ABSTRACT
Las enfermedades causadas por amebas de vida libre son infecciones oportunistas que pueden tener un curso fatal. Pueden producir afecciones diseminadas graves con compromiso del sistema nervioso central, como la encefalitis amebiana granulomatosa. Esta infección es cada vez más frecuente en América Latina, aunque se reconocen tardíamente debido a la similitud con otras patologías o porque es inusual incluirla en el diagnóstico diferencial. Comunicamos un caso fatal de una encefalitis amebiana granulomatosa por Balamuthia mandrillaris en una niña de 10 años. Destacamos la gravedad de la afectación cerebral y la falta de esquemas antimicrobianos validados para su tratamiento. Hoy en el mundo esta infección es considerada una enfermedad emergente, influenciada por el cambio climático, lo que llama a estar atentos a su presencia.
Diseases caused by free-living amoebae are opportunistic infections that can have a fatal course. They can cause very serious disseminated conditions with involvement of the central nervous system such as granulomatous amoebic encephalitis. This infection has become more common in Latin America, although its recognition is late due to the similarity with other pathological conditions or because it is unusual to include it in the differential diagnosis. We report a fatal case of granulomatous amoebic encephalitis due to Balamuthia mandrillaris in a 10-year-old girl. We highlight the severity of the brain involvement and the lack of validated schemes for its treatment. Today in the world this infection is considered an emerging disease, influenced by climate change, which calls for being attentive to its presence.
Subject(s)
Humans , Female , Child , Infectious Encephalitis/diagnosis , Amebiasis/diagnosis , Tomography, X-Ray Computed , Sequence Analysis, DNA , Fatal Outcome , Balamuthia mandrillaris/isolation & purification , Balamuthia mandrillaris/genetics , Infectious Encephalitis/diagnostic imaging , Amebiasis/diagnostic imagingABSTRACT
INTRODUCTION: To date, few studies have explored the specific risk factors of patients with listeriosis who develop rhombencephalitis, and there is insufficient information regarding imaging findings and clinical symptoms in patients with this disease. This work aimed to analyze the imaging findings associated with L. monocytogenes rhombencephalitis in a cohort of patients with listeriosis. MATERIALS AND METHODS: We conducted a retrospective observational study of all declared cases of listeriosis in a tertiary hospital from Granada, Spain, from 2008 to 2021. Risk factors, comorbidities, and clinical outcomes were collected for all patients. In addition, clinical symptoms and magnetic resonance imaging (MRI) findings were included for those patients who developed rhombencephalitis. Descriptive and bivariate analyses were performed using SPSS statistical software (IBM SPSS, version 21). RESULTS: Our cohort comprised 120 patients with listeriosis (41.7% women, mean age: 58.6 ± 23.8 years), of which 10 (8.3%) had rhombencephalitis. The most frequent MRI findings in patients with confirmed rhombencephalitis were T2-FLAIR hyperintensity (100%), T1 hypointensity (80%), scattered parenchymal enhancement (80%), and cranial nerve enhancement (70%), while the most frequent anatomical involvement were pons, medulla oblongata, and cerebellum. Complications occurred in 6 patients (abscess in 4, hemorrhage in 2, hydrocephalus in 1). CONCLUSIONS: Rhombencephalitis is associated with an increased in-hospital mortality in patients with listeriosis. The anatomical distribution and imaging characteristics of neurolisteriosis could be useful to suggest the diagnosis. Future studies with greater sample size should explore the association between anatomical location, imaging patterns, and associated complications (e.g., hydrocephalus, hemorrhage), and clinical outcomes.
