication, including known antibiotics, antipsychotic or antidepressant treatments, antihistamines, and several additional compounds used to treat a variety of conditions. The majority of identified anti-C. burnetii compounds target host neurotransmitter system components. Serotoninergic, dopaminergic, and adrenergic components are among the most highly represented targets and potentially regulate macrophage activation, cytokine production, and autophagy. Overall, our screen identified multiple host-directed compounds that can be pursued for potential use as anti-C. burnetii drugs. IMPORTANCECoxiella burnetii causes the debilitating disease Q fever in humans. This infection is difficult to treat with current antibiotics and can progress to long-term, potentially fatal infection in immunocompromised individuals or when treatment is delayed. Here, we identified many new potential treatment options in the form of drugs that are either FDA approved or have been used in late-stage clinical trials and target human neurotransmitter systems. These compounds are poised for future characterization as nontraditional anti-C. burnetii therapies.
Collapse
|
4
|
Vivekanandan A, Santyr B, Ranger A. Effects of systemic corticosteroid treatment on pseudotumoral hemicerebellitis: a case report and literature review. Childs Nerv Syst 2021; 37:2105-2113. [PMID: 33219391 DOI: 10.1007/s00381-020-04970-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Pseudotumoral hemicerebellitis is an acute, unilateral inflammation of the cerebellum that typically affects the pediatric population. The purpose of this paper is to review cases of pseudotumoral hemicerebellitis in the literature and evaluate if treatment with systemic corticosteroids reduces length of time to symptomatic recovery. METHODS We present a case report of a 12-year-old male with pseudotumoral hemicerebellitis and unilateral cerebellar dysfunction. Additionally, we review the thirty-five reported cases of pseudotumoral hemicerebellitis with respect to length of time to symptomatic recovery with or without systemic corticosteroid treatment. RESULTS Thirty cases reported length of time to symptomatic recovery. Including our case, the mean time to recovery for those treated with systemic corticosteroids (n = 20) was 48.05 days (SE = 16.3). The mean time to recovery for those treated without (n = 10) was 86.7 days (SE = 29.3). CONCLUSIONS Treatment with systemic corticosteroids was associated with a faster time to symptomatic recovery compared to without. Regardless of etiology, reducing inflammation and mass effect involved in pseudotumoral hemicerebellitis may be integral to a more rapid return to neurological baseline.
Collapse
Affiliation(s)
- Amirti Vivekanandan
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Brendan Santyr
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrianna Ranger
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Paediatric Neurosurgery, Children's Hospital, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada
| |
Collapse
|
5
|
|
6
|
Lenka A, Louis ED. Revisiting the Clinical Phenomenology of "Cerebellar Tremor": Beyond the Intention Tremor. THE CEREBELLUM 2019; 18:565-574. [PMID: 30565088 DOI: 10.1007/s12311-018-0994-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is a central feature of a range of diseases resulting from pathological changes in the cerebellum. Interestingly, in modern times, the terms "cerebellar tremor" and "intention tremor" are often used synonymously and interchangeably. However, "cerebellar tremor" (i.e., tremors of cerebellar origin) do not always present exclusively as intention tremor. In this article, we comprehensively revisit the clinical phenomenology of tremors observed in various diseases that are based in the cerebellum. By this, we mean diseases for which the cerebellum and its various connections are often seen as playing a central and defining role. These include spinocerebellar ataxias, essential tremor, orthostatic tremor, dystonia, acute cerebellitis, cerebellar tumors, paraneoplastic cerebellar degeneration, and cerebellar strokes. The theme of this article is to highlight, through published data available in the current literature, that the clinical phenomenology of tremor of cerebellar origin is heterogeneous, and it extends beyond that of intention tremor to include postural tremors, kinetic tremor, rest tremor, and orthostatic tremor. This heterogeneity is consistent with the seminal work of Gordon Holmes, in which he described a variety of tremors aside from intention tremor in the setting of cerebellar lesions. In the end, it would seem that the notion that intention tremor is the sole signature of cerebellar lesions is an over-simplification and is not correct. Future studies are warranted to identify and further characterize the heterogeneity of tremors arising from the various cerebellar etiologies.
Collapse
Affiliation(s)
- Abhishek Lenka
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Department of Neurology, Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA.
| |
Collapse
|
7
|
Melenotte C, Million M, Raoult D. New insights in Coxiella burnetii infection: diagnosis and therapeutic update. Expert Rev Anti Infect Ther 2019; 18:75-86. [PMID: 31782315 DOI: 10.1080/14787210.2020.1699055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Coxiella burnetii infection is still challenging physicians, mainly because no international coordination has been stated to standardize the therapeutic strategy and improve the clinical outcomes.Areas covered: Based on the recent knowledge on Q fever, we review here the clinical practices from Q fever diagnosis to therapy. We searched PubMed and Google Scholar to perform the qualitative synthesis.Expert opinion: Four major critical points are highlighted in this review. The first point is that Q fever diagnosis has been reviewed in the light of the new diagnosis tools, including molecular biology, transthoracic echocardiography, and 18F-FDG-PET/CT-scan imaging. Q fever diagnosis results from the presence of a microbiological criterion in addition to a lesional criterion. Second, the identification of the anticardiolipin antibodies as a novel biological predictive marker for acute Q fever complications (hemophagocytic syndrome, acute Q fever endocarditis, alithiasic cholecystitis, hepatitis, and meningitis). Third, the observation of a coincidence between Q fever and non-Hodgkin lymphoma that has made persistent C. burnetii infection a risk of non-Hodgkin lymphoma. Finally, we expose here the close follow-up we proposed from the French National Reference Center for patients with Q fever infection to detect relapse and complications.
