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Bodilsen J, Duerlund LS, Nielsen H. Corticosteroids for viral central nervous system infections. Curr Opin Infect Dis 2025; 38:271-279. [PMID: 40167047 DOI: 10.1097/qco.0000000000001106] [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] [Indexed: 04/02/2025]
Abstract
PURPOSE OF REVIEW Viruses are frequent causes of central nervous system (CNS) infection. Lacking specific antiviral treatment or inadequate clinical response may lead to treatment with corticosteroids. This review describes the rationale for and clinical experience with the use of adjunctive corticosteroids for viral CNS infections. RECENT FINDINGS Corticosteroids display anti-inflammatory, immunosuppressive, antiproliferative, and vasoconstrictive effects by genomic and nongenomic regulation of human cells. Recent population-based studies consistently show that empiric dexamethasone during diagnostic work-up for meningitis has neither been associated with improved outcome nor adverse effects in viral meningitis. Myelitis is most often due to noninfectious causes and standard empiric treatment includes high-dose methylprednisolone. There are no convincing data on viral myelitis to support a change of this approach. Corticosteroids have occasionally been employed in different types of viral encephalitis. Observational data and a few randomized clinical trials have not documented any substantial beneficial effects of adjunctive corticosteroids in viral encephalitis. Risks of harm with current treatment regimens remained low in published studies. SUMMARY Except for myelitis, there are no data to support routine use of corticosteroids for viral CNS infections. Large, multidisciplinary syndromic platform trials of all-cause encephalitis may be a viable way to inform treatment guidelines.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ESCMID Study Group of Infections of the Brain (ESGIB)
| | - Lærke Storgaard Duerlund
- Department of Infectious Diseases, Aalborg University Hospital
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ESCMID Study Group of Infections of the Brain (ESGIB)
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ESCMID Study Group of Infections of the Brain (ESGIB)
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2
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Imishti A, Nissen MJ, Øvrehus A, Larsen L. Ability to return to work and persistent symptoms six months after viral meningitis - a retrospective single-centre cohort study. Infect Dis (Lond) 2025; 57:551-560. [PMID: 39943919 DOI: 10.1080/23744235.2025.2463960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 01/28/2025] [Accepted: 01/31/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Viral meningitis (VM) is often perceived as mild and self-limiting, but some studies indicate reduced ability to work and cognitive sequelae post-infection. OBJECTIVES To investigate VM patients' self-reported return to work, persistent symptoms, and social limitations up to 6 months post-hospitalisation, assess predictors for full return to work at 6 months, and quantify neuropsychological testing use. METHODS Retrospective single-centre cohort study of VM patients from 2015 to 2020. Data collected covered hospitalisation, work status at admission, Glasgow Outcome Scale (GOS) score at discharge and neuropsychological testing. Additionally, information on work status and persistent symptoms (headaches, concentration difficulty, social limitations and sound sensitivity) at 1-, 3- and 6-month follow-up appointments. RESULTS In total, 246 patients were included in the study (median age 33 years, 51.6% female). In all, 26.0% of patients underwent neuropsychological testing. Persistent symptoms could be assessed in 223 patients at follow-up appointments. Headaches were most reported symptom, occurring in 55.6%, 37.7% and 27.8% of patients at 1, 3 and 6 months, respectively. Work status could be assessed in 199 patients. At 6 months, 52.8%patients were fully returned to work, while 24.1% reported a phased or no return. Full return to work was associated with male sex (OR 4.19, p = 0.003) and GOS score 5 at discharge (OR 15.11, p < 0.001). CONCLUSION Six months post-VM, approximately 25% of patients had reduced/no work ability and 30% at least one persistent symptom. Women had increased risk of not returning to full work.
