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Grau-López L, Flores-Pina B, Jiménez M, Carbonell J, Ciurans J, Chies E, Fagundez O, Fumanal A, Becerra JL. Epileptiform electroencephalogram discharges increase seizure recurrence risk in patients with acute symptomatic seizure due to a structural brain lesion. Seizure 2024; 117:56-59. [PMID: 38330750 DOI: 10.1016/j.seizure.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE The risk factors for seizure recurrence after acute symptomatic seizure due to a structural brain lesion are not well established. The aim of this study was to analyze possible associations between demographic, clinical, and electroencephalographic variables and epilepsy development in patients with acute symptomatic seizure due to an acute structural brain lesion. METHODS We designed an observational prospective study of patients with acute symptomatic seizure due to an acute structural brain lesion (hemorrhagic stroke, ischemic stroke, traumatic brain injury, or meningoencephalitis) who underwent EEG during their initial admission between January 2015 and January 2020. We analyzed prospectively recorded demographic, clinical, electroencephalographic (EEG), and treatment-related variables. All variables were compared between patients with and without seizure recurrence during 2 years of follow up. RESULTS We included 194 patients (41.2 % women; mean [SD] age, 57.3 [15.8] years) with acute symptomatic seizure due to an acute structural brain lesion. They all underwent EEG during admission and were followed for at least 2 years. The identifiable causes were hemorrhagic stroke (44.8 %), ischemic stroke (19.5 %), traumatic brain injury (18.5 %), and meningoencephalitis (17 %). Fifty-six patients (29 %) experienced a second seizure during follow-up. Seizure recurrence was associated with epileptiform discharges on EEG (52% vs 32 %; OR 2.3 [95 % CI, 1.2-4.3], p = 0.008) and onset with status epilepticus (17% vs 0.05 %, OR 4.03 [95 % CI 1.45-11.2], p = 0.009). CONCLUSIONS Epileptiform discharges on EEG and status epilepticus in patients with acute symptomatic seizure due to an acute structural brain lesion are associated with a higher risk of epilepsy development.
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Affiliation(s)
- Laia Grau-López
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain.
| | - Belén Flores-Pina
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Marta Jiménez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jaime Carbonell
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jordi Ciurans
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Eva Chies
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Olga Fagundez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Alejandra Fumanal
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Juan Luis Becerra
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
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Carpio A, Salgado C, DiCapua D, Fleury A, Suastegui R, Giagante B, Aguilera L, Quijada A, Nuñez L, Villanueva M, Plascencia‐Alvarez N, Hamamoto Filho PT, Piedra LM, Silva‐Rosas C, Kelvin EA. Causes and prognosis of adults experiencing a first seizure in adulthood: A pilot cohort study conducted in five countries in Latin America. Epilepsia Open 2024; 9:776-784. [PMID: 38366910 PMCID: PMC10984322 DOI: 10.1002/epi4.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024] Open
Abstract
There are limited data on first seizure (FS) among adults in low and middle-income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3- and 6-month follow-up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow-up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10-year risk of recurrence, which is part of the definition of epilepsy. PLAIN LANGUAGE SUMMARY: We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3-6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.
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Affiliation(s)
- Arturo Carpio
- School of MedicineUniversity of CuencaCuencaEcuador
- Hospital Santa InésCuencaEcuador
| | - Carla Salgado
- Facultad de MedicinaUniversidad de AzuayCuencaEcuador
| | - Daniela DiCapua
- Hospital Eugenio EspejoMinisterio de Salud PúblicaQuitoEcuador
- Universidad San Francisco de QuitoQuitoEcuador
| | - Agnes Fleury
- Departamento de Medicina Genómica y Toxicología AmbientalInstituto de Investigación Biomédicas, Universidad Nacional Autónoma de MéxicoCiudad de MexicoMexico
- Instituto Nacional de Neurología y Neurocirugia deCiudad de MexicoMexico
| | - Roberto Suastegui
- Instituto Nacional de Neurología y Neurocirugia deCiudad de MexicoMexico
| | - Brenda Giagante
- Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi de La PlataLa PlataArgentina
- Hospital de Alta Complejidad El Cruce “Néstor Kirchner”, ENyS, CONICETFlorencio VarelaArgentina
| | - Ledda Aguilera
- Hospital Clínico de la Universidad de ChileSantiago deChile
| | - Alonso Quijada
- Hospital Clínico de la Universidad de ChileSantiago deChile
| | - Lilia Nuñez
- Hospital 20 de NoviembreCiudad de MexicoMexico
| | - Manuela Villanueva
- Hospital de Alta Complejidad El Cruce “Néstor Kirchner”, ENyS, CONICETFlorencio VarelaArgentina
| | | | | | - Luis M. Piedra
- Hospital “José Carrasco” Instituto Ecuatoriano de Seguridad Social de CuencaCuencaEcuador
| | | | - Elizabeth A. Kelvin
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Department of Occupational HealthEpidemiology & Prevention Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell HealthHempsteadNew YorkUSA
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Eberhard R, Paquette K, Garfinkle J, Myers KA. Response to Hydrocortisone in an Extremely Preterm Neonate With Late-Onset Sepsis, Meningoencephalitis, and Drug-Resistant Seizures. Clin EEG Neurosci 2024; 55:252-256. [PMID: 36567490 DOI: 10.1177/15500594221147138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Corticosteroids are commonly used in children with bacterial meningitis; however, there are very few data regarding possible utility in neonates, particularly those born premature. We describe our experience using hydrocortisone in the treatment of a girl born at 26 weeks, 6 days gestation. She had suffered profound brain injury following late onset group B streptococcus sepsis and meningitis, and developed drug-resistant seizures. Because seizures continued despite treatment with phenobarbital, phenytoin, levetiracetam, lacosamide, and midazolam, intravenous hydrocortisone was added. We observed a marked decrease in focal electrographic seizures within 2 days of initiation of hydrocortisone. This experience suggests that corticosteroids could be a treatment option for drug-resistant seizures and status epilepticus in preterm neonates, particularly those with bacterial meningitis.
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Affiliation(s)
- Ralf Eberhard
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Katryn Paquette
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jarred Garfinkle
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth A Myers
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Medical Centre, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Lehner L, Thurau S, Pusl K, Tiedt S, Schöberl F, Forbrig R, Höglinger G, Strupp M. Meningoencephalitis and retinal vasculitis due to rickettsial infection. J Neurol 2024; 271:1469-1472. [PMID: 38001378 PMCID: PMC10896935 DOI: 10.1007/s00415-023-12097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Louisa Lehner
- Department of Neurology, LMU University Hospital, Ludwig Maximilians University Munich Marchioninistr, 15, 81377, Munich, Germany.
| | - Stephan Thurau
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Konstantin Pusl
- Department of Neurology, LMU University Hospital, Ludwig Maximilians University Munich Marchioninistr, 15, 81377, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Schöberl
- Department of Neurology, LMU University Hospital, Ludwig Maximilians University Munich Marchioninistr, 15, 81377, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Günter Höglinger
- Department of Neurology, LMU University Hospital, Ludwig Maximilians University Munich Marchioninistr, 15, 81377, Munich, Germany
| | - Michael Strupp
- Department of Neurology, LMU University Hospital, Ludwig Maximilians University Munich Marchioninistr, 15, 81377, Munich, Germany
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Palasamudram Kumaran S, Mathew T, John SK, Goddu Govindappa SK. Spinal cord infarction: a rare but serious complication of pneumococcal meningoencephalitis. BMJ Case Rep 2024; 17:e252209. [PMID: 38171643 PMCID: PMC10773378 DOI: 10.1136/bcr-2022-252209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Here, we report the case of a woman in her 40s who came with pyogenic meningitis and infarcts in the brain. While on treatment with antibiotics, she developed new-onset weakness involving bilateral lower limbs and one upper limb 2 weeks into the course of illness. MRI of the spine showed an infarct in the spinal cord. Spinal cord infarction as a complication of pyogenic meningitis is not well recognised unlike tuberculosis meningitis. Unlike ischaemic strokes where thrombolysis is done, for stroke related to infections, there are no definite strategies. Our patient was treated with physiotherapy, continued on antibiotics and slowly recovered over months and at 18-month follow-up, she was walking with a walker. The exact mechanism of thrombosis is not known but may be due to inflammation of the arterial wall and activation of the procoagulant cascade by infection-triggered inflammation. Spinal cord infarction can occur at any phase of the infection and may occur despite appropriate response to antibiotic treatments.
