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RATIONALE: Listeria monocytogenes (LM) is an important foodborne bacterium, and LM meningoencephalitis is rare in clinical practice, with poor prognosis in severe patients. It is prone to misdiagnosis in clinical practice. We first reported a case of severe LM meningoencephalitis with muscle lesions and evaluated the comprehensive condition. PATIENT CONCERNS: A 48-year-old man had a fever and was admitted to the neurology department due to dizziness, nausea, and vomiting for 20 days. DIAGNOSES: LM meningoencephalitis complicated with muscle lesions. INTERVENTIONS: We used moxifloxacin 0.4 g, qd, meropenem 2 g, q8h, and dexamethasone 10 mg, qd to reduce exudation and adhesion. Then due to consideration of side effects, we increased the dose of ampicillin by 2 g, q4h, stopped using meropenem and moxifloxacin, and turned to maintenance treatment with dexamethasone and ampicillin. We comprehensively managed his vital signs and physical organ functions, we also controlled some comorbidities. During the hospitalization period thereafter, we used intravenous anti-infection treatment with moxifloxacin 0.4 g, qd, ampicillin 0.5 g, q4h. OUTCOMES: Half a year later, the reexamination showed only protein elevation in cerebrospinal fluid and hydrocephalus in MRI. Afterward, the symptoms did not recur again. The patient recovered well after discharge. LESSONS: LM meningoencephalitis complicated with lower limb muscle lesions is clinically rare. This report focuses on relevant treatment plans, which provide value for the examination and comprehensive management of patients with LM infection in the future.
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Antibacterianos , Mareo , Fiebre , Náusea , Vómitos , Humanos , Masculino , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Fiebre/etiología , Mareo/etiología , Vómitos/etiología , Náusea/etiología , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/diagnóstico , Meningoencefalitis/microbiología , Moxifloxacino/uso terapéutico , Moxifloxacino/administración & dosificación , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Listeria monocytogenes/aislamiento & purificación , Ampicilina/uso terapéutico , Ampicilina/administración & dosificaciónRESUMEN
BACKGROUND: Scrub typhus is a mite-borne zoonotic disease caused by Orientia tsutsugamushi and commonly presents with fever, rash, and eschar. Systemic complications develop later in the illness including, meningoencephalitis, pericardial effusion, myocarditis, and pneumonitis. In this article, we will be presenting different neurological manifestations of scrub typhus along with functional outcomes studied at a tertiary care center in New Delhi. METHODS: This ambispective observational study was conducted at Army Hospital Research and Referral, New Delhi, during January 2018- January 2020. Febrile illness, serologically confirmed as scrub typhus and developing neurological complications were included. A predesigned clinical proforma was recorded for demographics, clinical features, neurological examination, supported with laboratory and/or radiology evaluation, and functional outcomes using the modified Rankin Scale (mRS). RESULTS: In our cohort of 7 patients' majority were male (71%) with mean age at presentation being 42.5 years. Eschar was present in only 2 cases (28%) and a syndromic clinical diagnosis of meningoencephalitis was made in 3 (43%), acute flaccid quadriparesis in 2 (28%); and symptomatic seizure and parkinsonism in 1 patient each (14%). CSF showed lymphocytic pleocytosis with protein elevation in 57% cases. Systemic dysfunction was noted in the form of thrombocytopenia (57%), hyponatremia (42%), elevated transaminases (57%). Symptoms resolved with Doxycycline ± Rifampicin therapy in all cases, with good functional outcomes in majority of (89%) cases. CONCLUSION: Neurological complications in scrub typhus have a wide spectrum involving meninges, encephalon, basal ganglia, cranial, and peripheral nerves. High index of suspicion with early serological testing (ELISA) is a must in undifferentiated fevers. Timely initiation of appropriate therapy leads to good clinical outcomes, in majority of cases with neurological involvement.
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Tifus por Ácaros , Humanos , Tifus por Ácaros/complicaciones , Tifus por Ácaros/diagnóstico , Masculino , Adulto , Femenino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/diagnóstico , India , Meningoencefalitis/diagnósticoRESUMEN
Acute pyogenic meningitis is a medical emergency. Bacteria are the major causative agents of pyogenic meningitis with Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis being the most common. Here, we describe a case of bacterial meningoencephalitis caused by Streptococcus porcinus. To our knowledge this is the first case described in literature. The patient was treated with ceftriaxone and supportive treatment.
