Bacterial Meningoencephalitis Research Articles

Epidemio-clinical aspects and neuro-meningeal tuberculosis prognosis in Batna

Neuromeningeal tuberculosis is rare, affecting around 1-2% of all tuberculosis cases and 5% of extra pulmonary tuberculosis cases. Our aim is to describe the epidemio-clinical, prognostic and evolutionary aspects of neuromeningeal tuberculosis. Materials and methods: To determine the spectrum of etiological agents of HIV-negative encephalitis and meningoencephalitis in Batna, we conducted a prospective study using an expanded testing approach. Patients were recruited from three departments (intensive care unit, infectious diseases department, pediatrics) during the period from April 1, 2012, to August 31, 2015. Data were collected according to the FLIPS case definition with a standardized form. We sought to identify etiological pathogens following a standardized procedure and to describe the epidemiological, clinical and biological features and outcomes associated with different causes. Results: A total of 141 patients with infectious encephalitis and meningoencephalitis were included in the study. Bacterial etiology was determined in 65/141 (46.1%) of whom 30 cases (21.3%) were of tuberculous origin; 21 confirmed and/or probable cases 9 possible cases with high clinical, epidemiological and radiological probability. The median age was 30.5 (0-83), predominantly female 12/18, 23.3% comorbidity with a frequency of motor deficits (86.7%) and psychiatric disorders (26.8%), respiratory involvement was present in 60% of cases, pleocytosis was present in 22/25 (73.4%). hyperalbuminorachy in 66. 7%, and hypoglycorachia in (46.7%). Anti-tuberculosis treatment was instituted in 90% of cases,17.6% were initially admitted to an intensive care unit, and the median length of hospital stay was 38.5 (1-146). death was identified in 46.6%, with 10% having sequelae. Conclusion: In our study, in addition to viruses, bacteria (especially intracellular) can be responsible for encephalitis and meningoencephalitis, in varying proportions. The most frequent and leading form of bacterial meningoencephalitis in adults is tuberculosis, the prognosis of which depends on early treatment.

Hydrogen Peroxide Is Responsible for the Cytotoxic Effects of Streptococcus pneumoniae on Primary Microglia in the Absence of Pneumolysin

Introduction: Streptococcus pneumoniae is the most common cause of bacterial meningitis and meningoencephalitis in humans. The bacterium produces numerous virulence determinants; among them, hydrogen peroxide (H2O2) and pneumolysin (Ply) contribute to bacterial cytotoxicity. Microglia, the resident phagocytes in the brain, are distinct from other macrophages, and we thus compared their susceptibility to pneumococcal toxicity and their ability to phagocytose pneumococci with those of bone-marrow-derived macrophages (BMDMs). Methods: Microglia and BMDMs were co-incubated with S. pneumoniae D39 to analyze the survival of phagocytes by fluorescence microscopy, bacterial growth by quantitative plating, and phagocytosis by an antibiotic protection assay. Ply was detected by hemolysis assay and Western blot analysis. Results: We found that microglia were killed during pneumococcal infection with a wild-type and an isogenic ply-deficient mutant, whereas the viability of BMDMs was not affected by pneumococci. Treatment with recombinant Ply showed a dose-dependent cytotoxic effect on microglia and BMDMs. However, high concentrations of recombinant Ply were required, and under the chosen experimental conditions, Ply was not detectable in the supernatant during infection of microglia. Inactivation of H2O2 by exogenously added catalase abolished its cytotoxic effect. Consequently, infection of microglia with pneumococci deficient for the pyruvate oxidase SpxB, primarily producing H2O2, resulted in reduced killing of microglia. Conclusion: Taken together, in the absence of Ply, H2O2 caused cell death in primary phagocytes in concentrations produced by pneumococci.

An umbrella review of the diagnostic value of next-generation sequencing in infectious diseases.

