-
Neurologic Clinics Nov 2018Neuroinfectious diseases continue to cause morbidity and mortality worldwide, with many emerging or reemerging infections resulting in neurologic sequelae. Careful... (Review)
Review
Neuroinfectious diseases continue to cause morbidity and mortality worldwide, with many emerging or reemerging infections resulting in neurologic sequelae. Careful clinical evaluation coupled with appropriate laboratory investigations still forms the bedrock for making the correct etiologic diagnosis and implementing appropriate management. The treating physician needs to understand the individual test characteristics of each of the many conventional candidate-based diagnostics: culture, pathogen-specific polymerase chain reaction, antigen, antibody tests, used to diagnose the whole array of neuroinvasive infections. In addition, there is a growing need for more comprehensive, agnostic testing modalities that can identify a diversity of infections with a single assay.
Topics: Humans; Infectious Encephalitis; Meningitis; Meningoencephalitis
PubMed: 30366549
DOI: 10.1016/j.ncl.2018.07.004 -
Archives of Disease in Childhood Apr 1956
Topics: Encephalitis; Humans; Meningoencephalitis; Whooping Cough
PubMed: 13314664
DOI: 10.1136/adc.31.156.87 -
Parasitology Feb 2021
Topics: Angiostrongylus cantonensis; Animals; Humans; Meningoencephalitis; Strongylida Infections
PubMed: 33315004
DOI: 10.1017/S003118202000236X -
PloS One 2022Acute meningoencephalitis is encountered commonly in the acute hospital setting and is associated with significant morbidity and mortality, in addition to significant... (Observational Study)
Observational Study
BACKGROUND
Acute meningoencephalitis is encountered commonly in the acute hospital setting and is associated with significant morbidity and mortality, in addition to significant healthcare costs. Multiplex PCR panels now allow syndromic testing for central nervous system infection. The BioFire® FilmArray® Meningoencephalitis (ME) allows testing of 14 target pathogens using only 0.2mls of cerebrospinal fluid (CSF). We conducted a retrospective observational study to assess the performance of the assay and secondarily to observe the clinical utility of negative results by comparing clinical outcomes of aseptic meningitis to bacterial and viral meningoencephalitis.
METHODS
Data for CSF samples tested using the FilmArray ME panel from October 2017 to October 2020 were analysed. Detection of bacterial and viral targets was analysed. Admission to critical care area, 90-day readmission rates, average length of stay and 30-day and 90-day mortality were analysed for three groups with following diagnoses: bacterial meningitis, viral meningoencephalitis, or aseptic meningitis.
RESULTS
From October 2017 to October 2020, 1926 CSF samples were received in the Clinical Microbiology laboratory. Of those, 543 CSF samples from 512 individual patients were tested using the FilmArray ME panel. Twenty-one bacterial targets and 56 viral targets were detected during the study period. For viral targets, the cumulative specificity was 98.9% (95% confidence interval: 93.1-99.9) when compared to the reference laboratory methods. The outcomes for 30- and 90-day mortality of the aseptic meningitis group were non-inferior relative to the viral meningoencephalitis and bacterial meningitis group. Patients with bacterial meningitis had a longer average length of stay. Aseptic meningitis was associated with a higher 90-day readmission rate than the other 2 groups, but without statistical significance.
CONCLUSION
In our hands, implementation of the FilmArray ME panel was relatively straightforward. We experienced a transition in our workflow processes that enabled streamlining of CSF diagnostics and the safe removal of Gram staining in those samples being tested by this molecular assay. Coupled to this improvement, there was a positive clinical impact on patient care due to rapid turnaround time to results.
Topics: Bacteria; Encephalitis; Humans; Meningitis; Meningitis, Aseptic; Meningitis, Viral; Meningoencephalitis; Multiplex Polymerase Chain Reaction; Tertiary Care Centers
PubMed: 35298491
DOI: 10.1371/journal.pone.0265187 -
The Lancet. Infectious Diseases Mar 2015Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the... (Review)
Review
Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii.
Topics: Adolescent; Anti-Inflammatory Agents; Antifungal Agents; Brain; Cryptococcosis; Cryptococcus gattii; Female; Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Meningoencephalitis; Microbiological Techniques; Microscopy; Radiography
PubMed: 25467646
DOI: 10.1016/S1473-3099(14)70945-4 -
Journal of the American Veterinary... Mar 2018
Topics: Angiostrongylus cantonensis; Animals; Animals, Zoo; Autopsy; Chiroptera; Diagnosis, Differential; Female; Hemorrhage; Meningoencephalitis; Strongylida Infections
PubMed: 29461163
DOI: 10.2460/javma.252.5.545 -
Journal of the American Veterinary... Dec 2018
Topics: Animals; Animals, Newborn; Autopsy; Cattle; Cattle Diseases; Diagnosis, Differential; Lameness, Animal; Male; Meningoencephalitis; Pasteurellaceae; Pasteurellaceae Infections
PubMed: 30451627
DOI: 10.2460/javma.253.11.1417 -
Microbiology Spectrum Apr 2022Brain infections are a major public health problem in India and other parts of the world, causing both mortality and lifelong disability. Even after a thorough...