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Antibacterianos , Ceftriaxona , Meningoencefalitis , Infecciones Estreptocócicas , Streptococcus , Humanos , Meningoencefalitis/microbiología , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/diagnóstico , Antibacterianos/uso terapéutico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/diagnóstico , Ceftriaxona/uso terapéutico , Streptococcus/aislamiento & purificación , Streptococcus/clasificación , Masculino , Resultado del Tratamiento , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/diagnósticoRESUMEN
Borrelia miyamotoi is an emerging tickborne pathogen that has been associated with central nervous system infections in immunocompromised patients, albeit infrequently. We describe a case-patient in Minnesota, USA, who had meningeal symptoms of 1 month duration. B. miyamotoi infection was diagnosed by Gram staining on cerebrospinal fluid and confirmed by sequencing.
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Borrelia , Meningoencefalitis , Humanos , Borrelia/aislamiento & purificación , Borrelia/genética , Minnesota/epidemiología , Meningoencefalitis/microbiología , Meningoencefalitis/diagnóstico , Masculino , Infecciones por Borrelia/diagnóstico , Infecciones por Borrelia/microbiología , Infecciones por Borrelia/tratamiento farmacológico , Infecciones por Borrelia/complicaciones , Antibacterianos/uso terapéutico , Persona de Mediana Edad , Enfermedad Aguda , FemeninoRESUMEN
OBJECTIVE: To describe the utility of film array meningoencephalitis (FAME) panel in the management of children with acute encephalitis syndrome (AES). METHODS: A retrospective audit was conducted between January 2017 to July 2022. We included children aged < 18 years with a diagnosis of AES for whom a CSF analysis study including FAME panel testing performed within 48 hours of admission was available. Electronic medical records were reviewed for details including demographic profile, clinical presentation, investigations and outcome. RESULTS: Out of 157 CSF samples sent for FAME panel testing, 49 were positive (31.4%.) Viral pathogens were identified in 42 (Enterovirus: 31, Human herpes virus 6: 9, Varicella zoster virus: 1, and Cytomegalovirus: 1) Bacterial pathogens were identified in 6 (Streptococcus pneumoniae: 2, Streptococcus agalactiae: 2, Hemophilus influenzae: 1, and Escherischia coli: 1). Fungal etiology (Cryptococcus neoformans) was detected in one child. Antibiotics could be stopped within 72 hours of initiation in 42 children in whom a viral etiology was established. Acyclovir could be stopped in 21 out of 32 children within 72 hours after the FAME panel testing. FAME panel was presumed to be false positive in 4 children. CONCLUSION: Etiology of AES could be established in nearly a third of children with AES using the rapid diagnostic FAME panel testing in CSF and it was found to be effective in reducing empirical antibiotic/antiviral therapy.
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Encefalopatía Aguda Febril , Humanos , India/epidemiología , Estudios Retrospectivos , Niño , Preescolar , Femenino , Masculino , Lactante , Encefalopatía Aguda Febril/diagnóstico , Encefalopatía Aguda Febril/tratamiento farmacológico , Encefalopatía Aguda Febril/epidemiología , Adolescente , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/diagnóstico , Meningoencefalitis/líquido cefalorraquídeoRESUMEN
A 40-year old female chimpanzee (Pan troglodytes) developed hyporexia, weight loss, followed by progressive and complete blindness. Tomography demonstrated an intracranial mass in the rostroventral brain involving the optic chiasm, with a presumptive diagnosis of neoplasm. However, histopathology revealed a granulomatous meningoencephalitis, and tissue samples tested positive for Mycobacterium tuberculosis.
