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1.
Indian Pediatr ; 61(5): 452-455, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38736224

RESUMEN

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.


Asunto(s)
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 cefalorraquídeo
2.
RMD Open ; 10(2)2024 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-38772678

RESUMEN

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.


Asunto(s)
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/inmunología
3.
J Med Primatol ; 53(3): e12700, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38706108

RESUMEN

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.


Asunto(s)
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/complicaciones
4.
BMC Infect Dis ; 24(1): 94, 2024 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-38229022

RESUMEN

BACKGROUND: In the 2022 mpox-outbreak most patients presented with mild symptoms. Central nervous system (CNS) involvement has previously been described as a rare and severe complication of mpox; however, diagnostic findings in cerebrospinal fluid (CSF) analysis and neuroimaging studies have only been reported in one case previously. CASE PRESENTATION: We report a previously healthy 37-year-old man with mpox complicated by encephalitis. He first presented with painful skin lesions and genital ulcers; polymerase chain reaction (PCR) from the lesions was positive for mpox. Twelve days later he was admitted with fever and confusion. Neuroimaging and CSF analysis indicated encephalitis. The CSF was PCR-negative for monkeypox virus but intrathecal antibody production was detected. He spontaneously improved over a few days course and recovered fully. CONCLUSIONS: This case of mpox-associated encephalitis shows that CNS involvement in mpox infection may have a relatively mild clinical course, and that detection of intrathecal antibody production can be used to establish the diagnosis if CSF monkeypox virus-PCR is negative.


Asunto(s)
Encefalitis , Meningoencefalitis , Mpox , Masculino , Humanos , Adulto , Monkeypox virus , Formación de Anticuerpos , Mpox/diagnóstico , Meningoencefalitis/diagnóstico
5.
Rinsho Shinkeigaku ; 64(2): 75-84, 2024 Feb 23.
Artículo en Japonés | MEDLINE | ID: mdl-38281748

RESUMEN

Glial fibrillary acidic protein (GFAP) antibody-associated disorders (AD) were recently proposed to be immune-mediated neurological disorders. The pathogenesis of GFAP antibody-AD is poorly understood. Pathologically, there is a marked infiltration of large numbers of lymphocytes, including CD8+ and CD4+ T cells, into the meningeal and brain parenchyma, especially around the perivascular areas. GFAP-specific cytotoxic T cells are considered to be the effector cells of GFAP antibody-AD. The common phenotype of GFAP antibody-AD includes meningoencephalitis with or without myelitis. During the clinical disease course, patients present with consciousness disturbances, urinary dysfunction, movement disorders, meningeal irritation, and cognitive dysfunction. The detection of GFAP antibodies in the cerebrospinal fluid (CSF) by cell-based assay is essential for a diagnosis of GFAP antibody-AD. The CSF can be examined for lymphocyte-predominant pleocytosis and elevated protein levels. Brain linear perivascular radial enhancement patterns are observed in about half of GFAP antibody-AD patients. Spinal cord magnetic resonance imaging is used to detect longitudinal extensive spinal cord lesions. Although corticosteroid therapy is generally effective, some patients have a poor prognosis and relapse.


Asunto(s)
Meningoencefalitis , Mielitis , Humanos , Proteína Ácida Fibrilar de la Glía/genética , Encéfalo , Meningoencefalitis/diagnóstico , Autoanticuerpos/líquido cefalorraquídeo , Astrocitos/patología
6.
J Am Vet Med Assoc ; 262(4): 481-488, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38266391

