Atezolizumab-induced encephalitis in a patient with metastatic breast cancer: a case report and review of neurological adverse events associated with checkpoint inhibitors

Immune-mediated encephalitis as an adverse event due to checkpoint inhibitors is very rare. We describe herein the case of a 38-year-old woman with metastatic triple-negative breast cancer who developed seizures and somnolence twelve days after receiving the first dose of Atezolizumab. Work up ruled out all infectious etiologies, and the patient was eventually diagnosed with immune-mediated meningoencephalitis. Symptoms recovered with a high-dose of steroids, and she was found to have an excellent response on follow-up imaging, which raised the question of whether a relationship exists between the occurrence, and severity of the adverse event and the response to treatment. Only a few other cases of atezolizumab-related encephalitis have been published. Early recognition and treatment are crucial; the reason why we are describing this case along with a review of the literature and a review on all the neurological immune-related adverse events due to the different checkpoint inhibitors.

Early and late neuropathological features of meningoencephalitis associated with Maraba virus infection

Maraba virus is a member of the genus Vesiculovirus of the Rhabdoviridae family that was isolated in 1983 from sandflies captured in the municipality of Maraba, state of Pará, Amazônia, Brazil. Despite 30 years having passed since its isolation, little is known about the neuropathology induced by the Maraba virus. Accordingly, in this study the histopathological features, inflammatory glial changes, cytokine concentrations, and nitric oxide activity in the encephalon of adult mice subjected to Maraba virus nostril infection were evaluated. The results showed that 6 days after intranasal inoculation, severe neuropathological-associated disease signs appeared, including edema, necrosis and pyknosis of neurons, generalized congestion of encephalic vessels, and intra- and perivascular meningeal lymphocytic infiltrates in several brain regions. Immunolabeling of viral antigens was observed in almost all central nervous system (CNS) areas and this was associated with intense microglial activation and astrogliosis. Compared to control animals, infected mice showed significant increases in interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (INF)-γ, MCP-1, nitric oxide, and encephalic cytokine levels. We suggest that an exacerbated inflammatory response in several regions of the CNS of adult BALB/c mice might be responsible for their deaths.

Meningoencefalitis bacteriana en niños de Guantánamo. Su comportamiento durante 2007-2013 / Bacterial meningoencephalitis in Guantanamo children. Your behavior during 2007-2013

Introducción: en la unidad de cuidados intensivos no siempre se conocen los factores que determinan el pronóstico del paciente con peritonitis. Objetivo: precisar los factores determinantes de la mortalidad por peritonitis secundaria en esta unidad en el Hospital "Dr. Agostinho Neto" durante los años 2014-2016. Método: se realizó un estudio analítico prospectivo y longitudinal de todos los pacientes ingresados en la citada UCI por peritonitis secundaria en los años 2014-2016 (n=70), los que se agruparon según fueran egresados vivos o fallecidos. Se precisaron las variables más relacionadas con la probabilidad de que el paciente falleciera y las más frecuentes en los fallecidos. Se calculó el riesgo absoluto (RA) de cada variable. Resultados: los factores más frecuentes fueron: fiebre (n=53), Síndrome respuesta inflamatoria sistémica (n=51) y la leucocitosis/desviación izquierda (n=51). Los factores con mayor probabilidad de determinar la muerte fueron: fallo multiorgánico (RA 17.8), fluido peritoneal fecaloideo (RA 7.8) y choque séptico (RA 7.3). Conclusión: Los factores que determinan la mortalidad por peritonitis secundaria son: la peritonitis difusa, presencia de fallo multiorgánico, hipoxemia ? 85 mmHg y/o Sp02 ? 90 por ciento, edad ? 60 años, presión intrabdominal poscirugía ? 21 cm H2O (15 mmHg), síntomas ? 24 h antes de cirugía, choque séptico, fluido peritoneal fecaloideo, origen colónico de la peritonitis(AU)

A retrospective longitudinal descriptive study was carried out to determine the behavior of children with bacterial meningoencephalitis at the Pediatric Hospital Pedro A Pérez in the period from 2007 to 2013. The study universe was composed of 58 patients. We studied a series of variables such as: behavior by age, age, main symptoms and signs at admission, evolution in intensive care, and prognosis. The data were collected from the medical records. The main results were: 2009 was the year of greatest morbidity, infants were the most affected, the main symptoms were: fever, headache and vomiting; electrolytic disorders and shock were the main complications and the favorable evolution prevailed. Conclusions and recommendations were issued(AU)

