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Pantelis C, Jayaram M, Hannan AJ, Wesselingh R, Nithianantharajah J, Wannan CMJ, Syeda WT, Choy KHC, Zantomio D, Christopoulos A, Velakoulis D, O’Brien TJ. Neurological, neuropsychiatric and neurodevelopmental complications of COVID-19. Aust N Z J Psychiatry 2021; 55:750-762. [PMID: 32998512 PMCID: PMC8317235 DOI: 10.1177/0004867420961472] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although COVID-19 is predominantly a respiratory disease, it is known to affect multiple organ systems. In this article, we highlight the impact of SARS-CoV-2 (the coronavirus causing COVID-19) on the central nervous system as there is an urgent need to understand the longitudinal impacts of COVID-19 on brain function, behaviour and cognition. Furthermore, we address the possibility of intergenerational impacts of COVID-19 on the brain, potentially via both maternal and paternal routes. Evidence from preclinical models of earlier coronaviruses has shown direct viral infiltration across the blood-brain barrier and indirect secondary effects due to other organ pathology and inflammation. In the most severely ill patients with pneumonia requiring intensive care, there appears to be additional severe inflammatory response and associated thrombophilia with widespread organ damage, including the brain. Maternal viral (and other) infections during pregnancy can affect the offspring, with greater incidence of neurodevelopmental disorders, such as autism, schizophrenia and epilepsy. Available reports suggest possible vertical transmission of SARS-CoV-2, although longitudinal cohort studies of such offspring are needed. The impact of paternal infection on the offspring and intergenerational effects should also be considered. Research targeted at mechanistic insights into all aspects of pathogenesis, including neurological, neuropsychiatric and haematological systems alongside pulmonary pathology, will be critical in informing future therapeutic approaches. With these future challenges in mind, we highlight the importance of national and international collaborative efforts to gather the required clinical and preclinical data to effectively address the possible long-term sequelae of this global pandemic, particularly with respect to the brain and mental health.
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Affiliation(s)
- Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
- Mid-West Area Mental Health Service, North Western Mental Health, Melbourne Health, St Albans, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Mahesh Jayaram
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
- Mid-West Area Mental Health Service, North Western Mental Health, Melbourne Health, St Albans, VIC, Australia
- Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Anthony J Hannan
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Robb Wesselingh
- Department of Neurology & Neurosciences, The Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Cassandra MJ Wannan
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - Warda Taqdees Syeda
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - KH Christopher Choy
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Daniela Zantomio
- Department of Clinical Haematology, Austin Hospital, Austin Health, Heidelberg, VIC, Australia
| | - Arthur Christopoulos
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
- Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Terence J O’Brien
- Department of Neurology & Neurosciences, The Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
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Yildiz H, Yarci E, Bozdemir SE, Ozdinc Kizilay N, Mengi S, Beskardesler N, Korukluoglu G, Mueller A, Bagci S. COVID-19-Associated Cerebral White Matter Injury in a Newborn Infant With Afebrile Seizure. Pediatr Infect Dis J 2021; 40:e268-e269. [PMID: 33902081 DOI: 10.1097/inf.0000000000003143] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) symptoms in newborn infants are incompletely described. We present the first case of neuroradiologic abnormality associated with COVID-19 in a newborn infant with afebrile seizure. This case underlines the possible neurologic involvement of severe acute respiratory syndrome coronavirus 2 in this age group.
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Affiliation(s)
- Harun Yildiz
- From the Department of Radiology, Dortcelik Children's Hospital
| | | | | | | | - Senay Mengi
- Department of Pediatrics, Dortcelik Children's Hospital, Bursa
| | | | - Gulay Korukluoglu
- Clinical Microbiology, Virology, National Virology Laboratory, Turkish Public Health Institution, Ankara, Turkey
| | - Andreas Mueller
- Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Soyhan Bagci
- Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
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Fragoso DC, Marx C, Dutra BG, da Silva CJ, da Silva PM, Martins Maia Junior AC, Tobara MC, Silva CDA, Dias L, Polycarpo AC, Richtmann R. COVID-19 as a Cause of Acute Neonatal Encephalitis and Cerebral Cytotoxic Edema. Pediatr Infect Dis J 2021; 40:e270-e271. [PMID: 33902082 DOI: 10.1097/inf.0000000000003145] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The majority of coronavirus disease 2019 (COVID-19) have been confirmed in adults, with only a few reported cases in children. In the pediatric population, COVID-19 infection appears to be often unremarkable or associated with mild respiratory symptoms. Little is known about neurologic complications related to COVID-19 in newborns. We present a case of severe encephalitis with cytotoxic brain edema in a newborn with COVID-19.
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Affiliation(s)
| | - Catherine Marx
- Neonatal Department, Hospital e Maternidade Santa Joana, São Paulo-SP, Brazil
| | | | | | | | | | | | | | - Livio Dias
- Neonatal Department, Hospital e Maternidade Santa Joana, São Paulo-SP, Brazil
| | | | - Rosana Richtmann
- Neonatal Department, Hospital e Maternidade Santa Joana, São Paulo-SP, Brazil
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Abstract
SUMMARY Neurological manifestations of coronavirus disease 2019 most commonly present in severe cases and range from mild complications, such as headache and dizziness, to severe complications, such as encephalopathy and acute cerebrovascular disease. Seizures, however, are an underreported neurological manifestation of this disease. We present three critically ill coronavirus disease 2019 patients with EEG monitoring who developed new-onset seizures and encephalopathy up to three-and-a-half weeks after symptom onset. There are several speculated etiologies for the development of new-onset seizures; however, the pathogenic mechanism remains unknown. Testing of coronavirus disease 2019 in the cerebrospinal fluid in addition to extensive research on neurological manifestations is warranted.
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Affiliation(s)
- Farhan Mithani
- Texas A&M Health Science Center College of Medicine, Bryan, Texas, U.S.A
| | - Meryim Poursheykhi
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Brandy Ma
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
- Weill Cornell Medical College, New York City, New York, U.S.A
| | - Robert G Smith
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Steven H Hsu
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
| | - Deepa Gotur
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
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Emami A, Fadakar N, Akbari A, Lotfi M, Farazdaghi M, Javanmardi F, Rezaei T, Asadi-Pooya AA. Seizure in patients with COVID-19. Neurol Sci 2020; 41:3057-3061. [PMID: 32949289 PMCID: PMC7501768 DOI: 10.1007/s10072-020-04731-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/15/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of the current study was to collect the data on the occurrence of seizures in patients with COVID-19 and to clarify the circumstances of the occurrence of seizures in these patients. METHODS All consecutive patients who referred to healthcare facilities anywhere in Fars province (located in South Iran with a population of 4.851 million people) from February 19 until June 2, 2020, and had confirmed COVID-19 by positive result on polymerase chain reaction testing and seizure were included. RESULTS During the study period, 6,147 people had confirmed COVID-19 in Fars province, Iran; 110 people died from the illness (case fatality rate 1.79%). During this time period, five people had seizures (seizure rate 0.08%). In four patients, seizure was one of the presenting manifestations, and in one person, it happened during the course of hospital admission. Two patients had status epilepticus. All patients experienced hypoxemia and four of them needed respirator. Two patients had related metabolic derangements and one had cerebrospinal fluid (CSF) lymphocytic pleocytosis. Brain imaging was abnormal in three patients. Four patients died. CONCLUSION New-onset seizures in critically ill patients with COVID-19 should be considered as acute symptomatic seizures and the treating physician should try to determine the etiology of the seizure and manage the cause immediately and appropriately. Detailed clinical, neurological, imaging, and electrophysiological investigations and attempts to isolate SARS-CoV-2 from CSF may clarify the role played by this virus in causing seizures in these patients.
