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Journal of Neurovirology Aug 2020Seven coronavirus (CoV) species are known human pathogens: the epidemic viruses SARS-CoV, SARS-CoV-2, and MERS-CoV and those continuously circulating in human... (Review)
Review
Seven coronavirus (CoV) species are known human pathogens: the epidemic viruses SARS-CoV, SARS-CoV-2, and MERS-CoV and those continuously circulating in human populations since initial isolation: HCoV-OC43, HCoV-229E, HCoV-HKU1, and HCoV-NL63. All have associations with human central nervous system (CNS) dysfunction. In infants and young children, the most common CNS phenomena are febrile seizures; in adults, non-focal abnormalities that may be either neurologic or constitutional. Neurotropism and neurovirulence are dependent in part on CNS expression of cell surface receptors mediating viral entry, and host immune response. In adults, CNS receptors for epidemic viruses are largely expressed on brain vasculature, whereas receptors for less pathogenic viruses are present in vasculature, brain parenchyma, and olfactory neuroepithelium, dependent upon viral species. Human coronaviruses can infect circulating mononuclear cells, but meningoencephalitis is rare. Well-documented human neuropathologies are infrequent and, for SARS, MERS, and COVID-19, can entail cerebrovascular accidents originating extrinsically to brain. There is evidence of neuronal infection in the absence of inflammatory infiltrates with SARS-CoV, and CSF studies of rare patients with seizures have demonstrated virus but no pleocytosis. In contrast to human disease, animal models of neuropathogenesis are well developed, and pathologies including demyelination, neuronal necrosis, and meningoencephalitis are seen with both native CoVs as well as human CoVs inoculated into nasal cavities or brain. This review covers basic CoV biology pertinent to CNS disease; the spectrum of clinical abnormalities encountered in infants, children, and adults; and the evidence for CoV infection of human brain, with reference to pertinent animal models of neuropathogenesis.
Topics: Animals; Betacoronavirus; COVID-19; Coronaviridae; Coronaviridae Infections; Coronavirus Infections; Humans; Meningitis, Viral; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32737861
DOI: 10.1007/s13365-020-00868-7 -
Prenatal Diagnosis Jul 2022Lymphocytic choriomeningitis virus (LCMV) uses rodents such as mice and hamsters as its principal reservoir. When women acquire LCMV during pregnancy because of contact... (Review)
Review
INTRODUCTION
Lymphocytic choriomeningitis virus (LCMV) uses rodents such as mice and hamsters as its principal reservoir. When women acquire LCMV during pregnancy because of contact with rodents, it can lead to congenital LCMV infection, which is associated with high mortality and morbidity. Although the number of cases reported in the literature is increasing, LCMV is rarely mentioned because a history of exposure to rodents is uncommon and mostly unknown.
OBJECTIVES
The main objective of this article was to summarize all morphological, antenatal, and postnatal abnormalities that may suggest a congenital LCMV infection.
METHODS
We reviewed PubMed case reports and case series where an antenatal and/or a postnatal description of at least one case of congenital LCMV infection was documented.
RESULTS
We found 70 cases of congenital LCMV infection, 68 of which had antenatal or postnatal brain abnormalities, which were mainly chorioretinitis (59/70), hydrocephaly (37/70), microcephaly (22/70), ventriculomegaly (11/70) and periventricular calcifications (11/70). Antenatal and postnatal extracerebral abnormalities were mainly small for gestational age, ascites, cardiomegaly or anemia. Other organ damage was rare, but could include skin abnormalities, hydrops or hepatosplenomegaly. Seventy percent (49/70) of cases had major cerebral abnormalities that could have been detected by antenatal ultrasound examination. Congenital LCMV infection is associated with a significant mortality rate (30%) and survivors often have severe neurologic sequelae.
CONCLUSION
LCMV is a rare congenital infection, but awareness of the various prenatal ultrasound morphological abnormalities should be improved, and LCMV should be considered when first-line etiological explorations are negative, especially when the mother's medical history indicates exposure to rodents.