TITLE: Epidemiología, clínica y resultados de imagen de rombencefalitis causada por L. monocytogenes. Un estudio observacional.Introducción. Hasta la fecha, pocos estudios han explorado los factores de riesgo específicos de los pacientes con listeriosis que desarrollan rombencefalitis, y no hay suficiente información sobre los hallazgos de imagen y los síntomas clínicos en pacientes con esta enfermedad. El objetivo de este trabajo fue analizar los hallazgos de imagen asociados a la rombencefalitis por L. monocytogenes en una cohorte de pacientes con listeriosis. Materiales y métodos. Se realizó un estudio observacional retrospectivo de todos los casos declarados de listeriosis en un hospital terciario de Granada, España, desde 2008 hasta 2021. Se recogieron los factores de riesgo, las comorbilidades y los resultados clínicos de todos los pacientes. Además, se incluyeron los síntomas clínicos y los hallazgos de resonancia magnética (RM) de los pacientes que desarrollaron rombencefalitis. Se realizaron análisis descriptivos y bivariados utilizando el software estadístico SPSS (IBM SPSS, versión 21). Resultados. Nuestra cohorte incluyó a 120 pacientes con listeriosis (41,7%, mujeres; edad media: 58,6 ± 23,8 años), de los cuales 10 (8,3%) tenían rombencefalitis. Los hallazgos más frecuentes en la RM de los pacientes con rombencefalitis confirmada fueron hiperintensidad en T2-FLAIR (100%), hipointensidad en T1 (80%), realce parenquimatoso disperso (80%) y realce de los nervios craneales (70%), mientras que la afectación anatómica más frecuente fue en la protuberancia, la médula oblongada y el cerebelo. Se produjeron complicaciones en seis pacientes (absceso en cuatro, hemorragia en dos e hidrocefalia en uno). Conclusiones. La rombencefalitis se asocia a un aumento de la mortalidad intrahospitalaria en pacientes con listeriosis. La distribución anatómica y las características de imagen de la neurolisteriosis podrían ser útiles para sugerir el diagnóstico. Futuros estudios con mayor tamaño muestral deberían explorar la asociación entre la localización anatómica, los patrones de imagen y las complicaciones asociadas (por ejemplo, hidrocefalia y hemorragia), y los resultados clínicos.
Subject(s)
Infectious Encephalitis , Listeria monocytogenes , Listeriosis , Rhombencephalon , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/epidemiology , Infectious Encephalitis/microbiology , Rhombencephalon/diagnostic imaging , Rhombencephalon/microbiology , Listeria monocytogenes/isolation & purification , Listeriosis/complications , Humans , Male , Female , Adult , Middle Aged , Aged , Spain/epidemiology , Longitudinal StudiesABSTRACT
BACKGROUND: Infectious encephalitis represents a rare but potentially severe clinical condition. However, limited international data are available in pediatric age. METHODS: We conducted a retrospective study to review (a) the clinical presentation; (b) laboratory, radiology, and neurophysiology findings; (c) the correlations between these exams and outcome; and (d) the therapy performed. RESULTS: Fifty-six patients were enrolled [22 female (39.6%), mean age 4.7 years, IQR 0.7-8.7 years], 19.6% presented neurologic sequelae. HSV was the single most frequently isolated pathogen (19.6%), although in most cases, the etiology remained undefined. 41.1% children presented prodromal before the development of neurologic signs. Fever was the most frequent constitutional symptom (83.9% of cases). Cerebrospinal fluid was normal in 48.5% of cases and electroencephalograpy in 24.5% cases. Brain computed tomography scans was normal in 33 (91.7%) cases, while cerebral magnetic resonance imaging (MRI) showed pathologic findings in 62.5% of cases. MRI was the only parameter associated with neurologic sequalae [P = 0.01; OR, 8.1 (95% CI: 1.52-42.84)]. CONCLUSIONS: Pediatric encephalitis is a heterogeneous entity with nonspecific clinical and laboratory findings, with undefined etiologies in most times. MRI can play a primary role, both on a diagnostic and prognostic point-of-view, and its role should be implemented and made more accessible. Further studies are needed to define the exact role and timing of steroids.
Subject(s)
Brain/drug effects , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/drug therapy , Brain/pathology , Brain/virology , Child , Child, Preschool , Encephalitis, Herpes Simplex/cerebrospinal fluid , Encephalitis, Herpes Simplex/diagnostic imaging , Female , Fever/virology , Humans , Infant , Infectious Encephalitis/cerebrospinal fluid , Magnetic Resonance Imaging , Male , Retrospective StudiesABSTRACT
Organisms penetrate the central nervous system (CNS) via three routes. The commonest is the hematogenous route, and other routes include contiguous or penetrating injury or rarely via retrograde axoplasmic route. Although the axoplasmic highway is often used by viruses, only a few bacteria are known to penetrate the CNS via this route. We present a 57-year-old man who developed a penetrating injury while working in a field. Over the next 4 months, he developed pain at the site of the poorly healing wound, which ascended up the right leg and presented as a conus-cauda syndrome. Magnetic resonance imaging (MRI) showed an enhancing intradural intramedullary enhancing lesion in the conus on the right side with cord edema from D11 to L1 level. Extensive evaluation was negative, and he continued to progress to holocord myelitis and developed bilateral corticospinal tract lesions ("tractopathy") in the brain stem and internal capsule. He died after developing a right-sided cerebritis with mass effect. Tissue biopsy from the brain at the time of decompressive craniectomy grew Burkholderia pseudomallei and confirmed a diagnosis of neuromelioidosis (NM). We reviewed the literature for NM, its variable presentations, and the concept of an "infectious tractopathy" and imaging findings which could generate suspicion of this entity.
