Antibody-induced neutrophil depletion prior to the onset of pneumococcal meningitis influences long-term neurological complications in mice

Abstract Toll-like receptor (TLR) 2 and 4 signalling pathways are central to the body’s defence against invading pathogens during pneumococcal meningitis. Whereas several studies support their importance in innate immunity, thereby preventing host mortality, any role in protecting neurological function during meningeal infection is ill-understood. Here we investigated both the acute immunological reaction and the long-term neurobehavioural consequences of experimental pneumococcal meningitis in mice lacking both TLR2 and TLR4. The absence of these TLRs significantly impaired survival in mice inoculated intracerebroventricularly with Streptococcus pneumoniae. During the acute phase of infection, TLR2/4-deficient mice had lower cerebrospinal fluid concentrations of interleukin-1β, and higher interferon-γ, than their wild-type counterparts. After antibiotic cure, TLR2/4 double deficiency was associated with aggravation of behavioural impairment in mice, as shown by diurnal hypolocomotion throughout the adaptation phases in the Intellicage of TLR-deficient mice compared to their wild-type counterparts. While TLR2/4 double deficiency did not affect the cognitive ability of mice in a patrolling task, it aggravated the impairment of cognitive flexibility. We conclude that TLR2 and TLR4 are central to regulating the host inflammatory response in pneumococcal meningitis, which may mediate diverse compensatory mechanisms that protect the host not only against mortality but also long-term neurological complications.

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Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315643 ◽

2018 ◽

Vol 104 (6) ◽

pp. 552-557 ◽

Cited By ~ 13

Author(s):

Seilesh Kadambari ◽

Serena Braccio ◽

Sonia Ribeiro ◽

David J Allen ◽

Richard Pebody ◽

...

Keyword(s):

White Cell Count ◽

Clinical Information ◽

Neurological Complications ◽

Surveillance Period ◽

Live Births ◽

Young Infants ◽

Hearing Test ◽

Surveillance Unit ◽

The Uk

ObjectivesThis study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.Participants, design and settingProspective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.Main outcome measuresTo describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.ResultsDuring the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.ConclusionThe incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

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The Other Side of SARS-CoV-2 Infection: Neurological Sequelae in Patients

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.632673 ◽

2021 ◽

Vol 13 ◽

Author(s):

Isabel M. Alonso-Bellido ◽

Sara Bachiller ◽

Guillermo Vázquez ◽

Luis Cruz-Hernández ◽

Emilio Martínez ◽

...

Keyword(s):

Nervous System ◽

Distress Syndrome ◽

Immune Reaction ◽

Cerebrovascular Disorders ◽

Neurological Complications ◽

Review Article ◽

Neurological Sequelae ◽

Long Term Consequences ◽

Taste And Smell

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the globe causing coronavirus disease 2019 (COVID-19). Because it affects the respiratory system, common symptoms are cough and breathing difficulties with fever and fatigue. Also, some cases progress to acute respiratory distress syndrome (ARDS). The acute phase of COVID-19 has been also related to nervous system symptoms, including loss of taste and smell as well as encephalitis and cerebrovascular disorders. However, it remains unclear if neurological complications are due to the direct viral infection of the nervous system, or they appear as a consequence of the immune reaction against the virus in patients who presented pre-existing deficits or had a certain detrimental immune response. Importantly, the medium and long-term consequences of the infection by SARS-CoV-2 in the nervous system remain at present unknown. This review article aims to give an overview of the current neurological symptoms associated with COVID-19, as well as attempting to provide an insight beyond the acute affectation.

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Is there a rendezvous for SARS-CoV-2 and Agmatine?

