Integrative Transcriptome and Proteome Analyses Provide New Insights Into the Interaction Between Live Borrelia burgdorferi and Frontal Cortex Explants of the Rhesus Brain.

Borrelia burgdorferi (Bb), which is neurotropic, can attack the central nervous system (CNS), leading to the development of various neurologic symptoms. The pathogenesis of Lyme neuroborreliosis (LNB) remains poorly understood. Presently, there is a lack of knowledge of the changes in mRNA and proteins in the CNS following early disseminated Lyme disease. Explants from the frontal cortex of 3 rhesus brains were incubated with medium alone or with medium containing live Bb for 6, 12, or 24 hours. Then, we analyzed identified mRNA and proteins in the frontal cortex tissues, allowing for an in-depth view of the transcriptome and proteome for a macroscopic and unbiased understanding of early disseminated Lyme disease in the brain. Through bioinformatics analysis, a complex network of enriched pathways that were mobilized during the progression of Lyme spirochete infection was described. Furthermore, based on the analysis of omics data, translational regulation, glycosaminoglycan/proteoglycan-binding activity in colonization and dissemination to tissues, disease-associated genes, and synaptic function were enriched, which potentially play a role in pathogenesis during the interaction between frontal cortex tissues and spirochetes. These integrated omics results provide unbiased and comprehensive information for the further understanding of the molecular mechanisms of LNB.

Meropenem-induced liver injury and beta-lactam cross-reactivity.

A 63-year-old man admitted to hospital for the management of a frontal lobe abscess developed elevated liver enzymes within 48 hours of receiving meropenem. Liver enzymes reached a maximum at 5 days postadministration of meropenem, with alanine aminotransferase 1160 U/L, aspartate aminotransferase 787 U/L, alkaline phosphatase 297 U/L and gamma-glutamyltransferase 252 U/L. Meropenem was ceased and liver function normalised. Meropenem was administered for a second time later in the patient's admission and again the patient developed rapidly increasing liver enzymes, with a mixed hepatocellular/cholestatic pattern. Other possible causes of liver injury were excluded following extensive investigations, and the patient's liver enzymes continued to normalise following meropenem discontinuation. The patient was asymptomatic during the admission and was transferred to a rehabilitation facility. This case demonstrates that meropenem can cause severe liver injury and that early recognition of drug-induced liver injury is important.

Neglected Recurrent Scalp Sinus: Calvarial Tuberculosis with Intracranial and Extracranial Extension.

BACKGROUND: Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions. CASE PRESENTATION: A 43-year-old man presented with a generalized seizure, altered mental state, scalp swelling, and pus-discharging sinus over the scalp. Magnetic resonance imaging of the brain indicated a conflicting diagnosis of anaplastic meningiomas and chronic osteomyelitis with intracranial extension. Débridement and drainage of intracranial pus was performed. Histopathologic examination revealed TB. After surgery, the patient's general condition improved, and he was started on antitubercular drugs. CONCLUSIONS: Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.

[Actinomycotic brain abscess in immunocompetent patient]. / Absceso cerebral actinomicótico en paciente inmunocompetente.

BACKGROUND: The actinomyces is germ commonly found in the normal flora of the oral cavity and gastro-intestinal and uro-genital tracts. Involvement in other locations is a very uncommon event. OBJECTIVES: To describe a patient with an actinomicotyc brain abscess CLINICAL CASE: We report the case of a patient who suffered a seizure and decreased level of consciousness. Imaging tests revealed the presence of lesions both in the lung and in the brain. An urgent craniotomy was performed and the diagnosis of actinomicotyc abscess was obtained. CONCLUSION: We describe the differential characteristics of this type of infection, discussing the diagnostic process and management in detail.

[Rhinoorbitocerebral zygomycosis caused by Rhizopus microsporus in a roe deer (Capreolus capreolus)]. / Rhinoorbitozerebrale Zygomykose durch Rhizopus microsporus bei einem Reh (Capreolus capreolus).

