Meningeal Symptoms Research Articles

Pediatric Multisystem Inflammatory Syndrome in a Patient with a Coma with a Hyperosmolar Component in the Manifestation of Type 1 Diabetes Mellitus: Clinical Case

Background. Due to the rarity of the combination of emergence diabetes mellitus type 1 (DM1), COVID-19, and multisystem inflammatory syndrome, each reported case represents valuable experience and increases the awareness of medical professionals. Clinical case description. A 7-year-old boy was admitted to the intensive care unit with a diagnosis of diabetes mellitus type 1, first identified. On day 2, ketoacidotic coma with a hyperosmolar component developed, a positive polymerase chain reaction (PCR) test for SARS-CoV-2 was obtained, and a picture of subarachnoid hemorrhage was described according to CT scans of the brain. On day 3, macrohematuria, peripheral edema, pasty complexion were noted; the clinical picture and laboratory examination data corresponded to a “cytokine storm” with the development of multiple organ failure. On day 5, tonic-clonic seizures and bloody discharge from the nasopharynx were noted. On day 6, a negative PCR test for SARS-CoV-2 was obtained, on chest X-rays there was a heterogeneous decrease in pneumatization in the basal sections on both sides, and bilateral hydrothorax. On day 9, meningeal symptoms were noted. On day 14, a repeated episode of a convulsive attack was registered, and changes in the brain according to MRI results were regarded as an inflammatory demyelinating lesion against the background of the course of multisystem inflammatory syndrome and DM or as posterior reversible encephalopathy (PRES syndrome). Against the background of the appointment of immunomodulatory, anticoagulant, antibacterial, antiviral therapy, positive dynamics was noted in the child's condition. On day 18, the patient in a stable condition of moderate severity was transferred to the Department of Pediatric Endocrinology for further treatment. After 14 days, the child was discharged from the hospital in a satisfactory condition. Conclusion. This case report may confirm the risk of developing multisystem inflammatory syndrome in children with DM1 and COVID-19, which requires an interdisciplinary approach and the appointment of therapy included in the standards of management of children with multisystem inflammatory syndrome.

Predictors of Resolution of Meningitis Symptoms in Tuberculous Meningitis: A Clinical, Magnetic Resonance Imaging, and Biomarker Study.

In tuberculous meningitis (TBM), the meningeal symptoms and their resolution after treatment may be dependent on clinical-radiological severity, cerebrospinal fluid (CSF), and proinflammatory cytokines, and these findings may be associated with outcome. There is a paucity of studies on the resolution of meningitis symptoms in TBM. We report on associations of clinical, magnetic resonance imaging (MRI), laboratory, and proinflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin 6 (IL-6)] findings with the resolution of meningitis symptoms (RMS), and the impact of RMS duration on the outcome in TBM. Seventy-one patients with TBM were included, and their clinical, laboratory, and MRI findings at baseline were recorded. mRNA profiling of TNF-α and IL-6 was done by reverse transcriptase polymerase chain reaction. The day of RMS (fever, headache, and vomiting) after treatment was noted. Predictors of long duration of RMS (>3 weeks) were evaluated by univariate followed by multivariate analysis. The impact of RMS on 6-month mortality and outcome was analyzed. Patients' median age was 25 years, and 45 (63.4%) were males. After antitubercular treatment, meningeal symptoms resolved in 35 (50.70%) by 21 days and in 90% of patients by 49 days. Longer time of RMS was associated with TBM stage, pretreatment duration, seizure, and hydrocephalus but not with TNF-α and IL-6. Seven (9.8%) patients died at 6 months, and duration of RMS predicted death (hazard ratio = 25.55, 95% CI: 1.108-589.40; P = 0.04).

Acute myeloid leukemia first presentation with central nervous system (CNS) involvement: a case report

BackgroundAcute myeloid leukemia (AML) typically presents with bone marrow myeloblast replacement, which can interfere with normal hematopoiesis. In rare cases, extramedullary involvement of myeloblasts can occur and affect various organs. When AML affects the central nervous system at the time of diagnosis, it is considered to be an unusual occurrence, with less than 5% of incidence.Case presentationA 19-year-old girl presented with progressively worsening frontal tension headache and blurred vision over a month. She also experienced sudden onset right eye strabismus and diplopia 25 days prior to her visit. Additionally, her complete blood count revealed pancytopenia.Following a thorough evaluation, including cytology and flow cytometry, of cerebrospinal fluid and bone marrow biopsy, she was diagnosed as AML with meningeal involvement.ConclusionPhysicians should consider underlying malignancy in patients with meningeal symptoms, cranial nerve involvement, and/or resistance to conventional therapies.

