Infections of the central nervous system

2020 ◽  
pp. 217-228
Author(s):  
Guleed Adan ◽  
Sam Nightingale ◽  
Christine Burness ◽  
Tom Solomon
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Early Recognition ◽  
Psychiatric Patients ◽  
Cns Infection ◽  
Cns Infections ◽  
System P ◽  
The Central Nervous System ◽  
Psychiatric Manifestations

Central nervous system (CNS) infections, caused by various pathogens, can lead to a wide range of neuropsychiatric sequelae, including acute psychosis, mood disorders, and chronic dementias. Early recognition is critical as brain infections are often treatable and possible neuropsychiatric illness can be reversed if the diagnosis is timely. In addition to psychiatric symptoms, CNS infections may also present with other signs such as fever, meningism, cranial nerve deficit, and seizures. Although the presence of these additional features can often provide a clue to an underlying CNS infection, they are not always present; hence CNS infections should be considered in the differential diagnosis of psychiatric patients in certain situations. In this chapter, CNS infections that have psychiatric manifestations or have psychiatric sequelae are discussed, in particular HIV, neurosyphilis, meningitis, and encephalitis.

Epidemiology of bacterial and parasitic infections of the central nervous system

2020 ◽  
pp. 379-386
Author(s):  
Charles R Newton
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Epidemiological Studies ◽  
Acute Bacterial Meningitis ◽  
Parasitic Infections ◽  
Case Definitions ◽  
Cns Infections ◽  
System P ◽  
The Central Nervous System ◽  
Brain Abscesses

This chapter looks at the epidemiology of bacterial and parasitic infections of the central nervous system (CNS). Bacteria and parasites are important infections of the CNS, but the epidemiology has changed significantly over the last few decades with the introduction of vaccines; appearance of organisms resistant to antimicrobial and anti-parasitic drugs; increase in number of immunocompromised people from human immunodeficiency virus (HIV) and oncological conditions; and increased movement of people throughout the world. The CNS infections present with a multitude of symptoms and signs, which often overlap, making case definitions for epidemiological studies difficult. The main syndromes of CNS infections are meningitis, encephalitis, epilepsy, and paralysis. Most bacteria gain access to the CNS via blood, although scalp, ear, and oropharyngeal infections are possible routes of infection. The chapter then discusses acute bacterial meningitis, brain abscesses, ventriculitis, tuberculosis meningitis, malaria, cysticercosis, onchocerciasis, sparganosis, and paragonimiasis.

scholarly journals Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 782
Author(s):  
Giovanni Autore ◽  
Luca Bernardi ◽  
Serafina Perrone ◽  
Susanna Esposito
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pediatric Patients ◽  
Treatment Strategies ◽  
Cns Infection ◽  
Pcr Analysis ◽  
Emerging Pathogens ◽  
Cns Infections ◽  
The Central Nervous System

Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.

Parasitic Infections of the Central Nervous System

2021 ◽  
pp. 1037-1043
Author(s):  
Micah D. Yost ◽  
Michel Toledano
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Differential Diagnosis ◽  
Hydatid Cyst ◽  
Cerebral Malaria ◽  
Parasitic Infections ◽  
Immunocompromised Patients ◽  
Cns Infections ◽  
System P ◽  
The Central Nervous System

Parasitic infections make up a small but important subset of central nervous system (CNS) infections. Although necessary to be considered in the comprehensive differential diagnosis for patients presenting with suspected neurologic infections, these conditions are particularly important in regions where parasitic infections are endemic and for immunocompromised patients. Among the most common parasitic infections of the CNS are neurocysticercosis, echinococcosis (hydatid cyst), toxoplasmosis, amebic meningoencephalitis, and cerebral malaria.

scholarly journals Microglia Fighting for Neurological and Mental Health: On the Central Nervous System Frontline of COVID-19 Pandemic

2021 ◽  
Vol 15 ◽  
Author(s):  
Elisa Gonçalves de Andrade ◽  
Eva Šimončičová ◽  
Micaël Carrier ◽  
Haley A. Vecchiarelli ◽  
Marie-Ève Robert ◽  
...  
Keyword(s):  
Mental Health ◽  
Central Nervous System ◽  
Nervous System ◽  
Inflammatory Responses ◽  
Psychiatric Symptoms ◽  
Brain Parenchyma ◽  
Molecular Signature ◽  
The Central Nervous System ◽  
Psychiatric Manifestations ◽  
The Brain

