Clinical Characterization of Neurobrucellosis in Kashi Region / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical characteristics of neurobrucellosis in Kashi， Xinjiang Uygur Autonomous Region， thus improve the diagnosis and treatment. MethodsA retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between December 2019 and January 2024. ResultsThe study included 9 males and 9 females， with a median age of 36 years （range： 17-54.5）. A clear epidemiological history was found in all the 18 brucllosis patients， 12 of whom presented with meningoencephalitis， 5 meningitis， and 1 encephalitis. Two comorbided with spinal meningitis， 2 osteoarthritis and 1 epididymitis. Most frequently reported clinical symptoms were headache， fever and fatigue. The prevalence rates of brucellosis by rose bengal plate agglutination test （RBPT） and serum agglutination test （SAT） were 11/12 and 8/9， respectively. Two of 10 patients had positive blood cultures， four of 16 had positive cerebrospinal fluid （CSF） cultures and five of five were detected to be positive by next-generation sequencing （NGS） for pathogens in CSF. CSF showed exudative changes and elevated number of leukocytes， with predominance of single nucleated cells. All patients were treated with the combined use of two to four from the drugs like doxycycline， rifampicin， ceftriaxone， cefixime， minocycline， levofloxacin and sulfanilamide. Most patients had a favorable prognosis. ConclusionsNeurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas. If there are exudative changes in CSF， differential diagnoses can be made by serological testing， blood culture， CSF culture and NGS. NGS could significantly increase the accuracy for neurobrucellosis diagnosis.

Evaluation of pathogen from the FilmArray meningitis/encephalitis panel and recommendations on atypical findings / Avaliação do patógeno do painel de meningite/encefalite FilmArray e recomendações sobre achados atípicos

Abstract Background Infectious meningoencephalitis is a potentially fatal clinical condition that causes inflammation of the central nervous system secondary to the installation of different microorganisms. The FilmArray meningitis/encephalitis panel allows the simultaneous detection of 14 pathogens with results in about one hour. Objective This study is based on retrospectively evaluating the implementation of the FilmArray meningitis/encephalitis panel in a hospital environment, highlighting the general results and, especially, analyzing the consistency of the test results against the clinical and laboratory conditions of the patients. Methods Data were collected through the results reported by the BioFire FilmArray system software from the meningitis/encephalitis panel. The correlated laboratory tests used in our analysis, when available, included biochemical, cytological, direct and indirect microbiological tests. Results In the analyzed period, there were 496 samples with released results. Of the total of 496 samples analyzed, 88 (17.75%) were considered positive, and 90 pathogens were detected, and in 2 of these (2.27%) there was co-detection of pathogens. Viruses were the agents most frequently found within the total number of pathogens detected. Of the 496 proven samples, 20 (4.03%) were repeated, 5 of which were repeated due to invalid results, 6 due to the detection of multiple pathogens and 9 due to disagreement between the panel results and the other laboratory tests and/or divergence of the clinical-epidemiological picture. Of these 20 repeated samples, only 4 of them (20%) maintained the original result after repeating the test, with 16 (80%) being non-reproducible. The main factor related to the disagreement of these 16 samples during retesting was the detection of bacterial agents without any relationship with other laboratory tests or with the patients' clinical condition. Conclusion In our study, simply reproducing tests with atypical results from the FilmArray meningitis/encephalitis panel proved, in most cases, effective and sufficient for interpreting these results.