Topics: Animals; Female; Fetal Diseases; Humans; Hydrocephalus; Lymphocytic Choriomeningitis; Lymphocytic choriomeningitis virus; Mice; Microcephaly; Pregnancy
PubMed: 35695127
DOI: 10.1002/pd.6192 -
Przeglad Epidemiologiczny 2022Meningitis and/or encephalitis are one of the main infectious diseases of the nervous system. These diseases are most commonly caused by bacterial and viral etiological...
INTRODUCTION
Meningitis and/or encephalitis are one of the main infectious diseases of the nervous system. These diseases are most commonly caused by bacterial and viral etiological factors. In this publication, meningitis and/or encephalitis caused by Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and those with a viral origin - in Poland, most often caused by tick-borne encephalitis virus - are presented in detail. In addition to epidemiological surveillance, immunoprophylaxis in the form of mandatory and recommended vaccinations is used in Poland to prevent these infections.
AIM OF THE STUDY
The aim of this study was to to assess the epidemiological situation of meningitis and encephalitis in Poland, in 2020.
MATERIAL AND METHODS
To analyse the epidemiological situation of neuroinfections in Poland were used data sent to NIPH NIH - NRI by Voivodeship Sanitary and Epidemiological Stations and published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020" and "Protective vaccination in Poland in 2020" and individual epidemiological interviews registered in the EpiBaza system.
RESULTS
In 2020, a total of 831 cases of meningitis and/or encephalitis were registered in Poland. This is a decrease in incidence of up to 62.9% compared to 2019. For infections of bacterial etiology, including cases of neuroborreliosis (incidence of 2.40 per 100,000), the number of cases decreased by 60.4% (from 931 to 369). In the viral infection group, there was a 64.9% decrease (from 1,318 to 462 cases). Of all registered cases, 56% were infections with a viral etiology. Compared to 2019, the number of cases with an S. pneumoniae etiology decreased by 61.3% and for N. meningitidis by 41.1%. It is interesting to note that, in the case of H. influenzae, we can speak of a 20% increase in cases compared to the previous year. In addition, we can see a decrease in the incidence of tick-borne encephalitis - from 265 in 2019 to 158 in 2020 (a decrease of 40.4%).
SUMMARY AND CONCLUSIONS
Overall, a downward trend in incidence was shown for both bacterial and viral meningitis and/or encephalitis. The SARS-CoV-2 pandemic and the introduction of restrictions on personto-person contact and various forms of activity, resulting in a reduction in pathogen transmission, were key to the significant reduction in the number of meningitis and/or encephalitis cases in 2020, but a reduction in the availability of medical facilities or the completeness of case reports due to the burden of anti-epidemic measures on the Sanitary Inspectorate cannot be excluded either. Only in the case of cases caused by H. influenzae was a slight increase observed compared to the previous year (12 versus 10 cases). Meningoencephalitis and/or encephalitis, due to its wide etiological range, poses a major challenge to the health care system, particularly in terms of correct clinical diagnosis.
Topics: Humans; Infant; Poland; Age Distribution; SARS-CoV-2; COVID-19; Meningitis; Encephalitis; Neisseria meningitidis; Incidence; Haemophilus influenzae; Streptococcus pneumoniae; Communicable Diseases; Registries
PubMed: 36524880
DOI: 10.32394/pe.76.35 -
Journal of Neurovirology Apr 2020A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and... (Review)
Review
A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.
Topics: Angiotensin-Converting Enzyme 2; Betacoronavirus; COVID-19; Coronavirus Infections; Encephalitis, Viral; Headache; Host-Pathogen Interactions; Humans; Meningitis; Myalgia; Myositis; Nervous System; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; Protein Binding; Receptors, Virus; SARS-CoV-2; Spike Glycoprotein, Coronavirus; Stroke; Virus Internalization
PubMed: 32447630
DOI: 10.1007/s13365-020-00840-5 -
Expert Review of Molecular Diagnostics May 2022Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as... (Review)
Review
INTRODUCTION
Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as well as the diagnosis and prognosis of bacterial sepsis. However, the role of PCT in extra-pulmonary infections is not well described.
AREAS COVERED
We reviewed the role of PCT in commonly experienced extra-pulmonary infections including meningitis, diabetic foot infection, prosthetic joint infection, osteomyelitis, and skin and soft tissue infection. PubMed and Medline online libraries were searched, from 2013 till 2022, for relevant articles.
