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ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis.
RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico.
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Resumen El virus dengue es un virus endémico en Argentina que, si bien inicialmente se consideró que no era neu rotrópico, actualmente se reconoce que tiene neuroinva sión, condicionando así una prevalencia de manifesta ciones neurológicas de hasta el 15% entre los enfermos. Aun siendo considerados síntomas de gravedad, existe subdiagnóstico de encefalitis por dengue debido a su variada forma de presentación clínica. Las manifesta ciones neurológicas de la encefalitis por dengue pueden abarcar desde fiebre y cefalea hasta alteraciones del nivel de conciencia y convulsiones. Si bien el líquido cefalorraquídeo (LCR) puede hallarse normal en hasta un tercio de los casos, lo habitual es que presente aumento de concentración de proteínas y pleocitosis. En cuanto a los métodos de neuroimagen, los hallazgos suelen ser variados e inespecíficos, e incluso pueden ser normales hasta en 40-50% de los casos. Se presentan 3 casos de encefalitis por dengue diag nosticados en un hospital universitario de Buenos Ai res, Argentina, en donde la presentación clínica varió desde desorientación témporo-espacial hasta estatus convulsivo refractario con diferentes presentaciones en el LCR pero todos con PCR positivo para dengue y con neuroimágenes sin alteraciones.
Abstract Dengue virus is an endemic virus in Argentina that, although it was initially considered to be non-neuro tropic, it is currently recognized to be neuroinvasive; thus conditioning a prevalence of neurological mani festations of up to 15% among patients. Even being considered severe symptoms, there is underdiagnoses of dengue encephalitis due to its varied clinical presenta tion. Neurological manifestations of dengue encephalitis can range from fever and headache to altered levels of consciousness and seizures. Although the cerebrospinal fluid may be normal in up to a third of cases, it usually presents increased protein concentration and pleocyto sis. Regarding neuroimaging methods, the findings are usually varied and nonspecific, and can even be normal in up to 40-50% of cases. We present three cases of dengue encephalitis di agnosed in a university hospital in Buenos Aires, Ar gentina, where the clinical presentation varied from temporal-spatial disorientation to refractory convulsive status with different presentations in the cerebrospinal fluid but all with positive PCR for dengue in it and with normal neuroimaging.
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Background: This prospective observational study aims to study magnetic resonance imaging (MRI) findings in the setting of acute febrile encephalopathy in children between 1 month to 18 year of age group.Methods: This study was conducted in patients of acute febrile encephalopathy admitted in pediatric intensive care unit (PICU) at tertiary care centre during January 2019 to December 2019 in age group one month to 18 years. 32 patients satisfied the inclusion criteria.Results: Of the 32 patients included in the study MRI was done in 28 patients. MRI brain was normal in 17 patients and abnormalities were found in 11 patients. Majority findings were cerebral enema and restricted diffusion 3 (10.5%). Other findings were T2 hyperintensity and FLAIR hyperintensity lesion in basal ganglia and thalami region 2 (7%), T2 and FLAIR hyperintensity hippocampal lesion in hippocampus 2 (7%), haemorrhagic lesion 1 (3.5%).Conclusions: Acute febrile encephalopathy is a life-threatening condition. It is important to identify the possible aetiology for directing specific treatment. Amongst others MRI is one modality that has the potential to identify possible aetiology. Paediatric intensive care physicians are not always updated regarding utility of MRI and its findings in acute febrile encephalopathy. The main reason being non-inclusion of this subject in curriculum. This study was intended to understand all the possible MRI findings in acute febrile encephalopathy, correlate it with clinical findings and ultimately aid in management of these cases.
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Intravenous methylprednisolone is an important therapeutic modality in many conditions, owing to their anti-inflammatory and immune-modulating properties. Along with other side-effects of corticosteroids, cardiovascular side-effects are also seen in varying degree in children. Sinus bradycardia is reported uncommonly in children following high dose intravenous methylprednisolone. We report two paediatric cases without any underlying cardiac problems with asymptomatic bradycardia following high dose intravenous methylprednisolone. Heart rate reduction was seen from 30-40% compared to the baseline heart rate, which returned to its normal value after 24-36 hours of stoppage of the offending drug. A high index of suspicion along with strict cardiovascular monitoring is necessary in patients receiving high dose of methylprednisolone.
