RESUMEN
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: As disseminated extrapulmonary tuberculosis infection can involve multiple systems and result in atypical clinical manifestations that mimic other diseases, the diagnosis may be difficult, especially in elderly patients. Delaying treatment can adversely affect the prognosis. And to achieve better prognosis, early detection and diagnosis are necessary, as well as early initiation of comprehensive treatment. CASE PRESENTATION: We present the case of a 78-year-old man with disseminated tuberculosis who developed the uncommon complication of urinary retention due to a psoas abscess, meningoencephalitis, and the rare secondary hemophagocytic lymphohistiocytosis syndrome. The patient achieved a favorable outcome following targeted therapy with antitubercular medications. CONCLUSIONS: This case highlights that disseminated extrapulmonary tuberculosis infection can present with a variety of manifestations, and may exhibit many rare and complex clinical presentations. Prompt and accurate diagnosis and treatment play a crucial role in improving prognosis for the patients with persistent fever.
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Antituberculosos , Linfohistiocitosis Hemofagocítica , Meningoencefalitis , Humanos , Masculino , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Linfohistiocitosis Hemofagocítica/diagnóstico , Anciano , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/microbiología , Meningoencefalitis/complicaciones , Antituberculosos/uso terapéutico , Absceso del Psoas/microbiología , Absceso del Psoas/tratamiento farmacológico , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Absceso/microbiología , Absceso/tratamiento farmacológicoRESUMEN
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
Sarcocystis spp. cause pigeon protozoan encephalitis, a neuronal disease. A female pigeon exhibiting torticollis had a necrotic area in the cerebral hemisphere surrounded by lesions with perivascular cuffing, gliosis, granulomatous foci, and meningitis. Non-necrotic lesions were also observed in the brainstem. Intact and degenerative schizonts were observed within the neuropils and neurons in the lesions. Deoxyribonucleic acid (DNA) was extracted from paraffin-embedded brain tissues and genetically analyzed after gel electrophoresis to determine Sarcocystis spp. using specific primer sets for 28S ribosomal ribonucleic acid and internal transcribed spacer region-1. DNA sequencing confirmed a significant homology with S. calchasi. This is the first report of meningoencephalitis with malacia caused by S. calchasi in a rock pigeon in Japan.
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Enfermedades de las Aves , Columbidae , Meningoencefalitis , Sarcocystis , Sarcocistosis , Animales , Sarcocystis/aislamiento & purificación , Sarcocystis/genética , Columbidae/parasitología , Sarcocistosis/veterinaria , Sarcocistosis/parasitología , Sarcocistosis/patología , Femenino , Japón , Enfermedades de las Aves/parasitología , Enfermedades de las Aves/patología , Meningoencefalitis/veterinaria , Meningoencefalitis/parasitología , Meningoencefalitis/patología , Encéfalo/patología , Encéfalo/parasitologíaRESUMEN
Chikungunya disease typically presents with the fever-arthralgia-rash symptom triad. However, an increase in the number of atypical clinical manifestations, particularly neurological disorders, has occurred. The current evidence regarding the pooled prevalence of Chikungunya virus (CHIKV)-associated neurological cases (CANCs) suspected of having an arboviral aetiology is not well-understood. Therefore, this meta-analysis included 19 studies (n = 7319 patients) and aimed to determine the pooled rate of exposure to CANC. The pooled positivity rate of CANC was 12 % (95 % CI: 6-19), and Brazil was overrepresented (11/19). These estimations varied between 3 and 14 % based on the diagnostic method (real-time PCR vs. ELISA-IgM) and biological samples (cerebrospinal fluid or blood specimens) used for detection of CHIKV. Regarding the frequency of CHIKV in neurological clinical subgroups, the rates were higher among patients with myelitis (27 %), acute disseminated encephalomyelitis (27 %), Guillain-Barré syndrome (15 %), encephalitis (12 %), and meningoencephalitis (7 %). Our analysis highlights the significant burden of CANC. However, the data must be interpreted with caution due to the heterogeneity of the results, which may be related to the location of the studies covering endemic periods and/or outbreaks of CHIKV. Current surveillance resources should also focus on better characterizing the epidemiology of CHIKV infection in neurological disorders. Additionally, future studies should investigate the interactions between CHIKV and neurological diseases with the aim of gaining deeper insight into the mechanisms underlying the cause-and-effect relationship between these two phenomena.
