Evaluation of pathogen from the FilmArray meningitis/encephalitis panel and recommendations on atypical findings / Avaliação do patógeno do painel de meningite/encefalite FilmArray e recomendações sobre achados atípicos

Abstract Background Infectious meningoencephalitis is a potentially fatal clinical condition that causes inflammation of the central nervous system secondary to the installation of different microorganisms. The FilmArray meningitis/encephalitis panel allows the simultaneous detection of 14 pathogens with results in about one hour. Objective This study is based on retrospectively evaluating the implementation of the FilmArray meningitis/encephalitis panel in a hospital environment, highlighting the general results and, especially, analyzing the consistency of the test results against the clinical and laboratory conditions of the patients. Methods Data were collected through the results reported by the BioFire FilmArray system software from the meningitis/encephalitis panel. The correlated laboratory tests used in our analysis, when available, included biochemical, cytological, direct and indirect microbiological tests. Results In the analyzed period, there were 496 samples with released results. Of the total of 496 samples analyzed, 88 (17.75%) were considered positive, and 90 pathogens were detected, and in 2 of these (2.27%) there was co-detection of pathogens. Viruses were the agents most frequently found within the total number of pathogens detected. Of the 496 proven samples, 20 (4.03%) were repeated, 5 of which were repeated due to invalid results, 6 due to the detection of multiple pathogens and 9 due to disagreement between the panel results and the other laboratory tests and/or divergence of the clinical-epidemiological picture. Of these 20 repeated samples, only 4 of them (20%) maintained the original result after repeating the test, with 16 (80%) being non-reproducible. The main factor related to the disagreement of these 16 samples during retesting was the detection of bacterial agents without any relationship with other laboratory tests or with the patients' clinical condition. Conclusion In our study, simply reproducing tests with atypical results from the FilmArray meningitis/encephalitis panel proved, in most cases, effective and sufficient for interpreting these results.

Resumo Antecedentes A meningoencefalite infecciosa é uma condição clínica potencialmente fatal que causa inflamação do sistema nervoso central secundária à instalação de diversos microrganismos. O painel de meningite/encefalite FilmArray permite a detecção simultânea de 14 patógenos, com resultados em cerca de uma hora. Objetivo Este estudo baseia-se em avaliar retrospectivamente a implementação do painel de meningite/encefalite FilmArray em ambiente hospitalar, destacando os resultados gerais e, principalmente, analisando a consistência dos resultados do teste frente às condições clínicas e laboratoriais dos pacientes. Métodos Os dados foram coletados por meio dos resultados relatados pelo software do sistema BioFire FilmArray do painel de meningite/encefalite. Os exames laboratoriais correlacionados utilizados em nossa análise, quando disponíveis, incluíram exames bioquímicos, citológicos, microbiológicos diretos e indiretos. Resultados No período analisado, foram 496 amostras com resultados divulgados. Do total de 496 amostras analisadas, 88 (17,75%) foram consideradas positivas e 90 patógenos foram detectados, sendo que em duas destas (2,27%) houve codetecção de patógenos. Os vírus foram os agentes mais frequentemente encontrados dentro do total de patógenos detectados. Das 496 amostras analisadas, 20 (4,03%) foram repetidas, sendo 5 repetidas por resultado inválido, 6 pela detecção de múltiplos patógenos e 9 por discordância dos resultados do painel com os demais exames laboratoriais e/ou divergência do quadro clínico-epidemiológico. Destas 20 amostras repetidas, apenas 4 delas (20%) mantiveram o resultado original após a repetição do teste, sendo 16 (80%) não reprodutíveis. O principal fator relacionado à discordância destas 16 amostras na retestagem foi a detecção de agentes bacterianos sem qualquer relação com os demais exames laboratoriais ou com o quadro clínico dos pacientes. Conclusão Em nosso estudo, a simples repetição dos testes com resultados atípicos do painel de meningite/encefalite FilmArray mostrou-se, na maior dos casos, efetiva e suficiente para a interpretação destes achados.