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Affiliation(s)
| | - Thomas Mathew
- Department of Neurology, St John's Medical College, Bangalore, Karnataka, India
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Antonescu F, Butnariu I, Antonescu-Ghelmez D, Tuta S, Voinescu BA, Manea MC, Bucur AI, Chelmambet AS, Moraru A. Neuro-Behçet's Disease Onset in the Context of Tuberculous Meningoencephalitis: A Case Report. Medicina (Kaunas) 2023; 59:2163. [PMID: 38138266 PMCID: PMC10744592 DOI: 10.3390/medicina59122163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Behçet's disease (BD) is a systemic vasculitis that frequently presents with a relapsing-remitting pattern. CNS involvement (Neuro-Behçet) is rare, affecting approximately 10% of patients. Its etiological mechanisms are not yet fully understood. The most commonly accepted hypothesis is that of a systemic inflammatory reaction triggered by an infectious agent or by an autoantigen, such as heat shock protein, in genetically predisposed individuals. Mycobacterium tuberculosis is known to be closely interconnected with BD, both affecting cell-mediated immunity to a certain extent and probably sharing a common genetic background. We present the case of a 34-year-old Caucasian woman who had been diagnosed with tuberculous meningitis 15 months prior, with significant neurological deficits and lesional burden on MRI with repeated relapses whenever treatment withdrawal was attempted. These relapses were initially considered as reactivation of tuberculous meningoencephalitis, and symptoms improved after a combination of antituberculous treatment and corticosteroid therapy. After the second relapse, the diagnosis was reconsidered, as new information emerged about oral and genital aphthous lesions, making us suspect a BD diagnosis. HLA B51 testing was positive, antituberculous treatment was stopped, and the patient was started on high doses of oral Cortisone and Azathioprine. Consequently, the evolution was favorable, with no further relapses and slow improvements in neurological deficits. To our knowledge, this is the first report of Neuro-Behçet's disease onset precipitated by tuberculous meningitis. We include a review of the available literature on this subject. Our case reinforces the fact that Mycobacterium tuberculosis infection can precipitate BD in genetically predisposed patients, and we recommend HLA B51 screening in patients with prolonged or relapsing meningoencephalitis, even if an infectious agent is apparently involved.
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Affiliation(s)
- Florian Antonescu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020023 Bucharest, Romania (M.C.M.)
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Ioana Butnariu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020023 Bucharest, Romania (M.C.M.)
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Dana Antonescu-Ghelmez
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020023 Bucharest, Romania (M.C.M.)
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Sorin Tuta
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020023 Bucharest, Romania (M.C.M.)
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Bianca Adriana Voinescu
- “Victor Babes” Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Mihnea Costin Manea
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020023 Bucharest, Romania (M.C.M.)
- “Prof. Dr. Alexandru Obregia” Clinical Psychiatry Hospital, 041915 Bucharest, Romania
| | - Amanda Ioana Bucur
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Altay Sercan Chelmambet
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
| | - Adriana Moraru
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041915 Bucharest, Romania
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Ponzetto E, Delhez Q, Hoppenbrouwers M, De Schryver N, Serck N, Dugernier T, Duray MC, Gressens B, Vinetti M, Sips GJ, van Kampen J, GeurtsvanKessel CH, van Boheemen S. Case Report: Late Reactivation of Herpes B Virus After a Monkey Bite: A Case of Severe Meningoencephalitis. Am J Trop Med Hyg 2023; 109:1277-1281. [PMID: 37972322 DOI: 10.4269/ajtmh.23-0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/28/2023] [Indexed: 11/19/2023] Open
Abstract
Macacine alphaherpesvirus 1, also known as herpes B virus (BV), is an alphaherpesvirus endemic to several macaque species, capable of causing zoonotic infections in humans, with high mortality rates. Evidence of reactivation in humans has rarely been reported. Here we depict a case of BV reactivation after 54 years, leading to severe meningoencephalitis. This case supports the use of antiviral prophylaxis in patients surviving a confirmed BV central nervous system infection. We sequenced DNA from BV obtained from the patient's cerebrospinal fluid. Phylogenetic analysis showed significant divergence in the clustering of this particular BV strain compared with other known BVs. Therefore, additional efforts are needed to obtain a broader sequence landscape from BVs circulating in monkeys.
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Affiliation(s)
- Ester Ponzetto
- Intensive Care Unit, Clinique Saint-Pierre, Ottignies, Belgium
| | - Quentin Delhez
- Intensive Care Unit, Clinique Saint-Pierre, Ottignies, Belgium
| | | | | | - Nicolas Serck
- Intensive Care Unit, Clinique Saint-Pierre, Ottignies, Belgium
| | | | | | | | - Marco Vinetti
- Intensive Care Unit, Clinique Saint-Pierre, Ottignies, Belgium
| | - Gregorius J Sips
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
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Fuentes I Ferrer MV, Sáez-Durán S, Bueno-Marí R, Galán-Puchades MT. [Health implications of the finding of Angiostrongylus cantonensis, the main cause of eosinophilic meningoencephalitis, in continental Europe (Valencia, Spain)]. Rev Esp Salud Publica 2023; 97:perspectiva31_fuentes_saez_bueno_galan. [PMID: 37937820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/12/2023] [Indexed: 11/09/2023] Open
Abstract
The rat pulmonary artery nematode, Angiostrongylus cantonensis (discovered in rats from the province of Canton, southern China, in 1933 ) is the main cause in humans of what is known as eosinophilic meningoencephalitis (EEM), with around of 3,000 confirmed cases in various parts of the world.
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Affiliation(s)
| | - Sandra Sáez-Durán
- Grupo de Investigación Parásitos y Salud; Facultat de Farmàcia; Universitat de València. Burjassot (València). España
| | - Rubén Bueno-Marí
- Grupo de Investigación Parásitos y Salud; Facultat de Farmàcia; Universitat de València. Burjassot (València). España
- Laboratorios Lokimica. Paterna (València). España
| | - María Teresa Galán-Puchades
- Grupo de Investigación Parásitos y Salud; Facultat de Farmàcia; Universitat de València. Burjassot (València). España
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Mourão JLV, Santana AA, Ramos MDC, Conterno L, Reis F. Post-infectious inflammatory response syndrome related to cryptococcal meningoencephalitis. Rev Soc Bras Med Trop 2023; 56:e04382023. [PMID: 37851831 PMCID: PMC10578870 DOI: 10.1590/0037-8682-0438-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- João Luiz Veloso Mourão
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brasil
| | - Alessa Andrade Santana
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Marcelo de Carvalho Ramos
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Lucieni Conterno
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Fabiano Reis
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brasil
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Kuo A, Trinh K, Le D. Author Response: Teaching NeuroImage: Cryptococcal Meningoencephalitis With Cryptococcoma and Gelatinous Pseudocysts. Neurology 2023; 101:683. [PMID: 37813591 PMCID: PMC10585697 DOI: 10.1212/wnl.0000000000207885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
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Farkas NS, Zolno R, Gaudioso CM, Mian AY, Mar S. Pearls & Oy-sters: MOG-AD Meningoencephalitis With Holocord Gray Matter Predominant Myelitis. Neurology 2023; 101:e1577-e1580. [PMID: 37487743 PMCID: PMC10585705 DOI: 10.1212/wnl.0000000000207637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/30/2023] [Indexed: 07/26/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has been implicated in a wide range of CNS encephalitis and myelitis presentations. We present a previously healthy 16-year-old girl who presented with acute onset headaches that rapidly progressed to encephalopathy, flaccid paraparesis, lower extremity hyperreflexia, and urinary retention. Serial MRI brain and total spine imaging demonstrated evolving diffuse supratentorial leptomeningeal enhancement and holocord gray matter restricted T2 bright lesion without enhancement. CSF was markedly inflammatory with MOG antibody positive >1:10,000. The patient improved after empiric steroids, plasma exchange, and IVIG.
