Neurological Infection Research Articles

Is there still hesitancy towards SARS-CoV-2 vaccination among people with neurological disease- a survey of the NeuroCOVID-19 task force of the European Academy of Neurology.

An online 3-item survey was sent to the European Academy of Neurology (EAN) community and inquired about the persistence of SARS-CoV-2 vaccination skepticism and the underlying thoughts and factors restricting vaccine use among patients with neurological conditions. We obtained 616 responses from 84 countries, predominantly from Europe. In the view of the treating neurologist, patients with multiple sclerosis (MS), neuroimmunological disorders (ND), and chronic neurological infections continued to have high levels of skepticism toward SARS-CoV-2 vaccination. Patients with MS/ND were quoted as the most hesitant group, with 60% of the respondents sharing this impression. The patient group perceived as most confident towards immunization against COVID-19 and with the lowest level of distrust towards the vaccine were those with sleep disorders. For all other conditions, perceived distrust ranged between 42 and 52%. Fear of adverse events of vaccination or disease reactivation was perceived by 87% of patients with MS/ND and more than 70% of patients with stroke/vascular neurology, neuromuscular disorders, chronic neurological infections, and peripheral neuropathy. Patients with sleep disorders (54%), autonomic disorders (46%), movement disorders (43%), and dementia (43%) were sensed as less fearful of vaccine-related adverse events. Despite the large body of evidence proving the efficacy and safety of SARS-CoV-2 vaccination, patients with certain neurological disorders still have a surprisingly high percentage of distrust and fear of adverse events. Our observations emphasize the importance of continuous evidence-based information delivery and patient education by treating neurologists.

Revisiting diagnostics: Rapid Diagnosis of Neurological Infections.

Revisiting diagnostics: Rapid Diagnosis of Neurological Infections.

Human Herpesvirus 6 Encephalitis in a Patient with a History of Psychotropic Drug Use: A Case Report

Human herpesvirus 6 (HHV-6) is a beta-herpesvirus typically associated with asymptomatic infections but can cause severe encephalitis, especially in immunocompromised individuals. This report details a case of HHV-6 encephalitis in an immunocompetent 35-year-old male with recent cocaine use. The patient initially presented with confusion and focal neurological deficits, with MRI showing bihemispheric demyelinating lesions. Acyclovir was initiated as empirical antiviral therapy, resulting in partial improvement. However, the patient was readmitted following discharge due to recurrent neurological symptoms, with MRI findings showing extensive, periventricular white matter lesions consistent with acute disseminated encephalomyelitis (ADEM) secondary to HHV-6. Given the atypical response to the treatment, this case highlights the need for further research on optimal antiviral therapies and the role of psychoactive substance use in neurological infections such as HHV-6 encephalitis.

Paroxysmal Sympathetic Hyperactivity in Pediatric Acquired Brain Injury: An Under-Recognized Entity

Abstract Paroxysmal sympathetic hyperactivity (PSH) is a less-known neurologic emergency that can be life-threatening. It is a form of extreme autonomic dysregulation leading to multiple episodes of sympathetic hyperactivity. The pathogenesis of this interesting entity is yet to be fully understood. It presents as unexplained tachycardia, hypertension, and sometimes hyperthermia. Poor awareness of this fact leads to unnecessary workup to look for the cause of fever and interventions such as change of antibiotics. If it is not treated adequately, it can even cause complications like arrhythmias that can be fatal at times. PSH secondary to acquired brain injury is better known in adults, but there are scarce reports in children. We describe six cases of PSH in children with acquired brain injury – four secondary to traumatic brain injury and two secondary to neurologic infection (one with bacterial meningitis and the other one with viral meningoencephalitis). PSH can be seen in non-traumatic brain injury cases like meningitis. Due to a lack of awareness about this common but under-recognized entity, it is seldom diagnosed and treated. Early detection and treatment can be life-saving and improve patient outcomes. Earlier onset may be associated with poorer outcomes and mortality.

Enterovirus and Parechovirus Neurologic Infections in Children: Clinical Presentations and Neuropathogenesis.