Clinical characteristics of children with Borrelia-related peripheral facial palsy and utility of cerebrospinal fluid testing.

To describe the aetiology and clinical characteristics of acute peripheral facial palsy (PFP) in children and investigate the utility of the European Federation of Neurological Societies (EFNS) criteria for diagnosing Borrelia-related PFP (BPFP) based on cerebrospinal fluid (CSF) testing and the Centers for Disease Control and Prevention (CDC) criteria based on serology. We retrospectively identified children aged <18 years diagnosed with acute PFP between 2014 and 2020. We used the EFNS criteria as the gold standard and the CDC criteria for diagnosing BPFP. Out of 257 children with PFP, 93 (36%) fulfilled the EFNS or CDC criteria for BPFP. We found a discrepancy between the EFNS criteria with CSF testing and the CDC without CSF testing in 27 (14%) of the 190 children with available data. Of the 37 children with PFP and ≥2 symptoms of fever, fatigue, nausea/vomiting or meningeal symptoms, 31 (84%) fulfilled the EFNS criteria for BPFP. Borrelia is a common cause of PFF in children, and its prevalence is higher in children with systemic symptoms. Also, CSF testing did not have decisive management implications in most cases. Therefore, clinical evaluation and Borrelia serology could be the initial steps in the diagnosis of PFP in children.

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.

Acute disseminated encephalomyelitis following the COVID-19 Vaccine Sinopharm in low- and middle-income country: a case report

Introduction and importance: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and various vaccines against it have been developed. Acute disseminated encephalomyelitis (ADEM) is a disease of the central nervous system that cause inflammation and demyelination and manifests as a multi-symptom acute neurological condition. Although infections are usually the cause of ADEM, vaccines may cause 5–10% of cases. Case presentation: A 40-year-old woman had received a second dose of the Sinopharm COVID-19 vaccine 4 months before her visit and experienced sudden gait imbalance and vertigo a day after her vaccination, which lasted for more than a month. On examination, no signs of skin bruising or bleeding were observed, and her vital signs were within the normal range. On neurological assessment, the patient had a Glasgow Coma Scale score of 14/15 (E4V5M5), had normal pupil size and light reaction, normal fundus, normal deep tendon reflexes and bilateral extensor plantar response. Meningeal symptoms were absent, and SARS-CoV-2 RNA tests using NAAT (Nucleic Acid Amplification Test) were negative. Development of central nervous system (CNS) manifestations during the recovery phase of fever, along with typical MRI findings; the diagnosis of para-infectious ADEM with COVID-19 vaccination was made. After the treatment with methylprednisolone sodium succinate injection, the patient showed improvement. Clinical discussion: ADEM associated with post-vaccinations is a rare condition. There has been growing evidence that shared epitopes between neuronal proteins and SARS-CoV-2 antigens may trigger autoimmune reactions against the CNS through molecular mimicry as its pathogenesis. Conclusion: We suggest the need for a strict vaccine safety monitoring system and post-vaccine monitoring and surveillance.

EP12.01-24 High-Dose Aumolertinib Combined Intrathecal Chemotherapy for LM from EGFR-Mutated NSCLC with Meningeal Symptoms as the First Symptom

EP12.01-24 High-Dose Aumolertinib Combined Intrathecal Chemotherapy for LM from EGFR-Mutated NSCLC with Meningeal Symptoms as the First Symptom

