Epidemiology, clinical and imaging features of rhombencephalitis caused by L. monocytogenes. A retrospective observational study. / Epidemiología, clínica y resultados de imagen de rombencefalitis causada por L. monocytogenes. Un estudio observacional.

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.

Amebic encephalitis and meningoencephalitis: an update on epidemiology, diagnostic methods, and treatment.

PURPOSE OF REVIEW: Free-living amebae (FLA) including Naegleria fowleri , Balamuthia mandrillaris , and Acanthamoeba species can cause rare, yet severe infections that are nearly always fatal. This review describes recent developments in epidemiology, diagnosis, and treatment of amebic meningoencephalitis. RECENT FINDINGS: Despite similarities among the three pathogenic FLA, there are notable variations in disease presentations, routes of transmission, populations at risk, and outcomes for each. Recently, molecular diagnostic tools have been used to diagnose a greater number of FLA infections. Treatment regimens for FLA have historically relied on survivor reports; more data is needed about novel treatments, including nitroxoline. SUMMARY: Research to identify new drugs and guide treatment regimens for amebic meningoencephalitis is lacking. However, improved diagnostic capabilities may lead to earlier diagnoses, allowing earlier treatment initiation and improved outcomes. Public health practitioners should continue to prioritize increasing awareness and providing education to clinicians, laboratorians, and the public about amebic infections.

Infectious encephalitis in elderly patients: a prospective multicentre observational study in France 2016-2019.

PURPOSE: Data on encephalitis in elderly patients are scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years. METHODS: We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016-2019. Cases were categorized in three age groups: (1) 18-64; (2) 65-79; (3) ≥ 80 years. RESULTS: Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥ 65 years, including 74 (15%) ≥ 80 years. Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P < 0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm3[13-220] in 65-79 years, 62 [17-180] in ≥ 80 years, vs. 114 [34-302] in < 65 years (P = 0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P < 0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P < 0.05 for each). In-hospital mortality was 6/234 (3%) in < 65 years, 18/183 (10%) in 65-79 years, and 13/73 (18%) in ≥ 80 years (P < 0.001). Age ≥ 80 years, coma on admission, CSF protein ≥ 0.8 g/L and viral encephalitis were independently predictive of 6 month mortality. CONCLUSION: Elderly patients represent > 50% of adults with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group.

Development of a risk scoring system for prognostication in HIV-related toxoplasma encephalitis.

BACKGROUND: This study aims to evaluate specific risk factors influencing prognosis of HIV-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them. METHODS: This is a six-center retrospective study of hospitalized HIV/TE patients. Data including six-week mortality after diagnosis, baseline characteristics, clinical features, laboratory tests and radiological characteristics of eligible patients were assimilated for risk model establishing. RESULTS: In this study, the six-week mortality among 94 retrospective cases was 11.7% (11/94). Seven specific risk factors, viz. time from symptom onset to presentation, fever, dizziness, CD4+ T-cell counts, memory deficits, patchy brain lesions, and disorders of consciousness were calculated to be statistically associated with mortality. A criterion value of '9' was selected as the optimal cut-off value of the established model. The AUC of the ROC curve of this scoring model was 0.976 (p < 0.001). The sensitivity and specificity of the risk scoring model was 100.0 and 86.9%, respectively, which were 81.8 and 94.1% of this scoring model in the verification cohort, respectively. CONCLUSIONS: The developed scoring system was established with simple risk factors, which also allows expeditious implementation of accurate prognostication, and appropriate therapeutic interventions in HIV-infected patients with TE.

Balamuthia mandrillaris infection in China: a retrospective report of 28 cases.

Balamuthia mandrillaris infection is a rare and fatal disease. We have recorded 28 cases of Balamuthia mandrillaris infection during the past 20 years. Eighteen patients (64%) were male and 10 (36%) were female. Patient age ranged from 3 to 74 (mean, 27) years. Patient locations were distributed among 12 Provinces in China. Twenty-seven (96%) patients lived in rural areas, and 17 (61%) patients reported a history of trauma before the appearance of skin lesions. All cases presented with skin lesions as the primary symptom, and 16 (57%) cases developed encephalitis. Histopathology of skin lesions revealed granulomatous changes with histiocytes, lymphocytes, and plasma cells infiltration. Amebas were identified in all cases with immunohistochemical staining. Follow-up information was available in 27 (96%) cases. Fifteen (56%) patients died due to encephalitis and 12 (44%) were free of disease after treatment. Our results show that the clinical characteristics of Balamuthia mandrillaris infection in China are very different from those in the US. Infection of traumatized skin may play an important role in the pathogenesis of the disease in China. Encephalitis usually develops 3-4 years after skin lesions in Chinese cases. Patients with only skin lesions have a higher cure rate than patients with encephalitis.

Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: Retrospective clinical study.

OBJECTIVE: Postoperative fever (POF), associated with posterior cranial fossa (PCF) surgery, occurs commonly and is a potential intracranial infection indicator of perioperative antibiotics prolongation and advancement. The existing prophylactic approaches to balancing the risk between intracranial infection and antibiotics abuse are debatable. METHODS: We retrospectively assessed 100 patients subjected to PCF tumor resection between December 2015 and December 2018 at a single institution. Forty febrile patients were selected for further analysis. Of them, 16 received basic and 24 advanced antibiotics and were subjected to prophylactic antibiotic assessment. RESULTS: The total POF rate of PCF tumor resection was 49.4%. POF occurred from day 1 to day 5, along with the abnormalities of cerebrospinal fluid (CSF) profiles and the mild meningeal irritation symptom. CSF cultures of all selected patients were negative. In the comparison between the basic and advanced antibiotic therapy, we found no statistically significant differences in the results of the average and dynamic analysis of the body temperature and CSF profiles. Negative results of outcome studies were also obtained in the duration of fever, duration of hospitalization, and total hospitalization expenses. However, the expenses were substantially increased in the advanced antibiotic treatment. CONCLUSIONS: Although POF is a common symptom after PCF tumor resection, definite intracranial infection is rare. A high body temperature and significant abnormal CSF profiles at an early stage may not be a specific and sufficient indicator of intracranial infection to upgrade antibiotics therapy when standard prophylactic protocols have been accurately achieved.

From Severe Herpes Zoster to Rare Suid Herpesvirus Encephalitis: A New Twist of the Varicellovirus Genus Infection in Patients with Kidney Diseases.

Both the herpes zoster virus and suid herpesvirus type 1 (SuHV-1) belong to the Varicellovirus genus of the α-herpesviridae subfamily. They may cause opportunistic infections especially in patients with kidney diseases, varying from latent illness to overt lethality. Under these circumstances, impaired renal function is both the culprit for and victim of the infection. However, fulminant eruption of severe skin herpes zoster in lupus nephritis (LN) patients under prolonged immunosuppressive therapy is rare and even more rarely seen is the SuHV-1 encephalitis in human. Facing the evolution of these rare infections, we hence chose to review the clinical pathogenicity of these two viruses which were cognate in origin but distinct in virulence. As such, we began with the first of the two above viral diseases and proceeded with peculiar renal involvement, unique clinical symptoms and pertinent lethal risk. Of importance, LN was used to exemplify the reciprocally detrimental interactions between impaired renal function and suppressed immune response. Then in a manner similar to the gradient overlay, SuHV-1 encephalitis was discussed focusing on its neurotropic features, specific MRI findings and exclusive test of high throughput sequencing. Our report highlighted novel presentations of the Varicellovirus genus infection by providing a productive multidisciplinary communication with pointed disclosure of the renal involvement. It may therefore be of great medical relevance and educational value for clinicians, especially the unseasoned ones, to foresee and manage similar cases in susceptible patients.

Epidemiology and Etiology of Severe Childhood Encephalitis in The Netherlands.

BACKGROUND: Limited data are available on childhood encephalitis. Our study aimed to increase insight on clinical presentation, etiology, and clinical outcome of children with severe encephalitis in the Netherlands. METHODS: We identified patients through the Dutch Pediatric Intensive Care Evaluation database and included children diagnosed with encephalitis <18 years of age admitted to 1 of the 8 pediatric intensive care units (PICU) in the Netherlands between January 2003 and December 2013. We analyzed demographic characteristics, clinical symptoms, neurologic imaging, etiology, treatment and mortality. RESULTS: We included 121 children with a median age of 4.6 years (IQR 1.3-9.8). The most frequently described clinical features were headache (82.1%), decreased consciousness (79.8%) and seizures (69.8%). In 44.6% of the children, no causative agent was identified. Viral- and immune-mediated encephalitis were diagnosed in 33.1% and 10.7% of the patients. A herpes simplex virus infection (13.2%) was mainly seen in children <5 years of age, median age, 1.73 years (IQR 0.77-5.01), while immune-mediated encephalitis mostly affected older children, median age of 10.4 years (IQR, 3.72-14.18). An age of ≥ 5 years at initial presentation was associated with a lower mortality (OR 0.2 [CI 0.08-0.78]). The detection of a bacterial (OR 9.4 [CI 2.18-40.46]) or viral (OR 3.7 [CI 1.16-11.73]) pathogen was associated with a higher mortality. CONCLUSIONS: In almost half of the Dutch children presenting with severe encephalitis, a causative pathogen could not be identified, underlining the need for enhancement of microbiologic diagnostics. The detection of a bacterial or viral pathogen was associated with a higher mortality.

