1
|
Sun H, Cheng D, Du X, Sun C, Zhang J. A Rare Influenza B Virus-Associated Cerebellitis Detected by 18F-FDG PET/CT Imaging. J Nucl Med 2025:jnumed.125.269548. [PMID: 40147843 DOI: 10.2967/jnumed.125.269548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Affiliation(s)
- Hukui Sun
- Nuclear Medicine and Radiotherapy Department, Zibo Central Hospital, Zibo, China
| | - Dayan Cheng
- Nuclear Medicine and Radiotherapy Department, Zibo Central Hospital, Zibo, China
| | - Xiangde Du
- Nuclear Medicine and Radiotherapy Department, Zibo Central Hospital, Zibo, China
| | - Chengwei Sun
- Nuclear Medicine and Radiotherapy Department, Zibo Central Hospital, Zibo, China
| | - Jiahui Zhang
- Nuclear Medicine and Radiotherapy Department, Zibo Central Hospital, Zibo, China
| |
Collapse
|
2
|
Rosero CI, Gravenstein S, Saade EA. Influenza and Aging: Clinical Manifestations, Complications, and Treatment Approaches in Older Adults. Drugs Aging 2025; 42:39-55. [PMID: 39775605 DOI: 10.1007/s40266-024-01169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2024] [Indexed: 01/11/2025]
Abstract
Influenza, a highly contagious respiratory viral illness, poses significant global health risks, particularly affecting older and those with chronic health conditions. Influenza viruses, primarily types A and B, are responsible for seasonal human infections and exhibit a propensity for antigenic drift and shift, contributing to seasonal epidemics and pandemics. The severity of influenza varies, but severe cases often lead to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Older adults, especially those over 65 years of age, face increased risks of immune senescence, chronic comorbidities, and decreased vaccine efficacy. Globally, influenza affects millions of people annually, with significant morbidity and mortality among older. Epidemiological patterns vary with climate, and risk factors include age, immunocompromised status, and preexisting chronic conditions. In older adults, influenza frequently results in hospitalization and death, which is exacerbated by immunosenescence and biological organ changes associated with aging. Clinical manifestations range from mild symptoms to severe complications such as viral pneumonia and multiorgan failure. Diagnosis often relies on antigen or molecular tests, with radiological examination aiding in severe cases. Treatment primarily involves antiviral agents, such as oseltamivir and peramivir, with the greatest benefit observed when initiated early. Management of severe cases may require hospitalization and supportive care, including addressing complications, such as secondary bacterial infections and cardiovascular events. This article highlights the need for improved vaccination strategies and novel treatments, including monoclonal antibodies and adoptive T cell therapies, to better manage severe influenza infections in vulnerable populations such as older.
Collapse
Affiliation(s)
| | - Stefan Gravenstein
- Brown University School of Public Health, Providence, RI, 02903, USA
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Providence Veterans Affairs Medical Center, Providence, RI, 02908, USA
| | - Elie A Saade
- University Hospitals of Cleveland, 11100 Euclid Ave, Mailstop 5083, Cleveland, OH, 44106, USA.
- Case Western Reserve University, Cleveland, OH, 44106, USA.
| |
Collapse
|
3
|
Nersesjan V, Boldingh MI, Paulsen EQ, Argren M, Høgestøl E, Aamodt AH, Popperud TH, Kondziella D, Jørgensen CS, Jensen VVS, Benros ME. Antibodies against SARS-CoV-2 spike protein in the cerebrospinal fluid of COVID-19 patients and vaccinated controls: a multicentre study. J Neurol 2024; 272:60. [PMID: 39680178 DOI: 10.1007/s00415-024-12769-4] [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: 09/09/2024] [Revised: 10/18/2024] [Accepted: 10/24/2024] [Indexed: 12/17/2024]
Abstract
INTRODUCTION SARS-CoV-2 antibodies in the cerebrospinal fluid (CSF) of COVID-19 patients possibly reflect blood-cerebrospinal fluid barrier (BCB) disruption due to systemic inflammation. However, some studies indicate that CSF antibodies signal a neurotropic infection. Currently, larger studies are needed to clarify this, and it is unknown if CSF antibodies appear solely after infection or also after COVID-19 vaccination. Therefore, we aimed to investigate the CSF dynamics of SARS-CoV-2 antibodies in a multicenter study of COVID-19 patients and vaccinated controls. METHODS A cohort study of Danish and Norwegian COVID-19 patients and controls investigated with a lumbar puncture (April 2020-December 2022). Serum and CSF were analysed locally for routine investigations, and centrally at Statens Serum Institut (Danish governmental public health institute) for SARS-CoV-2 IgG antibodies against the spike protein using the Euroimmun (quantitative) and Wantai (qualitative) assays. Primary outcome was the quantity of CSF SARS-CoV-2 antibodies post-COVID versus post-vaccination. Secondary outcomes included regression models examining the relationship between CSF antibodies and serum levels, albumin ratio, CSF pleocytosis, COVID-19 severity, and temporal antibody dynamics. RESULTS We included 124 individuals (Mean [SD] age 47.2 [16.6]; 59.7% males surviving COVID-19 and controls. Of these, 86 had paired CSF-serum testing. Antibody-index calculations did not support a SARS-CoV-2 brain infection. Multi-variate regression revealed that CSF SARS-CoV-2 antibodies were most strongly influenced by serum antibody levels and BCB permeability, as measured by increasing albumin ratio. CSF antibody levels displayed a dose-response relationship (p < 0.0001) influenced by preceding vaccinations or infections. CSF antibody levels (median [IQR]) were highest among those both previously infected and vaccinated, 100.0 [25.0-174.0], and those vaccinated without prior infection, 85.0 [12.0-142.0], and lowest among previously infected individuals without preceding vaccination, 5.9 [2.7-55.1], (p = 0.003). SARS-CoV-2 antibodies in CSF were also detected via qualitative assays in the COVID-19 (46.8%) and vaccinated (78.6%) groups, p = 0.03. CONCLUSION SARS-CoV-2 antibodies detected in CSF can be derived following both infection and vaccination for COVID-19. CSF antibody levels increase in a dose-response relationship with the number of prior infections and vaccinations and are most strongly influenced by serum antibody levels and BCB permeability. These findings stress the importance of carefully interpreting CSF antibody results when assessing neurological complications following infections not categorized as neurotropic.
Collapse
Affiliation(s)
- Vardan Nersesjan
- Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Maria Argren
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Einar Høgestøl
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Daniel Kondziella
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Charlotte Sværke Jørgensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Michael E Benros
- Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Chen H, Lan SC, Tseng YL, Chang YY, Lu YT, Lan MY. Acute necrotizing encephalopathy in adult patients with influenza: a case report and review of the literature. BMC Infect Dis 2024; 24:931. [PMID: 39251995 PMCID: PMC11382510 DOI: 10.1186/s12879-024-09844-6] [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: 06/19/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
The neurological complications of influenza affect mainly the pediatric Asian population. In the category of influenza-associated encephalopathy, acute necrotizing encephalopathy (ANE) is a rapidly progressive and fulminant brain disorder associated with significant neurological sequelae and mortality. To date, only a few adult cases of influenza-associated ANE have been reported. We describe a 44-year-old woman who presented with rapid progression of consciousness impairment and recurrent generalized convulsions. Influenza was diagnosed three days prior to presentation, and infection with influenza A (H3N2) pdm09 was subsequently confirmed. A diagnosis of ANE was made based on the presence of characteristic brain MRI findings, the exclusion of central nervous system infection, and an elevated serum interleukin-6 level. Pulse steroid therapy followed by tocilizumab was initiated, which led to clinical stabilization and improvement. Genetic testing revealed that the patient carried heterozygous human leukocyte antigen DQB1 03:03 and DRB1 09:01 genotypes. An analysis of the adult cases of influenza-associated ANE in the literature and the present case revealed a wide range of ages (22-71 years), a short interval (median 3 days) between the clinical onset of influenza and ANE, and a high overall mortality rate (32%). The thalamus was the most frequent (91%) location of the lesions. Our report highlights the importance of identifying this devastating but treatable neurological complication of influenza in adults, especially those of Asian descent. As a cytokine storm is the most accepted pathogenic mechanism for ANE, cytokine-directed therapies may be promising treatments for which further investigation is warranted.
Collapse
Affiliation(s)
- Hsi Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, NiaoSong, Kaohsiung, 833, Taiwan
| | - Shih-Chun Lan
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Lung Tseng
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, NiaoSong, Kaohsiung, 833, Taiwan
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, NiaoSong, Kaohsiung, 833, Taiwan
- Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ting Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, NiaoSong, Kaohsiung, 833, Taiwan
| | - Min-Yu Lan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, NiaoSong, Kaohsiung, 833, Taiwan.
- Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Center for Mitochondrial Research and Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
5
|
Lorkiewicz P, Waszkiewicz N. Viral infections in etiology of mental disorders: a broad analysis of cytokine profile similarities - a narrative review. Front Cell Infect Microbiol 2024; 14:1423739. [PMID: 39206043 PMCID: PMC11349683 DOI: 10.3389/fcimb.2024.1423739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/10/2024] [Indexed: 09/04/2024] Open
Abstract
The recent pandemic caused by the SARS-CoV-2 virus and the associated mental health complications have renewed scholarly interest in the relationship between viral infections and the development of mental illnesses, a topic that was extensively discussed in the previous century in the context of other viruses, such as influenza. The most probable and analyzable mechanism through which viruses influence the onset of mental illnesses is the inflammation they provoke. Both infections and mental illnesses share a common characteristic: an imbalance in inflammatory factors. In this study, we sought to analyze and compare cytokine profiles in individuals infected with viruses and those suffering from mental illnesses. The objective was to determine whether specific viral diseases can increase the risk of specific mental disorders and whether this risk can be predicted based on the cytokine profile of the viral disease. To this end, we reviewed existing literature, constructed cytokine profiles for various mental and viral diseases, and conducted comparative analyses. The collected data indicate that the risk of developing a specific mental illness cannot be determined solely based on cytokine profiles. However, it was observed that the combination of IL-8 and IL-10 is frequently associated with psychotic symptoms. Therefore, to assess the risk of mental disorders in infected patients, it is imperative to consider the type of virus, the mental complications commonly associated with it, the predominant cytokines to evaluate the risk of psychotic symptoms, and additional patient-specific risk factors.
Collapse
Affiliation(s)
- Piotr Lorkiewicz
- Department of Psychiatry, Medical University of Bialystok, Białystok, Poland
| | | |
Collapse
|
6
|
Herman J, Rittenhouse N, Mandino F, Majid M, Wang Y, Mezger A, Kump A, Kadian S, Lake EMR, Verardi PH, Conover JC. Ventricular-subventricular zone stem cell niche adaptations in a mouse model of post-infectious hydrocephalus. Front Neurosci 2024; 18:1429829. [PMID: 39145299 PMCID: PMC11322059 DOI: 10.3389/fnins.2024.1429829] [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: 05/08/2024] [Accepted: 07/02/2024] [Indexed: 08/16/2024] Open
Abstract
Congenital post-infectious hydrocephalus (PIH) is a condition characterized by enlargement of the ventricular system, consequently imposing a burden on the associated stem cell niche, the ventricular-subventricular zone (V-SVZ). To investigate how the V-SVZ adapts in PIH, we developed a mouse model of influenza virus-induced PIH based on direct intracerebroventricular injection of mouse-adapted influenza virus at two distinct time points: embryonic day 16 (E16), when stem cells line the ventricle, and postnatal day 4 (P4), when an ependymal monolayer covers the ventricle surface and stem cells retain only a thin ventricle-contacting process. Global hydrocephalus with associated regions of astrogliosis along the lateral ventricle was found in 82% of the mice infected at P4. Increased ependymogenesis was observed at gliotic borders and throughout areas exhibiting intact ependyma based on tracking of newly divided cells. Additionally, in areas of intact ependyma, stem cell numbers were reduced; however, we found no significant reduction in new neurons reaching the olfactory bulb following onset of ventriculomegaly. At P4, injection of only the non-infectious viral component neuraminidase resulted in limited, region-specific ventriculomegaly due to absence of cell-to-cell transmission. In contrast, at E16 intracerebroventricular injection of influenza virus resulted in death at birth due to hypoxia and multiorgan hemorrhage, suggesting an age-dependent advantage in neonates, while the viral component neuraminidase resulted in minimal, or no, ventriculomegaly. In summary, we tracked acute adaptations of the V-SVZ stem cell niche following onset of ventriculomegaly and describe developmental changes that help mitigate the severity of congenital PIH.
Collapse
Affiliation(s)
- Julianna Herman
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Nicole Rittenhouse
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Francesca Mandino
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Mushirah Majid
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Yuxiang Wang
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States
| | - Amelia Mezger
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Aidan Kump
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Sumeet Kadian
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| | - Evelyn M. R. Lake
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Wu Tsai Institute, Yale University, New Haven, CT, United States
| | - Paulo H. Verardi
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States
| | - Joanne C. Conover
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
| |
Collapse
|
7
|
Prada GI, Băjenaru OL, Chelu GC, Matei-Lincă CM, Nuţă CR, Moscu SG. Protecting the elderly from influenza in the context of immune system senescence. Elderly aged 65 and over are vulnerable to influenza and its associated complications.: Position paper by the Romanian Society of Gerontology and Geriatrics. J Med Life 2024; 17:746-754. [PMID: 39440332 PMCID: PMC11493167 DOI: 10.25122/jml-2024-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/26/2024] [Indexed: 10/25/2024] Open
Abstract
Influenza affects millions globally each year, often causing severe complications, hospitalizations, and deaths, particularly among the elderly. As the global population ages, infections will pose a growing health risk. Annual vaccination remains the most effective way to prevent influenza and its complications. After the age of 65, people suffering from chronic diseases become the majority of this population category. All the data support that most of the population over 65 years old, whose immune system goes through immunosenescence, presents multimorbidity, requiring age-appropriate anti-influenza protection. The immune response to the traditional influenza vaccine has been proven to be lower in the elderly, highlighting the need for a more immunogenic vaccine specifically tailored to the elderly population group. Therefore, high-dose (HD) influenza vaccines have demonstrated their safety and are more effective in preventing influenza and its associated complications compared to standard-dose (SD) vaccines in the elderly in the context of immunosenescence. These recommendations focus on the safety, effectiveness, and efficacy of HD influenza vaccines, adapted to the elderly and available on the Romanian market, to increase the vaccination rate and, thus, protect against influenza infection and its complications. Therefore, strategies such as increased accessibility and free immunizations, as well as ensuring that flu vaccines for the elderly are prescribed without restrictions based on the number of comorbidities, should be used.
Collapse
Affiliation(s)
- Gabriel-Ioan Prada
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
| | - Ovidiu-Lucian Băjenaru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania
| | - Gabriela-Cristina Chelu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania
| | | | - Cătălina-Raluca Nuţă
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania
| | - Sînziana-Georgeta Moscu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania
| |
Collapse
|
8
|
Li S, Xiao W, Li H, Hu D, Li K, Chen Q, Liu G, Yang H, Song Y, Peng Q, Wang Q, Ning S, Xiong Y, Ma W, Shen J, Zheng K, Hong Y, Yang S, Li P. Identification of neurological complications in childhood influenza: a random forest model. BMC Pediatr 2024; 24:347. [PMID: 38769496 PMCID: PMC11103977 DOI: 10.1186/s12887-024-04773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Among the neurological complications of influenza in children, the most severe is acute necrotizing encephalopathy (ANE), with a high mortality rate and neurological sequelae. ANE is characterized by rapid progression to death within 1-2 days from onset. However, the knowledge about the early diagnosis of ANE is limited, which is often misdiagnosed as simple seizures/convulsions or mild acute influenza-associated encephalopathy (IAE). OBJECTIVE To develop and validate an early prediction model to discriminate the ANE from two common neurological complications, seizures/convulsions and mild IAE in children with influenza. METHODS This retrospective case-control study included patients with ANE (median age 3.8 (2.3,5.4) years), seizures/convulsions alone (median age 2.6 (1.7,4.3) years), or mild IAE (median age 2.8 (1.5,6.1) years) at a tertiary pediatric medical center in China between November 2012 to January 2020. The random forest algorithm was used to screen the characteristics and construct a prediction model. RESULTS Of the 433 patients, 278 (64.2%) had seizures/convulsions alone, 106 (24.5%) had mild IAE, and 49 (11.3%) had ANE. The discrimination performance of the model was satisfactory, with an accuracy above 0.80 from both model development (84.2%) and internal validation (88.2%). Seizures/convulsions were less likely to be wrongly classified (3.7%, 2/54), but mild IAE (22.7%, 5/22) was prone to be misdiagnosed as seizures/convulsions, and a small proportion (4.5%, 1/22) of them was prone to be misdiagnosed as ANE. Of the children with ANE, 22.2% (2/9) were misdiagnosed as mild IAE, and none were misdiagnosed as seizures/convulsions. CONCLUSION This model can distinguish the ANE from seizures/convulsions with high accuracy and from mild IAE close to 80% accuracy, providing valuable information for the early management of children with influenza.
Collapse
Grants
- Pre-NSFC-2019-002 Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
- Pre-NSFC-2019-002 Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
Collapse
Affiliation(s)
- Suyun Li
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Weiqiang Xiao
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Dandan Hu
- Pediatric Neurology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Kuanrong Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qinglian Chen
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Guangming Liu
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Haomei Yang
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Yongling Song
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiuyan Peng
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiang Wang
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Shuyao Ning
- Neuroelectrophysiology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Guangzhou, 510623, China
| | - Yumei Xiong
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Wencheng Ma
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Jun Shen
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Kelu Zheng
- Pediatric Neurology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Yan Hong
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Sida Yang
- Neuroelectrophysiology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Guangzhou, 510623, China.
| | - Peiqing Li
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
| |
Collapse
|
9
|
Huang Y, Zhou B, Hong S, Cai Y. A case report and literature review on tocilizumab-cured acute necrotizing encephalopathy caused by influenza A virus. Front Pediatr 2024; 12:1351478. [PMID: 38646514 PMCID: PMC11026575 DOI: 10.3389/fped.2024.1351478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Acute Necrotizing Encephalopathy (ANE), is a kind of severe Central Nervous System Disease. The commonest pathogen is the influenza virus. The pathogenesis of ANE is bound up to genetic susceptibility and cytokine storm. Interleukin-6 (IL-6) is deemed as the core function in cytokine storm of ANE and that plays a significant role in evaluating the severity of Influenza-Related ANE. Tocilizumab, an IL-6 antagonist, is known to be safe and effective in the treatment of ANE when used early and has an essential role in improving prognosis and preventing disability. Case report This case reports a 2 year 10 month old boy who developed ANE after being infected with influenza A virus (H1N1-2019). After treatment with Tocilizumab, the child's consciousness was clear, no convulsions occurred, the movement of limbs was improved, and the lesions of encephalopathy were significantly reduced. Conclusion The early use of Tocilizumab is safe and effective for the treatment of ANE caused by influenza virus.