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Fiebre Chikungunya , Virus Chikungunya , Síndrome de Guillain-Barré , Enfermedades del Sistema Nervioso , Humanos , Brasil/epidemiología , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/diagnóstico , Virus Chikungunya/aislamiento & purificación , Encefalomielitis Aguda Diseminada/epidemiología , Encefalomielitis Aguda Diseminada/virología , Síndrome de Guillain-Barré/epidemiología , Síndrome de Guillain-Barré/virología , Meningoencefalitis/epidemiología , Meningoencefalitis/virología , Mielitis/epidemiología , Mielitis/virología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/virología , PrevalenciaRESUMEN
BACKGROUND: Co-therapy with albendazole and steroid is commonly used in patients with eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis infections. However, anthelminthics often worsen symptoms, possibly due to the inflammatory reaction to antigens released by dying worms. Therefore, the present study was to investigate the curative effects and probable mechanisms of the platelet-derived growth factor receptor-beta (PDGFR-ß) inhibitor AG1296 (AG) and the phosphoinositide 3-kinase inhibitor (PI3K) LY294002 (LY) in A. cantonensis-induced neurovascular unit dysfunction and eosinophilic meningoencephalitis. METHODS: Western blots were used to detect matrix protein degradation and the expressions of PDGFR-ß/PI3K signaling pathway. The co-localization of PDGFR-ß and vascular smooth muscle cells (VSMCs), and metalloproteinase-9 (MMP-9) and VSMCs on the blood vessels were measured by confocal laser scanning immunofluorescence microscopy. Sandwich enzyme-linked immunosorbent assays were used to test S100B, interleukin (IL)-6, and transforming growth factor beta in the cerebrospinal fluid to determine their possible roles in mouse resistance to A. cantonensis. RESULTS: The results showed that AG and LY cotherapy decreased the MMP-9 activity and inflammatory reaction. Furthermore, S100B, IL-6 and eosinophil counts were reduced by inhibitor treatment. The localization of PDGFR-ß and MMP-9 was observed in VSMCs. Furthermore, we showed that the degradation of the neurovascular matrix and blood-brain barrier permeability were reduced in the mouse brain. CONCLUSIONS: These findings demonstrate the potential of PDGFR-ß inhibitor AG and PI3K inhibitor LY co-therapy as anti-A. cantonensis drug candidates through improved neurovascular unit dysfunction and reduced inflammatory response.
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Angiostrongylus cantonensis , Cromonas , Meningoencefalitis , Morfolinas , Infecciones por Strongylida , Animales , Angiostrongylus cantonensis/efectos de los fármacos , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/parasitología , Infecciones por Strongylida/tratamiento farmacológico , Ratones , Cromonas/farmacología , Cromonas/uso terapéutico , Morfolinas/farmacología , Morfolinas/uso terapéutico , Transducción de Señal/efectos de los fármacos , Masculino , Receptor beta de Factor de Crecimiento Derivado de Plaquetas/metabolismo , Barrera Hematoencefálica/efectos de los fármacos , Modelos Animales de Enfermedad , Fosfatidilinositol 3-Quinasas/metabolismo , Antihelmínticos/uso terapéutico , Antihelmínticos/farmacología , Metaloproteinasa 9 de la Matriz/metabolismo , Eosinofilia/tratamiento farmacológico , Quimioterapia Combinada , SulfonamidasAsunto(s)
Amebiasis , Humanos , Amebiasis/tratamiento farmacológico , Amebiasis/enfermería , Amebiasis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Masculino , Infecciones Protozoarias del Sistema Nervioso Central/enfermería , Infecciones Protozoarias del Sistema Nervioso Central/diagnóstico , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
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