An one-year-old male roe deer (Capreolus capreolus) with abnormal behaviour was shot in order to exclude rabies virus infection. The 12.8 kg weighing animal was emaciated and revealed an asymmetric head with protruding left eye and expositional keratitis. There was a grey whitish soft mass within the caudal nasal cavity, which had infiltrated the frontal cerebrum through the cribriform plate and the retrobulbar tissue through the orbita. Histologically, the mass consisted of a chronic granulomatous inflammation with plentiful fungal hyphae. Fungal culture revealed mold fungi of the zygomycotic genus Rhizomucor, which were differentiated as Rhizopus microsporus by MALDI-TOF mass spectrometry and DNA-sequencing. Rhinoorbitocerebral zygomycosis has to be considered as a differential diagnosis for nasal and orbital tumour-like lesions and as a cause of abnormal behaviour of roe deer.

Brain involvement by leprosy presenting as a frontal cystic lesion.

Leprosy has a predilection for peripheral nerves and is not considered to involve the CNS. The idea that the CNS is exempt from Mycobacterium leprae bacilli has been suspected from a clinical perspective or CSF study in leprosy patients. However, there has been no direct evidence for CNS involvement by leprosy in a living patient. To the best of the authors' knowledge, the present case is the first report providing histopathological and molecular evidence for CNS involvement by leprosy in a living patient. Brain MRI revealed a 2-cm cystic lesion in the right frontal lobe of the patient. The medical history revealed that the patient had been receiving multidrug therapy for borderline lepromatous leprosy. Neuronavigation-guided craniotomy and lesion removal were performed due to a presumptive diagnosis of low-grade glioma. The brain specimen demonstrated variably thickened blood vessels and densely scattered foamy macrophages in the perivascular spaces and parenchymal stroma. Fite acid-fast stain displayed red granular inclusions that were suggestive for fragmented M. leprae. M. leprae-specific nested polymerase chain reaction amplification showed positive bands, and DNA sequencing also demonstrated homology with the M. leprae genome. This case supports the notion that M. leprae can involve the cerebral cortex regardless of cranial nerve engagement.

Bacterial cytolysin during meningitis disrupts the regulation of glutamate in the brain, leading to synaptic damage.

Streptococcus pneumoniae (pneumococcal) meningitis is a common bacterial infection of the brain. The cholesterol-dependent cytolysin pneumolysin represents a key factor, determining the neuropathogenic potential of the pneumococci. Here, we demonstrate selective synaptic loss within the superficial layers of the frontal neocortex of post-mortem brain samples from individuals with pneumococcal meningitis. A similar effect was observed in mice with pneumococcal meningitis only when the bacteria expressed the pore-forming cholesterol-dependent cytolysin pneumolysin. Exposure of acute mouse brain slices to only pore-competent pneumolysin at disease-relevant, non-lytic concentrations caused permanent dendritic swelling, dendritic spine elimination and synaptic loss. The NMDA glutamate receptor antagonists MK801 and D-AP5 reduced this pathology. Pneumolysin increased glutamate levels within the mouse brain slices. In mouse astrocytes, pneumolysin initiated the release of glutamate in a calcium-dependent manner. We propose that pneumolysin plays a significant synapto- and dendritotoxic role in pneumococcal meningitis by initiating glutamate release from astrocytes, leading to subsequent glutamate-dependent synaptic damage. We outline for the first time the occurrence of synaptic pathology in pneumococcal meningitis and demonstrate that a bacterial cytolysin can dysregulate the control of glutamate in the brain, inducing excitotoxic damage.

Fever and limp: thinking outside the box.

Fever and limp is a common presentation in the pediatric emergency department. We describe a case of a 21-month-old female patient with prolonged fever and difficulty bearing weight, ultimately diagnosed with a large intracranial abscess. Intracranial abscesses are a rare cause of limp and an uncommon diagnosis in pediatric patients without underlying congenital heart disease. This case highlights the importance of differentiating the features of limp secondary to pain from limp secondary to weakness, which is particularly difficult in the preschool-aged group. It is imperative for practitioners to consider disease of the central nervous system when evaluating acutely nonambulatory children with fevers.