Collapse
Affiliation(s)
- Cléa Melenotte
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| |
Collapse
|
8
|
Emelifeonwu JA, Shetty J, Kaliaperumal C, Gallo P, Sokol D, Soleiman H, Kandasamy J. Acute Cerebellitis in Children: A Variable Clinical Entity. J Child Neurol 2018; 33:675-684. [PMID: 29888646 DOI: 10.1177/0883073818777673] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute cerebellar ataxia is the most common cause of acute ataxia in children and it usually runs a self-limiting and ultimately benign clinical course. A small proportion of children have evidence of inflammatory swelling in the cerebellum. Many of these children suffer more severe and potentially life-threatening forms of cerebellar ataxia and may need more intensive treatments including urgent neurosurgical treatments. This more severe form of acute cerebellar ataxia is often termed acute cerebellitis. Many children with acute cerebellitis have long-term neurological sequela and evidence of structural cerebellar changes on follow-up imaging. Several patterns of cerebellar inflammation have been described. The authors describe the variabilities in the clinical and radiological patterns of disease in the cases that have been described in the literature.
Collapse
Affiliation(s)
- John Amaechi Emelifeonwu
- 1 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jay Shetty
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Pasquale Gallo
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Drahoslav Sokol
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Hamza Soleiman
- 1 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Jegajothy Kandasamy
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| |
Collapse
|
9
|
Melenotte C, Protopopescu C, Million M, Edouard S, Carrieri MP, Eldin C, Angelakis E, Djossou F, Bardin N, Fournier PE, Mège JL, Raoult D. Clinical Features and Complications of Coxiella burnetii Infections From the French National Reference Center for Q Fever. JAMA Netw Open 2018; 1:e181580. [PMID: 30646123 PMCID: PMC6324270 DOI: 10.1001/jamanetworkopen.2018.1580] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Q fever remains widespread throughout the world; the disease is serious and causes outbreaks and deaths when complications are not detected. The diagnosis of Q fever requires the demonstration of the presence of Coxiella burnetii and the identification of an organic lesion. OBJECTIVE To describe the hitherto neglected clinical characteristics of Q fever and identifying risk factors for complications and death. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study conducted from January 1, 1991, through December 31, 2016, included patients treated at the French National Reference Center for Q fever with serologic findings positive for C burnetii and clinical data consistent with C burnetii infection. Clinical data were prospectively collected by telephone. Patients with unavailable clinical data or an unidentified infectious focus were excluded. MAIN OUTCOMES AND MEASURES Q fever complications and mortality. RESULTS Of the 180 483 patients undergoing testing, 2918 had positive findings for C burnetii and 2434 (68.8% men) presented with clinical data consistent with a C burnetii infection. Mean (SD) age was 51.8 (17.4) years, and the ratio of men to women was 2.2. At the time of inclusion, 1806 patients presented with acute Q fever, including 138 with acute Q fever that progressed to persistent C burnetii infection, and 766 had persistent focalized C burnetii infection. Rare and hitherto neglected foci of infections included lymphadenitis (97 [4.0%]), acute Q fever endocarditis (50 [2.1%]), hemophagocytic syndrome (9 [0.4%]), and alithiasic cholecystitis (11 [0.4%]). Vascular infection (hazard ratio [HR], 3.1; 95% CI, 1.7-5.7; P < .001) and endocarditis (HR, 2.4; 95% CI, 1.1-5.1; P = .02) were associated with an increased risk of death. Independent indicators of lymphoma were lymphadenitis (HR, 77.4; 95% CI, 21.2-281.8; P < .001) and hemophagocytic syndrome (HR, 19.1; 95% CI, 3.4-108.6; P < .001). The presence of anticardiolipin antibodies during acute Q fever has been associated with several complications, including hepatitis, cholecystitis, endocarditis, thrombosis, hemophagocytic syndrome, meningitis, and progression to persistent endocarditis. CONCLUSIONS AND RELEVANCE Previously neglected foci of C burnetii infection include the lymphatic system (ie, bone marrow, lymphadenitis) with a risk of lymphoma. Cardiovascular infections were the main fatal complications, highlighting the importance of routine screening for valvular heart disease and vascular anomalies during acute Q fever. Routine screening for anticardiolopin antibodies during acute Q fever can help prevent complications. Positron emission tomographic scanning could be proposed for all patients with suspected persistent focused infection to rapidly diagnose vascular and lymphatic infections associated with death and lymphoma, respectively.