An increasing number of systematic reviews (SRs) have evaluated the diagnostic values of next-generation sequencing (NGS) in infectious diseases (IDs). This umbrella analysis aimed to assess the potential risk of bias in existing SRs and to summarize the published diagnostic values of NGS in different IDs. We searched PubMed, Embase, and the Cochrane Library until September 2023 for SRs assessing the diagnostic validity of NGS for IDs. Two investigators independently determined review eligibility, extracted data, and evaluated reporting quality, risk of bias, methodological quality, and evidence certainty in the included SRs. Eleven SRs were analyzed. Most SRs exhibited a moderate level of reporting quality, while a serious risk of bias was observed in all SRs. The diagnostic performance of NGS in detecting pneumocystis pneumonia and periprosthetic/prosthetic joint infection was notably robust, showing excellent sensitivity (pneumocystis pneumonia: 0.96, 95% CI 0.90-0.99, very low certainty; periprosthetic/prosthetic joint infection: 0.93, 95% CI 0.83-0.97, very low certainty) and specificity (pneumocystis pneumonia: 0.96, 95% CI 0.92-0.98, very low certainty; periprosthetic/prosthetic joint infection: 0.95, 95% CI 0.92-0.97, very low certainty). NGS exhibited high specificity for central nervous system infection, bacterial meningoencephalitis, and tuberculous meningitis. The sensitivity to these infectious diseases was moderate. NGS demonstrated moderate sensitivity and specificity for multiple infections and pulmonary infections. This umbrella analysis indicates that NGS is a promising technique for diagnosing pneumocystis pneumonia and periprosthetic/prosthetic joint infection with excellent sensitivity and specificity. More high-quality original research and SRs are needed to verify the current findings.

Ventricular empyema in a dog diagnosed by magnetic resonance imaging and immediate postmortem cerebrospinal fluid culture

AbstractA 1‐year 5‐month‐old, female, neutered springer spaniel presented collapsed in extensor rigidity. The dog had undergone ovariectomy 6 weeks previously, and a tooth root abscess was documented 2 months before this. Neurological signs were first reported 24 days after surgery, starting with lethargy and tremors, which progressed to generalised tonic‐clonic cluster seizures with inter‐ictal neurological deficits by 33 days after surgery. Magnetic resonance imaging of the brain revealed a conspicuous fluid–fluid level in the lateral ventricles consistent with ventricular empyema. Treatment was declined in favour of euthanasia, but postmortem cerebrospinal fluid sample showed marked pleocytosis with elevated protein and cultured a heavy growth of Staphylococcus pseudintermedius. The magnetic resonance imaging findings and positive cerebrospinal fluid culture were consistent with bacterial meningoencephalitis. Aetiology in this case was unknown, but may have been secondary to haematogenous spread, which is a rare but potential sequel to abdominal surgery, or intracranial extension of an oral infection.

Causes and prognosis of adults experiencing a first seizure in adulthood: A pilot cohort study conducted in five countries in Latin America.

There are limited data on first seizure (FS) among adults in low and middle-income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3- and 6-month follow-up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow-up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10-year risk of recurrence, which is part of the definition of epilepsy. PLAIN LANGUAGE SUMMARY: We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3-6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.

A THERAPEUTIC APPROACH TO MENINGOENCEPHALITIS BY Streptococcus pneumoniae IN BRAZIL

Introduction: Acute bacterial meningoencephalitis (ABM) are severe infections caused by microorganisms that are capable of reaching the meninges, as well as the brain. They areconsidered medical emergencies that require early diagnosis and immediate treatment. However, medical professionals have routinely encountered difficulties resulting from the Streptococcus pneumoniae’s antimicrobial resistance in the medical practice, becoming a public health problem in Brazil. The present article has the objective of revising literature and compiling data on S. pneumoniae’s resistance in ABM cases, with the intent of assisting the decision-making process on which therapy should be adopted. Methods: The study was conducted through the revision of literature regarding the treatment of ABM in humans published in the last 20 years, found in the PubMed/Medline, LILACS and SciELO digital databases. The first selection of articles was carried out by analyzing the titles and abstracts. The selected studies were read completely to determine their eligibility. Results and Discussions: The 45 selected articles described varying resistance of S. pneumoniae's to penicillin and ceftriaxone, which can reach approximately 50% to the first drug. The SIREVA Project (2016), developed in Brazil, deserves do to commended for being able to identify the following resistance patterns of the isolated pathogen in ABM cases: (1) 31,% to penicillins (sample of 334 patients), and (2) intermediate and high resistance to ceftriaxone, 6.9% and 5.6% respectively (sample of 320 patients). Despite the infrequent occurrence, present studies document the emergence of resistance mechanisms in pathogen strains to vancomycin. Nevertheless, the studies conducted in Brazil showed that the S. pneumoniae strains were completely sensitive to the previously mentioned drug. Conclusion: The association of ceftriaxone and vancomycin should be considered the best option to treat pneumococcal ABM in Brazil, due to the severity of the condition and the rising resistance of the pathogen to cephalosporins.

