Zika virus found in brain tissue of a multiple sclerosis patient undergoing an acute disseminated encephalomyelitis-like episode.

BACKGROUND: A range of different neurological manifestations has been reported in fetuses and adults after Zika virus (ZIKV) infection. OBJECTIVE: We describe a detection of the ZIKV in the brain tissue from a multiple sclerosis (MS) patient with acute disseminated encephalomyelitis (ADEM)-like event in Rio de Janeiro, Brazil. METHODS: Biological samples collected during the hospitalization were tested by serology and molecular diagnostic for various infectious agents. Histopathological analysis was performed using the anti-flavivirus group 4G2 monoclonal antibody, anti-ZIKV non-structural 1 (NS1) monoclonal antibody, and anti-CD4, CD8, and CD11b antibodies. RESULTS: Anti-ZIKV IgM and IgG antibodies were positive in the serum and urine. A brain biopsy showed ZIKV protein in brain cells and T CD8 infiltration in brain tissue. CONCLUSION: Our data describe the coexistence of a recent central nervous system (CNS) ZIKV infection accompanied by a severe ADEM-like syndrome outcome in a patient with clinical history of MS. A de novo immune response concomitant with ZIKV infection might be involved in the mechanism of the ADEM-like syndrome and response to immunotherapy. The present report reinforces the importance of providing the differential diagnosis of acute episodes of MS exacerbation in an environment prone to ZIKV expression.

[Acute disseminated encephalomyelitis due to Mycoplasma pneumoniae in a previously healthy boy]. / Encefalomielitis aguda diseminada por Mycoplasma pneumoniae en un niño previamente sano.

We present here the case of a previously healthy 5 year-old boy hospitalized in an intensive care unit due to tonic-clonic seizures focused on the face and right side of the body, and axillary temperature of 37.4°C. Common bacterial and viral etiology was ruled out through studies of cerebrospinal fluid (CSF) samples. Mycoplasma pneumoniae was suspected by a positive immunofluorescence serum test for IgM class antibodies. Finally, with a brain biopsy, M. pneumoniae was confirmed by polymerase chain reaction (PCR) and acute disseminated encephalomyelitis by pathological anatomy. The patient was treated with clarithromycin and had an uneventful evolution. At least to our knowledge, this is the first case in which M. pneumoniae DNA was detected by PCR in a brain biopsy.

Encephalomyelitis associated with microsporidian infection in farmed greater amberjack, Seriola dumerili (Risso).

An outbreak of a disease characterized by a peculiar spiral movement in farmed greater amberjack, Seriola dumerili (Risso), occurred in Kagoshima Prefecture, Japan, in May 2008, immediately after importing the fish from China. Although neither bacteria nor viruses were detected in routine diagnostic tests, histopathological observations of the affected fish revealed severe inflammation in the tegmentum of the brain including the medulla oblongata and the anterior part of the spinal cord. In addition, a microsporidian parasite was observed in the nerve cell bodies or axons in the inflamed tissues. We identified a microsporidian small subunit rRNA gene (SSU rDNA) from the lesion, and the sequence showed 96.1% identity with that of Spraguea lophii. Subsequent in situ hybridization using probes presumably specific to the SSU rRNA confirmed that the parasite observed in histopathology harboured the identified SSU rRNA. Apparently degenerated microsporidian cells or spores were also frequently observed in tissue sections. Thus, the disease was most probably caused by the infection of a hitherto unknown microsporidian parasite that has a genetic affinity to the genus Spraguea, in the central nervous system of the amberjack.

Acute disseminated encephalomyelitis due to Rickettsia conorii infection.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated acute inflammatory demyelinating disorder, which typically occurs after viral infections or immunisation. We present a case of a man with acute Rickettsia conorii infection whose diagnosis was delayed. He presented with fever, headache, an eschar and an acute paraplegia. The R. conorii IgM serum titre was 1:128. Magnetic resonance imaging showed multifocal lesions in the brain and spinal cord consistent with inflammatory demyelination. The patient responded well to doxycycline and a short course of high-dose corticosteroids. To our knowledge this is the first case of ADEM associated with Mediterranean spotted fever - we found a previous report of ADEM in a child with Rocky Mountain spotted fever, whose diagnosis of rickettsial infection was also delayed. We hypothesise that delayed diagnosis of spotted fever group rickettsial infections could rarely result in ADEM.