Collapse
Affiliation(s)
| | - Bin Zhou
- Pediatric Intensive Care Unit, Xiamen Children's Hospital, Children's Hospital of Fudan University (Xiamen Branch), Xiamen, China
| | | | | |
Collapse
|
10
|
Costa B, Vale N. Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment. Int J Mol Sci 2024; 25:3730. [PMID: 38612542 PMCID: PMC11011490 DOI: 10.3390/ijms25073730] [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: 12/07/2023] [Revised: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.
Collapse
Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| |
Collapse
|
11
|
Xu Z, Wang H, Jiang S, Teng J, Zhou D, Chen Z, Wen C, Xu Z. Brain Pathology in COVID-19: Clinical Manifestations and Potential Mechanisms. Neurosci Bull 2024; 40:383-400. [PMID: 37715924 PMCID: PMC10912108 DOI: 10.1007/s12264-023-01110-0] [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: 01/12/2023] [Accepted: 05/25/2023] [Indexed: 09/18/2023] Open
Abstract
Neurological manifestations of coronavirus disease 2019 (COVID-19) are less noticeable than the respiratory symptoms, but they may be associated with disability and mortality in COVID-19. Even though Omicron caused less severe disease than Delta, the incidence of neurological manifestations is similar. More than 30% of patients experienced "brain fog", delirium, stroke, and cognitive impairment, and over half of these patients presented abnormal neuroimaging outcomes. In this review, we summarize current advances in the clinical findings of neurological manifestations in COVID-19 patients and compare them with those in patients with influenza infection. We also illustrate the structure and cellular invasion mechanisms of SARS-CoV-2 and describe the pathway for central SARS-CoV-2 invasion. In addition, we discuss direct damage and other pathological conditions caused by SARS-CoV-2, such as an aberrant interferon response, cytokine storm, lymphopenia, and hypercoagulation, to provide treatment ideas. This review may offer new insights into preventing or treating brain damage in COVID-19.
Collapse
Affiliation(s)
- Zhixing Xu
- First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Hui Wang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Siya Jiang
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jiao Teng
- Affiliated Lin'an People's Hospital of Hangzhou Medical College, First People's Hospital of Hangzhou Lin'an District, Lin'an, Hangzhou, 311300, China
| | - Dongxu Zhou
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Zhong Chen
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Chengping Wen
- Laboratory of Rheumatology and Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Zhenghao Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
- Laboratory of Rheumatology and Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| |
Collapse
|
12
|
Kirk NM, Liang Y, Ly H. Comparative Pathology of Animal Models for Influenza A Virus Infection. Pathogens 2023; 13:35. [PMID: 38251342 PMCID: PMC10820042 DOI: 10.3390/pathogens13010035] [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: 10/18/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Animal models are essential for studying disease pathogenesis and to test the efficacy and safety of new vaccines and therapeutics. For most diseases, there is no single model that can recapitulate all features of the human condition, so it is vital to understand the advantages and disadvantages of each. The purpose of this review is to describe popular comparative animal models, including mice, ferrets, hamsters, and non-human primates (NHPs), that are being used to study clinical and pathological changes caused by influenza A virus infection with the aim to aid in appropriate model selection for disease modeling.
Collapse
Affiliation(s)
| | | | - Hinh Ly
- Department of Veterinary & Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Twin Cities, MN 55108, USA; (N.M.K.); (Y.L.)
| |
Collapse
|
13
|
Ahmed W, Feng J, Zhang Y, Chen L. SARS-CoV-2 and Brain Health: New Challenges in the Era of the Pandemic. Microorganisms 2023; 11:2511. [PMID: 37894169 PMCID: PMC10609574 DOI: 10.3390/microorganisms11102511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Respiratory viral infections have been found to have a negative impact on neurological functions, potentially leading to significant neurological impairment. The SARS-CoV-2 virus has precipitated a worldwide pandemic, posing a substantial threat to human lives. Growing evidence suggests that SARS-CoV-2 may severely affect the CNS and respiratory system. The current prevalence of clinical neurological issues associated with SARS-CoV-2 has raised significant concerns. However, there needs to be a more comprehensive understanding of the specific pathways by which SARS-CoV-2 enters the nervous system. Based on the available evidence, this review focuses on the clinical neurological manifestations of SARS-CoV-2 and the possible mechanisms by which SARS-CoV-2 invades the brain.
Collapse
Affiliation(s)
- Waqas Ahmed
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Jia Feng
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Yifan Zhang
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
| | - Lukui Chen
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
| |
Collapse
|
14
|
Seasonal Trends in the Prevalence and Incidence of Viral Encephalitis in Korea (2015-2019). J Clin Med 2023; 12:jcm12052003. [PMID: 36902789 PMCID: PMC10003849 DOI: 10.3390/jcm12052003] [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: 02/16/2023] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Viral infections are a common cause of encephalitis. This study investigated the relationship between the incidence of encephalitis and that of respiratory and enteric viral infections in all age groups from 2015 to 2019, using the Health Insurance Review and Assessment (HIRA) Open Access Big Data Platform. We identified monthly incidence patterns and seasonal trends using the autoregressive integrated moving average (ARIMA). The Granger causality test was used to analyze correlations between encephalitis incidence and the positive detection rate (PDR) at 1-month intervals. A total of 42,775 patients were diagnosed with encephalitis during the study period. The incidence of encephalitis was highest in the winter (26.8%). The PDRs for respiratory syncytial virus (HRSV) and coronavirus (HCoV) were associated with the trend in encephalitis diagnosis in all age groups, with a 1-month lag period. In addition, an association with norovirus was observed in patients aged over 20 years, and with influenza virus (IFV) in patients aged over 60 years. This study found that HRSV, HCoV, IFV, and norovirus tended to precede encephalitis by 1 month. Further research is required to confirm the association between these viruses and encephalitis.
Collapse
|
15
|
Reddy MK, Ca J, Kandi V, Murthy PM, Harikrishna GV, Reddy S, Gr M, Sam K, Challa ST. Exploring the Correlation Between Influenza A Virus (H3N2) Infections and Neurological Manifestations: A Scoping Review. Cureus 2023; 15:e36936. [PMID: 37139284 PMCID: PMC10151103 DOI: 10.7759/cureus.36936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Influenza A virus (IAV), particularly the H3N2 variant, is known to cause respiratory manifestations, but it can also lead to neurological complications ranging from mild symptoms like headache and dizziness to severe conditions such as encephalitis and acute necrotizing encephalopathy (ANE). In this article, the correlation between the H3N2 variant of the IAV and neurological manifestations is discussed. Additionally, prompt recognition and treatment of influenza-associated neurological manifestations are highlighted to prevent infection-related long-term complications. This review briefly discusses various neurological complications linked to IAV infections, such as encephalitis, febrile convulsions, and acute disseminated encephalomyelitis, and the potential mechanisms involved in the development of neurological complications.
Collapse
Affiliation(s)
- Mithun K Reddy
- Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Jayashankar Ca
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Venkataramana Kandi
- Clinical Microbiology, Prathima Institute of Medical Sciences, Karimnagar, IND
| | - Pooja M Murthy
- Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | | | - Snigdha Reddy
- General Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Manish Gr
- General Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Koshy Sam
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Sai Teja Challa
- General Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| |
Collapse
|
16
|
Zhang J. Investigating neurological symptoms of infectious diseases like COVID-19 leading to a deeper understanding of neurodegenerative disorders such as Parkinson's disease. Front Neurol 2022; 13:968193. [PMID: 36570463 PMCID: PMC9768197 DOI: 10.3389/fneur.2022.968193] [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: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 12/12/2022] Open
Abstract
Apart from common respiratory symptoms, neurological symptoms are prevalent among patients with COVID-19. Research has shown that infection with SARS-CoV-2 accelerated alpha-synuclein aggregation, induced Lewy-body-like pathology, caused dopaminergic neuron senescence, and worsened symptoms in patients with Parkinson's disease (PD). In addition, SARS-CoV-2 infection can induce neuroinflammation and facilitate subsequent neurodegeneration in long COVID, and increase individual vulnerability to PD or parkinsonism. These findings suggest that a post-COVID-19 parkinsonism might follow the COVID-19 pandemic. In order to prevent a possible post-COVID-19 parkinsonism, this paper reviewed neurological symptoms and related findings of COVID-19 and related infectious diseases (influenza and prion disease) and neurodegenerative disorders (Alzheimer's disease, PD and amyotrophic lateral sclerosis), and discussed potential mechanisms underlying the neurological symptoms and the relationship between the infectious diseases and the neurodegenerative disorders, as well as the therapeutic and preventive implications in the neurodegenerative disorders. Infections with a relay of microbes (SARS-CoV-2, influenza A viruses, gut bacteria, etc.) and prion-like alpha-synuclein proteins over time may synergize to induce PD. Therefore, a systematic approach that targets these pathogens and the pathogen-induced neuroinflammation and neurodegeneration may provide cures for neurodegenerative disorders. Further, antiviral/antimicrobial drugs, vaccines, immunotherapies and new therapies (e.g., stem cell therapy) need to work together to treat, manage or prevent these disorders. As medical science and technology advances, it is anticipated that better vaccines for SARS-CoV-2 variants, new antiviral/antimicrobial drugs, effective immunotherapies (alpha-synuclein antibodies, vaccines for PD or parkinsonism, etc.), as well as new therapies will be developed and made available in the near future, which will help prevent a possible post-COVID-19 parkinsonism in the 21st century.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
17
|
Hernandez R, Ota R, Medina Y, Hernandez Y, Julayanont P, Wilms H. Acute necrotizing encephalopathy. Proc AMIA Symp 2022; 35:725-727. [DOI: 10.1080/08998280.2022.2086781] [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] Open
Affiliation(s)
- Roberto Hernandez
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Richi Ota
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Yasier Medina
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Yaimara Hernandez
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Parunyou Julayanont
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Henrik Wilms
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| |
Collapse
|
18
|
Whitlock F, Murcia PR, Newton JR. A Review on Equine Influenza from a Human Influenza Perspective. Viruses 2022; 14:v14061312. [PMID: 35746783 PMCID: PMC9229935 DOI: 10.3390/v14061312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
Influenza A viruses (IAVs) have a main natural reservoir in wild birds. IAVs are highly contagious, continually evolve, and have a wide host range that includes various mammalian species including horses, pigs, and humans. Furthering our understanding of host-pathogen interactions and cross-species transmissions is therefore essential. This review focuses on what is known regarding equine influenza virus (EIV) virology, pathogenesis, immune responses, clinical aspects, epidemiology (including factors contributing to local, national, and international transmission), surveillance, and preventive measures such as vaccines. We compare EIV and human influenza viruses and discuss parallels that can be drawn between them. We highlight differences in evolutionary rates between EIV and human IAVs, their impact on antigenic drift, and vaccine strain updates. We also describe the approaches used for the control of equine influenza (EI), which originated from those used in the human field, including surveillance networks and virological analysis methods. Finally, as vaccination in both species remains the cornerstone of disease mitigation, vaccine technologies and vaccination strategies against influenza in horses and humans are compared and discussed.
