Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.

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Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

Journal of Neurosurgery ◽

10.3171/2017.10.jns17359 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1107-1126 ◽

Cited By ~ 6

Author(s):

Faith C. Robertson ◽

Jacob R. Lepard ◽

Rania A. Mekary ◽

Matthew C. Davis ◽

Ismaeel Yunusa ◽

...

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

Infectious Diseases ◽

Low Income ◽

Meta Analysis ◽

Case Fatality ◽

Low Income Countries ◽

Cns Infection ◽

Cns Infections

OBJECTIVECentral nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity.METHODSA systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types.RESULTSThe search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease.CONCLUSIONSThis systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.

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Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis

Sensors ◽

10.3390/s21062065 ◽

2021 ◽

Vol 21 (6) ◽

pp. 2065

Author(s):

Irene Cortés-Pérez ◽

Noelia Zagalaz-Anula ◽

Desirée Montoro-Cárdenas ◽

Rafael Lomas-Vega ◽

Esteban Obrero-Gaitán ◽

...

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

Motor Function ◽

Video Game ◽

Meta Analysis ◽

Leap Motion ◽

Motion Controller ◽

Motor Dexterity ◽

Quality Evidence

Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson’s disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.

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Pre and Probiotics Involved in the Modulation of Oral Bacterial Species: New Therapeutic Leads in Mental Disorders?

Microorganisms ◽

10.3390/microorganisms9071450 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1450

Author(s):

Yoann Maitre ◽

Rachid Mahalli ◽

Pierre Micheneau ◽

Alexis Delpierre ◽

Marie Guerin ◽

...

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

Oral Health ◽

Mental Disorders ◽

Meta Analysis ◽

Bacterial Species ◽

Oral Microbiome ◽

Oral Microbiota ◽

Therapeutic Leads

This systematic review aims to identify probiotics and prebiotics for modulating oral bacterial species associated with mental disorders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline, we search the electronic MEDLINE database published till January 2021 to identify the studies on probiotics and/or prebiotics for preventing and treating major oral dysbiosis that provokes mental disorders. The outcome of the search produces 374 records. After excluding non-relevant studies, 38 papers were included in the present review. While many studies suggest the potential effects of the oral microbiota on the biochemical signalling events between the oral microbiota and central nervous system, our review highlights the limited development concerning the use of prebiotics and/or probiotics in modulating oral dysbiosis potentially involved in the development of mental disorders. However, the collected studies confirm prebiotics and/or probiotics interest for a global or targeted modulation of the oral microbiome in preventing or treating mental disorders. These outcomes also offer exciting prospects for improving the oral health of people with mental disorders in the future.

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Systematic Review and Meta-Analysis: Do Clinical Trials Testing Antimuscarinic Agents for Overactive Bladder Adequately Measure Central Nervous System Adverse Events?

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2011.03473.x ◽

2011 ◽

Vol 59 (7) ◽

pp. 1332-1339 ◽

Cited By ~ 41

Author(s):

Amélie Paquette ◽

Pauline Gou ◽

Cara Tannenbaum

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Clinical Trials ◽

Nervous System ◽

Overactive Bladder ◽

Adverse Events ◽

Meta Analysis ◽

Antimuscarinic Agents

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab104 ◽

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.

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