BACKGROUND: The information relating to the outcome specifically for juvenile dogs with meningoencephalitis of unknown etiology (MUE) is lacking. OBJECTIVES: To describe the clinical presentation, diagnostic findings, treatment, and outcome in a cohort of dogs with MUE <52 weeks old. ANIMALS: Thirty-four client-owned dogs. METHODS: Multicenter retrospective case series. Records from 5 referral centers were searched. Data was extracted from the medical records and referring veterinarians were contacted for survival data if this was not available from the record. RESULTS: The mean age was 31 weeks; the youngest dog was 11 weeks and 3 dogs were <16 weeks old. Altered mentation (71%), ataxia (44%), seizures (29%), and circling (26%) were the most common presenting complaints. Neuroanatomical localization was to the forebrain (38%), multifocal (35%), brainstem (18%), and cerebellum (12%). Corticosteroid monotherapy (n = 15) and corticosteroid plus cytosine arabinoside (n = 15) were used in equal proportions. Outcome data was available for 26 dogs, 8 (31%) were alive at the time of data collection with a follow-up range of 135 to 2944 days. Death or euthanasia was related to MUE in 17/18 dogs that died during the study period. Kaplan-Meier survival analysis demonstrated a median survival time for all-cause death of 84 days. CONCLUSION: The prognosis for MUE in this subset of dogs was considered poor.
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Enfermedades de los Perros , Meningoencefalitis , Animales , Perros , Enfermedades de los Perros/tratamiento farmacológico , Meningoencefalitis/veterinaria , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/mortalidad , Estudios Retrospectivos , Femenino , Masculino , Resultado del Tratamiento , Corticoesteroides/uso terapéutico , Citarabina/uso terapéutico , Citarabina/administración & dosificaciónRESUMEN
BACKGROUND: Treatment options available for meningoencephalitis of unknown origin (MUO) in dogs are suboptimal, and currently, no single treatment protocol appears to be superior. OBJECTIVES: Compare neurological deterioration rates at 7 days between dogs with MUO treated with corticosteroids alone or combined with cytosine arabinoside (CA) continuous rate infusion (CRI) and compare clinical deterioration and survival at 30 and 100 days. ANIMALS: Sixty-nine dogs with magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) features or both compatible with MUO. METHODS: Parallel, blinded, randomized controlled trial. Simple randomization into 2 treatment groups: 4 mg/kg/day prednisolone (or dexamethasone equivalent) for 2 days or 200 mg/m2 CA CRI over 8 hours plus 2 mg/kg/day prednisolone. Blinding of the treatment protocol was carried out using reversible redaction of clinical records, and treatment failure was defined as deterioration of neurological assessment or death. Using intention-to-treat analysis, proportions failing treatment at 7, 30, and 100 days were compared using Fisher's exact test. All-cause mortality at 100 days was compared using Kaplan-Meier survival curves. RESULTS: Thirty-five dogs were allocated to corticosteroid only, and 34 dogs were allocated to combined CA CRI and corticosteroid. Proportions failing treatment at 7, 30, and 100 days were 7/35 (20%), 9/35 (26%), and 15/35 (43%) in the corticosteroid-only group and 8/34 (24%), 11/34 (32%), and 23/34 (68%) in the corticosteroid and CA CRI group. All-cause mortality at 100 days was not significantly different between groups (P = .62). Clinically relevant treatment-related adverse effects were not observed. CONCLUSIONS AND CLINICAL IMPORTANCE: We found no difference in outcome between corticosteroid monotherapy and combined cytarabine CRI and corticosteroid therapy at 7, 30, and 100 days after diagnosis in dogs with MUO.