A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report

BACKGROUND: Septic cerebral venous sinus thrombosis or septic cavernous thrombosis is an extremely rare disorder, with 2 to 13 cases per million per year, following the introduction of antibiotics and advances in diagnostic imaging. It is a complex pathology, difficult to diagnose and life threatening. It has a high risk of otoneurologic sequelae, and it requires follow-up by various specialties, as treatment is medical and surgical, including neurology, internal medicine, intensive care, otorhinolaryngology, and infectiology, among others. Due to the low occurrence of septic cavernous thrombosis, the diagnosis may be erroneous or delayed, increasing complications and mortality. It is essential to perform a complete physical examination with emphasis on the ophthalmological, otological, rhinosinusal and neurological examinations, which is why this case is described. THE CASE: We describe a 77-year-old male patient, with history of high blood pressure, nasopharyngeal carcinoma in remission, bilateral hearing loss, prostatic hyperplasia, otitis media, and chronic mastoiditis. He was admitted due sudden onset of difficulty standing, gait instability, mutism, unquantified fever spikes, headache, and vertigo. The initial laboratory tests only revealed a complete blood count with leukocytosis. A simple brain computed tomography (CT) scan did not show relevant findings; therefore, a lumbar puncture (LP) was carried out due to suspicion of bacterial meningoencephalitis. Analysis of cerebrospinal fluid (CSF) showed pleocytosis with a predominance of polymorphonuclear cells, hypoglycorrhachia and hyperproteinorrachia. Empirical antibiotic therapy was started with Vancomycin and Cefepime. At day five since onset of symptoms, he did not have improvements of his symptoms, so a new LP was carried out and antibiotic therapy was escalated. In the CSF it was found an increased cellularity with greater hypoglycorrhachia, persistent hyperproteinorrachia, and cellular shift to lymphocyte predominance. A contrast-enhanced magnetic resonance imaging (MRI) of the brain was requested, showing pyogenic ventriculitis and decreased flow at the left transverse sinus, suggesting possible thrombosis, which was later confirmed with a contrast-enhanced brain angio-MRI. Furthermore, due to the otological involvement, a CT scan of the ears was performed, which showed severe bilateral otomastoiditis with bilateral mastoid cholesteatomas, bilateral otitis externa, and osteomyelitis of the left petrous apex. A diagnosis of a septic thrombosis of the left transverse sinus, in the context of meningoencephalitis secondary to a parameningeal focus, was made. Treatment with Meropenem 1 gr intravenously every 8 hours and Vancomycin 1 gr every 8 hours was continued up to 28 days. During the hospitalization, otorhinolaryngology did a mastoidectomy and continued outpatient antibiotic management with Ciprofloxacin for seven more days. The patient did not require anticoagulation, and at follow-up he was notably recovered, and in control studies the recanalization of the thrombosis was confirmed. CONCLUSION: Septic cerebral venous sinus thrombosis is a rare pathology, but with a high associated morbidity and mortality, which requires multidisciplinary management. It is vital to know its pathophysiology and predisposing factors to include it in differential diagnoses when managing a patient with meningeal symptoms.

A case of reversible isolated cognition impairment in meningoencephalitis without abnormal MRI findings