Collapse
Affiliation(s)
- Cléa Melenotte
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Camélia Protopopescu
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Matthieu Million
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Sophie Edouard
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - M. Patrizia Carrieri
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Carole Eldin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Emmanouil Angelakis
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Félix Djossou
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne, Guyane Française
| | - Nathalie Bardin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Pierre-Edouard Fournier
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Jean-Louis Mège
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Didier Raoult
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| |
Collapse
|
10
|
A Rare Cause of Childhood Cerebellitis-Influenza Infection: A Case Report and Systematic Review of Literature. Case Rep Pediatr 2017; 2017:4039358. [PMID: 28299224 PMCID: PMC5337386 DOI: 10.1155/2017/4039358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/16/2016] [Accepted: 01/15/2017] [Indexed: 11/21/2022] Open
Abstract
Acute cerebellitis is a benign neurologic condition generally caused by viral or bacterial infections. Influenza associated cerebellitis is extremely rare; a 6-year-old boy with acute cerebellitis, who presented with fever, vomiting, weakness, febrile seizure, and acute cerebellar features, is discussed in this article.
Collapse
|
11
|
Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D. From Q Fever to Coxiella burnetii Infection: a Paradigm Change. Clin Microbiol Rev 2017; 30:115-190. [PMID: 27856520 PMCID: PMC5217791 DOI: 10.1128/cmr.00045-16] [Citation(s) in RCA: 528] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii is the agent of Q fever, or "query fever," a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between "acute" and "chronic" Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.
Collapse
Affiliation(s)
- Carole Eldin
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Cléa Mélenotte
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Oleg Mediannikov
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Eric Ghigo
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Matthieu Million
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Sophie Edouard
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Max Maurin
- Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France
| | - Didier Raoult
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| |
Collapse
|
12
|
Carceller Lechón F, Duat Rodríguez A, Sirvent Cerdá SI, Khabra K, de Prada I, García-Peñas JJ, Madero López L. Hemicerebellitis: Report of three paediatric cases and review of the literature. Eur J Paediatr Neurol 2014; 18:273-81. [PMID: 24423631 DOI: 10.1016/j.ejpn.2013.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
Abstract
Acute inflammation of a single cerebellar hemisphere (hemicerebellitis) is a rare disorder of unknown origin. The clinical presentation is mainly characterized by headache, ataxia, dysmetria, and vomiting. In addition, some children may develop severe intracranial hypertension. The neuroimaging of hemicerebellitis raises a challenging differential diagnosis, particularly with posterior fossa tumours. Although there is no standard treatment for hemicerebellitis, its outcome is usually favourable. However, ipsilateral hemicerebellar atrophy develops in up to half of cases, and a minority of children may show persisting fine motor and/or neurocognitive sequelae. In this article, we contribute with three new reports and review a total of 35 cases of hemicerebellitis.
Collapse
Affiliation(s)
| | | | | | - Komel Khabra
- Department of Statistics, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | | | | | | |
Collapse
|
13
|
Rodríguez-Cruz PM, Janet-Signoret S, Miranda-Herrero MC, Barredo-Valderrama E, Vázquez-López M, Ruiz-Martín Y, Castro-De Castro P. Acute hemicerebellitis in children: case report and review of literature. Eur J Paediatr Neurol 2013; 17:447-53. [PMID: 23660196 DOI: 10.1016/j.ejpn.2013.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022]
Abstract
Acute hemicerebellitis in childhood is an extremely rare unilateral presentation of cerebellitis mimicking a tumour. Its aetiology is unknown, although an inflammatory or postinfectious origin is presumed. Its clinical outcome is generally good and a self-limited evolution, in the absence of specific treatment, is usually expected. MRI findings can be misunderstood leading to erroneous diagnosis and invasive treatments. Clinical improvement and regression of the pathological findings in serial MRI will help differentiate acute hemicerebellitis from a neoplastic process. Surgical procedures should be performed only in case of clinical deterioration. We present a case of pseudotumoral hemicerebellitis in an eight-year-old girl, presenting with severe headache. This paper provides a review on hemicerebellitis and highlights the clinical, diagnostic, therapeutic features and outcome of this entity.
Collapse
Affiliation(s)
- Pedro M Rodríguez-Cruz
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
14
|
Lim JA, Kim JM, Lee ST, Jung KH, Kim YS, Lee SK, Chu K. Brainstem encephalitis caused by Coxiella burnetii. J Clin Neurosci 2013; 21:699-701. [PMID: 24210800 DOI: 10.1016/j.jocn.2013.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/26/2013] [Indexed: 11/30/2022]
Abstract
Coxiella burnetii is the causative agent of Q fever, which rarely causes neurologic symptoms. We describe a patient who presented with progressive sensory changes, dizziness, and motor weakness. The cerebrospinal fluid revealed pleocytosis, and MRI indicated the presence of a diffuse brain stem lesion. An indirect immunofluorescence test revealed antibodies against C. burnetii. The symptoms improved with antibiotics against C. burnetii. Q fever should be considered as a possible etiology of brainstem encephalitis.