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay / Clinical and epidemiological characterization of the Chikungunya epidemic in Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

Caracterización clínica y epidemiológica de la epidemia de Chikungunya en el Paraguay

Durante el verano del 2022 y 2023 ocurrió la mayor epidemia de Chikungunya en Paraguay, y una de las más grandes reportadas en la región. Estuvo centralizada en el área metropolitana de Asunción en una primera etapa, pero se expandió al resto del país durante los primeros meses del 2023. Este trabajo tiene el objetivo de describir epidemiológica y clínicamente la epidemia desde su inicio en la semana epidemiológica 40 del 2022 hasta la semana 20 del 2023. Metodología: es un estudio descriptivo que utiliza los datos públicos disponibles en la página de la Dirección General de Vigilancia de la Salud. Fueron confirmados 86.761 casos, 58% femenino, 8227 ingresos hospitalarios y 248 fallecidos. La letalidad global es de 2.8 por mil casos confirmados. Los grupos etarios más afectados corresponden a la franja de 0 a 4 años (9%), sin embargo, la mayor incidencia de casos se da en mayores de 80 años. Los principales desafíos de esta enfermedad son el abordaje multidisciplinario en la gestión del manejo del vector, la evaluación de las causas de esta alta letalidad y la necesidad de una vacuna de uso poblacional.

During the summer of 2022 and 2023, the largest Chikungunya epidemic occurred in Paraguay, and one of the largest reported in the region. It was centralized in the metropolitan area of Asunción in a first stage, but it expanded to the rest of the country during the first months of 2023. This work has the objective of describing the epidemic epidemiologically and clinically from its beginning in epidemiological week 40 of 2022 to week 20 of 2023. Methodology: it is a descriptive study that uses the public data available on the page of the General Directorate of Health Surveillance. 86,761 cases were confirmed, 58% female, 8,227 hospital admissions, and 248 deaths. The global lethality is 2.8 per thousand confirmed cases. The most affected age groups correspond to the 0 to 4-year-old group (9%), however, the highest incidence of cases occurs in people over 80 years of age. The main challenges of this disease are the multidisciplinary approach in the management of the vector, the evaluation of the causes of this high lethality and the need for a vaccine for population use.

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A

ABSTRACT We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.

Co-infection of Coronavirus Omicron variant and Salmonella Meningoencephalitis

@#It has been considered that viral infections predispose patients to bacterial infections due to immunosuppression.3 However, it is still unclear what exact roles co-infections play in patients with COVID-19 infection1. Centers for Disease Control and Prevention defines co -infection as an infection concurrent with the initial infection. This report discusses a case of meningoencephalitis presenting with seizures. Notable in this case was the detection of SARS-CoV-2 RNA and Salmonella in the CSF.

Autoimmune glial fibrillary acidic protein astrocytopathy / 中华神经科杂志

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a rare immune-mediated inflammatory disease of central nervous system reported in recent years, and its specific biological marker is anti-GFAP autoantibody. In this paper, the etiology, pathogenesis, clinical manifestations, auxiliary examination and treatment of the disease are comprehensively expounded, so as to improve the understanding of clinicians, especially neurologists.

Characteristic of cardiac and neurological forms of non-polio enterovirus infection

Enterovirus infections (EVI) are ubiquitous and generally present with mild symptoms and have a favorableprognosis with full recovery. But sometimes it can be challenging to diagnose mixed forms of EVI which can result in fatal outcomes. An interesting case report on a patient admitted to the Grodno Regional infectious diseases clinical hospital. The patientwas diagnosed with enteroviral infection. Histological slides of the brain, heart, lung and other systemic organs were prepared on autopsy and are presented in this scientific paper. Generalized EVI in mixed form can cause primary lesions of the brain (destructive edema), the heart (necrotizing cardiomyopathy), and sepsis while also affecting other organ systems. This can lead to unfavorable outcomes similar to that in our case report. Mixed form EVI (meningitis, myocarditis, and sepsis) can progress rapidly towards an adverse course, with the development of severe life-threatening complications. We strongly suggest that mandatory PCR screening for EVI should be carried out in young individuals with sepsis-like diseases and with a fever of unexplained origin at the time of presentation.