RESUMEN

OBJECTIVES: To evaluate blood and cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP) in dogs with meningoencephalitis of unknown origin (MUO); to evaluate whether blood CRP concentration is associated with epidemiological, clinicopathologic, and MRI findings; and to investigate blood CRP predictive power in survival. ANIMALS: 30 client-owned dogs with MUO, 15 client-owned dogs with steroid-responsive meningitis arteritis (SRMA; positive control group), and 15 healthy dogs (negative control group). METHODS: Blood CRP concentration was measured in each group, while it was performed in CSF only in the MUO and SRMA groups. The analysis of epidemiological data included breed, age, sex, duration of clinical signs, and history of seizures. Blinded analysis of MRI was performed based on a classification grid, and traditional CSF analysis parameters were assessed. The predictive power of blood CRP concentration regarding survival at 6 months was investigated. RESULTS: Of the 30 dogs with MUO, 9 (30%) had an increased CRP concentration in blood, and 3 (10%) showed a measurable CRP in CSF. Median blood CRP concentration in dogs with MUO was 0.1 mg/L (range, 0.1 to 102 mg/L), which was not statistically different from the healthy dog group but significantly lower than the SRMA control group. Only the duration of clinical signs was positively associated with an increased blood CRP level. Blood CRP concentration was not associated with survival at 6 months. CLINICAL RELEVANCE: Blood CRP concentration is of limited value for the diagnosis and prognosis of dogs with MUO. Chronicity of the disease may be associated with an increased concentration of blood CRP.


Asunto(s)
Arteritis , Enfermedades de los Perros , Meningitis , Meningoencefalitis , Humanos , Perros , Animales , Proteína C-Reactiva , Meningoencefalitis/diagnóstico , Meningoencefalitis/veterinaria , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis/veterinaria , Arteritis/diagnóstico , Arteritis/veterinaria , Arteritis/líquido cefalorraquídeo
7.
Am J Trop Med Hyg ; 110(2): 246-249, 2024 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-38190743

RESUMEN

Acanthamoeba spp. are rare etiological agents of meningoencephalitis with high mortality. We present three cases of Acanthamoeba meningoencephalitis in immunocompetent individuals from Eastern India. The first patient presented with fever and headache; the second with headache, visual disturbance, and squint; and the third presented in a drowsy state. The cases presented on March 3, 18, and 21, 2023 respectively. The first two patients had concomitant tubercular meningitis for which they received antitubercular therapy and steroid. Their cerebrospinal fluid showed slight lymphocytic pleocytosis and increased protein. The diagnosis was done by microscopy, culture, and polymerase chain reaction. They received a combination therapy comprising rifampicin, fluconazole, and trimethoprim-sulfamethoxazole. The first patient additionally received miltefosine. She responded well to therapy and survived, but the other two patients died despite intensive care. Detection of three cases within a period of 1 month from Eastern India is unusual. It is imperative to sensitize healthcare providers about Acanthamoeba meningoencephalitis to facilitate timely diagnosis and treatment of the disease.


Asunto(s)
Acanthamoeba , Amebiasis , Infecciones Protozoarias del Sistema Nervioso Central , Meningoencefalitis , Humanos , Femenino , Infecciones Protozoarias del Sistema Nervioso Central/diagnóstico , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológico , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , India , Cefalea
8.
Infection ; 52(1): 165-172, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37515691

RESUMEN

PURPOSE: We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS: FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS: FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION: FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.


Asunto(s)
Encefalitis , Meningitis , Meningoencefalitis , Humanos , Meningitis/diagnóstico , Encefalitis/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Leucocitosis , Meningoencefalitis/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos
9.
Am J Vet Res ; 85(1)2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-37913632

RESUMEN

Necrotizing meningoencephalitis (NME) is a fatal neuroinflammatory disease that previously carried a uniformly grave prognosis. Our recent identification of a novel early form of NME in Pugs suggests that disease onset and progression are likely more insidious than previously recognized and provides new hope that early therapeutic intervention may halt disease progression and ultimately prevent or cure NME. This novel perspective also sheds new light on the clinical similarities to multiple sclerosis (MS) in humans and provides a rationale for cross-species translation. The history of recent scientific discoveries in NME and new parallels between MS and NME will be reviewed.


