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T AM, Singh B, Rupali P. Central nervous system infections in the tropics. Curr Opin Infect Dis 2024; 37:201-210. [PMID: 38529912 DOI: 10.1097/qco.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Emerging and re-emerging central nervous system (CNS) infections are a major public health concern in the tropics. The reasons for this are myriad; climate change, rainfall, deforestation, increased vector density combined with poverty, poor sanitation and hygiene. This review focuses on pathogens, which have emerged and re-emerged, with the potential for significant morbidity and mortality. RECENT FINDINGS In recent years, multiple acute encephalitis outbreaks have been caused by Nipah virus, which carries a high case fatality. Arboviral infections, predominantly dengue, chikungunya and Zika are re-emerging increasingly especially in urban areas due to changing human habitats, vector behaviour and viral evolution. Scrub typhus, another vector borne disease caused by the bacterium Orientia tsutsugamushi , is being established as a leading cause of CNS infections in the tropics. SUMMARY A syndromic and epidemiological approach to CNS infections in the tropics is essential to plan appropriate diagnostic tests and management. Rapid diagnostic tests facilitate early diagnosis and thus help prompt initiation and focusing of therapy to prevent adverse outcomes. Vector control, cautious urbanization and deforestation, and reducing disturbance of ecosystems can help prevent spread of vector-borne diseases. Regional diagnostic and treatment approaches and specific vaccines are required to avert morbidity and mortality.
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Affiliation(s)
| | - Bhagteshwar Singh
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Institute of Infection Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Infectious Diseases
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
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López N, Cuesta G, Rodríguez-Vega S, Rosas E, Chumbita M, Casals-Pascual C, Morata L, Vergara A, Bodro M, Bosch J, Herrera S, Martínez JA, Mensa J, Garcia-Vidal C, Marcos MÁ, Vila J, Soriano A, Puerta-Alcalde P. Multiplex real-time PCR FilmArray performance in the diagnosis of meningoencephalitis: lights and shadows. Infection 2024; 52:165-172. [PMID: 37515691 PMCID: PMC10810907 DOI: 10.1007/s15010-023-02076-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.
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Affiliation(s)
- Néstor López
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Genoveva Cuesta
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | | | - Enric Rosas
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Climent Casals-Pascual
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Vila
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain.
- Universitat de Barcelona (UB), Barcelona, Spain.
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Yao XP, Hong JC, Jiang ZJ, Pan YY, Liu XF, Wang JM, Fan RJ, Yang BH, Zhang WQ, Fan QC, Li LX, Lin BW, Zhao M. Systemic and cerebrospinal fluid biomarkers for tuberculous meningitis identification and treatment monitoring. Microbiol Spectr 2024; 12:e0224623. [PMID: 38047697 PMCID: PMC10783035 DOI: 10.1128/spectrum.02246-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
IMPORTANCE Tuberculous meningitis is a life-threatening infection with high mortality and disability rates. Current diagnostic methods using cerebrospinal fluid (CSF) samples have limited sensitivity and lack predictive biomarkers for evaluating prognosis. This study's findings reveal excessive activation of the immune response during tuberculous meningitis (TBM) infection. Notably, a strong negative correlation was observed between CSF levels of monokine induced by interferon-γ (MIG) and the CSF/blood glucose ratio in TBM patients. MIG also exhibited the highest area under the curve with high sensitivity and specificity. This study suggests that MIG may serve as a novel biomarker for differentiating TBM infection in CSF or serum, potentially leading to improved diagnostic accuracy and better patient outcomes.
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Affiliation(s)
- Xiang-Ping Yao
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jian-Chen Hong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zai-Jie Jiang
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Yu-Ying Pan
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Xiao-Feng Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jun-Mei Wang
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Rui-Jie Fan
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Bi-Hui Yang
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Wei-Qing Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qi-Chao Fan
- Department of Infectious Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Li-Xiu Li
- Department of Oncology, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Bi-Wei Lin
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Miao Zhao
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Cheng J, Dang C, Li X, Wang J, Huang X, Li Y, Cui X. The participation of clinical pharmacists in the treatment of patients with central nervous system infection can improve the effectiveness and appropriateness of anti-infective treatments: a retrospective cohort study. Front Pharmacol 2023; 14:1226333. [PMID: 37745082 PMCID: PMC10512419 DOI: 10.3389/fphar.2023.1226333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Central nervous system infection (CNSI) treatment in hospital neurosurgery emphasizes the importance of optimizing antimicrobial therapy. Timely and appropriate empiric antibiotic treatment is critical for managing patients with bacterial meningitis. Objectives: To evaluate the activities of clinical pharmacists in the anti-infective treatment of patients with CNSI in neurosurgery. Method: A single-center retrospective cohort study was carried out from January 2021 to March 2023 at a tertiary teaching hospital in China. The study sample included a group that received pharmacy services and a group that did not. In the pharmacy services group, the anti-infective treatment plan was led and developed by pharmacists. Pharmaceutical care, including medication therapy and all CNSI treatment regimens, was administered in daily unit rounds by pharmacists. Baseline demographics, treatment outcomes, and rational use of antibiotics were compared between the two groups, and the impact of a antimicrobial stewardship (AMS) program was evaluated. Results: Of the 306 patients assessed according to the inclusion and exclusion criteria, 151 patients were included, and 155 patients were excluded due to abnormal data and missing information on antibiotic costs or antimicrobial use. Eventually, 73 were included in the pharmacy services group and 78 in the group without pharmacist participation. The antibiotic use density (AUD) of the pharmacy services group decreased from 167.68 to 127.63 compared to the group without pharmacist participation. After the pharmacist services, the AUD for linezolid decreased from 9.15% to 5.23% and that for miscellaneous agents decreased from 17.91% to 6.72%. The pharmacy services group had better improvement (p < 0.05) and a significantly higher score for the rational use of antibiotics (p < 0.05) than the group without pharmacist participation. Conclusion: The clinical pharmacist services evaluation results demonstrated an essential role of clinical pharmacist-led AMS programs in the effective and appropriate use of anti-infective treatments in neurosurgery with patients with CNSI.
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Affiliation(s)
- Jie Cheng
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
- Department of Clinical Pharmacy, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - ChuanDong Dang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Xiao Li
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - JianJun Wang
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Xin Huang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Yan Li
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - XueYan Cui
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
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Jain AK, Tansey G, Hartig R, Mitchell AS, Basso MA. Trends and Treatment Approaches for Complications in Neuroscience Experiments with Monkey Species. Comp Med 2023; 73:216-228. [PMID: 37208151 PMCID: PMC10290483 DOI: 10.30802/aalas-cm-22-000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/12/2022] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Our goal in this manuscript is to advance the assessment and treatment of monkey species in neuroscience research. We hope to begin a discussion and establish baseline data on how complications are identified and treated. We surveyed the neuroscience research community working with monkeys and compiled responses to questions about investigator demographics, assessment of animal wellbeing, treatment choices, and approaches to mitigate risks associated with CNS procedures and promote monkey health and wellbeing. The majority of the respondents had worked with nonhuman primates (NHP) for over 15 y. Identification of procedure-related complications and efficacy of treatment generally rely on common behavioral indices. Treatments for localized inflammatory responses are generally successful, whereas the treatment success for meningitis or meningoencephalitis, abscesses, and hemorrhagic stroke are less successful. Behavioral signs of pain are treated successfully with NSAIDs and opioids. Our future plans are to collate treatment protocols and develop best practices that can be shared across the neuroscience community to improve treatment success rates and animal welfare and therefore science. Human protocols can be used to develop best practices, assess outcomes, and promote further refinements in treatment practices for monkeys to enhance research outcomes.