Collapse
Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Chongro-Gu, 110-744 Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Medical Center, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Chongro-Gu, 110-744 Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Chongro-Gu, 110-744 Seoul, South Korea
| | - Young Su Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Chongro-Gu, 110-744 Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Chongro-Gu, 110-744 Seoul, South Korea.
| |
Collapse
|
15
|
Manto M, Jissendi P. Infectious Diseases of the Posterior Fossa. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2013:2027-2038. [DOI: 10.1007/978-94-007-1333-8_93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
16
|
Desai J, Mitchell WG. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. J Child Neurol 2012; 27:1482-8. [PMID: 22805251 DOI: 10.1177/0883073812450318] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute cerebellar ataxia and acute cerebellitis represent a process characterized by parainfectious, postinfectious, or postvaccination cerebellar inflammation. There is considerable overlap between these entities. The mildest cases of acute cerebellar ataxia represent a benign condition that is characterized by acute truncal and gait ataxia, variably with appendicular ataxia, nystagmus, dysarthria, and hypotonia. It occurs mostly in young children, presents abruptly, and recovers over weeks. Neuroimaging is normal. Severe cases of cerebellitis represent the other end of the spectrum, presenting with acute cerebellar signs often overshadowed by alteration of consciousness, focal neurological deficits, raised intracranial pressure, hydrocephalus, and even herniation. Neuroimaging is abnormal and the prognosis is less favorable than in acute cerebellar ataxia. Acute disseminated encephalomyelitis may be confused with acute cerebellitis when the clinical findings are predominantly cerebellar, but lesions on neuroimaging are usually widespread. Paraneoplastic opsoclonus-myoclonus syndrome is often initially misdiagnosed as acute cerebellar ataxia, but has very specific features, course, and etiopathogensis.
Collapse
Affiliation(s)
- Jay Desai
- Division of Neurology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | | |
Collapse
|
17
|
|
18
|
Coeli GNM, Silva GCD, Tiengo RR, Fernandes JOM, Fernandes WLM, Lourenço DNL. Cerebelite aguda com herniação tonsilar: relato de caso. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cerebelite aguda é uma síndrome inflamatória rara frequentemente caracterizada por rápida disfunção cerebelar. Neste estudo relatamos os achados de imagem do caso de uma criança com cerebelite aguda, herniação tonsilar e hidrocefalia hipertensiva. O agente etiológico não foi descoberto. O tratamento foi conservador, com manitol e corticoide. A análise evolutiva por imagem demonstrou resolução do quadro clínico sem sequelas.
Collapse
Affiliation(s)
| | | | | | - José Otávio Meyer Fernandes
- Hospital Escola de Itajubá; Faculdade de Medicina de Itajubá; Clínica Sul Mineira Tomosul; Clínica Magsul, Brasil
| | | | | |
Collapse
|
19
|
Palmela C, Badura R, Valadas E. Acute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients. Germs 2012; 2:43-59. [PMID: 24432263 DOI: 10.11599/germs.2012.1013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/22/2012] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Q fever is a worldwide zoonosis caused by Coxiella burnetii. The main characteristic of acute Q fever is its clinical polymorphism, usually presenting as a febrile illness with varying degrees of hepatitis and/or pneumonia. Q fever is endemic in Portugal, and it is an obligatory notifiable disease since 1999. However, its epidemiological and clinical characteristics are still incompletely described. METHODS We performed a retrospective study of 32 cases admitted in the Infectious Diseases Department, Santa Maria's University Hospital, from January 2001 to December 2010, in whom acute Q fever was diagnosed by the presence of antibodies to phase II Coxiella burnetii antigens associated with a compatible clinical syndrome. RESULTS Out of the 32 cases recorded, 29 (91%) were male, with a male:female ratio of 9.7:1. Individuals at productive age were mainly affected (88%, n=28, with ages between 25 and 64 years). Clinically, the most common manifestation of acute Q fever was hepatic involvement (84%, n=27), which occurred isolated in 53% (n=17) of the cases. Hepatitis was more severe, presenting with higher values of liver function tests, in patients presenting both pulmonary and hepatic involvement. Additionally, we report one case of myocarditis and another one with neurological involvement. Empiric but appropriate antibiotic therapy was given in 66% (n=21) of the cases. There was a complete recovery in 94% (n=30) of the patients, and one death. We confirmed the sub-notification of this disease in Portugal, with only 47% (n=15) of the cases notified. CONCLUSION In Portugal further studies are needed to confirm our results. From the 32 cases studied, acute Q fever presented more frequently as a febrile disease with hepatic involvement affecting mainly young male individuals. Furthermore, acute Q fever is clearly underdiagnosed and underreported in Portugal, which suggests that an increased awareness of the disease is needed, together with a broader use of serological testing.