AbstractBackgroundWe report a case of meningoencephalitis with reversible isolated cognition impairment without abnormal MRI findings.MethodA 75‐year‐old man presented with confusion including bizarre behavior 2 days ago. Before visiting the hospital, his son found the patient naked and under the blanket saying it was cold. Fever didn’t occur. Mental status was alert without awareness. On neurologic examination, mutism was found. Muscle power on both upper and lower limbs was normal. Routine laboratory test showed that leukocytes count was normal but eosinophils were increased to 14.0%. Initial brain MRI including DWI and contrast enhanced image revealed no enhanced structural lesions. Initial K‐MMSE score was 4 points while the previous K‐MMSE score 3‐months‐ago was 25 points. There was no epileptic form discharge in EEG. CSF study demonstrated that WBC count was 18/L. protein was 42.6mg/dL, and glucose was 103mg/dL. CSF opening pressure was 5cmH2O. Culture study including gram stain, AFB stain, PAS stain showed no growth of aerobe, anaerobe, fungus and hyphae. Mycobacterium tuberculosis PCR and HSV PCR were negative. ADA was under 3 IU/I. Serum paraneoplastic antibodies were all negative.ResultThe patient showed only isolated cognition impairment without fever and there was no evidence of meningoencephalitis on the contrast enhanced MRI. Although the patient revealed CNS infection with unknown cause in CSF profile, it has some possibilities; 1) Aseptic meningoencephalitis with viral infection, 2) Bacterial meningoencephalitis with early stage, 3) Parasitic meningoencephalitis, 4) Autoimmune meningoencephalitis. Because of the negative findings in autoimmune antibody test, autoimmune meningoencephalitis was less likely. After treatment with acyclovir 0.6g for 7days, ceftriaxone 4g, vancomycin 2.5g and Ampicillin 8g for 10 days, confusion and mutism were improved with K‐MMSE 18 points.ConclusionMany reports have been published on meningoencephalitis accompanied by fever, altered mentality, seizure, muscle weakness and abnormal MRI findings respectively. However there have been few cases of meningoencephalitis with isolated cognition impairment and normal MRI simultaneously. If it is a change of consciousness and cognition impairment caused by meningoencephalitis, it can be reversible with proper treatment. Therefore, if only sudden onset isolated CNS symptom with normal brain MR finding, it is essential to check CSF profile.

The clinical biochemical and hematological profile of scrub typhus meningoencephalitis

Background: Scrub typhus is a zoonotic infectious disease caused by the Gram-negative coccobacillus Orientia tsutsugamushi. Meningoencephalitis occurs in two-thirds of all the infected cases. Aims and Objectives: The study of these cases was conducted to study the clinical, biochemical, and hematological features of scrub typhus meningoencephalitis. Materials and Methods: We included 12 patients who were admitted in the General Medicine Ward of Medical College and Hospital, Kolkata, between May 2021 and July 2022. The serum scrub typhus immunoglobulin M (IgM) test was used to diagnose the cases after ruling out dengue, malaria, leptospirosis, bacterial, tubercular, and viral meningoencephalitis. Results: A triad of fever, altered sensorium, and meningeal signs were present in all of the cases. 2 patients had seizures, 1 patient had lateral rectus palsy, 1 patient had a generalized maculopapular rash, and eschar was seen in only 2 cases. The most common laboratory abnormalities were hyponatremia, anemia, and transaminitis (each 83.33%). 8 cases (66.7%) had a combination of anemia, hyponatremia, and transaminitis. Cerebrospinal fluid abnormalities included protein elevation (75%) and lymphocytic pleocytosis (83.33%). Scrub typhus IgM was positive in all of them. All the cases showed excellent response to doxycycline. Conclusion: A high degree of clinical suspicion is required to diagnose scrub typhus meningoencephalitis. The eschar is detected in very few cases and it may be difficult to recognize the same among the dark-skinned Indian population. However, as per our study, any case of meningoencephalitis with a combination of anemia, hyponatremia, and deranged liver function tests should always raise the possibility of the aforementioned disease and doxycycline therapy must be started promptly.

Pituitary apoplexy associated with gram-negative meningitis following transsphenoidal surgery