Asunto(s)
Enfermedades de los Perros , Meningoencefalitis , Esclerosis Múltiple , Humanos , Perros , Animales , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/veterinaria , Meningoencefalitis/diagnóstico , Meningoencefalitis/veterinaria , Meningoencefalitis/genética , Fenotipo , Enfermedades de los Perros/genética
10.
J Infect Chemother ; 30(3): 263-265, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37863259

RESUMEN

A 37-year-old woman was hospitalized with fever and consciousness disturbance. She showed systemic inflammation with stress cardiomyopathy. Brain computed tomography showed diffuse brain edema. Cerebrospinal fluid (CSF) findings revealed markedly elevated cerebrospinal fluid pressure with pleocytosis, elevated protein, and elevated interleukin 6. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nicking enzyme amplification reaction test using a nasopharyngeal swab was positive, and the patient was diagnosed with SARS-CoV-2 infection. From the negative result of the CSF SARS-CoV-2 polymerase chain reaction test and no findings of bacterial or viral infection, we diagnosed meningoencephalitis by multisystem inflammation syndrome in adults (MIS-A). Intravenous methylprednisolone pulse therapy improved her symptoms and brain edema. There have been no cases of MIS-A with meningoencephalitis, and no initial treatment strategy has been established, especially in emergency cases of suspected MIS-A. The present case suggested Early intravenous methylprednisolone pulse with anti-coronaviral therapies after the exclusion of bacterial infection would be useful in suspected MIS-A with emergent meningoencephalitis cases.


Asunto(s)
Edema Encefálico , COVID-19 , Enfermedades del Tejido Conjuntivo , Meningoencefalitis , Humanos , Adulto , Femenino , COVID-19/complicaciones , COVID-19/diagnóstico , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Inflamación , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Metilprednisolona/uso terapéutico
11.
Medicina (Kaunas) ; 59(12)2023 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-38138266

RESUMEN

Behçet's disease (BD) is a systemic vasculitis that frequently presents with a relapsing-remitting pattern. CNS involvement (Neuro-Behçet) is rare, affecting approximately 10% of patients. Its etiological mechanisms are not yet fully understood. The most commonly accepted hypothesis is that of a systemic inflammatory reaction triggered by an infectious agent or by an autoantigen, such as heat shock protein, in genetically predisposed individuals. Mycobacterium tuberculosis is known to be closely interconnected with BD, both affecting cell-mediated immunity to a certain extent and probably sharing a common genetic background. We present the case of a 34-year-old Caucasian woman who had been diagnosed with tuberculous meningitis 15 months prior, with significant neurological deficits and lesional burden on MRI with repeated relapses whenever treatment withdrawal was attempted. These relapses were initially considered as reactivation of tuberculous meningoencephalitis, and symptoms improved after a combination of antituberculous treatment and corticosteroid therapy. After the second relapse, the diagnosis was reconsidered, as new information emerged about oral and genital aphthous lesions, making us suspect a BD diagnosis. HLA B51 testing was positive, antituberculous treatment was stopped, and the patient was started on high doses of oral Cortisone and Azathioprine. Consequently, the evolution was favorable, with no further relapses and slow improvements in neurological deficits. To our knowledge, this is the first report of Neuro-Behçet's disease onset precipitated by tuberculous meningitis. We include a review of the available literature on this subject. Our case reinforces the fact that Mycobacterium tuberculosis infection can precipitate BD in genetically predisposed patients, and we recommend HLA B51 screening in patients with prolonged or relapsing meningoencephalitis, even if an infectious agent is apparently involved.


Asunto(s)
Síndrome de Behçet , Meningoencefalitis , Tuberculosis Meníngea , Femenino , Humanos , Adulto , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Antígeno HLA-B51 , Tuberculosis Meníngea/complicaciones , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Recurrencia Local de Neoplasia , Meningoencefalitis/complicaciones , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Recurrencia
12.
PLoS One ; 18(12): e0296036, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38127927