A case of West Nile fever in the Kursk region of Russia

Aim: to analyze the features of the clinical course of a case of West Nile fever (WNF) first detected in the Kursk region. Materials and methods. The article presents the first case of WNF detected in the Kursk region, confirmed by detection of pathogen RNA in the PCR test. Results. Patient Ch., 68 years old, was hospitalized to the intensive care unit of the Regional Clinical Infectious Diseases Hospital with severe intoxication, fever up to 39°C, positive meningeal symptoms of Kernig, Brudzinsky, severe neck stiffness. Upon admission, the analysis of peripheral blood showed leukocytosis up to 13.6×109, lymphopenia up to 5%, ESR acceleration up to 20 mm/h. Biochemical analysis revealed a significant increase in CRP, an increase in transaminase activity. In the cerebrospinal fluid, cytosis was noted up to 71 cells per mm3, an increase in protein up to 872 mg/l, the number of neutrophils up to 60%, lymphocytes - up to 40%, and the loss of a delicate plaque. The results of the study revealed high titers of Ig M and Ig G to the antigens of the virus, as well as the detection of WNF virus RNA in the blood and cerebrospinal fluid by PCR. Taking into account the data of the epidemiological anamnesis, clinical symptoms, positive results of ELISA and PCR of blood and cerebrospinal fluid for the causative agent of WNF, the diagnosis was made: West Nile fever with CNS damage, meningeal form (serous meningitis), severe course. Dyscirculatory encephalopathy of complex (dyscirculatory, dysmetabolic) genesis with scattered microsymptomatics. Conclusion. The described clinical case indicates that the WNF causative agent circulates in the Kursk region, which justifies the need for blood and cerebrospinal fluid testing in all patients with hyperthermia of unknown origin, combined with neurological symptoms for the WNF virus.

Brain Eating Amoeba: A Critical Analysis

Abstract: Primary amoebic meningoencephalitis (PAM) is an uncommon yet deadly brain infection caused by a eukaryotic organism known as Naegleria fowleri (N. fowleri). The objective of this review is to consolidate recently published case reports of N. fowleri infections by detailing its epidemiology and clinical features, with the aim of disseminating this information to healthcare professionals. A critical analysis was done by using different available databases until August 31, 2023. All studies from 2013 onwards were extracted, and rigorous quality assessments were performed prior to their inclusion in the final analysis. The cases were geographically diverse, with 72.7% of cases resulting in mortality. The youngest case involved an 11- day-old infant, while the oldest was a 75-year-old individual. Substantial exposure to brackish water, either through recreational activities or the habit of nasal flushing, preceded the onset of symptoms. Early symptoms included fever, headache, and vomiting, while later stages exhibited neurological manifestations. Accurate diagnosis remains challenging due to symptom overlap with bacterial meningitis. Confirmatory tests involve visualizing the amoeba directly or using polymerase chain reaction (PCR) techniques. Infection with N. fowleri is rare but leads to PAM, a condition with global presence and significant fatality risk. A suggested clinical case profile, based on the findings, involves the sudden onset of fever, headache, vomiting, and meningeal symptoms after exposure to freshwater within the past 14 days. Continuous health promotion and public education about freshwater activities can enhance awareness and knowledge before engaging in such activities involving brackish water.

P20.05.A USE OF VISMODEGIB IN ADULT PATIENTS WITH NEOPLASTIC MENINGITIS FROM SONIC HEDGEHOG (SHH)-ACTIVATED MEDULLOBLASTOMAS: A CASE REPORT

Abstract BACKGROUND Vismodegib is a SHH-inhibitor that proved to be effective in locally-recurrent SHH-activated medulloblastoma. However, whether vismodegib is effective in case of neoplastic meningitis (NM) as well has not been assessed so far. Here, we present a case of a patient with NM from SHH-activated medulloblastoma who showed a dramatic response to vismodegib. Case Report: A 34-year-old patient was diagnosed with a SHH-activated cerebellar medulloblastoma in 2015. He underwent gross-total resection, cranio-spinal radiotherapy (RT) and 5 cycles of lomustine, vincristine and cisplatin. Then, he remained disease-free until October 2021, when the MRI showed a new single contrast-enhanced nodule in the spine (T10), which was treated with stereotactic RT. However, the following MRI showed a diffuse leptomeningeal involvement, with new multiple linear and nodular lesions. The CSF cytology confirmed the presence of neoplastic cells. Therefore, in April 2022 vismodegib (150 mg daily) was started. The treatment was well tolerated, except for increased creatine phosphokinase (CTCAE v3.0 grade 1). After only 2 months of therapy, a reduction of the meningeal enhancement was seen on MRI, and after 4 months all nodular and linear lesions disappeared. Similarly, CSF cytology became negative after 4 months of treatment. However, after 8 months of treatment (December 2022), the MRI of the spine showed the new appearance of meningeal contrast-enhanced lesions, and CSF cytology confirmed the presence of neoplastic cells. Therefore, vismodegib was dismissed. In few days, the patient (who did not have any symptoms so far) developed severe meningeal symptoms, and palliative care was started, until his death in February 2023. CONCLUSION To our knowledge, this is the first report of an adult patient with NM from SHH-activated medulloblastoma achieving a complete response with vismodegib, even if temporary. Data from larger series are needed to confirm the effectiveness and safety of vismodegib in case of leptomeningeal spread.