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Affiliation(s)
- Aarti Kishore Jain
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Ginger Tansey
- National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Renée Hartig
- Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York; Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Anna S Mitchell
- Department of Experimental Psychology, Oxford University, Tinsley Building, Oxford, United Kingdom; School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Michele A Basso
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Washington National Primate Research Center, Departments of Biological Structure and Physiology and Biophysics, University of Washington, Seattle, Washington;,
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Pajor MJ, Long B, Koyfman A, Liang SY. High risk and low prevalence diseases: Adult bacterial meningitis. Am J Emerg Med 2023; 65:76-83. [PMID: 36592564 DOI: 10.1016/j.ajem.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/19/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Acute bacterial meningitis in adults is a rare but serious condition that carries a high rate of morbidity. OBJECTIVE This review highlights pearls and pitfalls of acute bacterial meningitis in adults, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Meningitis encompasses a broad spectrum of disease involving inflammation of the meninges and subarachnoid space. It classically presents with fever, nuchal rigidity, and altered mental status, but this triad is not present in all cases. Up to 95% of patients will have at least two of the following four cardinal symptoms: fever, nuchal rigidity, altered mental status, and headache. The most common bacterial etiologies are S. pneumoniae and N. meningitidis. Cerebrospinal fluid testing obtained by lumbar puncture remains the gold standard in diagnosis. Head computed tomography prior to lumbar puncture may not be necessary in most patients. Empiric treatment consists of vancomycin, ceftriaxone, and dexamethasone. Elevated intracranial pressure should be managed using established neurocritical care strategies. CONCLUSION A better understanding of the pearls and pitfalls of acute bacterial meningitis can assist emergency clinicians in pursuing its timely diagnosis and management.
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Affiliation(s)
- Michael J Pajor
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Stephen Y Liang
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Hwee TANGP, Koh Cheng THOON. Imaging of Congenital/Childhood Central Nervous System Infections. Neuroimaging Clin N Am 2023; 33:207-224. [DOI: 10.1016/j.nic.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Puranik N, Yadav D, Song M. Insight into Early Diagnosis of Multiple Sclerosis by Targeting Prognostic Biomarkers. Curr Pharm Des 2023; 29:2534-2544. [PMID: 37921136 DOI: 10.2174/0113816128247471231018053737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/04/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
Multiple sclerosis (MS) is a central nervous system (CNS) immune-mediated disease that mainly strikes young adults and leaves them disabled. MS is an autoimmune illness that causes the immune system to attack the brain and spinal cord. The myelin sheaths, which insulate the nerve fibers, are harmed by our own immune cells, and this interferes with brain signal transmission. Numbness, tingling, mood swings, memory problems, exhaustion, agony, vision problems, and/or paralysis are just a few of the symptoms. Despite technological advancements and significant research efforts in recent years, diagnosing MS can still be difficult. Each patient's MS is distinct due to a heterogeneous and complex pathophysiology with diverse types of disease courses. There is a pressing need to identify markers that will allow for more rapid and accurate diagnosis and prognosis assessments to choose the best course of treatment for each MS patient. The cerebrospinal fluid (CSF) is an excellent source of particular indicators associated with MS pathology. CSF contains molecules that represent pathological processes such as inflammation, cellular damage, and loss of blood-brain barrier integrity. Oligoclonal bands, neurofilaments, MS-specific miRNA, lncRNA, IgG-index, and anti-aquaporin 4 antibodies are all clinically utilised indicators for CSF in MS diagnosis. In recent years, a slew of new possible biomarkers have been presented. In this review, we look at what we know about CSF molecular markers and how they can aid in the diagnosis and differentiation of different MS forms and treatment options, and monitoring and predicting disease progression, therapy response, and consequences during such opportunistic infections.
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Affiliation(s)
- Nidhi Puranik
- Biological Sciences Department, Bharathiar University, Coimbatore, Tamil Nadu, 641046, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Korea
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Analysis of Cases with Cerebrospinal Fluid Characteristics Similar to Tuberculous Meningitis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9692804. [PMID: 36624852 PMCID: PMC9825210 DOI: 10.1155/2022/9692804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/02/2023]
Abstract
Purpose The diagnosis of tuberculous meningitis (TBM) is difficult and relies on the patient's clinical presentation and initial cerebrospinal fluid testing. Treatment outcomes for some patients with early consideration of TBM meningitis are often poor. Patients and Methods. In this study, we retrospectively analyzed 24 non-TBM patients whose early changes of cerebrospinal fluid were similar to those of TBM through the second-generation cerebrospinal fluid sequencing technology. Results All patients included in this study had an acute onset, including 5 patients with a history of upper respiratory tract infection, 9 patients with fever, 6 patients with headache, 5 patients with psychiatric symptoms, 6 patients with cognitive impairment, 9 patients with signs of meningeal irritation, and 6 patients with seizures. Sixteen patients presented with altered content and level of consciousness during their admission. The leukocyte counts (median, 124.0 × 106/L) and total protein concentrations (median, 1300 mg/L) were higher than normal reference values in all patients, whereas glucose (median, 1.345 mmol/L) and chloride concentration values (average, 111.7 ± 5.2 mmol/L) were lower than normal reference values. The patients included 2 cases of Liszt's meningitis, 2 cases of Brucella infection in the CNS, 4 cases of Varicella zoster virus encephalitis, 2 cases of human herpes simplex virus type 1, 2 cases of lupus encephalopathy, 2 cases of anti-NMDAR receptor encephalitis, 2 cases of meningeal carcinomatosis, 5 cases of cryptococcal meningitis, 2 cases of CNS sarcoidosis, and a case of invasive Rhizopus oryzae infection. All patients were tested for NGS in cerebrospinal fluid. Eight patients were diagnosed with anti-NMDAR encephalitis, meningeal carcinomatosis, lupus encephalopathy, and CNS sarcoidosis. Nine patients experienced death; 15 patients had a good prognosis and left no significant sequelae. Conclusion The analysis of patients with TBM-like cerebrospinal fluid changes will help improve the diagnostic accuracy of the disease and reduce misdiagnosis and underdiagnosis.
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Benyumiza D, Kumakech E, Gutu J, Banihani J, Mandap J, Talib ZM, Wakida EK, Maling S, Obua C. Caregiver's perspectives on the Central Nervous System infection illness trajectory among older persons with dementia in Northern Uganda-a qualitative community-based study. BMC Geriatr 2022; 22:825. [PMID: 36303115 PMCID: PMC9609188 DOI: 10.1186/s12877-022-03499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have explored the Central Nervous System (CNS) infection illness trajectory among older persons with dementia in sub-Saharan African (SSA) settings. This study explored the Caregiver’s perspectives on the Central Nervous System infection illness trajectory among the older persons with dementia in Northern Uganda. Methods This was a qualitative study conducted in Lira District northern Uganda in March 2022 amongst purposively selected 20 caregivers of the older persons aged 50 + years with a positive history of CNS infection and later life dementia. Data were collected using an in-depth interview guide. Audio recordings and field notes of the interviews were undertaken. The interviews generated data on the CNS infection illness trajectory from onset to the current demented state of the older persons. The audio-recorded interviews were transcribed verbatim before manual reflective thematic analysis. Results Older persons with a positive history of CNS infection illness and later life dementia in rural northern Uganda presented with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also manifestations of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines was sought and utilized for the treatment and care of the CNS infection illness and dementia by the older persons amidst improper diagnosis and mismanagement. Conclusions and recommendations Older persons with early-life CNS infections illness and later-life dementia were reported to present with symptoms including neck pain, back pain, chronic headache, high blood pressure, and fatigue. The reported symptoms of CNS infection illness may be intertwined with co-morbidities particularly traumatic injury involving the head, neck, and spine, high blood pressure, and chronic headache. Healthcare professionals should integrate routine screening of older persons for the history of CNS infections, chronic headache, high blood pressure, trauma to the head, neck, and spine, and dementia and early treatment.
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Affiliation(s)
- Deo Benyumiza
- Department of Nursing and Midwifery, Faculty of Health Science, Lira University, P.O. Box 1035, Lira City, Uganda
| | - Edward Kumakech
- Department of Nursing and Midwifery, Faculty of Health Science, Lira University, P.O. Box 1035, Lira City, Uganda
| | - Jastine Gutu
- Office of the Health Professional Education Partnership Initiative – Transforming Ugandan Institution’s Training Against HIV/AIDS (HEPI-TUITAH) Program Administration, Faculty of Health Science, Lira University, Lira, Uganda
| | - Jude Banihani
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA
| | - Joshua Mandap
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA
| | - Zohray M. Talib
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA ,grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda
| | - Edith K. Wakida
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA ,grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda
| | - Samuel Maling
- grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Pathogenesis of Fungal Infections in the Central Nervous System: Host and Pathogen Factors in Neurotropism. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-022-00444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Hussain SZM, Anwer MO, Noor SM, Hashmi S, Anwer S, Yaqoob U. Aseptic meningitis after 20 years of endoscopic transsphenoidal pituitary surgery: a rare complication. Med Pharm Rep 2022; 95:471-474. [PMID: 36506608 PMCID: PMC9694754 DOI: 10.15386/mpr-2046] [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: 01/17/2021] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022] Open
Abstract
A transsphenoidal surgical (TSS) approach is used for pituitary gland surgery involving pituitary adenomas, as well as for the biopsy of various neurosurgical tumors. TSS, although a relatively safe procedure, can lead to complications like hypopituitarism, visual impairment, nasal septal perforation, diabetes insipidus, carotid artery injury, and cerebrospinal fluid (CSF) leaks. Aseptic meningitis is also one of the complications of this procedure with an incidence of 1-2%, presenting with symptoms similar to bacterial meningitis, but with a low-grade fever of <102 F or even apyrexia. Here, we present a rare case of aseptic meningitis due to CSF leakage, presenting after 20 years of endoscopic surgery. A ventriculoperitoneal shunt was placed to stem the leak after two unsuccessful attempts of endonasal repair.