RESUMEN

INTRODUCTION: Meningoencephalitis in children poses a diagnostic challenge, as etiology remains unknown for most of patients. Viral metagenomics by shotgun sequencing represents a powerful tool for investigating unknown viral infections related to these cases. PATIENTS AND METHODS: In a two-year, reference-centre, retrospective study, we investigated the usefulness of viral metagenomics of cerebrospinal fluid (CSF) for the diagnosis of viral infectious meningoencephalitis in forty seven pediatric patients, forty of them previously tested negative with a routine neurologic panel of viral targets that included herpesvirus 1-3 and enterovirus. We enhanced the detection by targeting viral sequences by hybrid capture. Raw sequence data was analysed using three bioinformatics pipelines. RESULTS: Out of forty remaining children with meningoencephalitis of unknown viral etiology, a significant detection of viral nucleic acid by shotgun sequencing was found in twenty one, which was confirmed in ten of them by specific PCR: seven human endogenous retrovirus K113 (HER K113), one parechovirus 3, one human herpesvirus 5 (HHV5); one enterovirus B (Echovirus 9). The remaining eleven CSF were not confirmed by PCR: three rotavirus, one human herpesvirus 7 (HHV7), one influenza A, one mastadenovirus C, one sindbis virus, one torque teno virus, one human immunodeficiency virus 1 (HIV-1), one human alphaherpesvirus 3 (HHV3), one human alphaherpesvirus 2 (HHV2). CONCLUSIONS: Underutilization of currently available meningitis-encephalitis diagnostic techniques such as BioFire® FilmArray® is the main cause of undiagnosed cases of meningoencephalitis. However, in this study we detected uncommon viruses that should be considered, including virus, rotavirus, sindbis virus, influenza A virus and HHV7. No other viral sequences that could be readily linked to CNS inflammation were detected. Some findings may stem from reagent or sample contamination, as seen with papillomavirus; for others, the clinical relevance of the virus remains uncertain and should be substantiated by further studies, as is the case with endogenous retrovirus K113 virus. Online bioinformatics pipeline CZID represents a valuable tool for analysing shotgun sequencing data in cases of neurological conditions with unknown etiology. Altogether, this study highlights the potential of shotgun sequencing in identifying previously unknown viral neuropathogens and sheds light on the interpretation issues related to its application in clinical microbiology.


Asunto(s)
Meningoencefalitis , Virosis , Virus , Humanos , Niño , Estudios Retrospectivos , Meningoencefalitis/diagnóstico , Virus/genética , Virosis/complicaciones , Virosis/diagnóstico , Inflamación , Herpesvirus Humano 3 , Metagenómica/métodos
14.
Rev Med Inst Mex Seguro Soc ; 61(Suppl 3): S492-S496, 2023 Oct 02.
Artículo en Español | MEDLINE | ID: mdl-37935013

RESUMEN

Background: Fusarium infection in the central nervous system is a rare pathology generally reported in patients with hematological malignancies. Clincal case: A patient with Fusarium meningoencephalitis during the late postpartum period is presented. The patient's main symptom was holocranial headache with poor response to analgesics, adding dysarthria and blurred vision. Initially, it was classified as aseptic meningitis due to the absence of bacterial isolation, however, 8 weeks after the onset of the symptoms, Fusarium development was obtained in cerebrospinal fluid cultures. Targeted treatment with liposomal amphotericin and voriconazole was established, with partial improvement at first; however, at 16 weeks from the onset of the clinical picture, the patient presented sudden deterioration of alertness, an ischemic area was found in the occipital lobe by imaging study, which quickly led the patient to a fatal outcome. Conclusion: Despite the fact that in recent years Fusarium spp infection has been detected more frequently in the population, the treatment is still not well established, making management of the Central Nervous System a challenge.


Introducción: la infección por Fusarium en el sistema nervioso central es una patología rara, reportada generalmente en pacientes con neoplasias hematológicas. Caso clínico: se presenta una paciente con meningoencefalitis por Fusarium durante el periodo de puerperio tardío. El síntoma principal de la paciente fue cefalea holocraneana con baja respuesta a analgésicos, agregándose disartria y visión borrosa. De manera inicial, se catalogó como meningitis aséptica por ausencia de aislamiento bacteriano, no obstante, a las 8 semanas posterior al inicio del cuadro se obtuvo desarrollo de Fusarium en los cultivos de líquido cefalorraquídeo. Se estableció tratamiento dirigido con anfotericina liposomal y voriconazol, con mejoría parcial en un inicio; sin embargo, la paciente a las 16 semanas desde el inicio del cuadro clínico presentó deterioro súbito del estado de alerta, se evidenció zona isquémica en el lóbulo occipital por estudio de imagen, lo que rápidamente llevó a la paciente a un desenlace fatal. Conclusión: a pesar de que en los últimos años la infección por Fusarium spp se ha detectado con mayor frecuencia en la población, el tratamiento aún no se encuentra bien establecido ocasionando que sea un reto el manejo en Sistema Nervioso Central.