COVID-19 - postinfectious hypercoagulable state as a probable cause of basilar artery occlusion - Case Report

Covid-19 can manifest with serious neurological complications and hypercoagulability. Latest data from China showed neurological complications in 36% of 214 COVID-19 patients- mainly ischemic stroke. Coagulopathy associated with Covid-19 was reported to increase the risk of stroke also in young adults without comorbidities. A 29-year-old patient with hypertension admitted to the hospital with dysarthric speech and balance disorders and dizziness with vomiting was referred for thrombectomy of an occluded basilar artery after ineffective RTPA therapy. After the thrombectomy, a gradual reduction in the neurological deficit was observed-the permeability of the basilar artery was restored. However, during the intervention, the posterior right cerebral artery was damaged and a short-term extravasation of the contrast blood to the subarachnoid space occurred. MRI showed minor multifocal ischemic changes in the area of the cerebellum, pons and cerebral peduncle. In the pre-hospital interview a week earlier, transient changes in smell and taste were noted. On the day of admission, the patient had a negative antigen and PCR tests for SARS-CoV-2- virus. Laboratory tests showed high D-Dimers (5696 H ng /ml) and reduced fibrinogen. After mechanical thrombectomy, the patient reported double vision when looking straight and left. He was correctly oriented with slight ataxia and a deficit of strength in the left limbs, meningeal symptoms were negative. It is important to understand the association between Covid 19 and the possibility of an ischemic stroke and coagulation changes in order to choose appropriate stroke treatment methods.

The Spectrum of Presentation, Diagnosis, and Clinical Outcome of Central Nervous System Tuberculosis: A Case Series in Bangabandhu Sheikh Mujib Medical University

Bangladesh has the highest prevalence of tuberculosis (TB). Of these, tubercular meningitis is the most common and most devastating. The usual course is that of insidious onset and subacute progression. Adults with TBM often present with the classic meningitis symptoms of fever, headache, and meningismus (stiff neck) along with focal neurological deficits, behavioral changes, and alterations in consciousness. TBM is prone to rapid deterioration once meningeal symptoms and focal neurological signs supervene, leading to stupor, coma, and death within 5 to 8 weeks [1,2].

PREVALENCE OF MENINGITIS IN THE FIRST EPISODE OF FEBRILE SEIZURE IN CHILDREN AGED BETWEEN 6 TO 18 MONTHS- TRIPURA MEDICAL COLLEGE &amp; DR BRAM TEACHING HOSPITAL, HAPANIA, AGARTALA, Tripura-799014

Background:Febrile seizures (FS) are the most common type of childhood seizures,affecting 2–5% of children older than 1 month and most commonly from 6 months–5 years old. It is a major cause of paediatric admissions worldwide. In India, AAP 2010 guidelines are followed for performing Lumbar Puncture (LP) in first episode of febrile seizure despite India having wide difference in the epidemiology of meningitis and immunisation coverage as compared to USA. This study has been done to find out whether AAP guidelines are applicable in India also or there is a need for our own guidelines. Although FS induce by age related hyper-excitability of the brain to fever,determining the cause of the fever is critical in the evaluation of these children. The relationship between seizure and bacterial meningitis has been identified well in previous studies. Seizures may be the sole presentation of bacterial meningitis in febrile infants. Seizures are the first manifestation of meningitis in 16.7% of children and in onethird of these patients, whereas meningeal signs and symptoms may not be evident. Therefore, it is mandatory to exclude underlying meningitis in children presenting with fever and seizure prior to making the diagnosis of FS. The initial concern in these children is always to make a proper decision regarding to do an LP to exclude meningitis. Awareness of the prevalence of meningitis and its related factors in children presenting with FS to help physicians to make proper decisions in these situations is necessary.There are several clinical studies worldwide reporting the prevalence of meningitis among children with FS. Some of these studies suggest that in the absence of typical meningeal signs, then an LP should be considered in children with complex seizures, prior antibiotic therapy, age less than 12 months, or incomplete vaccination history.The present study determines the prevalence of meningitis and its associated risk factors in children with FS.

Systematic Review of Brain-Eating Amoeba: A Decade Update.