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Affiliation(s)
| | | | | | | | - Sanam Anwer
- Central Southside Community Hospital, Chicago, United States of America
| | - Uzair Yaqoob
- Dow University of Health Sciences, Karachi, Pakistan
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13
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Zhao Y, Ren B, Yu W, Zhang H, Zhao D, Lv J, Xie Z, Jiang K, Shang L, Yao H, Xu Y, Zhao G. Construction of an Assisted Model Based on Natural Language Processing for Automatic Early Diagnosis of Autoimmune Encephalitis. Neurol Ther 2022; 11:1117-1134. [PMID: 35543808 PMCID: PMC9338198 DOI: 10.1007/s40120-022-00355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Early diagnosis and etiological treatment can effectively improve the prognosis of patients with autoimmune encephalitis (AE). However, anti-neuronal antibody tests which provide the definitive diagnosis require time and are not always abnormal. By using natural language processing (NLP) technology, our study proposes an assisted diagnostic method for early clinical diagnosis of AE and compares its sensitivity with that of previously established criteria. Methods Our model is based on the text classification model trained by the history of present illness (HPI) in electronic medical records (EMRs) that present a definite pathological diagnosis of AE or infectious encephalitis (IE). The definitive diagnosis of IE was based on the results of traditional etiological examinations. The definitive diagnosis of AE was based on the results of neuronal antibodies, and the diagnostic criteria of definite autoimmune limbic encephalitis proposed by Graus et al. used as the reference standard for antibody-negative AE. First, we automatically recognized and extracted symptoms for all HPI texts in EMRs by training a dataset of 552 cases. Second, four text classification models trained by a dataset of 199 cases were established for differential diagnosis of AE and IE based on a post-structuring text dataset of every HPI, which was completed using symptoms in English language after the process of normalization of synonyms. The optimal model was identified by evaluating and comparing the performance of the four models. Finally, combined with three typical symptoms and the results of standard paraclinical tests such as cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), or electroencephalogram (EEG) proposed from Graus criteria, an assisted early diagnostic model for AE was established on the basis of the text classification model with the best performance. Results The comparison results for the four models applied to the independent testing dataset showed the naïve Bayesian classifier with bag of words achieved the best performance, with an area under the receiver operating characteristic curve of 0.85, accuracy of 84.5% (95% confidence interval [CI] 74.0–92.0%), sensitivity of 86.7% (95% CI 69.3–96.2%), and specificity of 82.9% (95% CI 67.9–92.8%), respectively. Compared with the diagnostic criteria proposed previously, the early diagnostic sensitivity for possible AE using the assisted diagnostic model based on the independent testing dataset was improved from 73.3% (95% CI 54.1–87.7%) to 86.7% (95% CI 69.3–96.2%). Conclusions The assisted diagnostic model could effectively increase the early diagnostic sensitivity for AE compared to previous diagnostic criteria, assist physicians in establishing the diagnosis of AE automatically after inputting the HPI and the results of standard paraclinical tests according to their narrative habits for describing symptoms, avoiding misdiagnosis and allowing for prompt initiation of specific treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00355-7.
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Affiliation(s)
- Yunsong Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bin Ren
- Department of Information, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wenjin Yu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Haijun Zhang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Di Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Junchao Lv
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhen Xie
- College of Life Sciences and Medicine, Northwest University, Xi'an, China
| | - Kun Jiang
- Department of Information, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China
| | - Han Yao
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Yongyong Xu
- College of Life Sciences and Medicine, Northwest University, Xi'an, China.
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
- College of Life Sciences and Medicine, Northwest University, Xi'an, China.
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14
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Zelek WM, Morgan BP. Targeting complement in neurodegeneration: challenges, risks, and strategies. Trends Pharmacol Sci 2022; 43:615-628. [DOI: 10.1016/j.tips.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022]
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15
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Barros Domingues R, Mendes-Correa MC, Vilela de Moura Leite FB, Vega Dos Santos M, Senne Soares CA. Evaluation of the Utilization of FilmArray Meningitis/Encephalitis in Children With Suspected Central Nervous System Infection: A Retrospective Case Series. Pediatr Emerg Care 2022; 38:58-61. [PMID: 34050110 DOI: 10.1097/pec.0000000000002462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The etiology of central nervous system infections is often difficult to establish. FilmArray meningitis/encephalitis (ME) panel is a multiplex polymerase chain reaction for rapid identification of 14 pathogens. The aim of this study was to evaluate potential real-life contributions of the use of this method in the pediatric population. METHODS We herein report the results obtained with FilmArray ME in a retrospective case series of 367 children with suspected central nervous system infection. We identified viral and bacterial agents by FilmArray, and we evaluated the potential diagnostic contributions of the use of the panel taking into account the cytological, biochemical, and microbiological results of the cerebrospinal fluid (CSF) analysis. RESULTS The FilmArray ME panel detected a viral infection in 186 cases (50.7%) and a bacterial infection in 12 cases (3.3%). Fifty-three cases (28.4%) of viral infection had at least 1 CSF finding that could be mistaken for bacterial meningitis. Enterovirus was identified in 2 cases with normal CSF findings. Among 12 bacterial infection cases, only 6 (50%) had a positive result with conventional microbiology analysis (Gram stain and culture). The CSF findings suggestive of bacterial meningitis were found in all 6 cases in which FilmArray was the only method to identify bacterial etiological agent. CONCLUSIONS FilmArray ME panel identified an etiological agent in cases in which conventional CSF analysis failed, providing potential clinical contributions to the management of such cases.
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16
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Khaba MC, Ngale TC, Makhado NA. Fungal infection of the central nervous system: Autopsy analysis of six cases. SAGE Open Med Case Rep 2022; 10:2050313X221122419. [PMID: 36105784 PMCID: PMC9465580 DOI: 10.1177/2050313x221122419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Fungal infections of the central nervous system are fatal and rare clinical
entities observable in immunosuppressed patients from varying causes. They carry
higher risks of morbidities and mortality as compared to viral, bacterial or
parasitic central nervous system infections. This study describes
clinicopathological description of the central nervous system fungal infections
with antemortem diagnostic challenges. This is a 9-year retrospective study of
six cases composed of three females and three males with a mean age of
29.3 years. All six decedents presented with signs of meningeal irritation. They
all suffered from immunodeficiency of varying causes. The gross and microscopic
features revealed cryptococcosis, candidiasis and mucormycosis as the cause of
the central nervous system infection. Early diagnosis and appropriate medical
treatment are of paramount importance in improving the overall survival of
patients with central nervous system mycosis. A few autopsy cases with fungal
infection of the central nervous system have been described; therefore, more
autopsies studies are needed to re-enforce on the existing epidemiology of these
fatal infections. Moreover, this will assist in further elucidating the varying
gross features and tissue reaction patterns associated with them.
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17
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Yang H, Fan Y, Zhu Z, Wu H, Chen Z, Hu X, Wu T, Zhang M. Strategies for the Emergency Treatment of Pregnant Women with Neurological Symptoms during the COVID-19 Pandemic. Aging Dis 2022; 14:290-298. [PMID: 37008058 PMCID: PMC10017149 DOI: 10.14336/ad.2022.0718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) has been spreading all over the world for more than two years. Though several kinds of vaccines are currently available, emergence of new variants, spike mutations and immune escape have raised new challenges. Pregnant women are vulnerable to respiratory infections due to their altered immune defence and surveillance functions. Besides, whether pregnant persons should receive a COVID-19 vaccine is still under debate because limited data are available on the efficacy and safety of receiving a vaccine during pregnancy. Physiological features and lack of effective protection making pregnant women at high risk of getting infected. Another concern is that pregnancy may trigger the onset of underlying existing neurological disease, which is highly similar to those neurological symptoms of pregnant women caused by COVID-19. These similarities interfere with diagnosis and delay timely and effective management. Therefore, providing efficient emergency support for pregnant women suffering from neurological symptoms caused by COVID-19 remains a challenge among neurologists and obstetricians. To improve the diagnosis and treatment efficiency of pregnant women with neurological symptoms, we propose an emergency management framework based on the clinicians' experience and available resources. This emergency care system aimed at addressing the conundrums faced by the emergency guarantee system under COVID-19 pandemic and could serve as a potential multisystem project for clinical practice and medical education.