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Affiliation(s)
- Amir Emami
- Burn & Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Fadakar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbari
- Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Javanmardi
- Burn & Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Rezaei
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA USA
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Shah J, Sijun L, Hui Z, Zeb F, Haq IU, Ullah A. Neurological Complications Of Hand, Foot And Mouth Disease In Children: A Review. J Ayub Med Coll Abbottabad 2020; 32:562-569. [PMID: 33225664] [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] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hand-Foot-and-Mouth disease (HFMD) is a viral illness commonly seen in young children, characterized by fever, vomiting, ulcerative lesions in oral mucosa, and vesicles on hands and feet. The early symptoms resolve but sometimes, it leads to more harsh neurological complications and even death. Therefore, the objective of this review was set to provide an overview of the symptoms, pathogenic agents, and treatment of neurological complications associated with HFMD. METHODS We reviewed literature from PubMed and Science Direct covering at least one of our objectives from inception to 4th March 2018. RESULTS This review represents 6 countries including China, Vietnam, Cambodia, South Korea, Taiwan, and Australia. Fifteen studies with a total of 1043 patients were included. The majority of HFMD cases with neurological complications were reported in China, predominance in boys as compared to girls, with 97% cases under 15 years of age. Meningoencephalitis and brainstem encephalitis contributed 70% of all neurological complications related to HFMD. Human Enterovirus71 genotype C, especially C4a was a causative agent associated with severe complications. Among symptoms, fever, vomiting, myoclonic jerks or seizure, headache, convulsion, and rashes were reported in almost all neurological complications. The common and supportive treatments were the administration of intravenous immunoglobulin and glucocorticoid therapies. CONCLUSIONS Early detection and appropriate treatment of severe neurological complications can minimize the risk of adverse health outcomes. Evidence based clinical practice guidelines for early detection and treatment would be significant in the management of these devastating neurological complications.
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Affiliation(s)
- Jahan Shah
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Liu Sijun
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Zhao Hui
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Falak Zeb
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Ijaz Ul Haq
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Amin Ullah
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
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Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol 2020; 26:619-630. [PMID: 32839951 PMCID: PMC7444681 DOI: 10.1007/s13365-020-00895-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 06/16/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 01/01/2023]
Abstract
The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.
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Affiliation(s)
- Fatima Khatoon
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Kartikay Prasad
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India
| | - Vijay Kumar
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, Uttar Pradesh, 201303, India.
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8
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Abstract
BACKGROUND Reports on neurologic manifestations of coronavirus disease 2019 (COVID-19) have attracted broad attention. We present an unusual case of COVID-19-associated encephalitis mimicking a glial tumor. CASE DESCRIPTION A 35-year-old woman presented with headache and seizures. T2 fluid-attenuated inverse recovery imaging showed hyperintensities in the left temporal lobe. Magnetic resonance spectroscopy showed an elevated choline peak. Imaging findings were suggestive of high-grade glioma. Antiepileptic medication failed to achieve seizure control. A left anterior temporal lobectomy was performed. The patient had no postoperative deficits, and her symptoms completely improved. Histologic examination revealed encephalitis. Postoperatively, our patient tested positive for COVID-19. CONCLUSIONS Our case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors. For prompt diagnosis and prevention of transmission, clinicians should consider COVID-19 in patients with similar presentation.
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Affiliation(s)
- Ibrahim E Efe
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Orhun Utku Aydin
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alper Alabulut
- Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Ozgur Celik
- Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Kerameddin Aydin
- Department of Neurosurgery, Ondokuz Mayis University Samsun, Samsun, Turkey; Department of Neurosurgery, VM Medical Park Samsun Hospital, Samsun, Turkey.
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9
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Steinbach RJ, Haese NN, Smith JL, Colgin LMA, MacAllister RP, Greene JM, Parkins CJ, Kempton JB, Porsov E, Wang X, Renner LM, McGill TJ, Dozier BL, Kreklywich CN, Andoh TF, Grafe MR, Pecoraro HL, Hodge T, Friedman RM, Houser LA, Morgan TK, Stenzel P, Lindner JR, Schelonka RL, Sacha JB, Roberts VHJ, Neuringer M, Brigande JV, Kroenke CD, Frias AE, Lewis AD, Kelleher MA, Hirsch AJ, Streblow DN. A neonatal nonhuman primate model of gestational Zika virus infection with evidence of microencephaly, seizures and cardiomyopathy. PLoS One 2020; 15:e0227676. [PMID: 31935257 PMCID: PMC6959612 DOI: 10.1371/journal.pone.0227676] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022] Open
Abstract
Zika virus infection during pregnancy is associated with miscarriage and with a broad spectrum of fetal and neonatal developmental abnormalities collectively known as congenital Zika syndrome (CZS). Symptomology of CZS includes malformations of the brain and skull, neurodevelopmental delay, seizures, joint contractures, hearing loss and visual impairment. Previous studies of Zika virus in pregnant rhesus macaques (Macaca mulatta) have described injury to the developing fetus and pregnancy loss, but neonatal outcomes following fetal Zika virus exposure have yet to be characterized in nonhuman primates. Herein we describe the presentation of rhesus macaque neonates with a spectrum of clinical outcomes, including one infant with CZS-like symptoms including cardiomyopathy, motor delay and seizure activity following maternal infection with Zika virus during the first trimester of pregnancy. Further characterization of this neonatal nonhuman primate model of gestational Zika virus infection will provide opportunities to evaluate the efficacy of pre- and postnatal therapeutics for gestational Zika virus infection and CZS.
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Affiliation(s)
- Rosemary J. Steinbach
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Nicole N. Haese
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Jessica L. Smith
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Lois M. A. Colgin
- Division of Comparative Medicine, Pathology Services Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Rhonda P. MacAllister
- Division of Comparative Medicine, Clinical Medicine Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Justin M. Greene
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Christopher J. Parkins
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - J. Beth Kempton
- Department of Otolaryngology, Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Edward Porsov
- Department of Otolaryngology, Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Xiaojie Wang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Lauren M. Renner
- Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Trevor J. McGill
- Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brandy L. Dozier
- Division of Comparative Medicine, Clinical Medicine Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Craig N. Kreklywich
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Takeshi F. Andoh
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Marjorie R. Grafe
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Heidi L. Pecoraro
- Veterinary Diagnostic Services Department, North Dakota State University, Fargo, North Dakota, United States of America
| | - Travis Hodge
- Division of Comparative Medicine, Time Mated Breeding Services Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Robert M. Friedman
- Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Lisa A. Houser
- Division of Comparative Medicine, Behavioral Services Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Terry K. Morgan
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Peter Stenzel
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jonathan R. Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Robert L. Schelonka
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jonah B. Sacha
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Victoria H. J. Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Martha Neuringer
- Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - John V. Brigande
- Department of Otolaryngology, Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Christopher D. Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Antonio E. Frias
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Anne D. Lewis
- Division of Comparative Medicine, Pathology Services Unit, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Meredith A. Kelleher
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Alec J. Hirsch
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Daniel Neal Streblow
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
- * E-mail:
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10
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Abstract
RATIONALE Acute necrotizing encephalopathy (ANE) is a rapidly progressing disease associated with frequent neurologic sequelae and has poor prognosis. Currently, the diagnosis and treatment of ANE rely on neuroradiologic findings and offering supportive care. Here, we report the successful treatment of a teenager diagnosed with ANE using combination of high-dose methylprednisolone and oseltamivir. PATIENT CONCERNS The patient, a 15-year-old female, presented with impaired consciousness and seizures secondary to acute upper respiratory tract infection. A series of brain magnetic resonance images (MRIs) were obtained toward establishing a possible diagnosis. DIAGNOSIS Based on the history of presenting illness and subsequent brain MRI scans, the patient was diagnosed to be suffering from ANE. INTERVENTIONS Following the diagnosis, the patient was placed on therapy comprising of high-dose methylprednisolone and oseltamivir. OUTCOMES After treatment with methylprednisolone and oseltamivir for 15 days, the patient recovered nearly completely from ANE as confirmed by subsequent brain MRI scans. No complications or other emerging clinical symptoms were noted for the duration of follow-up that lasted 6 months. LESSONS Contrary to common reports, ANE can occur beyond pediatric populations and its treatment should not be restricted to supportive care. Our case suggests that the use of high-dose corticosteroids and oseltamivir leads to promising prognosis.
