Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts. Patients with acquired immunodeficiency syndrome (AIDS) are at increased risk for CMV infection, and the most prevalent clinical manifestation is retinitis, followed by colitis, esophagitis, pneumonitis, and encephalitis. CMV oophoritis is poorly described in the literature with some cases reported in patients with hematological or solid malignancies, bone marrow or solid organ transplantation, immunosuppressive therapy, and advanced AIDS cases. We report the case of a 61-year-old woman with a recent diagnosis of AIDS, which was associated with a wasting syndrome. The patient presented with abdominal pain, headache, cutaneous vesicular lesions on the abdomen, anemia, lymphopenia, and hyponatremia; she died suddenly on the fourth day of hospitalization. The autopsy was performed and demonstrated disseminated CMV infection with hemorrhagic encephalitis as the immediate cause of death. Additionally, pneumonitis, extensive adrenalitis, ulcerated enteritis, focal hepatitis, and necrotizing oophoritis were found.

Encefalomielitis aguda diseminada viral / Acute disseminated viral encephalomyelitis

La encefalomielitis aguda diseminada (EMAD) es un trastorno neurológico caracterizado por inflamación del cerebro y médula espinal causada por un daño a la mielina, afectando al sistema nervioso central de manera difusa. Esta afección puede manifestarse de manera espontánea o secundaria a infecciones o a vacunación. La mayoría de las veces evoluciona de manera monofásica con manifestaciones clínicas inespecíficas, por lo que la sospecha diagnóstica es fundamental. La EMAD es la causa más frecuente de afectación de sustancia blanca. La incidencia es mayor en la edad prepuberal con una incidencia de aproximadamente 0,2-0,4 casos/100000 habitantes año. Tiene predominio estacional, siendo más frecuente en los meses de invierno y primavera. Afecta más a varones. A continuación presentaremos nuestra experiencia con un caso sin diagnóstico previo de esta excepcional y poco frecuente patología el cual se convirtió en un reto diagnóstico(AU)

Acute disseminated encephalomyelitis ADEM is a neurological disorder characterized by inflammation of the brain and spinal cord caused by damage to the myelin, affecting diffusely the central nervous system. This condition can appear spontaneously or secondary to infections or vaccination. Most of the time it evolves in a monophasic manner with nonspecific clinical manifestations, so that he diagnostic suspicion is fundamental. ADEM is the most frequent cause of white matter involvement. The incidence is higher in the prepubertal age with an incidence of approximately 0.2-0.4 cases / 100,000 inhabitants per year. It has a seasonal predominance, being more frequent in the winter and spring months. It affects more males. Below we present our experience with a case without previous diagnosis of this rare pathology which became a diagnostic challenge(AU)

Rasmussen's encephalitis: a case report / Encefalitis de Rasmussen: reporte de caso

Rasmussen's encephalitis (RE) is a rare but severe immune-mediated brain disorder leading to unilateral hemispheric atrophy, associated progressive neurological dysfunction with intellectual decline, and intractable seizures. It is a well-established cause of pharmacologically intractable epilepsy. The report is on a 17-month-old infant, treated at the Mario Catarino Rivas Hospital Honduras. Family history: grandfather epileptic secondary trauma from 20 years. Personal history: two previous emergency visits (at 16 months and 16 months 8 days) for convulsions for which she was admitted three days and was treated with valproic acid 30 mg/kg per day. The infant is admitted in the emergency, with a history of about three hours after onset of tonic convulsions, focused on left-side with drooling, oculogiros and relaxation of sphincters and fever of 38.5 ° C. Entered as convulsive syndrome in the study, however, as the days passed the number of seizures increased to 60 per day and was gradually presenting alterations in neurodevelopment. MRI reported leukoencephalopathy of undetermined origin and biopsy reported findings consistent with Rasmussen's syndrome. She was treated with immunoglobulin every two weeks for six doses after two months of hospitalization with achieved improvement. Currently, episodes of seizures have decreased significantly and almost not convulsing, she presented alterations in neurodevelopment.