Coronaviruses ◽

10.2174/2666796703666220106112842 ◽

2022 ◽

Vol 03 ◽

Author(s):

Nandkishor Kotagale ◽

Brijesh Taksande ◽

Nazma Inamdar

Keyword(s):

Neuromuscular Diseases ◽

Neurological Complications ◽

Nervous System Diseases ◽

Review Of The Literature ◽

Long Term Effects ◽

Peripheral Nervous System Diseases ◽

Neurological Effects ◽

Specific Symptoms

Abstract: The catastrophe of the ongoing COVID-19 pandemic is caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). The respiratory system appears to be ground zero in the majority of the patients. However, many other organs can get infected by cytokines, chemokines and other mediators released in response to the presence of the virus. The neurotropism by the SARS-CoV-2 is established beyond doubt. In addition to non-specific symptoms, the symptoms specific to central and/or peripheral nervous system diseases as well as neuromuscular diseases have been observed in numerous clinical cases. These observations and the experiences with other coronavirus infections earlier and flu pandemics raise concerns not only about the neurological effects in active disease but also about the long-term effects generated by the infection, immune and inflammatory functions. The knowledge of biological actions of agmatine in the backdrop of physiological events instigated by invading SARS-CoV-2 and host’s response, especially in neural events, focuses on the possible overlaps of biomolecular pathways at a number of instances. This is not surprising since the factors stimulated during SARS-CoV-2 infection are the disease-generating neuroinflammatory components altered by agmatine. Hence, we hypothesize the possible beneficial role of agmatine in SARS-CoV-2 infection. Based on a narrative review of the literature, agmatine can be proposed as a plausible beneficial candidate for supporting treatment of SARS-CoV-2 infection and for addressing post-infection neurological complications.

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Long-term neurologic and cognitive outcome and quality of life in adults after pneumococcal meningitis

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2020.01.020 ◽

2020 ◽

Vol 26 (10) ◽

pp. 1361-1367 ◽

Cited By ~ 2

Author(s):

A.T. Kloek ◽

M.C. Brouwer ◽

B. Schmand ◽

M.W.T. Tanck ◽

D. van de Beek

Keyword(s):

Quality Of Life ◽

Pneumococcal Meningitis ◽

Cognitive Outcome

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Clinical Characteristics, Acute Complications, and Neurologic Outcomes of Salmonella Meningitis in Saudi Infants and Children

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0039-1696977 ◽

2019 ◽

Vol 15 (01) ◽

pp. 031-038

Author(s):

Sarah Alsubaie ◽

Abdulkarim Alrabiaah

Keyword(s):

Age Of Onset ◽

Sinus Thrombosis ◽

Neurological Complications ◽

Infants And Children ◽

University Hospital ◽

Neurologic Complications ◽

Neurodevelopmental Outcomes ◽

Acute Complications ◽

Salmonella Meningitis

Abstract Objective This study aimed to clarify the clinical presentations, acute complications, and long-term sequelae of Salmonella meningitis in Saudi infants and children. Methods This retrospective study, conducted from 1999 to 2016, evaluated the neurological complications and long-term outcomes of children 14 years of age and younger diagnosed with Salmonella meningitis at King Khalid University Hospital. All affected children had 3 years of follow-up to assess neurologic complications and mortality. Results Invasive Salmonella infection occurred in 141 patients. Of those, 14 (10%) had meningitis. The median age of onset of infection was 4.7 months. The most frequent symptoms at presentation included fever (100%), seizures (71%), diarrhea, and vomiting (43%). Nontyphoidal Salmonella species were isolated in all (but one) cerebrospinal fluid samples. Relapse occurred in four patients owing to inadequate antibiotic duration, although the organisms were susceptible to ceftriaxone. The majority of patients (86%) developed acute neurologic complications, including subdural empyema and multiple cerebral infarcts (57%), hydrocephalus (36%), ventriculitis (29%), and cerebral venous sinus thrombosis (21%). Four patients (28.5%) died due to Salmonella meningitis complications. Four patients survived with full recovery. Six patients (60%) had long-term neurologic complications. Hydrocephalus, cerebral palsy, developmental delay, and epilepsy occurred in five, four, three, and three patients, respectively. Conclusion Salmonella meningitis results in significant mortality and adverse neurodevelopmental outcomes. The probability of relapse after an apparent recovery should be considered. Consensus on antibiotic treatment for Salmonella meningitis is needed.