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Affiliation(s)
- Albulena Imishti
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Anne Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Research Unit of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Research Unit of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Xue W, Qu Y, Ma S, Li Z, Lyu S, Diao X, Sun K, Wang Z, Sun R. Design, synthesis, and in-vitro/in-vivo pharmacodynamic studies of novel aza-fused heterocyclic compounds against herpes simplex virus type 1. Bioorg Chem 2025; 162:108589. [PMID: 40403497 DOI: 10.1016/j.bioorg.2025.108589] [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: 03/22/2025] [Revised: 05/08/2025] [Accepted: 05/11/2025] [Indexed: 05/24/2025]
Abstract
Herpes simplex virus type 1 (HSV-1) is a prevalent pathogen that can lead to severe diseases, including herpes labialis, keratitis, and encephalitis. The development of novel antiviral therapies is significant due to the limited number of available treatments and the emergence of drug-resistant strains. In this study, a series of aza-fused heterocyclic derivatives were synthesized and evaluated for antiviral efficacy. Compound 5i demonstrated notable antiviral activity in vitro with an EC50 (Effective Concentration 50 %) of 1.95 ± 0.07 μM. This effect was achieved by inhibiting viral replication and targeting viral ICP4 and gD proteins. In addition, the expression of STING and NF-κB signaling pathways was down-regulated, cytokine storm was reduced, and the multi-targeted activity of compound 5i inhibited apoptosis. The high efficacy of compound 5i was demonstrated in a mouse herpes encephalitis model. Infected mice's survival significantly improved, and viral load in brain tissue was substantially reduced in the presence of compound 5i. Furthermore, compound 5i demonstrated favorable safety in preliminary in vivo evaluations, with no adverse effects on major organs observed. In conclusion, the aza-fused heterocyclic derivative 5i has substantial potential as a therapeutic agent for HSV-1 infection, providing a valuable foundation for further drug development and clinical translation.
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Affiliation(s)
- Wenhua Xue
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Qu
- School of Pharmaceutical Sciences, Zhengzhou University, Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou 450001, China; Key Laboratory of "Runliang" Antiviral Medicines Research and Development, Institute of Drug Discovery & Development, Zhengzhou University, Zhengzhou 450001, China
| | - Shouye Ma
- School of Pharmaceutical Sciences, Zhengzhou University, Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou 450001, China
| | - Ziyan Li
- School of Pharmaceutical Sciences, Zhengzhou University, Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou 450001, China; Key Laboratory of "Runliang" Antiviral Medicines Research and Development, Institute of Drug Discovery & Development, Zhengzhou University, Zhengzhou 450001, China
| | - Su Lyu
- School of Nursing, Henan University of Chinese Medicine, Zhengzhou 450001, China
| | - Xiaoqiong Diao
- School of Chemistry & Chemical Engineering, Henan University of Technology, Zhengzhou 450001, China
| | - Kai Sun
- School of Pharmaceutical Sciences, Zhengzhou University, Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou 450001, China.
| | - Zhenya Wang
- School of Pharmaceutical Sciences, Zhengzhou University, Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou 450001, China; Key Laboratory of "Runliang" Antiviral Medicines Research and Development, Institute of Drug Discovery & Development, Zhengzhou University, Zhengzhou 450001, China; International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China.
| | - Ranran Sun
- Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, P.R. China; College of Chemistry, Pingyuan Laboratory, State Key Laboratory of Antiviral Drugs, Zhengzhou University, Zhengzhou 450001, China.
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4
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Xie S, Sun W, Lai Z, Liu X. Are Glucocorticoids Truly Effective in Improving the Clinical Prognosis of HSV-1 Encephalitis? Infect Drug Resist 2025; 18:1287-1296. [PMID: 40059937 PMCID: PMC11890644 DOI: 10.2147/idr.s501628] [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] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 02/20/2025] [Indexed: 04/15/2025] Open
Abstract
Background Survivors of herpes simplex encephalitis (HSE) commonly experience significant neurological sequelae, imposing a substantial burden on both society and families. The efficacy of glucocorticoids in treating patients with HSE remains controversial. This study aims to evaluate the effectiveness of glucocorticoids in patients with HSE and analyze the clinical characteristics of this patient population. Methods This retrospective study evaluated the clinical characteristics, auxiliary examinations, and patient prognosis of HSE patients diagnosed with mNGS, and analyzed the prognosis of patients in both Glucocorticoid and Non-glucocorticoid groups. Assess the prognosis based on the improvement of GOS score and MMSE score at 1 and 3 months after discharge. Results A retrospective analysis was conducted in 29 hSE patients who met the criteria for GOS score improvement 3 months after discharge. The hormone group was better than the non-hormone group (2 (0-2) scores VS 1 (1-2) scores). There was no significant difference between the two groups in GOS score 1 month after discharge. However, no statistical difference was found in improving patient outcomes between the two groups. Conclusion Despite the hormone group not obtaining the anticipated positive outcomes, potentially due to the relatively limited sample size in this study, previous case series reports have indicated that glucocorticoids, when used as an adjunct to acyclovir therapy, may enhance patient outcomes. Consequently, further extensive clinical studies involving multiple centers and larger sample sizes are warranted to investigate this matter further.
