Cytokine and chemokine responses in the blood and cerebrospinal fluid of patients with human herpesvirus 6B-associated acute encephalopathy with biphasic seizures and late reduced diffusion

To determine the involvement of oxidative stress in the pathogenesis of acute encephalopathy associated with human herpesvirus-6 (HHV-6) infection, we measured the levels of oxidative stress markers 8-hydroxy-2′-deoxyguanosine (8-OHdG) and hexanoyl-lysine adduct (HEL), tau protein, and cytokines in cerebrospinal fluid (CSF) obtained from patients with HHV-6-associated acute encephalopathy (HHV-6 encephalopathy)(n=16)and complex febrile seizures associated with HHV-6 (HHV-6 complex FS)(n=10). We also examined changes in CSF-8OHdG and CSF-HEL levels in patients with HHV-6 encephalopathy before and after treatment with edaravone, a free radical scavenger. CSF-8-OHdG levels in HHV-6 encephalopathy and HHV-6 complex FS were significantly higher than in control subjects. In contrast, CSF-HEL levels showed no significant difference between groups. The levels of total tau protein in HHV-6 encephalopathy were significantly higher than in control subjects. In six patients with HHV-6 infection (5 encephalopathy and 1 febrile seizure), the CSF-8-OHdG levels of five patients decreased after edaravone treatment. Our results suggest that oxidative DNA damage is involved in acute encephalopathy associated with HHV-6 infection.

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HUMAN HERPESVIRUS 7 RELATED ACUTE ENCEPHALOPATHY WITH BIPHASIC SEIZURES AND LATE REDUCED DIFFUSION

10.26226/morressier.58fa1768d462b80290b50c22 ◽

2017 ◽

Author(s):

Garyfallia Syridou

Keyword(s):

Human Herpesvirus ◽

Acute Encephalopathy

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Acute childhood encephalopathy with prolonged fever, pleocytosis and elevated inflammatory cytokines in the cerebrospinal fluid and transient splenial lesion

Journal of the International Child Neurology Association ◽

10.17724/jicna.2019.166 ◽

2019 ◽

Author(s):

Rena Okada ◽

Yuri Sakaguchi ◽

Takeshi Matsushige ◽

Isamu Kamimaki ◽

Toshiki Takenouchi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Mental Status ◽

Nationwide Survey ◽

Altered Mental Status ◽

Acute Encephalopathy ◽

C Reactive Protein ◽

Reactive Protein ◽

Prolonged Fever ◽

Splenial Lesion ◽

Male Patients

Background: Acute encephalopathy during childhood represents a highly heterogeneous group of infectious and non-infectious pathologies. According to a recent nationwide survey on acute childhood encephalopathy in Japan, the combination of clinical and radiographic features left approximately half of the affected children unclassified, mainly because of the lack of disease-specific biomarkers. Case: Herein, we document a school-aged boy who manifested with acute encephalopathy that was characterized by a prolonged fever, altered mental status, urinary retention, and intention tremor lasting for more than a month. Accompanying features included syndrome of inappropriate secretion of antidiuretic hormone, pleocytosis with elevated interleukin-6 and interferon-gamma levels in the cerebrospinal fluid, and a transient splenial lesion on neuroimaging. No pathogens were identified, and C-reactive protein was negative throughout his clinical course. This constellation of clinical features was not compatible with any of the existing entities of acute pediatric encephalopathy. Discussion: Our retrospective literature review identified two additional school-aged male patients who exhibited highly similar clinical courses. The prolonged altered mental status with pleocytosis in the cerebrospinal fluid and a transient splenial lesion in the absence of serum inflammatory markers suggest a primary central nervous system pathology. Conclusion: This combination of features defines this presumably new group of acute childhood febrile encephalopathy with prolonged fever and ataxia in school-aged boys.