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Enfermedades del Simio Antropoideo , Ceguera , Meningoencefalitis , Mycobacterium tuberculosis , Pan troglodytes , Animales , Femenino , Enfermedades del Simio Antropoideo/diagnóstico , Enfermedades del Simio Antropoideo/microbiología , Enfermedades del Simio Antropoideo/patología , Mycobacterium tuberculosis/aislamiento & purificación , Ceguera/veterinaria , Ceguera/etiología , Ceguera/microbiología , Ceguera/diagnóstico , Meningoencefalitis/veterinaria , Meningoencefalitis/microbiología , Meningoencefalitis/diagnóstico , Granuloma/veterinaria , Granuloma/microbiología , Granuloma/patología , Granuloma/diagnóstico , Tuberculosis/veterinaria , Tuberculosis/diagnóstico , Tuberculosis/complicacionesRESUMEN
OBJECTIVE: Patients with X linked agammaglobulinemia are susceptible to enterovirus (EV) infections. Similarly, severe EV infections have been described in patients with impaired B-cell response following treatment with anti-CD20 monoclonal antibodies (mAbs), mostly in those treated for haematological malignancies. We aimed to describe severe EV infections in patients receiving anti-CD20 mAbs for immune-mediated inflammatory diseases (IMIDs). METHODS: Patients were included following a screening of data collected through the routine surveillance of EV infections coordinated by the National Reference Center and a review of the literature. Additionally, neutralising antibodies were assessed in a patient with chronic EV-A71 meningoencephalitis. RESULTS: Nine original and 17 previously published cases were retrieved. Meningoencephalitis (n=21/26, 81%) associated with EV-positive cerebrospinal fluid (n=20/22, 91%) was the most common manifestation. The mortality rate was high (27%). EV was the only causal agents in all reported cases. Patients received multiple anti-CD20 mAbs infusions (median 8 (5-10)), resulting in complete B-cell depletion and moderate hypogammaglobulinemia (median 4.9 g/L (4.3-6.7)), and had limited concomitant immunosuppressive treatments. Finally, in a patient with EV-A71 meningoencephalitis, a lack of B-cell response to EV was shown. CONCLUSION: EV infection should be evoked in patients with IMIDs presenting with atypical organ involvement, especially meningoencephalitis. Anti-CD20 mAbs may lead to impaired B-cell response against EV, although an underlying primary immunodeficiency should systematically be discussed.
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Anticuerpos Monoclonales , Antígenos CD20 , Infecciones por Enterovirus , Humanos , Infecciones por Enterovirus/inmunología , Infecciones por Enterovirus/diagnóstico , Masculino , Femenino , Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/inmunología , Persona de Mediana Edad , Adulto , Meningoencefalitis/inmunología , Meningoencefalitis/virología , Meningoencefalitis/etiología , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Anciano , Rituximab/uso terapéutico , Linfocitos B/inmunología , Agammaglobulinemia/inmunología , Agammaglobulinemia/complicaciones , Inflamación/inmunologíaRESUMEN
BACKGROUND: Neurofilament light chain (NfL) is released into the peripheral circulation by damaged axons. OBJECTIVES: To evaluate the diagnostic value of serum NfL concentration in dogs with intracranial diseases. ANIMALS: Study included 37 healthy dogs, 31 dogs with idiopathic epilepsy (IE), 45 dogs with meningoencephalitis of unknown etiology (MUE), 20 dogs with hydrocephalus, and 19 dogs with brain tumors. METHODS: Cohort study. Serum NfL concentrations were measured in all dogs using single-molecule array technology. RESULTS: Serum NfL concentration in dogs with each structural disease was significantly higher than in healthy dogs and dogs with IE (P = .01). The area under the receiver operating characteristic curve of NfL for differentiating between dogs with structural diseases and IE was 0.868. An optimal cutoff value of the NfL 27.10 pg/mL had a sensitivity of 86.67% and a specificity of 74.19% to differentiate the dogs with IE from those with structural brain diseases. There were significant correlations between NfL concentrations and lesion size: (1) MUE, P = .01, r = 0.429; (2) hydrocephalus, P = .01, r = 0.563. CONCLUSIONS AND CLINICAL IMPORTANCE: Serum NfL could be a useful biomarker for distinguishing IE from structural diseases in dogs and predicting the lesion sizes of MUE and hydrocephalus.