[Acute disseminated encephalomyelitis associated with Mycoplasma pneumoniae infection in children: 2 case reports]. / Encéphalomyélite aigüe disséminée associée a l'infection par mycoplasme pneumoniae a propos de 2 observations pédiatriques.

BACKGROUND: Extrapulmonary complications of Mycoplasma pneumoniae infection are rare and dominated by nervous system disorders. Two patients suffering from acute disseminated encephalomyelitis associated with M. Pneumoniae infection are reported. AIM: Report of two new cases CASES REPORT: The 2 cases, M. Pneumoniae infection was documented by the positivity of serology, polymerase chain reaction and culture in the respiratory tract. Patient 1 recovered after prolonged mechanical ventilation in the paediatric intensive care unit. He was fully conscious 1 month after admission and able to walk with help 2.5 months after the onset of the disease. The 2nd patient died after 9 days of hospitalisation in the intensive care unit. The death was caused by neurovegetative disorders.

Acute disseminated encephalomyelitis following Campylobacter jejuni gastroenteritis: Case report and review of the literature.

We describe a case of a 25-year-old male with a diagnosis of acute disseminated encephalomyelitis (ADEM) following infection with Campylobacter jejuni, which is implicated in various human pathologies regarding the central nervous system (CNS) with acute course like Guillain-Barré syndrome (GBS), Miller-Fisher syndrome (MFS), Bickerstaff's brainstem encephalitis (BEE), acute transverse myelitis (ATM) as well as ADEM. These conditions are caused by cross-reactivity between Campylobacter's epitopes and cells of the CNS that causes an immunomediated inflammatory demyelination of the CNS. In the acute phase, magnetic resonance (MR) can detect pathologic signal intensity at the CNS with areas of pathologic contrast enhancement at cortical and spinal white matter that normalize over time or can be stable. These findings can be associated with edema in parts of the CNS. The lesions typically appear at different times during the disease course and also can have a different evolution. Our purpose therefore was to describe the clinical course and MR findings of this case and perform a critical review of the literature.

Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis.

A 4-year-old male presented with acute disseminated encephalomyelitis with seizures and transient amaurosis after initial symptoms of a flulike febrile infection 1 week earlier. Immunoglobulin M type antibody titers against Mycoplasma pneumoniae were significantly increased in serum and cerebrospinal fluid. The patient improved appreciably on immunosuppressive therapy with immunoglobulin. This patient exemplifies a rare case of acute disseminated encephalomyelitis presenting with bilateral transient amaurosis as a complication of M. pneumoniae infection. Aydin A, Atasever S, Cakmakci H. Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis.

Encephalomyelitis-associated antimyelin autoreactivity induced by streptococcal exotoxins.

OBJECTIVE: After implicating Streptococcus pyogenes as causing acute disseminated encephalomyelitis (ADEM) in a child, we wanted to prove that in vivo activation of autoreactive T lymphocytes by superantigens of this Streptococcus contributed to the dramatic demyelination. BACKGROUND: ADEM is a demyelinating disorder of the CNS sharing many similarities with MS. Demyelination in MS is considered to be the result of an autoimmune process mediated by autoreactive T lymphocytes with specificity for myelin antigens. METHODS: Phenotypic analysis and proliferation assays on blood monocytes, as well as isolation of myelin basic protein (MBP)-reactive T-cell lines/clones; and TCR repertorium analysis by PCR-ELISA and cytokine production. RESULTS: 1) The blood T-cell receptor (TCR) repertoire was compatible with in vivo expansion induced by S. pyogenes exotoxins. 2) TCR expression analysis indicated clonal expansion of CD8+ MBP-reactive T cells, suggesting in vivo activation. MBP-reactive T cells showed crossreactivity to S. pyogenes supernatant and exotoxins. 3) Cytokine mRNA quantification of the mononuclear cells revealed a Th2-biased profile. CONCLUSION: In vivo exposure to S. pyogenes may have induced activation of pathogenic myelin reactive T cells, contributing to the dramatic inflammatory demyelination.

Multiphasic disseminated encephalomyelitis associated with streptococcal infection.