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Retrospective Review of Clinical Utility of Shotgun Metagenomic Sequencing Testing of Cerebrospinal Fluid from a U.S. Tertiary Care Medical Center

Journal of Clinical Microbiology ◽

10.1128/jcm.01729-20 ◽

2020 ◽

Vol 58 (12) ◽

Author(s):

Kyle G. Rodino ◽

Michel Toledano ◽

Andrew P. Norgan ◽

Bobbi S. Pritt ◽

Matthew J. Binnicker ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Mayo Clinic ◽

Medical Center ◽

Tertiary Care ◽

Human Herpesvirus ◽

Reference Laboratory ◽

Metagenomic Sequencing ◽

Shotgun Metagenomic Sequencing ◽

Tertiary Care Medical Center ◽

Positive Results

ABSTRACT Shotgun metagenomic sequencing can detect nucleic acids from bacteria, fungi, viruses, and/or parasites in clinical specimens; however, little data exist to guide its optimal application to clinical practice. We retrospectively reviewed results of shotgun metagenomic sequencing testing requested on cerebrospinal fluid samples submitted to an outside reference laboratory from December 2017 through December 2019. Of the 53 samples from Mayo Clinic patients, 47 were requested by neurologists, with infectious diseases consultation in 23 cases. The majority of patients presented with difficult-to-diagnose subacute or chronic conditions. Positive results were reported for 9 (17%) Mayo Clinic patient samples, with 6 interpreted as likely contamination. Potential pathogens reported included bunyavirus, human herpesvirus 7, and enterovirus D-68, ultimately impacting care in two cases. Twenty-seven additional samples were submitted from Mayo Clinic Laboratories reference clients, with positive results reported for three (11%): two with potential pathogens (West Nile virus and Toxoplasma gondii) and one with Streptococcus species with other bacteria below the reporting threshold (considered to represent contamination). Of 68 negative results, 10 included comments on decreased sensitivity due to high DNA background (n = 5), high RNA background (n = 1), insufficient RNA read depth (n = 3), or quality control (QC) failure with an external RNA control (n = 1). The overall positive-result rate was 15% (12/80), with 58% (7/12) of these interpreted as being inconsistent with the patient’s clinical presentation. Overall, potential pathogens were found in a low percentage of cases, and positive results were often of unclear clinical significance. Testing was commonly employed in cases of diagnostic uncertainty and when immunotherapy was being considered.

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About pathognomonic images: an infrequent case of acute encephalopathy

Italian Journal of Medicine ◽

10.4081/itjm.2008.3.39 ◽

2013 ◽

pp. 39-41

Author(s):

Alessandro Grasso ◽

Pietro Nurra ◽

Luigia Cavallo ◽

Giorgio Menardo

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Brain Mri ◽

Acute Diarrhoea ◽

Complete Recovery ◽

Diagnostic Techniques ◽

Clinical Event ◽

Acute Encephalopathy ◽

Wernicke Encephalopathy ◽

Cerebral Mri

BACKGROUND The occurrence of acute encephalopathy is a dramatic clinical dilemma when usual diagnostic techniques (blood tests, cerebral CT and cerebrospinal fluid analysis) show no abnormalities. CLINICAL CASE We describe a case of a 73 years old man admitted in our Internal Medicine Unit for acute diarrhoea with vomiting and fever who developed a prolonged gastrointestinal dysmotility syndrome with poor nutritional intake. Although a parenteral support was provided, he developed acute encephalopathy followed by hypotension and lactic acidosis without evidence of renal and hepatic disease or glycemic alterations. Likewise, no cerebral CT and cerebrospinal fluid alterations were found. Conversely, cerebral MRI showed marked and diffuse DP-2 and FLAIR hyperintensity of the mesencephalic tectal plate, of the periaqueductal area, and of the periventricular region of the third ventricle including the median thalamic area. These MRI descriptions were considered pathognomonic of Wernicke encephalopathy. Thus, the immediate use of ev thiamine was followed by a prompt and complete recovery of neurological, hemodinamic and metabolic conditions. CONCLUSIONS Non-alcoholic Wernicke encephalopathy is a rare and dramatic clinical event with high mortality. In this context, brain MRI is the best diagnostic tool providing a typical picture.

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