Collapse
Affiliation(s)
| | - Robert Badura
- MD, Infectious and Parasitic Diseases University Clinic, Faculty of Medicine, Santa Maria's University Hospital, Lisbon, Portugal
| | - Emília Valadas
- PhD, Infectious and Parasitic Diseases University Clinic, Faculty of Medicine, Santa Maria's University Hospital, Lisbon, Portugal
| |
Collapse
|
20
|
Delsing CE, Warris A, Bleeker-Rovers CP. Q Fever: Still More Queries than Answers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 719:133-43. [DOI: 10.1007/978-1-4614-0204-6_12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
21
|
Roldan H, Garcia-Conde M, Ginoves-Sierra M, Rodriguez R. Acute Hemicerebellitis with Obstructive Hydrocephalus in a Young Adult. World Neurosurg 2011; 75:726-30; discussion 618-9. [DOI: 10.1016/j.wneu.2010.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/03/2010] [Accepted: 10/19/2010] [Indexed: 11/28/2022]
|
22
|
Shkalim V, Amir J, Kornreich L, Scheuerman O, Straussberg R. Acute cerebellitis presenting as tonsillar herniation and hydrocephalus. Pediatr Neurol 2009; 41:200-3. [PMID: 19664537 DOI: 10.1016/j.pediatrneurol.2009.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 04/01/2009] [Accepted: 04/06/2009] [Indexed: 11/28/2022]
Abstract
Acute cerebellitis is a rare inflammatory syndrome, often characterized by cerebellar dysfunction of rapid onset. We describe two children, a girl aged 5 years and a boy aged 11 years, with acute cerebellitis. Both manifested tonsillar herniation and hydrocephalus. The cause was Mycoplasma pneumoniae infection in the first patient, and unknown in the second. The girl was treated conservatively with steroids and diuretics, as well as vibramycin, and the boy required insertion of a ventriculostomy. Both presented a good prognosis and full recovery.
Collapse
Affiliation(s)
- Vered Shkalim
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel.
| | | | | | | | | |
Collapse
|
23
|
Million M, Lepidi H, Raoult D. Fièvre Q : actualités diagnostiques et thérapeutiques. Med Mal Infect 2009; 39:82-94. [DOI: 10.1016/j.medmal.2008.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 07/17/2008] [Indexed: 01/17/2023]
|
24
|
Seneviratne JK, Blair JE, Smith BE. Brachial plexopathy associated with Q fever: Case report and review of the literature. Muscle Nerve 2008; 38:1644-8. [DOI: 10.1002/mus.21104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
25
|
Luijnenburg SE, Hanlo PW, Han KS, Kors WA, Witkamp TD, Verbeke JIML. Postoperative hemicerebellar inflammation mimicking recurrent tumor after resection of a medulloblastoma. Case report. J Neurosurg Pediatr 2008; 1:330-3. [PMID: 18377311 DOI: 10.3171/ped/2008/1/4/330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The authors present the case of a 4-year-old boy in whom a medulloblastoma in the left cerebellar hemisphere was successfully resected with no signs of residual tumor on the postoperative magnetic resonance (MR) images. A second MR imaging study performed 1 month after surgery demonstrated an extensive, contrast-enhancing lesion in the left cerebellar hemisphere, which simulated massive recurrent tumor, and repeated surgery was considered. A third postoperative MR imaging study, performed for evaluation of the craniospinal axis 10 days after the second postoperative study, still showed some contrast enhancement in the left cerebellar hemisphere, but the lesion had almost disappeared. Postoperative hemicerebellar inflammation seemed to be the most likely explanation. This case illustrates that early postoperative inflammation can mimic recurrent tumor on MR images obtained after resection of a medulloblastoma and caution should be taken in interpreting such images. Clinical history, neurological examination, laboratory findings, and repeated MR imaging studies can be helpful in evaluating the patient accurately.
Collapse
Affiliation(s)
- Saskia E Luijnenburg
- Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
26
|
Acute Q fever in children presenting with encephalitis. Pediatr Neurol 2008; 38:44-6. [PMID: 18054692 DOI: 10.1016/j.pediatrneurol.2007.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 08/02/2007] [Accepted: 09/06/2007] [Indexed: 11/21/2022]
Abstract
We describe the cases of three children with encephalitis associated with Coxiella burnetii infection. Neurologic features ranged from status epilepticus and coma to headache and pseudotumor cerebri syndrome. Patients had good response to antibiotic treatment with doxycycline and recovered fully. Q fever should be included in the differential diagnosis of children with encephalitis, and routine serological testing should be considered, especially in endemic areas.