Primary amoebic meningoencephalitis (PAM) is a rare but lethal infection of the brain caused by a eukaryote called Naegleria fowleri (N. fowleri). The aim of this review is to consolidate the recently published case reports of N. fowleri infection by describing its epidemiology and clinical features with the goal of ultimately disseminating this information to healthcare personnel. A comprehensive literature search was carried out using PubMed, Web of Science, Scopus, and OVID databases until 31 December 2022 by two independent reviewers. All studies from the year 2013 were extracted, and quality assessments were carried out meticulously prior to their inclusion in the final analysis. A total of 21 studies were selected for qualitative analyses out of the 461 studies extracted. The cases were distributed globally, and 72.7% of the cases succumbed to mortality. The youngest case was an 11-day-old boy, while the eldest was a 75-year-old. Significant exposure to freshwater either from recreational activities or from a habit of irrigating the nostrils preceded onset. The symptoms at early presentation included fever, headache, and vomiting, while late sequalae showed neurological manifestation. An accurate diagnosis remains a challenge, as the symptoms mimic bacterial meningitis. Confirmatory tests include the direct visualisation of the amoeba or the use of the polymerase chain reaction method. N. fowleri infection is rare but leads to PAM. Its occurrence is worldwide with a significant risk of fatality. The suggested probable case definition based on the findings is the acute onset of fever, headache, and vomiting with meningeal symptoms following exposure to freshwater within the previous 14 days. Continuous health promotion and health education activities for the public can help to improve knowledge and awareness prior to engagement in freshwater activities.

Вирусные инфекции – причина или триггер развития гемобластоза?

In recent decades, there has been an increase in the number of oncological cases in children. Most common diseases are hemoblastoses, which are characterized by clinical polymorphism in the disease onset, so differential diagnosis should be made. This article presents a clinical case of serous meningitis in a child with increasing dynamics of lymphocytic pleocytosis. The clinical diagnosis of lymphocytic choriomeningitis was based on clinical and anamnestic data (accommodation in the private sector, moderate severity of the general infectious syndrome in combination with severe cerebral and meningeal symptoms), laboratory data (increasing lymphocytic pleocytosis and cell-protein dissociation in the cerebrospinal fluid). The therapy correction included antiviral therapy, which helped to achieve normalization of the cerebrospinal fluid and clinical recovery of the child from an acute neuroinfectious disease in a short time. This clinical case is unique in that 2.5 months after the disease onset, the patient developed convergent strabismus and was hospitalized. Routine blood analysis revealed 25% of blast forms. Further, the diagnosis of acute lymphoblastic leukemia was confirmed, and specific therapy was initiated. It is generally recognized that a prolonged infectious process can be a trigger for both autoimmune and paraneoplastic processes, so long-time patient observation should be provided by a group of specialists (pediatrician, neurologist, infectionist, etc.), and control laboratory examination should be done. Key words: herpesviruses, children, leukemia, lymphocytic choriomeningitis, meningitis, cytoflavin

Varicella-zoster virus infection with concomitant lower cranial polyneuropathy in the absence of fever, headache and meningeal signs

We present varicella-zoster virus (VZV) infection with concomitant lower cranial polyneuropathy in the absence of meningeal symptoms. Physical examination showed involvement of cranial nerves IX and X in Case 1 and of cranial nerves IX, X, and XI in Case 2. Cerebrospinal fluid (CSF) analysis revealed mild lymphocytic pleocytosis, normal protein levels, and absence of VZV-DNA based on polymerase chain reaction (PCR) analysis. Serum anti-VZV antibody testing showed positive results in both cases, which confirmed the diagnosis of VZV infection. VZV infection accompanied by lower cranial polyneuropathy is rare; therefore, it is important to consider VZV reactivation as an etiopathogenetic contributor to pharyngeal palsy and hoarseness. We emphasize the importance of serological analysis for precise diagnosis in VZV infection with multiple lower cranial nerve palsies because the VZV-DNA PCR test may show negative results in patients without meningitis symptoms or in those with normal CSF protein levels.

Meningeal Sporotrichosis Due to Sporothrix brasiliensis: A 21-Year Cohort Study from a Brazilian Reference Center.

