MENINGO-ENCEPHALITIS IN A MIDDLE-AGED WOMAN HOSPITALIZED FOR COVID-19.

OBJECTIVE: The aim: To pay attention of clinicians to possible lesions of the central nervous system (encephalitis) in patients with COVID-19. PATIENTS AND METHODS: Case presentation: A 44-year-old woman was admitted to our clinic because of 2-month-history of mild fever, bilateral lower lobe pneumonia, respiratory failure, generalized weakness, and some neurologic symptoms. SARS-CoV-2 RNA was detected in nasopharyngeal swab. Chest CT demonstrated bilateral pulmonary poly segmental consolidations in the mid and lower zones. Focal hyper intensive abnormalities in various parts of the left hemisphere were found at MR brain imaging in T2WI, and T2 FLAIR mode. Cerebrospinal fluid (CSF) examination showed a white cell count of 31/uL (normal <5/uL), protein 0.73 g/L (0.15-0.45), and glucose 1.4 mmole/L (2.2-3.9). Standard CSF neuroviral PCR panel and PCR for SARS-CoV-2 were negative. She was treated with ganciclovir, and dexamethasone. Due to suspected tuberculosis meningitis (cytosis, decreased level of protein and glucose), she also received ex juvantibus a course of anti-TB therapy (isoniazid, kanamycin, and levofloxacin) and made a steady improvement. CONCLUSION: Conclusion: This case shows that SARS-CoV-2 in association with other pathogens may cause various lesions of the CNS accompanied by severe neurological manifestations in adults.

A RARE BRAINSTEM INFLAMMATORY SYNDROME, CLIPPERS, MYTH OR FACT. CASE REPORT WITH CRITICAL REVIEW.

A very rare inflammatory disease of CNS, CLIPPERS syndrome, was recently described and only a few sporadic cases are reported in the medical literature. Its etiology and pathogenesis are unknown, that together with the polymorphic and sometimes confounding neurological manifestations, and radiological findings represent a real diagnostic and therapeutic challenge for clinicians. Aim: To highlight the importance of clear and specific diagnostic assessment. Here we present the case of a 40-year-old male with a subacute lymphocytic midbrain inflammation accompanied by vasculitis. We discuss the symptoms, imaging and treatment of this lesion.

Subacute enterovirus-associated encephalitis in a young adult coinfected with borrelia burgdorferI.

OBJECTIVE: The aim: To pay attention of clinicians to sterile encephalitis in adults, which in fact may be caused by EVs. RESULTS: Results: A young woman was admitted to our clinic because of 3-month-history of mild fever, left-sided soft facial paralysis, and generalized weakness. MR brain imaging in T2W, FLAIR, and T1W mode showed focal hyper intensive abnormalities in various parts of the left hemisphere. EV RNA was detected in the patient's CSF on admission. IgM class antibodies to B.burgdorferi were present in the blood. Antibiotics and ribavirin have been administrated with a good effect. CONCLUSION: Conclusion: This case shows that EV infection may cause brainstem encephalitis accompanied by severe neurological manifestations in adults.

A CASE OF MRI-NEGATIVE HERPES VIRUS ENCEPHALITIS PRESENTED BY RAMSAY HUNT SYNDROME.

Ramsay Hunt syndrome (RHS) occurs due to reactivation of latent Varicella Zoster Virus (VZV) infection in the geniculate ganglion of the facial nerve. Major clinical symptoms include ipsilateral facial paralysis, otic pain, and herpetic vesicles (rashes) along the nerve with accompanying ear pain. Rarely clinical findings include retrograde transaxonal spread of the virus from the ganglion into the brain parenchyma with developing the encephalitis or multiple cranial nerve involvement. We describe here a patient with both RHS along with complicating brainstem encephalitis developed due to the coinfection of VZV and EBV.

Vaccination coverage rates and the incidence of vaccine preventable diseases among children in sumy region of Ukraine.