Collapse
|
27
|
Melek E, Ozyer U, Erol I, Alehan F, Muhteşem Ağildere A. +H-proton-magnetic resonance spectroscopic findings in a patient with acute hemicerebellitis presenting without localized signs: a case report. Eur J Paediatr Neurol 2006; 10:202-6. [PMID: 16952473 DOI: 10.1016/j.ejpn.2006.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/12/2006] [Accepted: 07/26/2006] [Indexed: 11/26/2022]
Abstract
Acute cerebellitis (AC) is an inflammatory process involving the cerebellum. Usually, this pathology is bilateral; it is unusual to have a unilateral cerebellitis. Only seven cases of hemicerebellitis have been reported in the literature. Here, we review the literature and report the magnetic resonance imaging (MRI) and proton-magnetic resonance spectroscopic (+H-MRS) findings of a case of acute hemicerebellitis in a 15-year-old girl presenting with 15 days' history of headache.
Collapse
Affiliation(s)
- Engin Melek
- Faculty of Medicine, Department of Pediatrics, Baskent University, Ankara, Turkey
| | | | | | | | | |
Collapse
|
28
|
Adachi M, Kawanami T, Ohshima H, Hosoya T. Cerebellar atrophy attributed to cerebellitis in two patients. Magn Reson Med Sci 2006; 4:103-7. [PMID: 16340165 DOI: 10.2463/mrms.4.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In a review of magnetic resonance (MR) images from patients with spinocerebellar degeneration (SCD), we found 2 rare patients considered to be in late-stage cerebellitis who showed isolated cerebellar atrophy. The patients were negative for the spinocerebellar ataxia (SCA) genes and had no symptoms of hypothyroidism, history of malignant tumors, or history of alcohol and drug (phenytoin) abuse, which may cause cerebellar atrophy. MR images demonstrated generalized atrophy of the cerebellum, excluding the brainstem or cerebrum. In these cases, moreover, slightly high intensities were noted in the affected cerebellar cortices on fluid-attenuated inversion recovery (FLAIR) images. The distribution of widening of the folia and cortical high intensities on FLAIR images might be important clues with which to diagnose late-stage cerebellitis.
Collapse
Affiliation(s)
- Michito Adachi
- Department of Radiology, Ohshima Clinic, Sakurada Nishi, Yamagata 990-2321, Japan.
| | | | | | | |
Collapse
|
29
|
Tlili-Graiess K, Mhiri Souei M, Mlaiki B, Arifa N, Moulahi H, Jemni Gharbi H, Yacoub M, Essoussi M. Imagerie des cérébellites aiguës chez l’enfant. J Neuroradiol 2006; 33:38-44. [PMID: 16528204 DOI: 10.1016/s0150-9861(06)77226-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute cerebellitis is one of the main causes of acute cerebellar dysfunction in children. It is either infectious, usually viral, post-infectious or post vaccinal in etiology. Diagnosing acute cerebellitis may be difficult in patients with only subtle cerebellar signs and when cerebro-spinal fluid examination is normal. MRI is the most adequate imaging technique to demonstrate cerebellar involvement. The authors report the clinical and neuro-imaging findings in 4 paediatric cases. Patient's age varied from 2 to 7 years and predominant clinical symptoms were fever, headache and vomiting; ataxia was noted only in 2 cases. Viral serologic tests were negative in 3 cases and demonstrated Epstein-Barr virus in 1. Initial MRI examination (2 cases) demonstrated increased intensity on T2W and Flair sequences of the cerebellar gray matter with pial enhancement. Clinical outcome was good with complete resolution of symptoms in 3 cases and persistent mild right upper limb paresis in one. The resolution of the signal abnormality was well demonstrated on MRI in one case, suggesting an inflammatory etiology with moderate residual cerebellar atrophy.
Collapse
Affiliation(s)
- K Tlili-Graiess
- Service d'Imagerie Médicale, CHU Sahloul, 4054 Sousse, Tunisie.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Takahashi H, Tokue Y, Kikuchi T, Kobayashi T, Gomi K, Goto I, Shiraishi H, Fukushi H, Hirai K, Nukiwa T, Watanabe A. Prevalence of community-acquired respiratory tract infections associated with Q fever in Japan. Diagn Microbiol Infect Dis 2004; 48:247-52. [PMID: 15062916 DOI: 10.1016/j.diagmicrobio.2003.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 11/13/2003] [Indexed: 10/26/2022]
Abstract
A multicenter prospective cohort study to assess the occurrence and characteristics of acute Q fever associated with community acquired respiratory infections was performed. Among the 400 patients enrolled for the study, 10 (2.50%) patients (5 out of 120 cases of pneumonia, 3 out of 131 cases of acute bronchitis, and 2 out of 149 cases of upper respiratory infections) were diagnosed as having acute Q fever. Contact with dogs or cats before the onset of the disease was confirmed in most of the patients. The clinical profiles of these 10 patients were generally similar to those reported from other countries, such as fever, general fatigue and liver dysfunction, except for the predominance of sporadic cases among the urban population. Our study demonstrates that Q fever is not uncommon cause of community-acquired respiratory infections even in Japan.