La encefalitis de Rasmussen (ER)es un trastorno poco frecuente pero grave, mediado inmunológicamente, que afecta al cerebro y conduce a la atrofia hemisférica unilateral, disfunción neurológica progresiva asociada con deterioro intelectual y convulsiones intratables. Lactante de 17meses de edad, atendida en el Hospital Mario Catarino Rivas, Honduras. Con antecedentes familiares: abuelo epiléptico secundario a trauma a partir de los 20 años. Antecedentes personales: dos ingresos previos por cuadros convulsivos por los cuales estuvo ingresada tres días, en tratamiento con ácido valproico 30 mg/kg por día. Es recibida en la emergencia, con historia de aproximadamente tres horas de evolución de convulsiones tónicas, focalizadas en hemicuerpo izquierdo con sialorrea, oculogiros y relajación de esfínteres, febril 38,5 °C. Ingresada como síndrome convulsivo en estudio, sin embargo, al pasar los días incrementó el número de convulsiones hasta 60 diarios y progresivamente fue presentando alteraciones en su neurodesarrollo. La Resonancia Magnética reportó leucoencefalopatia de origen no determinado y la biopsia reportó hallazgos compatibles con Síndrome de Rasmussen. Fue tratada con inmunoglobulina cada quince días por seis dosis y después de dos meses de hospitalización, se logró egresar. Actualmente, los episodios de convulsiones han disminuido considerablemente y casi no convulsiona, presenta alteraciones en su neurodesarrollo.

Neurologic Manifestations of Enterovirus 71 Infection in Korea

Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.

A case of tumor-like inflammatory demyelinating disease with progressive brain and spinal cord involvement / Um caso de doença desmielinizante inflamatória semelhante a tumor com envolvimento progressivo de cérebro e medula espinhal

CONTEXT: Tumor-like inflammatory demyelinating disease (TIDD) usually occurs in the brain and rarely occurs in the spinal cord. TIDD appears to be very similar to tumors such as gliomas on imaging, which may lead to incorrect or delayed diagnosis and treatment. CASE REPORT: Because of headache and incoherent speech, a 24-year-old Chinese male presented to our hospital with a two-week history of respiratory infections. After dexamethasone treatment, his symptoms still got worse and surgery was performed for diagnostic purposes. Histological examination revealed that the lesion was inflammatory. Further lesions appeared in the spine (T3 and T4 levels) after two months and in the right occipital lobe after three months. After intravenous immunoglobulin (IVIG) and methylprednisolone treatment, his symptoms improved. CONCLUSION: Progressive lesions may damage the brain and spinal cord, and long-term prednisolone and IVIG therapy are beneficial in TIDD patients.

CONTEXTO: A doença desmielinizante inflamatória tumoral (DDIT) geralmente ocorre no cérebro e raramente na medula espinhal. A DDIT é muito semelhante a tumores tais como gliomas em exames de imagem, o que pode conduzir a diagnóstico e tratamento tardios e incorretos. RELATO DO CASO: Por causa de dor de cabeça e discurso incoerente, um homem chinês de 24 anos de idade foi ao hospital com história de duas semanas de infecções respiratórias. Após o tratamento com dexametasona, seus sintomas ficaram ainda piores e a cirurgia foi realizada para fins de diagnóstico. O exame histológico revelou que a lesão era inflamatória. Mais lesões apareceram na coluna vertebral (níveis T3 e T4) após dois meses, e no lobo occipital direito depois de três meses. Depois de tratamento com imunoglobulina intravenosa (IGIV) e metilprednisolona, seus sintomas melhoraram. CONCLUSÃO: Lesões progressivas podem danificar o cérebro e a medula espinhal, e prednisolona a longo prazo e terapia de IGIV são benéficas em pacientes DDIT.

Inflammatory reaction In epilepsy / Reação inflamatória na epilepsia / Reacción inflamatoria En la epilepsia

Epilepsies are the second most common neurological disease. The pathological mechanisms of this disease are not fully unders- tood. Several studies claim that inflammation plays a significant role both in structural and physiological changes that lead to the emergence of seizures. Although in some epilepsies, such as Rasmussen?s encephalitis, the inflammation has definite importance, in several other epileptic syndromes, the participation of inflammatory reaction still lacks evidence. In such cases, the experimental models are useful for reveal how cytokines, molecules that modulate the inflammatory response, may affect seizures and how seizures may change the expression of these inflammatory molecules. Even with these works, much remains to be clarified with regard to the influence of inflammation on epileptic syndromes. The purpose of this brief review is to discuss the links between inflammatory processes, the origin of crises, and tissue damages in epilepsy.

