Determination of pentraxin 3 levels in cerebrospinal fluid during central nervous system infections.

Pentraxin 3 (PTX3) is an acute phase protein; its plasmatic levels significantly rise during severe infections. Data on PTX3 levels in cerebrospinal fluid (CSF) of patients with central nervous system (CNS) infections are lacking. We aimed (a) to assess the diagnostic potential of measuring CSF PTX3 levels in patients with CNS infections and (b) to establish CSF PTX3 cutoffs to distinguish between bacterial and aseptic meningoencephalitis (ROC curve). PTX3 levels were measured in CSF from 19 patients admitted to Trieste Hospital, Italy, with CNS infection. A diagnosis of bacterial infection and aseptic meningoencephalitis was made in 7 (37%) and 12 (63%) patients, respectively. Subjects with bacterial infections showed significantly higher PTX3 levels (13.5 vs 1.27 ng/mL in aseptic meningoencephalitis, p = 0.010). We identified two different CSF PTX3 levels cutoffs. (1) The best cutoff to maximise Youden's J was 9.6 ng/mL with a sensitivity, specificity, positive predictive value and negative predictive value (NPV) of 71.4%, 91.4%, 83.3%, 84.6%, respectively. (2) The cutoff with higher NPV (100%) was 3.6 ng/mL; a diagnosis of bacterial infections was obtained in 0% patients with CSF PTX3 levels < 3.6 ng/mL vs 58% of those with CSF PTX3 levels ≥ 3.6 ng/mL (p = 0.017). CSF PTX3 levels are higher in bacterial meningitis than aseptic meningoencephalitis. A cutoff of 3.6 ng/mL of CSF PTX3 has a high NPV and can be used to exclude bacterial CNS infections.

Comprehensive immunohistochemical studies on canine necrotizing meningoencephalitis (NME), necrotizing leukoencephalitis (NLE), and granulomatous meningoencephalomyelitis (GME).

In dogs, there are several idiopathic meningoencephalitides, such as necrotizing meningoencephalitis (NME), necrotizing leukoencephalitis (NLE), and granulomatous meningoencephalomyelitis (GME). Although they are often assumed to be immune mediated, the etiology of these diseases remains elusive. In this study, the histopathology of the lesions caused by these conditions and the inflammatory cell populations produced in response to them were examined among dogs affected with GME, NME, or NLE to understand their pathogeneses. The brain tissues of dogs with NME (n = 25), NLE (n = 5), or GME (n = 9) were used. The inflammatory cells were identified by immunohistochemistry using antibodies against CD3, IgG, CD20, CD79acy, and CD163. In NME and NLE, malacic changes were located in the cerebral cortex, as well as the cerebral white matter and thalamus, respectively. The distribution of the brain lesions in NME and NLE was breed specific. In GME, granulomatous lesions that were mostly composed of epithelioid macrophages were observed in the cerebral white matter, cerebellum, and brainstem. Although the proportions of IgG-, CD20-, and CD79acy-positive cells (B cells) were not significantly different among the GME, NME, and NLE lesions, that of CD3-positive cells (T cells) was increased in GME. In NME and NLE, CD163-positive cells (macrophages) had diffusely infiltrated the cerebral cortex and white matter, respectively. However, in GME, CD163-positive cells accumulated around the blood vessels in the cerebral and cerebellar white matter. The distributions of these lesions were quite different among GME, NME, and NLE, whereas there were no marked differences in the proportions of inflammatory cells.

[Acute urinary retention secondary to aseptic meningoencephalitis in an infant--case report].