Cannabidiol reduces host immune response and prevents cognitive impairments in Wistar rats submitted to pneumococcal meningitis.

Pneumococcal meningitis is a life-threatening disease characterized by an acute infection affecting the pia matter, arachnoid and subarachnoid space. The intense inflammatory response is associated with a significant mortality rate and neurologic sequelae, such as, seizures, sensory-motor deficits and impairment of learning and memory. The aim of this study was to evaluate the effects of acute and extended administration of cannabidiol on pro-inflammatory cytokines and behavioral parameters in adult Wistar rats submitted to pneumococcal meningitis. Male Wistar rats underwent a cisterna magna tap and received either 10µl of sterile saline as a placebo or an equivalent volume of S. pneumoniae suspension. Rats subjected to meningitis were treated by intraperitoneal injection with cannabidiol (2.5, 5, or 10mg/kg once or daily for 9 days after meningitis induction) or a placebo. Six hours after meningitis induction, the rats that received one dose were killed and the hippocampus and frontal cortex were obtained to assess cytokines/chemokine and brain-derived neurotrophic factor levels. On the 10th day, the rats were submitted to the inhibitory avoidance task. After the task, the animals were killed and samples from the hippocampus and frontal cortex were obtained. The extended administration of cannabidiol at different doses reduced the TNF-α level in frontal cortex. Prolonged treatment with canabidiol, 10mg/kg, prevented memory impairment in rats with pneumococcal meningitis. Although descriptive, our results demonstrate that cannabidiol has anti-inflammatory effects in pneumococcal meningitis and prevents cognitive sequel.

[Cerebral trunk abscess due to Neisseria meningitidis in a 28-year-old immunocompetent patient]. / Abcès du tronc cérébral àNeisseria meningitidis chez une patiente de 28ans, immunocompétente.

Meningococcal disease can manifest in very different clinical situations. Meningococcal meningitis and fulminant meningococcemia (or purpura fulminans) are the most common forms of these infections, but many other manifestations can be seen including septic arthritis, pericarditis, pleurisy and conjunctivitis. Brain abscesses have also been described; they are a rare complication of meningococcal disease. We report the case of a 28-year-old immunocompetent patient who developed meningococcal infection associated with brain abscesses and oligo-arthritis.

Cefalea y visión borrosa en una mujer de 26 años / Headache and blurred vision in a 26 years old woman

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Fonsecaea monophora cerebral phaeohyphomycosis: case report of successful surgical excision and voriconazole treatment and review.

We report a case of Fonsecaea monophora cerebral phaeohyphomycosis successfully treated with surgical excision and voriconazole monotherapy in a patient receiving maintenance immunosuppression therapy for 8 years after cadaveric renal transplantation. She presented with a severe frontal headache in the absence of any constitutional or neurologic symptoms. Brain magnetic resonance imaging showed an irregular 3.1 x 3.4 cm ring-enhancing lesion in her left frontal lobe. The patient underwent craniotomy and resection of her mass, with intraoperative spillage of some of her abscess contents into her lateral ventricle. Histopathology of her resected mass showed necrotic fragments of brain parenchyma with granulomatous inflammation and numerous pigmented fungal forms. A mold, recovered from cultures inoculated with portions of her brain resection specimen, was later definitively identified as Fonsecaea monophora. Initial serum (1-->3) beta-D-glucan (BG) levels exceeded 500 pg/ml. The patient received voriconazole, which she tolerated well, without recurrent headaches or abscess formation noted on serial brain imaging. Her BG declined to <31 pg/ml one year following her abscess resection. She discontinued antifungal therapy after an 18-month treatment course, and has remained free of any clinical or radiographic evidence of recurrent abscess formation three years later.