Acanthamoeba and its pathogenic role in granulomatous amebic encephalitis.

Acanthamoeba is a free-living amoeba that is widely distributed in the environment. It is an opportunist protist, which is known to cause rare yet fatal infection of the central nervous system (CNS), granulomatous amebic encephalitis (GAE) in humans. GAE cases are increasingly been reported among immunocompromised patients, with few cases in immunocompetent hosts. Diagnosis of GAE primarily includes neuroimaging, microscopy, cerebrospinal fluid (CSF) culture, histopathology, serology and molecular techniques. Early diagnosis is vital for proper management of infected patients. Combination therapeutic approach has been tried in various GAE cases reported worldwide. We tried to present a comprehensive review, which summarizes on the epidemiology of GAE caused by Acanthamoeba along with the associated clinical symptoms, risk factors, diagnosis and treatment of GAE among infected patients.

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae.

OBJECTIVES: This is a retrospective observational study conducted in one of the largest clinical center of neurosurgery in China. Our aim was to determine the epidemiological characteristics of carbapenem-resistant Enterobacteriaceae (CRE) related meningitis/encephalitis and to elucidate the risk factors for CRE neurosurgical infections. PATIENTS AND METHODS: We performed a retrospective study between January 2012 and December 2017 of patients who underwent neurosurgery. The medical records of each patient were reviewed, and 20 clinical variables on risk factors were extracted and evaluated by Multivariate logistic analysis for CRE-meningitis/encephalitis. RESULTS: In 2012-2017, the positive rate of neurosurgical meningitis/encephalitis was 7.9% (2947/29605), Enterobacteriaceae accounted for 6.3% (185/2947) of all bacterial infections. Totally, 133 Enterobacteriaceae include 26 CRE isolates were available in this study. Of them, Univariate analysis showed that the risk factors of CRE meningitis were ventilator, bacteremia, Intensive Care Unit (ICU) admission, hospital acquired pneumonia and mortality attribute to infection. Multivariate logistic analysis showed that hospital acquired pneumonia and mortality attribute to infection were independent risk factors for CRE meningitis. CONCLUSION: CRE is one of the most serious drug-resistant bacteria published by World Health Organization (WHO) in 2016, and meningitis/encephalitis caused by CRE is an important sign of the failure of the neurosurgery, which demands the physician's immediate attention.

Genetic diversity of Listeria monocytogenes strains in ruminant abortion and rhombencephalitis cases in comparison with the natural environment.

BACKGROUND: Listeria monocytogenes is the causative agent of listeriosis, a serious disease affecting both animals and humans. Here, multilocus sequence typing (MLST) was used to characterize the genetic diversity of Listeria monocytogenes strains isolated from the natural environment and animal clinical cases in Europe. The prevalence of clonal complexes (CCs) obtained was compared according to (i) the origin of isolation - clinical cases vs. natural environment - and (ii) the clinical form of animal listeriosis - rhombencephalitis vs. abortion. To this aim, two datasets were constructed. The clinical dataset consisted of 350 animal clinical isolates originating from France and Slovenia and supplemented with isolates from Switzerland and Great Britain. The natural environment dataset consisted of 253 isolates from the natural environment originating from Slovenia and supplemented with isolates from nine other European countries. RESULTS: For the clinical cases, CC1, CC4-CC217 and CC412 were the most prevalent in rhombencephalitis and CC1, CC37 and CC4-CC217 in abortion. The hypervirulent CC1 and CC4-CC217 prevailed in both datasets. These results indicated that livestock is constantly exposed to hypervirulent CCs. CC1 was significantly associated with a clinical origin, whereas CC9, CC29 and CC14 were associated with the natural environment. CC1 was predominant among rhombencephalitis cases both in cattle and small ruminants, and its prevalence did not differ significantly between these two groups. A novel association of CC37 and CC6 with abortion cases was revealed. CONCLUSIONS: Here, we show that CC1 and CC4-CC217 are prevalent in isolates of environmental and animal clinical origin, suggesting that ruminants are frequently exposed to hypervirulent CCs. The presence of CC4 in two mastitis cases calls for further attention due to direct threat to the consumer. We showed several associations between CCs and the origin of isolation or clinical form of listeriosis, e.g. CC37 and CC6 with abortion. This study improves our understanding of the population structure of L. monocytogenes isolates from the natural environment and animal clinical cases. Moreover, it provides a basis for future studies aiming to determine the underlying mechanisms of phenotypic traits of interest.