Actualización de la situación epidemiológica de las meningoencefalitis / Update on the epidemiological situation of meningoencephalitis

En el siguiente apartado se analizarán los casos de meningitis desde la Semana epidemiológica (SE) 1 a la 48 del 2016 (hasta 03/12/2016) provenientes de la notificación a través del SNVS (tanto del módulo C2 como SIVILA). Incluye las notificaciones recogidas de efectores públicos y privados de la Ciudad. Todos los casos fueron analizados de manera individual, evitando duplicaciones de datos e integrando la información en una base unificada. Para la construcción de los corredores endémicos se tomaron los datos hasta la cuatrisemana epidemiológica 12 completa que culmina el 03/12/2016. La construcción de las tasas, se realizó en base a las proyecciones poblacionales aportadas por la Dirección de Estadística y Censos (DGEyC) de la Ciudad Autónoma de Buenos Aires. (AU)

Situación epidemiológica de las meningoencefalitis / Epidemiological situation of meningoencephalitis

La meningoencefalitis son enfermedades endemoepidémicas de distribución universal, generalmente graves, que requieren un rápido tratamiento por la velocidad de su evolución y la posibilidad de secuelas o muerte. La meningitis de etiología infecciosa es una patología de notificación obligatoria, inmediata y universal, lo que permite conocer su incidencia, distribución etaria, ubicación geográfica, estacionalidad, características de su evolución, entre otras variables, para orientar las estrategias de prevención y control. Se analizan los casos de meningitis desde la SE 1 a la 37 del 2016, (17 de Septiembre) provenientes de la notificación a través del Sistema Nacional de Vigilancia Sanitaria, y la situación epidemiológica en la Ciudad de Buenos Aires

Histopathological and molecular characterization of encephalitic listeriosis in small ruminants from northern Paraná, Brazil

Listeriosis is a disease primarily of ruminants caused by the Gram-positive bacterium Listeria monocytogenes. Ruminants either demonstrate manifestations of the encephalitic, septicemic, or reproductive form of listeriosis. The pathological and molecular findings with encephalitic listeriosis in a 5.5-month-old, male, mixed-breed goat and a 3-year-old Texel-crossed sheep from northern Paraná, Brazil are described. Clinically, the kid demonstrated circling, lateral protrusion of the tongue, head tilt, and convulsions; the ewe presented ataxia, motor incoordination, and lateral decumbency. Brainstem dysfunctions were diagnosed clinically and listeriosis was suspected. Necropsy performed on both animals did not reveal remarkable gross lesions; significant histopathological alterations were restricted to the brainstem (medulla oblongata; rhombencephalitis) and were characterized as meningoencephalitis that consisted of extensive mononuclear perivascular cuffings, neutrophilic and macrophagic microabscesses, and neuroparenchymal necrosis. PCR assay and direct sequencing, using genomic bacterial DNA derived from the brainstem of both animals, amplified the desired 174 base pairs length amplicon of the listeriolysin O gene of L. monocytogenes. Phylogenetic analyses demonstrated that the strains associated with rhombencephalitis during this study clustered with known strains of L. monocytogenes lineage I from diverse geographical locations and from cattle of the state of Paraná with encephalitic listeriosis. Consequently, these strains should be classified as L. monocytogenes lineage I. These results confirm the active participation of lineage I strains of L. monocytogenes in the etiopathogenesis of the brainstem dysfunctions observed during this study, probably represent the first characterization of small ruminant listeriosis by molecular techniques in Latin America, and suggest that ruminants within the state of Paraná were infected by the strains of the same lineage of L. monocytogenes.