Asunto(s)
Fusarium , Meningoencefalitis , Femenino , Humanos , Antifúngicos/uso terapéutico , Voriconazol/uso terapéutico , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico
15.
PLoS One ; 18(11): e0290394, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37939056

RESUMEN

Primary amoebic meningoencephalitis (PAM) is a rapidly progressing central nervous system (CNS) infection caused by Naegleria fowleri, a free-living amoeba found in warm freshwater. The disease progression is very rapid, and the outcome is nearly always fatal. We aim to describe the disease course in patients admitted with PAM in a tertiary care center in Karachi, Pakistan between the periods of 2010 to 2021. A total of 39 patients were included in the study, 33 males (84.6%). The median age of the patients was 34 years. The most frequent presenting complaint was fever, which was found in 37 patients (94.9%) followed by headache in 28 patients (71.8%), nausea and vomiting in 27 patients (69.2%), and seizures in 10 patients (25.6%). Overall, 39 patients underwent lumbar puncture, 27 patients (69.2%) had a positive motile trophozoites on CSF wet preparation microscopy, 18 patients (46.2%) had a positive culture, and 10 patients had a positive PCR. CSF analysis resembled bacterial meningitis with elevated white blood cell counts with predominantly neutrophils (median, 3000 [range, 1350-7500] cells/µL), low glucose levels median, 14 [range, 1-92] mg/dL), and elevated protein levels (median, 344 [range, 289-405] mg/dL). Imaging results were abnormal in approximately three-fourths of the patients which included cerebral edema (66.7%), hydrocephalus (25.6%), and cerebral infarctions (12.8%). Only one patient survived. PAM is a fatal illness with limited treatment success. Early diagnosis and prompt initiation of treatment can improve the survival of the patients and reduce mortality.


Asunto(s)
Amebiasis , Infecciones Protozoarias del Sistema Nervioso Central , Meningoencefalitis , Naegleria fowleri , Masculino , Humanos , Adulto , Pakistán/epidemiología , Infecciones Protozoarias del Sistema Nervioso Central/diagnóstico , Infecciones Protozoarias del Sistema Nervioso Central/epidemiología , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológico , Punción Espinal , Amebiasis/diagnóstico , Amebiasis/epidemiología , Meningoencefalitis/diagnóstico , Meningoencefalitis/epidemiología
16.
BMC Vet Res ; 19(1): 190, 2023 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-37798783

RESUMEN

BACKGROUND: Thirty-two-day-old broiler chickens at a farm located in northwestern South Korea displayed adverse neurological symptoms including limping, lying down, and head shaking. Approximately 2.1% of chickens died or were culled due to severe symptoms. Five carcasses were submitted to the Avian Disease Division of the Animal and Plant Quarantine Agency (APQA) for disease diagnosis. RESULTS: Broilers displayed severe pericarditis and perihepatitis associated with gross lesions. Broilers also displayed microscopic lesions in the cerebrum and in the granular layer of the cerebellum, which were associated with multifocal perivascular cuffing and purulent necrosis in the cerebrum, and severe meningitis with heterophil and lymphocyte infiltration. Staphylococcus spp. were identified in the liver and heart using bacteriological culture. PCR/RT-PCR assays revealed that broilers were negative for avian Clostridium botulinum, Newcastle disease virus, and avian encephalomyelitis virus. Bacterial and viral metagenomic analysis of brain sample further revealed the presence of Pseudomonas spp. and Marek's disease virus, which are known etiological agents of chicken meningoencephalitis. CONCLUSIONS: This study reports a diagnostic analysis of gross and histopathological lesions from 32-day-old broilers displaying unique neurological symptoms that revealed the presence of the several neurological diseases including meningoencephalitis. The causative agents associated with meningoencephalitis of broilers that had not been identified by routine diagnostic methods could be diagnosed by metagenomics, which proves the usefulness of metagenomics as a diagnostic tool for unknown neurological diseases in broilers.