Subject(s)
Foot Injuries/complications , Foot/microbiology , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/microbiology , Melioidosis/complications , Myelitis/complications , Anti-Bacterial Agents/therapeutic use , Brain/diagnostic imaging , Brain/microbiology , Burkholderia pseudomallei/pathogenicity , Fatal Outcome , Foot/pathology , Foot Injuries/microbiology , Humans , Infectious Encephalitis/drug therapy , Infectious Encephalitis/etiology , Magnetic Resonance Imaging , Male , Melioidosis/diagnostic imaging , Melioidosis/drug therapy , Middle Aged , Spinal Cord/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Infectious Encephalitis/etiology , Pneumonia, Viral/complications , Coronavirus Infections/drug therapy , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/drug therapy , Language Disorders/etiology , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Pneumonia, Viral/diagnosis , Coronavirus Infections/diagnosis , Psychomotor Agitation/etiologyABSTRACT
TITLE: Encefalitis multifocal como manifestación neurológica de la infección por COVID-19.
Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Infectious Encephalitis/etiology , Pandemics , Pneumonia, Viral/complications , Aged , Antiviral Agents/therapeutic use , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Humans , Infectious Encephalitis/cerebrospinal fluid , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/drug therapy , Language Disorders/etiology , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Nasopharynx/virology , Neuroimaging , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Psychomotor Agitation/etiology , SARS-CoV-2 , Tremor/etiologySubject(s)
Chikungunya Fever/pathology , Dengue/pathology , Infectious Encephalitis/pathology , Substantia Nigra/pathology , Adult , Chikungunya Fever/diagnostic imaging , Child , Dengue/diagnostic imaging , Female , Humans , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/virology , Magnetic Resonance Imaging , Male , Substantia Nigra/diagnostic imagingABSTRACT
Opsoclonus, an uncommon clinical sign, and is often described in the context of opsoclonus myoclonus ataxia syndrome (OMAS). OMAS may be paraneoplastic or postinfectious. However, opsoclonus with or without OMAS may occur in association with a wide gamut of infections. Infection-associated opsoclonus/OMAS (IAO) needs recognition as a separate entity, since it demands relatively brief immunosuppression, symptomatic treatment, and has a better outcome. Case records of children, who presented with opsoclonus to a tertiary-care teaching hospital of North India over a period of 1 year (2017-2018), were reviewed. Those with opsoclonus in the setting of an acute infection/febrile illness (symptomatic opsoclonus; IAO) were included. Of 15 children with opsoclonus, 6 children [median age: 42 months (range: 8 months to 7 years); 2 boys] had opsoclonus associated with an infective or febrile illness. Additional clinical findings in these children included myoclonus (n = 2), ataxia (n = 4) and behavioral abnormalities (n = 4). All these patients had an associated neurologic or nonneurologic illness- scrub typhus (n = 1), tuberculous meningitis (n = 1), mumps encephalitis (n = 1), brainstem encephalitis (n = 1), acute cerebellitis (n = 1), and subacute sclerosing panencephalitis (SSPE, n = 1). Children with acute cerebellitis, brainstem encephalitis, and mumps encephalitis were treated with steroids while those with scrub typhus, tuberculosis, and SSPE were treated with antibiotics, antitubercular therapy, and Isoprinosine, respectively. None of them needed long-term maintenance immunotherapy. The evaluation for tumor was negative in all. Three of the 6 children are functionally normal at the last follow-up. Acute neuro infections may trigger opsoclonus. A careful analysis of clinical data and suitable investigations can help differentiate these children from those with OMAS. This distinction may avoid unwarranted long-term immunosuppression.