Collapse
Affiliation(s)
- Hiroshi Takahashi
- Department of Respiratory Oncology and Molecular Medicine, Division of Cancer Control, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Drevets DA, Leenen PJM, Greenfield RA. Invasion of the central nervous system by intracellular bacteria. Clin Microbiol Rev 2004; 17:323-47. [PMID: 15084504 PMCID: PMC387409 DOI: 10.1128/cmr.17.2.323-347.2004] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infection of the central nervous system (CNS) is a severe and frequently fatal event during the course of many diseases caused by microbes with predominantly intracellular life cycles. Examples of these include the facultative intracellular bacteria Listeria monocytogenes, Mycobacterium tuberculosis, and Brucella and Salmonella spp. and obligate intracellular microbes of the Rickettsiaceae family and Tropheryma whipplei. Unfortunately, the mechanisms used by intracellular bacterial pathogens to enter the CNS are less well known than those used by bacterial pathogens with an extracellular life cycle. The goal of this review is to elaborate on the means by which intracellular bacterial pathogens establish infection within the CNS. This review encompasses the clinical and pathological findings that pertain to the CNS infection in humans and includes experimental data from animal models that illuminate how these microbes enter the CNS. Recent experimental data showing that L. monocytogenes can invade the CNS by more than one mechanism make it a useful model for discussing the various routes for neuroinvasion used by intracellular bacterial pathogens.
Collapse
Affiliation(s)
- Douglas A Drevets
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
| | | | | |
Collapse
|
32
|
De Bruecker Y, Claus F, Demaerel P, Ballaux F, Sciot R, Lagae L, Buyse G, Wilms G. MRI findings in acute cerebellitis. Eur Radiol 2004; 14:1478-83. [PMID: 14968261 DOI: 10.1007/s00330-004-2247-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 10/17/2003] [Accepted: 01/05/2004] [Indexed: 11/25/2022]
Abstract
Acute cerebellitis is an inflammatory process involving the cerebellum. We report the clinical, CT and MRI features of four cases and a review of the literature. Bilateral diffuse hemispheric abnormalities represent the most common imaging presentations. Our observations demonstrate the various imaging appearances of acute cerebellitis. Simultaneous involvement of both hemispheres and the vermis has not been reported previously. The development of cerebellar atrophy following an initial normal MR imaging examination is also a new finding. In atypical clinical presentation, MR imaging can lead to the diagnosis. MR imaging findings have, however, no prognostic value.
Collapse
Affiliation(s)
- Y De Bruecker
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Soussan V, Husson B, Tardieu M. [Description and prognostic value of cerebellar MRI lesions in children with severe acute ataxia]. Arch Pediatr 2003; 10:604-7. [PMID: 12907067 DOI: 10.1016/s0929-693x(03)00273-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this work was to evaluate NMR cerebellar abnormalities in children with severe acute ataxia. Among 8 consecutively observed children, NMR performed in 6 during the acute phase was pathological in 4, demonstrating hyperintense signal in the T2-weighed sequences of dentate nuclei (2 cases, associated in 1 with hyperintense signal in the medium cerebellar peduncle) or of the cerebellar cortex associated with cerebellar swelling (2 cases). NMR performed in 7 cases after at least 1 month of evolution showed cerebellar atrophy in 4 cases. After 1 to 6 years of clinical follow-up, 4/8 children had clinical sequellae, including 3 of the 4 children with initially abnormal NMR. Conversely, the 2 patients with initially normal NMR had a good clinical recovery. NMR during the acute phase gives informations on prognosis in patients with severe acute ataxia.
Collapse
Affiliation(s)
- V Soussan
- Service de neurologie, département de pédiatrie, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | | | | |
Collapse
|
34
|
Ciardi M, Giacchetti G, Fedele CG, Tenorio A, Brandi A, Libertone R, Ajassa C, Borgese L, Delia S. Acute cerebellitis caused by herpes simplex virus type 1. Clin Infect Dis 2003; 36:e50-4. [PMID: 12539091 DOI: 10.1086/345781] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 10/14/2002] [Indexed: 01/01/2023] Open
Abstract
Cerebellar disorders due to herpes simplex virus (HSV) infection are rare and always associated with herpes simplex encephalitis. We report 2 cases of severe primary acute cerebellitis caused by HSV type 1 that were identified by nested polymerase chain reaction performed on cerebrospinal fluid samples.
Collapse
Affiliation(s)
- Maria Ciardi
- Department of Infectious and Tropical Diseases, University La Sapienza, 00161 Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Sommer JB, Schoerner C, Heckmann JG, Neundoerfer B, Hilz MJ. Mononeuritis multiplex caused by Coxiella burnetii infection (Q fever). Acta Neurol Scand 2002; 106:371-3. [PMID: 12460144 DOI: 10.1034/j.1600-0404.2002.02054.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
After 1 week of flu-like illness, a 64-year-old man developed rapidly progressive mononeuritis multiplex involving the right arm and both legs. Serologic studies identified Coxiella burnetii as the cause of the febrile disease (Q fever). Fourteen days doxycycline treatment (200 mg daily) induced rapid and complete recovery. After 6 months, flu-like symptoms, weakness and hypalgesia of the right leg reappeared. Antibody titers again identified Q fever. Doxycycline was re-established and induced prompt recovery. Q fever has been associated with various neurologic complications such as meningoencephalitis, cerebellitis, optic neuritis or polyneuroradiculitis. This is the first report on Q fever related mononeuritis multiplex. Prolonged antibiotic treatment may be required to prevent relapsing infection from the resistant bacterium.