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Outcomes from stereotactic surgery for essential tremor

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-318240 ◽

2018 ◽

Vol 90 (4) ◽

pp. 474-482 ◽

Cited By ~ 29

Author(s):

Robert Francis Dallapiazza ◽

Darrin J Lee ◽

Philippe De Vloo ◽

Anton Fomenko ◽

Clement Hamani ◽

...

Keyword(s):

Essential Tremor ◽

Focused Ultrasound ◽

Neurological Complications ◽

Treatment Modalities ◽

Beneficial Effects ◽

Appropriate Treatment ◽

Long Term Follow Up ◽

Added Benefit ◽

One Year

There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.

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Long-term outcomes of pneumococcal meningitis in childhood and adolescence

European Journal of Pediatrics ◽

10.1007/s00431-010-1390-5 ◽

2011 ◽

Vol 170 (8) ◽

pp. 997-1006 ◽

Cited By ~ 22

Author(s):

Deborah Christie ◽

Russell M. Viner ◽

Kyle Knox ◽

Pietro G. Coen ◽

Han Wang ◽

...

Keyword(s):

Pneumococcal Meningitis ◽

Childhood And Adolescence ◽

Long Term Outcomes

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Effects of Moringa oleifera on Glycaemia and Insulin Levels: A Review of Animal and Human Studies

Nutrients ◽

10.3390/nu11122907 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2907 ◽

Cited By ~ 5

Author(s):

Karina Vargas-Sánchez ◽

Edwin Garay-Jaramillo ◽

Rodrigo E. González-Reyes

Keyword(s):

Moringa Oleifera ◽

Food Source ◽

Neurological Complications ◽

Diabetic Animal ◽

Human Studies ◽

Therapeutic Interventions ◽

Diverse Range ◽

Insulin Levels ◽

Long Term Studies

Diabetes and related neurological complications are serious worldwide public health problems. The increasing number of affected individuals make it necessary to implement novel nutritional and therapeutic interventions. The tree Moringa oleifera (MO) has been used as a food source and for traditional medicine purposes due to possible antihyperglycemic, antioxidant, anti-inflammatory, and lipid regulating properties. These properties may be explained by the presence of numerous phytochemicals in the leaves, fruits, roots and, oil of the tree. The evidence for acute antihyperglycemic effects of MO extract on diabetic animal models seems to be robust, but more chronic and long-term studies are needed. In contrast, the hypoglycemic effects of MO on humans are not as clear. The scarce number of human studies, together with a diverse range of methodologies and MO doses, may explain this. In addition, evidence regarding changes in insulin levels due to MO intervention is ambiguous, both in animal and human studies. Therefore, more structured studies are needed to clarify if MO has an effect on insulin levels or activity.

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Superficial Temporal Artery to Proximal Middle Cerebral Artery Anastomosis: Clinical and Angiographic Long Term Results

Neurosurgery ◽

10.1227/00006123-198612000-00015 ◽

1986 ◽

Vol 19 (6) ◽

pp. 992-997 ◽

Cited By ~ 15

Author(s):

Massimo Collice ◽

Orazio Arena ◽

Romero A. Fontana

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Good Alternative ◽

Neurological Complications ◽

Long Term Results ◽

Cortical Surface ◽

First Choice

Abstract Anastomosis of the superficial temporal artery (STA) with a proximal segment of the middle cerebral artery (MCA) has been proposed as a new cerebral revascularization technique alternative to the conventional bypass on the cortical surface. We introduced this procedure in our surgical practice in 1982 for patients with internal carotid artery (ICA) aneurysms not suitable for direct repair in whom occlusion of the ICA is considered necessary. One patient died because a conventional STA-MCA bypass did not prevent a major stroke caused by a therapeutic ICA occlusion. We are reporting our surgical technique and the immediate and long term clinical and angiographic results in five cases operated on during the period June 19, 1982, through January 19, 1983. The early and late patency rates were good. No neurological complications were observed after the bypass procedure or during a 3-year follow-up period. In our opinion, the use of proximal segments of the MCA as recipient arteries for supratentorial revascularization is a good alternative to the use of cortical surface arteries and, in selected cases, could be the first choice technique.

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