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Affiliation(s)
- Haojun Yang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yishu Fan
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqing Zhu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Haiyue Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuohui Chen
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinhang Hu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tong Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence should be addressed to: Dr. Mengqi Zhang, Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China. .
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18
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Central nervous system infection in the intensive care unit: Development and validation of a multi-parameter diagnostic prediction tool to identify suspected patients. PLoS One 2021; 16:e0260551. [PMID: 34843551 PMCID: PMC8629274 DOI: 10.1371/journal.pone.0260551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background Central nervous system infections (CNSI) are diseases with high morbidity and mortality, and their diagnosis in the intensive care environment can be challenging. Objective: To develop and validate a diagnostic model to quickly screen intensive care patients with suspected CNSI using readily available clinical data. Methods Derivation cohort: 783 patients admitted to an infectious diseases intensive care unit (ICU) in Oswaldo Cruz Foundation, Rio de Janeiro RJ, Brazil, for any reason, between 01/01/2012 and 06/30/2019, with a prevalence of 97 (12.4%) CNSI cases. Validation cohort 1: 163 patients prospectively collected, between 07/01/2019 and 07/01/2020, from the same ICU, with 15 (9.2%) CNSI cases. Validation cohort 2: 7,270 patients with 88 CNSI (1.21%) admitted to a neuro ICU in Chicago, IL, USA between 01/01/2014 and 06/30/2019. Prediction model: Multivariate logistic regression analysis was performed to construct the model, and Receiver Operating Characteristic (ROC) curve analysis was used for model validation. Eight predictors—age <56 years old, cerebrospinal fluid white blood cell count >2 cells/mm3, fever (≥38°C/100.4°F), focal neurologic deficit, Glasgow Coma Scale <14 points, AIDS/HIV, and seizure—were included in the development diagnostic model (P<0.05). Results The pool data’s model had an Area Under the Receiver Operating Characteristics (AUC) curve of 0.892 (95% confidence interval 0.864–0.921, P<0.0001). Conclusions A promising and straightforward screening tool for central nervous system infections, with few and readily available clinical variables, was developed and had good accuracy, with internal and external validity.
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Abstract
Infectious meningitis and encephalitis are associated with significant morbidity and mortality worldwide. Acute bacterial meningitis is rapidly fatal and early recognition and institution of therapy are imperative. Viral meningitis is typically a benign self-limited illness. Chronic meningitis (defined as presenting with >4 weeks of symptoms) is most often caused by tuberculosis and fungal infection. Because the diagnostic testing for tuberculous meningitis is insensitive and cultures often take weeks to grow, therapy is often initiated empirically when the diagnosis is suspected. Human simplex virus encephalitis is the most common cause of encephalitis and requires prompt treatment with intravenous acyclovir.
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Affiliation(s)
- Rachel J Bystritsky
- Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-280, San Francisco, CA 94143, USA.
| | - Felicia C Chow
- Department of Neurology, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA; Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
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20
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Fisher KM, Montrief T, Ramzy M, Koyfman A, Long B. Cryptococcal meningitis: a review for emergency clinicians. Intern Emerg Med 2021; 16:1031-1042. [PMID: 33420904 DOI: 10.1007/s11739-020-02619-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cryptococcal Meningitis (CM) remains a high-risk clinical condition, and many patients require emergency department (ED) management for complications and stabilization. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of CM. DISCUSSION This review evaluates the diagnosis, management, and empiric treatment of suspected CM in the ED. CM can easily evade diagnosis with a subacute presentation, and should be considered in any patient with a headache, neurological deficit, or who is immunocompromised. As a definitive diagnosis of CM will not be made in the ED, management of a patient with suspected CM includes prompt diagnostic testing and initiation of empiric treatment. Multiple types of newer Cryptococcal antigen tests provide high sensitivity and specificity both in serum and cerebrospinal fluid (CSF). Patients should be treated empirically for bacterial, fungal, and viral meningitis, specifically with amphotericin B and flucytosine for presumed CM. Additionally, appropriate resuscitation and supportive care, including advanced airway management, management of increased intracranial pressure (ICP), antipyretics, intravenous fluids, and isolation, should be initiated. Antiretroviral therapy (ART) should not be initiated in the ED for those found or known to be HIV-positive for risk of immune reconstitution inflammatory syndrome (IRIS). CONCLUSIONS CM remains a rare clinical presentation, but carries significant morbidity and mortality. Physicians must rapidly diagnose these patients while evaluating for other diseases and complications. Early consultation with an infectious disease specialist is imperative, as is initiating symptomatic care.
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Affiliation(s)
- Kathryn Marie Fisher
- Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA
| | - Mark Ramzy
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
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21
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Dey R, Bishayi B. Ciprofloxacin and dexamethasone in combination attenuate S. aureus induced brain abscess via neuroendocrine-immune interaction of TLR-2 and glucocorticoid receptor leading to behavioral improvement. Int Immunopharmacol 2021; 97:107695. [PMID: 33962227 DOI: 10.1016/j.intimp.2021.107695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
Staphylococcus aureus induced brain abscess is a critical health concern throughout the developing world. The conventional surgical intervention could not regulate the abscess-induced brain inflammation. Thus further study over the alternative therapeutic strategy for treating a brain abscess is of high priority. The resident glial cells recognize the invading S. aureus by their cell surface Toll-like receptor-2 (TLR-2). Glucocorticoid receptor (GR) was known for its immunosuppressive effects. In this study, an attempt had been taken to utilize the functional relationship or cross-talking between TLR-2 and GR during the pathogenesis of brain abscesses. Here, the combination of an antibiotic (i.e. ciprofloxacin) and dexamethasone was used to regulate the brain inflammation either in TLR-2 or GR blocking condition. We were also interested to figure out the possible impact of alternative therapy on behavioral impairments. The results indicated that combination treatment during TLR-2 blockade significantly reduced the bacterial burden and abscess area score in the infected brain. However, marked improvements were observed in anxiety, depression-like behavior, and motor co-ordination. The combination treatment after TLR-2 blocking effectively scavenged free radicals (H2O2, superoxide anion, and NO) through modulating antioxidant enzyme activities that ultimately control S. aureus induced glial reactivity possibly via up-regulating GR expression. The exogenous dexamethasone might regulate the GR expression in the brain by increasing the corticosterone concentration and the GC-GR mediated signaling. Therefore, this in-vivo study demonstrates the possible regulatory mechanism of bacterial brain abscess that involved TLR-2 and GR as a part of neuroendocrine-immune interaction.
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Affiliation(s)
- Rajen Dey
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, Calcutta, West Bengal, India
| | - Biswadev Bishayi
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, Calcutta, West Bengal, India.
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22
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Samara E, Siasios I, Katsiardanis K, Liaptsi E, Tsoleka K, Deretzi G. Brain abscess in a rheumatoid arthritis patient treated with leflunomide - A case presentation and review. Surg Neurol Int 2021; 12:97. [PMID: 33880202 PMCID: PMC8053466 DOI: 10.25259/sni_886_2020] [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] [Received: 12/08/2020] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Immunosuppression is a significant parameter in the pathogenesis of brain abscesses (BA) and it could be the result of severe infections such as acquired immunodeficiency syndrome or drug-induced, by several medications used for systemic autoimmune diseases. Leflunomide is a pyrimidine synthesis inhibitor that affects the proliferation of lymphocytes and is used as a disease-modifying antirheumatic drug. Mild infections, particularly those of the respiratory tract and herpes zoster, are one of its most common adverse effects. However, atypical and severe infections have also been reported under treatment with leflunomide. Case Description: A 70-year old female was referred to our hospital with headache, aphasia, and right-sided hemiparesis and a lesion of the left parietal lobe initially interpreted as a malignancy. Her medical history revealed a 12-year old history of rheumatoid arthritis under current treatment with leflunomide. A cerebral magnetic resonance imaging (MRI) revealed typical findings for a BA. She subsequently underwent a left craniotomy, which confirmed the MRI-based diagnosis. The abscess was evacuated and cultures were obtained intraoperatively. In the postoperative examination, the patient showed no neurological deficit. Conclusion: The differential diagnostic considerations in immunocompromised patients with neurologic deficits should include focal central nervous system infections such as a BA, even in the absence of fever or immunosuppressant-induced leukopenia. It also demonstrates the importance of early neurosurgical intervention for the prevention of sequelae. To the best of our knowledge, this is the second-to-date reported case of a BA under immunomodulatory therapy with leflunomide.