BackgroundPituitary apoplexy (PA) is a rare but potentially life-threatening condition. While it is uncommon, it can present with findings that are clinically indistinguishable from acute bacterial meningitis. We report an unusual case of simultaneous coexistence of bacterial meningoencephalitis and pituitary apoplexy following transsphenoidal surgery (TSS) for pituitary macroadenoma, emphasizing the possibility of coexistence of the two entities.Case presentationA 62-year-old man was admitted with a moderate headache, gait disturbance, and progressively decreasing vision. Sellar magnetic resonance imaging showed a giant pituitary tumor of 4 × 5 cm with invasion of the cavernous sinus bilaterally, and a mass effect on the optic chiasm. The patient underwent a TSS and partial resection of a giant pituitary tumor. On postoperative day 11, he presented with an acute, severe headache and altered sensorium. An urgent computed tomography (CT) scan revealed hemorrhagic swelling of the residual. A complete analysis of the anterior pituitary hormones revealed panhypopituitarism. Administering steroid ameliorated the clinical features, but after decreasing the dose, the patient continued to deteriorate in his neurological status, a high fever, and marked stiffness were noted on postoperative day 14. Given the neck stiffness, leukocytosis, and high C-reactive protein level, acute meningitis was suspected, and the cerebrospinal fluid (CSF) was tested, which was consistent with acute bacterial meningitis. In the results of the bacterial cultures of the CSF, E. coli was identified and switched to ceftriaxone. The patient's neurological status and body temperature improved gradually. CSF test results returned to normal levels, and ceftriaxone was discontinued on day 10.ConclusionsThis is a report on a case of a giant pituitary tumor that developed late postoperative PA after having undergone a partial tumor resection. A postoperative CT scan showed hemorrhagic expansion of the residual tumor mass. Further, the patient exhibited typical symptoms of acute meningoencephalitis, the result of the cultures of the CSF was positive, and the patient's general condition deteriorated. In addition, laboratory findings indicated leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis. We highlighted diagnostic challenges and therapeutic delays arising as a result of rare concomitance.

Bacterial meningoencephalitis secondary to disseminated strongyloidiasis in a pacient with COVID-19

Introduction. Strongyloidiasis in a parasitic diseases determined by the intestinal nematode Strongyloides stercoralis. In most cases, this disease is asymptomatic, but the immunocompromised patients can develop severe forms like hyper infestation and disseminated strongyloidiasis. There severe forms of the disease are associated with bacteremias with gastrointestinal microorganisms which can determine infectious complication anywhere in the body. Bacterial meningitis is the most common complication of this kind. Case presentation. We present you the case of a 78 years old patient who initially presented in another hospital for suddenly installed aphasia. He was clinical and paraclinical evaluated and the suspected diagnosis was acute meningoencephalitis, so he was transferred in our hospital. This is a case about a patient with an immunocompromised status determined by recent infection with SARS-CoV-2 who was hospitalized and received prolonged corticosteroid therapy. The clinical examination performed at the admission shows a patient with mediocre general status, partially cooperative, partially time-spatial oriented and to one’s own person, discreet neck stiffness, anxious-depressive mood, with acute respiratory failure. A coproparasitological examination is performed which reveals the presence of filariform larvae of Strongyloides stercoralis in the stool. Also, a parasitic PCR test from a stool sample is positive for Strongyloides stercoralis. These clinical and paraclinical findings corroborated with those found in the cerebrospinal fluid examination establish the diagnosis: acute bacterial meningoencephalitis secondary to disseminated strongyloidiasis. During the disease’s evolution, he is confirmed with a new infection with SARS-CoV-2. He receives antiviral treatment, antiparasitic treatment, antibiotic treatment and symptomatic treatment. The evolution of the disease is favorable. Conclusions. The immunocompromised status of the patient determined the evolution of the infestation with Strongyloides stercoralis to a severe form complicated with acute bacterial meningoencephalitis. The difficulty in establishing the diagnosis of strongyloidiasis is represented by the fact that Romania is a non-endemic country for the infection with this parasite.

ACUTE ENCEPHALOMYELOPOLYRADICULONEUROPATHY THAT OCCURRED AFTER BNT162B2 MRNA VACCINATION AGAINST COVID-19: A CLINICAL CASE REVIEW

SARS-CoV-2 and side effects of SARS-CoV-2 vaccination show tropism to nervous system structures. Neurological side effects from the central and peripheral nervous systems have been observed quite rarely after vaccination against COVID-19 compared to a large number of vaccinated individuals. The article presents a clinical case of simultaneous damage to the central and peripheral nervous systems in the form of acute autoimmune inflammatory encephalomyelopolyradiculoneuropathy, which occurred after receiving the first dose of the BNT162b2 mRNA vaccine. The severe course of encephalomyelopolyradiculoneuropathy with peripheral tetraplegia, sensory disturbances, bulbar syndrome, and dysautonomia, followed by the occurrence of pneumonia, secondary bacterial meningoencephalitis, the need for long-term mechanical ventilation led to the occurrence of pneumothorax and multiple organ failure, which caused the patient’s death after one and a half months of intensive therapy.
 Thus, the acute autoimmune inflammatory encephalomyelopolyradiculoneuropathy can be considered as a probable rare neurological complication of SARS-CoV-2 vaccination with mRNA-based vaccines. Encephalomyelopolyradiculoneuropathy can have a severe course, accompanied by multiple complications and leading to death. Establishing of the causal relationships of the occurrence of rare neurological pathological conditions close in time to vaccination against SARS-CoV-2 with mRNA-based vaccines requires additional further researches.