As epilepsias são a segunda doença neurológica mais frequentes. Os mecanismos patológicos dessa doença ainda não são completamente compreendidos. Vários trabalhos alegam que a inflamação tem um papel importante tanto nas alterações estruturais quanto fisiológicas que levam à geração de crises. Embora em alguns tipos de epilepsia, como a encefalite de Rasmussen, a inflamação tenha importância evidente, em várias outras síndromes epilépticas ainda faltam evidências para confirmar a participação da reação inflamatória. Nesses casos, os modelos experimentais são úteis para revelar como as citocinas, moléculas que modulam a resposta inflamatória, podem afetar as crises e como as crises podem alterar a expressão dessas moléculas inflamatórias. Mesmo com esses trabalhos, muito ainda precisa ser esclarecido com relação à influência da inflamação sobre as síndromes epilépticas. O objetivo desta breve revisão foi discutir as ligações entre os processos inflamatórios, a origem das crises e os danos teciduais na epilepsia.

Las epilepsias son la segunda enfermedad neurológica más común. Los mecanismos patológicos de esta enfermedad no se entienden completamente. Varios estudios afirman que la inflamación juega un papel importante tanto en los cambios estructurales como en los fisiológicos que conducen a la generación de las convulsiones. Aunque en algunos tipos de epilepsia, tales como la encefalitis de Rasmus- sen, la inflamación tiene una importancia evidente, en varios otros síndromes epilépticos todavía carecen de pruebas para confirmar la participación de la reacción inflamatoria. En estos casos, los modelos experimentales son útiles para revelar cómo las citoquinas, molé- culas que modulan la respuesta inflamatoria, pueden afectar a las convulsiones y cómo las convulsiones pueden cambiar la expresión de estas moléculas inflamatorias. Incluso con estos trabajos, queda mucho por aclarar con respecto a la influencia de la inflamación en los síndromes epilépticos. El propósito de esta breve revisión es discutir los vínculos entre los procesos inflamatorios, el origen de la crisis y el daño tisular en la epilepsia.

Osteonecrosis Related to Once-Yearly Zoledronic Acid Treatment in an Osteoporotic Patient after Dental Implant

This paper presents a case of osteonecrosis of the jaw related to zoledronic acid (5 mg) administered once yearly to treat osteoporosis. A 79-year-old woman who has been treated for osteoporosis for 5 years with 5 applications of zoledronic acid was referred for evaluation. The patient had been submitted to dental implant placement and there was no osseointegration. On clinical examination, suppuration and exposed bone on the alveolar ridge were observed. Radiographic examination revealed an osteolytic area and bone sequestration. Both clinical and radiological features were suggestive of osteonecrosis. The treatment consisted of surgery to remove the affected bone completely. The patient is asymptomatic at 9 months after surgery. Dentists and oral surgeons should be alert to the possibility of osteonecrosis related to the use of once-yearly injections of zoledronic acid for the treatment of postmenopausal osteoporosis.

O presente estudo teve como objetivo apresentar um caso de osteonecrose dos maxilares associada ao uso de ácido zoledrônico (5 mg) administrado uma vez ao ano para tratar a osteoporose. Uma mulher de 79 anos de idade estava em tratamento de osteoporose por 5 anos com 5 aplicações do ácido zoledrônico foi encaminhada para nossa avaliação. A paciente tinha sido submetida à colocação de implante dental e não houve osseointegração. Ao exame clínico, supuração e osso exposto no rebordo alveolar foram observados. Os exames radiográficos revelaram uma área osteolítica e sequestro ósseo. Ambos os aspectos clínicos e radiográficos eram sugestivos de osteonecrose. O tratamento consistiu de cirurgia para remover todo o osso afetado. A paciente está assintomática há 9 meses (desde a cirurgia). Cirurgiões-dentistas e cirurgiões orais devem estar atentos para a possibilidade de osteonecrose relacionada ao uso de injeções anuais de ácido zoledrônico para tratamento da osteoporose pós-menopausa.

