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Results: 11

(searched for: Unusual Coinfection of Central Nervous System)
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Matthew Laurence Fielies, Iain Scott Walker
British Journal of Neurosurgery pp 1-4; doi:10.1080/02688697.2020.1725439

The publisher has not yet granted permission to display this abstract.
Arantxa Berzosa Sánchez, Marta Illán Ramos, Esther Culebras, José Tomás Ramos Amador
Journal of Pediatrics, Perinatology and Child Health, Volume 4, pp 27-30; doi:10.26502/jppch.74050037

Abstract:
Central nervous system infections may encompass a wide spectrum of manifestations from meningitis, if only meningeal inflammation is presented, to encephalitis, if the parenchyma is involved, although frequently both are affected leading to meningoencephalitis. Mainly caused by viruses, bacterial origin should always be ruled out because of its worse prognostic. An adolescent of 13-years-old is presented, who complained of fever, psychomotor agitation and altered level of consciousness of sudden onset. Once the diagnosis of meningoencephalitis was suspected samples from blood and cerebrospinal-fluid (CSF) were collected, and antibiotics were started. After 24 hours Neisseria meningitidis was isolated in blood culture and Human Herpesvirus 6 was detected by PCR in CSF, receiving treatment against both pathogens (cefotaxime and ganciclovir) with a prompt recovery. Even when bacterial and virus coinfection is not a common finding in CNS infections, it may occur, with high impact on clinical evolution of the patient. In order to stablish an accurate microbiological diagnosis, appropriate samples should be taken. It is also important to remark that treatment should be adjusted accordingly to microbiological results.
Pilar Enríquez-Ruano, Cristian Eduardo Navarro, Michael Ariza-Varón, Andrea Del Pilar Calderón-Castro
Spinal Cord Series and Cases, Volume 5; doi:10.1038/s41394-019-0238-0

The publisher has not yet granted permission to display this abstract.
Michele De Souza Bastos, Valquiria Do Carmo Alves Martins, Natália Lessa Da Silva, Samya Jezine, Sérgio Pinto, Valderjane Aprigio, Rossicleia Lins Monte, Silvio Fragoso, Marzia Puccioni-Sohler
Memórias do Instituto Oswaldo Cruz, Volume 114; doi:10.1590/0074-02760180450

Abstract:
BACKGROUND Amazon, the largest tropical forest of the world, has suffered from dengue outbreaks since 1998. Cerebrospinal fluid (CSF) of patients, from Amazonas state, suspected of central nervous system (CNS) viral infection was studied using molecular and immunological methods. OBJECTIVE To evaluate the importance of CSF investigation in patients with acute dengue virus (DENV) infection of CNS. METHODS CSF samples of 700 patients were analysed by reverse transcription polymerase chain reaction (RT-PCR) to detect the presence of dengue virus (DENV) RNA and by enzyme-linked immunosorbent assay (ELISA) to detect presence of DENV specific IgM. FINDINGS DENV infection was detected in 4.3% of the CSF samples; 85.7% (24/28) by DENV IgM and 14.3% (4/28) by viral RNA. DENV detected by viral RNA were to be found serotypes DENV-2 (three patients) and DENV-1 (one patient). The neurological diagnosis in patients CNS infection of DENV included encephalitis (10), meningoencephalitis (10), meningitis (6), acute myelitis (1), and encephalomyelitis (1). The majority (89.3%) had intrathecal inflammation: pleocytosis, hyperproteinorrachia and DENV IgM antibodies. Hypoglycorrhachia and/or high levels of lactate in CSF were found in 36% of the patients. Co-infection (CMV, HIV, EBV, and/or Mycobacterium tuberculosis) was observed in eight (28.6%) cases. CONCLUSIONS We found intense inflammatory CSF that is unusual in CNS disorders caused by dengue infection. It may be due co-infections or the immunogenetic background of the local Amerindian Brazilian population. CSF examination is an important diagnostic support tool for neurological dengue diagnosis.
Abhijeet Singh, Viswesvaran Balasubramanian, Nitesh Gupta
Journal of Family Medicine and Primary Care, Volume 7, pp 618-628; doi:10.4103/jfmpc.jfmpc_56_18