Infecção por Varicela-Zóster em paciente imunossupresso com complicações graves e inesperado desfecho clínico favorável / Varicella Zoster virus infection in immunosuppressed patient with serious complications and unexpected favorable clinical outcome / Infección por Varicela Zóster en paciente inmunosuprimido con complicaciones graves y evolución clínica favorable inesperada

O vírus varicela-zóster pode recorrer diante de imunodeficiência. A falta de imunidade celular pode ser tão grave a ponto de comprometer o sistema nervoso central. Neste caso, o paciente apresentou quadro de aids com meningoencefalopatia por vasculite. Pela alta suspeição diagnóstica, foi iniciado tratamento, empírica e precocemente, com aciclovir, corticoide e anticonvulsivante endovenosos. O diagnóstico se deu posteriormente. Com base neste caso, foi proposta uma estratégia eficaz de atendimento.

Varicella zoster virus infection may recur in the face of immunodeficiency, which can be so severe as to compromise the central nervous system. In the case studied, the patient presented a clinical picture of AIDS along with vasculitis meningoencephalopathy. Due to high diagnostic suspicion, intravenous Acyclovir, Corticosteroid and Intravenous Anticonvulsant were administered early. Diagnosis occurred later. On this case, an effective care strategy was proposed.

El virus de la varicela zóster puede reaparecer ante una inmunodeficiencia. La falta de inmunidad celular puede ser tan grave como para comprometer el sistema nervioso central. En este caso, el paciente desarrolló SIDA junto con meningoencefalopatía por vasculitis. Debido a la alta sospecha diagnóstica, se inició de forma empírica y precoz Aciclovir, corticoides y anticonvulsivantes intravenosos. Después, se realizó el diagnóstico. A partir de este caso se planteó una estrategia de atención eficaz.

Experiencia de dos años con el uso de panel de RPC múltiple de meningitis-encefalitis en pacientes pediátricos en un hospital de tercer nivel en Argentina

Introducción: La meningitis bacteriana aguda (MBA) y la encefalitis son infecciones graves y el retraso en el tratamiento determina mayor morbimortalidad. En 2015 la FDA. aprobó un panel de RPC múltiple, BioFire® Filmarray® meningitis-encefalitis (FA-ME), que desde el 2019 se encuentra disponible en nuestro hospital. Objetivos: Estimar número de determinaciones positivas mediante FA-ME, evaluar concordancia con cultivo convencional (CC) y describir si FA-ME permitió realizar cambios en el tratamiento. Material y Métodos: Estudio retrospectivo, descriptivo, realizado durante 2019-2021 en el Hospital de Niños Pedro Elizalde. Se revisaron reportes de niños con meningitis, encefalitis y meningoencefalitis y líquido-cefalorraquídeo patológico a quienes se les realizó FA-ME. Resultados: Se incluyó a 32 niños, edad promedio: 48 meses. Fueron positivas 13 determinaciones de FA-ME: siete bacterias y seis virus. En dos MBA obtuvo desarrollo mediante CC. Con FA-ME se ajustó el tratamiento en dos MBA y se acortó el tratamiento intravenoso (IV). Discusión: Nuestro trabajo permitió conocer la etiología de cinco MBA con cultivo negativo, de las cuales dos habían recibido antimicrobianos, administrar quimioprofilaxis a contactos epidemiológicos, acortar el tratamiento IV y suministrar menos dosis de aciclovir; en concordancia con la literatura médica. Conclusiones: FA-ME permitió identificar la etiología en cinco MBA que no desarrollaron en CC, ajustar tratamientos empíricos inadecuados y acortar duración del tratamiento parenteral.

