Signs Of Meningoencephalitis Research Articles

Detection of herpesviruses and enteroviruses in patients with suspected infectious meningoencephalitis in three referral hospitals in Yaounde, Cameroon.

In Cameroon, routine diagnosis of central nervous system (CNS) infections is based on the detection of bacteria, fungi, parasites, and mycobacteria in cerebrospinal fluids. Therefore, there is no data on viral etiologies of meningoencephalitis (ME) in the country. We aim to identify viral etiologies (herpesviruses and enteroviruses) of MEin Cameroon, to provide useful information to physicians that will help improving management of ME. From February to May 2018, adult patients with clinical signs of ME in three referral hospitals in Yaounde were included. Detection of herpesviruses and enteroviruses was performed using reverse transcriptase polymerase chain reaction. P value of 5% was chosen as the threshold for statistical significance in statistical analyses. Eighty-one patients were included and 15 (18.51%) were positive for herpesviruses. No enterovirus was detected. The most prevalent virus was Epstein-Barr virus (8.6%) and most of herpesviruses were detected from human immunodefeciency virus (HIV)-positive patients (86.7%). The overall mortality rate was high, 60.5% (49/81) and analysis of risk factors showed that HIV-positive status and altered state of consciousness were associated with higher risk of death (odds ratio [OR], 5.41; confidence interval [CI]: 1.91-16.88;P = .002 and OR, 3.24; CI:1.11-0.13;P = .036 respectively). We showed that herpesviruses are present in patients with ME symptoms in Yaounde and can be sometimes in coinfection with others common pathogens of CNS infections. There is therefore a need for increased clinician awareness and education regarding the diagnostic and management of CNS infections in Cameroon to limit unnecessary use of antibiotics.

DIAGNOSTIC MEANING OF DETERMINATION OF HOMOCYSTEIN IN THE BLOOD SERUM IN CHILDREN WITH NEUROINFECTIONS

The aim of the study was to determine the serum level of homocysteine in children with neuroinfections. Mаterials and methods: A blood serum assay of 60 children with viral and bacterial neuroinfections was performed using the enzyme immunoassay to evaluate homocysteinemia as a marker of endothelial dysfunction. Results: In interpreting the results, the average level of hyperhomocysteinemia in patients with bacterial and viral neuroinfections was established. The highest homocysteine levels in serum were observed in bacterial neuroinfections, especially in the presence of signs of meningoencephalitis and pneumococcal etiology of the disease. Dependence of changes in the level of homocysteinemia from the sex of sick children was not revealed. Conclusion: Neuroinfections in children, regardless of the cause, are accompanied by hyperhomocysteinemia, indicating the presence of endothelial activation in this pathology, more pronounced in the case of a bacterial etiology of the infectious process and the combined lesion of the soft dura mater and the brain substance.

Highly Pathogenic Avian Influenza A(H5N1) Virus Struck Migratory Birds in China in 2015.

Approximately 100 migratory birds, including whooper swans and pochards, were found dead in the Sanmenxia Reservoir Area of China during January 2015. The causative agent behind this outbreak was identified as H5N1 highly pathogenic avian influenza virus (HPAIV). Genetic and phylogenetic analyses revealed that this Sanmenxia H5N1 virus was a novel reassortant, possessing a Clade 2.3.2.1c HA gene and a H9N2-derived PB2 gene. Sanmenxia Clade 2.3.2.1c-like H5N1 viruses possess the closest genetic identity to A/Alberta/01/2014 (H5N1), which recently caused a fatal respiratory infection in Canada with signs of meningoencephalitis, a highly unusual symptom with influenza infections in humans. Furthermore, this virus was shown to be highly pathogenic to both birds and mammals, and demonstrate tropism for the nervous system. Due to the geographical location of Sanmenxia, these novel H5N1 viruses also have the potential to be imported to other regions through the migration of wild birds, similar to the H5N1 outbreak amongst migratory birds in Qinghai Lake during 2005. Therefore, further investigation and monitoring is required to prevent this novel reassortant virus from becoming a new threat to public health.

Asymmetric Weakness and West Nile Virus Infection

BackgroundWeakness is a common presentation in the emergency department (ED). Asymmetric weakness or weakness that appears not to follow an anatomical pattern is a less common occurrence. Acute flaccid paralysis with no signs of meningoencephalitis is one of the more uncommon presentations of West Nile virus (WNV). Patient may complain of an acute onset of severe weakness, or even paralysis, in one or multiple limbs with no sensory deficits. This weakness is caused by injury to the anterior horn cells of the spinal cord. We present a case of acute asymmetric flaccid paralysis with preserved sensory responses that was eventually diagnosed as neuroinvasive WNV infection. Case ReportA 31-year-old male with no medical history presented with complaints of left lower and right upper extremity weakness. Computed tomography scan was negative and multiple other studies were performed in the ED. Eventually, he was admitted to the hospital and was found to have decreased motor amplitudes, severely reduced motor neuron recruitment, and denervation on electrodiagnostic study. Cerebrospinal fluid specimen tested positive for WNV immunoglobulin (Ig) G and IgM antibodies. Why Should an Emergency Physician Be Aware of This?Acute asymmetric flaccid paralysis with no signs of viremia or meningoencephalitis is an unusual presentation of WNV infection. WNV should be included in the differential for patients with asymmetric weakness, especially in the summer months in areas with large mosquito populations.