EXPERT OPINION
For meningitis, PCT could distinguish bacterial from viral meningitis. PCT distinguished septic arthritis from different inflammatory states but had variable performance in discriminating septic arthritis from crystal arthropathy. For periprosthetic joint infections, results were inconclusive. PCT had a potential role in diagnosis of more complex infections such as osteomyelitis and diabetic foot infections, but further studies are needed for a definitive cutoff. In skin and soft tissue infections, PCT performance was variable requiring further investigation to define cutoff for the discrimination of cellulitis from necrotizing fasciitis. We find that PCT performed best for meningitis and helps in the reduction of unnecessary antibiotic treatment, but has variable outcomes with other extra-pulmonary infections.
Topics: Arthritis, Infectious; Biomarkers; Diabetic Foot; Humans; Osteomyelitis; Procalcitonin; Sepsis
PubMed: 35757858
DOI: 10.1080/14737159.2022.2094705 -
Przeglad Epidemiologiczny 2023Meningitis meningitis and/or encephalitis regardless of etiology are subject to monitoring in Poland as part of routine epidemiological surveillance. In this paper,...
INTRODUCTION
Meningitis meningitis and/or encephalitis regardless of etiology are subject to monitoring in Poland as part of routine epidemiological surveillance. In this paper, meningitis and/or encephalitis in 2021 caused by Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and tick-borne encephalitis virus are discussed in detail. In Poland, immunoprophylaxis in the form of mandatory or recommended vaccinations is used to prevent diseases caused by the aforementioned etiological agents.
AIM OF THE STUDY
The aim of this study was to assess the epidemiological incidence of meningoencephalitis and encephalitis in Poland, in 2021 including analysis of the impact of the COVID-19 pandemic.
MATERIAL AND METHODS
To analyse the epidemiological situation of neuroinfections in Poland, we used data sent to NIPH NIH - NRI by Voivodeship Sanitary and Epidemiological Stations and published in the annual bulletin: "Infectious diseases and poisonings in Poland in 2021" and "Protective vaccination in Poland in 2021" as well as individual epidemiological interviews recorded in the EpiBase system.
RESULTS
In 2021, a total of 973 cases of meningitis and/or encephalitis were registered in Poland. This is a 16.1% increase in the number of cases compared to 2020, but still a 57% decrease in the number of cases compared to 2019 when 2,249 cases were recorded. For infections of bacterial etiology, including cases of neuroborreliosis, the number of cases increased by 38.3% (from 376 to 520, incidence from 0.96 to 1.76 per 100,000). Compared to 2020 and 2019, the incidence of meningitis and/or encephalitis of N. meningitidis decreased by 10.7% (from 0.13 to 0.15) and 47.4% (from 0.25 to 0.13), respectively, and for H. influenzae by 75% (from 0.01 to 0.03) and 70% (from 0.01 to 0.03). For S. pneumoniae, we can speak of an increase in incidence against 2020 of 57.1% (121 vs 77 cases, incidence 0.32 vs 0.20) and a decrease against 2019. (121 vs 190, incidence 0.32 vs 0.47). Infections of viral etiology accounted for 47% of all registered cases. There was a slight decrease in their number, by 2% (from 462 to 453 cases). In addition, there was an increase in cases of tick-borne encephalitis, from 158 in 2020 to 210 in 2021 (an increase of 32.9%), and a decrease in cases from 265 in 2019 (a decrease of 20.8%).
SUMMARY AND CONCLUSIONS
2021 showed an overall upward trend in the number of recorded cases of bacterial meningitis and/or encephalitis, and a slight decrease in the number of viral meningitis and/or encephalitis cases compared to 2020. Still, the observed number of meningitis and/or encephalitis cases in 2021, both bacterial and viral incidences, remains below the levels observed in the pre-pandemic COVID-19 period (2019). As a result of the SARS-CoV-2 outbreak, the introduction of measures to limit the transmission of the SARS-CoV-2 virus has been observed to reduce the spread of other droplet- and airborne pathogens, thus also pathogens such as S. pneumoniae, H.influenzae and N. menningitidis.
