scholarly journals Coinfection withCryptococcus GattiiandMycobacterium Tuberculosisin an Otherwise Healthy 18-Year-Old Woman

2011 ◽  
Vol 18 (4) ◽  
pp. e62-e63 ◽  
Author(s):  
Lindsay Van Tongeren ◽  
Tawimas Shaipanich ◽  
John A Fleetham
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Immune System ◽  
Medical History ◽  
Healthy Individual ◽  
Host Immune System ◽  
Healthy Young Woman ◽  
History Of

A case ofCryptococcus gattii(pulmonary and central nervous system) andMycobacterium tuberculosis(pulmonary) coinfection in an otherwise healthy young woman is reported. The patient presented with a two-month history of dry cough. She had an unremarkable medical history. Both tuberculosis and cryptococcosis were diagnosed following bronchoscopy, and a subsequent lumbar puncture revealedC gattiiin the cerebrospinal fluid. There is evidence that bothM tuberculosisandC gattiimay have suppressive effects on the host immune system. This suggests a mechanism by which an otherwise healthy individual developed these two infections.

scholarly journals Fatal central nervous system co-infection with SARS-CoV-2 and tuberculosis in a healthy child

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bishara J. Freij ◽  
Bassam M. Gebara ◽  
Rabail Tariq ◽  
Ay-Ming Wang ◽  
John Gibson ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Infection ◽  
Local Health ◽  
Imaging Findings ◽  
Brain Herniation ◽  
Radiographic Findings ◽  
Cerebellar Tissue

Abstract Background Central and peripheral nervous system symptoms and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens. Case presentation A five-year-old girl with fever and headache was diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis complex DNA was detected by PCR. Ventricular cerebrospinal fluid that day was negative for mycobacterial DNA. Tracheal aspirate samples for mycobacterial DNA and culture from days 22 and 27 of illness were negative by PCR but grew Mycobacterium tuberculosis after 8 weeks, long after the child’s passing. She had no known exposures to tuberculosis and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread. Conclusion The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection. However, the cause of death was brain herniation from her rapidly progressive central nervous system tuberculosis. SARS-CoV-2 may mask or worsen occult tuberculous infection with severe or fatal consequences.

scholarly journals Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs

2020 ◽  
Author(s):  
Gisela Vasconcelos ◽  
Ligia Santos ◽  
Catarina Couto ◽  
Margarida Cruz ◽  
Alice Castro
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Infectious Diseases ◽  
Miliary Tuberculosis ◽  
Central Nervous System Involvement ◽  
Total Recovery ◽  
Prompt Diagnosis ◽  
Timely Treatment

Tuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected.

scholarly journals Utility of Flow Cytometry of Cerebrospinal Fluid as a Screening Tool in the Diagnosis of Central Nervous System Lymphoma

2013 ◽  
Vol 137 (11) ◽  
pp. 1610-1618 ◽  
Author(s):  
Meredith Pittman ◽  
Susan Treese ◽  
Ling Chen ◽  
John L. Frater ◽  
TuDung T. Nguyen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Flow Cytometry ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Predictive Value ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Predictive Values ◽  
History Of

Context.—Experiences at our institution show that flow cytometry analysis (FCA) has become routine clinical practice in the workup of patients with altered mental status, even if risk factors are low. Objective.—To assess diagnostic accuracy of combined FCA and cytology in the diagnosis of central nervous system lymphoma in an unselected patient population with neurologic symptoms, including patients with no history of lymphoma or suspicious radiology. Design.—Between 2001 and 2011, cerebrospinal fluid was submitted from 373 patients for lymphoma screening by FCA. The medical records were reviewed for patient symptomatology, history of malignancy, brain imaging, FCA results, cytology results, brain biopsy, and clinical follow-up. Results.—A lymphoid malignancy was detected by FCA in 4% of cases. A positive diagnosis was more likely in patients with either a history of hematologic malignancy and/or a suspicious radiology result (P = .009). All patients with no history of lymphoma and no suspicious radiology (n = 102) had negative cytology, and none had a correspondingly positive FCA result. The positive and negative predictive values of combined cytology and FCA in the patients with history of lymphoma and/or abnormal imaging results were 92% and 89%, respectively, when compared with open brain tissue biopsy, and 89% and 86%, respectively, when compared with clinical follow-up. When low-risk patients were included, the positive predictive value remained at 92%, but the negative predictive value dropped to 52% with the open brain biopsy as the reference, and values did not change significantly for the group with clinical follow-up. Conclusions.—Concurrent FCA and cytology are most useful in the appropriate clinical setting, and we propose a triage algorithm for how FCA on cerebrospinal fluid is best used.

