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Srichawla BS, Manan MR, Kipkorir V, Dhali A, Diebel S, Sawant T, Zia S, Carrion-Alvarez D, Suteja RC, Nurani K, Găman MA. Neuroinvasion of emerging and re-emerging arboviruses: A scoping review. SAGE Open Med 2024; 12:20503121241229847. [PMID: 38711470 PMCID: PMC11072077 DOI: 10.1177/20503121241229847] [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: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 05/08/2024] Open
Abstract
Background Arboviruses are RNA viruses and some have the potential to cause neuroinvasive disease and are a growing threat to global health. Objectives Our objective is to identify and map all aspects of arbovirus neuroinvasive disease, clarify key concepts, and identify gaps within our knowledge with appropriate future directions related to the improvement of global health. Methods Sources of Evidence: A scoping review of the literature was conducted using PubMed, Scopus, ScienceDirect, and Hinari. Eligibility Criteria: Original data including epidemiology, risk factors, neurological manifestations, neuro-diagnostics, management, and preventive measures related to neuroinvasive arbovirus infections was obtained. Sources of evidence not reporting on original data, non-English, and not in peer-reviewed journals were removed. Charting Methods: An initial pilot sample of 30 abstracts were reviewed by all authors and a Cohen's kappa of κ = 0.81 (near-perfect agreement) was obtained. Records were manually reviewed by two authors using the Rayyan QCRI software. Results A total of 171 records were included. A wide array of neurological manifestations can occur most frequently, including parkinsonism, encephalitis/encephalopathy, meningitis, flaccid myelitis, and Guillain-Barré syndrome. Magnetic resonance imaging of the brain often reveals subcortical lesions, sometimes with diffusion restriction consistent with acute ischemia. Vertical transmission of arbovirus is most often secondary to the Zika virus. Neurological manifestations of congenital Zika syndrome, include microcephaly, failure to thrive, intellectual disability, and seizures. Cerebrospinal fluid analysis often shows lymphocytic pleocytosis, elevated albumin, and protein consistent with blood-brain barrier dysfunction. Conclusions Arbovirus infection with neurological manifestations leads to increased morbidity and mortality. Risk factors for disease include living and traveling in an arbovirus endemic zone, age, pregnancy, and immunosuppressed status. The management of neuroinvasive arbovirus disease is largely supportive and focuses on specific neurological complications. There is a need for therapeutics and currently, management is based on disease prevention and limiting zoonosis.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Arkadeep Dhali
- Department of Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sebastian Diebel
- Department of Family Medicine, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Tirtha Sawant
- Department of Neurology, Spartan Health Sciences University, Spartan Drive St, Saint Lucia
| | - Subtain Zia
- Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Richard C Suteja
- Faculty of Medicine, Udayana University, Kampus Bukit, Jl, Raya Kampus Unud Jimbaran, Kec, Kuta Sel, Kabupaten Badung, Bukit Jimbaran, Bali, Indonesia
| | - Khulud Nurani
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, București, Romania
- Bucharest, Romania and Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, București, Romania
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2
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Lu HZ, Xie YZ, Gao C, Wang Y, Liu TT, Wu XZ, Dai F, Wang DQ, Deng SQ. Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012217. [PMID: 38820529 PMCID: PMC11168630 DOI: 10.1371/journal.pntd.0012217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/12/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Dengue fever (DF) and West Nile fever (WNF) have become endemic worldwide in the last two decades. Studies suggest that individuals with diabetes mellitus (DM) are at a higher risk of developing severe complications from these diseases. Identifying the factors associated with a severe clinical presentation is crucial, as prompt treatment is essential to prevent complications and fatalities. This article aims to summarize and assess the published evidence regarding the link between DM and the risk of severe clinical manifestations in cases of DF and WNF. METHODOLOGY/PRINCIPAL FINDINGS A systematic search was conducted using the PubMed and Web of Science databases. 27 studies (19 on DF, 8 on WNF) involving 342,873 laboratory-confirmed patients were included in the analysis. The analysis showed that a diagnosis of DM was associated with an increased risk for severe clinical presentations of both DF (OR 3.39; 95% CI: 2.46, 4.68) and WNF (OR 2.89; 95% CI: 1.89, 4.41). DM also significantly increased the risk of death from both diseases (DF: OR 1.95; 95% CI: 1.09, 3.52; WNF: OR 1.74; 95% CI: 1.40, 2.17). CONCLUSIONS/SIGNIFICANCE This study provides strong evidence supporting the association between DM and an increased risk of severe clinical manifestations in cases of DF and WNF. Diabetic individuals in DF or WNF endemic areas should be closely monitored when presenting with febrile symptoms due to their higher susceptibility to severe disease. Early detection and appropriate management strategies are crucial in reducing the morbidity and mortality rates associated with DF and WNF in diabetic patients. Tailored care and targeted public health interventions are needed to address this at-risk population. Further research is required to understand the underlying mechanisms and develop effective preventive and therapeutic approaches.