Amibas de vida libre Acanthamoeba, Balamuthia, Naegleria, Sappinia y Paravahlkampfia: agentes de infección en humano y transmisoras de microorganismos / Free-living amoebae Acanthamoeba, Balamuthia, Naegleria, and Paravahlkampfia Sappinia: agents of human infection and transmission of microorganisms

Se han reportado como agentes causales de enfermedad en humanos: Naegleria fowleri, agente causal de meningoencefalitis amibiana primaria en individuos inmunocompetentes: varias especies de género Acanthamoeba que pueden producir encefalitis granulomatosa amibiana en individuos inmunosuprimidos, úlceras corneales, lesiones en piel y otros órganos en personas inmunocompetentes; Ballamuthia mandrillares agente causal de encefalitis y lesiones en piel en personas inmunocompetentes, Sappinia pedata responsable de un caso de encefalitis en un individuo inmunocompetente y Paravahlkamphfia sp en un caso de queratitis y Paravahlkamphfia francinae en un caso de meningoencefalitis aminiana primera, en paciente en paciente inmunocompetente. No se conoce totalmente los factores de los que depende que las enfermedades producidas por amibas de vida libre se presenten, influyen la presencia de algunas enfermedades, contacto con aguas en las cuales se encuentran estas amibas, y la presencia de enzimas capaces de ejercer efecto citopático. Además el uso de lentes de contacto, algunas costumbres y necesidades humanos rompen el equilibrio ecológico, aumentando así la probabilidad de contacto del hombre con estas amibas. Se han evidenciado en ellas microorganismo en un proceso de endosimbiosis lo que por lo que amibas de vida libre intervienen en la transmisión de ciertos microorganismos patógenos y las amibas se transforman en un incubador potencial y transmisorasde agentes infecciosos. Debe investigarse sobre aspectos biológicos y la relación con el humano.

Have been reported as causative agents of disease in humans: Naegleria fowleri, the causative agent of primary amoebic meningoencephalitis in immunocompetent individuals, several species of Acanthamoeba that con cause granulomatous amoebic encephalitis in immunosuppressed individuals, corneal ulcers, skin lesions and other organs in people immunocompetent; Ballamuthia madrillares causative agent of encephalitis and skin lesions in immunocompetent persons, Sappinia pedata, responsible for a case of encephalitis in an immunocompetent individual Paravahlkamphfia sp in a case of keratitis and Paravanhlkamphfia francinae in a case of primary amoebic meningoencephalitis in an immunocompetent patient. Not fully understood the factors that it depends on diseases caused by free-living amoebae are present, influencing the presence of some diseases, contact with water where are these amoebae, and the presence of enzymes capable of the cytopathic effect. Furthermore, the use of contact lenses, some customs and human needs break the ecological balance, thereby increasing the likelihood of human contact with these amoebae. Have been evidenced in these microorganisms in the process of endosymbiosis that so the free-living amoebae in the transmission of certain pathogenic microorganisms and amoebas and become a potential incubator and transmission of infectious agents. Biological aspects should be investigated and the relationship with the human.

Estudio clínico-epidemiológico de la criptococosis en Venezuela: años 1994-2003 / Clinical-epidemological study of cryptococcosis in Venezuela: 1994-2003

La criptococosis es una enfermedad oportunista de distribución mundial. Frecuentemente es una infección definitoria de SIDA. El tratamiento antirretroviral ha disminuido su frecuencia. El impacto de esta entidad en Venezuela es desconocido. El objetivo de este trabajo es describir las características más relevantes de la criptococosis en nuestro país. Se revisaron 110 historias clínicas de pacientes hospitalizados con el diagnostico de criptococosis, entre 1994 y 2003, en 6 hospitales. Los datos recolectados incluyeron: características demográficas, clínicas, diagnósticas, terapéuticas y la evolución de los pacientes. Para el análisis se utilizaron los programas SPSS 10.0 y EpiInfo 6.04 (2001). Dentro de los 110 pacientes evaluados se incluyeron 17 protocolos de autopsia. Uno solo de los pacientes tenia 8 años de edad, el resto era mayor de 15 años. 91 eran del sexo masculino y 19 femenino. 91 (82,73 por ciento) tenían SIDA y 19 (17,27 por ciento) eran VIH negativo. En los pacientes con SIDA el valor promedio de CD4+ fue < 200 cel/mm³ y la carga viral era > 30000 copias/mL; 52 (57,14 por ciento) de los casos no tenían otra infección oportunista y 39 (42,86 por ciento) tenían otras condiciones asociadas, tales como tuberculosis (30,97 por ciento), neumocistosis (28,21 por ciento), y toxoplasmosis (20,51 por ciento). En los pacientes VIH negativo, el uso de esteroides (25 por ciento) fue el factor de riesgo predominante. Dos pacientes eran embarazadas. En 107 (57,27 por ciento) se encontró infección del SNC. 12 (13,19 por ciento) de los pacientes con SIDA tenían alteración de pares craneales. Se encontró afectación pulmonar en 4 (3,77 por ciento) pacientes, 1 de ellos con SIDA. La criptococosis fue la enfermedad definitoria de SIDA en el 61,54 por ciento de los casos. 33 (30 por ciento) de los pacientes fallecieron. En la mayoría de los pacientes la criptococosis se asoció a SIDA. A pesar de la eficacia del tratamiento antirretrovial, esta micosis es todavia ...