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Affiliation(s)
- Shuhua Xie
- Department of Neurology, Ganzhou People’s Hospital, Jiangxi, 341000, People’s Republic of China
| | - Wei Sun
- Department of Neurology, Ganzhou People’s Hospital, Jiangxi, 341000, People’s Republic of China
| | - Zhaohui Lai
- Department of Neurology, Ganzhou People’s Hospital, Jiangxi, 341000, People’s Republic of China
| | - Xianghong Liu
- Department of Neurology, Ganzhou People’s Hospital, Jiangxi, 341000, People’s Republic of China
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Dyckhoff-Shen S, Klein M. [Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache]. Med Klin Intensivmed Notfmed 2025; 120:97-102. [PMID: 39542903 DOI: 10.1007/s00063-024-01210-3] [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: 09/25/2024] [Revised: 10/03/2024] [Accepted: 10/10/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Simultaneous symptoms of impaired consciousness and fever are suspicious for acute bacterial meningitis. This is a medical emergency and prompt action is essential. OBJECTIVES The clinical workup for suspected bacterial meningitis as well as treatment recommendations and differential diagnosis for the main symptoms of decreased vigilance and fever are described. METHODS Evaluation of selective literature using PubMed (U.S. National Library of Medicine®, Bethesda, MD, USA), especially taking into account the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) guideline of community-acquired bacterial meningoencephalitis in adults. RESULTS Bacterial meningoencephalitis presents with the main symptoms of impaired consciousness, nuchal rigidity, headache and fever, which may, however, be absent in some cases. The diagnosis is confirmed by investigation of the cerebrospinal fluid. Further diagnostics include emergency laboratory tests, blood cultures, microbiological examinations, and cranial computed tomography (CCT). Empirical treatment should be administered promptly. CONCLUSION Acute bacterial meningitis must be considered in cases of loss of vigilance and fever, requiring a rapid, structured approach in the emergency department.
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Affiliation(s)
- Susanne Dyckhoff-Shen
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität (LMU) Klinikum Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - Matthias Klein
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität (LMU) Klinikum Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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6
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Tyrberg T, Hagberg L, Nilsson S, Grahn A. Incidence and Risk Factors for Varicella-Zoster Virus-Associated Central Nervous System Infections: A Nationwide Swedish Retrospective Case-Control Study. J Med Virol 2025; 97:e70166. [PMID: 39865326 PMCID: PMC11771675 DOI: 10.1002/jmv.70166] [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: 07/25/2024] [Revised: 12/01/2024] [Accepted: 12/28/2024] [Indexed: 01/28/2025]
Abstract
The determinants of varicella-zoster virus (VZV)-associated central nervous system (CNS) infection have not been fully elucidated. This study aimed to investigate the incidence and risk factors, including immunosuppression, for different manifestations of VZV-associated CNS infection. Patient registers were used to include adults diagnosed with VZV-associated CNS infections between 2010 and 2019 in Sweden. Nationwide registers covering specialized care, and regional registers covering primary care, were used. Controls without a VZV diagnosis during the study period were matched by age and sex. Risk factors were calculated using multivariable logistic regression. A total of 1488 adult cases with VZV-associated CNS infection were identified, yielding an incidence of 1.92/100 000 person-years, which increased over the study period. Meningitis was the most frequent (45%), followed by encephalitis (38%), and Ramsay Hunt syndrome (17%). The highest incidence was observed in individuals over 70 years of age (4.15/100 000 person-years), in whom encephalitis was most common. Statistically significant risk factors for VZV-associated CNS infection were HIV, hematological cancer, treatment with specific immunosuppressants or glucocorticoids, chronic obstructive pulmonary disease, diabetes, solid cancer, stroke, and congestive heart failure. Encephalitis was associated with older age, more immunosuppressive conditions, and more comorbidities than other manifestations. In conclusion, VZV is a common cause of adult viral CNS infection, for which elderly individuals with immunosuppressive or comorbid conditions are at the highest risk. The strongest risk factors found were HIV, hematological cancer, and treatment with specific immunosuppressants or high-dose glucocorticoids.