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Background: The present study was performed to study the role of inflammatory markers viz. C-reactive protein, procalcitonin, serum ferritin and serum lactate dehydrogenase in predicting the mortality and outcome in patients with acute encephalitis syndrome admitted to pediatrics ICU, BRD medical college, Gorakhpur.Methods: 140 patients/children of the age group ranging from 1 year to 16 years admitted in the acute encephalitis syndrome unit of BRDMC during 1 August 2021 to 31 July 2022 were analyzed with the prospective observational study.Results: Vaccination status (p<0.001) and socioeconomic status (p=0.020) were associated with mortality outcome in AES patients. Serum procalcitonin levels with cut off value >0.10 mg/dl and serum LDH levels with cut off value of 480u/L have shown a positive association with the mortality in AES patients. (p=0.041 and p=0.038, and strength of association is 0.67 and 0.65, respectively. C-reactive protein with a cut-off value 10 mg/dl and serum ferritin with a cut-off value 140 ng/ml have shown no association with mortality with p values of 0.143 and 0.267, respectively. The Area under the ROC curve is maximum for serum procalcitonin (0.937) with a cut-off value 0.10 ng/dl with 100% sensitivity and 75.8% specificity (confidence interval 95%: 0.894-0.980). The negative predictive value is 100% and PPV is 13.7%. Similarly, the area under the ROC curve for CRP with a cut-off 10mg/dl is 0.900 (confidence interval 95%: 0.841-0.959) with 100% sensitivity of and 64.8%. specificity. Consequently, the negative predictive value is 100 % and the positive predictive value of 11.1%.Conclusions: For predicting the mortality in AES patients 2 prognostic markers viz. C reactive protein and procalcitonin can prove to be promising prognostic screening tests, and therefore, both the tests are advised consecutively.
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Resumen Introducción: La enfermedad asociada a la glicoproteína oligodendrocitaria de mielina (MOGAD) comprende un espectro amplio de manifestaciones clínicas y hallazgos imagenológicos, donde la evidencia reciente indica que la encefalitis de tallo es una posible manifestación de MOGAD. Presentación de caso: Se presenta el caso de una paciente femenina de 32 años con curso de enfermedad fluctuante y buena respuesta a esteroides, con afectación predominante del tallo cerebral de nueve años de evolución y posterior compromiso del nervio óptico. La paciente no cumplía criterios para esclerosis múltiple o neuromielitis óptica y otros diagnósticos diferenciales fueron excluidos. Finalmente, el diagnóstico de MOGAD fue confirmado mediante la detección de anticuerpos IgG contra la proteína MOG. Discusión: Las lesiones de tallo cerebral en MOGAD se han descrito en el 30 % de los casos de una cohorte española de pacientes positivos para MOG-IgG. Las lesiones tienden a ser bilaterales, mal definidas y de gran tamaño. A pesar de que los bajos títulos del examen pueden generar dudas sobre el diagnóstico, Banwell et al. recientemente propusieron unos nuevos criterios diagnósticos que incluyen bajos títulos de MOG-IgG y, ante ello, los criterios clínicos de soporte apoyan el diagnóstico. Conclusiones: Los pacientes con signos de encefalitis de tallo sin clara etiología deben ser evaluados con anticuerpos asociados a la proteína MOG, para confirmar o descartar el diagnóstico.
Abstract Introduction: MOG antibody-associated disease (MOGAD) comprises a broad spectrum of clinical manifestations and imaging findings. Recent evidence indicates that brainstem encephalitis is a possible manifestation of MOGAD. Case presentation: We present the case of a 32-year-old female patient with a 9-year history of a fluctuating disease course and good response to steroids, with almost exclusive brainstem involvement and subsequent optic nerve involvement. The patient did not meet the criteria for multiple sclerosis or neuromyelitis optica, and other differentials were excluded. The diagnosis of MOGAD was confirmed by IgG antibodies against the MOG protein. Discussion: Brainstem lesions in MOGAD have been described in 30% of a Spanish cohort of MOG-IgG positive patients. The lesions tend to be bilateral, poorly defined, and large. Although low titers on the assay may raise doubts about the diagnosis, Banwell et al recently proposed new diagnostic criteria that include low MOG-IgG titers. In the face of low titers, the supporting clinical criteria support the diagnosis. Conclusions: Patients with signs of brainstem encephalitis without a clear etiology should be evaluated for MOG-associated antibodies to confirm or rule out the diagnosis.