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Citarabina , Dexametasona , Enfermedades de los Perros , Quimioterapia Combinada , Meningoencefalitis , Prednisolona , Animales , Perros , Citarabina/uso terapéutico , Citarabina/administración & dosificación , Enfermedades de los Perros/tratamiento farmacológico , Meningoencefalitis/veterinaria , Meningoencefalitis/tratamiento farmacológico , Masculino , Femenino , Quimioterapia Combinada/veterinaria , Prednisolona/uso terapéutico , Prednisolona/administración & dosificación , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Corticoesteroides/uso terapéutico , Corticoesteroides/administración & dosificación , Infusiones Intravenosas/veterinariaRESUMEN
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: Pugs commonly present with thoracolumbar myelopathy, also known as pug dog myelopathy (PDM), which is clinically characterised by progressive signs involving the pelvic limbs, no apparent signs of pain and, often, incontinence. In addition to meningeal fibrosis and focal spinal cord destruction, histopathology has confirmed lymphohistiocytic infiltrates in the central nervous system (CNS) in a considerable number of pugs with PDM. Lymphohistiocytic CNS inflammation also characterises necrotising meningoencephalitis (NME) in pugs. This study aimed to investigate the potential contribution of an immunological aetiology to the development of PDM. METHODS: The concentrations of glial fibrillary acidic protein (GFAP) in serum and CSF and of anti-GFAP autoantibodies in CSF were measured with an ELISA. In addition, a commercial test was used for genetic characterisation of the dog leukocyte antigen class II haplotype, which is associated with NME susceptibility. RESULTS: This study included 87 dogs: 52 PDM pugs, 14 control pugs, four NME pugs and 17 dogs of breeds other than pugs that were investigated for neurological disease (neuro controls). Anti-GFAP autoantibodies were present in 15 of 19 (79%) of the PDM pugs tested versus six of 16 (38%) of the neuro controls tested (p = 0.018). All 18 PDM pugs evaluated had detectable CSF GFAP. Serum GFAP was detected in two of three (67%) of the NME pugs and in two of 11 (18%) of the control pugs but not in any of the 40 tested PDM pugs. Male pugs heterozygous for the NME risk haplotype had an earlier onset of clinical signs (70 months) compared to male pugs without the risk haplotype (78 months) (p = 0.036). LIMITATIONS: The study was limited by the lack of healthy dogs of breeds other than pugs and the small numbers of control pugs and pugs with NME. CONCLUSIONS: The high proportion of PDM pugs with anti-GFAP autoantibodies and high CSF GFAP concentrations provide support for a potential immunological contribution to the development of PDM.
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Autoanticuerpos , Enfermedades de los Perros , Proteína Ácida Fibrilar de la Glía , Meningoencefalitis , Enfermedades de la Médula Espinal , Animales , Perros , Enfermedades de los Perros/genética , Enfermedades de los Perros/inmunología , Meningoencefalitis/veterinaria , Meningoencefalitis/genética , Meningoencefalitis/inmunología , Autoanticuerpos/sangre , Proteína Ácida Fibrilar de la Glía/genética , Proteína Ácida Fibrilar de la Glía/inmunología , Masculino , Enfermedades de la Médula Espinal/veterinaria , Enfermedades de la Médula Espinal/genética , Femenino , Genotipo , Predisposición Genética a la EnfermedadRESUMEN
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.
Asunto(s)
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
BACKGROUND: The prognosis of individual dogs with meningoencephalomyelitis of unknown etiology (MUE) remains difficult to predict. MUE cases with no lesions detected by magnetic resonance imaging (MRI) occur, but it is unknown whether this finding is associated with prognosis. HYPOTHESIS: MUE cases without detectable lesions on MRI have a better outcome than cases with detectable lesions. ANIMALS: Study included 73 client-owned dogs with MUE presenting to Purdue University Veterinary Hospital from 2010 to 2020. METHODS: Retrospective study. Dogs with a clinical diagnosis of MUE were identified by medical record search. MRI reports were reviewed for presence or absence of lesions consistent with MUE. Clinical findings at presentation, treatment, disease-specific survival, and outcomes including rates of remission and relapse were compared between cases with normal MRI or abnormal MRI. RESULTS: Overall, 54 dogs (74%) were classified as abnormal MRI, and 19 dogs (26%) were classified as normal MRI cases. Death caused by MUE occurred in 1/19 (5%) normal MRI dogs and 18/54 (33%) abnormal MRI dogs (P = .016). Median survival was >107 months in both groups, but survival was significantly longer in the normal MRI group (P = .019). On multivariate analysis, abnormal MRI was significantly related to death (hazard ratio, 7.71; 95% confidence interval 1.03-58.00, P = .0470), whereas significant relationships with death were not identified for either the use of secondary immunosuppressive medications or cerebrospinal fluid nucleated cell count. CONCLUSIONS: MUE dogs with no detectable lesions on MRI have reduced disease-related death compared with dogs with abnormal MRI. The presence or absence of MRI lesions in MUE dogs is prognostically relevant.