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Affiliation(s)
- Tobias Tyrberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
| | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anna Grahn
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
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7
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Inamoto A, Taniguchi T, Fujii Y, Miyoshi S. Varicella-zoster virus meningitis with hypoglycorrhachia, presenting with painless occipital herpes zoster mimicking atopic dermatitis. BMJ Case Rep 2025; 18:e258230. [PMID: 39870459 PMCID: PMC11795240 DOI: 10.1136/bcr-2023-258230] [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: 06/04/2024] [Accepted: 01/07/2025] [Indexed: 01/29/2025] Open
Abstract
Varicella-zoster virus (VZV) is a known cause of meningoencephalitis, typically in immunocompromised inpatients. We report a case of meningitis caused by VZV in an immunocompetent man in his 20s. Diagnosis was delayed due to the atypical presentation of painless occipital zoster mimicking atopic dermatitis, and the presence of hypoglycorrhachia in his cerebrospinal fluid. The clinical diagnosis of VZV meningitis poses significant diagnostic challenges, and nucleic acid tests for VZV detection are recommended for patients with severe cases who require empiric acyclovir treatment.
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Affiliation(s)
- Aya Inamoto
- Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tomohiro Taniguchi
- General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yasumitsu Fujii
- General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Sonoko Miyoshi
- General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
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8
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Hasbun R. Steroids for viral meningitis: a foe or a friend? Clin Microbiol Infect 2025; 31:8-9. [PMID: 39374653 DOI: 10.1016/j.cmi.2024.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/24/2024] [Accepted: 09/28/2024] [Indexed: 10/09/2024]
Affiliation(s)
- Rodrigo Hasbun
- Department of Medicine, Section of Infectious Disease, McGovern Medical School, UTHealth Science Center, 6431 Fannin St, 2.112 MSB, Houston, TX, USA.
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9
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Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Hansen BR, Helweg-Larsen J, Wiese L, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT. Dexamethasone in adults with viral meningitis: an observational cohort study. Clin Microbiol Infect 2025; 31:87-92. [PMID: 39182578 DOI: 10.1016/j.cmi.2024.08.015] [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: 04/02/2024] [Revised: 08/07/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES To investigate whether there is a dose-dependent association between empiric dexamethasone and outcome in viral meningitis. METHODS Observational cohort study of adults hospitalized for viral meningitis, both with and without a microbiologically confirmed diagnosis, in Denmark between 2015 and 2020. Dose-dependent associations between dexamethasone (one dose = 10 mg) and an unfavourable outcome (Glasgow Outcome Scale score 1-4) at 30 days after discharge were assessed using weighted logistic regression. Entropy balancing was used to compute weights. RESULTS Of 1025 included patients, 658 (64%) did not receive dexamethasone, 115 (11%) received 1-2 doses, 131 (13%) received 3-4 doses, and 121 (12%) received ≥5 doses. Among patients treated with dexamethasone, the median number of doses was higher for those without an identified pathogen than for those with a microbiologically confirmed viral aetiology (5 [interquartile range (IQR) 3-8] vs. 3 [IQR 2-5]; p < 0.001). Using no doses of dexamethasone as a reference, the weighted OR for an unfavourable outcome were 0.55 (95% CI, 0.29-1.07) for 1-2 doses, 1.13 (95% CI, 0.67-1.89) for 3-4 doses, and 1.43 (95% CI, 0.77-2.64) for ≥5 doses. In the subgroup of enteroviral meningitis, the weighted OR was 3.08 (95% CI, 1.36-6.94) for ≥5 doses, but decreased to 2.35 (95% CI, 0.65-8.40) when the reference group was restricted to patients treated with antibiotics for suspected bacterial meningitis. DISCUSSION This study showed no dose-dependent association between dexamethasone and an unfavourable outcome in patients with viral meningitis. In enteroviral meningitis, ≥5 doses were associated with an increased risk of an unfavourable outcome. However, sensitivity analysis indicated that the association was affected by unmeasured or residual confounding by severity.