OBJECTIVE: Introduction: Routine immunization contributes immensely to decline the incidence of vaccine preventable diseases among children. Statistical data shown the sharply decrease the vaccination coverage rates in Sumy region of Ukraine. The aim: Assess routine immunization uptake and its effect on the incidence of vaccine preventable diseases among children in Sumy region of Ukraine. RESULTS: Review: During some years, only 50-60 % of Sumy region children had received all recommended vaccines, which is far below World Health Organization target of 80 %. This has led to an increase of morbidity associated with some infectious diseases. Outbreaks of measles were registered in 2006 and 2012, when were ill 9346 and 7931 children respectively. Massive measles outbreak ongoing nowadays. Total number infected have already exceeded 35,000 cases. CONCLUSION: Conclusions: RI uptake in Ukraine is still below World Health Organization target. The main reason for the ongoing measles outbreak was low vaccination coverage for routine immunization antigens as a result of which collective immunity decreased to a critical level. Strict monitoring of the implementation of the immunization schedule by medical institutions at all levels are recommended to improve vaccination status of Ukrainian children.

Diagnostic value of specific antibody synthesis in brain of patients with neuroinfections

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Material and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups. Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn't depend on concentration of specific Ab in serum and CSF and wasn't followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusions: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

Effect of probiotics on altered gut microflora in patients with severe systemic inflammatory response syndrome.

OBJECTIVE: The aim: To estimate intestinal microbial changes and study the efficacy of probiotic preparations in systemic inflammation. PATIENTS AND METHODS: Materials and methods: The study involved 202 patients with chronic infections various sites, including 58 (28.7 %) patients with respiratory tract infections, 56 (27.7 %) patients with infections of the genitourinary system, 48 (23.7%) - with purulent inflammatory postoperative complications, and 40 HIV-infected patients. We studied the quantitative and qualitative composition of intestinal microflora on the background correction of probiotic preparations. RESULTS: Results: We have found quantitative and qualitative changes of intestinal microflora in all patients with chronic infections. Dysbiotic changes manifested in reducing the number of major orders symbionts (Lactobacillus spp., Bifidobacterium spp, Escherichia coli with normal enzymatic properties) and increase the number of pathogenic microorganisms (Staphylococcus aureus, Clostridium spp., Candida spp.). In all study groups after using probiotics, the number of pathogenic microorganisms (S. aureus, S. saprophyticus, S. epidermidis, C. albicans, and Cl. perfringens) were decreased and tended to restore normal range of microbial landscape. CONCLUSION: Conclusion: So, dysbiotic disorders of the intestine in patients with chronic inflammation characterized by decrease in the number of basic gut symbionts and reducing its protective properties that accompanied the advent of pathogenic microorganisms. In our study probiotics demonstrated statistically significant improvements in the qualitative and quantitative composition of microflora.

Ukrainian priorities for herpesvirus infections that affect the central nervous system.

OBJECTIVE: Introduction: Herpesviruses (HVs) are ubiquitous pathogens that infect humans usually during childhood, followed by a life-long persistence in a latent state in many sites of a body including the nerve cells. After reactivation HVs can affect the Central Nervous System (CNS) becoming a major cause of morbidity and mortality worldwide as well as long-term neurological sequelae. Despite being an important public health problem very few population-based studies were conducted so far in the world and none in Ukraine. The aim: to explore the clinical features and etiology of herpesvirus encephalitis (HVE) in a prospective single center study from January 2014 to January 2017. PATIENTS AND METHODS: Materials and methods: 107 adult patients with confirmed herpesvirus infection and symptoms of possible encephalitis (CNS lesion) were analyzed in the study. CSF and blood contents, antibody for HVs M and G classes, and MRI scans have been studied, but the crucial diagnostic sign was the presence of specific viral DNA in the CSF or blood. RESULTS: Results: 74 (69.3%) out of 107 patients were females, the male to female ratio was 1:2.2. The median age of patients was 36.9 years (range 20-65 years). Most common clinical features were fever, meningism (stiff neck), and focal neurological signs. The genome of HVs was detected in CSF samples obtained from all patients as follows: Herpes simplex virus 1 and 2 - 13 (12.1 %), Varicella zoster virus - 2 (1.8), Cytomegalovirus - 14 (13 %), Epstein Barr virus - 22 (20.5 %), Human herpesvirus 6 - 5 (4.7 %), Human herpesvirus 7 - 13 (12.1 %). Co-infection (≥ 2 HVs) was observed in 38 patients (35.5 %). CSF of 27 patients contained two viral DNA, and 11 - three one in various combination. Human herpesvirus 8 was not found. CONCLUSION: Conclusions: The most frequently diagnosed infections in hospital based study were Human herpesvirus 5 (EBV), followed by HSV-1/2, CMV, and HHV-7. Significant part of patients (35.5 %) were co-infected with two or three HVs. Predisposing factor for Ukrainian population is sex.