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Affiliation(s)
- Hua Li
- Department of Magnetic Resonance Imaging
| | | | | | - Yan Wang
- Department of Intensive Care Unit
| | - Lin Wu
- Department of Neurology, People's Hospital of RiZhao, Rizhao, China
| | - Xia Qin
- Department of Neurology, People's Hospital of RiZhao, Rizhao, China
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11
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van Enter BJD, Huibers MHW, van Rooij L, Steingrover R, van Hensbroek MB, Voigt RR, Hol J. Perinatal Outcomes in Vertically Infected Neonates During a Chikungunya Outbreak on the Island of Curaçao. Am J Trop Med Hyg 2018; 99:1415-1418. [PMID: 30328407 PMCID: PMC6283481 DOI: 10.4269/ajtmh.17-0957] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/07/2017] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Recent outbreaks of Chikungunya virus (CHIKV) infection confirm the vulnerability of neonates after vertical transmission. In 2014, CHIKV was reported for the first time in the Americas, including the island of Curaçao. We describe the outcomes of symptomatic neonates with vertically transmitted CHIKV infection during the CHIKV epidemic, who were admitted in the Saint Elisabeth Hospital, Willemstad, Curaçao. There were three symptomatic neonates with serologically confirmed infection. Two neonates developed neurological complications, including convulsions and intracerebral bleeding. One newborn, in whom maternal infection occurred 7 weeks before delivery, had a fatal outcome after birth. Maternal-fetal transmission of CHIKV may cause severe neonatal complications. There is a need to share experiences and to implement protocols toward the management of perinatal CHIKV infection.
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Affiliation(s)
- Bert J. D. van Enter
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Minke H. W. Huibers
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Linda van Rooij
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Radjinkoemar Steingrover
- Department of Clinical Microbiology and Infection Prevention, Saint Elisabeth Hospital, Willemstad, Curaçao
- Analytic Diagnostic Center, Willemstad, Curaçao
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Ralph R. Voigt
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Jeroen Hol
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Noordwest Ziekenhuis, Alkmaar, The Netherlands
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12
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Kharod SC, Carter BM, Kadam SD. Pharmaco-resistant Neonatal Seizures: Critical Mechanistic Insights from a Chemoconvulsant Model. Dev Neurobiol 2018; 78:1117-1130. [PMID: 30136373 PMCID: PMC6214781 DOI: 10.1002/dneu.22634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/29/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022]
Abstract
Neonatal seizures are harmful to the developing brain and are associated with mortality and long-term neurological comorbidities. Hypoxic-ischemic encephalopathy (HIE) seizures represent a significant proportion of such seizures. Phenobarbital (PB) remains the first line anti-seizure drug (ASD) treatment but fails ~50% of the time. Translational models of neonatal seizures are crucial to investigating mechanisms underlying PB-resistance. A model of PB-resistant ischemic seizures in postnatal day 7 (P7) CD-1 mice reported K-Cl cotransporter 2 (KCC2) degradation that has been shown to be due to activation of the TrkB pathway. We investigated PB-efficacy in a pentylenetetrazole (PTZ) model of neonatal seizures in the same strain and age using identical treatment protocols to gain insights into mechanisms underlying PB-resistance. A single dose of PTZ (80 mg/kg; IP) consistently induced repetitive seizures that did not progress to status epilepticus (SE). PB (25 mg/kg; IP, single dose) significantly suppressed the PTZ-induced seizures. This was associated with significant KCC2 upregulation and stable Na-K-Cl cotransporter 1 (NKCC1) expression at 24h. The TrkB pathway was not activated. PTZ seizure burdens were significantly higher than those reported for ischemic seizures, indicating seizure severity did not dictate the differences in PB-efficacy. Bumetanide (BTN) (0.1-0.2 mg/kg; IP) did not work as an anti-seizure agent, similar to the ischemic model. When investigating mechanisms underlying the emergence of PB-resistance in translational models, the method by which seizures are induced may dictate mechanisms underlying emergence of PB-resistance.
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Affiliation(s)
- Shivani C. Kharod
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
| | - Brandon M. Carter
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
| | - Shilpa D. Kadam
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
- Hugo Moser Research Institute at Kennedy Krieger; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD 21205
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13
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DePaula-Silva AB, Sonderegger FL, Libbey JE, Doty DJ, Fujinami RS. The immune response to picornavirus infection and the effect of immune manipulation on acute seizures. J Neurovirol 2018; 24:464-477. [PMID: 29687406 PMCID: PMC6105529 DOI: 10.1007/s13365-018-0636-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 01/23/2018] [Revised: 03/09/2018] [Accepted: 03/27/2018] [Indexed: 12/23/2022]
Abstract
Viral infection of the central nervous system can result in encephalitis. About 20% of individuals who develop viral encephalitis go on to develop epilepsy. We have established an experimental model where virus infection of mice with Theiler's murine encephalomyelitis virus (TMEV) leads to acute seizures, followed by a latent period (no seizures/epileptogenesis phase) and then spontaneous recurrent seizures-epilepsy. Infiltrating macrophages (CD11b+CD45hi) present in the brain at day 3 post-infection are an important source of interleukin-6, which contributes to the development of acute seizures in the TMEV-induced seizure model. Time course analysis of viral infection and inflammatory [CD11b+CD45hiLy-6Chi] and patrolling [CD11b+CD45hiLy-6Clow] monocyte and T cell infiltration into the brains of TMEV-infected C57BL/6J mice over the entire course of the acute viral infection was performed to elucidate the role of virus and the immune response to virus in seizures and viral clearance. The infiltrating inflammatory macrophages were present early following infection but declined over the course of acute viral infection, supporting a role in seizure development, while the lymphocyte infiltration increased rapidly and plateaued, advocating that they play a role in viral clearance. In addition, we showed for the first time that, while TMEV infection of RAG1-/- mice did not alter the number of mice experiencing acute seizures, TMEV infection of C57BL/6J mice depleted of macrophages resulted in a significant decrease in the number of mice experiencing seizures, again supporting a role for infiltrating macrophages in the development of acute seizures in the TMEV-induced seizure model.
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Affiliation(s)
| | | | - Jane E Libbey
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel J Doty
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert S Fujinami
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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14
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Kaneko M, Maruta M, Shikata H, Asou K, Shinomiya H, Suzuki T, Hasegawa H, Shimojima M, Saijo M. Unusual presentation of a severely ill patient having severe fever with thrombocytopenia syndrome: a case report. J Med Case Rep 2017; 11:27. [PMID: 28153057 PMCID: PMC5290612 DOI: 10.1186/s13256-016-1192-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/28/2016] [Accepted: 12/27/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome is an emerging infectious disease caused by a novel phlebovirus belonging to the family Bunyaviridate. Emergence of encephalitis/encephalopathy during severe fever with thrombocytopenia syndrome progression has been identified as a major risk factor associated with a poor prognosis. Here we report the case of a severely ill patient with severe fever with thrombocytopenia syndrome virus-associated encephalitis/encephalopathy characterized by a lesion of the splenium, which resolved later. CASE PRESENTATION A 56-year-old Japanese man presented with fever and diarrhea, followed by dysarthria. Diffusion-weighted magnetic resonance imaging demonstrated high signal intensity in the splenium of the corpus callosum. The severe fever with thrombocytopenia syndrome virus genome was detected in our patient's serum, and the clinical course was characterized by convulsion, stupor, and hemorrhagic manifestations, with disseminated intravascular coagulation and hemophagocytic lymphohistiocytosis. Supportive therapy not including administration of corticosteroids led to gradual improvement of the clinical and laboratory findings, and magnetic resonance imaging demonstrated resolution of the splenial lesion. The serum severe fever with thrombocytopenia syndrome viral copy number, which was determined with the quantitative reverse-transcription polymerase chain reaction, rapidly decreased despite the severe clinical course. Our patient's overall condition improved, allowing him to be eventually discharged. CONCLUSIONS Patients with encephalitis/encephalopathy due to severe fever with thrombocytopenia syndrome virus infection may have a favorable outcome, even if they exhibit splenial lesions and a severe clinical course; monitoring the serum viral load may be of value for prediction of outcome and potentially enables the avoidance of corticosteroids to intentionally cause opportunistic infection.