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Affiliation(s)
- Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Olie SE, Andersen CØ, van de Beek D, Brouwer MC. Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections. Clin Microbiol Rev 2024; 37:e0002124. [PMID: 39404267 PMCID: PMC11629637 DOI: 10.1128/cmr.00021-24] [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] [Indexed: 12/11/2024] Open
Abstract
SUMMARYCentral nervous system (CNS) infections can be caused by various pathogens, including bacteria, viruses, fungi, and parasites. Molecular diagnostic methods are pivotal for identifying the different causative pathogens of these infections in clinical settings. The efficacy and specificity of these methods can vary per pathogen involved, and in a substantial part of patients, no pathogen is identified in the cerebrospinal fluid (CSF). Over recent decades, various molecular methodologies have been developed and applied to patients with CNS infections. This review provides an overview of the accuracy of nucleic acid amplification methods in CSF for a diverse range of pathogens, examines the potential value of multiplex PCR panels, and explores the broad-range bacterial and fungal PCR/sequencing panels. In addition, it evaluates innovative molecular approaches to enhance the diagnosis of CNS infections.
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Affiliation(s)
- Sabine E. Olie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Christian Ø. Andersen
- Statens Serum Institute, Diagnostic Infectious Disease Preparedness, Copenhagen, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
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Song P, Seok JM, Kim S, Choi J, Bae JY, Yu SN, Park J, Choi K, Yang Y, Jeong D, Yang KI, Park H. Viral Etiology of Aseptic Meningitis and Clinical Prediction of Herpes Simplex Virus Type 2 Meningitis. J Pers Med 2024; 14:998. [PMID: 39338252 PMCID: PMC11433182 DOI: 10.3390/jpm14090998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/03/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Aseptic meningitis comprises meningeal inflammation and cerebrospinal fluid (CSF) pleocytosis without positive Gram stain and culture. Regional differences exist in the prevalence of viral etiologies of aseptic meningitis. We aimed to assess the etiologies of aseptic meningitis in immunocompetent adults, focusing on herpes simplex virus type 2 (HSV-2). METHODS This study retrospectively analyzed immunocompetent adults diagnosed with meningitis at a Korean tertiary care hospital from 2016 to 2018. Aseptic meningitis was defined through clinical and CSF analysis. We compared clinical and laboratory characteristics across viral etiologies and investigated predictors of HSV-2 meningitis. RESULTS A total of 98 patients (46.9% female) with aseptic meningitis were finally enrolled. The etiologies of aseptic meningitis were identified in 62 patients (63.3%), including enterovirus (28.5%), HSV-2 (16.3%), and varicella zoster virus (VZV, 15.3%). HSV-2 showed female predominance, with shorter admission times with longer hospital stays and a recurrent meningitis history. Compared to other viral etiologies, HSV-2 showed higher CSF white blood cell (WBC) counts and protein levels but lower C-reactive protein (CRP) levels. A random forest model identified previous meningitis history and serum CRP level as key predictors of HSV-2 meningitis. CONCLUSIONS This study provides insights into the etiologies of aseptic meningitis in a specific Korean region, identifying HSV-2 as a notable cause. The prediction model suggested that the clinical history of previous meningitis and serum CRP level may guide clinical assessment of meningitis.
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Affiliation(s)
- Pamela Song
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Seungju Kim
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Jaehyeok Choi
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Jae Yeong Bae
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Shi Nae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan 31151, Republic of Korea
| | - Jongkyu Park
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Kyomin Choi
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Youngsoon Yang
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Dushin Jeong
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Hyungkook Park
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
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Schwitter J, Branca M, Bicvic A, Abbuehl LS, Suter-Riniker F, Leib SL, Dietmann A. Long-term sequelae after viral meningitis and meningoencephalitis are frequent, even in mildly affected patients, a prospective observational study. Front Neurol 2024; 15:1411860. [PMID: 39087005 PMCID: PMC11288970 DOI: 10.3389/fneur.2024.1411860] [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: 04/03/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction An increasing number of studies demonstrate that viral meningitis and meningoencephalitis, even those with a mild course of meningitis, can result in residual sequelae. Methods We aimed to investigate the long-term outcome in both viral meningitis and meningoencephalitis/encephalitis patients and impact of long-term sequelae on patients' social and professional daily lives in a prospective observational study with a follow-up period of 20 months. Results A total of 50 patients (12% encephalitis, 58% meningoencephalitis and 30% meningitis) and 21 control persons participated in the study. The most common cause was the tick-borne encephalitis (TBE) virus. The most important persistent signs and symptoms after 2 years were subjective cognitive impairment (36%), fatigue and/or excessive daytime sleepiness (31%), disturbed nighttime sleep (31%) and headaches (13%), as well as feeling more rapidly exhausted after cognitive effort (53%). Independent of disease severity in the acute phase, almost one third of patients still reported mildly impaired social and/or professional life due to the long-term sequelae, with scores in the health status assessment still significantly lower compared to healthy controls. Discussion Regardless of the severity of the acute illness and despite constant improvement within 2 years, 67% of patients still had persistent signs and symptoms, but these were only relevant to everyday social or professional life in about 30% of these patients.