Enteroviruses (EVs) and parechoviruses (PeVs) are common pathogens of childhood. Enteroviral infections cause a range of clinical syndromes from mild illness to neurologic manifestations of meningitis, encephalitis, and acute flaccid myelitis. Disease manifestations are driven by a combination of viral replication and host immune response. Despite ubiquitousness and clinical importance, there are no approved targeted therapies for these viruses and most are without an available vaccine. Studies of EV neuropathogenesis began with poliovirus and are ongoing for other nonpolio EVs and PeVs. Many unanswered questions remain with regard to cellular tropism, mechanisms of dissemination, receptor usage, immunologic control, and cellular death. This review describes what is known about epidemiology, clinical presentations, and neuropathogenesis of these important pathogens.

Clinical features and outcomes of pseudolithiasis induced by ceftriaxone in Chinese children: a single-center observational study.

Ceftriaxone (CTX) is widely used in pediatric infectious disease treatment, although the diagnostic and therapeutic management of CTX-induced gallbladder pseudolithiasis (PL) remains challenging. In this study, we investigated the occurrence, clinical features, and management of CTX-induced PL in children. A retrospective case-control study was conducted on 185 pediatric patients receiving CTX at a single center. Data on treatment regimens, gallbladder imaging findings, and serum biochemical parameters post-CTX therapy were analyzed. Patients were classified into PL (n = 34) and non-PL (n = 151) groups based on imaging findings. PL was diagnosed in 18.4% of patients treated with CTX, primarily through ultrasound, which revealed hyperechoic material within the gallbladder. Compared with the non-PL group, patients with PL were older and taller, with no significant differences in CTX dosage (p = 0.915). Patients with PL also had higher rates of digestive and neurological infections (both p < 0.001). Serum analysis revealed distinct liver and kidney function markers in the PL group, including lower levels of total bile acids, adenosine deaminase, and lactate dehydrogenase, and higher creatinine levels (all p < 0.05). Discontinuation of CTX led to symptom resolution in most cases, and all cases of PL resolved within three months. The occurrence of PL is not significantly related to CTX dosage. Furthermore, the rate of CTX metabolism and excretion may play a key role in PL development. Overall, the findings demonstrate that ultrasound is an effective tool for monitoring the development of PL in children receiving CTX and that discontinuation of CTX could be an effective treatment for PL.

Epidemiology and Ecology of Toscana Virus Infection and Its Global Risk Distribution.

Toscana virus (TOSV), a member of the Phlebovirus genus transmitted by sandflies, is acknowledged for its capacity to cause neurological infections and is widely distributed across Mediterranean countries. The potential geographic distribution and risk to the human population remained obscure due to its neglected nature. We searched PubMed and Web of Science for articles published between 1 January 1971 and 30 June 2023 to extract data on TOSV detection in vectors, vertebrates and humans, clinical information of human patients, as well as the occurrence of two identified sandfly vectors for TOSV. We further predicted the global distribution of the two sandfly vectors, based on which the global risk of TOSV was projected, after incorporating the environmental, ecoclimatic, biological, and socioeconomic factors. A total of 1342 unique studies were retrieved, among which 389 met the selection criteria and were included for data extraction. TOSV infections were documented in 10 sandfly species and 14 species of vertebrates, as well as causing a total of 7571 human infections. The occurrence probabilities of two sandfly vectors have demonstrated the greatest contributions to the potential distribution of TOSV infection risk. This study provides a comprehensive overview of global TOSV distribution and potential risk zones. Future surveillance and intervention programs should prioritize high-risk areas based on updated quantitative analyses.

Combined anterior-posterior versus posterior only approach for surgical management of adult spinal deformity: a systematic review and meta-analysis of comparative studies.

The purpose of this systematic review and meta-analysis was to examine the clinical outcomes and complication rates for fusion procedures of adult spinal deformity (ASD) performed via an anterior-posterior approach as compared to a posterior-only approach to guide surgical decision-making. Numerous surgical techniques exist for operative management of ASD; however, no systematic review and meta-analysis exists comparing combined anterior-posterior approaches to posterior-only approach, despite significant interest in the current literature. Four databases were used to collect articles from database inception until September 9th, 2023. Inclusion criteria was articles that examined both anterior-posterior or posterior only surgical approach, adult patients, comparative studies, and articles in English. Seven comparative articles met the inclusion criteria. Included patients had a frequency weighted (FW) mean age of 60.2 ± 5.1 years and a FW mean follow-up of 40.4 ± 12.5 months. Qualitative data did not favor either group in terms of length of stay, radiographic outcomes, or functional outcomes. There was a total of 306 complications in the Anterior-Posterior group with a complication rate per patient of 1.0 ± 0.9 complications whereas there was a total of 380 complications in the Posterior Only group with a complication rate per patient of 1.0 ± 1.2 complications. Meta-analysis of specific complications found no significant difference in revision rate, dural tear rate, neurological complication rate, infection rate, or pseudoarthrosis rate. Surgical management for ASD may provide comparable results in terms of surgical parameters, radiographic outcomes, functional outcomes, and complication rates, irrespective of surgical approach.