Brain infections are a major public health problem in India and other parts of the world, causing both mortality and lifelong disability. Even after a thorough investigation, many cases remain without an etiological diagnosis. Primate erythroparvovirus 1 (B19V) has been identified as a pathogen associated with undiagnosed meningoencephalitis in other settings, including the United Kingdom, France, and Latvia. Here, we reported 13/403 (3.2%) B19V PCR positive cases of meningoencephalitis in West Bengal, India. The positive samples were mostly from children (10/13, 76.92%) and presented as a spectrum consisting of acute encephalitis (7/13), acute meningoencephalitis (3/13), and meningitis (3/13). Of the 13 cases, 8/13 (61.5%) had no known etiology and 5/13 (38.5%) had a previous etiological diagnosis. The cases did not cluster in time or by location, suggesting sporadic occurrence rather than outbreaks. We were able to retrieve the complete B19V genomes from cerebrospinal fluid (CSF) in 12/13 cases. The sequences clustered into genotype 3b with complete genomes from Brazil, Ghana, and France, and partial genomes from India and Kyrgyzstan. This is the first report of B19V in cases of neurological infections from India. It highlights the need to evaluate the causal relationship between B19V with meningoencephalitis in the country. These were also the first complete genomes of genotype 3b from CSF and will be critical in the evaluation of the relationship between genotypes and disease. Cases of meningoencephalitis with no known etiology remain a major challenge to clinical management of brain infections across the world. In this study, we detected and characterized the whole-genome of primate erythroparvovirus 1 (B19V) in cases of meningoencephalitis in India. Our work highlighted the association between B19V and brain infections which has been reported in other countries. Our work also emphasized the need to examine the role of B19V in meningoencephalitis, specifically whether it caused or contributed to the disease together with other pathogens in India. Our study provided the first 12 genomes of B19V from cerebrospinal fluid. These genomes will contribute to an understanding of how the virus is changing across different locations and over time.
Topics: Animals; DNA, Viral; Genomics; Genotype; India; Meningoencephalitis; Parvoviridae Infections; Parvovirus; Parvovirus B19, Human
PubMed: 35412386
DOI: 10.1128/spectrum.02251-21 -
Revista Do Instituto de Medicina... 2022The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus,... (Review)
Review
The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.
Topics: Brazil; COVID-19; Humans; Male; Meningoencephalitis; Pandemics; SARS-CoV-2
PubMed: 35195166
DOI: 10.1590/S1678-9946202264014 -
Journal of Veterinary Internal Medicine May 2021Acquired narcolepsy has rarely been reported in veterinary medicine.
BACKGROUND
Acquired narcolepsy has rarely been reported in veterinary medicine.
OBJECTIVE
To describe the presentation, clinicopathological features, diagnostic imaging findings, and management of dogs with suspected-acquired narcolepsy.
ANIMALS
Eight dogs with clinical features consistent with acquired narcolepsy.
METHODS
A call for suspected cases of acquired narcolepsy was made online, followed by a retrospective review of detailed medical records of potential cases. Dogs were included if episodes consistent with cataplexy were present during examination by a board-certified veterinary neurologist and diagnostic work-up included magnetic resonance imaging of the brain and analysis of cerebrospinal fluid.
RESULTS
Seven French Bulldogs and 1 Chihuahua (age range, 9-66 months) were included. Meningoencephalitis of unknown origin was diagnosed in 2 dogs, extracranial foci of inflammation were identified in 2 dogs (aspiration pneumonia, esophagitis, otitis media), and no abnormalities were found on diagnostic investigations in 4 dogs. Prednisolone was used in the management of all dogs, 6 dogs received imipramine, and 2 received cytosine arabinoside. An initial remission of signs was observed in all dogs, but a subsequent relapse of clinical signs was recorded for 4 dogs, of which 3 responded to adjustment or resumption of treatment.
CONCLUSIONS AND CLINICAL IMPORTANCE
The presence of cataplexy episodes should prompt a thorough diagnostic work-up to exclude the presence of intracranial (and extracranial) pathology. The potential for both remission and relapse of signs in suspected acquired cases is important for clinicians and owners to be aware of.
Topics: Animals; Cataplexy; Dog Diseases; Dogs; Meningoencephalitis; Narcolepsy; Prednisolone; Retrospective Studies
PubMed: 33960533
DOI: 10.1111/jvim.16116