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Affiliation(s)
- Nathan Shmuel Farkas
- From the Department of Neurology (N.S.F.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (R.Z., C.M.G., S.M.), Washington University in St. Louis School of Medicine; and Mallinckrodt Institute of Radiology (A.Y.M.), St. Louis, MO.
| | - Rachel Zolno
- From the Department of Neurology (N.S.F.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (R.Z., C.M.G., S.M.), Washington University in St. Louis School of Medicine; and Mallinckrodt Institute of Radiology (A.Y.M.), St. Louis, MO
| | - Cristina M Gaudioso
- From the Department of Neurology (N.S.F.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (R.Z., C.M.G., S.M.), Washington University in St. Louis School of Medicine; and Mallinckrodt Institute of Radiology (A.Y.M.), St. Louis, MO
| | - Ali Y Mian
- From the Department of Neurology (N.S.F.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (R.Z., C.M.G., S.M.), Washington University in St. Louis School of Medicine; and Mallinckrodt Institute of Radiology (A.Y.M.), St. Louis, MO
| | - Soe Mar
- From the Department of Neurology (N.S.F.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (R.Z., C.M.G., S.M.), Washington University in St. Louis School of Medicine; and Mallinckrodt Institute of Radiology (A.Y.M.), St. Louis, MO
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Siegler JE, Galetta S. Editors' Note: Teaching NeuroImage: Cryptococcal Meningoencephalitis With Cryptococcoma and Gelatinous Pseudocysts. Neurology 2023; 101:682. [PMID: 37813590 PMCID: PMC10585686 DOI: 10.1212/wnl.0000000000207875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
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13
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Feng Q, Zhang R. Reader Response: Teaching NeuroImage: Cryptococcal Meningoencephalitis With Cryptococcoma and Gelatinous Pseudocysts. Neurology 2023; 101:682. [PMID: 37813592 PMCID: PMC10585699 DOI: 10.1212/wnl.0000000000207884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
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Seshagiri DV, Viswanathan LG, Goyal A, Nagappa M, Kulanthaivelu K, Pruthi N, Mahadevan A, Sinha S. Granulomatous Amoebic Meningoencephalitis in an Immunocompromised Patient With AIDS and Neurosyphilis. Neurology 2023; 101:495-496. [PMID: 37185121 PMCID: PMC10513883 DOI: 10.1212/wnl.0000000000207307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Doniparthi Venkata Seshagiri
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Lakshminarayanapuram Gopal Viswanathan
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Aditi Goyal
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Madhu Nagappa
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nupur Pruthi
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anita Mahadevan
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sanjib Sinha
- From the Department of Neurology (D.V.S., L.G.V., M.N., S.S.), Department of Neuropathology (A.G., A.M.), Department of Neuroradiology (K.K.), and Department of Neurosurgery (N.P.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
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Sugumar K, Mohan V, Kasinathan A, Deepthi B, Gunasekaran D. Scrub Meningoencephalitis Associated With Ocular Bob and Downbeat Nystagmus-A Report of Two Cases. J Neuroophthalmol 2023; 43:e85-e86. [PMID: 35921557 DOI: 10.1097/wno.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kiruthiga Sugumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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16
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Trinh K, Le D, Kuo A. Teaching NeuroImage: Cryptococcal Meningoencephalitis With Cryptococcoma and Gelatinous Pseudocysts. Neurology 2023; 101:e782-e783. [PMID: 37130802 PMCID: PMC10437017 DOI: 10.1212/wnl.0000000000207359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/15/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Kelly Trinh
- From the Texas Tech University Health Sciences Center (K.T., D.L.), Lubbock, and Department of Radiology (A.K.), Midland Memorial Hospital, TX
| | - Duc Le
- From the Texas Tech University Health Sciences Center (K.T., D.L.), Lubbock, and Department of Radiology (A.K.), Midland Memorial Hospital, TX
| | - Anderson Kuo
- From the Texas Tech University Health Sciences Center (K.T., D.L.), Lubbock, and Department of Radiology (A.K.), Midland Memorial Hospital, TX.
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17
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Lan J, Lv L, Ye L, Wang T, Wu Z, Wu S, Peng C, Lu W, Lu T. Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature. J Med Case Rep 2023; 17:332. [PMID: 37542340 PMCID: PMC10403845 DOI: 10.1186/s13256-023-04066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/04/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. CASE PRESENTATION A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. CONCLUSION There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.
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Affiliation(s)
- Jianhua Lan
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Luyi Lv
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Ling Ye
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Tao Wang
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Zhiyu Wu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Shugen Wu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Chunxian Peng
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Weili Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China
| | - Tao Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China.
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18
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Damasceno LS, Cézar RC, Canuto MCDS, Barbosa Neto JDP, Leitão TDMJS. Cryptococcal meningoencephalitis: Risk factors associated to death in a hospital in Northeastern Brazil. J Mycol Med 2023; 33:101407. [PMID: 37295283 DOI: 10.1016/j.mycmed.2023.101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/14/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Cryptococcosis is an opportunistic systemic mycosis caused by pathogenic encapsulated yeasts of the genus Cryptococcus. The objective of the present study was to evaluate the risk factors associated with death of patients diagnosed with meningitis due to Cryptococcus spp. METHODS This retrospective cohort study included patients admitted to the São José Hospital (SJH) with Cryptococcal Meningoencephalitis (CM) who were diagnosed between 2010 and 2018. Data collection was carried out by reviewing the patients' medical records. Death during hospitalization was considered the primary outcome. RESULTS From 2010 to 2018, 21,519 patients were admitted to the HSJ, 124 of whom were hospitalized due to CM. The CM incidence rate was 5.8 cases/103 hospitalizations. We included 112 patients in the study. Male patients were the most affected (82.1%), and the median age was 37 years [IQR: 29-45]. HIV coinfection occurred in 79.4% of the patients. Fever (65.2%) and headache (88.4%) were the most frequent symptoms. Greater cellularity in the CSF was the most related factor to CM in non-HIV individuals (p < 0.05). Death during hospitalization occurred in 28.6% (n = 32) of the patients. The independent risk factors associated with death during the hospitalization were women (p = 0.009), age > 35 years (p = 0.046), focal neurological deficits (p = 0.013), altered mental status (p = 0.018) and HIV infection (p = 0.040). The twelve-month survival was lower in HIV-positive patients (p < 0.05). CONCLUSION Early diagnosis, optimal treatment, and clinical follow-up strategies, especially in HIV patients, should be prioritized.
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Affiliation(s)
- Lisandra Serra Damasceno
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil.
| | - Renan Carrasco Cézar
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Terezinha do Menino Jesus Silva Leitão
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
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19
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Abstract
We herein report a 49-year-old Japanese man with relapsing polychondritis (RP) and aseptic meningoencephalitis. Four years ago, the patient was diagnosed with RP. Prednisolone (PSL) was started at 30 mg/day, and the symptoms promptly disappeared. However, cognitive impairment gradually appeared from six months before hospitalization. Methylprednisolone pulse therapy was immediately initiated, followed by administration of PSL at 1 mg/kg/day. Intravenous cyclophosphamide was combined with PSL. After treatment, the patient's cognitive impairment clearly improved. In conclusion, RP rarely causes aseptic meningoencephalitis, highlighting the need for prompt and aggressive immunosuppressive therapy.