Resumo Antecedentes A meningoencefalite infecciosa é uma condição clínica potencialmente fatal que causa inflamação do sistema nervoso central secundária à instalação de diversos microrganismos. O painel de meningite/encefalite FilmArray permite a detecção simultânea de 14 patógenos, com resultados em cerca de uma hora. Objetivo Este estudo baseia-se em avaliar retrospectivamente a implementação do painel de meningite/encefalite FilmArray em ambiente hospitalar, destacando os resultados gerais e, principalmente, analisando a consistência dos resultados do teste frente às condições clínicas e laboratoriais dos pacientes. Métodos Os dados foram coletados por meio dos resultados relatados pelo software do sistema BioFire FilmArray do painel de meningite/encefalite. Os exames laboratoriais correlacionados utilizados em nossa análise, quando disponíveis, incluíram exames bioquímicos, citológicos, microbiológicos diretos e indiretos. Resultados No período analisado, foram 496 amostras com resultados divulgados. Do total de 496 amostras analisadas, 88 (17,75%) foram consideradas positivas e 90 patógenos foram detectados, sendo que em duas destas (2,27%) houve codetecção de patógenos. Os vírus foram os agentes mais frequentemente encontrados dentro do total de patógenos detectados. Das 496 amostras analisadas, 20 (4,03%) foram repetidas, sendo 5 repetidas por resultado inválido, 6 pela detecção de múltiplos patógenos e 9 por discordância dos resultados do painel com os demais exames laboratoriais e/ou divergência do quadro clínico-epidemiológico. Destas 20 amostras repetidas, apenas 4 delas (20%) mantiveram o resultado original após a repetição do teste, sendo 16 (80%) não reprodutíveis. O principal fator relacionado à discordância destas 16 amostras na retestagem foi a detecção de agentes bacterianos sem qualquer relação com os demais exames laboratoriais ou com o quadro clínico dos pacientes. Conclusão Em nosso estudo, a simples repetição dos testes com resultados atípicos do painel de meningite/encefalite FilmArray mostrou-se, na maior dos casos, efetiva e suficiente para a interpretação destes achados.

Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil

ABSTRACT This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment.

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay / Clinical and epidemiological characterization of the Chikungunya epidemic in Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

COVID-19 associated meningoencephalitis or a neuropsychiatric manifestation of systemic lupus erythematosus-a diagnostic dilemma

The infection with SARS-CoV-2 is associated with fever and respiratory symptoms but is not limited to respiratory system only. Since its appearance, several neurological symptoms have been reported, most commonly headache and anosmia, as well as less frequent complications such as COVID-19-associated encephalitis and meningitis. In this case report, we report a 40-year-old female recently infected with SARS-CoV-2, who presented with history of high-grade fever, cough, breathlessness 12 days back followed by altered sensorium and restlessness. The patient was also found to have underlying systemic lupus erythematosus which surfaced post-COVID-19 infection. Cerebrospinal fluid (CSF) analysis was done and the patient received IVIG therapy and showed dramatic improvement. SARS-CoV-2 has been implicated in development of autoimmune diseases.

Naegleria fowleri en Centro y Sudamérica: ¿La ameba come-cerebro está en el Perú? / Naegleria fowleri in Central and South America: The brain-eating amoeba is it in Peru?

RESUMEN Las amebas de vida libre (AVL) son entidades microbianas que son capaces de producir enfermedad en humanos y animales. Naegleria fowleri es una de las tres amebas patógenas en humanos, ésta se ha identificado en el continente sudamericano. Perú ha reportado sólo un caso el 2015, este caso no ha sido publicado, solo notificado al ministerio de salud. Es el caso de una niña menor de 11 años y se infectó en Piura, costa norte del Perú. Los pacientes fallecen al cabo de 5-7 días, es decir, es un curso agudo. Los países latinos como: Argentina, Brasil, Venezuela y Colombia describen 1, 5, 7 y 6 casos respectivamente. En esta revisión describiremos varios aspectos de esta ameba. La morfología, ecología, patología, epidemiología, clásico, los medios de cultivo adecuados y diagnósticos microbiológicos. Además, de la relación con el fenómeno "El niño" y la aparición de casos de meningitis.

ABSTRACT Free-living amoebae (FLA) are microbial entities that are capable of causing disease in humans and animals. Naegleria fowleri is one of the three free-living amoebae that are pathogenic to humans; it has been identified in the South American continent. Peru has reported only one case in 2015. This case has not been published, only notified to the Ministry of Health. The girl under 11 years old and was infected in Piura, north coast of Peru. Patients die after 5-7 days, that is, it is an acute course. Latin countries such as Argentina, Brazil, Venezuela and Colombia describe 1, 5, 7 and 6 cases respectively. In this review, we will describe various aspects of this amoeba. Morphology, ecology, pathology, epidemiology, adequate culture media, and microbiological and molecular diagnoses. In addition, the relationship with the phenomenon "El Niño" and the appearance of cases of meningitis.