Abstract:
Dengue fever (DF) is an arboviral disease caused by a positive-sense RNA virus of the genus Flavivirus. The overall incidence of DF has increased exponentially worldwide over the last three decades. The atypical clinical manifestations of DF grouped under expanded dengue syndrome (EDS), have also been reported more frequently for the last decade. These unusual manifestations are usually associated with coinfections, comorbidities, or complications of prolonged shock. Intracranial hemorrhage (ICH) is one of the rare manifestations of the central nervous system involvement by dengue as a part of EDS. The pathogenesis and treatment of this manifestation also remain controversial. Therefore, we report a case of a previously healthy 65-year-old female who developed ICH as a part of EDS along with a brief review of literature.
International Journal of Infectious Diseases, Volume 46, pp 79-81; doi:10.1016/j.ijid.2016.04.002

Abstract:
: ▶ HHV-6 reactivation could promote reactivation of T. gondii ▶ T. gondii seropositive patient is at high-risk for reactivation after cord blood transplantation ▶ Cord blood transplantation is an important risk factor for opportunistic diseases AbstractBackgroundWe report the first case of central nervous system coinfection by human herpes virus-6 (HHV-6) and Toxoplasma gondii, after umbilical cord blood transplantation, in a chronic leukemia myelomonocytic patient.Case presentation: A 65-year-old Caucasian man underwent an umbilical cord blood transplantation within a context of chronic myelomonocytic leukemia. On day 37 post-graft, he presented with a severe headache and PCR for Toxoplasma gondii and HHV-6 were positive on cerebrospinal fluid and blood. The patient was treated by pyrimethamine and sulfadiazine associated with ganciclovir.ConclusionHHV-6 reactivation could promote reactivation of T. gondii. This case suggests that toxoplasmosis seropositive patients that present with HHV-6 reactivation have to be closely monitored for toxoplasmosis.
Tobias Lahmer, Marlena Messer, Ursula Ehmer, Stefan Eser, Analena Beitz, Lisa Fekecs, Roland M. Schmid, Wolfgang Huber
Mycopathologia, Volume 181, pp 267-271; doi:10.1007/s11046-015-9952-8

The publisher has not yet granted permission to display this abstract.
BMC Infectious Diseases, Volume 12, pp 225-225; doi:10.1186/1471-2334-12-225

Abstract:
Legionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection. A 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution. Neurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.
Dragan Lepur, Z Vranjican, B Barsic, J Himbele, I Klinar
Published: 1 August 2005
Journal of Infection, Volume 51; doi:10.1016/j.jinf.2004.07.002

The publisher has not yet granted permission to display this abstract.
Kinetoplastid Biology and Disease, Volume 2, pp 17-17; doi:10.1186/1475-9292-2-17

Abstract:
Recently new aspects of the immunopathology of Chagas disease have been described in patients infected with HIV and unusual clinical manifestations such as cutaneous lesions, involvement of central nervous system and/or serious cardiac lesions related to the reactivation of the parasite have been reported. Two uncloned Trypanosoma cruzi strains previously isolated from chronic chagasic patients with HIV co-infection were studied in order to evaluate the impact of the immunosuppression on the genetic diversity of the parasite. We have exploited an experimental model to determine whether genetically distinct populations appear after immunosuppression as a consequence of in vivo selection or in vitro propagation. The in vitro and in vivo conditions have allowed us to study the selected populations. The first strain was isolated from a case of reactivation of Chagas disease in a patient which presented four cerebral lesions. It was possible to demonstrate that the patient was infected with at least three distinct populations of T. cruzi. The population, recovered after immunosuppression, in mice was genetically divergent from the primary human isolate. The second strain, isolated from a hemophiliac/HIV positive patient presenting cardiac manifestation of Chagas disease showed no marked genetic difference after experimental immunosuppression. The immunological condition of the patient, associated or not to the reactivation of the infection, and also the strain of the parasite may have an important role during the course of the disease. The in vivo mechanism that generates parasite genetic variability or the participation of the selection under stress conditions will require further investigation.
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