Background: Bacterial meningitis and encephalitis are life-threatening infections, a delay in its treatment is associated with high mortality. In 2015, FDA approved the Multiplex PCR FilmArray™ meningitis/encephalitis syndromic panel (FA-MEP), and it is available in our hospital since 2019. Aim: To estimate the number of positive FA-MEP, to evaluate the correlation to conventional culture (CC) results and to describe if the FA-MEP technology allowed changes in the treatment. Methods: Retrospective analysis of children with meningitis, encephalitis and meningoencephalitis and pathological cerebrospinal fluid analysis between 2019-2021, who were subject to FA-MEP testing at the Pedro Elizalde Children's Hospital. Results: 32 children, mean age: 48 months. 11 patients had positive FA-ME tests: 7 bacterial, 6 viral. 2 patients correlated with CC. Based on the FAMEP results, treatment was adjusted in 2 bacterial meningitis and the duration of intravenous treatment was shortened. Discussion: Our study allowed to establish the etiology of 5 culture negative bacterial meningitis, (2 had prior antibiotics), administer chemoprophylaxis to close contacts, and to administer fewer doses of acyclovir. Conclusions: The FA-MEP allowed us to identify 5 bacterial meningitis that tested negative by CC and early adjustment of inappropriate empirical antibiotics and to shorten the duration of parenteral treatments.

Ultrasonografía del diámetro de la vaina del nervio óptico en paciente con meningoencefalitis complicada / Ultrasonography of the optic nerve sheath diameter in patient with complicated meningoencephalitis

RESUMEN La ultrasonografía del diámetro de la vaina del nervio óptico es un método no invasivo para monitorizar la presión intracraneal. Se ha utilizado en múltiples patologías neurocríticas, incluyendo la infección complicada del sistema nervioso central. Se presenta el caso de una paciente femenina de 47 años, quien ingresó en la Unidad de Cuidados Intensivos luego de presentar progresión al estado comatoso secundario a cuadro de meningoencefalitis bacteriana. Al ingreso se constata midriasis bilateral arreactiva, ausencia parcial de reflejos del tallo encefálico y bradicardia. Ante la sospecha clínica de hipertensión intracraneal, se indica ultrasonografía del diámetro de la vaina del nervio óptico en plano axial. Se realizaron tres mediciones para cada ojo, mostrando un valor de 6,3, 6,6 y 6,00 mm en ojo derecho, y 6,8, 6,6 y 6,8 mm en el izquierdo (promedio biocular: 6,5 mm). Con esta medición se complementó el diagnóstico sospechado. Esta técnica representa un proceder seguro y no invasivo. Su uso completa los datos recogidos en el examen clínico. El punto de corte universalmente aceptado para el diagnóstico es de 5,0 mm o más para un valor de presión intracraneal > 20 mmHg.

ABSTRACT The optic nerve sheath ultrasonography is a non-invasive method for monitoring intracranial pressure. It has been used in multiple neurocritical pathologies, including the complicated infection of the central nervous system. The case of a 47-year-old female patient is presented; she was admitted to the Intensive Care Unit after presenting progression to comatose state secondary to bacterial meningoencephalitis. On admission, bilateral arreactive mydriasis, partial absence of brainstem reflexes and bradycardia are confirmed. Given the clinical suspicion of intracranial hypertension, ultrasonography of the optic nerve sheath diameter in the axial plane is indicated. Three measurements were made for each eye, showing a value of 6.3, 6.6 and 6.00 in the right eye, and 6.8, 6.6 and 6.8 in the left one (biocular average: 6.5 mm). With this measurement the suspected diagnosis was completed. This technique represents a secure and non-invasive procedure. Its use completes the data collected in the clinical examination. The universally accepted cut-off point for diagnosis is 5.0 mm or more for an intracranial pressure value of > 20 mmHg.

Cerebrospinal fluid analysis: current diagnostic methods in central nervous system infectious diseases / Novos métodos diagnósticos liquóricos nas doenças infecciosas do sistema nervoso central

ABSTRACT Cerebrospinal fluid (CSF) analysis is an important diagnostic tool for many conditions affecting the central nervous system (CNS), especially CNS infectious diseases. Despite its low specificity, CSF white blood cell counts, CSF protein levels, CSF serum glucose ratio and CSF lactate measurement are useful in differentiating infections caused by distinct groups of pathogens. CSF direct examination and cultures can identify causative organisms and antibiotic sensitivities as well. Adjunctive tests such as latex agglutination, different immunological assays and molecular reactions have great specificities and increasing sensitivities. In this article, some recent diagnostic methods applied to CSF analysis for frequent CNS infections are presented.