Effect of β-1,4-GalTI on the biological function of astrocytes treated by LPS.

Inflammation of the central nervous system (CNS) is a common feature of neurological disorders and infections, playing a crucial role in the development of CNS-related conditions. CNS inflammation is primarily regulated by glial cells, with astrocytes being the most abundant type in the mammalian CNS. Numerous studies have demonstrated that astrocytes, as immunocompetent cells, perform diverse and complex functions in both health and disease. Glycosylation, a critical post-translational modification of proteins, regulates numerous biological functions. The expression and activity of glycosyltransferases, the enzymes responsible for glycosylation, are closely associated with the pathogenesis of various diseases. β-1,4-GalTI, a mammalian glycosyltransferase, plays a significant role in cell-cell interactions, adhesion, and migration. Although many studies have focused on β-1,4-GalTI, few have explored its effects on astrocyte function. In this study, we constructed lentiviral vectors for both interference and overexpression of β-1,4-GalTI and discovered that β-1,4-GalTI knockdown inhibited astrocyte migration and proliferation, while its overexpression promoted these processes. Concurrently, β-1,4-GalTI knockdown reduced the expression of TNF-α, IL-1β, and IL-6, whereas overexpression enhanced the expression of these cytokines. These findings suggest that modulating β-1,4-GalTI activity can influence the molecular functions of astrocytes and provide a theoretical foundation for further research into β-1,4-GalTI as a potential therapeutic target in astrocyte-mediated inflammation.

Laser interstitial thermal therapy in the management of bottom-of-sulcus dysplasia-related epilepsy.

This study assessed the efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) versus open surgery (OS) for the treatment of patients with bottom-of-sulcus dysplasia (BOSD)-related epilepsy. Twenty-two patients underwent MRgLITT, while 39 underwent OS. Postoperative seizure-free rates were analyzed using Kaplan-Meier curves. The removal ratio, which represents the extent of damage, was calculated based on preoperative lesion volume and postoperative removal volume. Other outcomes, including adverse events, operative time, and hospital stay, were also compared. Kaplan-Meier curves indicated the seizure-free rates were comparable between the MRgLITT group (90.9%, 26.5 [23.0, 35.1] months) and OS group (89.7%, 25.2 [16.2, 34.6] months) at the final follow-up (p = 0.901, log-rank test). The removal ratio of MRgLITT (1.3 [1.1, 1.7]) was significantly lower (p = 0.007) than that of OS (5.8 [3.6, 8.5]). A comparison of postoperative neurological deficits, infection rates, and fever rates revealed no significant differences between MRgLITT and OS groups. The operative time (hours) of MRgLITT (3.0, [2.1, 4.9]) was significantly shorter (p = 0.007) than that of OS (3.5 [3.0, 4.5]). The hospital stay (days) after MRgLITT (6 [5.0, 7.5]) was significantly shorter (p < 0.001) than that of OS (11.0 [9.0, 13.5]). MRgLITT has advantages over OS, including comparable seizure control and adverse event profiles, along with reduced removal ratios, shorter operative time, and shorter hospital stays.

Detection of DNA of Leishmania infantum in the brains of dogs without neurological signs in an endemic region for leishmaniasis in the state of Rio Grande do Sul, Brazil.