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Affiliation(s)
- Masahiko Kaneko
- Department of Internal Medicine, Uwajima City Hospital, 1-1 Goten-machi, Uwajima City, Ehime 798-8510 Japan
| | - Masaki Maruta
- Department of Internal Medicine, Uwajima City Hospital, 1-1 Goten-machi, Uwajima City, Ehime 798-8510 Japan
| | - Hisaharu Shikata
- Department of Internal Medicine, Uwajima City Hospital, 1-1 Goten-machi, Uwajima City, Ehime 798-8510 Japan
| | - Kengo Asou
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime 791-0295 Japan
| | - Hiroto Shinomiya
- Ehime Prefectural Institute of Public Health and Environmental Science, 8-234 Sanbancho, Matsuyama, Ehime 790-0003 Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infection Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640 Japan
| | - Hideki Hasegawa
- Department of Pathology, National Institute of Infection Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640 Japan
| | - Masayuki Shimojima
- Department of Virology 1, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011 Japan
| | - Masayuki Saijo
- Department of Virology 1, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011 Japan
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15
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Wu JH, Parsons S. Fatal disseminated neonatal herpes simplex virus type 1 infection in neonates in a forensic setting. Forensic Sci Med Pathol 2017; 13:99-101. [PMID: 28101751 DOI: 10.1007/s12024-016-9834-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Jia Hao Wu
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
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16
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Abstract
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.
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Affiliation(s)
- Bridgette Jeanne Billioux
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Bryan Smith
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA.
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17
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Abstract
Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be life-saving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.
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Affiliation(s)
- Michael J Bradshaw
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arun Venkatesan
- Division of Neuroimmunology & Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Libbey JE, Hanak TJ, Doty DJ, Wilcox KS, Fujinami RS. NBQX, a highly selective competitive antagonist of AMPA and KA ionotropic glutamate receptors, increases seizures and mortality following picornavirus infection. Exp Neurol 2016; 280:89-96. [PMID: 27072529 DOI: 10.1016/j.expneurol.2016.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 02/02/2016] [Revised: 03/25/2016] [Accepted: 04/08/2016] [Indexed: 12/15/2022]
Abstract
Seizures occur due to an imbalance between excitation and inhibition, with the balance tipping towards excitation, and glutamate is the predominant excitatory neurotransmitter in the central nervous system of mammals. Since upregulation of expression and/or function of glutamate receptors can contribute to seizures we determined the effects of three antagonists, NBQX, GYKI-52466 and MK 801, of the various ionotropic glutamate receptors, AMPA, NMDA and KA, on acute seizure development in the Theiler's murine encephalomyelitis virus (TMEV)-induced seizure model. We found that only NBQX had an effect on acute seizure development, resulting in a significantly higher number of mice experiencing seizures, an increase in the number of seizures per mouse, a greater cumulative seizure score per mouse and a significantly higher mortality rate among the mice. Although NBQX has previously been shown to be a potent anticonvulsant in animal seizure models, seizures induced by electrical stimulation, drug administration or as a result of genetic predisposition may differ greatly in terms of mechanism of seizure development from our virus-induced seizure model, which could explain the opposite, proconvulsant effect of NBQX observed in the TMEV-induced seizure model.
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Affiliation(s)
- Jane E Libbey
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT 84112, USA
| | - Tyler J Hanak
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT 84112, USA
| | - Daniel J Doty
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT 84112, USA
| | - Karen S Wilcox
- Department of Pharmacology & Toxicology, University of Utah, 417 Wakara Way, Suite 3211, Salt Lake City, UT 84108, USA
| | - Robert S Fujinami
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT 84112, USA.
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Toler J, Deputy S, Zakris E, Bégué RE. Cognitive Dysfunction After Cranial Radiation for a Brain Tumor. J Pediatric Infect Dis Soc 2016; 5:96-9. [PMID: 26759498 DOI: 10.1093/jpids/piv085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 11/22/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Jeremy Toler
- Department of Neurology Department of Pediatrics
| | | | - Ellen Zakris
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans
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20
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Abstract
BACKGROUND The incidence of acute symptomatic (at the time of documented brain insult) seizures and single unprovoked seizures are 29-39 and 23-61 per 100 000 per year, respectively. After stabilization of the patient, finding the etiology of the seizure is of paramount importance. A careful history and physical examination may allow a diagnosis without need for further evaluation. METHODS In the literature, severe central nervous system involvement has been reported from human parvovirus B19 infection. We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure. She was afebrile and didn't have any focal neurological abnormalities. She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities. RESULTS Parvovirus infection was suspected due to the characteristic erythematous malar rash. Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection. Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index (>1.1). IgG index was equivocal (0.9-1.1). CONCLUSIONS We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery. Timely diagnosis can provide counselling regarding future seizure recurrence risk, curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Erin Willis
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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21
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Owatanapanich S, Wutthanarungsan R, Jaksupa W, Thisyakorn U. RISK FACTORS FOR SEVERE HAND, FOOT AND MOUTH DISEASE. Southeast Asian J Trop Med Public Health 2015; 46:449-459. [PMID: 26521518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We studied risk factors associated with severe hand, foot and mouth disease (HFMD) caused by enteroviruses among patients aged less than 15 years admitted to King Narai Hospital, Lopburi, Thailand during 2011-2013. Cases were divided into either mild or severe. Severe cases were those with encephalitis, meningitis, myocarditis, pneumonia, pulmonary edema or respiratory failure. Risk factors for severe infection were evaluated using univariate and multivariate logistic regression analysis. One hundred eighteen patients met the case definition of HFMD. Of these, 95 (80.5%) were classified as mild cases, and 23 (19.5%) as severe cases; there were 5 deaths (4.2%). Of the 23 severe cases, 9 were infected with coxsackievirus A16 (CA16), 8 with enterovirus 71 (EV71) and 4 with both EV71 and CA16. The most common presentations among the severe caseswere: seizures (74%), pneumonia (39%), encephalitis (39%), and meningitis (13%). The clinical manifestations significantly related to severe HFMD on univariate analysis were highest body temperature 39.00C, duration of fever 23 days, absence of skin lesions, diarrhea, dyspnea, seizures and hyperglycemia. The clinical manifestations significantly related to severe HFMD on both univariate and multivariate analyses were age less than 1 year, absence of oral lesions and drowsiness/lethargy. Clinicians should be aware of these factors. Early recognition of severe cases is important to increase the rates of successful outcomes and reduce mortality.
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22
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Belfquih H, Elmostarchid B. Intracérébral hemorrhage complicated viral hepatitis A. Pan Afr Med J 2015; 22:191. [PMID: 26918086 PMCID: PMC4752842 DOI: 10.11604/pamj.2015.22.191.3973] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hatim Belfquih
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Brahim Elmostarchid
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
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23
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Abstract
ABSTRACT:Background:Human immunodeficiency virus (HIV) infection frequently results in neurological complications but the impact of different neurological syndromes on patients' quality of life remains unknown.Methods:We investigated health-related quality of life (HRQoL) parameters among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients with and without neurological disease, including 11 dimensions of HRQoL within the Medical Outcomes Short-form Health Survey-HIV.Results:Comparisons of sociodemographic and systemic clinical variables did not differ between HIV/AIDS patients with (n=94) and without (n=75) neurological disease. However, patients with neurological diseases exhibited significantly lower HRQoL scores compared to matched controls, which was most evident among HIV/AIDS patients with cognitive impairment and sensory neuropathy. Prospective analysis revealed diminishing HRQoL scores prior to neurological diagnosis followed by a progressive and sustained improvement in HRQoL scores after intervention over a 96-week period.Conclusions:These studies indicate that while HIV-related neurological diseases are associated with reduced HRQoL scores, enhanced neurological care has a positive impact on HIV/AIDS patients' overall well-being.
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Affiliation(s)
- Rupang Pandya
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
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24
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Abstract
Roseola infantum, also known as exanthem subitum or sixth disease, is a generally benign febrile exanthem of infancy. It has a characteristic clinical course of high fever followed by the appearance of an exanthem upon defervescence. Febrile seizures are a frequent complication. Roseola is caused by infection with human herpesviruses 6 or 7 (HHV-6/7), which are acquired at a young age. Diagnosis is made by serology or by virus detection in body fluids and tissues. Treatment of roseola is supportive; recovery is usually complete with no significant sequelae. However, HHV-6/7 can reactivate in immunocompetent as well as immunocompromised individuals with severe systemic consequence.