Meningeal sporotrichosis is rare and occurs predominantly in immunosuppressed individuals. This retrospective study explored clinical and laboratory characteristics, treatment, and prognosis of patients with disseminated sporotrichosis who underwent lumbar puncture (LP) at a Brazilian reference center from 1999 to 2020. Kaplan-Meier and Cox regression models were used to estimate overall survival and hazard ratios. Among 57 enrolled patients, 17 had meningitis. Fifteen (88.2%) had HIV infection, and in 6 of them, neurological manifestations occurred because of the immune reconstitution inflammatory syndrome (IRIS). The most frequent symptom was headache (88.2%). Meningeal symptoms at first LP were absent in 7/17 (41.2%) patients. Sporothrix was diagnosed in cerebrospinal fluid either by culture or by polymerase chain reaction in seven and four patients, respectively. All but one patient received prolonged courses of amphotericin B formulations, and seven received posaconazole, but relapses were frequent. Lethality among patients with meningitis was 64.7%, with a higher chance of death compared to those without meningitis (HR = 3.87; IC95% = 1.23;12.17). Meningeal sporotrichosis occurs mostly in people with HIV and can be associated with IRIS. Screening LP is indicated in patients with disseminated disease despite the absence of neurological complaints. Meningitis is associated with poor prognosis, and better treatment strategies are needed.

Arbovirus fevers in children and adults in the Astrakhan region: clinical cases

Natural focal infections with transmissible transmission caused by viruses of West Nile Fever, Batai, Inco, Sindbis, Tyagin are registered in various territories of Russia, in the form of sporadic cases, characterized by polymorphism of clinical symptoms, from inapparent forms to severe, occurring with Central nervous system damage (meningitis, meningoencephalitis), which complicates the timely diagnosis and treatment of this pathology.Purpose: to describe our own clinical observations of five cases of arbovirus fevers.Results. Arbovirus fevers (West Nile Fever, Batai, Inko, Tyaginya) in the five clinical cases we have presented occurred in two clinical forms: catarrhal with hypertension syndrome, febrile fever and intense headache, vomiting in the absence of signs of inflammation in the CSF; and with damage to the central nervous system (meningitis). Catarrhal forms of arboviral fevers must be differentiated from ARVI, influenza, mononucleosis. Arbovirus fevers occurring with Central nervous system lesions (meningitis) had a significant similarity with enteroviral meningitis, both in terms of seasonality and clinical symptoms.Conclusion. In the territories of Russia endemic for mosquito fevers, in the summer period of the year, febrile patients with cerebral symptoms and / or meningeal symptoms should be examined for a group of arbovirus fevers.

Rapidly evolving necrotic skin lesions of the face

Rapidly evolving necrotic skin lesions of the face

A Retrospective Analysis of Tick-borne Encephalitis in Children Treated in Kaunas Hospital During 2012 to 2019.

Lithuania has the highest tick-borne encephalitis (TBE) rates in Europe. Although TBE incidence in children is lower, it may still cause long-term consequences. So far pediatric epidemiological and clinical characteristics of TBE in Lithuania were not described. We performed a retrospective analysis of 87 cases of children who were hospitalized for TBE in Kaunas Hospital of the Lithuanian University of Health Sciences from 2012 to 2019. Each case was identified with neurological symptoms and positive serological tests. Around half of the children (50.6%) reported having a tick bite, whereas 6.9% stated having exposure to unpasteurized milk. Biphasic course of the disease occurred in 70.1% of the cases. The most common clinical symptoms were headache (100%), fever (100%), nausea (85.1%), vomiting (78.2%), drowsiness (67.8%) and general weakness (66.7%). Meningeal symptoms were present in 93.1% of the cases, and 93.1% of the children had at least one focal neurological sign (tremor 82.3%, impaired balance 73.6%). Isolated meningitis was diagnosed in 57.5%, meningoencephalitis in 41.4% and meningoencephalomyelitis in 1.1% of the cases. Majority of younger children (1-8 years old) had meningitis (77.3%), whereas 49.2% of older children (9-17 years old) had more severe forms of TBE. Cerebrospinal fluid pleocytosis was found in 94.3% of cases (average white blood cell count: 111.7 per μL, protein: 0.5 g/L). Higher levels of cerebrospinal fluid protein were associated with more severe forms of TBE and older age. Duration of the symptomatic disease lasted ≈11 days. Early residual signs were observed in 75.9% of all cases. The epidemiological and clinical characteristics of TBE in children in Lithuania are similar to those described in other countries. Only half of the subjects reported having a tick bite. Younger children tend to suffer from meningoencephalitis and meningoencephalomyelitis less frequently than elder ones. Focal neurological signs were commonly observed. Majority of children had lasting symptoms of TBE upon discharge from the hospital.