Coronavirus disease 2019 (COVID-19) is marked by cardio-respiratory alterations, with increasing reports also indicating neurological and psychiatric symptoms in infected individuals. During COVID-19 pathology, the central nervous system (CNS) is possibly affected by direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, exaggerated systemic inflammatory responses, or hypoxia. Psychosocial stress imposed by the pandemic further affects the CNS of COVID-19 patients, but also the non-infected population, potentially contributing to the emergence or exacerbation of various neurological or mental health disorders. Microglia are central players of the CNS homeostasis maintenance and inflammatory response that exert their crucial functions in coordination with other CNS cells. During homeostatic challenges to the brain parenchyma, microglia modify their density, morphology, and molecular signature, resulting in the adjustment of their functions. In this review, we discuss how microglia may be involved in the neuroprotective and neurotoxic responses against CNS insults deriving from COVID-19. We examine how these responses may explain, at least partially, the neurological and psychiatric manifestations reported in COVID-19 patients and the general population. Furthermore, we consider how microglia might contribute to increased CNS vulnerability in certain groups, such as aged individuals and people with pre-existing conditions.

scholarly journals Viral infections of the central nervous system in Qatar: epidemiology, pathogenesis and clinical outcomes

2018 ◽  
Vol 12 (02.1) ◽  
pp. 29S
Author(s):  
Fatma Ben Abed ◽  
Muhamed Abukhattab ◽  
Obada Khalil ◽  
Ahmed Gohar ◽  
Hafedh Gazwani ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Outcomes ◽  
Healthcare System ◽  
Case Definition ◽  
Cns Infection ◽  
Viral Etiology ◽  
Gulf Region ◽  
Cns Infections ◽  
The Central Nervous System

Introduction: Virus-induced diseases of the central nervous system (CNS) represent a significant burden to human health worldwide. They are common causes of morbidities and mortality. There are no previous epidiomologic studies about viral CNS infections done in Qatar or in the Gulf region. We conducted this study to determine the etiology, clinical and epidimiological characteristics, and outcome of viral central nerveous system infection in patients across a larger national healthcare system. Methodology: We retrospectively evaluated all cerebrospinal fluid findings from January 2011 – March 2015 at any of the 7 hospitals in the Hamad Medical Corporation healthcare system. We included those with an abnormal CSF finding in our study. We excluded those with missing medical records, those with no clinical evidence of CNS infection or proven bacterial CNS infection. Based on pre-defined clinical and CSF (lab, culture, PCR) criteria, persons with abnormal CSF and CNS clinical findings were classified as having meningitis, meningoencephalitis, encephalitis or myelitis. We reviewed the laboratory results to determine the proportion of persons with confirmed viral etiology. Results: Among 7690 patients with available CSF results, 550 cases met the case definition criteria for viral CNS infection (meningitis 75%; meningoencephalitis 16%; encephalitis 9%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. Persons from Southeast Asia (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) accounted for 39.6 of all infections.  A definitive virologic etiologic agent was found in 38%, among whom enterovirus was the most common (44.3%) followed by Epstein-Barr virus (31%) and varicella zoster virus (12.4%). The clinical outcome was overall good, only 2 cases died and the rest discharged to home. Ninety-eight per cent were admitted to medical ward (mean stay 7.8±6.4 days) and 2 % to an intensive care unit. (mean stay 2.7±5.4 days). Among those with confirmed viral etiology, 83.8% received ceftriaxone, 38% received vancomycin and 38% received at least one other antibiotic. Conclusion: Viral etiology is not uncommon among those evaluated for CNS infection in Qatar, and is most commonly seen in Southeast Asian immigrants. Clinical outcomes are generally excellent in this group of patients. Antibiotics are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of CNS infections.

scholarly journals Metagenomic Next-Generation Sequencing for Pathogen Detection and Transcriptomic Analysis in Pediatric Central Nervous System Infections

2021 ◽  
Author(s):  
Nanda Ramchandar ◽  
Nicole G Coufal ◽  
Anna S Warden ◽  
Benjamin Briggs ◽  
Toni Schwarz ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Next Generation Sequencing ◽  
Usual Care ◽  
Transcriptomic Analysis ◽  
Cns Infection ◽  
Metagenomic Sequencing ◽  
Next Generation ◽  
Cns Infections ◽  
Generation Sequencing

Abstract Background Pediatric central nervous system (CNS) infections are potentially life-threatening and may incur significant morbidity. Identifying a pathogen is important, both in terms of guiding therapeutic management, but also in characterizing prognosis. Usual care testing by culture and PCR is often unable to identify a pathogen. We examined the systematic application of metagenomic next-generation sequencing (mNGS) for detecting organisms and transcriptomic analysis of cerebrospinal fluid (CSF) in children with CNS infections. Methods We conducted a prospective multi-site study that aimed to enroll all children with a CSF pleocytosis and suspected CNS infection admitted to one of three tertiary pediatric hospitals during the study timeframe. After usual care testing had been performed, the remaining CSF was sent for mNGS and transcriptomic analysis. Results We screened 221 and enrolled 70 subjects over a 12-month recruitment period. A putative organism was isolated from CSF in 25 (35.7%) subjects by any diagnostic modality. mNGS of the CSF samples identified a pathogen in 20 (28.6%) subjects, which were also all identified by usual care testing. The median time to result was 38 hours. Conclusion Metagenomic sequencing of CSF has the potential to rapidly identify pathogens in children with CNS infections.