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Biomarcadores , Enfermedades de los Perros , Proteínas de Neurofilamentos , Animales , Perros , Enfermedades de los Perros/sangre , Enfermedades de los Perros/diagnóstico , Proteínas de Neurofilamentos/sangre , Femenino , Masculino , Biomarcadores/sangre , Hidrocefalia/veterinaria , Hidrocefalia/sangre , Hidrocefalia/diagnóstico , Encefalopatías/veterinaria , Encefalopatías/sangre , Encefalopatías/diagnóstico , Epilepsia/veterinaria , Epilepsia/sangre , Epilepsia/diagnóstico , Meningoencefalitis/veterinaria , Meningoencefalitis/sangre , Meningoencefalitis/diagnóstico , Neoplasias Encefálicas/veterinaria , Neoplasias Encefálicas/sangre , Neoplasias Encefálicas/diagnóstico , Sensibilidad y Especificidad , Estudios de Cohortes , Estudios de Casos y ControlesRESUMEN
OBJECTIVES: To evaluate blood and cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP) in dogs with meningoencephalitis of unknown origin (MUO); to evaluate whether blood CRP concentration is associated with epidemiological, clinicopathologic, and MRI findings; and to investigate blood CRP predictive power in survival. ANIMALS: 30 client-owned dogs with MUO, 15 client-owned dogs with steroid-responsive meningitis arteritis (SRMA; positive control group), and 15 healthy dogs (negative control group). METHODS: Blood CRP concentration was measured in each group, while it was performed in CSF only in the MUO and SRMA groups. The analysis of epidemiological data included breed, age, sex, duration of clinical signs, and history of seizures. Blinded analysis of MRI was performed based on a classification grid, and traditional CSF analysis parameters were assessed. The predictive power of blood CRP concentration regarding survival at 6 months was investigated. RESULTS: Of the 30 dogs with MUO, 9 (30%) had an increased CRP concentration in blood, and 3 (10%) showed a measurable CRP in CSF. Median blood CRP concentration in dogs with MUO was 0.1 mg/L (range, 0.1 to 102 mg/L), which was not statistically different from the healthy dog group but significantly lower than the SRMA control group. Only the duration of clinical signs was positively associated with an increased blood CRP level. Blood CRP concentration was not associated with survival at 6 months. CLINICAL RELEVANCE: Blood CRP concentration is of limited value for the diagnosis and prognosis of dogs with MUO. Chronicity of the disease may be associated with an increased concentration of blood CRP.
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Arteritis , Enfermedades de los Perros , Meningitis , Meningoencefalitis , Humanos , Perros , Animales , Proteína C-Reactiva , Meningoencefalitis/diagnóstico , Meningoencefalitis/veterinaria , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis/veterinaria , Arteritis/diagnóstico , Arteritis/veterinaria , Arteritis/líquido cefalorraquídeoRESUMEN
BACKGROUND: In the 2022 mpox-outbreak most patients presented with mild symptoms. Central nervous system (CNS) involvement has previously been described as a rare and severe complication of mpox; however, diagnostic findings in cerebrospinal fluid (CSF) analysis and neuroimaging studies have only been reported in one case previously. CASE PRESENTATION: We report a previously healthy 37-year-old man with mpox complicated by encephalitis. He first presented with painful skin lesions and genital ulcers; polymerase chain reaction (PCR) from the lesions was positive for mpox. Twelve days later he was admitted with fever and confusion. Neuroimaging and CSF analysis indicated encephalitis. The CSF was PCR-negative for monkeypox virus but intrathecal antibody production was detected. He spontaneously improved over a few days course and recovered fully. CONCLUSIONS: This case of mpox-associated encephalitis shows that CNS involvement in mpox infection may have a relatively mild clinical course, and that detection of intrathecal antibody production can be used to establish the diagnosis if CSF monkeypox virus-PCR is negative.
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Encefalitis , Meningoencefalitis , Mpox , Masculino , Humanos , Adulto , Monkeypox virus , Formación de Anticuerpos , Mpox/diagnóstico , Meningoencefalitis/diagnósticoRESUMEN
Glial fibrillary acidic protein (GFAP) antibody-associated disorders (AD) were recently proposed to be immune-mediated neurological disorders. The pathogenesis of GFAP antibody-AD is poorly understood. Pathologically, there is a marked infiltration of large numbers of lymphocytes, including CD8+ and CD4+ T cells, into the meningeal and brain parenchyma, especially around the perivascular areas. GFAP-specific cytotoxic T cells are considered to be the effector cells of GFAP antibody-AD. The common phenotype of GFAP antibody-AD includes meningoencephalitis with or without myelitis. During the clinical disease course, patients present with consciousness disturbances, urinary dysfunction, movement disorders, meningeal irritation, and cognitive dysfunction. The detection of GFAP antibodies in the cerebrospinal fluid (CSF) by cell-based assay is essential for a diagnosis of GFAP antibody-AD. The CSF can be examined for lymphocyte-predominant pleocytosis and elevated protein levels. Brain linear perivascular radial enhancement patterns are observed in about half of GFAP antibody-AD patients. Spinal cord magnetic resonance imaging is used to detect longitudinal extensive spinal cord lesions. Although corticosteroid therapy is generally effective, some patients have a poor prognosis and relapse.