RESUMO A análise do líquido cefalorraquiano (LCR) é uma importante ferramenta diagnóstica para muitas condições que afetam o sistema nervoso central (SNC), especialmente as doenças infecciosas. Apesar da baixa especificidade, a contagem de leucócitos no LCR, a determinação dos níveis de proteína, glicose e lactato podem ser úteis na diferenciação de infecções causadas por diferentes grupos de patógenos. O exame direto e as culturas podem identificar organismos causadores de infecções bem como suas sensibilidades a antibióticos. Testes adjuvantes como aglutinação em látex, diferentes ensaios imunológicos e reações moleculares têm taxas de sensibilidades e especificidades crescentes. Neste artigo, são apresentados alguns métodos diagnósticos mais recentemente aplicados à análise do LCR no diagnóstico das infecções do SNC.

Profile of Neurological Manifestations in Children Presenting With Rickettsial Disease

Objective: To study the profile of neurological manifestation of rickettsial disease in children. Methods: Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results: Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion: Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.

Primary amoebic meningoencephalitis in children: a case report and literature review / 中华实用儿科临床杂志

A case of primary amoebic meningoencephalitis (PAM) treated in the First Affiliated Hospital of Xinxiang Medical University in March 6, 2022 was reported.The proband was a 14-year-old boy, who was admitted to the hospital because of " fever, headache and vomiting for 2 days" . Metagenomic next-generation sequencing (mNGS) was consequently conducted to examine the pathogens in cerebrospinal fluid.Naegleria infection was detected, so the child was diagnosed with PAM.The disease developed rapidly, and the patient died 29 hours after admission.In the paper, a total of 13 studies were reviewed, and 15 children with PAM were reported.Of the reported cases, only 1 case survived, 14 cases died.PAM had a low incidence, a dangerous condition, and high mortality.Most cases were diagnosed by autopsy or pathogen diagnosis in cerebrospinal fluid.This case is confirmed by mNGS of pathogens, and it is rarely reported at home and abroad.

Neurologic manifestation of Covid-19 pediatric patients admitted at the Philippine Children's Medical Center in the year 2020: a case series

@#<p>Covid-19 which was first documented in the Philippines in January 2020 had spread alarmingly. Severe acute respiratory symptoms were the most common presentation of this novel coronavirus infection. Reports have described neurologic manifestations of this disease involving the central nervous system as well as the peripheral nervous system. However, studies among the pediatric population are limited. In this paper, we present three pediatric patients who were diagnosed with COVID-19, via RT-PCR, presenting with seizures and behavioral changes. Two of these patients have no concomitant respiratory symptoms while the other one had Pediatric Community Acquired Pneumonia. These patients were managed as cases of acute viral meningoencephalitis and were given supportive care.</p>

Caracterización de la meningoencefalitis bacteriana en la provincia Camagüey en el período de 2016-2020

Introducción: Las infecciones del sistema nervioso central constituyen un importante problema de salud en todas las regiones del planeta; representan un reto para el médico de asistencia, el microbiólogo y el epidemiólogo, en función de un precoz y correcto diagnóstico, elementos básicos para un pronóstico satisfactorio. Objetivo: Determinar el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey. Métodos: Se realizó un estudio observacional descriptivo, transversal y retrospectivo, sobre el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey en el periodo comprendido desde el 2016 hasta el 2020. El universo de estudio estuvo constituido por todos los casos (128) diagnosticados con meningoencefalitis bacteriana, atendidos en los hospitales de más de 100 camas durante el período del primero de enero de 2016 al 31 de diciembre de 2020. Resultados: El año 2017 resultó ser el mayor número de casos, el agente causal predominante fue el Streptococcus pneumoniae; las edades pediátricas fueron las de mayor incidencia en especial el menor de un año y sexo masculino. El síntoma cardinal en el estudio fue la fiebre y el neumococo fue el más letal agente causal. Conclusiones: El diagnóstico precoz de las meningoencefalitis bacterianas conlleva a una menor letalidad y por ende menos secuelas.