This is your brain on death: a comparative analysis of a near-death experience and subsequent 5-Methoxy-DMT experience.

Much research has focused on the modeling of the near-death experience (NDE) by classical and atypical psychedelics; however, to date, no study has reported on the relationship between the NDE and the experience induced by the highly potent, endogenous psychedelic drug 5-Methoxy-DMT (5MeO-DMT). This article presents a case study of an individual who is popularly documented to have had a profound near-death experience while in a coma caused by bacterial meningoencephalitis. Additionally, the individual also subsequently underwent an experience with 5MeO-DMT. A semi-structured interview was conducted with the subject concerning his experiences with both the NDE and 5MeO-DMT. A basic thematic analysis was performed on both the original text describing the NDE as well as the interview itself, which mainly focused on the subject's experience with 5MeO-DMT. This analysis was organized to identify both the similar and different emergent themes between the two states, with a particular emphasis on the subject's perceptions of the similarities and differences between the experiences. There is a very high level of comparability between the original NDE and psychedelic experiences in general, including shared characteristics such as entering other worlds, meeting menacing or benevolent entities, experiencing synesthesia, perinatal regression, and lucid dreamlike properties. Much comparability was also identified with the 5MeO-DMT experience, in particular the major mystical experiential domains, such as ego dissolution, but especially transcendence of time and space. However, there were also a few unique themes (life review, the deceased, and the threshold) that emerged in the NDE that were not present in the 5MeO-DMT experience or other psychedelic experience studies, suggesting that these themes may be more unique to the NDE. Despite such similarities, the participant asserted that his NDE and psychedelic experiences were not similar enough to be attributed to endogenous psychedelics. In this study, we discussed several mechanisms that could potentially account for the NDE, including lucid dreams and perinatal regression. However, the study also explored the possibility that the unique etiology of the participant's NDE, bacterial meningoencephalitis affecting the neocortex, may have triggered similar downstream neural activity as that initiated by psychedelic agents through pyramidal neuronal activation. This hypothesis is presented with appropriate caveats and acknowledged as speculative.

Bacterial meningoencephalitis secondary to sinusitis caused by a moral fracture in an equine: Case report

Es remitido al Centro de Veterinaria y Zootecnia de la Universidad CES un equino hembra, de raza silla argentina, de 11 años y 503 kg de peso, por presentar ataxia, disfagia, fiebre e historial de secreción nasal. Cuatro meses atrás se le realizó un procedimiento odontológico donde se intentó extraer el segundo molar superior derecho (110) el cual se fracturó en el borde medial de la corona dentaria, posterior a esto quedó con un resto radicular en el mismo y no fue tratada. Las radiografías de cráneo revelaron un aumento en la radiopacidad en la región esfenopalatina, compatible con un empiema del seno esfenopalatino. Se realizó una punción de la región atlanto-occipital para toma de muestra y posterior análisis del LCR (líquido cefalorraquídeo), dando como diagnóstico presuntivo meningitis bacteriana. El tratamiento se enfocó en la disminución del edema e inflamación encefálica con el uso de antibióticos y antiinflamatorios. Al no evidenciar ninguna mejora significativa, el propietario decidió aplicar la eutanasia compasiva. En la necropsia se evidencia una fístula oronasal a nivel del molar implicado, así como un acumulo de pus a nivel del hipotálamo y la hipófisis en la base del encéfalo. El objetivo de este reporte de caso es describir la evolución, las manifestaciones clínicas, las pruebas diagnósticas y las lesiones macroscópicas y microscópicas; siendo el primer reporte de esta complicación en Colombia.