Topics: Humans; Infant; Poland; Pandemics; Age Distribution; Meningitis, Bacterial; Encephalitis; Neisseria meningitidis; Streptococcus pneumoniae; Haemophilus influenzae; Incidence; COVID-19; Registries
PubMed: 38334321
DOI: 10.32394/pe.77.35 -
Przeglad Epidemiologiczny 2021Infectious diseases of the nervous system are most often manifested in the form of meningitis. We distinguish meningitis and/or encephalitis according to their etiology,...
INTRODUCTION
Infectious diseases of the nervous system are most often manifested in the form of meningitis. We distinguish meningitis and/or encephalitis according to their etiology, i.e. bacterial and viral. The study discusses meningitis and encephalitis caused by: N. meningitidis, S. pneumoniae, H. influenzae and tick-borne encephalitis virus. This is due to the epidemiological surveillance of these diseases and the available prevention in the form of vaccinations against these diseases.
AIM OF THE STUDY
The aim of the study is to assess the epidemiological situation of meningitis and encephalitis in Poland in 2018.
MATERIAL AND METHODS
The epidemiological situation of meningitis and encephalitis in Poland was assessed on data from the annual bulletin "Infectious diseases and poisoning in Poland in 2018" and "Vaccinations in Poland in 2018".
RESULTS
In 2018, a total of 2406 cases of meningitis and/or encephalitis were registered in Poland. It is a 14.7% increase in incidence compared to 2017. An increase was recorded in the viral infections from 1212 to 1533 cases. In contrast, the number of infections with bacterial etiology decreased from 886 to 873 cases. Meningitis and/or encephalitis caused by pathogens specified in epidemiological surveillance have noticed a decreased incidence. The only exception is the increase in cases caused by S. pneumoniae, compared to 2017, from 177 to 212. This is an increase of 19.8% compared to the previous year. However, the number of cases of N. meningitidis showed a decrease of 16.4% during this period. Viral infections constituted 63.7% of all cases. Compared to 2017, it means an increase in the percentage of viral infections by 5.9 percentage points. Among laboratory confirmed cases of meningitis and/or encephalitis of known etiology, cases caused by Neisseria meningitidis (102 cases), Streptococcus pneumoniae (212 cases) and tick-borne encephalitis (197 cases) were predominant.
SUMMARY AND CONCLUSION
There is a general increasing trend in the number of cases of viral meningitis and/or encephalitis. On the other hand, thanks to vaccinations, no significant increase was noted in H. influenzae, meningococcal and TBE infections. There is a chance to minimize the incidence of bacterial meningitis and/or encephalitis as in the H. influenzae infections. On the other hand, it should be seen that the problem of diagnosing cases of viral etiology should be considered. This is more related to the determination of the etiological factor than the diagnosis of viral meningitis and/or encephalitis. Difficulties in determining the etiological factor indicate that, meningitis and/or encephalitis remain a challenge for healthcare and epidemiological surveillance institutions.
Topics: Age Distribution; Encephalitis; Humans; Incidence; Infant; Meningitis, Bacterial; Poland; Rural Population; Urban Population
PubMed: 34338472
DOI: 10.32394/pe.75.07 -
Cellular Physiology and Biochemistry :... Aug 2022In the context of chronic viral infections, the hepatic microenvironment dictates the outcome of the disease by influencing propagation of virus and regulation of... (Review)
Review
In the context of chronic viral infections, the hepatic microenvironment dictates the outcome of the disease by influencing propagation of virus and regulation of cytotoxic CD8 T cell response. Nevertheless, such regulation could be beneficial as it resolves the disease or could be detrimental as it causes liver pathological consequences. Liver pathology is a hallmark of chronic viral infection in both human and murine models. Such models show viral infection of hepatocytes and subsequent direct hepatic damage. Other compelling studies showed that liver injury was a consequence of overshooting CD8 T cells response in experimental mice, so-called immune-mediated liver pathology. This review highlights the viral-induced immune mediated aspects of liver pathology based on the lymphocytic choriomeningitis virus (LCMV) and Hepatitis virus settings.
Topics: Animals; CD8-Positive T-Lymphocytes; Humans; Liver; Lymphocytic Choriomeningitis; Lymphocytic choriomeningitis virus; Mice; Mice, Inbred C57BL; T-Lymphocytes, Cytotoxic
PubMed: 35926114
DOI: 10.33594/000000554 -
Internal and Emergency Medicine Jun 2021Cryptococcal Meningitis (CM) remains a high-risk clinical condition, and many patients require emergency department (ED) management for complications and stabilization. (Review)
Review
INTRODUCTION
Cryptococcal Meningitis (CM) remains a high-risk clinical condition, and many patients require emergency department (ED) management for complications and stabilization.