Distribution of Inflammatory Cells and Expression of PSGL-1 in Infant Brainstem Tissue Related Fatal Brainstem Encephalitis / 法医学杂志

OBJECTIVE@#To explore the distribution of inflammatory cells and positive expression of P-se- lectin glycoprotein ligand-1 (PSGL-1) in infant brainstem tissue from hand-foot-mouth disease related fatal brainstem encephalitis.@*METHODS@#Twenty brainstem samples from infants suffered from brainstem en- cephalitis were collected as the experimental group. Ten brainstem samples from infants died of non- brain diseases and injuries were collected as the control group. The distribution of inflammatory cells and the expression of PSGL-1 in the two groups were examined by immunohistochemical method. The characteristics of the positive cells were observed.@*RESULTS@#In brainstem tissue of the experimental group, there were sleeve infiltrations of inflammatory cells around the vessels and in the glial nodule. Microglia was the most and following was neutrophils around the vessels and in the glial nodule. There was a significant statistical difference among microglias, neutrophils and lymphocytes (P < 0.05). There was no sleeve infiltration in the control group. PSGL-1 protein was expressed widely in inflammatory cells in the experimental group, especially in the inflammatory cells around the vessels and in the glial nodule. But PSGL-1 positive staining could be observed significantly less in the control group comparing with the experimental group (P < 0.05).@*CONCLUSION@#Microglia is the main type of inflammatory cells involved in the progress of the fatal disease. Moreover, PSGL-1 could participate in the pathogenesis of hand-foot-mouth disease related fatal brainstem encephalitis.

Las encefalitis esquinas: Una Revisión / The equine encephalitis: a review

El grupo de las encefalitis Equina Venezolana, del Este, del Oeste y del Nilo Occidental (EEV, EEE, EEO y ENO respectivamente) son zoonosis transmitidas por mosquitos a humanos y equinos. Este grupo de enfermedades se mantienen en la naturaleza en ciclos enzoóticos de transmisión entre mosquitos y roedores silvestres o aves que son sus hospedadores naturales. La circulación de estos virus es enzoótica y ocurre en áreas geográficas definidas y tienen capacidad de causar epidemias/epizootias con morbilidad y mortalidad que puede ser de importancia significativa. Este artículo describe detalladamente todas las encefalitis virales que afectan a los équidos y sus aspectos clínicos, patológicos y diagnósticos.

The encephalitis of Venezuelan Equine, Eastern, Western and West Nile (VEE, EEE, WEE and ENO respectively) are zoonotic encephalitis transmitted by mosquitoes to humans and horses. This group of diseases is maintained in nature in cycle’s enzootic transmission between mosquitoes and wild rodents or birds are their natural hosts. The circulation of this virus is enzootic and occurs in defined geographical areas but is capable of causing epidemics / epizootics with morbidity and mortality can be significant importance. This article describes all viral encephalitis affecting equines and their clinical, pathological and diagnostic aspects.

Experimental encephalitis caused by Taenia crassiceps cysticerci in mice / Encefalite experimental causada por cisticercos de Taenia crassiceps em camundongos

OBJECTIVES: To present the experimental model of neurocysticercosis (NCC) caused by Taenia crassiceps cysticerci, to describe the inflammatory process, susceptibility, or resistance of BALB/c and C57BL/6 mice to this infection, and to describe the host-parasite relationship. METHODS: The animals were intracranially inoculated with initial stage T. crassiceps cysticerci. They were euthanized at 7, 30, 60, and 90 days after the inoculation. Their encephala were removed for the histopathologic analysis, classification of the parasites, and inflammatory lesions. RESULTS: Experimental NCC was observed on both mice lineages. BALB/c mice presented inflammatory lesions with greater intensity, inducing necrosis on late stage parasites, and with an acute inflammation pattern, while C57BL/6 mice showed greater capability on provoking early necrosis in the cysticerci, which showed a chronic inflammation pattern. CONCLUSIONS: This experimental model induced NCC on mice with characteristic inflammation and lesions. C57BL/6 mice were able to induce precocious necrosis of the parasites presenting inflammatory lesions with lower intensity.

OBJETIVOS: Apresentar o modelo experimental de neurocisticercose (NCC) com cisticercos de Taenia crassiceps, descrever a inflamação, suscetibilidade e resistência em camundongos BALB/c e C57BL/6, caracterizando melhor a relação parasito-hospedeiro. MÉTODOS: Os animais foram inoculados intracranialmente com cisticercos de T. crassiceps em estádio inicial e eutanasiados aos 7, 30, 60 e 90 dias após a infecção. Retiraram-se os encéfalos para análise histopatológica, classificação dos parasitos e lesões inflamatórias. RESULTADOS: Foi possível induzir NCC nas duas linhagens de camundongos utilizados como modelo experimental. Os animais BALB/c apresentaram lesões inflamatórias mais intensas do que os camundongos C57BL/6 e induziram nos parasitos necrose na fase tardia com padrão inflamatório agudo. Os C57BL/6 mostraram-se mais hábeis em provocar necrose precocemente nos cisticercos, mas com padrão inflamatório crônico. CONCLUSÕES: Este modelo experimental induziu NCC nos animais com inflamações e lesões. Os camundongos C57BL/6 foram hábeis em induzir precocemente necrose nos parasitos, apresentando lesões inflamatórias com menor intensidade.