Infectious ocular motor neuropathies.

PURPOSE OF REVIEW: Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies. RECENT FINDINGS: Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a wider range of organisms. SUMMARY: Infectious ocular motor neuropathies can occur anywhere along the length of cranial nerves III, IV, and VI. Characteristic clinical findings and imaging can be used to localize infections. Infectious causes may have characteristic clinical, laboratory, or imaging findings, but must still be carefully separated from inflammatory or neoplastic conditions.

Immune-mediated encephalitis for the infectious disease specialist.

PURPOSE OF REVIEW: Autoimmune encephalitis is increasingly recognized and must be distinguished from infectious forms of encephalitis. Moreover, physicians should be aware of infectious triggers of autoimmune encephalitis and of infectious complications associated with treatment. RECENT FINDINGS: Recent epidemiological studies suggest that the incidence of autoimmune encephalitis may rival that of infectious encephalitis. Although distinguishing autoimmune from infectious forms of encephalitis on clinical grounds can be challenging, recently proposed diagnostic criteria can provide some assistance. There has been an explosion in our knowledge of autoimmune encephalitis associated with antibodies to neuronal cell surface antigens, and two of the most common forms, anti-NMDA receptor encephalitis and anti-LGI1 encephalitis, are typically associated with distinctive clinical features. Although tumors have long been known to trigger autoimmune encephalitis, it has been recently recognized that herpes simplex encephalitis may trigger the generation of antineuronal autoantibodies resulting in an autoimmune neurologic relapse. Both first and second-line therapies for autoimmune encephalitis are associated with infectious complications, whereas emerging treatments, including anakinra and tocilizumab, may also result in increased susceptibility to certain infections. SUMMARY: The diagnosis and management of autoimmune encephalitis is complex, and awareness of diagnostic criteria and modalities, typical clinical syndromes, infectious triggers of disease, and infectious complications of therapies is critical in optimizing care for affected patients.

The Epidemiology and Clinical Features of Balamuthia mandrillaris Disease in the United States, 1974-2016.

BACKGROUND: Balamuthia mandrillaris is a free-living ameba that causes rare, nearly always fatal disease in humans and animals worldwide. B. mandrillaris has been isolated from soil, dust, and water. Initial entry of Balamuthia into the body is likely via the skin or lungs. To date, only individual case reports and small case series have been published. METHODS: The Centers for Disease Control and Prevention (CDC) maintains a free-living ameba (FLA) registry and laboratory. To be entered into the registry, a Balamuthia case must be laboratory-confirmed. Several sources were used to complete entries in the registry, including case report forms, CDC laboratory results, published case reports, and media information. SAS© version 9.3 software was used to calculate descriptive statistics and frequencies. RESULTS: We identified 109 case reports of Balamuthia disease between 1974 and 2016. Most (99%) had encephalitis. The median age was 36 years (range 4 months to 91 years). Males accounted for 68% of the case patients. California had the highest number of case reports, followed by Texas and Arizona. Hispanics constituted 55% for those with documented ethnicity. Exposure to soil was commonly reported. Among those with a known outcome, 90% of patients died. CONCLUSIONS: Balamuthia disease in the United States is characterized by a highly fatal encephalitis that affects patients of all ages. Hispanics were disproportionately affected. The southwest region of the United States reported the most cases. Clinician awareness of Balamuthia as a cause of encephalitis might lead to earlier diagnosis and initiation of treatment, resulting in better outcomes.

Rickettsia typhi as Cause of Fatal Encephalitic Typhus in Hospitalized Patients, Hamburg, Germany, 1940-1944.