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Affiliation(s)
- Hong-Zheng Lu
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Yu-Zhuang Xie
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Chen Gao
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Ying Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Ting-Ting Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Xing-Zhe Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, China
| | - Sheng-Qun Deng
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
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3
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: Clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2022; 64:473-483. [PMID: 36243447 DOI: 10.1016/j.rxeng.2021.06.007] [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: 12/12/2020] [Accepted: 06/21/2021] [Indexed: 06/16/2023]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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4
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Dervisoglu E, Altintas Taslicay C, Alparslan B, Anik Y. Progressive MRI findings of West Nile virus encephalitis in a patient with diabetes mellitus. BMJ Case Rep 2022; 15:e249142. [PMID: 35584859 PMCID: PMC9119133 DOI: 10.1136/bcr-2022-249142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s was admitted to our hospital with complaints of fatigue, loss of appetite and fever. His neurological examination was normal. He had a medical history of diabetes mellitus for 25 years. Urine analysis showed many leucocytes. Empirical antibiotic treatment was started for urinary system infection. Three days later, his mental status worsened with confusion and disorientation. MRI of the brain was normal. Two days later, the patient was intubated because of respiratory insufficiency. MRI showed restricted diffusion in bilateral thalamic nuclei. Encephalitis and ischaemia were considered in the differential diagnosis. Cerebrospinal fluid IgM antibody for West Nile virus was positive. Sixteen days later, cranial nerve reflexes were lost. MRI showed restricted diffusion and increased T2 signal intensity in the dorsal medulla and increased T2 signal intensity without diffusion restriction in bilateral substantia nigra and dentate nuclei. He died of cardiac arrest 40 days after hospitalisation.
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Affiliation(s)
| | | | - Burcu Alparslan
- Radiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - Yonca Anik
- Radiology, Kocaeli University School of Medicine, Izmit, Turkey
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5
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Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes. Pathogens 2022; 11:pathogens11010052. [PMID: 35056000 PMCID: PMC8779330 DOI: 10.3390/pathogens11010052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022] Open
Abstract
West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013–2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33–84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5–73), and the median hospital LOS was 34 days (range 7–97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3–5, 6 (26.0%) had slight disability/mRS 2–1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6–69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3–5, one (4.3%) had slight disability/mRS 2–1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.
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6
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2021; 64:S0033-8338(21)00114-4. [PMID: 34325916 DOI: 10.1016/j.rx.2021.06.003] [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: 12/12/2020] [Revised: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
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7
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Bailey C, Mach J, Kataria S, Tandon M, Lakhani DA, Sriwastava S. West Nile virus encephalitis: A report of two cases and review of neuroradiological features. Radiol Case Rep 2020; 15:2422-2426. [PMID: 33005280 PMCID: PMC7519252 DOI: 10.1016/j.radcr.2020.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/27/2023] Open
Abstract
West Nile virus (WNV) is a single-stranded RNA arbovirus of Flavivirus genus that is endemic to the United States and known to cause neuroinvasive disease. Diagnosis is confirmed by the presence of WNV-specific IgM antibodies within serum or cerebrospinal fluid (CSF). Radiologically, it presents as hyperintense T2 signal within deep brain structures (ie, thalami and mid-brain) with or without cerebral peduncle and substantia nigra involvement. On diffusion-weighted imaging, restricted diffusion is reported in basal ganglia and disseminated throughout the white matter. In this report, we describe the imaging findings for 2 cases of WNV from our institution; a 56-year-old female and a 34-year-old female. Increased vigilance for WNV is warranted, particularly in immunosuppressed patients presenting with a clinical picture of viral meningoencephalitis despite initial negative magnetic resonance imaging or CSF analysis. A high suspicion for WNV disease should prompt repeat imaging or laboratory workup.