Transmission Electron Microscopy as a Novel Tool for Diagnostics of Infectious Agents in The Cerebrospinal Fluid

Transmission electron microscopy (TEM) remains as an important and irreplaceable tool for direct microbiology diagnostics that allows a fast detection of infectious agents based on visualized morphology. An indisputable advantage this nonselective method is possibility to visualize all present agents in the biological samples in comparison with other techniques that are often highly specific. TEM uses negative contrast electron microscopic techniques where the objects of interests are captured on good film and copper grid coated with a carbon film with is stained by heavy metal salts. This staining surrounds the object and causes dark background, thus it makes the object of interests lighter due to lower ability to disperse primary electrons. By this technique we can visualize 2 nm substructure details. This technique is important not only in viral diagnostics but also in the detection of spirochetes in CSF that may cause several neural symptoms in patients particularly signs of meningoencephalitis. In CSF, we observed both whole spirochetes and their fragments. Importantly the positive diagnostic of the spirochetes can be found even though the serology and PCR methods are negative. To increase the specificity of this technique, we applied an immunoelectron microscopy that uses specific antibodies conjugated with gold particles that binds to the OspA and OspC antigen (Borrelia Burgdorferi). We can often visualize several agents in the CSF sample. Besides spirochetes, several viruses can be present such as Picornavirus or Paramyxovirus. TEM as a nonselective technique for the direct visualization of infectious agents in CSF highly increases the possibility to diagnose the cause of aseptic meningitis.

CHIKUNGUNYA - A SERIOUS THREAT FOR PUBLIC HEALTH.

Chikungunya is a contagious disease caused by Chikungunya virus, an arbovirus from the Togaviridae family. This infection is mostly spread by mosquitoes from the genus Aedes, especially Aedes albopiclus, which have spread from Asia to America and Europe including some countries surrounding Serbia. EPIDEMIOLOGIC FEATURES: The outbreak of epidemics has been reported in Philippines, Sumatra, Java, Indonesia, West Africa region (from Senegal to Cameroon), Congo, Nigeria, Angola, Uganda, Guinea, Malawi, Central African Republic, Burundi, South Africa and India. At the beginning of the 21st century, large outbreaks were recorded on the island of Réunion. During 2006, 1.400.000 cases of chikungunya infection were recorded in India. Local transmission of infection in continental Europe was reported from Northeast Italy (254 suspected and 78 laboratory confirmed cases in Emilia-Romagna region) and France (two cases in 2010). From December 2013 to June 2014, 5.294 confirmed cases and more than 180.000 suspected cases of chikungunya were reported in the Caribbean. The disease presents suddenly with fever, rush and arthralgia. In general, chikungunya is a mild self - limited disease. Less often, it may be presented with signs of meningoencephalitis or fulminant hepatitis, sometimes with fatal outcome. Fast developing international traffic and booming tourism as well as the vector spreading from its homeland make chikungunya a real threat to our country.

Herpes zoster with progression to acute varicella zoster virus‐meningoencephalitis

Acute meningoencephalitis (ME) from varicella zoster virus (VZV) reactivation is a rare and serious complication of herpes zoster (HZ). As early diagnostic detection is mandatory to prevent long-term sequelae, any clinical indication is helpful to identify patients that are at higher risk of the development of VZV-ME. In order to find such risk factors, the clinical data of 38 patients consecutively hospitalized for the treatment of HZ over a 1-year period were analyzed. Four of the 38 patients with HZ developed ME. Of these, three had involvement of the trigeminal nerve branch, one including an ophthalmic affection, and one presented with disseminated HZ. All were women with an average age of 83.5 years, in comparison with patients with HZ but without ME who had an average age of 69.3 years and a female preponderance of 60%. The first clinical signs of ME were rapidly progressing somnolence and meningism. Patients with HZ-ME were treated with intravenous acyclovir, oral glucocorticosteroids, and antiseizure therapy, and recovered almost completely without major residual symptoms. Progression of HZ to ME seems to occur more often than normally believed. Female patients above 80 years of age with either ophthalmic involvement or disseminated HZ are at a potentially high risk of the development of ME. The general recommendation of starting oral glucocorticosteroids from day 1 of antiviral treatment in older patients must be questioned, as it may stimulate VZV replication and dissemination.

California Serogroup Virus Infections in the Ryazan Region of the USSR

Serum samples from 60 people diagnosed in the summer of 1989 as having acute respiratory infections, meningitis or meningoencephalitis, acute pneumonia, Lyme disease, or other illnesses were tested by neutralization and hemagglutination-inhibition with Tahyna, Inkoo, and snowshoe hare viruses of the California serogroup (family Bunyaviridae, genus Bunyavirus). Demonstration of a diagnostic increase in antibody titers between paired serum samples from seven people showed that their illnesses were probably caused by Inkoo or Tahyna viruses. The clinical pictures were less specific. One patient had signs of meningoencephalitis, three had signs of meningitis, and three had influenza-like illnesses. These observations and other results suggest that California serogroup viruses are widespread in Russia and may account for an unexpectedly large number of presently undiagnosed febrile illnesses, some with central nervous system involvement.