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Autoimmune encephalitis has been an emerging disease in the pediatric age group for the last few years. It is of utmost importance to recognize the disease for the timely initiation of immunotherapy. The antibody-mediated encephalitis should be considered in the differentials apart from vasculitic, metabolic encephalopathy after ruling out bacterial, viral, tubercular, parasitic, and rickettsial causes. It can even coexist with herpes encephalitis in a quarter of the cases. The prodromal symptoms and progression to psychiatric, memory, speech disturbance, movement disorder, altered mental status, dysautonomia, and seizures within a span of a month characterize the disease. The approach to diagnosis involves various antibody testing in serum and cerebrospinal fluid along with brain imaging and electroencephalography. Early treatment with steroids, intravenous immunoglobulin, and plasmapheresis leads to better outcomes. A literature search was made using keywords in the Google Scholar and Pubmed databases before January 2024. The collected materials were reviewed for appropriate titles and content focusing on diagnosis and management. The article aims to provide a comprehensive review regarding the differential diagnosis and management of autoimmune encephalitis in children.
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Introducción: El herpes connatal es una entidad infrecuente asociada a elevada morbimortalidad. La probabilidad de transmisión al recién nacido va de 5% al 85%. El diagnóstico se dificulta por falta de clínica, serología no confiable y por la no disponibilidad de PCR en los servicios públicos de países en vías de desarrollo. La IgM en gestantes podría ser utilizada como un marcador de sospecha para evaluar al neonato. Objetivo: Caracterizar a los recién nacidos, hijos de gestantes con IgM positiva para HVS 1-2 y la frecuencia de encefalitis en los infantes. Materiales y métodos : Estudio observacional, descriptivo, prospectivo, realizado de mayo de 2020 a octubre de 2021. Se incluyeron recién nacidos (RN) de madres con IgM positiva para Herpes Virus Simplex (HVS) a partir de la segunda mitad del embarazo. En el RN se realizó serología IgG e IgM, y además, PCR- RT para HVS 1-2 en sangre y/o LCR, excluyéndose los nacidos en otras maternidades y/o sin datos de serología materna. Resultados: 36 pacientes. Edad materna 28 años (DS + 4), 5% con antecedentes de HVS, 61% cesárea. 36% prematuros, 13% RCIU. Síntomas agudos en el RN 22%. De ellos, 19% plaquetopenia, 44% alteración de GOT. 63% PCR HVS en sangre y 44% en LCR. Se encontró hemorragia, hidrocefalia, leucomalacia en 27%. No se encontró diferencias en la expresión clínica por tipo de parto. Conclusiones: Los RN hijos de gestantes con IgM positiva para VHS desde la segunda mitad del embarazo o periparto, presentaron infección por VHS determinada por PCR en sangre o LCR, independiente de la vía del parto. El diagnóstico serológico en embarazadas permite la pesquisa, diagnóstico y tratamiento temprano del RN.
Introduction: neonatal herpes is a rare entity associated with high morbidity and mortality. The probability of transmission to the newborn ranges from 5% to 85%. The diagnosis is difficult due to the lack of clinical signs, unreliable serology and the non-availability of PCR in public services in developing countries. IgM in pregnant women could be used as a suspected marker to evaluate the neonate. Objective: To characterize newborn children of pregnant women with positive IgM for HSV 1-2 and the prevalence of encephalitis in infants. Materials and methods: Observational, descriptive, prospective study, carried out from May 2020 to October 2021. Newborns (NB) of mothers with positive IgM for Herpes Virus Simplex (HSV) from the second half of pregnancy were included. In newborns, IgG and IgM were performed, and in addition, PCR-RT for HSV 1-2 in blood and/or CSF, excluding those born in other hospitales and/or without maternal serology data. Results: We included 36 patients. Maternal age was 28 years (DS + 4), 5% with a history of HSV. 61% were delivered via cesarean section, 36% were premature, 13% had IUGR. 22% of the newborns had acute symptoms. 19% had thrombocytopenia, 44% had GOT alteration. 63% were PCR positive for HSV in serum and 44% were CSF-positive. Hemorrhage, hydrocephalus and leukomalacia were found in 27%. No differences were found in clinical expression by type of delivery. Conclusions: Newborns born to pregnant women with positive IgM for HSV from the second half of pregnancy or peripartum, presented HSV infection as determined by PCR in blood or CSF, regardless of the route of delivery. Serological diagnosis in pregnant women allows early screening, diagnosis and treatment of the NB.