Collapse
Affiliation(s)
- Fleur Whitlock
- Medical Research Council, University of Glasgow Centre for Virus Research, Garscube Estate, Glasgow G61 1QH, UK; (F.W.); (P.R.M.)
- Equine Infectious Disease Surveillance (EIDS), Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Pablo R. Murcia
- Medical Research Council, University of Glasgow Centre for Virus Research, Garscube Estate, Glasgow G61 1QH, UK; (F.W.); (P.R.M.)
| | - J. Richard Newton
- Equine Infectious Disease Surveillance (EIDS), Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
- Correspondence:
| |
Collapse
|
19
|
Bohmwald K, Andrade CA, Gálvez NMS, Mora VP, Muñoz JT, Kalergis AM. The Causes and Long-Term Consequences of Viral Encephalitis. Front Cell Neurosci 2021; 15:755875. [PMID: 34916908 PMCID: PMC8668867 DOI: 10.3389/fncel.2021.755875] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Reports regarding brain inflammation, known as encephalitis, have shown an increasing frequency during the past years. Encephalitis is a relevant concern to public health due to its high morbidity and mortality. Infectious or autoimmune diseases are the most common cause of encephalitis. The clinical symptoms of this pathology can vary depending on the brain zone affected, with mild ones such as fever, headache, confusion, and stiff neck, or severe ones, such as seizures, weakness, hallucinations, and coma, among others. Encephalitis can affect individuals of all ages, but it is frequently observed in pediatric and elderly populations, and the most common causes are viral infections. Several viral agents have been described to induce encephalitis, such as arboviruses, rhabdoviruses, enteroviruses, herpesviruses, retroviruses, orthomyxoviruses, orthopneumovirus, and coronaviruses, among others. Once a neurotropic virus reaches the brain parenchyma, the resident cells such as neurons, astrocytes, and microglia, can be infected, promoting the secretion of pro-inflammatory molecules and the subsequent immune cell infiltration that leads to brain damage. After resolving the viral infection, the local immune response can remain active, contributing to long-term neuropsychiatric disorders, neurocognitive impairment, and degenerative diseases. In this article, we will discuss how viruses can reach the brain, the impact of viral encephalitis on brain function, and we will focus especially on the neurocognitive sequelae reported even after viral clearance.
Collapse
Affiliation(s)
- Karen Bohmwald
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina A Andrade
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás M S Gálvez
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valentina P Mora
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José T Muñoz
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
20
|
Xu H, Cai L, Hufnagel S, Cui Z. Intranasal vaccine: Factors to consider in research and development. Int J Pharm 2021; 609:121180. [PMID: 34637935 DOI: 10.1016/j.ijpharm.2021.121180] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023]
Abstract
Most existing vaccines for human use are administered by needle-based injection. Administering vaccines needle-free intranasally has numerous advantages over by needle-based injection, but there are only a few intranasal vaccines that are currently approved for human use, and all of them are live attenuated influenza virus vaccines. Clearly, there are immunological as well as non-immunological challenges that prevent vaccine developers from choosing the intranasal route of administration. We reviewed current approved intranasal vaccines and pipelines and described the target of intranasal vaccines, i.e. nose and lymphoid tissues in the nasal cavity. We then analyzed factors unique to intranasal vaccines that need to be considered when researching and developing new intranasal vaccines. We concluded that while the choice of vaccine formulations, mucoadhesives, mucosal and epithelial permeation enhancers, and ligands that target M-cells are important, safe and effective intranasal mucosal vaccine adjuvants are needed to successfully develop an intranasal vaccine that is not based on live-attenuated viruses or bacteria. Moreover, more effective intranasal vaccine application devices that can efficiently target a vaccine to lymphoid tissues in the nasal cavity as well as preclinical animal models that can better predict intranasal vaccine performance in clinical trials are needed to increase the success rate of intranasal vaccines in clinical trials.
Collapse
Affiliation(s)
- Haiyue Xu
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, United States
| | - Lucy Cai
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stephanie Hufnagel
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, United States
| | - Zhengrong Cui
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, United States.
| |
Collapse
|
21
|
Fatal case of simply influenza A (H3N2)-associated encephalitis in immunocompetent patient. Clin Neurol Neurosurg 2021; 210:106956. [PMID: 34583276 DOI: 10.1016/j.clineuro.2021.106956] [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: 08/10/2021] [Revised: 09/12/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
Influenza virus-associated encephalopathy/encephalitis is a rare entity in adults that can lead to severe neurological sequelae and even death. The clinical presentation can be quite diverse. This absence of a typical presentation along with the difficulty detecting the virus in the cerebrospinal fluid represents a diagnostic challenge. We present the case of a 79-year-old male with sudden onset of decreased consciousness and signs of right hemisphere damage. The presence of influenza A (H3N2) virus in respiratory sample along with compatible findings in cranial magnetic resonance led to the diagnosis. The patient died without responding to treatment with antivirals and immunomodulators and the anatomopathological study did not detect infectious agent. Early diagnostic suspicion is essential to establish adequate treatment and improve the prognosis.
Collapse
|
22
|
Barbosa-Silva MC, Lima MN, Battaglini D, Robba C, Pelosi P, Rocco PRM, Maron-Gutierrez T. Infectious disease-associated encephalopathies. Crit Care 2021; 25:236. [PMID: 34229735 PMCID: PMC8259088 DOI: 10.1186/s13054-021-03659-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Infectious diseases may affect brain function and cause encephalopathy even when the pathogen does not directly infect the central nervous system, known as infectious disease-associated encephalopathy. The systemic inflammatory process may result in neuroinflammation, with glial cell activation and increased levels of cytokines, reduced neurotrophic factors, blood-brain barrier dysfunction, neurotransmitter metabolism imbalances, and neurotoxicity, and behavioral and cognitive impairments often occur in the late course. Even though infectious disease-associated encephalopathies may cause devastating neurologic and cognitive deficits, the concept of infectious disease-associated encephalopathies is still under-investigated; knowledge of the underlying mechanisms, which may be distinct from those of encephalopathies of non-infectious cause, is still limited. In this review, we focus on the pathophysiology of encephalopathies associated with peripheral (sepsis, malaria, influenza, and COVID-19), emerging therapeutic strategies, and the role of neuroinflammation.
Collapse
Affiliation(s)
- Maria C Barbosa-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Maiara N Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Tatiana Maron-Gutierrez
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil.
- National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
23
|
Rockenschaub P, Hayward A, Shallcross L. Antibiotic Prescribing Before and After the Diagnosis of Comorbidity: A Cohort Study Using Primary Care Electronic Health Records. Clin Infect Dis 2021; 71:e50-e57. [PMID: 31631225 DOI: 10.1093/cid/ciz1016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Comorbidities such as diabetes and chronic obstructive pulmonary disease (COPD) increase patients' susceptibility to infections, but it is unclear how the onset of comorbidity impacts antibiotic use. We estimated rates of antibiotic use before and after diagnosis of comorbidity in primary care to identify opportunities for antibiotic stewardship. METHODS We analyzed UK primary care records from the Clinical Practice Research Datalink. Adults registered between 2008-2015 without prior comorbidity diagnoses were eligible for inclusion. Monthly adjusted rates of antibiotic prescribing were estimated for patients with new-onset stroke, coronary heart disease, heart failure, peripheral arterial disease, asthma, chronic kidney disease, diabetes, or COPD in the 12 months before and after diagnosis and for controls without comorbidity. RESULTS 106 540/1 071 943 (9.9%) eligible patients were diagnosed with comorbidity. Antibiotic prescribing rates increased 1.9- to 2.3-fold in the 4-9 months preceding diagnosis of asthma, heart failure, and COPD before declining to stable levels within 2 months after diagnosis. A less marked trend was seen for diabetes (rate ratio, 1.55; 95% confidence interval, 1.48-1.61). Prescribing rates for patients with vascular conditions increased immediately before diagnosis and remained 30%-39% higher than baseline afterwards. Rates of prescribing to controls increased by 17%-28% in the months just before and after consultation. CONCLUSIONS Antibiotic prescribing increased rapidly before diagnosis of conditions that present with respiratory symptoms (COPD, heart failure, asthma) and declined afterward. Onset of respiratory symptoms may be misdiagnosed as infection. Earlier diagnosis of these comorbidities could reduce avoidable antibiotic prescribing.