Multiphasic disseminated encephalomyelitis (MDEM) is a rare peculiar diagnosis which is defined as acute demyelinating central nervous system disease with relapses occurring only within 4 weeks of initial manifestation. This report describes the case of a 6-year-old boy with MDEM diagnosed by clinical findings and magnetic resonance imaging. The disease had a biphasic evolution, and with a second course of high-dose corticosteroids a complete recovery without further relapse was obtained during the following 18 months. Serological evidence of streptococcal infection as specific trigger for MDEM was given. Thus this report raises the question whether an additional penicillin prophylaxis could be valuable for prevention of streptococcus-associated MDEM relapses.

Acute disseminated encephalomyelitis associated with Pasteurella multocida meningitis.

OBJECTIVE: To describe a case of Pasteurella multocida meningitis associated with acute disseminated encephalomyelitis (ADEM). CASE REPORT: A 33-year-old woman employed in a dog pound presented herself to hospital with fever and meningismus and was found to have culture positive Pasteurella multocida meningitis. Despite appropriate antibiotic treatment her clinical course was characterized by a persistent fever and worsening encephalopathy, which prompted further neurological investigation. Spinal fluid exam and serial MRI scans as well as her one-year clinical course were found to be compatible with ADEM. CONCLUSION: Persistent fever and worsening encephalopathy in meningitis may indicate a para-infectious immune process such as ADEM, and may serve as indications for further neurological investigation.

Acute disseminated encephalomyelitis and poststreptococcal acute glomerulonephritis.

We experienced the case of a boy suffering from acute disseminated encephalomyelitis and concomitant acute glomerulonephritis. The multiple lesions observed on MR images, which located mainly in the cortical gray matter, quickly responded to methyl prednisolone pulse therapy. Renal biopsy confirmed the diagnosis of poststreptococcal acute glomerulonephritis. Streptococcus pyogenes was identified by pharyngeal culture, and the infection was serologically confirmed. We speculated that S. pyogenes infection was coincidentally involved in both diseases.

Acute disseminated encephalomyelitis after Rocky Mountain spotted fever.

Although acute disseminated encephalomyelitis has been observed after a variety of viral infections and an occasional bacterial infection, it has not been reported in association with rickettsial infections. Reported is a 7-year-old male with magnetic resonance images and clinical manifestations suggestive of acute disseminated encephalomyelitis after a tick bite and serologically proven Rocky Mountain spotted fever.

Vaccinia virus in postvaccinal encephalitis.

Results of virological examination of 239 samples taken from 84 children with neurological complications after smallpox vaccination are described. In postvaccinal encephalitis, vaccinia virus was isolated from blood, cerebrospinal fluid and pharyngeal secretions of 23 out of 40 children (57.5%) as well as from autopsy specimens sampled between 10-35 days after vaccination. During the acute period of disease, virus was detected in 17 out of 31 (54.2%) cerebrospinal fluid specimens. In 3 postvaccinal encephalitis cases the virus was present in brain and in a case of encephalomyelitis--in the spinal cord. These results confirmed the participation of vaccinia virus in the pathogenesis of postvaccinal encephalitis. The pathogenicity of vaccinia virus may be manifested only under a changed reactivity of the vaccinated host.

Wild measles virus strain: isolation and identification.

Four isolates of measles virus (Gag, Il, Buk and Shed) were obtained from suspensions of mononuclear cells from patients at the active stage of the disease. Vero cells were used for the virus isolation. All the isolates caused in the infected cell culture the appearance of symplasts of differently sized, star- or spindle-shaped multinuclear cells. The specificity of cytopathic effect was proved by the adsorption of monkey erythrocytes on the surface of cells infected by virus. The isolates were identified in virus neutralization (VN) and haemagglutination inhibition (HI) tests with different immune preparations: measles-globulin (standard), hyperimmune sera to rubella and mumps viruses, Sch. Zonne and Sch. Flexneria, as well as with conjugates of sera from measles patients and those vaccinated with live measles vaccine (LMV) L-16.

[A case of acute disseminated Mucor encephalitis in a heifer]. / Ein Fall von akuter disseminierter Mucor-Enzephalitis bei einem Rind.

The case of a 2 1/2 year old Swiss Braunvieh heifer suffering from an acute disseminated mycotic encephalitis caused by a Mucorales spp. infection is presented. Clinical signs and analysis of cerebrospinal fluid (increased protein concentration and pleocytosis) were typical for an acute encephalitis, probably due to a listeriosis. The histological examination of the brain revealed an acute disseminated thrombo-embolic encephalomyelitis due to a fungi infection, morphologically consistent with Mucorales spp. The occurrence of bovine cerebral mucormycosis is rare and therefore the veterinarian should become aware of a case which was clinically not distinguishable from a listeriosis.