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Affiliation(s)
- Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | | | - Akifumi Miyake
- Department of General Medicine, Saku Central Hospital, Japan
| | - Toshimasa Yamamoto
- Department of Neurology, Faculty of Medicine, Saitama Medical University, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
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20
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Bu Y, Liu H, Qian X, Sun F, Li C, Han J. Aquaporin 4-positive neuromyelitis optica spectrum disorder with meningoencephalitis-like onset: A case report. Front Immunol 2022; 13:938492. [PMID: 36275714 PMCID: PMC9585379 DOI: 10.3389/fimmu.2022.938492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Neuromyelitis optica spectrum disease (NMOSD) is a debilitating autoimmune inflammatory demyelinating disease of the central nervous system. The relationship between harboring an infection and NMOSD is currently unclear and needs further investigation. This article reports meningoencephalitis-like manifestations, including fever, headache, neck resistance, seizures, and pleocytosis, accompanied by nausea and vomiting, in a patient with serum AQP4 antibody-positive area postrema syndrome (APS). In the presence of aseptic meningitis combined with clinical symptoms such as optic neuritis and myelitis, the possibility of NMOSD diagnosis can be considered. However, for patients with unknown causes, especially combined with aseptic meningitis, a probable differential diagnosis of NMOSD is considered.
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Affiliation(s)
- Yi Bu
- Department of Neurology, affiliated Hospital of Chengde Medical University, Chengde, China
| | - Heng Liu
- Department of Pain, Hengshui People’s Hospital, Hengshui, China
| | - XuDong Qian
- Department of Neurology, affiliated Hospital of Chengde Medical University, Chengde, China
| | - Fan Sun
- Department of Neurology, affiliated Hospital of Chengde Medical University, Chengde, China
| | - ChengBo Li
- Department of Neurology, affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jingzhe Han
- Department of Neurology, Hengshui People’s Hospital, Hengshui, China
- *Correspondence: Jingzhe Han,
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21
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Ito N, Masuda T, Yamaguchi K, Sakamoto S, Horimasu Y, Nakashima T, Miyamoto S, Iwamoto H, Fujitaka K, Hamada H, Chayama K, Hattori N. Pneumonia and Meningoencephalitis Due to Varicella-zoster Virus Reinfection and Epstein-Barr Virus Reactivation in a Patient with Rheumatoid Arthritis. Intern Med 2022; 61:2961-2965. [PMID: 35249916 PMCID: PMC9593163 DOI: 10.2169/internalmedicine.8413-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A 72-year-old woman with rheumatoid arthritis was treated with methotrexate (MTX) and iguratimod. Upon examination of a liver tumor, blisters due to varicella-zoster virus (VZV) infection were observed. Despite oral administration of valacyclovir, she developed varicella pneumonia and meningoencephalitis. A VZV antibody test revealed reinfection. The liver tumor shrank after discontinuance of MTX, and polymerase chain reaction revealed the reactivation of the Epstein-Barr virus (EBV). Therefore, we were unable to deny MTX-associated lymphoproliferative disorder (MTX-LPD). This is the first case of a complication of pneumonia and meningoencephalitis due to VZV reinfection and EBV reactivation.
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Affiliation(s)
- Noriaki Ito
- Department of Internal Medicine, Hiroshima City Funairi Citizens Hospital, Japan
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Japan
- RIKEN Center for Integrative Medical Sciences, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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22
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Ono D, Sanjo N. [Neurological Manifestations of COVID-19: Meningoencephalitis and Encephalopathy]. Brain Nerve 2022; 74:845-851. [PMID: 35860930 DOI: 10.11477/mf.1416202137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Coronavirus disease (COVID-19) causes neurological symptoms in a high percentage of patients and is associated with various types of encephalitides and encephalopathies, which are etiologically classified into (a)direct infection of the central nervous system with severe acute respiratory syndrome coronavirus 2 and resultant meningoencephalitis (this is a rare presentation), (b)COVID-19-induced cytokine storms, which trigger endothelial cell injury, blood-brain barrier disruption, and microangiopathy and consequent encephalopathy and, (c)autoimmune encephalitis secondary to para- or post-infectious mechanisms that play a key role during the acute or post-COVID-19 phase. Notably, some patients present with neurological symptoms as the first manifestation. Radiologically characteristic encephalitides and encephalopathies, such as acute necrotizing encephalopathy, acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, and clinically mild encephalitis/encephalopathy with a reversible splenial lesion are also complicated by COVID-19. Further investigations and appropriate treatments are warranted in patients with COVID-19, who develop new neurological symptoms.
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Affiliation(s)
- Daisuke Ono
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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23
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Drexlin JC, Schweizer D, Stein VM. [Diagnostics in epilepsy - potential of magnetic resonance imaging]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2021; 49:29-42. [PMID: 33588463 DOI: 10.1055/a-1322-9439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Epilepsy is a common neurologic disease frequently encountered by small animal practitioners. The disease comprises a multiplicity of clinical presentations and etiologies and often necessitates a comprehensive as well as cost-intensive diagnostic workup. This is mandatory in order to be able to diagnose or exclude a metabolic cause of the seizures and to distinguish between idiopathic and structural epilepsy. The examination by means of magnetic resonance imaging (MRI) represents a central component of the diagnostic workup, which in turn has essential effects on treatment and prognosis. In order to achieve standardized examination and comparable results, it is of utmost importance to use defined MRI protocols. Accordingly, communication and interaction between clinical institutions may be facilitated and as of yet undetected structural changes might be recorded in future MRI techniques. This review article sets particularly emphasis on the definition and classification of epilepsy as well as its diagnostic imaging procedures and refers to statistics and specialists' recommendations for the diagnostic workup in dogs.
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Affiliation(s)
- Jana C Drexlin
- Abteilung für Klinische Neurologie, Departement für klinische Veterinärmedizin, Vetsuisse Fakultät, Universität Bern
| | - Daniela Schweizer
- Abteilung für Klinische Radiologie, Departement für klinische Veterinärmedizin, Vetsuisse Fakultät, Universität Bern
| | - Veronika M Stein
- Abteilung für Klinische Neurologie, Departement für klinische Veterinärmedizin, Vetsuisse Fakultät, Universität Bern
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24
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Soul JS, Bergin AM, Stopp C, Hayes B, Singh A, Fortuno CR, O'Reilly D, Krishnamoorthy K, Jensen FE, Rofeberg V, Dong M, Vinks AA, Wypij D, Staley KJ. A Pilot Randomized, Controlled, Double-Blind Trial of Bumetanide to Treat Neonatal Seizures. Ann Neurol 2021; 89:327-340. [PMID: 33201535 PMCID: PMC8122513 DOI: 10.1002/ana.25959] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In the absence of controlled trials, treatment of neonatal seizures has changed minimally despite poor drug efficacy. We tested bumetanide added to phenobarbital to treat neonatal seizures in the first trial to include a standard-therapy control group. METHODS A randomized, double-blind, dose-escalation design was employed. Neonates with postmenstrual age 33 to 44 weeks at risk of or with seizures were eligible. Subjects with electroencephalography (EEG)-confirmed seizures after ≥20 and <40mg/kg phenobarbital were randomized to receive additional phenobarbital with either placebo (control) or 0.1, 0.2, or 0.3mg/kg bumetanide (treatment). Continuous EEG monitoring data from ≥2 hours before to ≥48 hours after study drug administration (SDA) were analyzed for seizures. RESULTS Subjects were randomized to treatment (n = 27) and control (n = 16) groups. Pharmacokinetics were highly variable among subjects and altered by hypothermia. The only statistically significant adverse event was diuresis in treated subjects (48% vs 13%, p = 0.02). One treated (4%) and 3 control subjects died (19%, p = 0.14). Among survivors, 2 of 26 treated subjects (8%) and 0 of 13 control subjects had hearing impairment, as did 1 nonrandomized subject. Total seizure burden varied widely, with much higher seizure burden in treatment versus control groups (median = 3.1 vs 1.2 min/h, p = 0.006). There was significantly greater reduction in seizure burden 0 to 4 hours and 2 to 4 hours post-SDA (both p < 0.01) compared with 2-hour baseline in treatment versus control groups with adjustment for seizure burden. INTERPRETATION Although definitive proof of efficacy awaits an appropriately powered phase 3 trial, this randomized, controlled, multicenter trial demonstrated an additional reduction in seizure burden attributable to bumetanide over phenobarbital without increased serious adverse effects. Future trials of bumetanide and other drugs should include a control group and balance seizure severity. ANN NEUROL 2021;89:327-340.