Collapse
Affiliation(s)
| | - Andrew Hayward
- Institute of Epidemiology & Healthcare, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
24
|
The role of antibody indexes in clinical virology. Clin Microbiol Infect 2021; 27:1207-1211. [PMID: 33813108 DOI: 10.1016/j.cmi.2021.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serological techniques are an essential part of the diagnostic tools used in clinical virology. Among these techniques, antibody indexes are not novel, but do require specific expertise. Their niche has expanded substantially in recent years due to increasing evidence of their performance to diagnose viral infections. OBJECTIVES This narrative review describes the background and clinical applications of antibody indexes. The first objective is to provide an overview of the theoretical background, insights for implementation, limitations and pitfalls. The second objective is to review the available evidence for the diagnostic performance, with a specific focus on viral encephalitis and uveitis. SOURCES A comprehensive literature search was performed in PubMed, including original studies and reviews, with no time limit on the studies included. The following search terms were used: antibody index, Goldmann-Witmer coefficient, Reibergram, viral encephalitis, viral uveitis, herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, rubella virus, measles virus, enterovirus, influenza virus, flaviviruses. CONTENT Antibody indexes can support the diagnosis of a spectrum of viral infections in immune privileged sites such as the central nervous system and the eye, through the demonstration of virus-specific intrathecal or intraocular antibody production. This is especially useful in situations where PCR has a lower positivity rate: infections with rapid viral clearance due to natural immunity or treatment and chronic stages of viral infections. IMPLICATIONS Antibody indexes expand the clinical microbiologist's diagnostic toolbox. Careful interpretation of the results of these assays is crucial and further standardization of methods is required to improve interchangeability of results between laboratories.
Collapse
|
25
|
Reis R, Adragão F, Parente C, Nunes I, Ramos A, Nabais I, Silva I. A Seasonal Cause of Encephalitis: Influenza Virus A (H3N1) Infection. Eur J Case Rep Intern Med 2021; 8:002336. [PMID: 33768079 DOI: 10.12890/2021_002336] [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: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/05/2022] Open
Abstract
Influenza virus infection can have a range of presentations, from asymptomatic to life-threatening disease. We present the case of a 57-year-old woman with a known history of schizophrenia (controlled with medication) who presented to our emergency department in a coma after experiencing a seizure. She had reported flu-like symptoms in the previous week, which evolved to dyspnoea and altered mental status culminating in seizures and coma. Influenza virus A (H3N1) was identified in the cerebrospinal fluid. Although a rare cause of encephalitis, the influenza virus should be considered in the differential diagnosis, especially during epidemics. LEARNING POINTS Influenza virus encephalitis should be considered in some specific settings, such as during pandemics or seasonal epidemics.Altered mental status in a patient with a history of mental disease may be easily dismissed as secondary to prior disease or medication.Although rare, extrapulmonary manifestations of influenza virus infection can be serious and fatal.
Collapse
Affiliation(s)
- Rúben Reis
- Internal Medicine Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Francisco Adragão
- Internal Medicine Department, Centro Hospitalar do Algarve, Algarve, Portugal
| | - Catarina Parente
- Internal Medicine Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Inês Nunes
- Intensive Care Unit, Hospital de Cascais, Cascais, Portugal
| | - Armindo Ramos
- Intensive Care Unit, Hospital de Cascais, Cascais, Portugal
| | - Inês Nabais
- Internal Medicine Department, Hospital de Cascais, Cascais, Portugal
| | - Isa Silva
- Internal Medicine Department, Hospital de Cascais, Cascais, Portugal
| |
Collapse
|
26
|
McEntire CRS, Song KW, McInnis RP, Rhee JY, Young M, Williams E, Wibecan LL, Nolan N, Nagy AM, Gluckstein J, Mukerji SS, Mateen FJ. Neurologic Manifestations of the World Health Organization's List of Pandemic and Epidemic Diseases. Front Neurol 2021; 12:634827. [PMID: 33692745 PMCID: PMC7937722 DOI: 10.3389/fneur.2021.634827] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
The World Health Organization (WHO) monitors the spread of diseases globally and maintains a list of diseases with epidemic or pandemic potential. Currently listed diseases include Chikungunya, cholera, Crimean-Congo hemorrhagic fever, Ebola virus disease, Hendra virus infection, influenza, Lassa fever, Marburg virus disease, Neisseria meningitis, MERS-CoV, monkeypox, Nipah virus infection, novel coronavirus (COVID-19), plague, Rift Valley fever, SARS, smallpox, tularemia, yellow fever, and Zika virus disease. The associated pathogens are increasingly important on the global stage. The majority of these diseases have neurological manifestations. Those with less frequent neurological manifestations may also have important consequences. This is highlighted now in particular through the ongoing COVID-19 pandemic and reinforces that pathogens with the potential to spread rapidly and widely, in spite of concerted global efforts, may affect the nervous system. We searched the scientific literature, dating from 1934 to August 2020, to compile data on the cause, epidemiology, clinical presentation, neuroimaging features, and treatment of each of the diseases of epidemic or pandemic potential as viewed through a neurologist's lens. We included articles with an abstract or full text in English in this topical and scoping review. Diseases with epidemic and pandemic potential can be spread directly from human to human, animal to human, via mosquitoes or other insects, or via environmental contamination. Manifestations include central neurologic conditions (meningitis, encephalitis, intraparenchymal hemorrhage, seizures), peripheral and cranial nerve syndromes (sensory neuropathy, sensorineural hearing loss, ophthalmoplegia), post-infectious syndromes (acute inflammatory polyneuropathy), and congenital syndromes (fetal microcephaly), among others. Some diseases have not been well-characterized from a neurological standpoint, but all have at least scattered case reports of neurological features. Some of the diseases have curative treatments available while in other cases, supportive care remains the only management option. Regardless of the pathogen, prompt, and aggressive measures to control the spread of these agents are the most important factors in lowering the overall morbidity and mortality they can cause.
Collapse
Affiliation(s)
- Caleb R. S. McEntire
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Kun-Wei Song
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Robert P. McInnis
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - John Y. Rhee
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Michael Young
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Erika Williams
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Leah L. Wibecan
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Neal Nolan
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Amanda M. Nagy
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Jeffrey Gluckstein
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Shibani S. Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
27
|
Pilotto A, Masciocchi S, Volonghi I, Crabbio M, Magni E, De Giuli V, Caprioli F, Rifino N, Sessa M, Gennuso M, Cotelli MS, Turla M, Balducci U, Mariotto S, Ferrari S, Ciccone A, Fiacco F, Imarisio A, Risi B, Benussi A, Premi E, Focà E, Caccuri F, Leonardi M, Gasparotti R, Castelli F, Zanusso G, Pezzini A, Padovani A. Clinical Presentation and Outcomes of Severe Acute Respiratory Syndrome Coronavirus 2-Related Encephalitis: The ENCOVID Multicenter Study. J Infect Dis 2021; 223:28-37. [PMID: 32986824 PMCID: PMC7543535 DOI: 10.1093/infdis/jiaa609] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. Some sparse case reports have described various forms of encephalitis in COVID-19 disease, but very few data have focused on clinical presentations, clinical course, response to treatment and outcomes. Methods The ENCOVID multicentre study included patients with encephalitis with full infectious screening, CSF, EEG, MRI data and confirmed SARS-CoV-2 infection recruited from 13 centres in northern Italy. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results twenty-five cases of encephalitis positive for SARS-CoV-2 infection were included. CSF showed hyperproteinorrachia and/or pleocytosis in 68% of cases whereas SARS-CoV-2 RNA by RT-PCR resulted negative. Based on MRI, cases were classified as ADEM (n=3), limbic encephalitis (LE, n=2), encephalitis with normal imaging (n=13) and encephalitis with MRI alterations (n=7). ADEM and LE cases showed a delayed onset compared to the other encephalitis (p=0.001) and were associated with previous more severe COVID-19 respiratory involvement. Patients with MRI alterations exhibited worse response to treatment and final outcomes compared to other encephalitis. Conclusions SARS-CoV-2 infection is associated with a wide spectrum of encephalitis characterized by different clinical presentation, response to treatment and outcomes.