[Disseminated acute encephalomyelitis with fatal evolution: clinicopathological study]. / Encefalomielitis aguda diseminada de evolución fatal: estudio clinicopatológico.

INTRODUCTION: Disseminated acute encephalomyelitis is a monophasic demyelinating disease which progresses rapidly and is often fatal. It is an autoimmune condition, mediated by T lymphocytes, in which the immune response is directed against the myelin antigens. CLINICAL CASE: We describe the clinical, radiological and neuropathological findings in the case of a 31 year old woman who, ten days after complaining of a clinical condition of upper respiratory tract inflammation, presented with unilateral focal neurological signs, subsequent rapid deterioration of consciousness and death. On autopsy the neuropathological characteristics of disseminated acute encephalomyelitis were seen. CONCLUSIONS: The relative rarity of this condition at the present time makes clinical diagnosis difficult. The differential diagnosis with other conditions may be difficult also. Thus, this disease often leads to a neuropathological diagnosis.

[Infection due to Mycoplasma pneumoniae: three cases with neurological complications]. / Infección por Myoplasma Pneumoniae: tres casos con complicaciones neurológicas.

INTRODUCTION: Mycoplasma pneumoniae infection has been associated with severe central nervous system diseases. The pathogenesis of these disorders is unknown and the treatment uncertain. CASE REPORTS: The authors present three cases of central nervous system diseases: acute transverse myelitis, cerebellitis and encephalomyelitis associated with M. pneumoniae infection. CONCLUSIONS: M. pneumoniae infection should be considered in all cases of severe acute central nervous system symptomatology.

[Changes in the properties of the vaccinia virus isolated in postvaccinal encephalitis]. / Izmenenie svoistv virusa vaktsin, vydelennogo pri postvaktsinal'nom éntsefalite.

Properties of 6 isolates of vaccinia virus isolated from the brain and cerebrospinal fluid in postvaccination encephalitis were studied in comparison with 2 production strains of vaccinia virus with which the children had been vaccinated. Significant differences were found between the strains isolated in postvaccination encephalitis and reference virus strains. The plaques produced by the isolates from brain and CSF were larger (and in some isolates had a hemorrhagic pattern). The isolates were highly pathogenic for chick embryos, reproduced more actively in cells of the chorioallantoic membrane of chick embryos at higher temperature of incubation (40 degrees C), more intensively accumulated in the liver and brain of chick embryos at 37 degrees C and 40 degrees C, produced more intensive lesions and necroses in rabbit skin. The isolates were markedly thermostable at 56 degrees C and insensitive to interferon. It is suggested that the increased pathogenicity of the virus is manifested in the presence of altered immune responsiveness of the host.

[Results of a study of the pathogenesis of postvaccinal encephalitis]. / Nekotorye itogi izucheniia patogeneza postvaktsinal'nykh éntsefalitov.

The results of 10-year virological and immunological studies in patients with postvaccination encephalitis (PVE) developing after smallpox vaccination are analysed. Vaccinia virus was isolated from 23 (59%) out of 39 children in the acute stage of PVE and for a long period in the protracted course of the disease in 14 out of 24 from the cerebrospinal fluid in 15 out of 33 from the blood, in 8 out of 24 from the throat and in 4 out of 5 from the brain or spinal cord tissue. Examinations of 56 serum specimens from 36 children with PVE revealed considerable variations in the levels of virus-neutralizing antibodies (VNA): 6 had no VNA, while 10 children showed low titres (10-20). No cases of agammaglobulinemia were observed. Instances of defective immune response were found which was manifested by a delay in increasing levels of IgM and IgG in response to vaccination. Two children were shown to have a defective cellular immunity. It is concluded that vaccinia virus participates in the pathogenesis of PVE; realization of the pathogenic properties of the virus requires the proper conditions, the main of which appears to consist in the immunodeficient state. The analysis of the appurtenance of 342 children to blood groups of the ABO system did not confirm the dependence of the development of postvaccination complications upon the presence in the blood of the vaccinees of the A antigen or immunological advantages of persons having alpha-isoantibodies.