Subject(s)
Brain/diagnostic imaging , Infectious Encephalitis/complications , Infectious Encephalitis/diagnostic imaging , Magnetic Resonance Imaging/methods , Ocular Motility Disorders/etiology , Child , Child, Preschool , Female , Humans , India/epidemiology , Infant , Infectious Encephalitis/ethnology , MaleSubject(s)
Bacteremia/diagnosis , Infectious Encephalitis/diagnostic imaging , Paraspinal Muscles/diagnostic imaging , Typhoid Fever/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Ceftriaxone/therapeutic use , Humans , Infectious Encephalitis/drug therapy , Infectious Encephalitis/physiopathology , Magnetic Resonance Imaging , Male , Typhoid Fever/drug therapy , Typhoid Fever/physiopathologyABSTRACT
A 17-year-old woman was admitted to our hospital because of a high fever, consciousness disturbance, and delirious behavior. Methicillin susceptible Staphylococcus aureus (MSSA) infection was confirmed by blood culture. Transthoracic echocardiogram showed no abnormality at first. Diffusion-weighted brain MRI showed a high intensity lesion in the middle portion of the splenium, which was shown as low intensity on apparent diffusion coefficient map. Then, antibiotics therapy was started against suspected bacterial meningitis, while the lumbar puncture was not performed because of the decreased number of platelets. Since the systolic murmur appeared at the apex on day 12, the diagnosis with infectious endocarditis was made by transthoracic echocardiogram. The MRI abnormalities disappeared on day 16 and we diagnosed her with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with infectious endocarditis. This case suggests that MERS can occur associated with infectious endocarditis caused by Staphylococcus aureus.
Subject(s)
Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/therapy , Infectious Encephalitis/microbiology , Staphylococcal Infections , Staphylococcus aureus , Adolescent , Anti-Bacterial Agents/administration & dosage , Corpus Callosum/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Drug Therapy, Combination , Echocardiography , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Female , Humans , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/drug therapy , Infectious Encephalitis/etiology , Meropenem/administration & dosage , Mitral Valve Annuloplasty , Severity of Illness Index , Treatment Outcome , Vancomycin/administration & dosageABSTRACT
Despite recent advances in diagnostic and therapeutic modalities for infectious and autoimmune encephalitis, the management of patients with suspected or confirmed encephalitis poses a great challenge to physicians. Neuroimaging, including magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning, can play a crucial role in substantiating the diagnosis of encephalitis and eliminating clinical mimics of encephalitis from consideration. Moreover, characteristic neuroimaging patterns can aid in defining specific infectious and autoimmune etiologies. Volumetric and functional MRI, in particular, are being increasingly used to characterize outcomes following encephalitis and can shed light on brain reorganization and function after the acute phase of disease has resolved. Here, we discuss the uses of structural, functional, and PET neuroimaging in the clinical assessment of the acute and recovery phases of encephalitis.
Subject(s)
Brain/diagnostic imaging , Encephalitis/diagnostic imaging , Hashimoto Disease/diagnostic imaging , Infectious Encephalitis/diagnostic imaging , Neuroimaging/methods , Humans , Magnetic Resonance Imaging , Positron-Emission TomographySubject(s)
Cryptococcus neoformans , Cysts/diagnostic imaging , Infectious Encephalitis/diagnostic imaging , Magnetic Resonance Imaging , Meningitis, Cryptococcal/diagnostic imaging , Adult , Cysts/complications , Female , Humans , Infectious Encephalitis/complications , Magnetic Resonance Imaging/methods , Meningitis, Cryptococcal/complicationsABSTRACT
Granulomatous amebic encephalitis is a rare necrotizing infection of the CNS that occurs most commonly in immunocompromised individuals and is usually fatal. It is difficult to diagnose as the clinical symptoms and radiographic findings are often mistaken for other bacterial, viral, fungal, or protozoan infections. Herein, we present the case of a 69-year-old heart transplant recipient who suffered fulminant neurological decline â¼5 months after transplant. Extensive radiographic and laboratory testing did not provide a definite anatomic diagnosis and, despite aggressive clinical treatment, he died. An autopsy examination demonstrated numerous brain abscesses which contained amebic trophozoites and cysts. An indirect immunofluorescence assay performed at the Centers for Disease Control confirmed the presence of Acanthamoeba species. To the best of our knowledge, only 13 other cases of Acanthamoeba amebic encephalitis have been reported in patients who have received solid organ transplants and this is the second case reported in a heart transplant recipient. This case emphasizes that amebic encephalitis should be in the differential diagnosis for immunocompromised patients with new brain lesions found on radiographic imaging.