OBJECTIVE
This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of CM.
DISCUSSION
This review evaluates the diagnosis, management, and empiric treatment of suspected CM in the ED. CM can easily evade diagnosis with a subacute presentation, and should be considered in any patient with a headache, neurological deficit, or who is immunocompromised. As a definitive diagnosis of CM will not be made in the ED, management of a patient with suspected CM includes prompt diagnostic testing and initiation of empiric treatment. Multiple types of newer Cryptococcal antigen tests provide high sensitivity and specificity both in serum and cerebrospinal fluid (CSF). Patients should be treated empirically for bacterial, fungal, and viral meningitis, specifically with amphotericin B and flucytosine for presumed CM. Additionally, appropriate resuscitation and supportive care, including advanced airway management, management of increased intracranial pressure (ICP), antipyretics, intravenous fluids, and isolation, should be initiated. Antiretroviral therapy (ART) should not be initiated in the ED for those found or known to be HIV-positive for risk of immune reconstitution inflammatory syndrome (IRIS).
CONCLUSIONS
CM remains a rare clinical presentation, but carries significant morbidity and mortality. Physicians must rapidly diagnose these patients while evaluating for other diseases and complications. Early consultation with an infectious disease specialist is imperative, as is initiating symptomatic care.
Topics: Diagnosis, Differential; Emergency Service, Hospital; Evidence-Based Medicine; Humans; Meningitis, Cryptococcal
PubMed: 33420904
DOI: 10.1007/s11739-020-02619-2 -
Frontiers in Pediatrics 2022Non-polio-enteroviruses (EV) and human parechoviruses (HPeV) are small RNA viruses, which in newborns cause infections with a wide range of severity. Today molecular...
BACKGROUND
Non-polio-enteroviruses (EV) and human parechoviruses (HPeV) are small RNA viruses, which in newborns cause infections with a wide range of severity. Today molecular biology tools allow us to diagnose viral meningitis in neonates, sparing patients from useless antibiotics. Data on neurodevelopmental outcome of children who contract enterovirus meningitis in early childhood are still limited in the literature.
AIMS
To evaluate the neurodevelopmental outcome of newborns with documented e and meningitis contracted within the first months of life.
METHODS
and were detected on cerebrospinal fluid (CSF) and plasma by RT-PCR. The virological typing was done according to WHO recommendations. During the hospitalization each neonate underwent many diagnostic and instrumental examinations, to evaluate any neurological lesions attributable to the infection. After the discharge children entered in an outpatient interdisciplinary assessment process, comprehensive of the administration of Bayley III scales up to 12 months old.
RESULTS
We observed longitudinally 30 children, born at term (mean GA 39.7 ± 0.8 weeks, mean birthweight was 3,457 ± 405 grams), who contracted and meningitis within the first month of life (mean age at diagnosis was 15.8 ± 7.33 days). We were able to perform the genetic typing only on 15/30 (50.0%) cerebrospinal fluid (CSF) samples from 15 neonates. We found MRI anomalies in 9/26 observed neonates (34.6%): one of them presented brainstem abnormality that are specific of enteroviral central nervous system (CNS) involvement. During the follow up children displayed an overall normal neurodevelopment and no deficit in visual and hearing areas. The mean cognitive (105.19 ± 8.71), speech (100.23 ± 8.22) and motor (97.00 ± 8.98) composite scores, assessed by Bayley III, were normal in 29/30 (96.7%). Despite this, children with pathological brain magnetic resonance imaging (MRI) scored significantly lower ( = 0.01) than children with normal brain MRI on cognitive subscale at 12 months of life.
CONCLUSIONS
Early enterovirus infections can be associated to brain MRI abnormalities, more frequently the earlier the infection. Although within a normal range, our children with pathological brain MRI scored significantly lower than those with normal brain MRI on cognitive subscale at 12 months of life.
PubMed: 35669403
DOI: 10.3389/fped.2022.881516