Influence of Strongyloides stercoralis Coinfection on the Presentation, Pathogenesis, and Outcome of Tuberculous Meningitis.

BACKGROUND: Helminth infections may modulate the inflammatory response to Mycobacterium tuberculosis and influence disease presentation and outcome. Strongyloides stercoralis is common among populations with high tuberculosis prevalence. Our aim was to determine whether S. stercoralis coinfection influenced clinical presentation, cerebrospinal fluid (CSF) inflammation, and outcome from tuberculous meningitis (TBM). METHODS: From June 2017 to December 2019, 668 Vietnamese adults with TBM, enrolled in the ACT HIV or LAST ACT trials (NCT03092817 and NCT03100786), underwent pretreatment S. stercoralis testing by serology, stool microscopy, and/or stool polymerase chain reaction. Comparisons of pretreatment TBM severity, CSF inflammation (including cytokines), and 3-month clinical end points were performed in groups with or without active S. stercoralis infection. RESULTS: Overall, 9.4% participants (63 of 668) tested positive for S. stercoralis. Active S. stercoralis infection was significantly associated with reduced pretreatment CSF neutrophil counts (median [interquartile range], 3/µL [0-25/µL] vs 14 /µL [1-83/µL]; P = .04), and with reduced CSF interferon É£, interleukin 2, and tumor necrosis factor α concentrations (11.4 vs 56.0 pg/mL [P = .01], 33.1 vs 54.5 pg/mL [P = .03], and 4.5 vs 11.9 pg/mL [P = .02], respectively), compared with uninfected participants. Neurological complications by 3 months were significantly reduced in participants with active S. stercoralis infection compared with uninfected participants (3.8% [1 of 26] vs 30.0% [33 of 110], respectively; P = .01). CONCLUSIONS: S. stercoralis coinfection may modulate the intracerebral inflammatory response to M. tuberculosis and improve TBM clinical outcomes.

Streptococcus suis-Associated Meningitis in a Southern Region of Vietnam.

Streptococcus suis is the most common and severe cause of meningitis in Vietnam, but the recent data about epidemiological characteristics and sequelae are still inadequate. We performed a retrospective study to describe the epidemiology, clinical characteristics, and outcomes of patients with S. suis-associated meningitis. A retrospective study was carried out by searching records from the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between January 2016 and January 2020. All data concerning epidemiological, clinical, and subclinical characteristics and treatment results were collected and analyzed. Over the study period, 153 cases were included in this study, with 95 cases occurring in the 2016-2017 period. The median age of all patients was 52 years (range, 29-90 years), and 70.6% of patients were male. Fifty-two patients (34%) were farmers, and the Mekong Delta was the region with the highest number of cases (60.1%). The most frequent manifestation of infection was fever (151/153, 98.7%), followed by hearing loss (64/153, 41.8%), and one patient (0.7%) died. All isolates remained susceptible to ceftriaxone, penicillin, vancomycin, and levofloxacin, whereas 99.2% of isolates were resistant to tetracycline. Occupational exposure to pigs and the consumption of contaminated food have been identified as primary risk factors associated with this zoonosis, and our study found no significant changes in epidemiological factors compared with past data. The Mekong Delta continues to be the most affected region for S. suis meningitis in southern Vietnam, with S. suis serotype 2 remaining the most relevant agent.

Central Nervous System Infection Diagnosis by Next-Generation Sequencing: A Glimpse Into the Future?

Japanese encephalitis virus was detected by deep sequencing for the first time in urine of a 16-year-old boy with encephalitis. Seroconversion and polymerase chain reaction analysis confirmed the metagenomics finding. Urine is useful for diagnosis of flaviviral encephalitis, whereas deep sequencing can be a panpathogen assay for the diagnosis of life-threatening infectious diseases.