Collapse
Affiliation(s)
- Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, Fondazione Europea Ricerca Biomedica ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy
| | - Stefano Masciocchi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Irene Volonghi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Eugenio Magni
- Neurology Unit, Poliambulanza Hospital, Brescia, Italy
| | - Valeria De Giuli
- Neurology Unit, Istituti Ospedalieri, Azienda Socio Sanitaria Teritoriale di Cremona, Cremona, Italy
| | - Francesca Caprioli
- Neurology Unit, Istituti Ospedalieri, Azienda Socio Sanitaria Teritoriale di Cremona, Cremona, Italy
| | - Nicola Rifino
- Department of Neurology, Azienda Socio Sanitaria Teritoriale di Papa Giovanni XXII, Bergamo, Italy
| | - Maria Sessa
- Department of Neurology, Azienda Socio Sanitaria Teritoriale di Papa Giovanni XXII, Bergamo, Italy
| | | | - Maria Sofia Cotelli
- Neurology Unit, Azienda Socio Sanitaria Teritoriale della Valcamonica, Esine, Brescia, Italy
| | - Marinella Turla
- Neurology Unit, Azienda Socio Sanitaria Teritoriale della Valcamonica, Esine, Brescia, Italy
| | - Ubaldo Balducci
- Neurology Unit, Azienda Socio Sanitaria Teritoriale di Chiari, Chiari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alfonso Ciccone
- Department of Neurology and Stroke Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Teritoriale di Mantova, Mantova, Italy
| | - Fabrizio Fiacco
- Neurology Unit, Azienda Socio Sanitaria Teritoriale di Bergamo Est, Seriate, Italy
| | - Alberto Imarisio
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Risi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enrico Premi
- Stroke Unit, Azienda Socio Sanitaria Teritoriale Spedali Civili di Brescia, Rescia, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia and Azienda Socio Sanitaria Teritoriale di Spedali Civili Hospital, Brescia, Italy
| | - Francesca Caccuri
- Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia and Azienda Socio Sanitaria Teritoriale di Spedali Civili Hospital, Brescia, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Istituto di Ricerca e Cura a Carattere Scientifico Neurology Institute Besta, Milan, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Azienda Socio Sanitaria Teritoriale di Spedali Civili Hospital, Brescia, Italy
| | - Gianluigi Zanusso
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Pezzini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | |
Collapse
|
28
|
Roth T, DiPrinzio D, Fisher JD. Rapid and severe neurologic deterioration due to influenza associated encephalopathy in a healthy child. Am J Emerg Med 2021; 45:687.e1-687.e2. [PMID: 33422405 DOI: 10.1016/j.ajem.2020.12.081] [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: 11/11/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
Rapid neurologic deterioration is rare in healthy school age children, particularly in the absence of trauma or toxic exposure. Hemorrhagic or ischemic stroke, infectious etiologies and metabolic causes must be emergently considered. We present the clinical details of a previously well child with two days of mild viral symptoms who progressed from playful and active to severe neurologic injury over the course of eight hours.
Collapse
Affiliation(s)
- Taylor Roth
- Children's Hospital of Nevada at UMC, 800 Hope Pl, Las Vegas, NV 89106, USA; University of Nevada, Las Vegas Emergency Medicine Residency, 901 Rancho Lane, Ste 135, Las Vegas, NV 89106, United States of America.
| | - Dominic DiPrinzio
- Children's Hospital of Nevada at UMC, 800 Hope Pl, Las Vegas, NV 89106, USA; University of Nevada, Las Vegas Emergency Medicine Residency, 901 Rancho Lane, Ste 135, Las Vegas, NV 89106, United States of America.
| | - Jay D Fisher
- Children's Hospital of Nevada at UMC, 800 Hope Pl, Las Vegas, NV 89106, USA; University of Nevada, Las Vegas Emergency Medicine Residency, 901 Rancho Lane, Ste 135, Las Vegas, NV 89106, United States of America.
| |
Collapse
|
29
|
Radzišauskienė D, Vitkauskaitė M, Žvinytė K, Mameniškienė R. Neurological complications of pandemic A(H1N1)2009pdm, postpandemic A(H1N1)v, and seasonal influenza A. Brain Behav 2021; 11:e01916. [PMID: 33155427 PMCID: PMC7821618 DOI: 10.1002/brb3.1916] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Not much is known about influenza-associated neurological complications. We aimed to describe the case series of hospitalized patients who were confirmed with influenza A and presented with neurological symptoms in order to capture the broad spectrum of influenza clinical manifestation and suggest including influenza diagnostic in some neurological conditions. MATERIALS AND METHODS The inclusion criteria were age ≥ 18 and laboratory-confirmed influenza presenting with neurological symptoms. Influenza-associated neurological complication was described as a development of neurological symptom with no other origin. The outcomes were classified into 5 categories: 1. recovery with no significant disability; 2. minor disability (able to manage on their own); 3. moderate disability (requiring some help but able to walk without assistance); 4. severe disability (unable to walk without assistance and perform daily activities); 5. death. RESULTS In total, 12 patients (five women and seven men) were enrolled, with age range 18-71 years old. Neurological complications of pandemic A(H1 N1 )2009pdm influenza developed in seven out of 69 (10.1%) hospitalized patients. The most common neurological complication was encephalopathy. Neurological complications developed in two out of 24 (8.3%) hospitalized patients during postpandemic (H1 N1 )V period. One patient presented with encephalopathy, another with meningoencephalitis. During the 2018 influenza season, there was one patient who has developed influenza A neurological complications. Overall, two out of 104 (1.9%) influenza A patients developed influenza-associated neurological complications in 2019. CONCLUSIONS Every patient with unexplained neurological symptoms and signs similar to aseptic and septic meningitis/encephalitis has to be tested for influenza virus during epidemics and pandemics.
Collapse
Affiliation(s)
- Daiva Radzišauskienė
- Department of Infectious Diseases and Dermatovenerology, Vilnius University, Vilnius, Lithuania
| | | | | | - Rūta Mameniškienė
- Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
30
|
Ahn SJ, Moon J, Sunwoo JS, Jun JS, Lee ST, Park KI, Jung KH, Jung KY, Kim M, Lee SK, Chu K. Respiratory virus-related meningoencephalitis in adults. ENCEPHALITIS 2021; 1:14-19. [PMID: 37492493 PMCID: PMC10295871 DOI: 10.47936/encephalitis.2020.00052] [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: 11/08/2020] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 07/27/2023] Open
Abstract
Purpose Respiratory viruses (RVs) are pathogens that can cause central nervous system (CNS) infection, but previous research has been limited to a pediatric population. In recent years, several cases of adult RV meningoencephalitis have begun to be reported. We decided to research the CNS infection of RV in the entire neuroinfection registry. Methods We retrospectively reviewed the neurologic infection registry of Seoul National University (Seoul, Korea). Among a total of 661 patients in the registry, 10 adult patients were diagnosed with RV-related meningoencephalitis on RV multiplex polymerase chain reaction (PCR) screening test. We analyzed the clinical presentation, laboratory findings, and clinical course of the 10 patients. Results Three patients were definite RV meningoencephalitis who had positive PCR results from cerebrospinal fluid. The other seven patients were diagnosed with probable RV meningoencephalitis if they had positive PCR results in the sputum and negative results in other extensive workup. Conclusion RV-related meningoencephalitis should be considered a possible etiology in adult meningoencephalitis patients. To diagnose these viruses, screening test of RV PCR is recommended even in patients without upper respiratory infection symptoms.
Collapse
Affiliation(s)
- Seon-Jae Ahn
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Jun-Sang Sunwoo
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
31
|
Dumm RE, Wellford SA, Moseman EA, Heaton NS. Heterogeneity of Antiviral Responses in the Upper Respiratory Tract Mediates Differential Non-lytic Clearance of Influenza Viruses. Cell Rep 2020; 32:108103. [PMID: 32877682 PMCID: PMC7462569 DOI: 10.1016/j.celrep.2020.108103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/01/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023] Open
Abstract
Influenza viruses initiate infection in the upper respiratory tract (URT), but early viral tropism and the importance of cell-type-specific antiviral responses in this tissue remain incompletely understood. By infecting transgenic lox-stop-lox reporter mice with a Cre-recombinase-expressing influenza B virus, we identify olfactory sensory neurons (OSNs) as a major viral cell target in the URT. These cells become infected, then eliminate the virus and survive in the host post-resolution of infection. OSN responses to infection are characterized by a strong induction of interferon-stimulated genes and more rapid clearance of viral protein relative to other cells in the epithelium. We speculate that this cell-type-specific response likely serves to protect the central nervous system from infection. More broadly, these results highlight the importance of evaluating antiviral responses across different cell types, even those within the same tissue, to more fully understand the mechanisms of viral disease.
Collapse
Affiliation(s)
- Rebekah E Dumm
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sebastian A Wellford
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710, USA
| | - E Ashley Moseman
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Nicholas S Heaton
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA; Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA.
| |
Collapse
|
32
|
Koll K, Willinger S, Urlesberger K, Pirker W. Acute amnestic syndrome with hippocampal lesion due to influenza B-associated encephalopathy. Wien Klin Wochenschr 2020; 132:542-544. [PMID: 32778968 DOI: 10.1007/s00508-020-01721-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
Acute encephalopathy is a rare complication of influenza, particularly in adults. We report the case of a 77-year-old woman presenting with complete anterograde and significant retrograde amnesia developing during an influenza B infection. Cranial magnetic resonance imaging (MRI) showed hippocampal lesions including restricted diffusion during the acute phase. Symptoms partially improved following treatment with intravenous methylprednisolone and immunoglobulins but an amnesic syndrome persisted. We discuss possible causes of neurological complications in influenza infections.