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Meningoencefalitis , Mielitis , Humanos , Proteína Ácida Fibrilar de la Glía/genética , Encéfalo , Meningoencefalitis/diagnóstico , Autoanticuerpos/líquido cefalorraquídeo , Astrocitos/patologíaRESUMEN
Acanthamoeba spp. are rare etiological agents of meningoencephalitis with high mortality. We present three cases of Acanthamoeba meningoencephalitis in immunocompetent individuals from Eastern India. The first patient presented with fever and headache; the second with headache, visual disturbance, and squint; and the third presented in a drowsy state. The cases presented on March 3, 18, and 21, 2023 respectively. The first two patients had concomitant tubercular meningitis for which they received antitubercular therapy and steroid. Their cerebrospinal fluid showed slight lymphocytic pleocytosis and increased protein. The diagnosis was done by microscopy, culture, and polymerase chain reaction. They received a combination therapy comprising rifampicin, fluconazole, and trimethoprim-sulfamethoxazole. The first patient additionally received miltefosine. She responded well to therapy and survived, but the other two patients died despite intensive care. Detection of three cases within a period of 1 month from Eastern India is unusual. It is imperative to sensitize healthcare providers about Acanthamoeba meningoencephalitis to facilitate timely diagnosis and treatment of the disease.
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Acanthamoeba , Amebiasis , Infecciones Protozoarias del Sistema Nervioso Central , Meningoencefalitis , Humanos , Femenino , Infecciones Protozoarias del Sistema Nervioso Central/diagnóstico , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológico , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , India , CefaleaRESUMEN
A 37-year-old woman was hospitalized with fever and consciousness disturbance. She showed systemic inflammation with stress cardiomyopathy. Brain computed tomography showed diffuse brain edema. Cerebrospinal fluid (CSF) findings revealed markedly elevated cerebrospinal fluid pressure with pleocytosis, elevated protein, and elevated interleukin 6. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nicking enzyme amplification reaction test using a nasopharyngeal swab was positive, and the patient was diagnosed with SARS-CoV-2 infection. From the negative result of the CSF SARS-CoV-2 polymerase chain reaction test and no findings of bacterial or viral infection, we diagnosed meningoencephalitis by multisystem inflammation syndrome in adults (MIS-A). Intravenous methylprednisolone pulse therapy improved her symptoms and brain edema. There have been no cases of MIS-A with meningoencephalitis, and no initial treatment strategy has been established, especially in emergency cases of suspected MIS-A. The present case suggested Early intravenous methylprednisolone pulse with anti-coronaviral therapies after the exclusion of bacterial infection would be useful in suspected MIS-A with emergent meningoencephalitis cases.
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Edema Encefálico , COVID-19 , Enfermedades del Tejido Conjuntivo , Meningoencefalitis , Humanos , Adulto , Femenino , COVID-19/complicaciones , COVID-19/diagnóstico , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Inflamación , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Metilprednisolona/uso terapéuticoRESUMEN
Necrotizing meningoencephalitis (NME) is a fatal neuroinflammatory disease that previously carried a uniformly grave prognosis. Our recent identification of a novel early form of NME in Pugs suggests that disease onset and progression are likely more insidious than previously recognized and provides new hope that early therapeutic intervention may halt disease progression and ultimately prevent or cure NME. This novel perspective also sheds new light on the clinical similarities to multiple sclerosis (MS) in humans and provides a rationale for cross-species translation. The history of recent scientific discoveries in NME and new parallels between MS and NME will be reviewed.
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Enfermedades de los Perros , Meningoencefalitis , Esclerosis Múltiple , Humanos , Perros , Animales , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/veterinaria , Meningoencefalitis/diagnóstico , Meningoencefalitis/veterinaria , Meningoencefalitis/genética , Fenotipo , Enfermedades de los Perros/genéticaRESUMEN
PURPOSE: We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS: FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS: FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION: FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.