Canine visceral leishmaniasis (CVL) is a parasitic disease caused by the protozoan Leishmania infantum. Neurological infection occurs due to the parasite's ability to cross the blood-brain barrier. It is known that dogs can remain infected with a subclinical infection for life, potentially acting as reservoirs for L. infantum when bitten by sandflies. In this context, the objective of this study was to evaluate the occurrence of Leishmania spp. in the brains of dogs from the metropolitan region of Rio Grande do Sul, Brazil, without a history of neurological disease but residing in an endemic area for L. infantum. A total of 200 samples, from 2022 to 2023, were evaluated using conventional Polymerase Chain Reaction (PCR) with the primers Leishmini-F GGKAGGGGCGTTCTGC and Leishmini-R STATWTTACACCAACCCC, aiming to amplify a product of 120 base pairs for Leishmania spp. To identify the species, a multiplex PCR was used, differentiating L. braziliensis (127bp), L. amazonensis (100bp), and L. infantum (60bp), with the molecular target being the conserved region of the kinetoplast DNA (kDNA) minicircle, specific to Leishmania spp. Of the 200 samples evaluated, 26.5% (53/200) tested positive in the conventional PCR reaction for Leishmania spp., with the PCR multiplex the only species detected was Leishmania infantum. The average age of the positive animals was 5.08years, with 47.2% being females and 52.8% being males; among these, mixed-breed dogs were the most predominant, representing 43.4% of the total. Clinical signs varied: hepatomegaly in two dogs, pronounced neutrophilic hepatitis in one, splenomegaly in one with lymphoid hyperplasia, and glomerulonephritis and nephritis in two animals. Mild anemia and thrombocytopenia were found in eight, with pale mucous membranes in three, and diffuse alveolar edema in one case. Notable pathological findings included suspected distemper in one animal and lymphoplasmacytic meningitis in another. Histopathological findings revealed alveolar edema and acute renal failure. A third dog exhibited bilateral hydrocephalus and diffuse edema in the brain. Additional changes, such as mild inflammatory infiltrate and slight vacuolar degeneration, were observed in 11.3% of the analyzed brains. There was no clinical suspicion of leishmaniasis in any of the studied cases. Therefore, the detection of L. infantum DNA in the brains of dogs suggests that animals with subclinical infection may play a crucial role in the spread of leishmaniasis, and infection by Leishmania spp. should be considered as a differential diagnosis for neurological disease in endemic areas for the protozoan.

Limited evidence of infection with other tick-borne pathogens in patients tested for Lyme neuroborreliosis in the Netherlands

Ixodes ricinus is the main vector of the causative agents of Lyme neuroborreliosis. This tick species can also transmit tick-borne encephalitis virus (TBEV), spotted fever group (SFG) Rickettsia and Borrelia miyamotoi to humans. These tick-borne pathogens are present in Dutch ticks and have also been associated with human neurological infections, but well characterized disease cases are seldom reported. We therefore assessed the evidence for TBEV, SFG Rickettsia or B. miyamotoi infection in clinically well-described patients suspected of Lyme neuroborreliosis.We retrospectively included patients with specific predefined clinical criteria from patients that were tested for Lyme neuroborreliosis between 2010 and 2014 at an academic Lyme borreliosis Center. Serology was performed on available serum samples, and cerebrospinal fluid (CSF) was tested by molecular methods.Out of 514 potentially eligible patients, 176 individual patients were included. None of CSF samples was positive for the tested tick-borne pathogens, except for one previously described patient with Borrelia miyamotoi disease (BMD). Serology revealed 27, 14 and three patients with antibodies against SFG Rickettsia, B. miyamotoi and TBEV, respectively. No distinctive clinical symptoms or signs could be associated with seropositivity against any of these tick-borne pathogens.Apart from the previously published BMD case, we were unable to find convincing evidence of new cases of tick-borne encephalitis, spotted fever rickettsiosis or BMD in a cohort of patients suspected of Lyme neuroborreliosis. While antibodies against these tick-borne pathogens were detected, we could not associate these findings to clinical symptoms or signs. Therefore, prospective studies on humans with tick exposure are necessary to describe the prevalence, etiology and clinical symptoms of these tick-borne diseases other than Lyme borreliosis and tick-borne encephalitis.

Unsupervised Clustering of Adult Spinal Deformity Patterns Predicts Surgical and Patient-Reported Outcomes.

Retrospective cohort study. To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes. Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared. The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID).The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all P > .1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster. All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.

A Case of Acute Pericardial Abscess Due to Klebsiella Pneumoniae

Klebsiella pneumoniae (KPn) is a gram-negative bacterium, which is an opportunistic pathogen commonly found in the natural environment, and the infection rate of Klebsiella pneumoniae is increased in patients with underlying diseases such as diabetes mellitus, malignant tumors, liver and gallbladder diseases, and those who have received glucocorticoid therapy for a long period of time [1]-[4], which can cause urinary, respiratory, digestive, hematological, neurological and other multi-system infections with high morbidity and mortality rates [5]. Klebsiella pneumoniae infection involving the heart leading to purulent pericardial effusion has a lower incidence, and the literature in this regard reported extremely rare [6], mostly secondary to other parts of the infection, once suspected of pericardial abscess should be immediately performed pericardiocentesis to drain adequately, the application of saline to flush the pericardial cavity, can be thrombolysis of pericardial cavity with antibiotics or urokinase to speed up the process of treatment, to avoid the formation of constrictive pericarditis [7]-[9]. In order to improve clinicians' understanding of this disease, this article reports the diagnosis and treatment of a case of pericardial abscess caused by Klebsiella pneumoniae, with the aim of providing more case references for the clinic.