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Affiliation(s)
- Efthymia Samara
- Department of Neurology, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
| | - Konstantinos Katsiardanis
- Department of Neurology, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
| | - Eirini Liaptsi
- Department of Neurology, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
| | - Kalliopi Tsoleka
- Department of Neurosurgery, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
| | - Georgia Deretzi
- Department of Neurology, Papageorgiou Hospital of Thessaloniki, Periferiaki Odos N. Efkarpia, Thessaloniki, Central Macedonia, Greece
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Luciani M, Negro A, Spuntarelli V, Bentivegna E, Martelletti P. Evaluating and managing severe headache in the emergency department. Expert Rev Neurother 2021; 21:277-285. [PMID: 33297780 DOI: 10.1080/14737175.2021.1863148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Headache is the fifth most common reason to visit an emergency department (ED). In most of the cases, headache is benign and has a primary origin, with migraine as the most common diagnosis. Inappropriate use of ED for non-emergency conditions causes overcrowding, unnecessary testing, and increased medical costs.Areas covered: All stages of headache management in ED, from the reasons to go there, the diagnosis that is made and the investigations necessary to make it, to get to the therapies administered and those prescribed at discharge, if there were any. Finally, the authors evaluated the habit of recommending medical follow-up and how often the headache is still present at discharge or returns within 24 hours.Expert Opinion: Primary headaches are underdiagnosed, misdiagnosed, and the majority do not receive drug therapy either in ED or on discharge, and in cases where the therapy is prescribed is not specific. Increase the number of primary care medical services, spread the 'headaches culture' among GPs and ED doctors, the adoption of ICHD in the diagnostic protocols used in EDs and a fast referral to a headache center could decrease the inappropriate use of ED and improve the headache management in the emergency units.
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Affiliation(s)
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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Barani M, Mukhtar M, Rahdar A, Sargazi G, Thysiadou A, Kyzas GZ. Progress in the Application of Nanoparticles and Graphene as Drug Carriers and on the Diagnosis of Brain Infections. Molecules 2021; 26:molecules26010186. [PMID: 33401658 PMCID: PMC7795866 DOI: 10.3390/molecules26010186] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
The blood–brain barrier (BBB) is the protective sheath around the brain that protects the sensitive microenvironments of the brain. However, certain pathogens, viruses, and bacteria disrupt the endothelial barrier and cause infection and hence inflammation in meninges. Macromolecular therapeutics are unable to cross the tight junctions, thereby limiting their bioavailability in the brain. Recently, nanotechnology has brought a revolution in the field of drug delivery in brain infections. The nanostructures have high targeting accuracy and specificity to the receptors in the case of active targeting, which have made them the ideal cargoes to permeate across the BBB. In addition, nanomaterials with biomimetic functions have been introduced to efficiently cross the BBB to be engulfed by the pathogens. This review focuses on the nanotechnology-based drug delivery approaches for exploration in brain infections, including meningitis. Viruses, bacteria, fungi, or, rarely, protozoa or parasites may be the cause of brain infections. Moreover, inflammation of the meninges, called meningitis, is presently diagnosed using laboratory and imaging tests. Despite attempts to improve diagnostic instruments for brain infections and meningitis, due to its complicated and multidimensional nature and lack of successful diagnosis, meningitis appears almost untreatable. Potential for overcoming the difficulties and limitations related to conventional diagnostics has been shown by nanoparticles (NPs). Nanomedicine now offers new methods and perspectives to improve our knowledge of meningitis and can potentially give meningitis patients new hope. Here, we review traditional diagnosis tools and key nanoparticles (Au-NPs, graphene, carbon nanotubes (CNTs), QDs, etc.) for early diagnosis of brain infections and meningitis.
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Affiliation(s)
- Mahmood Barani
- Department of Chemistry, Shahid Bahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Mahwash Mukhtar
- Faculty of Pharmacy, Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, 6720 Szeged, Hungary;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 538-98615, Iran
- Correspondence: (A.R.); (G.Z.K.); Tel.: +30-2510-462218 (G.Z.K.)
| | - Ghasem Sargazi
- Noncommunicable Diseases Research Center, Bam University of Medical Science, Bam 5166-15731, Iran;
| | - Anna Thysiadou
- Department of Chemistry, International Hellenic University, 65404 Kavala, Greece;
| | - George Z. Kyzas
- Department of Chemistry, International Hellenic University, 65404 Kavala, Greece;
- Correspondence: (A.R.); (G.Z.K.); Tel.: +30-2510-462218 (G.Z.K.)
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25
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Tfaily MAH, Titanji B, Schniederjan MJ, Goodman A, Lava NS, Pouch SM, Collins MH, Adelman MW. Neuromyelitis Optica Presenting as Infectious Meningoencephalitis: Case Report and Literature Review. Am J Med Sci 2020; 361:534-541. [PMID: 33342552 DOI: 10.1016/j.amjms.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
In this patient-focused review, we present a 34-year-old previously healthy man admitted for fever and headache two weeks after a motor vehicle accident. On admission, his workup was concerning for meningoencephalitis based on elevated cerebrospinal fluid (CSF) white blood cell count and elevated CSF protein. He was admitted for management of meningoencephalitis. During his course, no causative infectious agent was identified despite an extensive workup. He additionally underwent an autoimmune and paraneoplastic workup that was negative. During his hospitalization, he developed acute transverse myelitis manifested by bilateral lower extremity paralysis. After four weeks marked by persistent clinical deterioration, brain biopsy was performed. Pathologic examination was consistent with neuromyelitis optica spectrum disorder (NMOSD). In this case report and literature review, we explore the presentations of NMOSD that mimic an infection. Clinicians should be aware of the possibility of NMOSD masquerading as infectious meningoencephalitis or acute transverse myelitis.
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Affiliation(s)
| | - Boghuma Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Goodman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Neil S Lava
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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26
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Li S, Nguyen IP, Urbanczyk K. Common infectious diseases of the central nervous system-clinical features and imaging characteristics. Quant Imaging Med Surg 2020; 10:2227-2259. [PMID: 33269224 DOI: 10.21037/qims-20-886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Shan Li
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
| | - Ivy P Nguyen
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
| | - Kyle Urbanczyk
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
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27
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Gundamraj S, Hasbun R. The Use of Adjunctive Steroids in Central Nervous Infections. Front Cell Infect Microbiol 2020; 10:592017. [PMID: 33330135 PMCID: PMC7719626 DOI: 10.3389/fcimb.2020.592017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 01/02/2023] Open
Abstract
Central nervous system (CNS) infections continue to be associated with significant neurological morbidity and mortality despite various existing therapies. Adjunctive steroid therapy has been employed clinically to reduce inflammation in the treatment of CNS infections across various causative pathogens. Steroid therapy can potentially improve clinical outcomes including reducing mortality rates, provide no significant benefit, or cause worsened outcomes, based on the causative agent of infection. The data on benefits or harms of adjunctive steroid therapy is not consistent in outcome or density through CNS infections, and varies based on the disease diagnosis and pathogen. We summarize the existing literature on the effects of adjunctive steroid therapy on outcome for a number of CNS infections, including bacterial meningitis, herpes simplex virus, West Nile virus, tuberculosis meningitis, cryptococcal meningitis, Angiostrongylus cantonensis, neurocysticercosis, autoimmune encephalitis, toxoplasmosis, and bacterial brain abscess. We describe that while steroid therapy is beneficial and supported in pathogens such as pneumococcal meningitis and tuberculosis, for other diseases, like Listeria monocytogenes and Cryptococcus neoformans they are associated with worse outcomes. We highlight areas of consistent and proven findings and those which need more evidence for supported beneficial clinical use of adjunctive steroid therapy.
