Rapid syndromic molecular testing and human parechovirus infection in children: A report of three cases in Argentina / Diagnóstico molecular sindrómico rápido e infección por parechovirus humano en ninos: reporte de 3 casos en Argentina

Abstract Human parechovirus (HPeV) is one of the members of the family Picornaviridae that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, orencephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.

Resumen Los parechovirus humanos (HPeV) son virus de la familia Picornaviridae, que se han asociado a diferentes cuadros clínicos, como fiebre de origen desconocido, gastroenteritis, sepsis, meningitis o encefalitis en ninos pequeños. Su detección no está disponible de rutina en la mayoría de los laboratorios de nuestro país, por lo que su prevalencia es desconocida. Reportamos 3 casos de infección del sistema nervioso central por HPeV con diferentes características clínicas, que se presentaron luego de la implementación de un panel molecular para el diagnóstico sindrómico de meningitis/encefalitis. Las técnicas de diagnóstico molecular podrían ayudar a mejorar el abordaje y el cuidado de estos pacientes, así como también a conocer la prevalencia de esta infección en Argentina.

Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room / 대한구급학회지

BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room / 대한중환자의학회지

BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Nocardia Brain Abscess Mimicking a Metastatic Brain Tumor: A Severe CNS Infection Requiring Aggressive Management

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

Encephalitis Induced by 2009 H1N1 Influenza A

The number of domestic cases of pandemic H1N1 influenza A was elevated in 2009. The common clinical symptoms associated with H1N1 influenza include respiratory symptoms such as cough, sore throat, rhinorrhea, fever, chills, myalgia, and fatigue. Gastrointestinal symptoms are relatively common. H1N1 influenza A infection brings about neurological symptoms in rare cases. However, there are few reports about H1N1 influenza A infection with neurological manifestations. We recently experienced an H1N1 influenza A patient who presented with disturbed mental status, seizures, and focal changes on brain magnetic resonance imaging, associated with infection.

A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate / 감염과화학요법

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.

A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate / 감염과화학요법

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.

Central Nervous System Infection Related to Intracranial Indwelling Catheters / 대한뇌혈관외과학회지

OBJECTIVE: Infection of the intracranial catheter remains the main morbidity and mortality associated with this procedure. In this retrospective study we have collected the information regarding the occurrence of this disease in order to find ways to reduce the incidence of central nervous system (CNS) infection related to an intracranial indwelling catheter. METHOD: In a six-year retrospective study we selected and reviewed the records of 242 patients (with a total of 314 catheters). We analyzed the incidence of infection, etiologic bacteria and factors affecting the risk of infection: catheter duration, catheter sequence, concurrent craniotomy, subcutaneous tunneling of catheter, cerebrospinal fluid (CSF) draining catheter, urokinase irrigation. RESULTS: Nineteen patients were infected. the infection rate was thus 8%. Staphylococcus aureus and Coagulase-Negative Staphylococcus are the most frequently-involved pathogens. The onset of infection ranged from 6 days to 38 days (with a mean of 14 days). There was a significant association between infection and a CSF draining catheter, a concurrent craniotomy, no subcutaneous tunneling, the duration of the catheter and multiple sequential catheters in the univariate logistic regression model. There was, however, no significant association between a CSF draining catheter and infection in the multivariate logistic regression model. CONCLUSION: The result of this study suggests that long catheter duration, no subcutaneous tunneling, multiple sequential catheters, concurrent craniotomy increase the incidence of CNS infection related to an intracranial indwelling catheter. An intracranial catheter must be placed using aseptic procedures with subcutaneous tunneling and maintenance of a strict closed system alsoshort duration as possible as.

Experiences of epilepsy surgery in intractable seizures with past history of CNS infection

We studied the clinical characteristics, location of epileptogenic regions, and the surgical outcomes in 18 patients with intractable epilepsy associated with previous CNS infections. All patients underwent an extensive presurgical evaluation and 11 patients had intracranial EEG monitoring. On the basis of presurgical evaluation, epileptic regions were localized to the mesial temporal (n = 12) and the neocortical (n = 6) regions. The age of the time of CNS infection was significantly younger and the latent period of non-febrile seizures after CNS infection was longer in patients with mesial temporal lobe epilepsy (MTLE). MRI showed hippocampal atrophy and hippocampal signal changes in 11 of 12 patients with MTLE. Among 6 patients with neocortical epilepsy (NE) 5 patients had normal MRI and one showed cerebral hemi-atrophy. Surgery was successful (class I & II) in all patients with MTLE, however, in the patients with neocortical epilepsy, seizure-free results were not achieved in any patients after resective surgery (6 patients) and only 2 patients achieved Class II outcomes after a second epilepsy surgery consisting of neocortical resection. Patients with MTLE after CNS infection were differentiated from the group of neocortical epilepsy by an earlier onset of CNS infection, a prolonged latent period and a higher frequency of meningitis. The characteristic pathology in this group was hippocampal sclerosis and the surgical result was excellent. Neocortical epilepsy following CNS infection usually had no focal lesion on MRI and was associated with a relatively poor surgical result. This study suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures. The association of MTLE with the younger age of CNS infections and with meningitis more frequently suggested that the neocortical neurons during infancy or early childhood may be more resistant to the epileptogenesis, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.