Enteric Nervous System and Its Relationship with Neurological Diseases.

The enteric nervous system (ENS) is a fundamental component of the gastrointestinal system, composed of a vast network of neurons and glial cells. It operates autonomously but is interconnected with the central nervous system (CNS) through the vagus nerve. This communication, known as the gut-brain axis, influences the bidirectional communication between the brain and the gut. Background/Objectives: This study aimed to review neurological pathologies related to the ENS. Methods: To this end, a comprehensive literature search was conducted in the "PubMed" database. Articles available in "free format" were selected, applying the filters "Humans" and limiting the search to publications from the last ten years. Results: The ENS has been linked to various neurological diseases, from autism spectrum disorder to Parkinson's disease including neurological infection with the varicella zoster virus (VZV), even sharing pathologies with the CNS. This finding suggests that the ENS could serve as an early diagnostic marker or therapeutic target for neurological diseases. Gastrointestinal symptoms often precede CNS symptoms, and the ENS's accessibility aids in diagnosis and treatment. Parkinson's patients may show intestinal lesions up to twenty years before CNS symptoms, underscoring the potential for early diagnosis. However, challenges include developing standardized diagnostic protocols and the uneven distribution of dopaminergic neurons in the ENS. Continued research is needed to explore the ENS's potential in improving disease prognosis. Conclusions: The ENS is a promising area for early diagnosis and therapeutic development. Nevertheless, it is essential to continue research in this area, especially to gain a deeper understanding of its organization, function, and regenerative capacity.

Inflammation and Elevated Osteopontin in Plasma and CSF in Cerebral Malaria Compared to Plasmodium-Negative Neurological Infections.

Cerebral malaria in young African children is associated with high mortality, and persisting neurological deficits often remain in survivors. Sequestered Plasmodium-infected red blood cells lead to cerebrovascular inflammation and subsequent neuroinflammation. Brain inflammation can play a role in the pathogenesis of neurologic sequelae. Therefore, we assessed a select set of proinflammatory analytes (IP10, IL23, MIP3α, GRO, MCP-1, and osteopontin in both the plasma and cerebrospinal fluid(CSF) of Zambian children with cerebral malaria and compared this with children with neurological symptoms that were negative for Plasmodium falciparum (non-cerebral malaria). Several similarities in plasma and CSF levels were found, as were some striking differences. We confirmed that IP10 levels were higher in the plasma of cerebral malaria patients, but this was not found in CSF. Levels of osteopontin were elevated in both the plasma and CSF of CM patients compared to the non-CM patients. These results show again a highly inflammatory environment in both groups but a different profile for CM when compared to non-cerebral malaria. Osteopontin may play an important role in neurological inflammation in CM and the resulting sequelae. Therefore, osteopontin could be a valid target for further biomarker research and potentially for therapeutic interventions in neuroinflammatory infections.

Probable Causative Agents and Demographic Patterns of Encephalitis, Meningitis, and Meningoencephalitis in a Single Tertiary Care Center.

Introduction Encephalitis, meningitis, and meningoencephalitis present significant challenges in clinical management owing to their diverse etiologies and potential complications. A high suspicion index is critical for guiding treatment strategies and improving patient outcomes. Understanding the demographic characteristics and frequency of causes of these conditions is essential to deliver optimized care. Objective This study aimed to investigate epidemiological causes and relative outcomes, including mortality, based on cultures, laboratory investigations, and demographic factors among patients with encephalitis, meningitis, and meningoencephalitis in a Saudi Arabian tertiary care center. Methods A retrospective cross-sectional study was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Data were collected from patients admitted between April 2016 and December 2022 who met the specified inclusion criteria. Results Among 233 patients, meningitis was the most prevalent diagnosis (65.77%), with bacterial agents being the predominant causative agents (79.74%). Higher mortality was significant with pediatrics <5 years and adults >60 years. Conclusion This study provides valuable insights into the epidemiology and clinical outcomes of central neurological infections based on a Saudi Arabian cohort. These findings underscore the importance of an accurate diagnosis and tailored management strategies. Further studies are warranted to enhance our understanding and to inform more predictable characteristics targeted in optimizing healthcare delivery for patients with such conditions.