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Affiliation(s)
- Christopher Bailey
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
| | - John Mach
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
| | - Saurabh Kataria
- Department of Neurology, Rockefeller Neuroscience Institute, School of Medicine, West Virginia University, Morgantown, WV
| | - Medha Tandon
- Army College of Medical Sciences, Base Hospital, New Delhi, India
| | - Dhairya A Lakhani
- Department of Radiology, School of Medicine, West Virginia University, Morgantown, WV
| | - Shitiz Sriwastava
- Department of Neurology, Rockefeller Neuroscience Institute, School of Medicine, West Virginia University, Morgantown, WV
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8
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Papagiannis I, Tsolaki M, Kiryttopoulos A, Antoniadi E, Kyriakogianni C, Fotiou D, Notas K, Liougka E, Myrou A, Hatzitolios A, Haloudis P, Papaioannou M, Spilioti M, Papa A, Tegos T. West Nile neuroinvasive disease. Report of four cases in Northern Greece, 2018. J Med Virol 2020; 92:1322-1325. [PMID: 32115715 DOI: 10.1002/jmv.25739] [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: 07/18/2019] [Accepted: 02/24/2020] [Indexed: 11/11/2022]
Abstract
West Nile virus (WNV) is a mosquito-borne RNA flavivirus which caused several epidemics worldwide. The year 2018 was a WNV record year for Europe, including Greece, with earlier and longer transmission season with higher than the previous number of cases. It has been proposed that some simple biochemical markers may be helpful for the recognition of WNV neuroinvasive disease, its differential from other neurological infectious diseases and prognosis. We describe four cases that suffered from WNV meningitis and/or encephalitis hospitalized in 2018 in a tertiary hospital in Thessaloniki, Greece, and investigate the importance of simple biomarkers for the recognition of WNV etiology.
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Affiliation(s)
- Ioannis Papagiannis
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Kiryttopoulos
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Antoniadi
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthi Kyriakogianni
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Fotiou
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Notas
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Liougka
- 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Hatzitolios
- 1st Propaedeutic Internal Medicine Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Haloudis
- 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martha Spilioti
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, National Reference Centre for Arboviruses, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Abstract
Donor-derived infections are defined as any infection present in the donor that is transmitted to 1 or more recipients. Donor-derived infections can be categorized into 2 groups: "expected" and "unexpected" infections. Expected transmissions occur when the donor is known to have an infection, such as positive serology for cytomegalovirus, Epstein Barr virus, or hepatitis B core antibody, at the time of donation. Unexpected transmissions occur when a donor has no known infection before donation, but 1 or more transplant recipients develop an infection derived from the common donor. Unexpected infections are estimated to occur in far less than 1% of solid organ transplant recipients. We will review the epidemiology, risk factors, and approaches to prevention and management of donor-derived viral infectious disease transmission in liver transplantation.
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10
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Bookstaver PB, Mohorn PL, Shah A, Tesh LD, Quidley AM, Kothari R, Bland CM, Weissman S. Management of Viral Central Nervous System Infections: A Primer for Clinicians. J Cent Nerv Syst Dis 2017; 9:1179573517703342. [PMID: 28579869 PMCID: PMC5415352 DOI: 10.1177/1179573517703342] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.