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Affiliation(s)
- Janine Schwitter
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Antonela Bicvic
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Zachariassen M, Thomsen MM, Hillig T, Trier-Petersen P, Jensen AV, Friis-Hansen LJ, Brandt CT. Tenascin-C in patients with central nervous system infections. J Neuroimmunol 2024; 392:578373. [PMID: 38776710 DOI: 10.1016/j.jneuroim.2024.578373] [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: 11/02/2023] [Revised: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The extracellular matrix protein tenascin-C has been discovered to be an important regulator of the response to tissue injury and repair in cerebrovascular diseases. This study investigated if tenascin-C is released in response to infections in the central nervous system (CNS). METHODS Tenascin-C concentration in the cerebrospinal fluid (CSF) was measured in patients, (>18 years) with and without CNS infections, admitted to a department of infectious diseases in Denmark. CSF tenascin-C was measured on the Meso-scale platform. RESULTS 174 patients were included of which 140 were diagnosed with a CNS infection and 34 where this was ruled out (control group). Median CSF tenascin-C levels were significantly higher among patients with bacterial meningitis (147 pg/mL), viral meningitis (33 mg/mL), viral encephalitis (39 pg/mL) and Lyme neuroborreliosis (45 pg/mL) when compared to controls (21 pg/mL). Correlations between tenascin-C and CSF markers of inflammation and age were only moderate. CONCLUSION Levels of CSF tenascin-C are higher among patients with bacterial and viral neuroinfections, already on admission, but exhibit only a modest correlation with baseline indices of neuroinflammation. CSF tenascin-C is highest among patients with bacterial meningitis compared to the other CNS infections. Patients with unfavorable outcomes presented with higher median CSF tenascin-C than their counterparts.
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Affiliation(s)
- Morten Zachariassen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
| | - Martin Munthe Thomsen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Pelle Trier-Petersen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Andreas Vestergaard Jensen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Lennart Jan Friis-Hansen
- Department of Clinical Microbiology, University Hospital Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Thomas Brandt
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
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Dulin M, Chevret S, Salmona M, Jacquier H, Bercot B, Molina JM, Lebeaux D, Munier AL. New Insights Into the Therapeutic Management of Varicella Zoster Virus Meningitis: A Series of 123 Polymerase Chain Reaction-Confirmed Cases. Open Forum Infect Dis 2024; 11:ofae340. [PMID: 38957692 PMCID: PMC11218771 DOI: 10.1093/ofid/ofae340] [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: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
Background Varicella zoster virus (VZV) can reactivate and cause meningitis, but few studies have distinguished it from meningoencephalitis regarding treatment recommendations.The objective of this study was to assess the outcomes of a large series of patients with VZV meningitis according to their therapeutic management. Methods We conducted a bicentric retrospective cohort study, in Paris, France, including all adult patients with a cerebrospinal fluid sample positive for VZV by polymerase chain reaction between April 2014 and June 2022. We distinguished meningitis from encephalitis according to the International Encephalitis Consortium criteria. Unfavorable outcome was defined as mortality or functional sequelae defined by a loss of 2 points on the modified Rankin Scale. Results We included 123 patients with meningitis. Among them, 14% received no antivirals, while 20% were treated with oral valacyclovir alone, 41% with a short course of intravenous (IV) acyclovir before switch to valacyclovir, and 25% with a long course of IV acyclovir. Outcomes were favorable regardless of antiviral regimen. In multivariate analysis, only age, underlying immunosuppression, and cranial radiculitis appear to be predictive factors for longer IV therapy, based on the Akaike information criterion. Conclusions In this study, patients with VZV meningitis had a good outcome, with no evidence of any impact of the treatment strategy. However, further studies are needed to support the possibility of milder treatment in immunocompetent patients, avoiding cost and side effects of IV acyclovir.