Cryptococcosis is an opportunistic disease of worldwide distribution. It is frequently an AIDS-defining infection. Antiretroviral treatment has reduced its occurrence. In Venezuela, the impact of this disease is unknown. The aim of this study is to describe the most relevant features of cryptococcosis in our country. 110 clinical records with a diagnosis of cryptococcosis hospitalized between 1994 and 2003 in 6 Venezuelan hospitals were analyzed. Data collected included demographic, clinical, diagnostic, therapeutic and outcome information. SPSS 10.0 software and EpiInfo 6, version 6.04 (2001) were used. 110 patients with cryptococcosis were enrolled, including 17 autopsy protocols. One was 8 years old, the rest were over 15. Nineteen were female and 91 male; 91 (82.73 percent) had AIDS, 19 (17.27 percent) were HIV negative. Among the AIDS patients, average CD4+ count was < 200 cel/mm3 and viral load was > 30000 copies/ml; 52 (57.14 percent) did not have other opportunistic infections or AIDS-related disease, and 39 (42.86 percent) had other associated conditions, such as tuberculosis (30.97 percent), PCP (28.21 percent) and toxoplasmosis (20.51 percent). In HIV negative patients, use of steroids (25 percent) was the predominant risk factor. Two patients were pregnant. 107 (57.27 percent) presented CNS infection; 12 (13.19 percent) with AIDS had cranial nerve alterations. Pulmonary disease was found in 4 (3.77 percent), of which one had AIDS. Cryptococcosis was an AIDS-defining infection in 61.54 percent of cases; 33 (30 percent) of the patients died. In most of the patients, cryptococcosis was associated with AIDS. In spite of the efficacy of antiretroviral treatment, this mycosis is still significant in Venezuela, perhaps due to late HIV infection diagnosis

Meningoencefalitis zigomicótica piogranulomatosa en un puercoespín de cola pren sil (Coendou prehensilis) / Piogranulomatous zygomycotic meningoencephalitisb in a prehensile tailed porcupine (Coendou prehensilis)

Con el término de zigomicosis (ZM) se designa un grupo de enfermedades causadas por hongos de la clase Zygomicetes, de los órdenes Mucorales y Entomophthorales, de varios géneros y especies. La presentación de ZM en animales ocurre esporádicamente en numerosas especies tanto en animales domésticos como silvestres (incluso en mamíferos marinos) y son pocos los casos comprobados de aislamiento e identificación del agente causal. Pocos hongos son considerados como neurotrópicos ya que tienden a localizarse en el SNC después de invadir el hospedador; sin embargo, la mayoría de los casos de meningitis o meningoencefalomielitis son parte de micosis sistémicas como la Candidiasis, la Criptococosis, la Aspergilosis o la ZM. El presente trabajo documenta el hallazgo de una meningoencefalitis zigomicotica secundaria a un trauma craneoencefálico en un puercoespín de cola prensil (Coendou prehensilis), siendo una enfermedad rara infrecuente en el sistema nervioso central tanto en humanos como en animales y adicionalmente sin reportes previos en esta especie.

With the word Zygomycosis (ZM) are designating a group of diseases caused by fungi of the class Zygomicetes, the orders Mucorales and Entomophthorales, of several genera and species. The presentation of ZM in animals occurs sporadically in many species both in domestic and wild animals (including marine mammals), and are checked few cases of isolation and identification of the causative agent. Few fungi are considered to be neurotropic because they tend to be located in the CNS after invading the host; however, most cases of meningitis or meningoencephalomyelitis are part of systemic fungal infection such as Candidiasis, Cryptococcosis, Aspergillosis or ZM. This paper documents the discovery of a zigomicotic meningoencephalomyelitis secondary to a head trauma in a prehensile-tailed porcupine (Coendou prehensilis), being a rare disease infrequent in the central nervous system both in human and animals and additionally without previous reports in this specie.