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Affiliation(s)
- P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Phillip L Mohorn
- Department of Pharmacy, Spartanburg Medical Center, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Ansal Shah
- Division of Infectious Diseases, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Lauren D Tesh
- Division of Advisory Committee and Consultant Management, Office of Executive Programs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - April M Quidley
- Department of Pharmacy Services, Vidant Medical Center, Greenville, NC, USA
| | - Ravish Kothari
- Department of Neurology, University of South Carolina/Palmetto Medical Group, Columbia, SC, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA, USA
| | - Sharon Weissman
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
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11
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Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol 2014; 49:86-98. [PMID: 24342678 DOI: 10.1053/j.ro.2013.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rakesh K Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
| | - Krishan K Jain
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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12
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Moritani T, Capizzano A, Kirby P, Policeni B. Viral Infections and White Matter Lesions. Radiol Clin North Am 2014; 52:355-82. [DOI: 10.1016/j.rcl.2013.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Abstract
Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.
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Affiliation(s)
- Andreas H Kramer
- Department of Critical Care Medicine and Clinical Neurosciences, Foothills Medical Center, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB T2N 2T9, Canada.
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14
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Bakri FG, Bahou YG, Al-Sammarrai FA, Hadidy A, Gharaibeh A, Zaid GK, Mahafzah A, Samara OA, Ababneh NA, Zak I. Fatal encephalitis due to BK virus in a patient with common variable immunodeficiency: a case report. J Clin Virol 2013; 57:363-9. [PMID: 23731846 DOI: 10.1016/j.jcv.2013.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/18/2013] [Accepted: 04/21/2013] [Indexed: 12/17/2022]
Abstract
Encephalitis due to BK virus is a rare condition. Here, we describe a young male patient with common variable immunodeficiency who developed fatal encephalitis due to BK virus. The patient presented initially with ocular symptoms that were followed by behavioral changes and spastic quadriparesis. Diagnosis was made by the compatible clinical findings and detection of viral DNA by polymerase chain reaction in the cerebrospinal fluid. To the best of our knowledge, this is the first report of BK virus encephalitis in a patient with common variable immunodeficiency. We suggest that BK virus should be suspected in cases of encephalitis; particularly in patients with immunodeficiency.
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Affiliation(s)
- Faris G Bakri
- Department of Medicine, Division of Infectious Diseases, The University of Jordan, PO Box 13046, Amman 11942, Jordan.
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15
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Singh N, Levi ME. Arenavirus and West Nile virus in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:361-71. [PMID: 23465029 DOI: 10.1111/ajt.12128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N Singh
- Division of Nephrology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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16
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Speers DJ, Flexman J, Blyth CC, Rooban N, Raby E, Ramaseshan G, Benson S, Smith DW. Clinical and radiological predictors of outcome for Murray Valley encephalitis. Am J Trop Med Hyg 2013; 88:481-9. [PMID: 23296449 DOI: 10.4269/ajtmh.12-0379] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A review of the laboratory-confirmed cases of Murray Valley encephalitis (MVE) from Western Australia between 2009 and 2011 was conducted to describe the clinical, laboratory, and radiological features of the disease. The nine encephalitis patients presented with altered mental state and seizures, tremor, weakness, or paralysis. All patients developed a raised C-reactive protein, whereas most developed acute liver injury, neutrophilia, and thrombocytosis. All patients with encephalitis developed cerebral peduncle involvement on early magnetic resonance imaging (MRI). The absence of thalamic MRI hyperintensity during the acute illness, with or without leptomeningeal enhancement, predicted a better neurological outcome, whereas those patients with widespread abnormalities involving the thalamus, midbrain, and cerebral cortex or the cerebellum had devastating neurological outcomes. MRI scans repeated months after acute illness showed destruction of the thalamus and basal ganglia, cortex, or cerebellum. These findings may help clinicians predict the neurological outcome when evaluating patients with MVE.
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Affiliation(s)
- David J Speers
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia.
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Imaging Spectrum of Bites, Stings, and Their Complications: Self-Assessment Module. AJR Am J Roentgenol 2009; 193:S42-5. [DOI: 10.2214/ajr.09.7171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Viral diseases of the central nervous system encompass a wide range of different processes, mainly inflammation affecting the brain (encephalitis), the meninges (meningitis), or a combined meningoencephalitis. The spinal cord can be affected as well (myelitis). Another group of viral-related disorders, sometimes without a clear pathophysiological mechanism disclosed, include post-viral illnesses. All of these groups of diseases are discussed in this article, with an emphasis on their imaging presentation, using magnetic resonance imaging.
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