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Affiliation(s)
- Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann M Bergin
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Stopp
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Breda Hayes
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Avantika Singh
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carmen R Fortuno
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deirdre O'Reilly
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kalpathy Krishnamoorthy
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frances E Jensen
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Min Dong
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin J Staley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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Dogan L, Kaya D, Sarikaya T, Zengin R, Dincer A, Akinci IO, Afsar N. Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series. Brain Behav Immun 2020; 87:155-158. [PMID: 32389697 PMCID: PMC7204750 DOI: 10.1016/j.bbi.2020.05.022] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Severe SARS-CoV-2 (COVID-19) infection has the potential for a high mortality rate. In this paper, we report the results of plasmapheresis treatment in a series of severely ill patients with COVID-19-related autoimmune meningoencephalitis in the Intensive Care Unit (ICU).
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Affiliation(s)
- Lerzan Dogan
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Dilaver Kaya
- Neurology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Tugce Sarikaya
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Rehile Zengin
- Infectious Diseases, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Alp Dincer
- Radiology, and Center for Neuroradiological Applications and Research, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Ibrahim Ozkan Akinci
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Nazire Afsar
- Neurology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
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26
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Pereira MEVDC, Gonzalez DE, Roberto FB, Foresto RD, Kirsztajn GM, Durão MDS. Listeria monocytogenes meningoencephalitis in a patient with Systemic Lupus Erythematosus. J Bras Nefrol 2020; 42:375-379. [PMID: 32406475 PMCID: PMC7657045 DOI: 10.1590/2175-8239-jbn-2019-0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/08/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents. METHODS We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection. DISCUSSION Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid. CONCLUSION The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.
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Affiliation(s)
| | - Diego Ennes Gonzalez
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Fernanda Badiani Roberto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Renato Demarchi Foresto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Gianna Mastroianni Kirsztajn
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Marcelino de Souza Durão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
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Alemayehu T, Ayalew S, Buzayehu T, Daka D. Magnitude of Cryptococcosis among HIV patients in sub-Saharan Africa countries: a systematic review and meta-analysis. Afr Health Sci 2020; 20:114-121. [PMID: 33402899 PMCID: PMC7750036 DOI: 10.4314/ahs.v20i1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Cryptococcus is encapsulated opportunistic yeast that causes life threatening meningoencephalitis of patients with human immunodeficiency virus (HIV). The magnitude of Cryptococcosis among HIV patients varies from 1–10% in Western countries as opposed to almost a one third of HIV-infected individuals in sub-Saharan Africa where it is associated with high mortality. Methodology By using key terms “Cryptococcosis among HIV patients in sub-saharan Africa countries”, articles that published in different journals from 2010–2017 searched on Pub-Med and Google scholar database. Those freely accessible and included the prevalence of Cryptococcosis in the result section, their PDF file was downloaded and the result extracted manually and presented in table. Articles that did not report the prevalence of Cryptococcosis, with a study design otherthan cross sectional, or a sample size less than 100, and those duplicated in the same study area and period by the same authors were excluded. The article selection followed the PRISMA guidelines and meta- analysis was performed using OpenMeta(analyst). Results The overall pooled magnitude of Cryptococcosis among HIV patients in sub saharan African countries was 8.3% (95%CI 6.1–10.5%). The highest prevalence was from Uganda (19%) and the least was from Ethiopia at 1.6%. There was 87.2 % of substantial heterogeneity among the studies with p-value<0.001. The symmetry ofthe forest plot showed that there was little publication bias. The most commonly used method for diagnosis of Cryptococcosis was lateral flow assay and latex agglutination test and culture was the least method employed. Conclusion The overall pooled magnitude of Cryptococcosisis high among HIV patients in sub-Saharan African countries. The studies showed substantial heterogeneity, and little publication bias. Most of the studies relied on LFA & LA that showed the scarcity of facilities for fungal culture. Therefore, paying attention to screening HIV patients; those with signs and symptoms of meningitis may help to reduce the loss of HIV patients.
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Affiliation(s)
- Tsegaye Alemayehu
- School of Medical Laboratory Science Hawassa University College of medicine and health sciences
| | | | - Temesgen Buzayehu
- School of Medical Laboratory Science Hawassa University College of medicine and health sciences
| | - Deresse Daka
- School of Medical Laboratory Science Hawassa University College of medicine and health sciences
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Hosoda T, Sakamoto M, Orikasa H, Kubomura A, Misaki T, Okabe N. Septic Meningitis and Liver Abscess due to Hypermucoviscous Klebsiella pneumoniae Complicated with Chronic Strongyloidiasis in a Human T-lymphotropic Virus 1 Carrier. Intern Med 2020; 59:129-133. [PMID: 31434825 PMCID: PMC6995716 DOI: 10.2169/internalmedicine.3403-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Recently, severe cases of infection due to hypermucoviscous Klebsiella pneumonia (hmKP) have been reported in Japan. The Amami Islands in Japan are also endemic regions for Strongyloides stercoralis. Disseminated strongyloidiasis strain often causes severe enterobacteria infection; however, whether or not chronic strongyloidiasis induces it remains unclear. We herein report a 71-year-old man who developed meningitis and liver abscess due to hmKP complicated with chronic strongyloidiasis. He died on the seventh hospital day. Strongyloides stercoralis were only found around the polyp in the cecum. Chronic strongyloidiasis can also induce severe infection due to enterobacteria, especially hypervirulent pathogens like hmKP, through the induction of mucosal rupture.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Mitsuo Sakamoto
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Hideki Orikasa
- Department of Pathology, Kawasaki Municipal Kawasaki Hospital, Japan
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Bah AR, Abasse ZE, Benmallem O, Habbal R. Very rare electrocardiograph abnormalities in meningitis. Pan Afr Med J 2020; 37:231. [PMID: 33552349 PMCID: PMC7847214 DOI: 10.11604/pamj.2020.37.231.23158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/07/2020] [Indexed: 11/11/2022] Open
Abstract
Osborn waves are produced when the J point deviates from baseline. While there are many known causes of Osborn waves, hypothermia remains the most common. We report electrocardiographic changes with Osborn wave in a 32-year-old woman with fatal meningoencephalitis, potentially reversible, probably non-ischaemic myocardial dysfunction may occur in association with acute non cardiac illnesses, such as brain injuries or severe infections. The mechanisms of the electrocardiography (ECG) abnormalities in this disease are unclear.