Introduction: Central nervous system infections are an important health problem in all regions of the planet; they represent a challenge for the attending physician, the microbiologist and the epidemiologist, based on an early and correct diagnosis, basic elements for a satisfactory prognosis. Objective: To determine the behavior of bacterial meningoencephalitis in the Province of Camagüey. Methods: A descriptive, cross-sectional and retrospective observational study was carried out on the behavior of bacterial meningoencephalitis in Camagüey province during the period 2016-2020. The study universe consisted of all cases (128) diagnosed with bacterial meningoencephalitis, attended in Hospitals with more than 100 beds during the period from January 1st, 2016 to December 31st, 2020. Results: The year 2017 turned out to be the one with the largest number of cases, the predominant causal agent was Streptococcus pneumoniae; pediatric ages were those with the highest incidence, especially those under 1 year of age and males. The cardinal symptom in the study was fever, and pneumococcus was the most lethal causative agent. Conclusions: The early diagnosis of bacterial meningoencephalitis leads to less lethality and therefore fewer sequelae.

Étiologies des méningites et méningoencéphalites dans les services de réanimation polyvalente à Libreville de 2020 à 2021 / Etiologies of meningitis and meningoencephalitis in intensive care units of Libreville from 2020 to 2021

Introduction. Les méningites/méningo-encéphalites sont des urgences médicales d'étiologies variées. La technique de diagnostic Multiplex Polymerase Chain Reaction (PCR) permet de détecter la présence de bactéries et de virus dans le liquide céphalorachidien (LCR) avec une spécificité et une sensibilité ≥ 90%. L'objectif de cette étude était d'identifier en utilisant cette technique, les principaux germes responsables des méningites et méningo-encéphalites en réanimation à Libreville. Patients et méthodes. Nous avons mené une étude transversale allant d'octobre 2020 à septembre 2021. Les critères d'inclusion étaient : être admis en réanimation au CHUL et à l'HIAOBO pour suspicion de méningite ou méningo-encéphalite, obtenir l'accord des familles pour l'analyse du liquide céphalorachidien (LCR) par multiplex PCR. Les variables étudiées étaient : la fréquence, les données sociodémographiques, les aspects cliniques et paracliniques. Résultats. Soixante et onze patients ont répondu aux critères d'inclusion. L'âge moyen était de 21,1 ± 10,4 ans et le sex ratio de 1,2. Les motifs d'admission étaient l'altération de l'état de conscience (77%) et l'état de mal épileptique (21%). Plasmodium falciparum a été retrouvé seul chez 38 patients (53,5%) et associé à Listeria monocytogenes chez 4 patients (1,4%). Les méningo-encéphalites à Herpès simplex virus ont été observées chez 4 patients (1,4%) dont l'âge variait entre 40 ans et moins de 50 ans. Un patient (1,4%) présentait une coinfection à S. épidermidis, flavivirus et alphavirus. Des méningo-encéphalites sans germes ont été observées chez 5 patients (%). Conclusion. Le principal germe responsable de méningoencéphalite en réanimation à Libreville est P. falciparum. Des virus tels que le flavivirus et l'alphavirus non détectés par les méthodes usuelles ont aussi été mis en évidence grâce au multiplex PCR.