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Encefalitis , Meningitis , Meningoencefalitis , Humanos , Meningitis/diagnóstico , Encefalitis/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Leucocitosis , Meningoencefalitis/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodosRESUMEN
INTRODUCTION: Meningoencephalitis in children poses a diagnostic challenge, as etiology remains unknown for most of patients. Viral metagenomics by shotgun sequencing represents a powerful tool for investigating unknown viral infections related to these cases. PATIENTS AND METHODS: In a two-year, reference-centre, retrospective study, we investigated the usefulness of viral metagenomics of cerebrospinal fluid (CSF) for the diagnosis of viral infectious meningoencephalitis in forty seven pediatric patients, forty of them previously tested negative with a routine neurologic panel of viral targets that included herpesvirus 1-3 and enterovirus. We enhanced the detection by targeting viral sequences by hybrid capture. Raw sequence data was analysed using three bioinformatics pipelines. RESULTS: Out of forty remaining children with meningoencephalitis of unknown viral etiology, a significant detection of viral nucleic acid by shotgun sequencing was found in twenty one, which was confirmed in ten of them by specific PCR: seven human endogenous retrovirus K113 (HER K113), one parechovirus 3, one human herpesvirus 5 (HHV5); one enterovirus B (Echovirus 9). The remaining eleven CSF were not confirmed by PCR: three rotavirus, one human herpesvirus 7 (HHV7), one influenza A, one mastadenovirus C, one sindbis virus, one torque teno virus, one human immunodeficiency virus 1 (HIV-1), one human alphaherpesvirus 3 (HHV3), one human alphaherpesvirus 2 (HHV2). CONCLUSIONS: Underutilization of currently available meningitis-encephalitis diagnostic techniques such as BioFire® FilmArray® is the main cause of undiagnosed cases of meningoencephalitis. However, in this study we detected uncommon viruses that should be considered, including virus, rotavirus, sindbis virus, influenza A virus and HHV7. No other viral sequences that could be readily linked to CNS inflammation were detected. Some findings may stem from reagent or sample contamination, as seen with papillomavirus; for others, the clinical relevance of the virus remains uncertain and should be substantiated by further studies, as is the case with endogenous retrovirus K113 virus. Online bioinformatics pipeline CZID represents a valuable tool for analysing shotgun sequencing data in cases of neurological conditions with unknown etiology. Altogether, this study highlights the potential of shotgun sequencing in identifying previously unknown viral neuropathogens and sheds light on the interpretation issues related to its application in clinical microbiology.
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Meningoencefalitis , Virosis , Virus , Humanos , Niño , Estudios Retrospectivos , Meningoencefalitis/diagnóstico , Virus/genética , Virosis/complicaciones , Virosis/diagnóstico , Inflamación , Herpesvirus Humano 3 , Metagenómica/métodosRESUMEN
Behçet's disease (BD) is a systemic vasculitis that frequently presents with a relapsing-remitting pattern. CNS involvement (Neuro-Behçet) is rare, affecting approximately 10% of patients. Its etiological mechanisms are not yet fully understood. The most commonly accepted hypothesis is that of a systemic inflammatory reaction triggered by an infectious agent or by an autoantigen, such as heat shock protein, in genetically predisposed individuals. Mycobacterium tuberculosis is known to be closely interconnected with BD, both affecting cell-mediated immunity to a certain extent and probably sharing a common genetic background. We present the case of a 34-year-old Caucasian woman who had been diagnosed with tuberculous meningitis 15 months prior, with significant neurological deficits and lesional burden on MRI with repeated relapses whenever treatment withdrawal was attempted. These relapses were initially considered as reactivation of tuberculous meningoencephalitis, and symptoms improved after a combination of antituberculous treatment and corticosteroid therapy. After the second relapse, the diagnosis was reconsidered, as new information emerged about oral and genital aphthous lesions, making us suspect a BD diagnosis. HLA B51 testing was positive, antituberculous treatment was stopped, and the patient was started on high doses of oral Cortisone and Azathioprine. Consequently, the evolution was favorable, with no further relapses and slow improvements in neurological deficits. To our knowledge, this is the first report of Neuro-Behçet's disease onset precipitated by tuberculous meningitis. We include a review of the available literature on this subject. Our case reinforces the fact that Mycobacterium tuberculosis infection can precipitate BD in genetically predisposed patients, and we recommend HLA B51 screening in patients with prolonged or relapsing meningoencephalitis, even if an infectious agent is apparently involved.