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Affiliation(s)
- Marie Dulin
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sylvie Chevret
- Biostatistics Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Maud Salmona
- Laboratory of Virology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Hervé Jacquier
- Laboratory of Microbiology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Béatrice Bercot
- Laboratory of Microbiology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - David Lebeaux
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne-Lise Munier
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Mark DG, Horton BH, Reed ME. Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. JAMA Netw Open 2024; 7:e247373. [PMID: 38639937 PMCID: PMC11031686 DOI: 10.1001/jamanetworkopen.2024.7373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Subarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied. Objective To determine whether CT cerebral angiography use has increased in lieu of lumbar puncture among emergency department (ED) patients with headache, with an increase in unruptured intracranial aneurysm detection. Design, Setting, and Participants This retrospective cohort study took place in 21 community EDs of an integrated health care system in Northern California between 2015 and 2021. Participants were adult (aged >17 years) health plan members with a chief concern of headache. Exclusions were prior diagnoses of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral arteriovenous malformation, or cerebrospinal fluid shunt. Data were analyzed from October to November 2023. Exposures CT cerebral angiography and/or lumbar puncture during the ED encounter. Main Outcomes and Measures Primary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis. Results Among 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White. Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (-11.1%; 95% CI, -12.0% to -10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%). Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = -.34, respectively). Conclusions and Relevance In this cohort study of ED patients with headache, increases in CT cerebral angiography use were associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. While this shift in diagnostic strategy appeared safe in the short-term, the long-term consequences remain unclear.
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Affiliation(s)
- Dustin G. Mark
- Department of Emergency Medicine, Kaiser Permanente Medical Center, Oakland, California
- Department of Critical Care Medicine, Kaiser Permanente Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Brandon H. Horton
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mary E. Reed
- Division of Research, Kaiser Permanente Northern California, Oakland
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16
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Petersen PT, Bodilsen J, Jepsen MPG, Hansen BR, Storgaard M, Larsen L, Helweg‐Larsen J, Wiese L, Lüttichau HR, Andersen CØ, Mogensen TH, Nielsen H, Brandt CT, for the Danish Study Group of Infections of the Brain (DASGIB). Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark: a nationwide cohort study. Eur J Neurol 2024; 31:e16081. [PMID: 37797296 PMCID: PMC11235955 DOI: 10.1111/ene.16081] [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: 08/08/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited. METHODS This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison. RESULTS Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis. CONCLUSIONS Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.
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Affiliation(s)
- Pelle Trier Petersen
- Department of Pulmonary and Infectious DiseasesNordsjællands HospitalHillerødDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jacob Bodilsen
- Department of Infectious DiseasesAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | | | | | - Merete Storgaard
- Department of Infectious DiseasesAarhus University HospitalAarhusDenmark
| | - Lykke Larsen
- Department of Infectious DiseasesOdense University HospitalOdenseDenmark
| | | | - Lothar Wiese
- Department of MedicineZealand University HospitalRoskildeDenmark
| | | | | | - Trine Hyrup Mogensen
- Department of Infectious DiseasesAarhus University HospitalAarhusDenmark
- Department of BiomedicineAarhus University HospitalAarhusDenmark
| | - Henrik Nielsen
- Department of Infectious DiseasesAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Oduoye MO, Akanbi-Hakeem HB, Muzammil MA, Arama UO, Abbasi HQ, Farhan K, Fariha FNU, Modupeoluwa OO, Paul HW, Badarou ADE, Akilimali A. Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations. Ann Med Surg (Lond) 2024; 86:345-352. [PMID: 38222679 PMCID: PMC10783331 DOI: 10.1097/ms9.0000000000001511] [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: 05/29/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Amidst coronavirus disease 2019 (COVID-19), there has been a misplaced priority on meningitis in the Niger Republic, thus refocusing resources and attention away from the continuing meningitis campaign in the Niger Republic. The over-strained state of public health resources and staff has also led to decreased surveillance, postponed diagnoses, and constrained immunization efforts in Niger Republic. This review aims to bridge the gaps regarding meningitis amid COVID-19 in Niger Republic and offer recommendations to government to mitigate meningitis in the country, with the hope of finding a permanent solution to this debilitating disease. The authors reviewed 45 past and present pieces of literature on meningitis and COVID-19 from 2013 to 2023 in well-renowned scientific databases such as PubMed, ResearchGate, Google Scholar, African Journals Online, Medline, and Embase. Since 2015, Niger Republic has experienced multiple meningitis epidemics that have resulted in 20, 789 cases and 1, 369 deaths [a case fatality rate (CFR) of 6.6%]. A total of 231 cases of meningitis were reported from 1 November 2021 to 31 January 2022. And recently, 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), occurred in the Zinder region, southeast of Niger Republic, from 1 November 2022 to 27 January 2023. Meningitis remains a public health concern in the world, especially in Niger Republic, which could lead to serious long-term complications. Therefore, adequate and novel measures and therapeutic actions should be implemented by the Niger Government to lessen the burden of the disease in the country.