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Bats spread the Nipah virus, which causes severe encephalitis and high mortality. Multiple reports have come from Malaysia, Bangladesh, Singapore, and India. Pteropus fruit bats are known to host the virus. The virus has caused four outbreaks in Kerala in the past quinquennium. Scholars believe the virus is indigenous to the state's bat population. Climate change, resource depletion, deforestation, natural terrain changes, farming, and industrialization all contribute to viral disease outbreaks. In this review, we will discuss the epidemiological background of the previous NiV outbreak. We will also examine the transmission method epidemic prevention and control strategies and possible causes of the outbreak. Four Nipah epidemics have occurred in Kerala in the past five years. Expert investigation suggests that the virus may be endemic in the state抯 bat population. Kerala, India, has many bat species. In 2018, research found viral infections in the local fruit bat population. Traditionally, people eat fresh toddy or sap from trees, which can be polluted by bats carrying the Nipah virus. Kerala's healthcare system also closely monitors unexplained fevers for Nipah virus infections. The World Health Organisation and Indian Council of Medical Research found that the entire state is susceptible to Nipah virus infections. The virus is a major cause of encephalitis outbreaks, which have high mortality rates, mostly in Indo-Bangladesh.
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Introducción: La encefalitis por anticuerpos contra el receptor N-metil.D.aspartato (NMDA-R) es un trastorno inflamatorio del sistema nervioso central (SNC) en el cual autoanticuerpos dirigidos hacia la subunidad NR1 del receptor N-metil-D aspartato (NMDA) desarrollan un conjunto de síntomas neuropsiquiátricos, convulsiones y movimientos anormales. El tratamiento recomendado incluye metilprednisolona (MP) y gamaglobulina (IVIg), y/o recambio plasmático terapéutico (RPT); y en caso de no respuesta: rituximab (RTX) y/o ciclofosfamida (CFM). Objetivos: Analizar características clínicas, bioquímicas, electroencefalograma (EEG), resonancia magnética (RM) cerebral, tratamientos recibidos y resultados observados en una serie de pacientes con encefalitis autoinmune (EA) probable o confirmada. Materiales y métodos: Analizamos las historias clínicas de pacientes menores a 17 años que cumplían criterios diagnósticos de Graus (2016) para EA probable, con seguimiento mayor a 6 meses, internados en el Hospital Garrahan entre 2008 y 2023. El diagnóstico se definió por la identificación de anticuerpos anti-NMDAR (N-metil D-aspartato) en líquido cefalorraquídeo (LCR) por ensayo basado en células - cell bassed assay (CBA). Resultados: Reunieron criterios de EA probable 94 pacientes con una edad media de 89.5 meses, 51% mujeres. Se dividieron en dos grupos: seropositivos y seronegativos de acuerdo al resultado del biomarcador. Seropositivos 45/94. El síntoma inicial más frecuente fue: convulsiones. El 28% requirió ingreso a Unidad de Cuidados Intensivos (UCI). 4 pacientes seropositivos y 1 seronegativo tuvieron encefalitis por el virus del herpes simple (Om) previamente. En una paciente seronegativa se diagnosticó teratoma ovárico. Hallazgos de estudios complementarios: LCR patológico en el 29%, RM cerebral en el 52%, EEG en el 74%. El tratamiento de primera línea más empleado fue MP + IVIg. El 46% de los pacientes presentó recuperación completa. Entre los pacientes que recibieron RTX, el 65% tuvo una recuperación completa. Ningún paciente que recibió RTX presentó recaída. Conclusión: Ante la sospecha de EA se debe considerar el inicio temprano de inmunoterapia para favorecer la rápida recuperación funcional. Se recomienda el uso temprano de RTX en los casos con presentación grave o respuesta subóptima al tratamiento de primera línea para beneficiar la respuesta clínica y reducir el riesgo de recaída (AU)
Introduction: Encephalitis due to antibodies against the N-methyl-D-aspartate receptor (NMDA-R) is an inflammatory disorder of the central nervous system (CNS) in which autoantibodies directed against the NR1 subunit of the N-methyl-D-aspartate (NMDA) receptor develop a set of neuropsychiatric symptoms, seizures, and abnormal movements. The recommended treatment includes methylprednisolone (MP) and intravenous immunoglobulin (IVIg), and/or therapeutic plasma exchange (TPE); and in case of non-response: rituximab (RTX) and/or cyclophosphamide (CFM). Objectives: To analyze clinical, biochemical, electroencephalogram (EEG), magnetic resonance imaging (MRI) of the brain, treatments received, and outcomes observed in a series of patients with probable or confirmed autoimmune encephalitis (AE). Materials and methods: We analyzed the medical records of patients under 17 years of age who met Graus' diagnostic criteria (2016) for probable AE, with follow-up of more than 6 months, hospitalized at Hospital Garrahan between 2008 and 2023. Diagnosis was defined by the identification of anti-NMDAR antibodies (N-methyl D-aspartate) in cerebrospinal fluid (CSF) by cell-based assay (CBA). Results: Ninety-four patients met criteria for probable AE with a mean age of 89.5 months, 51% female. They were divided into two groups: seropositive and seronegative according to the biomarker result. Seropositive 45/94. The most frequent initial symptom was seizures. Twenty-eight percent required admission to the Intensive Care Unit (ICU). Four seropositive patients and one seronegative patient had previously had herpes simplex encephalitis (Om). Ovarian teratoma was diagnosed in one seronegative patient. Findings of complementary studies: Pathological CSF in 29%, brain MRI in 52%, EEG in 74%. The most commonly used first-line treatment was MP + IVIg. Forty-six percent of patients experienced complete recovery. Among patients who received RTX, 65% had complete recovery. No patient who received RTX experienced relapse. Conclusion: In the suspicion of AE, early initiation of immunotherapy should be considered to promote rapid functional recovery. Early use of RTX is recommended in cases with severe presentation or suboptimal response to first-line treatment to benefit clinical response and reduce the risk of relapse (AU)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Autoantibodies , Encephalitis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Immunotherapy , Seizures , Magnetic Resonance Spectroscopy , Retrospective Studies , Treatment OutcomeABSTRACT
Las enfermedades causadas por amebas de vida libre son infecciones oportunistas que pueden tener un curso fatal. Pueden producir afecciones diseminadas graves con compromiso del sistema nervioso central, como la encefalitis amebiana granulomatosa. Esta infección es cada vez más frecuente en América Latina, aunque se reconocen tardíamente debido a la similitud con otras patologías o porque es inusual incluirla en el diagnóstico diferencial. Comunicamos un caso fatal de una encefalitis amebiana granulomatosa por Balamuthia mandrillaris en una niña de 10 años. Destacamos la gravedad de la afectación cerebral y la falta de esquemas antimicrobianos validados para su tratamiento. Hoy en el mundo esta infección es considerada una enfermedad emergente, influenciada por el cambio climático, lo que llama a estar atentos a su presencia.
Diseases caused by free-living amoebae are opportunistic infections that can have a fatal course. They can cause very serious disseminated conditions with involvement of the central nervous system such as granulomatous amoebic encephalitis. This infection has become more common in Latin America, although its recognition is late due to the similarity with other pathological conditions or because it is unusual to include it in the differential diagnosis. We report a fatal case of granulomatous amoebic encephalitis due to Balamuthia mandrillaris in a 10-year-old girl. We highlight the severity of the brain involvement and the lack of validated schemes for its treatment. Today in the world this infection is considered an emerging disease, influenced by climate change, which calls for being attentive to its presence.
Subject(s)
Humans , Female , Child , Infectious Encephalitis/diagnosis , Amebiasis/diagnosis , Tomography, X-Ray Computed , Sequence Analysis, DNA , Fatal Outcome , Balamuthia mandrillaris/isolation & purification , Balamuthia mandrillaris/genetics , Infectious Encephalitis/diagnostic imaging , Amebiasis/diagnostic imagingABSTRACT
Objective:To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE)with double positive anti-N-methyl-D-aspartate receptor(NMDAR)and anti-γ-aminobutyric acid B receptor(GABABR)secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians'awareness of this disease.Methods:The clinical data of one AE patient with double positive anti-NMDAR and anti-GABABR secondary to HSVE were collected,the diagnostic and therapeutic processes were summarized,and the relevant literatures were reviewed.Results:The patient,a 36-year-old male,developed a headache followed by limb convulsions,and progressed to disturbed consciousness.After admission,the routine biochemistry of the cerebrospinal fluid(CSF)was abnormal,and the herpes simplex virus-1(HSV-1)IgG antibody showed positive in the CSF;both CSF and serum tests for NMDAR antibodies were positive;the head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital white matter,leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis.Several months later,the patient experienced psychiatric behavior abnormalities,cognitive dysfunction,and sleep disorders,and both the serum NMDAR and GABABR antibodies showed positive results,prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABABR encephalitis.After treatment with steroid pulse therapy and intravenous immunoglobulin(IVIG),the patient's condition was improved and the patient was discharged.At one-year follow-up,the patient's psychiatric symptoms had completely resolved,leaving mild cognitive impairment.Conclusion:If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened,secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.