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Affiliation(s)
| | - Rodrigo Hasbun
- Department of Internal Medicine, UT Health McGovern Medical School, Houston, TX, United States
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28
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Stephens RJ, Liang SY. Central Nervous System Infections in the Immunocompromised Adult Presenting to the Emergency Department. Emerg Med Clin North Am 2020; 39:101-121. [PMID: 33218652 DOI: 10.1016/j.emc.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past 2 decades, the population of immunocompromised patients has increased dramatically in the United States. These patients are at elevated risk for both community-acquired and opportunistic central nervous system infections. We review the most common and serious central nervous system pathogens affecting these patients and outline a diagnostic and therapeutic approach to their management in the emergency department. We recommend a broad diagnostic evaluation, including neuroimaging and cerebrospinal fluid studies where appropriate, empiric antimicrobial therapy, and early involvement of subspecialists to provide comprehensive care for these complex patients.
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Affiliation(s)
- Robert J Stephens
- Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Stephen Y Liang
- Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA; Department of Internal Medicine, Division of Infectious Disease, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
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29
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Kumar D, Pannu AK, Dhibar DP, Singh R, Kumari S. The epidemiology and clinical spectrum of infections of the central nervous system in adults in north India. Trop Doct 2020; 51:48-57. [PMID: 33019910 DOI: 10.1177/0049475520959905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infections of the central nervous system (CNS) are a leading cause of mortality in low- and middle-income countries. We studied the spectrum, aetiology and outcome of CNS infections in 401 consecutive patients aged ≥12 years admitted at the medical emergency centre of PGIMER, Chandigarh, India. An aetiological diagnosis was made in 365 (91.0%) patients, with 149 (40.8%) microbiologically confirmed cases. CNS tuberculosis was the most prevalent cause (51.5%), followed by viral meningoencephalitis (13.9%), community-acquired bacterial meningitis (9.7%), cryptococcal meningitis (6.2%), scrub typhus meningoencephalitis (1.7%), neurocysticercosis (1.7%) and fungal brain abscess (1.7%). Human immunodeficiency virus (11.0%) and diabetes mellitus (6.2%) remained the usual predisposing conditions. We found a mortality rate of 27.9%, highest in cases without an aetiology (64.5%). Tuberculosis remained the most common cause; however, an increasing number of scrub typhus, dengue, fungal infections and non-classical bacterial pathogens may indicate a change in the epidemiology of community-acquired CNS infections in India.
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Affiliation(s)
- Devender Kumar
- Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Ashok Kumar Pannu
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Deba Prasad Dhibar
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Rajveer Singh
- Assistant Professor, Department of Neurology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Savita Kumari
- Professor and Head, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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30
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Hu MH, Wu CT, Hsia SH, Hung PC, Huang GS. Clinical Features and Risk Factors for Mortality in Children With Acute Encephalitis Who Present to the Emergency Department. J Child Neurol 2020; 35:724-730. [PMID: 32507002 DOI: 10.1177/0883073820930557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute encephalitis is an important pediatric emergency that tends to be associated with neurological morbidity, critical illness, and mortality. Few data have specifically focused on evaluating various early clinical parameters in the pediatric emergency department as candidate predictors of mortality. The present retrospective study assessed the clinical, laboratory, and neuroimaging findings of children with acute encephalitis who presented to the emergency department. Of 158 patients diagnosed with encephalitis, 7 (4.4%) had mortality. Compared to the survivors, a multivariate analysis revealed that an initial Glasgow Coma Scale score ≤ 5 (odds ratio [OR]: 8.3, P = .022), acute necrotizing encephalitis (OR: 12.1, P = .01), white blood count level ≤ 5.2 × 109 cells/L (OR: 28.7, P < .001), aspartate aminotransferase level > 35 U/L (OR: 14.3, P = .022), and influenza A infection (OR: 7.7, P = .027) were significantly associated with mortality. These results indicate that the early recognition of preliminary clinical features and the development of more specific etiologies for encephalitis are important for early treatment strategies.
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Affiliation(s)
- Mei-Hua Hu
- Division of Pediatric General Medicine, Department of Pediatrics, 38014Chang Gung Memorial Hospital, LinKou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, 56081Chang Gung University, Taoyuan, Taiwan.,School of Chinese Medicine, College of Medicine, 56081Chang Gung University, Taoyuan, Taiwan
| | - Chang-Teng Wu
- Division of Pediatric General Medicine, Department of Pediatrics, 38014Chang Gung Memorial Hospital, LinKou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, 38014Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Department of Pediatrics, 38014Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Go-Shine Huang
- Department of Anesthesiology, Tri-Service General Hospital, 71548National Defense Medical Center, Taipei, Taiwan
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31
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Cabral AD, Rafiei N, de Araujo ED, Radu TB, Toutah K, Nino D, Murcar-Evans BI, Milstein JN, Kraskouskaya D, Gunning PT. Sensitive Detection of Broad-Spectrum Bacteria with Small-Molecule Fluorescent Excimer Chemosensors. ACS Sens 2020; 5:2753-2762. [PMID: 32803944 DOI: 10.1021/acssensors.9b02490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Antibiotic resistance is a major problem for world health, triggered by the unnecessary usage of broad-spectrum antibiotics on purportedly infected patients. Current clinical standards require lengthy protocols for the detection of bacterial species in sterile physiological fluids. In this work, a class of small-molecule fluorescent chemosensors termed ProxyPhos was shown to be capable of rapid, sensitive, and facile detection of broad-spectrum bacteria. The sensors act via a turn-on fluorescent excimer mechanism, where close-proximity binding of multiple sensor units amplifies a red shift emission signal. ProxyPhos sensors were able to detect down to 10 CFUs of model strains by flow cytometry assays and showed selectivity over mammalian cells in a bacterial coculture through fluorescence microscopy. The studies reveal that the zinc(II)-chelates cyclen and cyclam are novel and effective binding units for the detection of both Gram-negative and Gram-positive bacterial strains. Mode of action studies revealed that the chemosensors detect Gram-negative and Gram-positive strains with two distinct mechanisms. Preliminary studies applying ProxyPhos sensors to sterile physiological fluids (cerebrospinal fluid) in flow cytometry assays were successful. The results suggest that ProxyPhos sensors can be developed as a rapid, inexpensive, and robust tool for the "yes-no" detection of broad-spectrum bacteria in sterile fluids.
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Affiliation(s)
- Aaron D. Cabral
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
| | - Nafiseh Rafiei
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - Elvin D. de Araujo
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
| | - Tudor B. Radu
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
| | - Krimo Toutah
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
| | - Daniel Nino
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Physics, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 1A7, Canada
| | - Bronte I. Murcar-Evans
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
| | - Joshua N. Milstein
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Physics, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 1A7, Canada
| | - Dziyana Kraskouskaya
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
| | - Patrick T. Gunning
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
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32
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Datta R. Unique presentation of intracranial pathology in the emergency department. Emerg Med Australas 2020; 32:901-902. [PMID: 32829490 DOI: 10.1111/1742-6723.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rachit Datta
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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33
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Posnakoglou L, Siahanidou T, Syriopoulou V, Michos A. Impact of cerebrospinal fluid syndromic testing in the management of children with suspected central nervous system infection. Eur J Clin Microbiol Infect Dis 2020; 39:2379-2386. [PMID: 32683594 DOI: 10.1007/s10096-020-03986-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022]
Abstract
The aim of the study was to evaluate the impact of the use of BioFire® FilmArray® meningitis/encephalitis(FA-ME) panel which enables rapid automated CSF testing for 14 common viral, bacterial, and yeast pathogens that cause CNS infections, in the management of children with suspected CNS infection. A prospective cohort study was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year, with possible CNS infection and CSF pleocytosis (> 15 cells/mm3). Children were randomized 1:1, either to use FA-ME or separate molecular CSF microbiological tests according to usual pediatric practice in the hospital. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. A total of 142 children were included in the study (71 cases). A pathogen was detected in 37/71(52.1%) children with the use of FA-ME and in 16/71(22.5%) in the control group (P value < 0.001). In aseptic meningitis cases a virus was detected in 27/61(44.2%) and in 11/66(16.7%) controls (P value < 0.001). Median (IQR) length of stay in cases and controls with aseptic meningitis was 5(4-8) and 8(6-10) days, respectively (P value < 0. 001). The median (IQR) duration of antimicrobials in cases and controls was 4(2-5.7) and 7(5-10) days, respectively (P value < 0.001). The hospitalization cost was calculated in cases and controls 1042€ (932-1372) and 1522€ (1302-1742), respectively (P value < 0.001). The use of FA-ME was able to reduce significantly the use of antimicrobials, the hospitalization days, and the total cost comparing to the control group in children with suspected CNS infection.