scholarly journals Introduction of a Patient with Neurobrucellosis with Clinical Manifestations of Vertigo and Nausea-Vomiting

2021 ◽  
Author(s):  
Maryam Dehghan ◽  
Zohre Akhondimeibody
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mental Disorders ◽  
Clinical Response ◽  
Brain Abscess ◽  
Clinical Manifestations ◽  
Response To Treatment ◽  
Routine Treatment ◽  
History Of

Introduction: Brucellosis is a common zoonotic disease. The clinical manifestations of this infection are different due to the involvement of different body systems. These include central nervous system (neurobrucellosis), which presents as meningitis, meningoencephalitis, cognitive-mental disorders and brain abscess. Our patient was a 59-year-old woman who presented with fever, nausea, vomiting, and dizziness 2 weeks prior to admission. A cerebrospinal fluid that was positive for brucellosis was diagnosed.The patient was treated with drugs effective in neuroblastosis and had an appropriate clinical response to treatment. Consider neurobrucellosis in endemic areas such as Iran in the patients with clinical manifestations of fever and vertigo who do not respond to routine treatment and other investigations, especially in a person with a history of exposure to brucellosis

scholarly journals Evaluation of the Mtb72F Polyprotein Vaccine in a Rabbit Model of Tuberculous Meningitis

2006 ◽  
Vol 74 (4) ◽  
pp. 2392-2401 ◽  
Author(s):  
Liana Tsenova ◽  
Ryhor Harbacheuski ◽  
Andre L. Moreira ◽  
Evette Ellison ◽  
Wilfried Dalemans ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Weight Loss ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Meningitis ◽  
Protective Efficacy ◽  
Rabbit Model ◽  
Cns Infection ◽  
The Brain

ABSTRACT Using a rabbit model of tuberculous meningitis, we evaluated the protective efficacy of vaccination with the recombinant polyprotein Mtb72F, which is formulated in two alternative adjuvants, AS02A and AS01B, and compared this to vaccination with Mycobacterium bovis bacillus Calmette-Guérin (BCG) alone or as a BCG prime/Mtb72F-boost regimen. Vaccination with Mtb72F formulated in AS02A (Mtb72F+AS02A) or Mtb72F formulated in AS01B (Mtb72F+AS01B) was protective against central nervous system (CNS) challenge with Mycobacterium tuberculosis H37Rv to an extent comparable to that of vaccination with BCG. Similar accelerated clearances of bacilli from the cerebrospinal fluid, reduced leukocytosis, and less pathology of the brain and lungs were noted. Weight loss of infected rabbits was less extensive for Mtb72F+AS02A-vaccinated rabbits. In addition, protection against M. tuberculosis H37Rv CNS infection afforded by BCG/Mtb72F in a prime-boost strategy was similar to that by BCG alone. Interestingly, Mtb72F+AS01B induced better protection against leukocytosis and weight loss, suggesting that the polyprotein in this adjuvant may boost immunity without exacerbating inflammation in previously BCG-vaccinated individuals.

CHAPTER 9: Immunology of TBEV-Infections

2020 ◽  
Keyword(s):  
Central Nervous System ◽  
T Cells ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Nk Cells ◽  
Peripheral Blood ◽  
Sample Collection ◽  
Tick Borne Encephalitis ◽  
Viral Infectious Disease ◽  
The Central Nervous System

Tick-borne encephalitis (TBE) is a viral infectious disease of the central nervous system caused by the tick-borne encephalitis virus (TBEV). TBE is usually a biphasic disease and in humans the virus can only be detected during the first (unspecific) phase of the disease. Pathogenesis of TBE is not well understood, but both direct viral effects and immune-mediated tissue damage of the central nervous system may contribute to the natural course of TBE. The effect of TBEV on the innate immune system has mainly been studied in vitro and in mouse models. Characterization of human immune responses to TBEV is primarily conducted in peripheral blood and cerebrospinal fluid, due to the inaccessibility of brain tissue for sample collection. Natural killer (NK) cells and T cells are activated during the second (meningo-encephalitic) phase of TBE. The potential involvement of other cell types has not been examined to date. Immune cells from peripheral blood, in particular neutrophils, T cells, B cells and NK cells, infiltrate into the cerebrospinal fluid of TBE patients.

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