Amebiasis cutánea por ameba de vida libre, heraldo ignorado de encefalitis letal. Reporte de caso / Free-living cutaneous amebiasis, ignored herald of lethal encephalitis. Case report

Introducción: Las enfermedades por amebas de vida libre (AVL) son poco frecuentes pero con letalidad mayor al 90% cuando comprometen el sistema nerviosos central (SNC). El cuadro clínico puede confundirse con enfermedades más prevalentes. Reporte de caso: Agricultor de 32 años procedente de Poroto-Trujillo-La Libertad-Perú, inicia enfermedad con una placa eritematosa centrofacial que se diagnosticó como tuberculosis cutánea (TBC), sin mejoría pese a recibir esquema completo de quimioterapia antituberculosa. Siete meses después presenta encefalitis severa falleciendo a los tres días de su ingreso al hospital. En la biopsia de piel se encontraron trofozoitos de AVL. Se plantea el diagnóstico de dermatitis cutánea por AVL complicada con encefalitis granulomatosa amebiana (EGA). No se han documentado casos similares en su lugar de procedencia. Conclusión: En el norte del Perú, las placas cutáneas en personas expuestas al suelo o agua estancada, deben considerarse señales de alerta ante la probabilidad de infección por AVL.

ABSTRACT Introduction: Diseases caused by free-living amoebas (FLA) are rare but with a lethality greater than 90% when they affect the central nervous system (CNS). The clinical picture can be confused with more prevalent diseases. Case report: A 32-year-old farmer from Poroto-Trujillo-La Libertad-Peru, started the disease with a central facial erythematous plaque that was diagnosed as cutaneous tuberculosis (CTB), without improvement despite receiving a complete regimen of anti-tuberculous chemotherapy. Seven months later, he presented severe encephalitis and died three days after his admission to the hospital. FLA trophozoites were found in the skin biopsy. A diagnosis of cutaneous dermatitis due to FLA complicated with granulomatous amebic encephalitis (GAE) is proposed. Similar cases have not been documented in his place of origin. Conclusion: In northern Peru, skin plaques in people exposed to the ground or stagnant water should be considered warning signs of the probability of AVL infection.

Clinical profile and outcome of patients with meningoencephalitis in a tertiary care hospital

Background: Encephalitis is an important cause of morbidity, mortality, and permanent neurologic sequelae globally. Causes are diverse and include viral and non-viral infections. In the emergency setting differentiating the bacterial from other causes such as viral, fungal, tubercular, toxic or autoimmune causes is extremely difficult. Although plenty of literature is available on meningitis, the clinic-etiological profile and outcome with meningoencephalitis remains not that well studied, except for in paediatric population. Methods: The present prospective observational study included 75 patients who presented with acute encephalitis syndrome in tertiary care hospital, Bengaluru. All patients were subjected to complete clinical evaluation and appropriate investigations to study the etiology, clinical profile and outcome in them. Results: Among 75 patients, majority of them were <60 years constituting about 73.2%, mean age being 49.14 years with female preponderance. 30 (40%) patients had viral meningoencephalitis where aetiology was confirmed in 15 patients, remaining were presumed to be of viral aetiology. 12 (16%) had tubercular meningitis and 8 (10.6%) had bacterial meningitis followed by cryptococcal meningitis 7 (9.3%). In about 18 (24%) patients, aetiology was not identified and were treated based on syndromic approach. The most common presentation was fever and altered sensorium. Thrombocytopenia was common among viral and bacterial aetiologies and those in unspecified etiological group. Mortality was highest among cryptococcal meningitis (71.4%) followed by tubercular (66.7%) and bacterial meningitis (62.5%). Conclusions: A large number of number of cases where aetiology cannot be identified maybe benefited by a syndromic approach and better diagnostic modalities.

Co-infection of Coronavirus Omicron variant and Salmonella Meningoencephalitis

@#It has been considered that viral infections predispose patients to bacterial infections due to immunosuppression.3 However, it is still unclear what exact roles co-infections play in patients with COVID-19 infection1. Centers for Disease Control and Prevention defines co -infection as an infection concurrent with the initial infection. This report discusses a case of meningoencephalitis presenting with seizures. Notable in this case was the detection of SARS-CoV-2 RNA and Salmonella in the CSF.

Autoimmune glial fibrillary acidic protein astrocytopathy / 中华神经科杂志

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a rare immune-mediated inflammatory disease of central nervous system reported in recent years, and its specific biological marker is anti-GFAP autoantibody. In this paper, the etiology, pathogenesis, clinical manifestations, auxiliary examination and treatment of the disease are comprehensively expounded, so as to improve the understanding of clinicians, especially neurologists.

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A

ABSTRACT We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.