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Affiliation(s)
- Ali Rida Bah
- Department of Cardiology, Ibn Rochd University Hospital Casablanca, Casablanca, Morocco
- Corresponding author: Ali Rida Bah, Department of Cardiology, Ibn Rochd University Hospital Casablanca, Casablanca, Morocco.
| | - Zeine El Abasse
- Department of Cardiology, Ibn Rochd University Hospital Casablanca, Casablanca, Morocco
| | - Othman Benmallem
- Department of Cardiology, Ibn Rochd University Hospital Casablanca, Casablanca, Morocco
| | - Rachida Habbal
- Department of Cardiology, Ibn Rochd University Hospital Casablanca, Casablanca, Morocco
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Affiliation(s)
- E Mukhametshina
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - P Gavrilov
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
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Affiliation(s)
- Allan R Tunkel
- From the Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); the Department of Medicine, Newton-Wellesley Hospital, Newton, MA (E.L.B.); and the Departments of Radiology (K.A.B.) and Pathology (M.M.-L.), Massachusetts General Hospital, the Department of Medicine, Brigham and Women's Hospital (F.M.M.), and the Departments of Radiology (K.A.B.), Medicine (F.M.M.), and Pathology (M.M.-L.), Harvard Medical School - all in Boston
| | - Elinor L Baron
- From the Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); the Department of Medicine, Newton-Wellesley Hospital, Newton, MA (E.L.B.); and the Departments of Radiology (K.A.B.) and Pathology (M.M.-L.), Massachusetts General Hospital, the Department of Medicine, Brigham and Women's Hospital (F.M.M.), and the Departments of Radiology (K.A.B.), Medicine (F.M.M.), and Pathology (M.M.-L.), Harvard Medical School - all in Boston
| | - Karen A Buch
- From the Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); the Department of Medicine, Newton-Wellesley Hospital, Newton, MA (E.L.B.); and the Departments of Radiology (K.A.B.) and Pathology (M.M.-L.), Massachusetts General Hospital, the Department of Medicine, Brigham and Women's Hospital (F.M.M.), and the Departments of Radiology (K.A.B.), Medicine (F.M.M.), and Pathology (M.M.-L.), Harvard Medical School - all in Boston
| | - Francisco M Marty
- From the Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); the Department of Medicine, Newton-Wellesley Hospital, Newton, MA (E.L.B.); and the Departments of Radiology (K.A.B.) and Pathology (M.M.-L.), Massachusetts General Hospital, the Department of Medicine, Brigham and Women's Hospital (F.M.M.), and the Departments of Radiology (K.A.B.), Medicine (F.M.M.), and Pathology (M.M.-L.), Harvard Medical School - all in Boston
| | - Maria Martinez-Lage
- From the Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); the Department of Medicine, Newton-Wellesley Hospital, Newton, MA (E.L.B.); and the Departments of Radiology (K.A.B.) and Pathology (M.M.-L.), Massachusetts General Hospital, the Department of Medicine, Brigham and Women's Hospital (F.M.M.), and the Departments of Radiology (K.A.B.), Medicine (F.M.M.), and Pathology (M.M.-L.), Harvard Medical School - all in Boston
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Abstract
We herein report a case of Campylobacter fetus meningoencephalitis in a patient with chronic alcoholism. C. fetus is a rare cause of meningitis. The patient presented with hallucinations and monology, and alcohol withdrawal was initially suspected. After he was unsuccessfully treated for alcohol withdrawal delirium, we diagnosed C. fetus meningoencephalitis. Ampicillin monotherapy gradually improved his clinical status. A previous report stated that C. fetus infection is associated with chronic alcoholism. In patients with chronic alcoholism and disturbed consciousness, an atypical bacterial central nervous system infection, such as C. fetus meningoencephalitis, should be considered.
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Affiliation(s)
- Sho Tanabe
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Motoyuki Tsuboi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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Abstract
RATIONALE Angiostrongylus cantonensis-induced eosinophilic meningoencephalitis (AEM) in infants is a very rare but fatal disease. Utilization of genetic assay to detect the cerebral parasite plays an important role for the treatment of the infection. PATIENT CONCERNS Two infants (<2 years) presented with cough, intermittent fever, mental fatigue, and poor diet. DIAGNOSIS The patients were under clinical examination and laboratory test including cardiac ultrasound, chest X-ray, blood or cerebrospinal fluid (CSF) cell counting, serum enzyme-linked immunosorbent assay (ELISA), head magnetic resonance imaging (MRI) and next-generation sequencing (NGS) on DNA from CSF. Due to hypereosinophils in patients' peripheral blood and CSF, and abundant DNA sequences from A cantonensis in CSF, the patients were diagnosed with Angiostrongylus eosinophilic meningoencephalitis. INTERVENTIONS The patients were treated with albendazole to deworm, and methylprednisolone to reduce inflammation. OUTCOME The patients were completely recovered from AEM without relapse after 10-day treatment. LESSONS ELISA and MRI are not sufficiently accurate for the diagnosis of AEM in infants. NGS can specify the infection by the cerebral parasite and offers a new effective approach for the early and precise diagnosis of AEM in infants.
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Affiliation(s)
- Mei Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhen Zhou
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Suhua Guo
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zengqing Li
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hui Zhao
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiusheng Deng
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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King KA, Ansari G, Panackal AA, Zalewski C, Anjum S, Bennett JE, Beri A, Kim HJ, Hammoud D, Brewer CC, Williamson PR. Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients. Otol Neurotol 2019; 40:e657-e664. [PMID: 31157723 PMCID: PMC6565454 DOI: 10.1097/mao.0000000000002242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM). STUDY DESIGN Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM. SETTING Tertiary referral center, National Institutes of Health Clinical Center. PATIENTS Previously healthy adult patients with CM without immune suppressive therapy before disease onset. INTERVENTIONS Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment. RESULTS Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count. CONCLUSIONS Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.
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Affiliation(s)
- Kelly A King
- National Institute on Deafness and Other Communication Disorders
| | | | - Anil A Panackal
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Chris Zalewski
- National Institute on Deafness and Other Communication Disorders
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Andrea Beri
- Biomedical Translational Research Information System
| | - Hung Jeff Kim
- National Institute on Deafness and Other Communication Disorders
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC
| | - Dima Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Carmen C Brewer
- National Institute on Deafness and Other Communication Disorders
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
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Affiliation(s)
- Kimon C Zachary
- From the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - Regina C LaRocque
- From the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - John A Branda
- From the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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Schafbuch RM, Hermida Casas JA, Hammac GK, Kritchevsky JE, Miller MA. Pathology in Practice. J Am Vet Med Assoc 2018; 253:1417-1419. [PMID: 30451627 DOI: 10.2460/javma.253.11.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Areej R El-Jawahri
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Pamela W Schaefer
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Joseph B El Khoury
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
| | - Maria Martinez-Lage
- From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston
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Čermáková S, Fait T. Acute enteroviral meningoencephalitis as unusual cause of diplopia in pregnancy and puerperium. Ceska Gynekol 2018; 83:281-285. [PMID: 30441959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe unusual cause of diplopia in early puerperal period. DESIGN Case report. SETTING Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol. CASE REPORT 34-year-old patient at 39 weeks of gestation complaining fever, headache and blurring of vision was referred to our medical center. She underwent caesarean section for tachycardia of fetus. Symptoms remained during early puerperium. We describe diagnostic and treatment hesitations. CONCLUSION The cause of her complains was viral meningoencephalitis which led in postencephalitic syndrome.