We evaluated formalin-fixed paraffin-embedded tissue specimens from 7 patients who died with encephalitic typhus in Hamburg, Germany, during World War II. The archived specimens included only central nervous system tissues >70 years old that had been stored at room temperature. We demonstrated successful detection of Rickettsia typhi DNA by a nested qPCR specific to prsA in 2 patients. These results indicate that R. typhi infections contributed to typhus outbreaks during World War II. Immunohistochemical analyses of brain tissue specimens of R. typhi DNA-positive and -negative specimens showed perivascular B-cell accumulation. Around blood vessels, nodular cell accumulations consisted of CD4-positive and CD8-positive T cells and CD68-positive microglia and macrophages; neutrophils were found rarely. These findings are similar to those of previously reported R. prowazekii tissue specimen testing. Because R. typhi and R. prowazekii infections can be clinically and histopathologically similar, molecular analyses should be performed to distinguish the 2 pathogens.

[Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia]. / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital.

Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus. Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.

Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital

Resumen Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus.

Abstract Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.

Assessment of risk for transplant-transmissible infectious encephalitis among deceased organ donors.

BACKGROUND: There were 13 documented clusters of infectious encephalitis transmission via organ transplant from deceased donors to recipients during 2002-2013. Hence, organs from donors diagnosed with encephalitis are often declined because of concerns about the possibility of infection, given that there is no quick and simple test to detect causes of infectious encephalitis. METHODS: We constructed a database containing cases of infectious and non-infectious encephalitis. Using statistical imputation, cross-validation, and regression techniques, we determined deceased organ donor characteristics, including demographics, signs, symptoms, physical exam, and laboratory findings, predictive of infectious vs non-infectious encephalitis, and developed a calculator which assesses the risk of infection. RESULTS: Using up to 12 predictive patient characteristics (with a minimum of 3, depending on what information is available), the calculator provides the probability that a donor may have infectious vs non-infectious encephalitis, improving the prediction accuracy over current practices. These characteristics include gender, fever, immunocompromised state (other than HIV), cerebrospinal fluid elevation, altered mental status, psychiatric features, cranial nerve abnormality, meningeal signs, focal motor weakness, Babinski's sign, movement disorder, and sensory abnormalities. CONCLUSION: In the absence of definitive diagnostic testing in a potential organ donor, infectious encephalitis can be predicted with a risk score. The risk calculator presented in this paper represents a prototype, establishing a framework that can be expanded to other infectious diseases transmissible through solid organ transplantation.

Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis.

OBJECTIVE: To evaluate the incidence and prevalence of autoimmune encephalitis and compare it to that of infectious encephalitis. METHODS: We performed a population-based comparative study of the incidence and prevalence of autoimmune and infectious encephalitis in Olmsted County, Minnesota. Autoimmune encephalitis diagnosis and subgroups were defined by 2016 diagnostic criteria, and infectious encephalitis diagnosis required a confirmed infectious pathogen. Age- and sex-adjusted prevalence and incidence rates were calculated. Patients with encephalitis of uncertain etiology were excluded. RESULTS: The prevalence of autoimmune encephalitis on January 1, 2014 of 13.7/100,000 was not significantly different from that of all infectious encephalitides (11.6/100,000; p = 0.63) or the viral subcategory (8.3/100,000; p = 0.17). The incidence rates (1995-2015) of autoimmune and infectious encephalitis were 0.8/100,000 and 1.0/100,000 person-years, respectively (p = 0.58). The number of relapses or recurrent hospitalizations was higher for autoimmune than infectious encephalitis (p = 0.03). The incidence of autoimmune encephalitis increased over time from 0.4/100,000 person-years (1995-2005) to 1.2/100,000 person-years (2006-2015; p = 0.02), attributable to increased detection of autoantibody-positive cases. The incidence (2.8 vs 0.7/100,000 person-years, p = 0.01) and prevalence (38.3 vs 13.7/100,000, p = 0.04) of autoimmune encephalitis was higher among African Americans than Caucasians. The prevalence of specific neural autoantibodies was as follows: myelin oligodendrocyte glycoprotein, 1.9/100,000; glutamic acid decarboxylase 65, 1.9/100,000; unclassified neural autoantibody, 1.4/100,000; leucine-rich glioma-inactivated protein 1, 0.7/100,000; collapsin response-mediator protein 5, 0.7/100,000; N-methyl-D-aspartate receptor, 0.6/100,000; antineuronal nuclear antibody type 2, 0.6/100,000; and glial fibrillary acidic protein α, 0.6/100,000. INTERPRETATION: This study shows that the prevalence and incidence of autoimmune encephalitis are comparable to infectious encephalitis, and its detection is increasing over time. Ann Neurol 2018;83:166-177.