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Affiliation(s)
- Lamprini Posnakoglou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Vasiliki Syriopoulou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece.
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34
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Masouris I, Klein M, Ködel U. The potential for CXCL13 in CSF as a differential diagnostic tool in central nervous system infection. Expert Rev Anti Infect Ther 2020; 18:875-885. [PMID: 32479125 DOI: 10.1080/14787210.2020.1770596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Central nervous system (CNS) infections can be life-threatening and are often associated with disabling sequelae. One important factor in most CNS infections is a timely pathogen-specific treatment. The diagnostic methods available, however, do not always reach a satisfying sensitivity and specificity. In these cases, there is need for additional diagnostic biomarkers. Chemokines represent potential candidates as biomarkers, since they are an important pillar of the host immune response. The aim of this review is to discuss the diagnostic potential of cerebrospinal fluid (CSF) CXCL13 in patients with CNS infections. Areas covered: Data were obtained from a literature search in PubMed up to October 2019. This review focusses on articles on the potential of CXCL13 as a diagnostic tool. The majority of identified studies aimed to characterize its role in two diseases, namely Lyme neuroborreliosis and neurosyphilis. Expert opinion: CSF CXCL13 has a significant potential as a diagnostic and monitoring add-on marker in Lyme neuroborreliosis. Differences in study design, control groups and clinical parameters between studies, however, affect sensitivity, specificity and cutoff values, underlining the need of further studies to address these issues and pave the way for a generalized clinical practice.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Uwe Ködel
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
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35
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Diaz-Arias LA, Pardo CA, Probasco JC. Infectious Encephalitis in the Neurocritical Care Unit. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Winegarner JH, Wittkopp J. Streptococcus pneumoniae Meningitis Associated With Over-the-Counter Sinus Irrigation. Cureus 2020; 12:e8258. [PMID: 32596076 PMCID: PMC7313434 DOI: 10.7759/cureus.8258] [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: 12/18/2022] Open
Abstract
We present the first reported case of Streptococcus pneumoniae bacterial meningitis that may be associated with use of an over-the-counter sinus irrigation. Sinus rinse or “Neti Pot” use is a common remedy for sinus congestion and is felt to be relatively safe. Given its widespread use, it is important to report possible associations with disease, in this case Streptococcus pneumoniae meningitis. A 50-year-old male with a history of sinusitis presented to the emergency department with a headache and altered mental status and was ultimately diagnosed with Streptococcus pneumoniae meningitis and sepsis. He had been using over-the-counter sinus rinses several times daily with distilled water. The patient had no radiographic evidence of contiguous spread or traumatic injury that would make him susceptible to direct cerebrospinal fluid infection. Inquiring about sinus irrigation use should be considered in patients with suspected meningitis. Emergency clinicians must consider meningitis in patients with Neti Pot use.
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Affiliation(s)
| | - Jeffrey Wittkopp
- Emergency Medicine, Brooke Army Medical Center, San Antonio, USA
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37
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Nguyen I, Urbanczyk K, Mtui E, Li S. Intracranial CNS Infections: A Literature Review and Radiology Case Studies. Semin Ultrasound CT MR 2020; 41:106-120. [DOI: 10.1053/j.sult.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Giamberardino MA, Affaitati G, Costantini R, Guglielmetti M, Martelletti P. Acute headache management in emergency department. A narrative review. Intern Emerg Med 2020; 15:109-117. [PMID: 31893348 DOI: 10.1007/s11739-019-02266-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. Most frequent primary forms motivating ED observation are acute migraine attacks, particularly status migrainous, and cluster headache. Though universally accepted guidelines do not exist for headache management in an emergency setting, pharmacological parenteral treatment remains the principal approach worldwide, with NSAIDs, neuroleptic antinauseants, triptans and corticosteroids, tailored to the specific headache type. Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED.
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Affiliation(s)
- Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Raffaele Costantini
- Institute of Surgical Pathology, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Martina Guglielmetti
- Department of Clinical Pathology, University of Sassari, Sassari, Italy
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy.
- UOC Medicina Interna, AOU Sant'Andrea, Rome, Italy.
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39
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Guryildirim M, Kontzialis M, Ozen M, Kocak M. Acute Headache in the Emergency Setting. Radiographics 2019; 39:1739-1759. [DOI: 10.1148/rg.2019190017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Melike Guryildirim
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| | - Marinos Kontzialis
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| | - Merve Ozen
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| | - Mehmet Kocak
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
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40
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Abdallah A, Demaerschalk BM, Kimweri D, Aden AA, Zhang N, Butterfield R, Asiimwe SB, O'Carroll CB. A comparison of the Full Outline of Unresponsiveness (FOUR) and Glasgow Coma Scale (GCS) Scores in Predicting Mortality Among Patients with Reduced Level of Consciousness in Uganda. Neurocrit Care 2019; 32:734-741. [PMID: 31392656 DOI: 10.1007/s12028-019-00806-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reduced level of consciousness (LOC) is a common cause of presentation among acutely ill adults in sub-Saharan Africa and is associated with high rates of mortality. Although the Full Outline of Unresponsiveness (FOUR) score is often used in clinical practice, its utility in predicting mortality has not been assessed in the region. METHODS We prospectively enrolled adults presenting with reduced LOC to Mbarara Regional Referral Hospital in Uganda. We recorded clinical and laboratory data and performed the FOUR and Glasgow Coma Scale (GCS) scores at admission. We used survival analysis, fit Cox proportional hazards regression models to assess the predictive properties of the two scores, and compared their performance using area under the receiver operating characteristic curve (AUROC). RESULTS We enrolled 359 patients, mean (SD) age was 51 (22.2) years, and 58% (210/359) were male. The median (interquartile range) admission FOUR and GCS scores were 13.0 (3.0-16.0) and 10.0 (3.0-14.0), respectively. Subjects with the FOUR score of 0-11 had a 2.6-fold higher hazard of 30-day mortality (HR 2.6, 95% CI 1.9-3.6, p < 0.001) compared to those with the score of 12-16. Those with the GCS score of 3-8 had a 2.7-fold higher hazard of 30-day mortality (HR 2.7, 95% CI 2.0-3.8, p < 0.001) compared to those with the score of 9-15. The AUROC (95% CI) for the FOUR score and GCS score was 0.68 (0.62-0.73) and 0.67 (0.62-0.73), respectively (p = 0.825). CONCLUSIONS The FOUR score is comparable to the GCS score in predicting mortality in Uganda. Our findings support the introduction of the FOUR score in guiding the management of patients with reduced LOC in sub-Saharan Africa.
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Affiliation(s)
- Amir Abdallah
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. .,Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
| | | | - Davis Kimweri
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Abdirahim Abdi Aden
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nan Zhang
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Phoenix, AZ, USA
| | - Richard Butterfield
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Phoenix, AZ, USA
| | - Stephen B Asiimwe
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Abstract
PURPOSE OF REVIEW Pneumococcal meningitis is the most frequent form of bacterial meningitis in Europe and the United States. Although early antimicrobial and adjuvant therapy with dexamethasone have helped to improve disease outcome in adults, mortality and morbidity rates remain unsatisfactorily high, emphasizing the need for additional treatment options. Promising targets for adjuvant therapy have been identified recently and will be the focus of this review. RECENT FINDINGS Brain disease in pneumococcal meningitis is caused by direct bacterial toxicity and excessive meningeal inflammation. Accordingly, promising targets for adjuvant therapy comprise limiting the release of toxic bacterial products and suppressing inflammation in a way that maximally protects against tissue injury without hampering pathogen eradication by antibiotics. Among the agents tested so far in experimental models, complement inhibitors, matrix-metalloproteinase inhibitors, and nonbacteriolytic antibiotics or a combination of the above have the potential to more efficiently protect the brain either alone (e.g., in children and outside the high-income settings) or in addition to adjuvant dexamethasone. Additionally, new protein-based pneumococcal vaccines are being developed that promise to improve disease prevention, namely by addressing the increasing problem of serotype replacement seen with pneumococcal conjugate vaccines. SUMMARY Pneumococcal meningitis remains a life-threatening disease requiring early antibiotic and targeted anti-inflammatory therapy. New adjuvant therapies showed promising results in animal models but need systematic clinical testing.