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25
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Blakely PK, Delekta PC, Miller DJ, Irani DN. Manipulation of host factors optimizes the pathogenesis of western equine encephalitis virus infections in mice for antiviral drug development. J Neurovirol 2014; 21:43-55. [PMID: 25361697 DOI: 10.1007/s13365-014-0297-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 08/06/2014] [Revised: 09/18/2014] [Accepted: 09/24/2014] [Indexed: 11/25/2022]
Abstract
While alphaviruses spread naturally via mosquito vectors, some can also be transmitted as aerosols making them potential bioterrorism agents. One such pathogen, western equine encephalitis virus (WEEV), causes fatal human encephalitis via multiple routes of infection and thus presumably via multiple mechanisms. Although WEEV also produces acute encephalitis in non-human primates, a small animal model that recapitulates features of human disease would be useful for both pathogenesis studies and to evaluate candidate antiviral therapies. We have optimized conditions to infect mice with a low passage isolate of WEEV, thereby allowing detailed investigation of virus tropism, replication, neuroinvasion, and neurovirulence. We find that host factors strongly influence disease outcome, and in particular, that age, gender, and genetic background all have significant effects on disease susceptibility independent of virus tropism or replication within the central nervous system. Our data show that experimental variables can be adjusted in mice to recapitulate disease features known to occur in both non-human primates and humans, thus aiding further study of WEEV pathogenesis and providing a realistic therapeutic window for antiviral drug delivery.
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MESH Headings
- Administration, Intranasal
- Alphavirus Infections/pathology
- Alphavirus Infections/virology
- Animals
- Behavior, Animal
- Cognition
- Disease Models, Animal
- Encephalitis Virus, Western Equine/pathogenicity
- Encephalitis Virus, Western Equine/physiology
- Host Specificity
- Injections, Intraperitoneal
- Injections, Subcutaneous
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Inbred DBA
- RNA, Viral/blood
- Seizures/pathology
- Seizures/virology
- Species Specificity
- Viral Load
- Virus Replication
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Affiliation(s)
- Pennelope K Blakely
- Department of Neurology, University of Michigan Medical School, 4007 Biomedical Sciences Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
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26
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Mansachs SJ, Stanchev H. [Parechovirus meningoencephalitis without CSF pleocytosis]. Ugeskr Laeger 2014; 176:V09130553. [PMID: 25350811] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Human parechovirus type 3 (HPeV3) can cause meningoence-phalitis which is difficult to distinguish from enterovirus (EV) or herpes simplex virus (HSV) meningoencephalitis. EV and HSV meningoencephalitis can appear without cerebrospinal fluid (CSF) pleocytosis. Our case was an eight-day-old girl who had seizures but lacked CSF pleocytosis. The diagnosis was HPeV3 meningoencephalitis which is only described in a few studies. Our analysis of these studies showed a tendency of neonates with HPeV3 meningoencephalitis lacking CSF pleocytosis. HPeV3 should be examined at neonatal seizures when CSF pleocytosis is lacking.
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Said-Conti V, Amrolia PJ, Gaze MN, Stoneham S, Sebire N, Shroff R, Marks SD. Successful treatment of central nervous system PTLD with rituximab and cranial radiotherapy. Pediatr Nephrol 2013; 28:2053-6. [PMID: 23743853 DOI: 10.1007/s00467-013-2499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/10/2013] [Accepted: 04/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary central nervous system (PCNS) post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation and is typically an Epstein-Barr virus (EBV)-induced B-cell CD20+ lymphoma. The modalities of treatment include reduction in immunosuppression, cranial radiotherapy (CRT), intravenous and intrathecal rituximab when CD20 is expressed on B-lymphocytes and PTLD cells, and chemotherapy. CASE-DIAGNOSIS/TREATMENT We report the successful treatment of EBV-driven PCNS PTLD by reduction in immunosuppression (RI), CRT, and intravenous rituximab. Our patient was an 11-year-old boy with a living-related renal transplant for end-stage renal failure (ESRF) secondary to posterior urethral valves (PUV) and bilateral renal dysplasia (BRD) and on triple immunosuppression with prednisolone, tacrolimus, and azathioprine who had a rising EBV load, which was managed with reduction in tacrolimus dose, withdrawal of azathioprine, and introduction of mycophenolate mofetil (MMF). CONCLUSIONS The patient presented 7 years post-transplant with a seizure and abnormal neurology secondary to polymorphous hyperplastic lesions in the brain, which responded to rituximab and CRT.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antigens, CD20/metabolism
- Antineoplastic Agents/administration & dosage
- Biopsy
- Central Nervous System Neoplasms/diagnosis
- Central Nervous System Neoplasms/immunology
- Central Nervous System Neoplasms/therapy
- Central Nervous System Neoplasms/virology
- Chemoradiotherapy
- Child
- Cranial Irradiation
- Drug Therapy, Combination
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/virology
- Humans
- Immunohistochemistry
- Immunosuppressive Agents/adverse effects
- Infusions, Intravenous
- Kidney Failure, Chronic/surgery
- Kidney Transplantation/adverse effects
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/therapy
- Lymphoma, B-Cell/virology
- Magnetic Resonance Imaging
- Male
- Rituximab
- Seizures/virology
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Valerie Said-Conti
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Trust, London, UK.
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Csonka T, Szepesi R, Bidiga L, Péter M, Klekner A, Hutóczky G, Csiba L, Méhes G, Hortobágyi T. [The diagnosis of herpes encephalitis--a case-based update]. Ideggyogy Sz 2013; 66:337-342. [PMID: 24358690] [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: 06/03/2023]
Abstract
Herpes simplex virus encephalitis (HSVE) is a rare and life-threatening infection. The clinical signs are diverse and often misleading regarding the aetiology. However, focal seizure with fever and typical CT/MRI finding should always raise the possibility of HSVE as early diagnosis and antiviral therapy is crucial. Before the advent of molecular techniques and high-tech imaging histological examination from multiple brain biopsies were often necessary. Although nowadays PCR and other molecular methods may provide an aetiological diagnosis some cases need neuropathological verification. Due to the high IgG seropositivity rate in the population the plasma IgG titer is not diagnostic and elevation of its plasma level requires several weeks. We report the case of a 25-years old male patient who initially presented with epileptic seizures. There was no final diagnosis and no causal treatment in the district general hospital. The patient was admitted to our institution in comatose state on day 9; the initiated diagnostic tests and therapy could not save the patient who died next day. The autopsy and subsequent neuropathological examination revealed HSVE. We present a flowchart on diagnostic work-up and special techniques to aid diagnosis in suspected viral encephalitis.
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Affiliation(s)
- Tamás Csonka
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Patológiai Intézet, Neuropatológiai Tanszék, Debrecen
| | - Rita Szepesi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Neurológiai Klinika, Debrecen
| | - László Bidiga
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Patológiai Intézet, Debrecen
| | - Mózes Péter
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Radiológiai Klinika, Debrecen
| | - Almos Klekner
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Idegsebészeti Klinika, Debrecen
| | - Gábor Hutóczky
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Idegsebészeti Klinika, Debrecen
| | - László Csiba
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Neurológiai Klinika, Debrecen
| | - Gábor Méhes
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Patológiai Intézet, Debrecen
| | - Tibor Hortobágyi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Patológiai Intézet, Neuropatológiai Tanszék, Debrecen
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G Mariam A, Assefa G. Clinical and neuroimaging profile of HIV-1 encephalopathy in infancy and childhood in a sub-Saharan African country. Ethiop Med J 2012; 50:337-347. [PMID: 23930479] [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: 06/02/2023]
Abstract
BACKGROUND Neurological dysfunction in AIDS is common, occurring in as many as eighty percent of children. Thus, it is important to recognize the central nervous system imaging appearance of HIV, in particular those of HIV encephalopathy, as this is an AIDS defining illness and with distinct neuro-imaging features essential for early diagnosis and timely therapeutic intervention AIM To identify the clinical features in HIV-1 infection of the central nervous system and their associated neuroradiological correlates. METHODS Retrospective review of the records of all children with HIV-1 encephalopathy identified among children with neurological and developmental problems and who were on follow up at a child development and neurology clinic in an African city. RESULTS A total of 22 children (10 male and 12 female) with HIV-1 encephalopathy were identified among 2382 children with various forms of neurological and developmental problems and who were on follow up at a child development and neurology clinic for a little bit over eight years period. All the children acquired the infection vertically. The age range of these children was between 10 months to 14 years. The median age was 5.6 years. The mean duration of symptom was 3.2 years. Global delay or regression in development along with signs of pyramidal tract involvement and seizures were the commonest clinical signs observed in these children. Neuro-behavioral problems were commonly observed among preschool and school aged children. In older children and preadolescents focal seizures with or with out neurologic deficit and neuroradiological findings were common. Nonhemorrhagic stroke was rare and occurred in one child and another child had cortical blindness. Three children had no neurological deficit. Rapid progression of the disease carried grave prognosis. Opportunistic infections and tumors of the central nervous system were also uncommon among these children. Brain volume loss with dilatation of the lateral ventricle, bilateral symmetrical or asymmetrical calcification of the basal ganglia and periventricular involvement of the white matter were the commonest neuro-radiological findings observed in these children. CONCLUSION Atrophy of the brain with dilatation of the lateral ventricles and calcification of the basal ganglia and peri-ventricular involvement of the white matter were the commonest neuro-radiological findings in children with HIV-1 encephalopathy. Similarly global delay or regression in development along with pyramidal tract signs and seizures were the commonest neurological findings. Behavioral problems were common in preschool and school aged children. Focal seizures were common in older children and preadolescents. Rapid progression of the disease carried grave prognosis.