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Affiliation(s)
- Malik Olatunde Oduoye
- Ahmadu Bello University, Zaria, Kaduna State
- Department of Research, Medical Research Circle, Bukavu
| | | | | | | | | | - Kanza Farhan
- Medical College, Jinnah Sindh Medical University, Karachi
| | | | | | - Houessou W. Paul
- Faculty of Health Sciences of Andre Salifou Zinder University, Niger Republic
| | - Achiraf-deen E. Badarou
- Department of General Medicine, FSS-Cotonou, Association of Medical Students of Cotonou, Cotonou, Littoral, Benin
| | - Aymar Akilimali
- Department of Research, Medical Research Circle, Bukavu
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of Congo
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18
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Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Helweg-Larsen J, Wiese L, Hansen BR, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT. Ramsay Hunt syndrome and concurrent varicella-zoster virus meningitis in Denmark: A nationwide cohort study. J Med Virol 2023; 95:e29291. [PMID: 38058258 DOI: 10.1002/jmv.29291] [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: 08/08/2023] [Revised: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Ramsay Hunt syndrome (RHS) is a manifestation of reactivated varicella-zoster virus (VZV) from the geniculate ganglion. Data on clinical features and outcomes of patients with RHS and concurrent VZV meningitis (henceforth RHS meningitis) are limited. Thus, we conducted a nationwide population-based cohort study of all adults hospitalized for RHS meningitis at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with VZV meningitis without cranial nerve palsies were included for comparison. In total, 37 patients with RHS meningitis (mean annual incidence: 1.6/1 000 000 adults) and 162 with VZV meningitis without cranial nerve palsies were included. In RHS meningitis, the median age was 52 years (interquartile range: 35-64), and in addition to peripheral facial nerve palsy (100%), dizziness (46%), and hearing loss (35%) were common symptoms. The triad of headache, neck stiffness, and photophobia/hyperacusis was less common in RHS meningitis than in VZV meningitis without cranial nerve palsies (0/27 [0%] vs. 24/143 [17%]; p = 0.02). At 30 days after discharge, 18/36 (50%) patients with RHS meningitis had persistent peripheral facial nerve palsy, with no statistically significant difference between those treated with and without adjuvant glucocorticoids (6/16 [38%] vs. 12/20 [60%]; p = 0.18). Additional sequelae of RHS meningitis included dizziness (29%), neuralgia (14%), tinnitus/hyperacusis (11%), hearing loss (9%), headache (9%), fatigue (6%), and concentration difficulties (3%). In conclusion, clinical features and outcomes of RHS meningitis were primarily related to cranial neuropathies.
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Affiliation(s)
- Pelle T Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Micha P G Jepsen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Birgitte R Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans R Lüttichau
- Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Flato UAP, Pereira BCDA, Costa FA, Vilela MC, Frigieri G, Cavalcante NJF, de Almeida SLS. Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism. Neurol Int 2023; 15:1403-1410. [PMID: 38132969 PMCID: PMC10745918 DOI: 10.3390/neurolint15040090] [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: 09/18/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
Neuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.
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Affiliation(s)
- Uri Adrian Prync Flato
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
- Hospital Israelita Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-900, Brazil
| | - Barbara Cristina de Abreu Pereira
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
| | - Fernando Alvares Costa
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
| | - Marcos Cairo Vilela
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
| | - Gustavo Frigieri
- Medical Investigation Laboratory 62, School of Medicine, University of São Paulo, São Paulo 01246-000, Brazil;
| | - Nilton José Fernandes Cavalcante
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
| | - Samantha Longhi Simões de Almeida
- Hospital Samaritano Higienópolis—Américas Serviços Médicos, São Paulo 01232-010, Brazil; (B.C.d.A.P.); (F.A.C.); (M.C.V.); (N.J.F.C.); (S.L.S.d.A.)
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