Collapse
Affiliation(s)
- Kitty Koll
- Department of Neurology, Klinik Ottakring - Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Susanne Willinger
- Department of Radiology, Klinik Ottakring - Wilhelminenspital, Vienna, Austria
| | - Karoline Urlesberger
- Department of Neurology, Klinik Ottakring - Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Klinik Ottakring - Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria.
| |
Collapse
|
33
|
Mylonaki E, Harrer A, Pilz G, Stalzer P, Otto F, Trinka E, Wipfler P. Neurological complications associated with influenza in season 2017/18 in Austria- a retrospective single center study. J Clin Virol 2020; 127:104340. [PMID: 32302952 DOI: 10.1016/j.jcv.2020.104340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/12/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurological complications associated with influenza (NCI) are rare events in adults with seasonal influenza. Information about the characteristics of neurological complications and the burden of disease has been limited to case reports, mainly during the pandemic 2009. Influenza-associated encephalopathy/encephalitis (IAE) is one of the most severe and frequently reported NCI, mostly caused by influenza A. Isolated case reports exist about NCI caused by influenza B. OBJECTIVES The aim of this single center retrospective study is the better understanding of the frequency and the characteristics of NCI in adults in season 2017-2018, depending on the influenza subtype A or B. STUDY DESIGN We reviewed 874 adult patients with laboratory confirmed influenza admitted to the Christian Doppler University Hospital Salzburg, Austria from December 2017 until March 2018 looking for NCI. RESULTS 37 (4 %) of the 874 patients with confirmed influenza had NCI. 4 (11 %) had influenza A and 33 (89 %) had influenza B. IAE was the most frequent complication diagnosed in 24 (65 %) patients, of whom all but one had influenza B and 3 (13 %) had neurological residuals. Moreover 6 (16 %) had isolated epileptic seizures, 2 (5 %) had acute inflammatory demyelinating polyneuropathy (AIDP), and 5 (14 %) were classified as having infection-associated stroke. CONCLUSIONS We report an incidence of 4 % for NCI and a high frequency of IAE caused by subtype B. Therefore, we recommend considering both influenza A and B as an etiologic factor of encephalopathy and other neurological disease in adults.
Collapse
Affiliation(s)
- Eirini Mylonaki
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria.
| | - Andrea Harrer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| | - Patrick Stalzer
- Department of Infection Control and Hospital Epidemiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Ferdinand Otto
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria; Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Peter Wipfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| |
Collapse
|
34
|
Abdelrahman HS, Safwat AM, Alsagheir MM. Acute necrotizing encephalopathy in an adult as a complication of H1N1 infection. BJR Case Rep 2019; 5:20190028. [PMID: 31938561 PMCID: PMC6945259 DOI: 10.1259/bjrcr.20190028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 01/29/2023] Open
Abstract
Acute necrotizing encephalitis is one of the recognized influenza-associated encephalopathies which has a characteristic multifocal symmetric involvement of the thalami bilaterally with only very few cases were reported in adults. We present a case of a young adult female who was presented with post-H1N1 Acute Necrotizing Encephalopathy with full neurological recovery after proper clinicoradiological diagnosis and rapid treatment with steroids and intravenous immunoglobulins.
Collapse
Affiliation(s)
- Heba S Abdelrahman
- Radiology department, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Safwat
- Neurology department, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Mahmoud M Alsagheir
- Anesthesia and intensive care department, Faculty of medicine, AL-Azhar University, Cairo, Egypt
| |
Collapse
|
35
|
Demailly Z, Derrey S, Gueit I, Caron F, Baron A, Dureuil B, Braud H, Gilard V. External ventricular drainage for intracranial hypertension syndrome complicating influenza-associated encephalitis. Neurochirurgie 2019; 66:70-71. [PMID: 31634506 DOI: 10.1016/j.neuchi.2019.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Z Demailly
- Department of Anesthesia and Intensive Care, Rouen University Hospital, 76000 Rouen, France.
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital, 76000 Rouen, France
| | - I Gueit
- Department of Infectious and Tropical Diseases, Rouen University Hospital, 76000 Rouen, France
| | - F Caron
- Department of Infectious and Tropical Diseases, Rouen University Hospital, 76000 Rouen, France
| | - A Baron
- Microbiology Laboratory, Rouen University Hospital, 76000 Rouen, France
| | - B Dureuil
- Department of Anesthesia and Intensive Care, Rouen University Hospital, 76000 Rouen, France
| | - H Braud
- Department of Anesthesia and Intensive Care, Rouen University Hospital, 76000 Rouen, France
| | - V Gilard
- Department of Neurosurgery, Rouen University Hospital, 76000 Rouen, France
| |
Collapse
|
36
|
Cantan B, Luyt CE, Martin-Loeches I. Influenza Infections and Emergent Viral Infections in Intensive Care Unit. Semin Respir Crit Care Med 2019; 40:488-497. [PMID: 31585475 PMCID: PMC7117087 DOI: 10.1055/s-0039-1693497] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Critically ill patients are admitted to an intensive care unit (ICU) for multiple reasons. In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs with viral infections is on the rise. Patients in whom an etiology would not have been identified in the past are currently being tested with more sensitive viral molecular diagnostic tools, and patients being admitted to ICUs have more preexisting medical conditions that can predispose to viral infections. Viral infections can trigger the dysregulation of the immune system by inducing a massive cytokine response. This cytokine storm can cause endothelial damage and dysfunction, deregulation of coagulation, and, consequently, alteration of microvascular permeability, tissue edema, and shock. In severe influenza, this vascular hyperpermeability can lead to acute lung injury, multiorgan failure, and encephalopathy. In immunocompetent patients, the most common viral infections are respiratory, and influenza should be considered in patients with severe respiratory failure being admitted to ICU. Seasonality and coinfection are two important features when considering influenza as a pathogen in critically ill patients. Herpesviridae (HSV, CMV, and EBV) may reactivate in ICU patients, and their reactivation is associated with morbidity/mortality. However, whether a specific treatment may impact on outcome remains to be determined.
Collapse
Affiliation(s)
- Ben Cantan
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University (Paris 6), Paris, France.,INSERM, UMRS 1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.,Department of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER), University of Barcelona, Barcelona, Spain
| |
Collapse
|
37
|
Puppala GK, Prabhu AN, Gorthi SP, Chandran V. Acute Influenza A Virus-Associated Encephalitis with Bilateral Lateral Geniculate Body Hemorrhagic Infarction-Complicating Pregnancy. Ann Indian Acad Neurol 2019; 22:355-357. [PMID: 31359962 PMCID: PMC6613422 DOI: 10.4103/aian.aian_319_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Goutham Kumar Puppala
- Department of Neurology, Kasturba Hospital, Kasturba Medical College, Mahe, Manipal, Karnataka, India
| | - Arvind N Prabhu
- Department of Neurology, Kasturba Hospital, Kasturba Medical College, Mahe, Manipal, Karnataka, India
| | - Shankar Prasad Gorthi
- Department of Neurology, Kasturba Hospital, Kasturba Medical College, Mahe, Manipal, Karnataka, India
| | - Vijay Chandran
- Department of Neurology, Kasturba Hospital, Kasturba Medical College, Mahe, Manipal, Karnataka, India
| |
Collapse
|
38
|
Yuan HT, Ho TH, Lee JT, Chen PC, Wang CW, Yang FC. Simply influenza A (H3N2)-associated encephalitis with seizure. Am J Emerg Med 2019; 37:1808.e1-1808.e3. [PMID: 31230923 DOI: 10.1016/j.ajem.2019.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/15/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022] Open
Abstract
Influenza-associated acute encephalopathy (IAE) is more prevalent in children than in adults and often results in neurological sequelae or even death. Diagnosis of IAE is difficult as clinical presentation varies significantly and the influenza virus is rarely detected in cerebrospinal fluid. Moreover, seizures in adults due to influenza infection are rare. Herein, we describe the case of an adult presenting with both acute encephalitis and seizures. A 38-year-old female was admitted to the emergency department with acute respiratory symptoms and fever, followed by quick progression to stupor within 24 h. A rapid antigen test was influenza A-positive, and polymerase chain reaction of nasal secretions confirmed the H3N2 subtype. Brain magnetic resonance imaging showed bilateral water restriction lesions at the thalamus and the cerebellum and an electroencephalogram showed frequent episodic generalized sharp-and-slow waves over the bilateral frontal region. Based on the neuroimaging and laboratory findings, we diagnosed the patient with adult influenza A (H3N2)-related encephalitis complicated by seizure. Treatment with oseltamivir and anticonvulsants led to complete neurologic recovery by day 14. This report describes two unusual neurological manifestations of influenza A, i.e., encephalitis and seizures, in an adult. We emphasize that, in adults presenting with acute viral encephalitis, clinicians should consider influenza infection as part of the differential diagnosis, and that typical neuroimaging in conjunction with laboratory detection of influenza virus and/or intrathecal antibody production suggestive of IAE, may help establish an accurate diagnosis.
Collapse
Affiliation(s)
- Hao-Tang Yuan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan; Division of Neurology, Department of Internal Medicine, Tri-Service General Hospital Sungsan Branch, National Defense Medical Center, No.131, Jiankang Road, Songshan 104, Taipei, Taiwan
| | - Tsung-Han Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Po-Chuan Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chih-Wei Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| |
Collapse
|
39
|
Klein RS, Garber C, Funk KE, Salimi H, Soung A, Kanmogne M, Manivasagam S, Agner S, Cain M. Neuroinflammation During RNA Viral Infections. Annu Rev Immunol 2019; 37:73-95. [PMID: 31026414 PMCID: PMC6731125 DOI: 10.1146/annurev-immunol-042718-041417] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neurotropic RNA viruses continue to emerge and are increasingly linked to diseases of the central nervous system (CNS) despite viral clearance. Indeed, the overall mortality of viral encephalitis in immunocompetent individuals is low, suggesting efficient mechanisms of virologic control within the CNS. Both immune and neural cells participate in this process, which requires extensive innate immune signaling between resident and infiltrating cells, including microglia and monocytes, that regulate the effector functions of antiviral T and B cells as they gain access to CNS compartments. While these interactions promote viral clearance via mainly neuroprotective mechanisms, they may also promote neuropathology and, in some cases, induce persistent alterations in CNS physiology and function that manifest as neurologic and psychiatric diseases. This review discusses mechanisms of RNA virus clearance and neurotoxicity during viral encephalitis with a focus on the cytokines essential for immune and neural cell inflammatory responses and interactions. Understanding neuroimmune communications in the setting of viral infections is essential for the development of treatments that augment neuroprotective processes while limiting ongoing immunopathological processes that cause ongoing CNS disease.