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Abstract
AIM To report on a different clinical course of pandemic influenza A (H1N1) infection among children who were neurologically impaired before the acute onset of the disease, in comparison with children who were neurologically intact. METHODS In a period of 6 months, six children with neurological complications associated with pandemic A (H1N1) infection were identified in a single institution paediatric emergency room. The children suffered from seizures or altered mental status during pandemic A (H1N1) infection. All children underwent extensive clinical and laboratory assessment. Three children were neurologically impaired before the acute onset of the H1N1 infection. The other three were neurologically intact before the acute viral infection. RESULTS In all six patients, pandemic influenza A (H1N1) viral RNA was detected in nasopharyngeal specimens but none in the cerebrospinal fluid. Five children fully recovered or returned to baseline at discharge. The clinical course of the disease and recovery were different between the children who were neurologically impaired before the acute viral infection and those who were neurologically intact. CONCLUSIONS It is possible that children with various neurological conditions are in a higher risk to develop further neurological complications during pandemic influenza A (H1N1) infection.
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Affiliation(s)
- Ibrahim Omari
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel
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Thrasher AN, Chusid MJ, Jacobson RD, St Clair NE. HHV-6 infection in a case of an infant with fever, seizures, and shock. WMJ 2010; 109:153-155. [PMID: 20672556] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Amy N Thrasher
- Department of Pediatrics, the Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, USA.
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Medici MC, Abelli LA, Dodi I, Dettori G, Chezzi C. Norovirus RNA in the blood of a child with gastroenteritis and convulsions--A case report. J Clin Virol 2010; 48:147-9. [PMID: 20381416 DOI: 10.1016/j.jcv.2010.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 06/08/2009] [Revised: 02/26/2010] [Accepted: 03/05/2010] [Indexed: 11/18/2022]
Abstract
Potential extra-intestinal spread is an important issue in understanding the pathogenesis of NoV disease. A previously healthy 14-month-old boy was admitted to the Pediatric Emergency Department of the University-Hospital of Parma, Italy, for afebrile convulsions in a gastroenteritis episode. Bacterial culture and microscopic examination on cerebrospinal fluid (CSF) yielded negative results as well as PCRs and reverse-transcription PCRs (RT-PCRs) for neurotropic viruses performed either on CSF or plasma. Stools were subjected to electron microscopy and conventional cell culture, yielding negative results. NoV was found in stools and plasma by nested RT-PCR targeting the NoV polymerase gene. The nucleotide sequences obtained from the two specimens showed 100% identity, demonstrating that the strain invading the blood stream was from the intestine, and, in comparison with GenBank sequences, they belonged to NoV genotype GII.4, "2006b" variant. The child had no abnormal electrolyte balance and no fever that could justify seizures, encouraging the hypothesis that NoV could be the cause of the neurologic disorder. These findings further induce to review the current concept of human NoV focused on intestinal infection.
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Affiliation(s)
- Maria Cristina Medici
- Section of Microbiology, Department of Pathology and Laboratory Medicine, University of Parma School of Medicine, Viale Antonio Gramsci 14, 43100 Parma, Italy.
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Bandyopadhyay SK, Bandyopadhyay R, Dutta A. Profile of tuberculous meningitis with or without HIV infection and the predicators of adverse outcome. W INDIAN MED J 2009; 58:589-592. [PMID: 20583689] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To compare the clinical, radiological and cerebrospinal fluid (CSF) findings, at hospital admission, among adult patients with tuberculous meningitis (TBM) with or without HIV infection and to identify the factors that predict adverse outcome at six months. METHODS A total of 82 adult patients with TBM were included (40 HIV-positive and 42 HIV-negative). Several clinical (duration of illness, Glasgow Coma Scale score, presence of high temperature, headache, cranial nerve or sphincter abnormality, seizures and endocrine dysfunction), radiological (presence of hydrocephalus, cerebral infarction and oedema, meningeal enhancement, granuloma) and cerebrospinal fluid parameters (glucose, protein, lactate, lymphocytes, neutrophils and adenosine deaminase values) were recorded along with CD4 count in the peripheral blood. Statistical analysis was performed using the chi-square test. Individual variables were evaluated as prognostic factors for adverse outcome in both groups by calculating the relative risk of association for each. RESULTS Temperature more than 38.33 degrees C was more common in the HIV-negative group while seizures, hydrocephalus, cerebral infarction and low CD4 count occurred significantly more commonly in the HIV-positive group. Hydrocephalus had strong association with severe neurological deficit and seizure with death in both the groups. CONCLUSION Several clinical and laboratory features of TBM in patients who are HIV-positive are distinctly different from those without HIV infection; some of these have an association with the probability of adverse outcome.
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Affiliation(s)
- S K Bandyopadhyay
- Department of Medicine, Nil Ratan Sircar Medical College and Hospital, 138, A JC Bose Road, Kolkata 700014, India.
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Centers for Disease Control and Prevention (CDC). Neurologic complications associated with novel influenza A (H1N1) virus infection in children - Dallas, Texas, May 2009. MMWR Morb Mortal Wkly Rep 2009; 58:773-8. [PMID: 19629027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Neurologic complications, including seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders, have been described previously in association with respiratory tract infection with seasonal influenza A or B viruses, but not with novel influenza A (H1N1) virus. On May 28, 2009, the Dallas County Department of Health and Human Services (DCHHS) notified CDC of four children with neurologic complications associated with novel influenza A (H1N1) virus infection admitted to hospitals in Dallas County, Texas, during May 18-28. This report summarizes the clinical characteristics of those four cases. Patients were aged 7-17 years and were admitted with signs of influenza-like illness (ILI) and seizures or altered mental status. Three of the four patients had abnormal electroencephalograms (EEGs). In all four patients, novel influenza A (H1N1) viral RNA was detected in nasopharyngeal specimens but not in cerebrospinal fluid (CSF). Antiviral therapy included oseltamivir (four patients) and rimantadine (three patients). All four patients recovered fully and had no neurologic sequelae at discharge. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus. For children who have ILI accompanied by unexplained seizures or mental status changes, clinicians should consider acute seasonal influenza or novel influenza A (H1N1) virus infection in the differential diagnosis, send respiratory specimens for appropriate diagnostic testing, and promptly initiate empirical antiviral treatment, especially in hospitalized patients.