Characteristic of cardiac and neurological forms of non-polio enterovirus infection

Enterovirus infections (EVI) are ubiquitous and generally present with mild symptoms and have a favorableprognosis with full recovery. But sometimes it can be challenging to diagnose mixed forms of EVI which can result in fatal outcomes. An interesting case report on a patient admitted to the Grodno Regional infectious diseases clinical hospital. The patientwas diagnosed with enteroviral infection. Histological slides of the brain, heart, lung and other systemic organs were prepared on autopsy and are presented in this scientific paper. Generalized EVI in mixed form can cause primary lesions of the brain (destructive edema), the heart (necrotizing cardiomyopathy), and sepsis while also affecting other organ systems. This can lead to unfavorable outcomes similar to that in our case report. Mixed form EVI (meningitis, myocarditis, and sepsis) can progress rapidly towards an adverse course, with the development of severe life-threatening complications. We strongly suggest that mandatory PCR screening for EVI should be carried out in young individuals with sepsis-like diseases and with a fever of unexplained origin at the time of presentation.

Infecção por Varicela-Zóster em paciente imunossupresso com complicações graves e inesperado desfecho clínico favorável / Varicella Zoster virus infection in immunosuppressed patient with serious complications and unexpected favorable clinical outcome / Infección por Varicela Zóster en paciente inmunosuprimido con complicaciones graves y evolución clínica favorable inesperada

O vírus varicela-zóster pode recorrer diante de imunodeficiência. A falta de imunidade celular pode ser tão grave a ponto de comprometer o sistema nervoso central. Neste caso, o paciente apresentou quadro de aids com meningoencefalopatia por vasculite. Pela alta suspeição diagnóstica, foi iniciado tratamento, empírica e precocemente, com aciclovir, corticoide e anticonvulsivante endovenosos. O diagnóstico se deu posteriormente. Com base neste caso, foi proposta uma estratégia eficaz de atendimento.

Varicella zoster virus infection may recur in the face of immunodeficiency, which can be so severe as to compromise the central nervous system. In the case studied, the patient presented a clinical picture of AIDS along with vasculitis meningoencephalopathy. Due to high diagnostic suspicion, intravenous Acyclovir, Corticosteroid and Intravenous Anticonvulsant were administered early. Diagnosis occurred later. On this case, an effective care strategy was proposed.

El virus de la varicela zóster puede reaparecer ante una inmunodeficiencia. La falta de inmunidad celular puede ser tan grave como para comprometer el sistema nervioso central. En este caso, el paciente desarrolló SIDA junto con meningoencefalopatía por vasculitis. Debido a la alta sospecha diagnóstica, se inició de forma empírica y precoz Aciclovir, corticoides y anticonvulsivantes intravenosos. Después, se realizó el diagnóstico. A partir de este caso se planteó una estrategia de atención eficaz.

Experiencia de dos años con el uso de panel de RPC múltiple de meningitis-encefalitis en pacientes pediátricos en un hospital de tercer nivel en Argentina / Two-year experience with the multiple PCR panel meningitis-encephalitis panel in children in a third level hospital in Argentina

INTRODUCCIÓN: La meningitis bacteriana aguda (MBA) y la encefalitis son infecciones graves y el retraso en el tratamiento determina mayor morbimortalidad. En 2015 la FDA. aprobó un panel de RPC múltiple, BioFire® Filmarray® meningitis-encefalitis (FA-ME), que desde el 2019 se encuentra disponible en nuestro hospital. OBJETIVOS: Estimar número de determinaciones positivas mediante FA-ME, evaluar concordancia con cultivo convencional (CC) y describir si FA-ME permitió realizar cambios en el tratamiento. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo, realizado durante 2019-2021 en el Hospital de Niños Pedro Elizalde. Se revisaron reportes de niños con meningitis, encefalitis y meningoencefalitis y líquido-cefalorraquídeo patológico a quienes se les realizó FA-ME. RESULTADOS: Se incluyó a 32 niños, edad promedio: 48 meses. Fueron positivas 13 determinaciones de FA-ME: siete bacterias y seis virus. En dos MBA obtuvo desarrollo mediante CC. Con FA-ME se ajustó el tratamiento en dos MBA y se acortó el tratamiento intravenoso (IV). DISCUSIÓN: Nuestro trabajo permitió conocer la etiología de cinco MBA con cultivo negativo, de las cuales dos habían recibido antimicrobianos, administrar quimioprofilaxis a contactos epidemiológicos, acortar el tratamiento IV y suministrar menos dosis de aciclovir; en concordancia con la literatura médica. CONCLUSIONES: FA-ME permitió identificar la etiología en cinco MBA que no desarrollaron en CC, ajustar tratamientos empíricos inadecuados y acortar duración del tratamiento parenteral.