Reproductive failures associated with antibodies against caprine arthritis-encephalitis virus, Toxoplasma gondii and Neospora caninum in goats in the state of Sao Paulo, Brazil / Falhas reprodutivas associadas com a presença de do vírus da artrite-encefalite caprina, Toxoplasma gondii e Neospora caninum em caprinos no estado de São Paulo, Brasil

This study aimed at assessing the occurrence of antibodies against the caprine arthritis-encephalitis virus (CAEV), Toxoplasma gondii and Neospora caninum, as well as the associations between the presence of antibodies and the occurrence of reproductive failures in goats. Serum samples were collected from 923 goats of both sexes, over 3 months of age, from 17 dairy farms located in different municipalities of São Paulo State, Brazil. Infections by T. gondii, N. caninum and CAEV were evaluated by indirect methods of diagnosis based on indirect fluorescence antibody test (IFAT), Neospora agglutination test (NAT), and agar gel immunodiffusion (AGID), respectively. A survey was conducted on the farms to obtain information about reproduction dates (abortions, stillbirths and births of weak and premature kids) and zoosanitary management. Antibodies against CAEV, T. gondii and N. caninum was found in 37.81%, 23.62% and 17.23% respectively. There was no significant association between the presence of anti-CAEV antibodies and CAEV/T. gondii or CAEV/N. caninum co-infection, suggesting that CAEV does not predispose goats to infection by these agents. However, when CAEV/T. gondii (p<0.01) or CAEV/N. caninum (p<0.001) co-infection was present, the occurrence of reproductive failures was significantly higher what could indicate that CAEV-induced immunosuppression may predispose goats to develop the clinical symptoms of toxoplasmosis and neosporosis increasing the risks of the reproductive failures.

O objetivo do presente estudo foi avaliar a ocorrência de anticorpos para o vírus da atrite-encefalite caprina (CAEV), Toxoplasma gondii e Neospora caninum e de possíveis associações entre a presença de anticorpos e a ocorrência de problemas reprodutivos em caprinos. Para tanto, foram colhidas amostras sangüíneas de 923 caprinos de ambos os sexos, acima de três meses de idade e oriundos de 17 propriedades leiteiras, de diferentes municípios do estado de São Paulo, Brasil. Os diagnósticos para T. gondii, N. caninum e CAEV foram baseados, respectivamente, na reação de imunofluorescência indireta (RIFI), teste de aglutinação para Neospora (NAT) e a imunodifusão em gel de ágar (IDGA). Um inquérito epidemiológico foi aplicado nas propriedades para obtenção de informações sobre dados reprodutivos (abortamentos, natimortalidade e nascimentos de filhotes fracos e prematuros) e de manejo zoossanitário. As ocorrências de anticorpos foram de 37,81% para CAEV, de 23,62% para T. gondii e de 17,23% para N. caninum. Não houve associação significativa entre a presença de anticorpos anti-CAEV e co-infecção com T. gondii ou N. caninum, sugerindo que o CAEV não predispõe os caprinos à infecção por estes agentes. Entretanto, quando havia, nas fazendas, animais com co-infecção pelo CAEV e T. gondii (p<0,01) ou CAEV e N. caninum (p<0,001) as ocorrências de falhas reprodutivas foram significativamente maiores, sugerindo que a imunossupressão causada pelo CAEV pode predispor os caprinos ao desenvolvimento de sintomas clínicos da toxoplasmose e neosporose, potencializando os riscos da ocorrência de problemas reprodutivos causados por estas enfermidades.