Epstein-barr virus-associated encephalitis in a case-series of more than 40 patients.

OBJECTIVE: Introduction: Epstein-Barr virus (EBV) infection can present with neurologic manifestations including encephalitis, aseptic meningitis, Guillain-Barre syndrome, and many others. Most reported cases have been in children. Little is known about EBV encephalitis in adults. The aim: To describe the clinical presentations, investigational findings, management and outcome of adult patients with EBV encephalitis. PATIENTS AND METHODS: Materials and methods: This report conducted a retrospective review of all cases of EBV-associated encephalitis compiled in the Kyiv's referral hospital from January 2016 to December 2017. RESULTS: Review: Out of 226 adult patients hospitalized with acute encephalitis during the study period, 48 (21.2%) were identified as having evidence of EBV-infection: convincing EBV serology and/or positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) in patients that had no bacterial cause of encephalitis. EBV monoinfection was registered in 24 (50%) patients. Mixed herpesvirus infection with one to four viruses in addition to EBV was detected in the rest. The most common symptoms were fever, confusion, headache, focal neurological deficits, vestibulo-ataxic disorders. CSF cytosis, content of protein and glucose were close to normal. Magnetic resonance imaging (MRI) showed focal (28/58.3%) and diffuse (15/31.3%) changes of the brain parenchymal. All patients got antiviral medication: ganciclovir, valganciclovir or valaciclovir, as a rule. Outcome: 26 (54%) patients recovered without any disabling sequela, 21 (44%) patients with remaining preservations were transferred to a convalescence facility. One patient, which condition worsened against the background of the therapy, were moved to an intensive care unit. No patient died. CONCLUSION: Conclusions: CNS infection with EBV only and as a mixed infection is common in Ukraine. Presentation of EBV-infection is non-specific, both as MR imaging, sometimes reminding of HSV-1 infection. Prognosis of the disease is favorable.

Identification of human herpesvirus 7 in the cerebrospinal fluid of adult ukrainian with relapsing-remitting multiple sclerosis. A case study.

OBJECTIVE: Introduction: In this study, we investigated the possible involvement of Human herpesvirus 7 in multiple sclerosis. The aim: To contribute to clarifying the controversy on the association between Human Herpesviruses 7 (HHV-7) and multiple sclerosis (MS) studying patient with relapsing-remitting MS (RRMS). PATIENTS AND METHODS: Case study: Young female admitted to adult tertiary referral, infectious diseases hospital, Kyiv, Ukraine, with signs of a focal neurological deficit. Meningeal symptoms were not detected. The preadmission illness lasted some years. Clinical diagnosis was relapsing-remitting multiple sclerosis (RRMS). On admission, general condition was of moderate severity. She has a mild fever, confusion, speech and coordination disorders, dizziness, worsening of memory, inability to walk (inferior paraparesis). Focal lesions were detected on MRI scan. The spinal fluid contained oligoclonal IgG-chains and HHV-7 DNA. After two weeks of intensive antiviral treatment, the patient's condition improved significantly,the function of the lower limbs recovered almost completely, and she was discharged home. CONCLUSION: Conclusion: Here we present a comprehensive clinical, radiological and virological analysis of the HHV-7-associated case of multiple sclerosis.