Asunto(s)
Meningoencefalitis , Enfermedad de Newcastle , Enfermedades de las Aves de Corral , Animales , Pollos/microbiología , Virus de la Enfermedad de Newcastle , Encéfalo/patología , Meningoencefalitis/diagnóstico , Meningoencefalitis/veterinaria , Enfermedades de las Aves de Corral/microbiología
19.
J Clin Microbiol ; 61(10): e0042623, 2023 10 24.
Artículo en Inglés | MEDLINE | ID: mdl-37702495

RESUMEN

Rapid identification of the causative pathogens of central nervous system infections is essential for providing appropriate management and improving patient outcomes. The performance of QIAstat-Dx Meningitis/Encephalitis (ME) Panel-a multiplex PCR testing platform-in detecting pathogens implicated in meningitis and/or encephalitis was evaluated using BioFire FilmArray ME Panel as a comparator method. This multicenter study analyzed 585 retrospective residual cerebrospinal fluid specimens and 367 contrived specimens. The QIAstat-Dx ME Panel showed positive percent agreement (PPA) values of 100% for Neisseria meningitidis, Streptococcus agalactiae, Escherichia coli K1, Listeria monocytogenes, and Cryptococcus gattii/neoformans on clinical samples compared to the BioFire FilmArray ME Panel. The PPA values observed for Haemophilus influenzae and Streptococcus pneumoniae were 80% and 88.24%, respectively. Negative percent agreement (NPA) values were >99.0% for each of the six bacterial targets and one fungal target tested with clinical samples. One viral target, herpes simplex virus 1, exhibited a PPA value of 100.0%, while the remaining viral targets-human parechovirus, herpes simplex virus 2, human herpes virus 6, and varicella zoster virus-were >90.0%, with the exception of enterovirus, which had a PPA value of 77.8%. The QIAstat-Dx ME Panel detected five true-positive and four true-negative cases compared to BioFire FilmArray ME Panel. The NPA values for all viral pathogens were >99.0%. Overall, the QIAstat-Dx ME Panel showed comparable performance to the BioFire FilmArray ME Panel as a rapid diagnostic tool for community-acquired meningitis and encephalitis.


Asunto(s)
Encefalitis , Meningitis , Meningoencefalitis , Humanos , Reacción en Cadena de la Polimerasa Multiplex/métodos , Estudios Retrospectivos , Meningitis/diagnóstico , Encefalitis/diagnóstico , Meningoencefalitis/diagnóstico
20.
Front Public Health ; 11: 1174536, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37575122

RESUMEN

Neonatal meningitis is rare but devastating disease. Multidrug-resistant (MDR, multi-drug resistant) bacteria are a major global health risk. We report an Escherichia coli meningitis isolate with multiple resistance patterns and unusual serotype (O75) that caused sudden neonatal death. The isolate was resistant to antibiotics other than cefoperazone/sulbactam and imipenem, challenging the combination of antibiotics commonly used in the empirical treatment of neonatal sepsis. Despite aggressive symptomatic and supportive treatment of the infant based on laboratory tests and clinical practice, the infant eventually died. This is the first case of meningoencephalitis due to serotype O75 reported in China. The presence of highly pathogenic multidrug-resistant microorganisms isolated in neonates underscores the need to implement rapid resistance diagnostic methods and should prompt consideration of alternatives to empiric treatment of neonatal bacterial meningitis.


Asunto(s)
Antibacterianos , Meningoencefalitis , Lactante , Recién Nacido , Humanos , Antibacterianos/uso terapéutico , Escherichia coli , Cefoperazona/uso terapéutico , Sulbactam/uso terapéutico , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico
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