Introduction. Meningitis/meningoencephalitis are medical emergencies of various etiologies. The Multiplex Polymerase Chain Reaction (PCR) technique allows the detection of the presence of bacteria and viruses in the cerebrospinal fluid (CSF) with a specificity and sensibility of above 90%. The aim of this study was to identify the most common germs responsible for meningitis and meningoencephalitis in the intensive care units of Libreville using this technique,. Patients and methods. We conducted a transversal study from October 2020 to September 2021. Inclusion criteria were: being admitted to intensive care unit of CHUL and HIAOBO for suspicion of meningitis or meningoencephalitis and having the parent's approval for multiplex PCR analysis of CSF. Variables studied included frequency, sociodemographic data, clinical and paraclinical aspects. Results. Seventy one patients were included. Mean age was 21.1 ± 10.4 years and the sex ratio was 1.2. Reasons for admission were altered consciousness (77%) and epilepsy (21%). Plasmodium (P) faciparum was detected alone in 38 cases (53.5%) and associated to Listeria monocytogenes in 4 patients (5.6%). Herpex simplex viral meningoencephalitis was observed in 4 patients (5.6%) aged between 40 and less than 50 years. One patient (1.4%) had co-infection with S. epidermidis, flavivirus and alphavirus. Meningoencephalitis with no germs was found in 5 patients (7%). Conclusion. The main etiology of meningoencephalitis in intensive care units of Libreville is P. falciparum. Viruses not detected by usual methods like flavivirus and alphavirus were detected by multiplex PCR.

COVID-19-associated meningoencephalitis in a Brazilian patient: case report and literature review

ABSTRACT The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.

A case report of bacterial endocarditis with complicated intracranial complications / 中华神经科杂志

Infective endocarditis (IE) is an infectious disease that affects the inner surface of the heart. Its first symptom often manifests as a localized neurological deficit, which can conceal the diagnosis of IE and delay the treatment. Here is a report of a severe case of IE with complicated central nervous system complications admitted to the First Hospital of Jilin University, so as to improve clinicians′ attention to the diagnosis and treatment of such conditions.

Transmission characteristics and prevention measures of Naegleria fowleri： a review / 上海预防医学

Objective To review the Naegleria fowleri and primary amoebic meningoencephalitis caused by the naegleria fowleri， so as to strengthen the public awareness of the disease and its prevention. Methods We reviewed the literatures and reports， and summarized the following information： epidemic status， life cycle and characteristics， environmental distribution and infection routes， pathogenesis and clinical manifestations， diagnosis and treatment， prevention and control measures. Results Primary amoeba meningoencephalitis is a water-borne disease caused by the Naegleria fowleri， which enters human body through the nose and arrives at the central nervous system through olfactory nerve， leading to hemorrhagic and necrotic meningitis. Although the disease is rare， it has a fatality rate of 95%. Most of the patients reported were healthy children or young adults who had nasal contact with water contaminated with Naegleria fowleri a week before symptoms appeared. At present， its pathology can be divided into contact mechanism and non-contact mechanism. In contact mechanism， the Naegleria fowleri relies on the phagocytosis of food cup on its surface and the release of cytolytic molecules that directly destroy host cells. In non-contact mechanism， the Naegleria fowleri has toxic effects by secreting proteins. The clinical symptoms are episodic， with an average time of five days from illness to death. At beginning， the symptoms may include headache， vomiting， fever and other influenza-like symptoms， followed by central nervous system symptoms， such as stiff neck， drowsiness， anorexia， fear and so on. Intravenous or intrathecal injection of amphotericin B is considered to be the basic treatment of this disease， which can be combined with other adjunct therapies such as ventricular shunt and cooling to reduce encephaledema. Conclusion Primary amoebic meningoencephalitis is a rare but highly fatal disease. We should strengthen the public awareness of the disease and its prevention， especially to avoid nasal contact with contaminated water. We should also strengthen scientific research， improve the level of diagnosis， and develop effective drugs to prevent the disease before it happens.

Diagnosis and treatment for acute phase of suppurative meningoencephalitis / 中华神经科杂志

Suppurative meningoencephalitis is the kind of intracranial infectious disease which exhibits comparatively more severe clinical manifestations, more expensive diagnostic and treatment costs and poorer prognosis. Early diagnosis and effective treatment are essential for better improvement of disease prognosis. Clear identification of intrinsic and extrinsic factors causing the acute phase of suppurative meningoencephalitis, as well as its epidemiological and pathogenic characteristics, clinical manifestations and classifications, imaging features and laboratory tests explanations, may contribute greatly to the diagnostic correctness and treatment efficacy, thus promoting diagnostics and medical treatment of this disease which remains ultimately critical to patients′ prognosis.