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Objective Evaluation of the efficacy and safety of intravenous(IV)combined with intrathecal/intraventricular injection(ITH/IVT)of polymyxin against intracranial infection with multidrug-resistant bacteria.Methods The databases,including Wanfang,VIP,Chinese Biomedical Literature,Pubmed,Embase,ScienceDirect,and Cochrane Library were searched,case-control studies on IV+ITH/IVT polymyxin against intracranial infection with multidrug-resistant bacteria by January 2023 were screen.RevMan 5.4 software was used for meta-analysis.Results A total of 9 retrospective studies were included.The fatality rate in IV+ITH/IVT polymyxin group was significantly lower than that in IV group(OR =0.19,95%CI:0.11-0.35,P<0.01).There was no significant difference in ICU hospitalization days(OR =-2.32,95%CI:-23.59-18.89,P =0.83)and adverse reaction rate(OR =0.93,95%CI:0.26-3.38,P =0.91)between IV+ITH/IVT group and IV group.Conclusion IV+ITH/IVT polymyxin in treating the intracranial infection with multidrug-resistant bacteria can significantly reduce fatality rate,and does not significantly increase adverse reactions.
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Summarizing the nursing experience of a child with HHV-6B encephalitis after umbilical cord blood transplantation and CAR-T therapy. The child was 4 years old and was diagnosed with acute T lymphocytic leukemia on May 28, 2021. Nursing points: meticulously observe symptoms for early diagnosis and treatment; develop a specialized management plan, implement individualized care; enhance medication management to improve the quality of care; establish a shared decision-making communication model to prevent hospital-acquired infections; provide patient-centered care for lumbar puncture; assess the needs of the child and family, alleviate negative emotions; improve pre-discharge preparation, emphasize continuity of care. With proactive treatment and careful nursing, the child′s condition improved, and they were discharged. Follow-up for six months showed the child in a sustained remission state with no adverse sequelae, and normal life resumed.
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Purpose To summarize the clinical and imaging features of neonatal herpes simplex encephalitis(NHSE).Materials and Methods Clinical and imaging data of 5 NHSE from January 2016 to June 2023 in Beijing Children's Hospital,Capital Medical University were retrospectively collected.All five children underwent MRI examinations,with three of them undergoing enhanced scanning simultaneously.Two children had previously undergone CT scans.The location,density/signal,enhancement characteristics as well as follow-up imaging changes of the lesions were reviewed.Results The main clinical manifestations of NHSE were fever(5 cases)and seizure(4 cases),sometimes accompanied by herpes(2 cases).Imaging examinations in NHSE typically presented with symmetric(1 case)or diffuse/multifocal(4 cases)lesions in bilateral cerebral hemispheres,along with involvement of the bilateral thalamus(5 cases).Early CT scans showed either no abnormalities(1 case)or extensive areas of low density(1 case).MRI examinations usually demonstrated restricted diffusion of acute phase lesions(3 cases)and significant leptomeningeal enhancement in affected areas(3 cases).Intracranial lesions often led to the diffuse atrophy of brain parenchyma and polycystic encephalomalacia(3 cases),indicating a poor prognosis.Conclusion The clinical manifestations of NHSE are nonspecific.Early MRI examinations are of great value for accurate diagnosis and disease evaluation.
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Objective:To analyze the correlation between peripheral blood lymphocyte subsets, especially B cells, and the relapse of autoimmune encephalitis (AE).Methods:A retrospective analysis was conducted on patients with AE who were diagnosed and treated in Peking Union Medical College Hospital from January 2012 to January 2023. The clinical data including gender, age and changes in related indicators of CD19 +B cells, CD16/56 +NK cells, CD3 +T cells, CD4 +T cells, CD8 +T cells, IgG, IgA, and IgM before and after recurrence were analyzed.Binary Logistic regression analysis was applied to the study of correlation between AE recurrence and gender, age, CD19 +B cells, CD16/56 +NK cells, CD3 +T cells, CD4 +T cells, CD8 +T cells, IgG, IgA and IgM. The receiver operating characteristic (ROC) curves of the cells that affect AE recurrence (CD19 +B cells, CD16/56 +NK cells, CD3 +T cells, CD4 +T cells and CD8 +T cells) were plotted separately. Results:A total of 198 eligible AE patients were included, including 98 males and 100 females, aged (39.52±17.91) years. Among these patients, 78 cases had relapses, with a recurrence rate of 39.4%. The results of Logistic regression analysis showed that CD19 +B cells ( B=0.006, P<0.001), CD16/56 +NK cells ( B=0.004, P<0.05), CD3 +T cells ( B=-0.011, P<0.05), CD4 +T cells ( B=0.014, P<0.05) and CD8 +T cells ( B=0.010, P<0.05) were highly correlated with the relapse of AE. ROC curve analysis showed that CD19 +B cells (area under the curve: 0.833, P<0.001, critical value: 73.5/μl; sensitivity: 69.2%, specificity: 86.7%), CD3 +T cells (area under the curve: 0.784, P<0.001), CD4 +T cells (area under the curve: 0.808, P<0.001), and CD8 +T cells (area under the curve: 0.742, P<0.001) all had a certain predictive value for AE relapse. Among all the indicators, the area under the curve of CD19 +B cells was the largest, which had a higher value in predicting AE recurrence. Conclusion:The increase in peripheral blood CD19 +B cells has high predictive value for the relapse of AE.