Remote cerebellar hemorrhage following repeated lumbar punctures

BackgroundRemote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery. No case of RCH secondary to repeated lumbar punctures (LPs) has been previously reported.Case presentationA 49-year-old man presented with impaired consciousness following persistent fever. Cerebrospinal fluid examination showed high opening pressure, elevated white blood cells, increased protein level, and decreased glucose level, resulting in a diagnosis of bacterial meningoencephalitis. Treatment with repeated LPs and intrathecal injection of ceftriaxone resulted in an improvement in neurological symptoms. However, on day 31 of treatment, brain magnetic resonance image (MRI) showed streaky bleeding in bilateral cerebellum (zebra sign), leading to a diagnosis of RCH. Close observation and repeated brain MRI imaging without specific treatments led to the absorption of bilateral cerebellar hemorrhage, and the patient was discharged with improved neurological symptoms. Repeated brain MRI scans one month after discharge showed that bilateral cerebellar hemorrhage had improved, and had disappeared one year after discharge.ConclusionWe reported a rare occurrence of LPs-induced RCH presenting as isolated bilateral inferior cerebellar hemorrhage. Clinicians should be vigilant of the risk factors for RCH, closely monitoring patients' clinical symptoms and neuroimaging findings to determine the need for specialized treatment. Furthermore, this case highlights the importance of ensuring the safety of LPs and managing any potential complications appropriately.

Clinical presentation, treatment, and outcome of 24 dogs with bacterial meningitis or meningoencephalitis without empyema (2010-2020).

Bacterial meningitis (BM) and meningoencephalitis (BMEM) are associated with high case fatality rates and neurologic sequelae in people, but limited data exists on outcome in dogs. To report the clinicopathologic features, treatment and outcome of BM/BMEM in dogs, with a focus on clinical presentation, relapse and long-term neurological deficits. Twenty-four client-owned dogs diagnosed with BM/BMEM without empyema. Retrospective case series of dogs diagnosed with BM/BMEM from 5 veterinary referral hospitals between January 2010 and August 2020. Twenty-four dogs were included. Median duration of clinical signs was 2 days (range ≤24 hours to 30 days) and signs recorded included pyrexia (3) and cervical hyperesthesia (10). Neurological deficits were present in 18 dogs including altered mentation (12), ataxia (8), nonambulatory status (8), head tilt (8), and cranial nerve deficits (13). Intracellular bacteria were visualized on cerebrospinal fluid (CSF) analysis in 15/24 dogs, with positive CSF bacteriological culture in 8/21. Otitis media/interna (OMI) was diagnosed in 15/24 dogs, of which 6/15 dogs underwent total ear canal ablation and lateral bulla osteotomy. Twenty dogs survived to hospital discharge. Median duration of antibiotic administrations was 8 weeks (range, 2-16 weeks). Glucocorticoids were administered to 15 dogs. Median follow-up time was 92 days (range, 10-2233 days). Residual neurological deficits were reported in 9 dogs, with a single case of suspected relapse. Clinical signs were variable in dogs with BM/BMEM, the nidus of bacterial infection was often OMI and the majority of dogs made a full recovery with treatment.

Cerebrospinal fluid cystatin C levels in patients with anti-NMDAR encephalitis and other neurological diseases

BackgroundCystatin C has neuroprotective and immunomodulatory effects on the central nervous system. However, the role of cerebrospinal fluid (CSF) cystatin C in anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) remains unknown. MethodsIn this study, CSF levels of cystatin C were determined in 73 patients with anti-NMDARE; 496 patients with other neurological diseases, comprising 108 with neuromyelitis optica, 77 with multiple sclerosis, 71 with schizophrenia, 68 with cryptococcus meningitis or meningoencephalitis, 43 with tuberculous meningitis or meningoencephalitis, 43 with bacterial meningitis or meningoencephalitis (BM), 35 with Guillain–Barré syndrome, 23 with spinal cord injury (SCI), 14 with amyotrophic lateral sclerosis (ALS), and 14 with idiopathic epilepsy; and 136 control patients with non-inflammatory diseases. The associations of CSF cystatin C with anti-NMDARE and its clinical parameters were evaluated. ResultsCSF cystatin C levels were significantly lower in patients with anti-NMDARE than in patients with BM, SCI, and ALS, especially among those with poor functional status (modified Rankin Scale [mRS] ≥4). CSF cystatin C levels were also significantly lower in anti-NMDARE patients with poor functional status (mRS ≥4) than in those with good functional status (mRS <4). CSF cystatin C levels were significantly associated with mRS scores and CSF white blood cell counts in anti-NMDARE patients. ConclusionsCSF levels of cystatin C are decreased in anti-NMDARE patients and negatively associated with disease severity.