Collapse
Affiliation(s)
- Robyn S Klein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri 63110, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Charise Garber
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Kristen E Funk
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Hamid Salimi
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Allison Soung
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Marlene Kanmogne
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Sindhu Manivasagam
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Shannon Agner
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Matthew Cain
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| |
Collapse
|
40
|
González-Senac NM, Somoza Fernández G, García Alhambra MÁ. [Encephalopathy in an elderly patient after an influenza B flu diagnosis: A case report]. Rev Esp Geriatr Gerontol 2019; 54:121-122. [PMID: 30396784 DOI: 10.1016/j.regg.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/04/2018] [Accepted: 09/04/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Gema Somoza Fernández
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | |
Collapse
|
41
|
Chen CYJ, Virk A. 57-Year-Old Woman With Fever and Confusion. Mayo Clin Proc 2019; 94:145-148. [PMID: 30503028 DOI: 10.1016/j.mayocp.2018.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/12/2018] [Accepted: 03/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Chieh-Yu Joy Chen
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Abinash Virk
- Advisor to resident and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
42
|
Neuroinvasion of influenza A/H3N2: a fatal case in an immunocompetent adult. J Neurovirol 2018; 25:275-279. [DOI: 10.1007/s13365-018-0690-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/10/2018] [Accepted: 10/24/2018] [Indexed: 01/12/2023]
|
43
|
Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM. Neurologic Alterations Due to Respiratory Virus Infections. Front Cell Neurosci 2018; 12:386. [PMID: 30416428 PMCID: PMC6212673 DOI: 10.3389/fncel.2018.00386] [Citation(s) in RCA: 427] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/09/2018] [Indexed: 11/14/2022] Open
Abstract
Central Nervous System (CNS) infections are one of the most critical problems in public health, as frequently patients exhibit neurologic sequelae. Usually, CNS pathologies are caused by known neurotropic viruses such as measles virus (MV), herpes virus and human immunodeficiency virus (HIV), among others. However, nowadays respiratory viruses have placed themselves as relevant agents responsible for CNS pathologies. Among these neuropathological viruses are the human respiratory syncytial virus (hRSV), the influenza virus (IV), the coronavirus (CoV) and the human metapneumovirus (hMPV). These viral agents are leading causes of acute respiratory infections every year affecting mainly children under 5 years old and also the elderly. Up to date, several reports have described the association between respiratory viral infections with neurological symptoms. The most frequent clinical manifestations described in these patients are febrile or afebrile seizures, status epilepticus, encephalopathies and encephalitis. All these viruses have been found in cerebrospinal fluid (CSF), which suggests that all these pathogens, once in the lungs, can spread throughout the body and eventually reach the CNS. The current knowledge about the mechanisms and routes used by these neuro-invasive viruses remains scarce. In this review article, we describe the most recent findings associated to neurologic complications, along with data about the possible invasion routes of these viruses in humans and their various effects on the CNS, as studied in animal models.
Collapse
Affiliation(s)
- Karen Bohmwald
- Millennium Institute on Immunology and Immunotherapy (MIII), Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás M. S. Gálvez
- Millennium Institute on Immunology and Immunotherapy (MIII), Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariana Ríos
- Millennium Institute on Immunology and Immunotherapy (MIII), Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy (MIII), Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
44
|
Fox J, Barbour S, Junco SJ. Central nervous system laboratory-confirmed influenza meningo-encephalitis treated with peramivir. Int J Antimicrob Agents 2018; 52:517-518. [PMID: 30318059 DOI: 10.1016/j.ijantimicag.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 06/20/2018] [Accepted: 06/30/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Jarod Fox
- Division of Infectious Diseases, Orlando Regional Medical Center/Orlando Health, Orlando, FL, USA.
| | - Sarah Barbour
- Division of Infectious Diseases, Orlando Regional Medical Center/Orlando Health, Orlando, FL, USA
| | - Shauna Jacobson Junco
- Department of Pharmacy, Orlando Regional Medical Center/Orlando Health, Orlando, FL, USA
| |
Collapse
|
45
|
Yong CH, Vallat W, Norton G. Influenza B-related meningoencephalitis in adults. BMJ Case Rep 2018; 2018:bcr-2018-224960. [PMID: 29930187 PMCID: PMC6020884 DOI: 10.1136/bcr-2018-224960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 12/24/2022] Open
Abstract
We present a case involving an 85-year-old man with acute confusion and new onset seizure following a 1-week history of respiratory prodrome. This case report describes a case of influenza B-related meningoencephalitis supported by evidence of an influenza B infection and temporal relation of the neurological event and respiratory illness in the absence of other identifiable cause. Diagnosis is guided by cerebrospinal fluid profile and nasopharyngeal PCR. Treatment is largely supportive and the effect of vaccination on prevention of this neurological complication remains unclear.
Collapse
Affiliation(s)
- Chen Han Yong
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Wilson Vallat
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Graham Norton
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| |
Collapse
|
46
|
McKimm-Breschkin JL, Jiang S, Hui DS, Beigel JH, Govorkova EA, Lee N. Prevention and treatment of respiratory viral infections: Presentations on antivirals, traditional therapies and host-directed interventions at the 5th ISIRV Antiviral Group conference. Antiviral Res 2018; 149:118-142. [PMID: 29162476 PMCID: PMC7133686 DOI: 10.1016/j.antiviral.2017.11.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
The International Society for Influenza and other Respiratory Virus Diseases held its 5th Antiviral Group (isirv-AVG) Conference in Shanghai, China, in conjunction with the Shanghai Public Health Center and Fudan University from 14-16 June 2017. The three-day programme encompassed presentations on some of the clinical features, management, immune responses and virology of respiratory infections, including influenza A(H1N1)pdm09 and A(H7N9) viruses, MERS-CoV, SARS-CoV, adenovirus Type 80, enterovirus D68, metapneumovirus and respiratory syncytial virus (RSV). Updates were presented on several therapeutics currently in clinical trials, including influenza polymerase inhibitors pimodivir/JNJ6362387, S033188, favipiravir, monoclonal antibodies MHAA45449A and VIS410, and host directed strategies for influenza including nitazoxanide, and polymerase ALS-008112 and fusion inhibitors AK0529, GS-5806 for RSV. Updates were also given on the use of the currently licensed neuraminidase inhibitors. Given the location in China, there were also presentations on the use of Traditional Chinese Medicines. Following on from the previous conference, there were ongoing discussions on appropriate endpoints for severe influenza in clinical trials from regulators and clinicians, an issue which remains unresolved. The aim of this conference summary is to provide information for not only conference participants, but a detailed referenced review of the current status of clinical trials, and pre-clinical development of therapeutics and vaccines for influenza and other respiratory diseases for a broader audience.
Collapse
Affiliation(s)
| | - Shibo Jiang
- College of Basic Medical Sciences, Fudan University, Shanghai, China; Lindsley F. Kimball Research Institute, New York Blood Center, NY, USA
| | - David S Hui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - John H Beigel
- Leidos Biomedical Research, Inc., Support to National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elena A Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, USA
| | - Nelson Lee
- Faculty of Medicine and Dentistry, University of Alberta, Canada
| |
Collapse
|
47
|
Midha D, Kumar A, Vasudev P, Iqbal ZA, Mandal AK. Adult Influenza A (H1N1) Related Encephalitis: A Case Report. Indian J Crit Care Med 2018; 22:384-387. [PMID: 29910555 PMCID: PMC5971654 DOI: 10.4103/ijccm.ijccm_344_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The year 2009–2010 saw H1N1 influenza outbreaks occurring in almost all countries of the world, causing the WHO to declare it a pandemic of an alert level of 6. In India, H1N1 influenza outbreaks were again reported in late 2014 and early 2015. Since then, sporadic cases of H1N1 influenza have been reported. H1N1 influenza usually presents itself with respiratory tract symptoms. In a minority of patients, abdominal symptoms may occur as well. Acute influenza-associated encephalopathy/encephalitis mostly occurs in the pediatric population, whereas in adults, it is a rare complication. The incidence of neurological complications appears to have increased after the 2009 H1N1 influenza A virus pandemic. We would like to draw attention to an adult patient case who initially presented with respiratory symptoms but then deteriorated and developed encephalitis, which is rarely reported. As per literature reviewed by Victoria Bangualid and Judith Berger on PubMed, only 21 cases of neurological complications were found in adult influenza A patients, out of whom 8 had encephalopathy.
Collapse
Affiliation(s)
- Devinder Midha
- Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
| | - Arun Kumar
- Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
| | - Pratibha Vasudev
- Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
| | - Zafar Ahmad Iqbal
- Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
| | - Amit Kumar Mandal
- Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
| |
Collapse
|