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Objective:To explore the clinical characteristics of patients with antibodies against contactin-associated protein-like 2 (CASPR2).Methods:The clinical data of 24 patients with anti-CASPR2 encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively analyzed. According to the age of first onset, the patients were divided into early onset group (10 cases, onset age<45 years) and late onset group (14 cases, onset age≥45 years). The clinical data including clinical manifestations, auxiliary examinations, and treatment response between these 2 groups were compared.Results:Among the 24 patients, there were 13 cases with epilepsy, 13 cases with cognitive decline, 13 cases with mental disorders, 14 cases with autonomic dysfunction, 8 cases with peripheral nerve hyperexcitability, 5 cases with Morvan syndrome, 5 cases with unstable walking, and 8 cases with sleep disorders. Among the 10 cases of the early onset group, 7 cases are females, and 8 cases showed epilepsy. The incidence rate of epilepsy in the early onset group was higher than that in the late onset group (5/14, Fisher exact probability, P=0.047). Among the 14 cases of the late onset group, 6 cases are females, 9 cases showed cognitive impairment and 8 cases presented with mental disorders. There were 6 cases with abnormal brain magnetic resonance imaging (MRI). The cerebrospinal fluid protein of the late onset group [0.37 (0.29, 0.58) g/L] was higher than that in the early onset group [0.22 (0.16, 0.30) g/L; Z=-2.667, P=0.008]. The modified Rankin Scale (mRS) scores before and after treatment were 3.29±0.83 and 1.50 (0.75, 2.25), which were higher than those in the early onset group [mRS scores before and after treatment were 2.10±0.99 and 0 (0, 1.00), t=-3.188, P=0.004; Z=-2.335, P=0.020]. Conclusions:There are various symptoms in patients with anti-CASPR2 encephalitis. The early onset patients are common in women, with a higher incidence of epilepsy. The late onset patients are common in males, with prominent manifestations of cognitive impairment and mental disorders, which have a greater impact on daily living abilities. And abnormal MRI findings are common, and the cerebrospinal fluid protein is higher in late onset patients. Anti-CASPR2 antibody may cause more severe immune damage to the nervous system in elderly patients.
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Objective:To investigate and analyze the use and duration of anti-seizure medications (ASMs) in patients with chronic epilepsy after autoimmune encephalitis (AE), as well as the effect of ASMs use on the formation of this epilepsy to provide relevant evidence for the choice of ASMs in patients with acute seizure or chronic epilepsy after AE.Methods:A retrospective follow-up study was performed on AE patients (including patients with antibody-negative autoimmune limbic encephalitis) diagnosed in the Affiliated Brain Hospital of Nanjing Medical University from December 1, 2013 to October 31, 2022. The dates of the first seizure onset and the chronic epilepsy formation (defined as 1 year after immunotherapy) were recorded. The initial time, types and numbers of ASMs used in acute symptomatic seizure (ASS) and the maintenance time, types and numbers of ASMs in chronic epilepsy period (the continuation or the combined therapy of ASMs) were collected, respectively. A Logistic regression model was used to analyze multi-influencing factors on the formation of chronic epilepsy after AE.Results:A total of 332 patients were enrolled in this study, of whom 32.5% (108/332) with antibody-negative autoimmune limbic encephalitis. In total, 54.8% (182/332) of patients were males, and the age of onset was (40.7±19.7) years. Finally, 81.0% (269/332) of participants manifested ASS, and 57.2% (190/332) developed chronic epilepsy up to the last follow-up. The follow-up time was 1-8 years, with a median of 2 years. All patients received ASMs treatment during ASS period. Among the ASS patients, 48.0% (129/269) were prescribed monotherapy of ASMs, and 52.0% (140/269) were given the combined therapy of ASMs. Of all the patients with ASMs, 70.3% (189/269) were given early ASMs treatment (within 24 hours of the seizure onset), and 29.7% (80/269) were given delayed ASMs treatment. Subsequently, 81.0% (218/269) of the ASS patients continued the ASMs treatment (>6 months), and 19.0% (51/269) stopped use of ASMs. In the chronic epilepsy stage, 79.5% (151/190) of thee epilepsy patients continued ASMs, of whom 37.1% (56/151) were treated with monotherapy, and 62.9% (95/151) were treated