BACKGROUND: Bacterial meningitis and encephalitis are life-threatening infections, a delay in its treatment is associated with high mortality. In 2015, FDA approved the Multiplex PCR FilmArray™ meningitis/encephalitis syndromic panel (FA-MEP), and it is available in our hospital since 2019. AIM: To estimate the number of positive FA-MEP, to evaluate the correlation to conventional culture (CC) results and to describe if the FA-MEP technology allowed changes in the treatment. METHODS: Retrospective analysis of children with meningitis, encephalitis and meningoencephalitis and pathological cerebrospinal fluid analysis between 2019-2021, who were subject to FA-MEP testing at the Pedro Elizalde Children's Hospital. RESULTS: 32 children, mean age: 48 months. 11 patients had positive FA-ME tests: 7 bacterial, 6 viral. 2 patients correlated with CC. Based on the FAMEP results, treatment was adjusted in 2 bacterial meningitis and the duration of intravenous treatment was shortened. DISCUSSION: Our study allowed to establish the etiology of 5 culture negative bacterial meningitis, (2 had prior antibiotics), administer chemoprophylaxis to close contacts, and to administer fewer doses of acyclovir. CONCLUSIONS: The FA-MEP allowed us to identify 5 bacterial meningitis that tested negative by CC and early adjustment of inappropriate empirical antibiotics and to shorten the duration of parenteral treatments.

Ultrasonografía del diámetro de la vaina del nervio óptico en paciente con meningoencefalitis complicada / Ultrasonography of the optic nerve sheath diameter in patient with complicated meningoencephalitis

RESUMEN La ultrasonografía del diámetro de la vaina del nervio óptico es un método no invasivo para monitorizar la presión intracraneal. Se ha utilizado en múltiples patologías neurocríticas, incluyendo la infección complicada del sistema nervioso central. Se presenta el caso de una paciente femenina de 47 años, quien ingresó en la Unidad de Cuidados Intensivos luego de presentar progresión al estado comatoso secundario a cuadro de meningoencefalitis bacteriana. Al ingreso se constata midriasis bilateral arreactiva, ausencia parcial de reflejos del tallo encefálico y bradicardia. Ante la sospecha clínica de hipertensión intracraneal, se indica ultrasonografía del diámetro de la vaina del nervio óptico en plano axial. Se realizaron tres mediciones para cada ojo, mostrando un valor de 6,3, 6,6 y 6,00 mm en ojo derecho, y 6,8, 6,6 y 6,8 mm en el izquierdo (promedio biocular: 6,5 mm). Con esta medición se complementó el diagnóstico sospechado. Esta técnica representa un proceder seguro y no invasivo. Su uso completa los datos recogidos en el examen clínico. El punto de corte universalmente aceptado para el diagnóstico es de 5,0 mm o más para un valor de presión intracraneal > 20 mmHg.

ABSTRACT The optic nerve sheath ultrasonography is a non-invasive method for monitoring intracranial pressure. It has been used in multiple neurocritical pathologies, including the complicated infection of the central nervous system. The case of a 47-year-old female patient is presented; she was admitted to the Intensive Care Unit after presenting progression to comatose state secondary to bacterial meningoencephalitis. On admission, bilateral arreactive mydriasis, partial absence of brainstem reflexes and bradycardia are confirmed. Given the clinical suspicion of intracranial hypertension, ultrasonography of the optic nerve sheath diameter in the axial plane is indicated. Three measurements were made for each eye, showing a value of 6.3, 6.6 and 6.00 in the right eye, and 6.8, 6.6 and 6.8 in the left one (biocular average: 6.5 mm). With this measurement the suspected diagnosis was completed. This technique represents a secure and non-invasive procedure. Its use completes the data collected in the clinical examination. The universally accepted cut-off point for diagnosis is 5.0 mm or more for an intracranial pressure value of > 20 mmHg.