Astrocytic and microglial response and histopathological changes in the brain of horses with experimental chronic Trypanosoma evansi infection / Resposta astrocítica e microglial e alterações histopatológicas no sistema nervoso central de eqüinos infectados cronicamente com Trypanosoma evansi

This study aimed to characterize astrocytic and microglial response in the central nervous system (CNS) of equines experimentally infected with T. evansi. The experimental group comprised males and females with various degrees of crossbreeding, ages between four and seven years. The animals were inoculated intravenously with 10(6) trypomastigotes of T. evansi originally isolated from a naturally infected dog. All equines inoculated with T. evansi were observed until they presented symptoms of CNS disturbance, characterized by motor incoordination of the pelvic limbs, which occurred 67 days after inoculation (DAI) and 124 DAI. The animals in the control group did not present any clinical symptom and were observed up to the 125th DAI. For this purpose the HE histochemical stain and the avidin biotin peroxidase method was used. Lesions in the CNS of experimentally infected horses were those of a wide spread non suppurative meningoencephalomyelitis.The severity of lesions varied in different parts of the nervous system, reflecting an irregular distribution of inflammatory vascular changes. The infiltration of mononuclear cells was associated with anisomorphic gliosis and reactive microglia was identified. The intensity of the astrocytic response in the CNS of the equines infected by T. evansi characterizes the importance of the performance of these cells in this trypanosomiasis. The characteristic gliosis observed in the animals in this experiment suggests the ability of these cells as mediators of immune response. The parasite, T. evansi, was not identified in the nervous tissues.

Este estudo objetivou caracterizar a participação astrocítica e microglial no sistema nervoso central (SNC) de eqüinos experimentalmente infectados com T. evansi. O grupo experimental foi formado por machos e fêmeas com vários graus de cruzamentos e idade variando entre quatro e sete anos. Os animais foram inoculados com 10(6) tripomastigotas de T. evansi, originalmente isolada de um cão infectado naturalmente. Todos os eqüinos inoculados foram observados até o aparecimento dos sintomas neurológicos, caracterizados por incoordenação motora dos membros pélvicos, o qual ocorreu entre 67 e 124 dias após a inoculação (DPI). Os animais do grupo controle não apresentaram sinais clínicos e foram observados até o 125º DPI. Para este propósito, foram utilizados os métodos histoquímicos (HE) e imunoistoquímicos do complexo avidina-biotina peroxidase (ABC). A lesão no sistema nervoso central (SNC) dos eqüinos infectados com T. evansi foi caracterizada como meningoencefalomielite não supurativa. A gravidade das lesões variou em diferentes segmentos do SNC, refletindo distribuição irregular das alterações vasculares. Infiltrado perivascular e meníngeo foi associado a gliose anisomórfica e microgliose reativa. A intensidade da resposta astrocítica no SNC dos equinos infectados com T. evansi caracteriza a importância da performance destas células nas tripanossomíases. A gliose observada nos animais deste experimento sugerem a habilidade destas células como mediadoras da resposta imune. T. evansi não foi identificado no parênquima do SNC.

Meningoencefalitis amebiana primaria: comunicacion de dos nuevos casos Venezolanos / Primary amebic meningoencephalitis: two new cases report from Venezuela

La meningoencefalitis amebiana primaria (MAP) es infrecuente. Describimos dos nuevos casos de MAP en pacientes Venezolanos. Caso 1, Varón de 10 años, con fiebre, cefalea, vómitos y debilidad generalizada, y antecedente de inmersión en un estanque de agua días antes del inicio de sus síntomas, falleciendo 72 horas después del ingreso. Caso 2, Varón de 23 años con historia de cefalea, fiebre, vómitos, somnolencia y cambios de conducta. El paciente falleció 40 horas después. El estudio neuropatológico en ambos casos reveló MAP por Naegleria fowleri. La encefalitis por amebas anfizoicas debe sospecharse en casos de meningoencefalitis asépticas.

Primary amebic menigoencephalitis (PAM) is rare. Two cases of PAM in Venezuelan patients are described. Case 1, a 10 year-old male with headache, fever, vomiting. The patient swam in a water reservoir before the onset of his disease. He died during his third hospital day. Case 2, a 23 year-old male with a history of headache, fever, vomiting, drowsiness, and behavioral disturbances. The patient died on his second hospital day. The diagnosis in both cases was PAM due to Naegleria fowleri. Central nervous system infection by free-living amebas should be considered in meningoencephalitides with bacterial-free cerebro-spinal fluid.