Frecuencia de agentes virales en niños con afectación del sistema nervioso central en el estado Zulia, Venezuela: durante el año 2007 / Incidence of viral agents in children with central nervous system affectation in the state of Zulia, Venezuela: during 2007

Diversos virus afectan el sistema nervioso central (SNC) ocasionando encefalitis, principalmente en la edad pediátrica. Determinar la implicación de agentes virales en infecciones del sistema nervioso central (SNC) en niños del estado Zulia, Venezuela durante el año 2007. Se recolectaron 109 muestras de líquido cefalorraquídeo(LCR) y suero, provenientes de pacientes entre 1 día de nacido a 14 años, que presentaron sintomatología clínica sugestiva de afectación del SNC y cuyo estudio bacteriológico convencional de LCR resultó negativo. Se determinó la relación albúmina LCR/suero a fin de descartar contaminación, resultando 24 pares óptimos para la determinación por la técnica de ELISA de anticuerpos IgM específicos para los virus Herpes Simple (VHS), Epstein Barr (VEB), Dengue, Rubéola, Sarampión y Encefalitis Equina Venezolana (EEV). De los 24 casos analizados, 15 (62,5%) resultaron positivos. Los agentes causantes de encefalitis fueron: 11 casos de Dengue (45,8%) (p<0,05), 3 de VHS (12,5%) y un caso de VEB (4,2%). No se detectaron casos de Rubéola, Sarampión, ni EEV. La pleocitocis con predominio de linfocitos fue el hallazgo más frecuente en los casos con encefalitis viral (EV) confirmada, sin diferencias significativas al relacionarlo con el agente viral infectante. Se evidencia que una proporción significativa de los niños con encefalitis es debida a agentes virales y se destaca un incremento en los casos de dengue con afectación del SNC en la región

Various viruses affect the central nervous system (CNS) causing encephalitis, mainly in pediatric patients. To determine the involvement of viral agents for central nervous system (CNS) infections in children in the State of Zulia, Venezuela during the year 2007. 109 samples of cerebrospinal fluid (CSF) and serum were collected from patients between 1 day and 14 years of age, who presented clinical symptoms suggestive of CNS involvement and whose conventional CSF bacteriological study proved negative. The CSF Albumin /serum relation ship was determined in order to rule out contamination, resulting in 24 optimal pairs for determining the IgM and IgG antibodies specific for herpes simplex virus (HSV), Epstein Barr (EBV), Dengue fever, rubella, measles and Venezuelan Equine Encephalitis (VEE) using the ELISA technique. Of the 24 cases examined, 15 (62.5%) were positive. The causative agents for encephalitis were 11 cases of Dengue (45.8%) (p<0.05), 3 VHS (12.5%) and 1 case of EBV (4.2%). There were no cases of rubella, measles or VEE. Pleocytosis with lymphocyte predominance was the most common finding in cases with confirmed viral encephalitis (VE), without significant differences related to the infecting viral agent. Results show that a significant proportion of encephalitis in children is due to viral agents, highlighting an increase in dengue cases with CNS affection in the region

Atypical necrotizing encephalitis associated with systemic canine distemper virus infection in pups

This report describes the naturally occurring atypical neuropathological manifestation of systemic canine distemper virus (CDV) infection in two 16-day-old Pit Bull pups. CDV-induced changes affected the gray and white matter of the forebrain while sparing the hindbrain. Histologically, there was necrosis with destruction of the nervous parenchyma due to an influx of inflammatory and reactive cells associated with eosinophilic intranuclear inclusion bodies within glial cells. Positive immunoreactivity against CDV antigens was predominantly observed within astrocytes and neurons. RT-PCR was used to amplify CDV-specific amplicons from brain fragments. These findings suggest the participation of CDV in the etiopathogenesis of these lesions.

Generalidades / General aspects

La meningitis se define como la inflamación de las membranas que rodean al cerebro y a la médula espinal, que involucra la aracnoides, piamadre y el líquido cefalorraquídeo. Puede ocurrir a cualquier edad y es una emergencia, ya que si no se diagnostica precozmente y se indica tratamiento, puede ocasionar una mortalidad que varía del 2% al 30%, de acuerdo a la edad, o dejar secuelas permanentes tales como hidrocefalia, infarto cerebral, parálisis de pares craneales, alteraciones neuroendocrinas, colecciones intracraneales, hipertensión endocraneana, sordera neurosensorial, retraso psicomotor y parálisis cerebral. Se clasifica, de acuerdo a su tiempo de evolución en: aguda, crónica, recurrente; de acuerdo a su etiología en: infecciosas y no infecciosas. Las infecciosas pueden ser: virales, bacterianas, por hongos y por parásitos. Las no infecciosas pueden ser: tumorales, por enfermedades sistémicas y tóxicas. Los agentes infecciosos que invaden al Sistema Nervioso Central y causan meningitis, lo hacen a través de tres mecanismos: primero colonizan e infectan al huésped a través de la piel, nasofaringe, tracto respiratorio (la mayoría), genitourinario o gastrointestinal. Invaden la submucosa, vencen las barreras del huésped (física e inmunidad) y penetran al Sistema Nervioso Central por 3 vías: torrente sanguíneo, acceso retrógrado neuronal e inoculación directa, produciendo inflamación de las meninges