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Huamaní C, Galindo D, Quijano-Zapata F, Aldave R. [Not Available]. Rev Neurol 2017; 65:383-384. [PMID: 28990650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- C Huamaní
- Hospital Nacional Guillermo Almenara, Lima, Peru
| | - D Galindo
- Hospital Nacional Guillermo Almenara, Lima, Peru
| | | | - R Aldave
- Hospital Nacional Guillermo Almenara, Lima, Peru
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Shimozono K, Hayashi Y, Nishinaka T, Kobayashi S. [An adult case of group A streptococcus meningitis associated with steroid-responsive meningoencephalitis]. Rinsho Shinkeigaku 2017; 57:499-503. [PMID: 28804111 DOI: 10.5692/clinicalneurol.cn-001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A previously healthy 80-year-old woman presented to our service in a comatose state. On examination the patient had fever and neck stiffness. Laboratory investigation showed polymorphonuclear pleocytosis in cerebro-spinal fluid (CSF). These findings prompted us to a diagnosis of bacterial or viral meningitis and combination therapy consisting of ceftriaxone, vancomycin and acyclovir was started immediately. Two days later, culture of blood yielded Streptococcus pyogenes (group A streptococcus; GAS). The antibiotic therapy was converted to intravenous ampicillin for 14 days. Fever resolved quickly, however, somnolence persisted. Fluid attenuated inversion recovery image of the brain, taken on the day 29, showed focal hyperintense lesions on the right subcortical area in the temporal and parietal lobes. Three times repeated intravenous steroid pulse therapy (methylprednisolone 1,000 mg/day, 3 days) resulted in complete improvement of her consciousness disturbance. We considered the present case to be a steroid-responsive meningoencephalitis caused by GAS infection.
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Varela Barca L, López-Menéndez J, Redondo Palacios A, Rodríguez-Roda Stuart J. Septic Shock, Meningoencephalitis and Multiple Pulmonary Emboli: Case Report of an Uncommon Clinical Presentation of Ventricular Septal Defect Acute Infective Endocarditis. J Heart Valve Dis 2017; 26:606-609. [PMID: 29762935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The case is reported of a 55 year-old woman, with a previously known congenital septal defect, who was admitted to the emergency department with a diagnosis of meningoencephalitis, septic shock, and rapid clinical deterioration. Echocardiography revealed a vegetation occupying the right-side heart. Endocarditis affectation of the septal defect, aortic and tricuspid valves was noted and blood cultures were positive for Staphylococcus aureus. Urgent surgical treatment was performed whereby the ventricular septal defect was closed, a meticulous debridement of the affected area was conducted, and the aortic and tricuspid valves were replaced.
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Affiliation(s)
- Laura Varela Barca
- Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain. Electronic correspondence:
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Shimoda Y, Ohtomo S, Arai H, Ohtoh T, Tominaga T. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report. BMC Neurol 2017; 17:157. [PMID: 28793877 PMCID: PMC5551018 DOI: 10.1186/s12883-017-0934-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cryptococcal meningoencephalitis (CM) causes cerebral infarction, typically, lacunar infarction in the basal ganglia. However, massive cerebral infarction leading to death is rare and its pathophysiology is unclear. We report a case of CM causing massive cerebellar infarction, which led to cerebral herniation and death. CASE PRESENTATION A 56-year-old man who suffered from dizziness and gait disturbance for one month was admitted to our hospital and subsequently diagnosed with a cerebellar infarction. He had a past medical history of hepatitis type B virus infection and hepatic failure. Although the findings on magnetic resonance imaging (MRI) imitated an arterial infarction of the posterior inferior cerebellar artery, an accompanying irregular peripheral edema was observed. The ischemic lesion progressed, subsequently exerting a mass effect and leading to impaired consciousness. External and internal decompression surgeries were performed. Cryptococcus neoformans was confirmed in the surgical specimen, and the patient was diagnosed with CM. In addition, venule congestion in the parenchyma was observed with extensive fibrosis and compressed veins in the subarachnoid space. The patient died 26 days after admission. Autopsy revealed that pathological changes were localized in the cerebellum. CONCLUSION C. neoformans can induce extensive fibrosis of the subarachnoid space, which may compress small veins mechanically inducing venule congestion and massive cerebral infarction. In such cases, the clinical course can be severe and even rapidly fatal. An atypical pattern of infarction on MRI should alert clinicians to the possibility of C. neoformans infection.
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Affiliation(s)
- Yoshiteru Shimoda
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
| | - Takashi Ohtoh
- Department of Pathology, South Miyagi Medical Center, Shibata-gun, Miyagi Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Brito CAA, Azevedo F, Cordeiro MT, Marques ETA, Franca RFO. Central and peripheral nervous system involvement caused by Zika and chikungunya coinfection. PLoS Negl Trop Dis 2017; 11:e0005583. [PMID: 28704365 PMCID: PMC5509110 DOI: 10.1371/journal.pntd.0005583] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Carlos A. A. Brito
- Department of Clinical Medicine, Federal University of Pernambuco - UFPE, Recife, Brazil
| | | | - Marli T. Cordeiro
- Department of Virology and Experimental Therapy, Oswaldo Cruz Foundation - FIOCRUZ, Aggeu Magalhães Institute, Recife, Brazil
| | - Ernesto T. A. Marques
- Department of Virology and Experimental Therapy, Oswaldo Cruz Foundation - FIOCRUZ, Aggeu Magalhães Institute, Recife, Brazil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Center for Vaccine Research, Pittsburgh, Pennsylvania, United States of America
| | - Rafael F. O. Franca
- Department of Virology and Experimental Therapy, Oswaldo Cruz Foundation - FIOCRUZ, Aggeu Magalhães Institute, Recife, Brazil
- * E-mail:
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Affiliation(s)
- Martin A Samuels
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - R Gilberto Gonzalez
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - Azure T Makadzange
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - E Tessa Hedley-Whyte
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
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Maciel RA, Ferreira LS, Wirth F, Rosa PD, Aves M, Turra E, Goldani LZ. Corticosteroids for the management of severe intracranial hypertension in meningoencephalitis caused by Cryptococcus gattii: A case report and review. J Mycol Med 2016; 27:109-112. [PMID: 27818191 DOI: 10.1016/j.mycmed.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/09/2023]
Abstract
Immune reconstitution inflammatory syndrome in meningitis caused by Cryptococcus gattii in immunocompetent patients after initiation of antifungal therapy appears to be the result of paradoxical antifungal treatment-induced clinical deterioration due to improved local immune responses to cryptococcal organisms. Recent anecdotal reports have suggested a favorable clinical response to corticosteroids in select patients with C. gattii central nervous system (CNS) infections. In this report, we describe a 65-year-old patient with meningoencephalitis caused by C. gattii who developed persistent intracranial hypertension and was successfully managed with antifungal therapy, repeated lumbar puncture and corticosteroids. Our observations suggest a possible benefit of dexamethasone in the management of select cases of C. gattii CNS infection with intracranial hypertension. Further studies are necessary to evaluate the long-term use of steroids in select patients with C. gattii with intracranial hypertension.
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Affiliation(s)
- R-A Maciel
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - L-S Ferreira
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - F Wirth
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - P-D Rosa
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - M Aves
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - E Turra
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
| | - L-Z Goldani
- Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Jacobs M, Rodger A, Bell DJ, Bhagani S, Cropley I, Filipe A, Gifford RJ, Hopkins S, Hughes J, Jabeen F, Johannessen I, Karageorgopoulos D, Lackenby A, Lester R, Liu RSN, MacConnachie A, Mahungu T, Martin D, Marshall N, Mepham S, Orton R, Palmarini M, Patel M, Perry C, Peters SE, Porter D, Ritchie D, Ritchie ND, Seaton RA, Sreenu VB, Templeton K, Warren S, Wilkie GS, Zambon M, Gopal R, Thomson EC. Late Ebola virus relapse causing meningoencephalitis: a case report. Lancet 2016; 388:498-503. [PMID: 27209148 PMCID: PMC4967715 DOI: 10.1016/s0140-6736(16)30386-5] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There are thousands of survivors of the 2014 Ebola outbreak in west Africa. Ebola virus can persist in survivors for months in immune-privileged sites; however, viral relapse causing life-threatening and potentially transmissible disease has not been described. We report a case of late relapse in a patient who had been treated for severe Ebola virus disease with high viral load (peak cycle threshold value 13.2). METHODS A 39-year-old female nurse from Scotland, who had assisted the humanitarian effort in Sierra Leone, had received intensive supportive treatment and experimental antiviral therapies, and had been discharged with undetectable Ebola virus RNA in peripheral blood. The patient was readmitted to hospital 9 months after discharge with symptoms of acute meningitis, and was found to have Ebola virus in cerebrospinal fluid (CSF). She was treated with supportive therapy and experimental antiviral drug GS-5734 (Gilead Sciences, San Francisco, Foster City, CA, USA). We monitored Ebola virus RNA in CSF and plasma, and sequenced the viral genome using an unbiased metagenomic approach. FINDINGS On admission, reverse transcriptase PCR identified Ebola virus RNA at a higher level in CSF (cycle threshold value 23.7) than plasma (31.3); infectious virus was only recovered from CSF. The patient developed progressive meningoencephalitis with cranial neuropathies and radiculopathy. Clinical recovery was associated with addition of high-dose corticosteroids during GS-5734 treatment. CSF Ebola virus RNA slowly declined and was undetectable following 14 days of treatment with GS-5734. Sequencing of plasma and CSF viral genome revealed only two non-coding changes compared with the original infecting virus. INTERPRETATION Our report shows that previously unanticipated, late, severe relapses of Ebola virus can occur, in this case in the CNS. This finding fundamentally redefines what is known about the natural history of Ebola virus infection. Vigilance should be maintained in the thousands of Ebola survivors for cases of relapsed infection. The potential for these cases to initiate new transmission chains is a serious public health concern. FUNDING Royal Free London NHS Foundation Trust.