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Wang C, Xu H, Deng J, Yu H, Chen Y, Wang S, Huang W, Hao J, Wang C, Deng H, Chen Y. Prognostic factors in pediatric pneumococcal meningitis patients in mainland China: a retrospective multicenter study. Infect Drug Resist 2019; 12:1501-1512. [PMID: 31239727 PMCID: PMC6560191 DOI: 10.2147/idr.s193671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Prognosis of pneumococcal meningitis (PM) remains very poor, especially in less developed countries. Currently, few multi-centric studies on pediatric PM have been reported in mainland China. Objectives: This study aimed to explore the correlation of clinical and laboratory findings with complications and prognosis in pediatric PM. Methods: The pediatric PM patients were retrospectively recruited from ten pediatric tertiary hospitals across China between January 2013 and June 2018. Clinical, biochemical, and microbiological data and follow-up information were collected. Predictive factors for complications and prognostic factors for overall survival (OS) and sequelae-free survival (SFS) were analyzed. Results: A total of 132 pediatric PM patients were included. Seventy-one patients had complications, 25 patients died, and 39 patients had neurological sequelae. Multivariate logistic regression suggested that age less than 28 months (adjusted OR=2.654, 95%CI=1.067–6.600, P=0.036) and lower white blood cells in blood (aOR=3.169, 95%CI=1.395–7.202, P=0.006) were associated with high risk of complications. Multivariate Cox’s proportional hazard regression suggested that age less than 28 months (aHR=6.479, 95%CI=1.153–36.404, P=0.034), coma (aHR=9.808, 95%CI=2.802–34.323, P=0.000), and non-adjuvant steroid therapy (aHR=4.768 95%CI=1.946–11.678, P=0.001) were independent prognostic factors for poor OS; coma (aHR=5.841, 95%CI=2.652–12.864, P=0.000), septic shock on admission (aHR=2.949, 95%CI=1.049–8.290, P=0.040), and lower glucose level in cerebrospinal fluid (CSF) (aHR=2.523, 95%CI=1.336–4.765, P=0.004) were independent prognostic factors for poor SFS. Conclusion: Age, coma, and adjuvant steroid therapy were independent factors for OS, while coma, septic shock on admission, and lower glucose level in CSF were independent factors for SFS in pediatric PM patients. These factors might be used to identify PM patients with poor prognosis and guide individual treatment.
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Affiliation(s)
- Caiyun Wang
- Infection Disease Department, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, People's Republic of China
| | - Hongmei Xu
- Infection Disease Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, People's Republic of China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen 518038, People's Republic of China
| | - Hui Yu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, People's Republic of China
| | - Yiping Chen
- Infection Disease Department, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Shifu Wang
- Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong University, Jinan, 250022, People's Republic of China
| | - Weichun Huang
- Department of Clinical Laboratory, Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Jianhua Hao
- Infection Disease Department, Kaifeng Children's Hospital, Kaifeng 475000, People's Republic of China
| | - Chun Wang
- Clinical Laboratory, Children's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200040, People's Republic of China
| | - Huiling Deng
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, People's Republic of China
| | - Yinghu Chen
- Infection Disease Department, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, People's Republic of China
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Lin CH, Lin WD, Chou IC, Lee IC, Hong SY. Epilepsy and Neurodevelopmental Outcomes in Children With Etiologically Diagnosed Central Nervous System Infections: A Retrospective Cohort Study. Front Neurol 2019; 10:528. [PMID: 31156546 PMCID: PMC6529952 DOI: 10.3389/fneur.2019.00528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Central nervous system (CNS) infection in childhood can lead to neurological sequelae, including epilepsy, and neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). This study investigated the association of etiologically diagnosed childhood brain infections with the subsequent risks of epilepsy and neurodevelopmental disorders. Objectives: We retrospectively analyzed the data of children aged <18 years who had definite brain infections with positive cerebrospinal fluid cultures from January 1, 2005, to December 31, 2017. These patients were followed to evaluate the risks of epilepsy and neurodevelopmental disease (ADHD and ASD) after brain infections (group 1) in comparison with the risks in those without brain infections (group 2). Results: A total of 145 patients with an average age of 41.2 months were included in group 1. Enterovirus accounted for the majority of infections, followed by group B Streptococcus, S. pneumoniae, and herpes simplex virus. A total of 292 patients with an average age of 44.8 months were included in group 2. The 12-year risk of epilepsy in group 1 was 10.7 (95% confidence interval [CI], 2.30-49; p < 0.01). Compared with group 2 (reference), the risk of ASD in the age interval of 2-5 years in group 1 was 21.3 (95% CI, 1.33-341.4; p = 0.03). The incidence of ADHD in group 1 was not significantly higher than that in group 2. Conclusions: This study identified the common etiological causes of brain infections in Taiwanese children. The highest-risk neurodevelopmental sequelae associated with brain infections was epilepsy. Children who had a diagnosis of brain infection (specially Enterovirus) should be followed since they are at greater risk of developing epilepsy and ASD.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatrics Pulmonology, China Medical University, Children's Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - I-Ching Chou
- Division of Pediatrics Neurology, China Medical University, Children's Hospital, Taichung, Taiwan.,College of Chinese Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Inn-Chi Lee
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Syuan-Yu Hong
- Division of Pediatrics Neurology, China Medical University, Children's Hospital, Taichung, Taiwan
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Daimary PP, Das S, Chatterjee SS, Krishnapillai R. Rapidly progressive dementia in a case of progressive multifocal leukoencephalopathy. Indian J Psychiatry 2019; 61:315-316. [PMID: 31142914 PMCID: PMC6532471 DOI: 10.4103/psychiatry.indianjpsychiatry_76_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Soumitra Das
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. E-mail:
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Gazibera B, Suljic-Mehmedika E, Serdarevic N, Baljic R, Gojak R. Predictive Role of Electroencephalography in Regard to Neurological and Cognitive Sequelae After Acute Central Nervous System Infection. Acta Inform Med 2019; 27:234-239. [PMID: 32055089 PMCID: PMC7004286 DOI: 10.5455/aim.2019.27.234-239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Electroencephalography can also be used to monitor long-term recovery of the patient after acute phase of the disease. Impaired neurocognitive function after infection, similar to brain injury, may present a transient but also prolonged problem for the functioning of an individual. Some studies have shown that importance of EEG may not be significant in sequel monitoring, because the extensive changes in EEG seen with severe forms of CNS infection do not necessarily imply a longer-term poor outcome. Aim: To examine the predictive potential of electroencephalography (EEG) in regard to the emergence of neurological and cognitive sequelae of acute central nervous system (CNS) infection. Methods: The study included 62 patients treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, who were diagnosed with acute CNS infection. The EEG record was characterized as: normal, non-specific changes of mild, moderate and severe degree and specific changes. The sequelae (headache, cognitive dysfunction, neurological and neurophysiological disorders, audiological and behavioral disorders) was evaluated by combining neurological, psychiatric, pediatric, otolaryngological, ophthalmic and infectological examination in the Neuroinfective Counseling Department for up to 6 months after discharge. Results: After a treatment of an acute CNS infection 25 (40.3%) patients had no sequelae and 37 (59.7%) were with sequelae. The EEG in the initial stage of the disease (Wald’s coefficient = 12.8), followed by the age of the patients (Wald = 6.4), had the greatest influence on the prediction of sequela (p=0.0001). For each additional degree of verified pathological changes in the EEG, the risk of sequelae was increased by 5 degrees (OR = 5.3), respectively. There was no statistically significant association between changes in cerebrospinal fluid (CSF) findings, meningeal symptoms, and signs with sequelae development. Conclusion: Younger age, as well as severe clinical status of a patient, which implies a disorder of consciousness and seizures on admission, are associated with irreversible consequences on a previously mentally healthy individual. Pathological changes (Delta and Theta waves, spike slow complex wave) on the EEG finding significantly predicted presence of sequelae. .
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Affiliation(s)
- Belma Gazibera
- Clinic for Infectious Diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enra Suljic-Mehmedika
- Clinic of Neurology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nafija Serdarevic
- Clinical Chemistry and Biochemistry, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Rusmir Baljic
- Clinic for Infectious Diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Refet Gojak
- Clinic for Infectious Diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Sili U, Tavsanli ME, Tufan A. Herpes Simplex Virus Encephalitis in Geriatric Patients. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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