We report the case of a 21-month-old boy with urinary retention secondary to aseptic meningitis. After high fever for 10 days, appetite loss, somnolence, acute transient urinary retention, constipation and mild dysesthesia in bilateral lower limbs developed. Brisk reflexes were present in the lower extremities along with a positive Babinski reflex. Cerebrospinal fluid (CSF) examination revealed mild mononuclear cell-dominant pleocytosis. Human herpes virus (HHV)-6 was not detected in the CSF by polymerase chain reaction (PCR) analysis; however, it was detected in the throat, plasma, and mononuclear cells of the peripheral blood. Virus-specific immunoglobulin M antibodies against HHV-6 were not detected by enzyme immunoassay. Brain magnetic resonance imaging (MRI) yielded normal results; however, T1-weighted MRI of the conus terminalis with contrast enhancement showed region of high intensity from the lower thoracic to lumbar meninges. In T2-weighted imaging, slight hyperintensity was observed in the lumbar spinal cord without enhancement effect. The catheter was removed 1 week after high-dose intravenous methyl-prednisolone treatment and the patient was able to walk 3 weeks later without any sequelae. Vesicorectal disturbance and the neurological symptoms observed in aseptic meningitis were similar to those of HSV type 2-induced lumbosacral meningo-radiculitis, designated as Elsberg syndrome or meningitis-retention syndrome in adults. The recurrence of HHV-6 might be immunologically related to this meningitis-retention syndrome based on the results of PCR analysis and enzyme immunoassay for virus-specific antibodies. Several reports have described lumbosacral meningo-radiculitis in adults and older children, but this appears to be particularly rare in infants.

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.

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. (AU)

[Acute disseminated encephalomyelitis after active immunization against early summer encephalitis]. / Akute disseminierte Enzephalomyelitis nach aktiver Immunisierung gegen Frühsommermeningoenzephalitis.

After repeated immunization against european spring-summer encephalitis, a 36-year-old patient developed recurrent retrobulbar neuritis, had a fit of grand mal epilepsy and a focal motor clonic-tonic attack status as a result of post-vaccination ADEM. Post-vaccination encephalomyelitis after TBE-vaccination is a very rare complication of vaccination and has so far only been described occasionally. We observed the clinical course of post-vaccination ADEM after TBE vaccination over 12 years.

Hallazgos tomográficos en 92 casos de meningoencefalitis purulenta en menores de 12 años, junio 1982-agosto 1989 Hospital Central Universitario "AMP" Barquisimeto, Venezuela / Tomographies finding in 92 cases of purulent meningoencephalitis in minors of 12 years, june 1982-august 1989 Hospital Central Universitario \"AMP\" Barquisimeto-Venezuela

En el Departamento de Pediatría del Hospital Central "Antonio María Pineda" de Barquisimeto, Venezuela se revisaron los expedientes clínicos de 92 niños menores de 12 años, que egresaron con el diagnóstico de meningoencefalitis purulenta (MEP) desde junio de 1982 a agosto de 1989 y se les practicó tomografía axial computarizada de cráneo (TACC). Se detectó anormalidad en 78 casos (85 por ciento): hidrocefalia en 24, hidrocefalia con atrofia cortico subcortical en 7, atrofia cortico-corticortical en 20, efusión subdural en 19 absceso cerebral en 8. El promedio de nuestra casuística y de otros autores informa: normal 34 por ciento, atrofia cerebral 31 por ciento, hidrocefalia 31 por ciento, efusión subdural 23 por ciento, cerebritis 12 por ciento y absceso cerebral 6 por ciento. Existen las siguientes situaciones en las cuales debe solicitarse (TACC: 1) persistencia o ocurrencia del estado de inconscistencia después de 72 horas de tratamiento: 2) crisis convulsivas persistentes o recurrentes después de 72 horas de tratamiento; 3) persistencia o recurrencia de signos de hipertensión endocraneana después de 48 horas de tratamiento; 4) aparición de signología neurológica focalizada; 5) persistencia de fiebre sin causa evidente después de 8 días de tratamiento antimicrobiano; 6) aumento significativo del perímetro cefálico; 7) elevación persistente de proteinorraquia; 8) persistente predominio de polimorfonucleares en el LCR; 9) cultivo del LCR persistentemente positivo; 10) infección por Citrobacter diversus; 11) meningoencefalitis recurrente. Sugerimos pueda solicitarse TACC en casos de meningoencefalitis a enterobacterias, presencia de celulitis orbitaria o periorbitaria, si el paciente es portador de sistema derivativo del LCR, o de cardiopatía congénita cianógena más aún si cursa con endocarditis infecciosa. Debe facilitarse la práctica de TACC a todos los casos que ameriten

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

[Virologic diagnosis of meningoencephalitis]. / Diagnostic virologique des méningo-encéphalites.

Many viruses can be responsible for meningoencephalitis. The principal ones are listed and the main features of their virological diagnosis are described. It must be borne in mind that a virological diagnosis must always be guided by the clinical context and that viral meningoencephalitis, relatively uncommon in Europe, is much more frequent in tropical countries.