with combined therapy. The incidence of chronic epilepsy was 81.3% (65/80) in the delayed ASMs treatment group, higher than the 66.1% (125/189) in the early ASMs treatment group,with statistically significant difference (χ 2=6.189, P=0.013). There were no statistically significant differences in the ASMs types and whether combined therapy of ASMs was used between chronic epilepsy group and non-chronic epilepsy group. The Logistic regression model showed that delayed ASMs treatment ( OR=2.306,95% CI 1.032-6.387, P=0.018), positive anti-neuronal intracellular antibodies ( OR=2.626,95% CI 1.536-9.531, P=0.004,compared with anti- neuronal surface antibodies), abnormal brain magnetic resonance imaging ( OR=9.883,95% CI 3.608-27.071, P<0.001), elevated cerebrospinal fluid protein ( OR=2.874,95% CI 1.115-7.409, P=0.029), and abnormal electroencephalogram ( OR=9.287,95% CI 3.767-22.896, P<0.001) were independent risk factors for chronic epilepsy after AE. Conclusions:The development of chronic epilepsy after AE is associated with the occurrence of ASS and the delayed use of ASMs, but the type of ASMs or whether the combined ASMs therapy is used is not associated with the formation of chronic epilepsy after AE. It is concluded that early ASMs treatment for the AE patients with ASS may reduce the incidence of chronic epilepsy. For AE patients with ASS who have undergone early standardized treatment, long-term, combined ASMs treatment may not be necessary.
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Objective @#Mendelian randomization analysis was used to explore the causal relationship of T.gondii in- fection and the cyst distribution and inflammation in brain tissue by immunohistochemistry.@*Methods @#Genome- wide association analysis data of T.gondii infection and encephalitis were obtained ,single nucleotide polymor- phisms (SNPs) were selected,Mendelian randomization analysis was conducted by inverse variance weighting,and the causal relationship between T.gondii infection and encephalitis was evaluated by OR value and 95% CI.Quality control was carried out by using heterogeneity test,horizontal multi-efficiency test and leave-one-out sensitivity test. Immunohistochemical staining was performed using brain sections of mice infected with tissue cysts of Wh6 strain for image analysis using Image J software. @*Results @#A total of 29 SNPs were associated with toxoplasmic encephalitis. The results of IVW method suggested that T.gondii infection made encephalitis risk 0. 98 times higher ( OR = 0. 98, 95% CI = 0. 76 to 1. 27) ,indicating no causal relationship between the two.The quality control results suggested that the selected SNPs were stable and reliable.Toxoplasma cysts were distributed in various parts of the brain tis- sue.@*Conclusion @# T.gondii infection and encephalitis are related,but there is no sufficient evidence to prove the causal relationship between the two.
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ObjectiveTo explore the clinical characteristics of neurobrucellosis in Kashi, Xinjiang Uygur Autonomous Region, thus improve the diagnosis and treatment. MethodsA retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between December 2019 and January 2024. ResultsThe study included 9 males and 9 females, with a median age of 36 years (range: 17-54.5). A clear epidemiological history was found in all the 18 brucllosis patients, 12 of whom presented with meningoencephalitis, 5 meningitis, and 1 encephalitis. Two comorbided with spinal meningitis, 2 osteoarthritis and 1 epididymitis. Most frequently reported clinical symptoms were headache, fever and fatigue. The prevalence rates of brucellosis by rose bengal plate agglutination test (RBPT) and serum agglutination test (SAT) were 11/12 and 8/9, respectively. Two of 10 patients had positive blood cultures, four of 16 had positive cerebrospinal fluid (CSF) cultures and five of five were detected to be positive by next-generation sequencing (NGS) for pathogens in CSF. CSF showed exudative changes and elevated number of leukocytes, with predominance of single nucleated cells. All patients were treated with the combined use of two to four from the drugs like doxycycline, rifampicin, ceftriaxone, cefixime, minocycline, levofloxacin and sulfanilamide. Most patients had a favorable prognosis. ConclusionsNeurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas. If there are exudative changes in CSF, differential diagnoses can be made by serological testing, blood culture, CSF culture and NGS. NGS could significantly increase the accuracy for neurobrucellosis diagnosis.