Collapse
Affiliation(s)
- J B Sommer
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | |
Collapse
|
36
|
Guerrini L, Belli G, Cellerini M, Nencini P, Mascalchi M. Proton MR spectroscopy of cerebellitis. Magn Reson Imaging 2002; 20:619-22. [PMID: 12467871 DOI: 10.1016/s0730-725x(02)00600-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Single voxel proton MR spectroscopy ((1)H-MRS) of the vermis was obtained in two patients with cerebellitis. In the acute phase (1)H-MRS revealed low N-acetyl-aspartate (NAA)/creatine (Cr) and NAA/choline (Cho) and normal Cho/Cr ratios. Decrease of the concentration of NAA was confirmed by quantitative analysis in one patient. The NAA/Cr and NAA/Cho ratios and NAA concentration were increased in (1)H-MRS examinations obtained 10 and 24 months after the acute episode. (1)H-MRS demonstrates reversible metabolite changes in cerebellitis.
Collapse
Affiliation(s)
- Laura Guerrini
- Radiodiagnostica I, Dipartimento di Fisiopatologia Clinica, Università di Firenze, Viale Morgagni 85, Italy
| | | | | | | | | |
Collapse
|
37
|
Abstract
Many recent reports of acute cerebellitis with a critical or potentially critical course have changed the conception of the disease from an acute cerebellar ataxia with a benign course to a notable disease entity with a heterogeneous pathogenesis. The most characteristic finding by magnetic resonance imaging is diffuse cortical swelling of the cerebellum, often complicated by hydrocephalus or tonsillar herniation. A timely assessment and appropriate choice of treatment, including surgical intervention when indicated, are key to improving the outcome of affected patients.
Collapse
Affiliation(s)
- Yukio Sawaishi
- Department of Pediatrics, Akita University School of Medicine, Akita City, Japan.
| | | |
Collapse
|
38
|
Teive HA, Zavala JA, Iwamoto FM, Bertucci-Filho D, Werneck LC. Cerebelite aguda causada por vírus Epstein-Barr: relato de caso. ARQUIVOS DE NEURO-PSIQUIATRIA 2001. [DOI: 10.1590/s0004-282x2001000400027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A cerebelite aguda pode ocorrer em associação a infecção pelo vírus da varicela-zoster, enterovirus, caxumba, micoplasma e outros agentes infecciosos. A cerebelite aguda é uma complicação rara da infecção pelo vírus Epstein-Barr (EBV). Relatamos o caso de uma mulher de 21 anos com história de 12 dias de evolução com náuseas, vômitos, ataxia de marcha e membros, tremor cefálico e de membros, opsoclono, mioclonias e rash cutâneo. Sorologia para EBV foi positiva. A infecção pelo EBV, com complicações neurológicas, pode não se apresentar com os sinais e sintomas clássicos da mononucleose infeciosa.
Collapse
|
39
|
Levy EI, Harris AE, Omalu BI, Hamilton RL, Branstetter BF, Pollack IF. Sudden death from fulminant acute cerebellitis. Pediatr Neurosurg 2001; 35:24-8. [PMID: 11490187 DOI: 10.1159/000050381] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute cerebellitis is postulated to result from viral and/or autoimmune etiologies. This disease has been reported to have a variable course. We report a case of sudden death from acute fulminant cerebellitis in a 13-year-old ballet dancer. Serial CT and MRI demonstrated rapid progression of the disease. Histopathologic correlation is provided. The etiologies, clinical course, therapeutic interventions and postmortem evaluation of this potentially life-threatening condition are briefly reviewed.
Collapse
Affiliation(s)
- E I Levy
- Department of Neurosurgery, Children's Hospital of Pittsburgh, PA, USA
| | | | | | | | | | | |
Collapse
|
40
|
Kubota H, Tanabe Y, Komiya T, Hirai K, Takanashi J, Kohno Y. Q fever encephalitis with cytokine profiles in serum and cerebrospinal fluid. Pediatr Infect Dis J 2001; 20:318-9. [PMID: 11303840 DOI: 10.1097/00006454-200103000-00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 7-year-old boy with acute encephalitis was proved to have Coxiella burnetii infection. Cerebrospinal fluid but not serum had elevated values of interleukins 1-beta and 6, but not of tumor necrosis factor.
Collapse
Affiliation(s)
- H Kubota
- Department of Pediatrics, Faculty of Medicine, Chiba University, Japan.
| | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- M S LeDoux
- Department of Neurology, University of Tennessee College of Medicine, Memphis, TN 38163, USA.
| |
Collapse
|
42
|
Taillé C, Fournier P, Bissuel F, Longuet P, Leport C, Vildé J. Méningoencéphalite au cours d'une fièvre Q. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(00)88288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|