Subject(s)
Acanthamoeba/pathogenicity , Central Nervous System Protozoal Infections/etiology , Heart Transplantation/adverse effects , Infectious Encephalitis/etiology , Aged , Autopsy , Central Nervous System Protozoal Infections/diagnostic imaging , Fatal Outcome , Humans , Infectious Encephalitis/diagnostic imaging , Magnetic Resonance Imaging , MaleABSTRACT
BACKGROUND: Acanthamoeba species can cause disseminating infections in immunocompromised individuals. CASE PRESENTATION: Here, we report a case of granulomatous acanthamoebic encephalitis with a lethal outcome in a 54-year-old German man who was human immunodeficiency virus-positive. The diagnosis was based on symptoms of progressive neurological deficits, including sensorimotor paralysis of his right leg and deteriorating alertness. Due to the rapid course and rather late diagnosis of the infection, effective treatment could not be applied and he died 12 days after hospital admission. CONCLUSIONS: To the best of our knowledge, this is the second case of granulomatous acanthamoebic encephalitis reported within Germany. Our case highlights the importance of early diagnosis of granulomatous acanthamoebic encephalitis to prevent fatal outcome.
Subject(s)
Acanthamoeba/isolation & purification , Central Nervous System Protozoal Infections/parasitology , HIV Infections/complications , Infectious Encephalitis/parasitology , Central Nervous System Protozoal Infections/complications , Central Nervous System Protozoal Infections/diagnostic imaging , Fatal Outcome , Granuloma/diagnostic imaging , Granuloma/parasitology , Humans , Infectious Encephalitis/complications , Infectious Encephalitis/diagnostic imaging , Male , Middle AgedSubject(s)
Aspergillus flavus/pathogenicity , Brain Stem Infarctions/complications , Brain Stem Infarctions/virology , Haemophilus Infections/complications , Haemophilus influenzae/pathogenicity , Immunocompetence , Infectious Encephalitis/complications , Anti-Bacterial Agents/therapeutic use , Brain Stem Infarctions/diagnostic imaging , Female , Haemophilus Infections/diagnostic imaging , Humans , Infectious Encephalitis/diagnostic imaging , Middle AgedABSTRACT
BACKGROUND: Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis. METHOD: We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis". RESULTS: We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. CONCLUSION: Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).
Subject(s)
Infectious Encephalitis/diagnostic imaging , Magnetic Resonance Imaging/methods , Neuroimaging/methods , Adult , Diagnosis, Differential , Humans , Infectious Encephalitis/microbiology , Infectious Encephalitis/virology , Tomography, X-Ray ComputedSubject(s)
Infectious Encephalitis/diagnosis , Listeria monocytogenes/pathogenicity , Listeriosis/diagnosis , Multiple Sclerosis/diagnosis , Rhombencephalon/pathology , Diagnosis, Differential , Female , Humans , Infectious Encephalitis/diagnostic imaging , Infectious Encephalitis/pathology , Multiple Sclerosis/diagnostic imaging , Rhombencephalon/diagnostic imagingABSTRACT
PURPOSE: In 2015, an outbreak of group B streptococcal (GBS) infection caused by Streptococcus agalactiae Serotype III, multilocus sequence type 283, related to consuming infected raw freshwater fish, affected more than 200 patients in Singapore. We describe the clinical, laboratory, and neuroimaging features of a subgroup of adults with central nervous system (CNS) infections caused by GBS. MATERIALS AND METHODS: The database of the Singapore Neurologic Infections Program (SNIP), a national multicenter study for surveillance of infectious neurologic disease, was reviewed to select patients with GBS CNS infection during the outbreak. Cases were diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) findings and identification or isolation of Streptococcus agalactiae in the blood or CSF. Demographic, clinical and neuroradiological information was obtained prospectively and retrospectively abstracted. RESULTS: Fourteen patients (6 male, 8 female; median age, 58 years) presented with fever, meningism, headache, encephalopathy, focal neurological deficits, and/or seizures. All except two were previously healthy. Diffusion-weighted imaging (DWI) on admission was abnormal in 13 patients, showing tiny hyperintensities in the subarachnoid space (7 patients), ventricles (6 patients) and brain parenchyma (8 patients); 5 patients had cerebellar abnormalities. CONCLUSION: Among healthy non-pregnant adults infected with Serotype III, multilocus sequence type 283 GBS meningitis linked to eating infected raw freshwater fish, DWI detected small pus collections and unusual cerebellar involvement. A collaborative national surveillance system that includes MRI can be helpful during unusual food-borne zoonotic infectious disease outbreaks. LEVEL OF EVIDENCE: 4 J. Magn. Reson. Imaging 2017;45:507-514.