Clinical Features of Molar Root-Incisor Malformation: A Retrospective Study

This study aimed to identify the clinical characteristics of molar root-incisor malformation (MRIM) and provide clinical considerations for treatments. Panoramic radiographs and electronic medical records of 64 patients with MRIM were retrospectively reviewed. Age, gender, follow-up period, medical history, complications, distribution of MRIM teeth, treatment, and prognosis were analyzed. Females were affected 1.56 times more than males, and the average age was 8.2 years. Dental complications, including periapical lesions, abscesses, and alveolar bone loss, were observed in 71.9%, and eruption disturbance of adjacent teeth was noticed in 37.5%. Most patients had medical histories in the first year of life. The most prevalent history was prematurity or low birthweight, followed by neurological conditions, surgeries, medications, and infections. All patients had MRIM on permanent first molars. The primary second molars were the second most frequently involved, followed by maxillary permanent central incisors and primary first molars. The prevalence was low on permanent lateral incisors and canines. Extraction was the most prevalent treatment done on MRIM-affected teeth, and most extraction sockets were managed by the eruption of permanent second molars. Few cases received endodontic treatment but with low success rates. Early detection of MRIM and prompt, appropriate treatment are important to avoid unnecessary discomfort from complications.

Rapid development of neurological infection in a patient with human immunodeficiency virus following schistosomiasis: A case report

AbstractHIV‐1 and schistosomal infections present significant global health challenges, and neurological manifestations of these pathogens are easily misdiagnosed due to their rarity. Here, we report the case of a 36‐year‐old patient with acquired immunodeficiency syndrome who was initially diagnosed with human immunodeficiency virus‐1 (HIV‐1) infection 4 years earlier, although untreated for approximately 3 years until he began antiretroviral therapy (ART) following a tuberculosis diagnosis and hospitalization. Despite achieving virological suppression of HIV‐1 1 year after ART, he was readmitted with high fever and headache. Initial therapy for suspected tuberculosis based on clinical performance and brain imaging features failed, and further investigation confirmed an intracranial infection caused by schistosomiasis. Following anti‐schistosomal treatment and optimized ART, the patient recovered fully and was discharged. This case of a patient in Asia infected with human immunodeficiency virus (HIV) who rapidly developed a neurological infection subsequent to acquiring schistosomiasis highlights the need for awareness of such coinfections in patients with HIV.

Safety and efficacy assessment of an mRNA rabies vaccine in dogs, rodents, and cynomolgus macaques

Rabies is a lethal disease caused by the rabies virus (RABV), which causes acute neurological infections in mammals, including human beings. We previously reported that an mRNA vaccine (LVRNA001) encoding the rabies virus’s glycoprotein induced strong protective immune responses to rabies in mice and dogs. Here, we further evaluate the safety of LVRNA001. First, we performed a confirmative efficacy study in dogs, which showed that LVRNA001 fully protected the animals from the virus, both pre- and post-infection. Moreover, using pre- and post-exposure prophylaxis murine models, we showed that LVRNA001, built from the CTN-1 strain, was able to protect against various representative RABV strains from the China I–VII clades. To evaluate the safety of the vaccine, chronic and reproductive toxicity studies were performed with cynomolgus macaques and rats, respectively. In a repeated-dose chronic toxicity study, vaccinated monkeys displayed no significant alterations in body weight, temperature, or hematological and biochemical markers. Lymphocyte subset measurement and histopathological examination showed that no toxicity was associated with the vaccine. The immunogenicity study in cynomolgus macaques demonstrated that LVRNA001 promoted the generation of neutralizing antibodies and Th1-biased immune response. Evaluation of reproductive toxicity in rats revealed that administration of LVRNA001 had no significant effects on fertility, maternal performance, reproductive processes, and postnatal outcomes. In conclusion, LVRNA001 can provide efficient protection against rabies virus infection in dogs and mice, and toxicity studies showed no significant vaccine-related adverse effects, suggesting that LVRNA001 is a promising and safe vaccine candidate for rabies prophylaxis and therapy.