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Ghotbi F, Shiva F. An assessment of the necessity of lumbar puncture in children with seizure and fever. J PAK MED ASSOC 2009; 59:292-295. [PMID: 19438132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE It is frequently thought that lumbar puncture (LP), is a mandatory procedure in all children who have fever and a seizure; because a convulsion may be the sole clinical manifestations of bacterial meningitis. To assess whether meningitis could be recognized using readily available clinical information. METHODS This study was done during a 4 yr period from 2002-2006. A total of 254 previously healthy children aged 6 months to 5 years, were brought consecutively to the paediatric department of a teaching university hospital after their first fever-associated-seizure; lumbar puncture (LP) was performed in all cases. Children with seizure and fever and meningitis served as cases and those with fever and seizure, but no meningitis, served as control. Factors compared in the two groups were: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use. RESULTS Twelve, (4.7%), cases were diagnosed as meningitis. Risk factors significantly associated with meningitis were: age < 12 months, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use, (p < 0.05). All children with meningitis had at least one of the risk factors mentioned above. CONCLUSION Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizure and fever; thus there is no need for routine lumbar puncture in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or who have received prior antibiotics.
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MESH Headings
- Child, Preschool
- Encephalitis, Viral/diagnosis
- Encephalitis, Viral/physiopathology
- Encephalitis, Viral/virology
- Female
- Fever/diagnosis
- Fever/etiology
- Fever/virology
- Humans
- Infant
- Male
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Bacterial/physiopathology
- Meningitis, Viral/diagnosis
- Meningitis, Viral/physiopathology
- Meningitis, Viral/virology
- Risk Factors
- Seizures/diagnosis
- Seizures/etiology
- Seizures/virology
- Spinal Puncture
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Affiliation(s)
- Fatemeh Ghotbi
- Department of Pediatrics, Taleghani Medical Center, Shaheed Beheshti Medical University, Tehran, Iran
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Nakamura M, Yamanaka G, Kawashima H, Watanabe Y, Ioi H, Kashiwagi Y, Takekuma K, Hoshika A, Hayakawa M, Suzuki S. Clinical application of rapid assay of interleukin-6 in influenza-associated encephalopathy. Dis Markers 2009; 21:199-202. [PMID: 16403955 PMCID: PMC3851426 DOI: 10.1155/2005/671609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The characteristics of influenza-associated encephalopathy is the high mortality and nimble progress with coma which appears in general cases within 48 hours. Most of patients show no abnormalities in the standard blood checks on admission or in early stage. In this study we investigated if a rapid assay of interleukin (IL)-6 is useful in influenza-associated encephalopathy in early stages. The levels of IL-6 in patients with influenza-associated encephalopathy did not show any significant difference compared with those in patients with febrile convulsion and rotavirus-associated convulsion. However the levels of IL-6 in severe cases were significantly higher than those of mild cases with influenza-associated encephalopathy. Consequently the rapid assay of serum IL-6 is useful to evaluate and decide the therapies.
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Affiliation(s)
| | - Gaku Yamanaka
- Department of PaediatricsTokyo Medical UniversityJapan
| | - Hisashi Kawashima
- Department of PaediatricsTokyo Medical UniversityJapan
- *Hisashi Kawashima:
| | | | - Hiroaki Ioi
- Department of PaediatricsTokyo Medical UniversityJapan
| | | | | | | | - Mizuho Hayakawa
- Department of Central Clinical LaboratoryTokyo Medical UniversityJapan
| | - Shigeru Suzuki
- Department of Central Clinical LaboratoryTokyo Medical UniversityJapan
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Jackson ST, Mullings A, Bennett F, Khan C, Gordon-Strachan G, Rhoden T. Dengue infection in patients presenting with neurological manifestations in a dengue endemic population. W INDIAN MED J 2008; 57:373-376. [PMID: 19566019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.
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Affiliation(s)
- S T Jackson
- Department of Microbiology, The University of the West Indies, Kingston 7, Jamaica, West Indies.
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Abstract
Rotavirus can cause seizures and encephalopathy in infants and young children. We report reversible EEG abnormalities in a 2 year and 7 month old boy who had a single seizure during rotavirus gastroenteritis. His EEG showed bilateral independent temporoparietal sharp waves. The EEG was normal 10 days after the first EEG and the patient has been followed with no neurological sequelae. The EEG literature in children developing seizures secondary to rotavirus infection including ours suggest the involvement of mostly posterior cerebral areas. The localization and reversibility of the process can enlighten the pathophysiology underlying this disorder.
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Affiliation(s)
- Ugur Isik
- Acibadem Institute of Neurological Sciences, Division of Pediatric Neurology, Istanbul, Turkey.
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Giørtz-Carlsen B, Rittig S, Thelle T. [Neurological symptoms and acute hepatitis associated with parvovirus B19]. Ugeskr Laeger 2007; 169:4075-4077. [PMID: 18078665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The spectrum of symptoms correlated to parvovirus B19 infections has expanded greatly during the past years. We report a case of anaemia, encephalitis-like symptoms and acute hepatitis in a 15-months-old Danish girl associated with parvovirus B19, verified by positive serum IgM og IgG antibodies. She presented with non-febrile seizures and decreased level of consciousness. Later she developed signs of acute hepatitis. The course was benign.
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Abstract
A case is presented of cardiac arrhythmia associated with varicella zoster infection, affecting a 34-year-old man. The patient presented with episodes of seizure-like activity, which were subsequently shown to be caused by ventricular fibrillation. The literature regarding this unusual complication of varicella zoster infection is discussed, as it affects both children and adults. Physicians who may face this condition, in accident and emergency, acute medicine, critical care medicine and infectious diseases, should all be aware of this serious complication.
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Getts DR, Matsumoto I, Müller M, Getts MT, Radford J, Shrestha B, Campbell IL, King NJC. Role of IFN-gamma in an experimental murine model of West Nile virus-induced seizures. J Neurochem 2007; 103:1019-30. [PMID: 17854352 DOI: 10.1111/j.1471-4159.2007.04798.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [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] [Indexed: 11/29/2022]
Abstract
Seizures are a major complication of viral encephalitis. However, the mechanisms of seizure-associated neuronal dysfunction remain poorly understood. We report that intranasal inoculation with West Nile virus (WNV) (Sarafend) causes limbic seizures in C57BL/6 mice, but not in interferon (IFN)-gamma-deficient (IFN-gamma-/-) mice. Both strains showed similar levels of virus in the brain, as well as similar concentrations of the cytokines, tumor necrosis factor and interleukin-6, both of which can alter neuronal excitability. Experiments in chimeric IFN-gamma-/- mice reconstituted with IFN-gamma-producing leukocytes showed that IFN-gamma is not required during central nervous system infection for limbic seizure development, suggesting a role for IFN-gamma in the developing brain. This was supported responses to pentylenetetrazole, kainic acid (KA), and N-methyl-d-aspartate (NMDA). Both strains of mice exhibited similar behavior after pentylenetetrazole challenge. However, while NMDA and KA treatment resulted in characteristic seizures in C57BL/6 mice, these responses were diminished (NMDA treatment) or absent (KA treatment) in IFN-gamma-/- mice. Furthermore, NMDA-receptor blockade with MK-801 in WNV-infected C57BL/6 mice abrogated seizures and prolonged survival. Our data show that IFN-gamma plays an important role in the development of the excitatory seizure pathways in the brain and that these cascades become pathogenic in encephalitic WNV infection.
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Affiliation(s)
- Daniel R Getts
- The Discipline of Pathology, The University of Sydney, Sydney, New South Wales, Australia
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Mannonen L, Herrgård E, Valmari P, Rautiainen P, Uotila K, Aine MR, Karttunen-Lewandowski P, Sankala J, Wallden T, Koskiniemi M. Primary human herpesvirus-6 infection in the central nervous system can cause severe disease. Pediatr Neurol 2007; 37:186-91. [PMID: 17765806 DOI: 10.1016/j.pediatrneurol.2007.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/20/2007] [Accepted: 05/25/2007] [Indexed: 10/22/2022]
Abstract
Human herpesvirus-6 (HHV-6) infection is common in infancy, and symptoms are usually mild. However, encephalitis and other neurologic complications have been reported. Primary HHV-6 infection has been rarely confirmed in the central nervous system. We studied 21 children with suspected HHV-6 infection, drawn from a prospective, large-scale study of neurologic infections in Finland. Human herpesvirus-6 polymerase chain reaction was performed on cerebrospinal fluid samples, and antibody tests were performed on serum and cerebrospinal fluid. We identified nine children, aged 3 to 24 months, who had HHV-6-specific nucleic acid in cerebrospinal fluid. Primary infection was confirmed by seroconversion of specific antibodies in six, whereas one had a fourfold increase, and one had a fourfold decrease, in the antibody titer supporting recent infection. Generalized and prolonged seizures appeared in six children, four had a rash, four had ataxia, and four had gastroenteritis. All but two had a high fever. At follow-up, four children had evident neurologic sequelae, ataxia, and developmental disability, and needed special education. Primary HHV-6 infection may invade the central nervous system, and can cause neurologic symptoms and potentially permanent disability in children aged <or=2 years. The possibility of HHV-6 infection must be considered when treating acutely ill children, and especially those with convulsions.