Effects of an injectable functionalized self-assembling nanopeptide hydrogel on angiogenesis and neurogenesis for regeneration of the central nervous system

Nanoscale ◽  
2017 ◽  
Vol 9 (42) ◽  
pp. 16281-16292 ◽  
Author(s):  
Tzu-Wei Wang ◽  
Kai-Chieh Chang ◽  
Liang-Hsin Chen ◽  
Shih-Yung Liao ◽  
Chia-Wei Yeh ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brain Tissue ◽  
Tissue Regeneration ◽  
Self Assembling ◽  
System P ◽  
Injured Brain ◽  
The Central Nervous System

Functionalised self-assembling nanopeptide hydrogel mediates angiogenesis and neurogenesis for injured brain tissue regeneration.

CHRONIC LEAD ENCEPHALOPATHY

PEDIATRICS ◽  
1960 ◽  
Vol 25 (2) ◽  
pp. 309-315
Author(s):  
Harry H. White ◽  
Fred D. Fowler
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pediatric Patients ◽  
Early Recognition ◽  
Central Nervous System Involvement ◽  
Fast Screening ◽  
The Central Nervous System ◽  
Lead Encephalopathy ◽  
Urinary Coproporphyrin

Chronic lead encephalopathy must be considered in the differential diagnosis of pediatric patients who present with manifestations of schizophrenia, behavior disorders or degenerative diseases of the central nervous system. Determination of urinary coproporphyrin is a simple, fast screening procedure applicable to office practice. The prognosis for normal mental development following encephalopathy is poor. It is hoped that early recognition of the more subtle signs of central nervous system involvement will allow treatment to be instituted soon enough to prevent the crippling mental deterioration which is so often a sequela of lead poisoning.

A practical pH-compatible fluorescent sensor for hydrazine in soil, water and living cells

The Analyst ◽  
2020 ◽  
Vol 145 (22) ◽  
pp. 7380-7387 ◽  
Author(s):  
Huming Yan ◽  
Fangjun Huo ◽  
Yongkang Yue ◽  
Jianbin Chao ◽  
Caixia Yin
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Respiratory Tract ◽  
Human Body ◽  
Water Solubility ◽  
Fluorescent Sensor ◽  
Living Cells ◽  
Human Organs ◽  
System P ◽  
The Central Nervous System

The excellent water solubility of hydrazine (N2H4) allows it to easily invade the human body through the skin and respiratory tract, thereby damaging human organs and the central nervous system.

scholarly journals Neurobrucellosis mimicking primary vasculitis of the central nervous system: we should perform a metagenomic analysis of the cerebrospinal fluid prior to brain biopsy

2021 ◽  
Author(s):  
Marina Barrionuevo Mathias ◽  
Fernando Gatti ◽  
Gustavo Bruniera ◽  
Vitor Paes ◽  
Gisele Sampaio Silva ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Brain Mri ◽  
Genetic Material ◽  
Clinical Manifestations ◽  
Brain Biopsy ◽  
Metagenomic Analysis ◽  
Normal Brain ◽  
The Central Nervous System

Context Primary angiitis of the central nervous system (PACNS) is characterized by the inflammation of small and medium CNS arteries; the clinical manifestations include headache, cognitive impairment and focal neurological deficits. The gold standard test for diagnosis is brain biopsy. Neurobrucellosis is an infection associated with cattle farming, which leads to neurological and psychiatric symptoms. We report a case of neurobrucellosis mimicking PACNS. Case report Male, 32 years old, with fever, headache, dizziness and cognitive impairments for 30 days. History of stroke 2 years before, with mild sequelae right hemiparesis; investigation showed suspected intracranial dissection. On physical examination, he had apathy, preserved strength, reduced reflexes with plantar flexor responses. General laboratory tests, autoantibodies and serology were normal. Brain MRI showed deep left nucleocapsular gliosis and cerebral angiography revealed stenosis of the ICA and MCA. CSF showed 42 cells/ mm³, glucose 46 mg/dL, protein 82 mg/dL. Blood PCR was negative for Brucella. Immunophenotyping of the CSF and PET-CT excluded neoplasia. Brain biopsy was inconclusive for vasculitis. Metagenomic analysis of the CSF detected 78% of Brucella genetic material. Serum agglutination test was 1:40 for brucella. Conclusions PACNS is diagnosed by exclusion. The patient filled criteria for possible PACNS, image compatible with vascular stenosis, but inconclusive brain biopsy. Brucellosis is an endemic disease in underdeveloped countries that can present as CNS vasculitis. Metagenomic analysis allows the detection of different pathogens using a single method. The case illustrates the use of metagenomics in rare diseases characterized by vasculitis, with change in clinical outcomes and conduct.

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