Meningoencephalitis by Naegleria fowleri: epidemiological study in Anzoategui state, Venezuela

Um caso de meningoencefalite amebiana primária, causada por Naegleria fowleri, foi diagnosticada no município de Independência no Estado de Anzoategui, Venezuela. Este caso motivou a realização deste estudo epidemiológico com o objetivo de identificar amebas de vida livre nessa área. Foram colhidas amostras representativas de água e realizadas análises fisicoquímicas e microbiológicas. Trofozoítos e cistos de Naegleria spp foram detectados em 44,4% (n=4). Verificou-se excelente concordância entre a observação das amebas de vida livre em esfregaços e aquelas de culturas monoxênicas em ágar não nutriente com Klebsiella pneumoniae (Kappa=1; p=0,003). Obteve-se uma carga variável de microrganismos mesófilos aeróbicos. As médias de mofos e leveduras foram de 3,0 CFU/ml (SD+2,0) e 102,9 CFU/ml(SD+32,2), respectivamente. Cem por cento das amostras apresentaram um número maior provável de coliformes totais e fecais de 240.000 NMP/100ml. Naegleria spp estava presente nas águas do município de Independência no Estado de Anzoategui, o que constitui um risco para a população que usa essas fontes.

Meningoencefalitis por mycoplasma pneumoniae en un adulto joven / Mycoplasma pneumoniae meningoencephalitis in a yuong adult

Las infecciones por Mycoplasma pneumoniae presentan complicaciones del sistema nervioso de distinto tipo, que si bien son infrecuentes pueden ser graves; habitualmente tienen evolución favorable pero pueden dejar secuelas permanentes. Se presenta una paciente adulta joven con una meningoencefalitis aguda que no dejó secuelas como complicación de una infección respiratoria baja. El diagnóstico se efectuó por detección de anticuerpos específicos.

Meningoencefalite por toxoplasmose / Toxoplasmic meningoencephalitis

A toxoplasmose é uma das infecçöes mais comuns do sistema nervoso central na síndrome da imunodeficiência adquirida, ocorrendo em cerca de 19 por cento dos pacientes. Este artigo descreve os achados patológicos e também os achados de imagem por tomografia computadorizada e ressonância magnética na meningoencefalite por toxoplasmose.

Meningoencefalites toxoplásmica e chagásica em pacientes com infecção pelo vírus da imunodeficiência humana: diagnóstico diferencial anatomopatológico e tomográfico / Toxoplasmic and chagasic meningoencephalitis in patients with human immunodeficiency virus infection: anatomopathologic and tomographic differential diagnosis

Em 22 pacientes com sorologia positiva para o vírus da imunodeficiência humana, com ou sem síndrome da imunodeficiência adquirida, dos quais 7 com meningoencefalite toxoplásmica e 15 com meningoencefalite chagásica associadas, procuraram-se dados diferenciais, entre as duas encefalopatias, tanto à anatomia patológica quanto à tomografia computadorizada do crânio. Os resultados observados e os dados da literatura nos permitiram concluir que enquanto na meningoencefalite necrosante focal por Toxoplasma gondii o acometimento dos núcleos da base é freqüente, na meningoencefalite necrosante focal causada pelo Trypanosoma cruzi, lesões dessas estruturas parecem não ocorrer ou ser excepcionais. De outro lado, o acometimento da substância branca parece nitidamente maior na meningoencefalite chagásica que na meningoencefalite toxoplásmica, ao passo que o parasitismo e a hemorragia do tecido nervoso, bem como as lesões das bainhas de mielina são mais freqüentes e intensos na meningoencefalite causada pelo Trypanosoma cruzi que naquela por Toxoplasma.

Twenty-two HIV+ patients with encephalitis were studied. Of these, 7 had meningoencephalitis due to Toxoplasma gondii (MT) and 15 due to Trypanosoma cruzi (MC). Pathologic and computerized axial tomography (CAT) changes were compared. We found that focal necrotizing encephalitis due to Toxoplasma involved the cerebral cortex and the basal ganglia, whereas lesions due to Trypanosoma cruzi were centered in the white matter, sometimes extending into the cortex. Hemorrhages, myelin lesions and organisms were more pronounced in chagasic than in toxoplasmic encephalitis. These findings are consistent with the literature reviewed.