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Affiliation(s)
- Laura Mannonen
- Haartman Institute, Department of Virology, University of Helsinki, Helsinki, Finland.
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Abstract
Three patients, a 2-year-old girl, a 14-month-old girl, and a 15-month-old boy, were admitted with multiple episodes of benign afebrile seizures. Electroencephalograms recorded 1 or 2 days after the last seizure revealed epileptiform discharges. All 3 patients developed a fulminant Rotazyme-positive diarrhea toward the end of their respective hospital stay. The prospects of immunological detection in diagnosis and treatment are discussed.
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Affiliation(s)
- Stanley Iyadurai
- Departments of Neurology, Barrow Neurological Institute, St Joseph's Hospital, 350 West Thomas Road, Phoenix, AZ 85013, USA.
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Affiliation(s)
- T Ben-Ami
- Department of Pediatrics Kaplan Medical Center, Rehovot, Israel.
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Afenjar A, Rodriguez D, Rozenberg F, Dorison N, Guët A, Mignot C, Doummar D, Billette de Villemeur T, Ponsot G. [Human herpes virus type 6, etiology of an acute encephalitis in childhood: case report]. Arch Pediatr 2007; 14:472-5. [PMID: 17306516 DOI: 10.1016/j.arcped.2006.12.020] [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: 06/19/2006] [Accepted: 12/22/2006] [Indexed: 11/19/2022]
Abstract
Primary infection with human herpesvirus-6 (HHV-6) causes the classical roseola infantum. Otherwise the infection is clinically silent but it may sometimes be responsible for central nervous system involvement. In order to illustrate such a type of lesions, we report on a 16-month-old girl with acute leucoencephalitis. The disease started with pyrexia 40 degrees C, followed by an episode of seizure, erythematous rash on the trunk and then coma. Brain MRI showed wide lesions on white matter. HHV-6 DNA was detected by PCR in the CSF and serum at the acute stage, and tests for HHV-6 antibody showed a significant increase of IgG antibody titre between acute and convalescent sera. One month later complete clinical recovery was observed while the MRI showed a partial disappearance of the lesions. The sero-conversion associated with the detection of the viral DNA in the serum identified a primary HHV-6 infection and the detection of viral nucleic acid in CSF gives arguments for the responsibility of the virus in the pathogenesis. When facing an acute leuco-encephalitis in infants, it is important to perform exhaustive virology investigations to rule out the implication of HHV-6 as well as other commonly incriminated pathogens (EBV, CMV, mycoplasma, enterovirus) to avoid accusing wrongly the vaccines.
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Affiliation(s)
- A Afenjar
- Service de Neuropédiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, 26, avenue du Docteur-A.-Netter, 75012 Paris, France.
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Abstract
BACKGROUND Japanese encephalitis (JE) is associated with high mortality and neurological sequelae. The unpredictable course and lack of specific treatment pose major challenges in management. The tropical climate and paddy ecosystem in Nepal provide a suitable setting. AIMS To determine the aetiology of febrile encephalopathy and describe the clinico-laboratory profile and outcome of JE in Nepali children. METHODS A hospital-based prospective and observational study was conducted over a 1-year period (2000-2001). Children aged from >1 month to 14 years with fever >38 degrees C for <2 weeks and altered sensorium were recruited. JE was confirmed by anti-JE IgM in cerebrospinal fluid and/or serum. RESULTS Of 117 consecutively enrolled patients, 58 had JE. Ten patients had concomitant infections, four with malaria and six with bacterial meningitis, and were excluded from analysis. Clinical findings were as follows: boys, 69%; age 4-14 years, 71%; presentation during summer and autumn, 83%; fever >3 days, 69%; altered sensorium <2 days, 50%; Glasgow coma score 8-12, 63%; seizures, 58%. Four (8.3%) died. At discharge, neurological sequelae were detected in 24 (50%) and hemiparesis was the most common form. Longer duration of vomiting, altered sensorium and focal neurological deficit on admission were independently associated with sequelae at discharge. Sequelae persisted in nine (18.8%) at 6 weeks follow-up. Long duration of altered sensorium (beta co-efficient 0.35, odds ratio 1.4, p=0.042) and presence of focal neurological deficit on admission (beta co-efficient 1.6, odds ratio 5.2, p=0.049) were independent predictors of sequelae at 6 weeks. CONCLUSION JE was the commonest cause of febrile encephalopathy. Neurological sequelae were common but resolved in two-thirds of cases.
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Affiliation(s)
- Ajit Rayamajhi
- Department of Paediatrics, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal.
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Tuncel D, Ozbek AE, Demirpolat G, Karabiber H. Subacute sclerosing panencephalitis with generalized seizure as a first symptom: a case report. Jpn J Infect Dis 2006; 59:317-9. [PMID: 17060698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Subacute sclerosing panencephalitis (SSPE) can show variations in its clinical course. Typical initial symptoms consist of intellectual decline, deterioration in school performance, and myoclonic jerks. Atypical forms of presentation such as generalized seizures and acute or subacute coma can be observed rarely. This report describes a 5-year-old boy with an atypical feature of SSPE, generalized seizures. For 1 month his only symptom was seizures, followed by personality and behavioral changes and myoclonic jerks. A diagnosis of SSPE was made based on the boy's history of measles, characteristic electroencephalogram changes and compatible magnetic resonance, and elevated anti-measles antibody titers in the cerebrospinal fluid and serum. The case presented in this article is a good example of SSPE in which, at early stages, some of the signs and symptoms can lead to an erroneous diagnosis.
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Affiliation(s)
- Deniz Tuncel
- Department of Neurology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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Hagemann G, Mentzel HJ, Weisser H, Kunze A, Terborg C. Multiple reversible MR signal changes caused by Epstein-Barr virus encephalitis. AJNR Am J Neuroradiol 2006; 27:1447-9. [PMID: 16908555 PMCID: PMC7977541] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This report presents the imaging findings of an unusual case of Epstein-Barr virus (EBV) encephalitis. A young man presented with a short-lasting history of febrile infection, neuropsychologic deficits, ataxia, and seizures. MR imaging revealed fully reversible signal intensities (T2, diffusion-weighted imaging with a decreased apparent diffusion coefficient) in the splenium of the corpus callosum and both posterior hemispheres. EBV infection must be added to the list of differential diagnoses of (reversible) splenial lesions.
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Affiliation(s)
- G Hagemann
- Department of Neurology, Friedrich-Schiller-University, Erlanger Allee 101, 07740 Jena, Germany.
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Abstract
OBJECTIVES To determine the incidence, nature, and outcome of encephalopathy associated with viral gastroenteritis in hospitalized children. METHODS Retrospective chart review of all children during a 4-year period with viral gastroenteritis identified by International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision (ICD-9-CM/ICD-10) codes. Children with encephalopathy were defined as cases; the remainder served as controls. RESULTS Thirteen (7.2%) of 181 children presented with encephalopathy (typical febrile seizures, 4; atypical febrile seizures, 4; afebrile seizures, 3; with alteration in level of consciousness alone, 2). Between cases and controls, the mean age (17.4 vs. 14.9 months, respectively) and temperature (38.4 degrees C vs. 38.5 degrees C, respectively) were not significantly different (mean age, P = 0.52; temperature, P = 0.61). The mean length of hospital stay was longer in children with encephalopathy (7 vs. 4.3 days; P = 0.03). All children recovered without sequelae. CONCLUSIONS Encephalopathy, including afebrile seizures and nonconvulsive encephalopathy, is a relatively common presenting sign of acute viral gastrointestinal tract infection in hospitalized children, has a good outcome, but is associated with increased diagnostic testing and length of stay.
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