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Síndrome de Behçet , Meningoencefalitis , Tuberculosis Meníngea , Femenino , Humanos , Adulto , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Antígeno HLA-B51 , Tuberculosis Meníngea/complicaciones , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Recurrencia Local de Neoplasia , Meningoencefalitis/complicaciones , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , RecurrenciaRESUMEN
Background: Fusarium infection in the central nervous system is a rare pathology generally reported in patients with hematological malignancies. Clincal case: A patient with Fusarium meningoencephalitis during the late postpartum period is presented. The patient's main symptom was holocranial headache with poor response to analgesics, adding dysarthria and blurred vision. Initially, it was classified as aseptic meningitis due to the absence of bacterial isolation, however, 8 weeks after the onset of the symptoms, Fusarium development was obtained in cerebrospinal fluid cultures. Targeted treatment with liposomal amphotericin and voriconazole was established, with partial improvement at first; however, at 16 weeks from the onset of the clinical picture, the patient presented sudden deterioration of alertness, an ischemic area was found in the occipital lobe by imaging study, which quickly led the patient to a fatal outcome. Conclusion: Despite the fact that in recent years Fusarium spp infection has been detected more frequently in the population, the treatment is still not well established, making management of the Central Nervous System a challenge.
Introducción: la infección por Fusarium en el sistema nervioso central es una patología rara, reportada generalmente en pacientes con neoplasias hematológicas. Caso clínico: se presenta una paciente con meningoencefalitis por Fusarium durante el periodo de puerperio tardío. El síntoma principal de la paciente fue cefalea holocraneana con baja respuesta a analgésicos, agregándose disartria y visión borrosa. De manera inicial, se catalogó como meningitis aséptica por ausencia de aislamiento bacteriano, no obstante, a las 8 semanas posterior al inicio del cuadro se obtuvo desarrollo de Fusarium en los cultivos de líquido cefalorraquídeo. Se estableció tratamiento dirigido con anfotericina liposomal y voriconazol, con mejoría parcial en un inicio; sin embargo, la paciente a las 16 semanas desde el inicio del cuadro clínico presentó deterioro súbito del estado de alerta, se evidenció zona isquémica en el lóbulo occipital por estudio de imagen, lo que rápidamente llevó a la paciente a un desenlace fatal. Conclusión: a pesar de que en los últimos años la infección por Fusarium spp se ha detectado con mayor frecuencia en la población, el tratamiento aún no se encuentra bien establecido ocasionando que sea un reto el manejo en Sistema Nervioso Central.
Asunto(s)
Fusarium , Meningoencefalitis , Femenino , Humanos , Antifúngicos/uso terapéutico , Voriconazol/uso terapéutico , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológicoRESUMEN
Primary amoebic meningoencephalitis (PAM) is a rapidly progressing central nervous system (CNS) infection caused by Naegleria fowleri, a free-living amoeba found in warm freshwater. The disease progression is very rapid, and the outcome is nearly always fatal. We aim to describe the disease course in patients admitted with PAM in a tertiary care center in Karachi, Pakistan between the periods of 2010 to 2021. A total of 39 patients were included in the study, 33 males (84.6%). The median age of the patients was 34 years. The most frequent presenting complaint was fever, which was found in 37 patients (94.9%) followed by headache in 28 patients (71.8%), nausea and vomiting in 27 patients (69.2%), and seizures in 10 patients (25.6%). Overall, 39 patients underwent lumbar puncture, 27 patients (69.2%) had a positive motile trophozoites on CSF wet preparation microscopy, 18 patients (46.2%) had a positive culture, and 10 patients had a positive PCR. CSF analysis resembled bacterial meningitis with elevated white blood cell counts with predominantly neutrophils (median, 3000 [range, 1350-7500] cells/µL), low glucose levels median, 14 [range, 1-92] mg/dL), and elevated protein levels (median, 344 [range, 289-405] mg/dL). Imaging results were abnormal in approximately three-fourths of the patients which included cerebral edema (66.7%), hydrocephalus (25.6%), and cerebral infarctions (12.8%). Only one patient survived. PAM is a fatal illness with limited treatment success. Early diagnosis and prompt initiation of treatment can improve the survival of the patients and reduce mortality.