Meningitis is defined as the inflammation of the membranes that surround the brain and the spinal marrow, which involves the aracnoides, the pia mater and the spinal fluid. It can occur at any age, and it constitutes an emergency, since it may cause a mortality rate between 2 and 30 % or lead to permanent sequela as: brain edema, cerebral infarction, cranial nerve paralysis, neuroendocrine disorders, intracranial collections or hypertension, neurosensorial deafness, psychomotor delay, and cerebral palsy. According to the length of its evolution it is classified in acute, chronic and recurrent; according to its etiology, in infectious and non infectious. Infectious etiologies are viral, bacterial, fungic and parasitic. Non infectious etiologies are tumoral, toxic and systemic diseases. Infectious agents that invade the Central Nervous System (CNS) may cause meningitis by three mechanisms: first they colonize and infect the guest via skin, respiratory, genitourinary or gastrointestinal systems. They invade the submucosa, overcome the guest’s physical and immune barriers, and penetrate the CNS through 3 routes: blood, neuronal retrograde access and direct inoculation

Neuropathological spectrum of lesions associated with intractable epilepsies: a 10-year experience with a series of 153 resections.

BACKGROUND: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. AIMS: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. MATERIALS AND METHODS: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). RESULTS: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. CONCLUSION: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the extratemporal ones.

Neuropathological spectrum of Rasmussen encephalitis.

BACKGROUND: Rasmussen encephalitis (RE) is a chronic epileptic disorder of unknown etiology, and is clinically characterized by progressive neurological deterioration, focal seizures often progressing to intractable epilepsy, cognitive decline and hemispheric atrophy. AIMS: We report the spectrum of neuropathological changes seen in RE, and discuss the evolutionary mechanisms of this disease. MATERIALS AND METHODS: Surgically obtained specimens from RE patients diagnosed during 2002-2004 at this institute were evaluated for the presence and extent of different histopathological features of RE. The H&E and immunohistochemistry stained slides were also evaluated for the type and distribution pattern of inflammatory infiltrates, along with a semiquantitative evaluation for the severity of inflammation. RESULTS: Four cases of RE were admitted during the study period, all of which presented with partial seizures with successive deterioration to intractable epilepsy. The age at onset varied between 5 and 10 years (mean 7.8 years), with three male and one female patients. Subsequently, all four patients underwent hemispherotomy. Histopathological features of perivascular lymphocytic infiltrate, neuronal loss, microglial nodules, and reactive astrocytosis, with or without evidence of neuronophagia confirmed a diagnosis of RE. These cases also had varying degrees of T-cell-rich (CD3-positive) inflammatory infiltrates and CD68-immunopositive microglial proliferation. It was observed that the severity of inflammation had a trend to inversely correlate with the duration of symptoms. CONCLUSION: It is proposed that an accurate evaluation and histopathological grading of these lesions may possibly have a role in patient prognostication.

Experimental meningoencephalomyelitis by Encephalitozoon cuniculi in cyclophosphamide-immunosuppressed mice

A encefalitozoonose constitui protozoose emergente em indivíduos imunocomprometidos. Este estudo visa examinar o desenvolvimento de infecção experimental por Encephalitozoon cuniculi no sistema nervoso central de camundongos imunossuprimidos. Camundongos Balb-C adultos foram inoculados intraperitonealmente com esporos de E. cuniculi, tratados com ciclofosfamida durante o período experimental e sacrificados dos 15 aos 75 dias pós-inoculação. Fragmentos teciduais foram coletados e processados para estudos de microscopia de luz e eletrônica de transmissão. Granulomas multifocais foram vistos em todos os órgãos. Foi observada meningoencefalomielite linfocítica, difusa, não-supurativa, com degeneração e necrose neuronal, infiltração macrofágica e astrocitose reativa. Esporos de E. cuniculi foram vistos nos microgranulomas ou ocorreram sem associação com reação inflamatória. Os parasitas raramente foram notados em cortes corados com Hematoxilina-Eosina, mas eram Gram-chromotrope-positivos. Esporos e formas proliferativas foram encontrados em vacúolos parasitóforos dentro de células neurais e macrófagos. A encefalitozoonose experimental em camundongos imunossuprimidos fornece um modelo adequado para o estudo de lesões cerebrais associadas com tais protozoários no homem.