Asunto(s)
Enfermedades de los Perros , Imagen por Resonancia Magnética , Meningoencefalitis , Animales , Perros , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/patología , Imagen por Resonancia Magnética/veterinaria , Estudios Retrospectivos , Femenino , Masculino , Meningoencefalitis/veterinaria , Meningoencefalitis/diagnóstico por imagen , Meningoencefalitis/mortalidad , Pronóstico , Análisis de SupervivenciaRESUMEN
Neonatal meningoencephalitis caused by human parechovirus infection is being increasingly recognized in recent literature. While most cases are postnatally acquired, intrauterine infection is rare, presents early and has a more severe impact on brain health and development. We discuss here an infant born preterm at 34 weeks gestational age, with neonatal course remarkable for severe encephalopathy presenting on day 2 of life due to human parechovirus meningoencephalitis transmitted in utero. Early magnetic resonance brain imaging detected extensive white matter injury and subsequently evolved into multicystic leukoencephalopathy. Posthospital discharge, infant was noted to have early neurodevelopmental impairment at 4 months corrected age.
Asunto(s)
Meningoencefalitis , Parechovirus , Infecciones por Picornaviridae , Humanos , Recién Nacido , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Recien Nacido Prematuro , Imagen por Resonancia Magnética/métodos , Meningoencefalitis/diagnóstico por imagen , Meningoencefalitis/patología , Neuroimagen , Infecciones por Picornaviridae/diagnóstico , Infecciones por Picornaviridae/patologíaRESUMEN
BACKGROUND: Meningoencephalitis of unknown origin (MUO) comprises a group of noninfectious inflammatory diseases affecting the central nervous system of dogs. Previous studies have reported individual risk factors for survival but prognostication for MUO remains challenging. OBJECTIVES: Identify clinical prognostic variables in dogs with MUO. ANIMALS: A retrospective study of 447 dogs presented to 2 UK referral hospitals and diagnosed with MUO. METHODS: Medical records of dogs diagnosed with MUO were retrospectively reviewed. Multivariable logistic regression was used for the identification of risk factors for survival and Cox proportional hazards analysis for the identification of risk factors for clinical relapse. RESULTS: Eighty-two percent (366/447) of dogs with presumptive MUO survived to discharge and 63.5% (284/447) were alive at 6 months; 36% of the latter (103/284) had persistent neurological deficits. Breed (pugs; P = .03), epileptic seizures (P < .001), paresis (P < .001), and higher neurodisability scale (NDS) score (P < .001) at presentation were negatively associated with survival to 6 months. Dogs with persistent deficits had higher NDS scores on presentation (P = .001). Median follow-up time was 11 months (interquartile range [IQR], 1-24) and 50.6% (160/316) relapsed during treatment (median time to relapse, 7 months; IQR, 2-15). Incomplete resolution of the clinical signs during the 6 months after diagnosis (P < .001), higher NDS score (P < .001), and longer duration of the clinical signs (P < .001) were associated with relapse. CONCLUSIONS AND CLINICAL IMPORTANCE: Knowledge of risk factors associated with survival, incomplete recovery and clinical relapse in MUO can help guide monitoring and treatment and improve owner communications regarding prognosis for this debilitating disease.