Cerebrospinal fluid analysis: current diagnostic methods in central nervous system infectious diseases / Novos métodos diagnósticos liquóricos nas doenças infecciosas do sistema nervoso central

ABSTRACT Cerebrospinal fluid (CSF) analysis is an important diagnostic tool for many conditions affecting the central nervous system (CNS), especially CNS infectious diseases. Despite its low specificity, CSF white blood cell counts, CSF protein levels, CSF serum glucose ratio and CSF lactate measurement are useful in differentiating infections caused by distinct groups of pathogens. CSF direct examination and cultures can identify causative organisms and antibiotic sensitivities as well. Adjunctive tests such as latex agglutination, different immunological assays and molecular reactions have great specificities and increasing sensitivities. In this article, some recent diagnostic methods applied to CSF analysis for frequent CNS infections are presented.

RESUMO A análise do líquido cefalorraquiano (LCR) é uma importante ferramenta diagnóstica para muitas condições que afetam o sistema nervoso central (SNC), especialmente as doenças infecciosas. Apesar da baixa especificidade, a contagem de leucócitos no LCR, a determinação dos níveis de proteína, glicose e lactato podem ser úteis na diferenciação de infecções causadas por diferentes grupos de patógenos. O exame direto e as culturas podem identificar organismos causadores de infecções bem como suas sensibilidades a antibióticos. Testes adjuvantes como aglutinação em látex, diferentes ensaios imunológicos e reações moleculares têm taxas de sensibilidades e especificidades crescentes. Neste artigo, são apresentados alguns métodos diagnósticos mais recentemente aplicados à análise do LCR no diagnóstico das infecções do SNC.

Profile of Neurological Manifestations in Children Presenting With Rickettsial Disease

Objective: To study the profile of neurological manifestation of rickettsial disease in children. Methods: Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results: Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion: Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.

Transmission characteristics and prevention measures of Naegleria fowleri： a review / 上海预防医学

Objective To review the Naegleria fowleri and primary amoebic meningoencephalitis caused by the naegleria fowleri， so as to strengthen the public awareness of the disease and its prevention. Methods We reviewed the literatures and reports， and summarized the following information： epidemic status， life cycle and characteristics， environmental distribution and infection routes， pathogenesis and clinical manifestations， diagnosis and treatment， prevention and control measures. Results Primary amoeba meningoencephalitis is a water-borne disease caused by the Naegleria fowleri， which enters human body through the nose and arrives at the central nervous system through olfactory nerve， leading to hemorrhagic and necrotic meningitis. Although the disease is rare， it has a fatality rate of 95%. Most of the patients reported were healthy children or young adults who had nasal contact with water contaminated with Naegleria fowleri a week before symptoms appeared. At present， its pathology can be divided into contact mechanism and non-contact mechanism. In contact mechanism， the Naegleria fowleri relies on the phagocytosis of food cup on its surface and the release of cytolytic molecules that directly destroy host cells. In non-contact mechanism， the Naegleria fowleri has toxic effects by secreting proteins. The clinical symptoms are episodic， with an average time of five days from illness to death. At beginning， the symptoms may include headache， vomiting， fever and other influenza-like symptoms， followed by central nervous system symptoms， such as stiff neck， drowsiness， anorexia， fear and so on. Intravenous or intrathecal injection of amphotericin B is considered to be the basic treatment of this disease， which can be combined with other adjunct therapies such as ventricular shunt and cooling to reduce encephaledema. Conclusion Primary amoebic meningoencephalitis is a rare but highly fatal disease. We should strengthen the public awareness of the disease and its prevention， especially to avoid nasal contact with contaminated water. We should also strengthen scientific research， improve the level of diagnosis， and develop effective drugs to prevent the disease before it happens.

Diagnosis and treatment for acute phase of suppurative meningoencephalitis / 中华神经科杂志

Suppurative meningoencephalitis is the kind of intracranial infectious disease which exhibits comparatively more severe clinical manifestations, more expensive diagnostic and treatment costs and poorer prognosis. Early diagnosis and effective treatment are essential for better improvement of disease prognosis. Clear identification of intrinsic and extrinsic factors causing the acute phase of suppurative meningoencephalitis, as well as its epidemiological and pathogenic characteristics, clinical manifestations and classifications, imaging features and laboratory tests explanations, may contribute greatly to the diagnostic correctness and treatment efficacy, thus promoting diagnostics and medical treatment of this disease which remains ultimately critical to patients′ prognosis.