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Affiliation(s)
- Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | - David J Bell
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Sanjay Bhagani
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Cropley
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Ana Filipe
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Robert J Gifford
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Susan Hopkins
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Farrah Jabeen
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ingolfur Johannessen
- Regional Virus Laboratory Specialist Virology Centre, Edinburgh Royal Infirmary, Edinburgh, UK
| | | | - Angie Lackenby
- Virus Reference Department, National Infection Service, Public Health England, Colindale, UK
| | - Rebecca Lester
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Rebecca S N Liu
- Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Tabitha Mahungu
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Daniel Martin
- Division of Surgery, University College London, London, UK
| | - Neal Marshall
- Department of Pharmacy, Royal Free London NHS Foundation Trust, London, UK
| | - Stephen Mepham
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Orton
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Monika Patel
- High Containment Microbiology Department, National Infection Service, Public Health England, Colindale, UK
| | - Colin Perry
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | | | | | | | | | - Kate Templeton
- Regional Virus Laboratory Specialist Virology Centre, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Simon Warren
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Gavin S Wilkie
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Maria Zambon
- Virus Reference Department, National Infection Service, Public Health England, Colindale, UK
| | - Robin Gopal
- High Containment Microbiology Department, National Infection Service, Public Health England, Colindale, UK
| | - Emma C Thomson
- Queen Elizabeth University Hospital, Glasgow, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
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Xia S, Li X, Shi Y, Liu J, Zhang M, Gu T, Pan S, Song L, Xu J, Sun Y, Zhao Q, Lu Z, Lu P, Li H. A Retrospective Cohort Study of Lesion Distribution of HIV-1 Infection Patients With Cryptococcal Meningoencephalitis on MRI: Correlation With Immunity and Immune Reconstitution. Medicine (Baltimore) 2016; 95:e2654. [PMID: 26871791 PMCID: PMC4753886 DOI: 10.1097/md.0000000000002654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this paper is to correlate the MRI distribution of cryptococcal meningoencephalitis in HIV-1 infection patients with CD4 T cell count and immune reconstitution effect.A large retrospective cohort study of HIV patients from multi-HIV centers in China was studied to demonstrate the MRI distribution of cryptococcal meningoencephalitis and its correlation with the different immune status.The consecutive clinical and neuroimaging data of 55 HIV-1-infected patients with cryptococcal meningoencephalitis collected at multi-HIV centers in China during the years of 2011 to 2014 was retrospectively analyzed. The enrolled patients were divided into 2 groups based on the distribution of lesions. One group of patients had their lesions at the central brain (group 1, n = 34) and the other group of patients had their lesions at the superficial brain (group 2, n = 21). We explored their MRI characterization of brain. In addition, we also compared their CD4 T cell counts and immune reconstitution effects between the 2 groups based on the imaging findings.No statistical difference was found in terms of age and gender between the 2 groups. The medians of CD4 T cell counts were 11.67 cells/mm (3.00-52.00 cells/mm) in group 1 and 42.00 cells/mm (10.00-252.00 cells/mm) in group 2. Statistical difference of CD4 T cell count was found between the 2 groups (P = 0.023). Thirteen patients in group 1 (13/34) and 12 patients in group 2 (12/21) received highly active antiretroviral treatment (HAART). Patients of group 2 received HAART therapy more frequently than patients of group 1 (P = 0.021).Central and superficial brain lesions detected by MR imaging in HIV-1-infected patients with cryptococcal meningoencephalitis are in correlation with the host immunity and HAART therapy.
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Affiliation(s)
- Shuang Xia
- From the Department of Radiology, Tianjin First Central Hospital (SX, MZ, TG), Tianjin; Department of Radiology, Youan Hospital Affiliated of Capital Medical University (XL, HL), Xitoutiao, Youan Menwai, Beijing; Department of Radiology, Zhengzhou Sixth People's Hospital (YS, LS), Zhengzhou, Henan Province; Department of Radiology, Guangzhou Eighth People's Hospital (JL), Guangzhou, Guangdong Province; Department of Radiology, Shengjing Hospital of China Medical University (SP), Shenyang, Liaoning Province; Department of Infection, Zhengzhou Sixth People's Hospital (JX, YS, QZ), Zhengzhou, Henan Province; Department of Radiology, Zhongnan Hospital of Wuhan University (ZL), Wuhan, Hubei Province; and Department of Radiology, Shenzhen Third People's Hospital of Guangdong Medical College (PL), Shenzhen, Guangdong Province
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Abstract
Relapsing polychondritis (RP) is a rare inflammatory disorder of the cartilagenous structures, and it sometimes involves the central nervous system. Encephalitis associated with RP causes a wide variety of symptoms according to the affected sites. We herein report the first case of 72-year-old right-handed man who developed acute meningoencephalitis associated with RP involving the corpus callous. After immunosuppressive therapy, his symptoms dramatically improved, but difficulty in performing bimanual movements with occasional diagonistic dyspraxia in his right hand remained. Because callosal signs are easily missed, especially in acute settings, it would be useful to know that RP can sometimes cause callosal disconnection syndrome.
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Affiliation(s)
- Toru Baba
- Department of Behavioral Neurology & Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Japan
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50
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Lin YJ, Lo C, Cheng SJ, Chou CL, Hseuh IH. Recurrent nonconvulsive status epilepticus in a patient with progressive left hemispheric leukoencephalopathy after a remote viral meningoencephalitis. Epilepsy Behav 2015; 49:178-83. [PMID: 26139418 DOI: 10.1016/j.yebeh.2015.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 01/28/2023]
Abstract
Nonconvulsive status epilepticus (NCSE), defined as changes in behavior and/or mental processes from baseline with continuous epileptiform discharges, remains a diagnostic and treatment challenge. Here, we present a 68-year-old female who developed 3 episodes of NCSE 10 years after a viral meningoencephalitis which gradually progressed to left hemispheric leukoencephalopathy. In this case, we hypothesize that immune-mediated mechanisms and perhaps genetic predisposition played a role in epileptogenesis, and these will be discussed. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- Ya-Ju Lin
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - Chiening Lo
- Department of Neurology, National Cheng Kung University Hospital Dou-Liou Branch, No. 345, Jhuangjing Road, Dou-Liou City, Yun-Lin County 640, Taiwan.
| | - Sho-Jen Cheng
- Department of Radiology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - Chao-Liang Chou
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - I-Hung Hseuh
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
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