Aquatics: A Boon or Bane under the Shadow of Naegleria fowleri:A Meta-analysis and Systemic review

Water sports activities during hot summer seasons attract all age groups specially children and young adult. Same season acts favorably for multiplication of Naegleria fowleri in stagnant or slow moving water and exposure will lead to highly fatal Primary Amoebic Meningoencephalitis. Naegleria fowleri travels from nasopharyngeal mucosa to brain to cause highly fatal disease. In-spite of more than 300 cases reported worldwide the figure is still underreported or erroneously reported due to Clinical &amp; Biochemical similarity with Acute Bacterial Meningitis. Radiological finding CT or MRI scan are also initially normal for initial 2 days and unable to differentiate between bacterial or parasitic meningoencephalitis. Diagnosis of low surviving disease depend mainly on Microscopy/Giemsa staining, which can be confirmed by amoebic culture, PCR and gene sequencing with the help of reference center (CDC). Treatment can be intravenous and/or intrathecal Amphotericin-B, Rifampicin and Fluconazole. Miltefosine shows some promising results but not found satisfactory. So, prevention is the only hope to fight with Naegleria fowleri infection, which needs to be looked at seriously by concerned authorities, especially in developing countries. A total of 29 articles selected for meta-analysis study from Pubmed &amp; Google Scholar. Surprising water exposure history found in many article that included enjoyment in Water-Splashing Festival, bathing in pond &amp; unchlorinated water, religious nasal cleaning practice with contaminated water, accidental fall in river with remain submerged for long time and many more, were results in fatal Primary Amoebic Meningoencephalitis. This review cover clinical management of the cases of Primary Amoebic Meningoencephalitis as well as more important it’s preventive aspect which include identification of source of Naegleria fowleri, restricted activity with public awareness about unknown dangers of fatal disease acquired during enjoyment, which was missed by some authors.

Diagnostic accuracy of the metagenomic next-generation sequencing (mNGS) for detection of bacterial meningoencephalitis: a systematic review and meta-analysis.

The early diagnosis of bacterial meningoencephalitis (BM/E) is difficult, and delay in diagnosis can cause complications leading to neurological impairment/death. In cases of unexplained BM/E, the metagenomic NGS (mNGS) offers an advantage over conventional methods, especially when a rare pathogen is implicated or the patient is on antibiotics. This study aims to evaluate and compare the diagnostic efficacy of mNGS for the diagnosis of BM/E using cerebrospinal fluid (CSF) specimens versus a composite reference standard (CRS). The electronic databases (Embase, PubMed, and Web of Science) were searched up to 15 June 2021. Studies such as cohort, case-control, prospective, or retrospective studies that assessed the diagnostic efficacy of mNGS in suspected bacterial meningitis/encephalitis cases were included. Ten studies met the inclusion criteria, including three retrospective and seven prospective studies. The sensitivity of mNGS for diagnosis of BM/E from CSF samples ranged from 33 (95% CI: 13-62) to 98% (95% CI: 76-99). The specificity of mNGS ranged from 67 (95% CI: 55-78) to 98% (95% CI: 95-99). The estimated AUC (area under curve) by hierarchical summary receiver operating characteristic (HSROC) of the studies being analyzed was 0.912. The meta-regression analysis demonstrated that the different types of studies (single-center vs. multi-center) had an effect on the specificity of mNGS for BM/E compared with CRS (90% vs. 96%, meta-regression P < 0.05). The current analysis revealed moderate diagnostic accuracy of mNGS. This approach can be helpful, especially in cases of undiagnosed BM/E by identification of organism and subsequently accelerating the patient management.

Outcomes of implementation of the FilmArray meningoencephalitis panel in a tertiary hospital between 2017 and 2020.

BackgroundAcute 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.MethodsData 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.ResultsFrom 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.ConclusionIn 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.