Chagasic meningoencephalitis in the immunodeficient

Based on their own experience on the literature, the authors compare the brain pathology due to HIV+ associated Trypanosoma cruzi reactived infecction to that described for the natural history of the Chagas' disease (CD). The peculiar focal necrotizing chagasic meningoencephalitis (MECNF) which appears only in immunedeficient chagasics, especially when the deficiency is due HIV is a safe criterion for reactivation of CD. MECNF morphologic findings are unlike to those found either for some cases of acute phase CD or for chronic nervous form of CD.

Naegleria meningomyeloencephalitis.

A case of primary amebic meningoencephalitis (PAM) with severe spinal cord involvement was documented in a 12 year-old boy from Samut Prakan Province, Thailand. This is the first reported case of Naegleria meningomyeloencephalitis in Thailand. He had a history of swimming in the canal nearby his house prior to the fever, headache and convulsion which rapidly progressed into a comatose state. PAM was only detected at post-mortem. The findings included suppurative exudates and necrosis of the olfactory bulbs and the basal parts of the frontal, temporal lobes, pons, cerebellum, medulla and the spinal cord. Numerous Naegleria trophozoites were present in the brain and spinal cord. Foci of neuronal degeneration and demyelination were noted.

Prevención de la meningoencefalitis por Haemophilus influenzae b y por Neisseria meningitidis / Prevention of meningoencephalitis by Haemophilus influenzae b and Neisseria meningiditis

Las meningitis bacterianas son un importante problema de salud pública en la población pediátrica. En este capítulo se tratarán conjuntamente a dos de los más relevantes agentes etiológicos, Haemophilus influenzae del serotipo b y Neisseria meningitidis, debido a que los cuadros clínicos que provocan son prácticamente indistinguibles y a que además tienen varias características en común: a) forman parte de la flora normal de la faringe de individuos sanos; b) se transmiten de persona a persona a través de objetos; c) presentan reactividad cruzada con antígenos de otras especies bacterianas; d) poseen una cápsula prominente de naturaleza polisacarídica; e) tienen una membrana externa formada por varias clases de proteínas; y f) cuentan con la capacidad de elaborar protesas extracelulares contra inmunoglobulina. En México las enfermedades invasivas causadas por H. influenzae no han recibido la atención que requieren y el conocimiento que se tiene es insuficiente para poder evaluar su impacto real como problema de salud. Hasta la fecha en México, se han hecho un gran número de estudios en relación con estos padecimientos, aunque la mayoría se han basado en su diagnóstico clínico o bacteriológico, el reconocimiento de sus complicaciones tales como las secuelas neurológicas en el caso de la meningitis y su tratamiento con medicamentos antimicrobianos. Con base a estos estudios sólo se cuenta con datos sobre la frecuencia de casos de meningitis purulenta en la población infantil, los que indican que H. influenzae es el agente causal más frecuente, encontrándose aproximadamente en el 25 por ciento de los casos, seguido por Streptococcus pneumoniae. H. influenzae también es la causa bacteriana principal de secuelas neurológicas graves hasta en el 50 por ciento de los pacientes que sobrevivien a la infección meníngea

Manifestaçöes meníngeas na endocardite infecciosa / Maningeal manifestatious with infectious endocarditis

Säo apresentados três casos fatais de endocardite infecciosa tendo, entre os sintomas iniciais, manifestaçöes meníngeas clínicas e liquóricas que trouxeram dúvidas de interpretaçäo. No primeiro, havia pleocitose no líquor compatível com "meningite asséptica"; na realidade, esse caso foi uma endocardite subaguda no qual foi angiograficamente identificado aneurisma micótico de artéria cerebral média direita, que rompeu posteriormente. No segundo, as manifestaçöes clínicas foram de meningoencefalite piogênica e de hemorragia subaracnóide concomitantes. O terceiro paciente exibiu desde o início alteraçöes clínicas e liquóricas de meningite piogênica e, no segundo exame de líquor, o aspecto era de hemorragia subaracnóidea. Os estudos de necrópsia possibilitaram uma análise clinico-patológica correlata. Faz-se revisäo da literatura sobre as lesöes neurológicas na endocardite infecciosa, recebendo ênfase as alteraçöes meníngeas e os aneurismas micóticos