Descripción de un caso de aborto bovino asociado a infección por Neospora sp en México / Description of a case of bovine abortion associated to Neospora sp infection in México

En el siguiente informe se describe un caso de aborto bovino asociado a neosporosis en México. El feto fue remitido para su estudio al Departamento de Patología de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad Nacional Autónoma de México. El feto fue expulsado al quinto mes de gestación, siendo macho y de raza Holstein. En el estudio microscópico se encontró encefalitis no supurativa con múltiples focos de necrosis y gliosis, además de un quiste parasitario oval de pared gruesa de 21 x 22 mm. Varias secciones de tejido nervioso desparafinadas se examinaron para estudio inmunohistoquímico, utilizando anticuerpos anti Neospora caninum encontrándose grupos de taquizoitos extracelulares asociados a las áreas de gliosis. También se encontró miocarditis y hepatitis no supurativa discreta. Se cree que este es el primer caso descrito en México de aborto bovino asociado a lesiones características y a la presencia de estructuras parasitarias correspondientes a Neospora sp. Sin embargo, es necesario realizar más estudios anatomopatológicos e inmunológicos para poder determinar la prevalencia y la significancia de aborto bovino asociado a neosporosis en México

Importancia de la microscopía electrónica de transmisión en el diagnóstico de la epidemia de encefalitis equina venezolana de 1995 en la Guajira Venezolana / The importance of transmission electron microscopy in the diagnosis of venezuelan equine encephalitis during the epidemic of 1995 in the venezuelan Guajira

Se estudió con el microscopio electrónico de transmisión el cerebro de 25 ratones lactantes, inoculados intercerebralmente con el sobrenadante de células VERO cultivadas e infectadas con el virus de la EEV, como control positivo, con muestras de suero o líquido cefalorraquídeo de pacientes con síntomas y signos de encefalitis, con sueros de pacientes sanos, con sueros de equinos enfermos y con solución borato-salina de albúmina bovina, como control negativo. Las muestras se tomaron del brote epizoótico y epidémico en Octubre del año 1995 en la región de la Guajira Venezolana al norte del Estado Zulia. El estudio ultraestructural se hizo a ciegas, pero, confirmo la presencia de pacientes de Togavirus en el 100 por ciento de los casos examinados cuando correspondían a muestras virológicamente positivas. Se destaca la utilidad, precisión y la rapidez del método empleado

Encefalitis amebiana granulomatosa en una paciente no inmunodeprimida: un hecho excepcional / Granulomatous amebic encephalitis in a non-immunosuppressed patient

La infección humana por amebas de vida libre es muy rara y en general grave. Las amebas de los géneros Naegleria determinan una meningoencefalitis aguda fulminante, y las del género Acanthamoeba una enfermedad subaguda granulomatosa que con más frecuencia se observa en pacientes inmunodeprimidos. Se estudió una paciente de medio rural, sin antecedentes patológicos, sin elementos de inmunosupresión,que ingresa con un cuadro de un mes de evolución, con crisis convulsivas. En la TAC presentó un proceso expansivo fronto-parietal. Se intervino quirúrgicamente con ese diagnóstico. La biopsia extemporánea informó proceso inflamatorio en bloque. El estudio anátomo patológico en diferido, mostró un proceso inflamatorio crónico granulomatoso necrotizante con escasa supuración, con microorganismos con formas quísticas y trofozoíticas entre 15 y 30 micras, que con las técnicas especiales son compatibles con amebas de vida libre. Se realizó el diagnóstico de Encefalitis Amebiana Granulomatosa (EAG). Esta entidad es muy rara y generalmente afecta a pacientes inmunodebilitados y es excepcional en pacientes inmunocompetentes. El tratamiento puede ser médico-quirúrgico o, quirúrgico con exéresis en bloque. Cuando el diagnóstico es precoz y es unifocal se puede obtener una excelente evolución, como en este caso