6 Transfusion Support for Haemophiliacs

Weakness is a common presentation in the emergency department (ED). Asymmetric weakness or weakness that appears not to follow an anatomical pattern is a less common occurrence. Acute flaccid paralysis with no signs of meningoencephalitis is one of the more uncommon presentations of West Nile virus (WNV). Patient may complain of an acute onset of severe weakness, or even paralysis, in one or multiple limbs with no sensory deficits. This weakness is caused by injury to the anterior horn cells of the spinal cord. We present a case of acute asymmetric flaccid paralysis with preserved sensory responses that was eventually diagnosed as neuroinvasive WNV infection.A 31-year-old male with no medical history presented with complaints of left lower and right upper extremity weakness. Computed tomography scan was negative and multiple other studies were performed in the ED. Eventually, he was admitted to the hospital and was found to have decreased motor amplitudes, severely reduced motor neuron recruitment, and denervation on electrodiagnostic study. Cerebrospinal fluid specimen tested positive for WNV immunoglobulin (Ig) G and IgM antibodies.Acute asymmetric flaccid paralysis with no signs of viremia or meningoencephalitis is an unusual presentation of WNV infection. WNV should be included in the differential for patients with asymmetric weakness, especially in the summer months in areas with large mosquito populations.

Diagnostic Brain Biopsy

Abstract A consecutive series of 50 diagnostic cerebral biopsies carried out over a 12-year period (1960 to 1972) at The Neurological Institute of New York is reported. The goal of the biopsy was to acquire a definitive diagnosis to aid the patient, counsel the family, and advance scientific knowledge. General indications for biopsy were either chronic bilateral cerebral findings associated with progressive dementia or profound retardation or acute unilateral cerebral findings, usually associated with signs of meningoencephalitis. Four patients were not suitable for analysis, leaving 46 patients to be surveyed. Diagnostic neuropathological features were judged to be present in 17 specimens (37%). Abnormal but not diagnostic pathological changes were found in 22 specimens (48%). Thus, 39 specimens (85%) displayed some abnormality. No apparent neuropathological changes were present in 7 specimens (15%). These findings correspond favorably with the results of others and suggest that a certain “irreducible minimum” of normal biopsies occurs with the techniques utilized. Fourteen (30%) of the patients were known to be alive at the conclusion of the study. Twenty-two patients (48%) had died, but necropsy findings were available for only 10 of these. Except in 2 cases in which biopsies had been normal, no discrepancy was noted between the basic neuropathological changes found at necropsy and those of the biopsy specimen. One death could be directly attributed to the procedure, and total morbidity and mortality was approximately 13%. The authors recommend that any biopsy program should be organized at an institutional level to take into account the patient's special illness and the capabilities of that institution. In addition, suitable material must be forwarded to appropriate experts who have the knowledge and facility to make full use of biopsy material.

Transmission of Toxoplasma gondii across the guinea-pig placenta.

6 guinea-pigs were inoculated intraperitoneally at 4-54 days of pregnancy with 60 or 100 Toxoplasma cysts in mouse-brain saline suspension. All foetuses were infected. 3 sows died on 17-19th post-inoculation day, with signs of meningo-encephalitis, and displayed focal lymphocytic inflammation and, in 2, Toxoplasma rosette formation in the cerebral hemisphere. 6 Sows previoulsy inoculated with 100-200 cysts were followed in later pregnancy: 5 of 17 foetuses were found to be infected when delivered-a further 4, and 3 carneous moles, were not examined. 4 non-pregnant sows died at 12-14 days after inoculation with 100-200 cysts, with similar clinical signs to those in the first group. Antibody titres of 256 were found at 2½ weeks, rising to a maximum of 16 384 at 6 weeks. Levels were consistently falling by 12-14 weeks. Transmission across the placenta could not wholly be prevented by the presence of antibody except in high titre, and the important factor was concluded to be the parasitaemia. The strain RB is midway in virulence in guinea-pigs between strains RH and 76.

Cerebral mucormycosis: Pathogenesis of the disease: Description of the fungus, rhizopus oryzae, isolated from a fatal case

Rhizopus oryzae has been isolated and identified as the infectious agent in one of two diabetic patients dying of cerebral mucormycosis. To our knowledge this rare and fatal complication of diabetes mellitus has never been diagnosed prior to the patient's death. The clinical and autopsy findings of this fungus disease in our own and previously reported cases are reviewed. The paranasal sinuses are suggested as a possible portal of entry of the infection and problems of pathogenesis are discussed. From this study emerges a syndrome consisting of uncontrolled diabetes mellitus associated with ophthalmoplegia, signs of meningoencephalitis and, possibly, sinusitis. These characteristic manifestations may permit an antemortem diagnosis of this disorder.