Characteristics and biomarkers of patients with central nervous system infection admitted to a referral hospital in Northern Vietnam

Abstract Background Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries; therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis. Methods We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014. All patients who were ≥ 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein ≥40 mg/dL) were included in the study. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA). Results Total number of patients admitted to the department was 7506; among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis); median age was 45 (IQR 31–58), 62.6% were male, and 60.9% were tested for HIV infection. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture; an etiology was identified in 27.5% (n=112). S. suis (8.8%), N. meningitis (3.2%), and S. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. M. tuberculosis was found in 3.2%. Mixed pathogens were detected in 1.8% of the CSF samples. Rural residence (aOR 4.1, 95% CI 1.2–14.4) and raised CSF ADA (≥10 IU/L) (aOR 25.5, 95% CI 3.1–212) were associated with bacterial meningitis when compared with viral meningitis; similarly, raised CSF ADA (≥10 IU/L) (aOR 42.2, 95% CI 2.0–882) was associated with tubercular meningitis. Conclusions Addition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Raised CSF ADA (≥10 IU/L) was strongly associated with bacterial and tubercular meningitis. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods.

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Neonatal Ureaplasma parvum meningitis complicated with subdural hematoma: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-021-05968-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Canyang Zhan ◽

Lihua Chen ◽

Lingling Hu

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Subdural Hematoma ◽

Central Nervous System Infection ◽

Neonatal Meningitis ◽

High Morbidity ◽

Ureaplasma Parvum ◽

Protein Levels ◽

Csf Analysis ◽

Empirical Antibiotics

Abstract Background Neonatal meningitis is a severe infectious disease of the central nervous system with high morbidity and mortality. Ureaplasma parvum is extremely rare in neonatal central nervous system infection. Case presentation We herein report a case of U. parvum meningitis in a full-term neonate who presented with fever and seizure complicated with subdural hematoma. After hematoma evacuation, the seizure disappeared, though the fever remained. Cerebrospinal fluid (CSF) analysis showed inflammation with CSF pleocytosis (1135–1319 leukocytes/μl, mainly lymphocytes), elevated CSF protein levels (1.36–2.259 g/l) and decreased CSF glucose (0.45–1.21 mmol/l). However, no bacterial or viral pathogens in either CSF or blood were detected by routine culture or serology. Additionally, PCR for enteroviruses and herpes simplex virus was negative. Furthermore, the CSF findings did not improve with empirical antibiotics, and the baby experienced repeated fever. Thus, we performed metagenomic next-generation sequencing (mNGS) to identify the etiology of the infection. U. parvum was identified by mNGS in CSF samples and confirmed by culture incubation on mycoplasma identification medium. The patient’s condition improved after treatment with erythromycin for approximately 5 weeks. Conclusions Considering the difficulty of etiological diagnosis in neonatal U. parvum meningitis, mNGS might offer a new strategy for diagnosing neurological infections.

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045 Primary cutibacterium acnes central nervous system infection causing focal seizures: an unusual presentation of a rare disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.40 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A15.2-A15

Author(s):

Sophie E Waller ◽

Sarah Browning ◽

Elizabeth Pepper

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Infection ◽

Cns Infection ◽

Delayed Presentation ◽

Pathogenic Potential ◽

Focal Seizures ◽

Device Infection ◽

Cutibacterium Acnes ◽

Neurosurgical Intervention

IntroductionCutibacterium acnes is a Gram positive, anaerobic bacterium of low pathogenic potential that forms part of the normal cutaneous flora. Although most often identified as a contaminant in culture of microbiological specimens, it is commonly implicated in both postoperative wound and implantable device infection. Neurosurgical device infections secondary to C. acnes are well recognised and are likely secondary to bacterial contamination from the skin during surgery. Indolent infection characterised by delayed presentation of weeks to months following intervention is common. C. acnes infection involving the central nervous system (CNS) in the absence of previous neurosurgical intervention is rare, but has been described following dental or mastoid infections and following facial trauma. A further case series has reported de novo C. acnes CNS infection occurring in the absence of these recognised risk factors, but with clinical features of meningitis being common to all.Methods and resultsWe describe a unique case of primary C. acnes extra-dural collection in a previously well patient with no neurosurgical history presenting with sub-acute focal seizures and progressive focal leptomeningeal thickening on MRI.ConclusionC. acnes CNS infection can occur in the immunocompetent and in the absence of neurosurgical intervention.

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Partial Status Epilepticus with Paradoxical Protein-Cytologic Dissociation in Cerebrospinal Fluid

International Journal of Epilepsy ◽

10.1055/s-0040-1716432 ◽

2020 ◽

Author(s):

Neeraj Singh ◽

John J. Lansing ◽

Aparna Polavarapu

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Status Epilepticus ◽

Central Nervous System Infection ◽

Case Series ◽

Refractory Status Epilepticus ◽

Multiple Drug ◽

High Morbidity ◽

Drug Interventions

AbstractStatus epilepticus is associated with high morbidity and mortality, often requiring multiple drug interventions and intensive care monitoring. Etiology of status epilepticus plays a crucial role in the treatment, natural course and outcome of the patient, prompting extensive testing and imaging. For example, an important risk for status epilepticus in adults and children is the presence of an underlying viral or bacterial central nervous system infection, appropriate treatment of which can improve the outcome of the patient. We present three cases of new-onset refractory status epilepticus in women who did not have evidence of a central nervous system infection and had significantly elevated leukocytes compared to protein in the cerebrospinal fluid. This finding suggests an autoimmune etiology; however, standard autoimmune testing was unremarkable in all cases. This case series highlights the variability in presentation and clinical course in patients presenting with status epilepticus of unknown cause, and we discuss the importance of further research into appropriate and reliable diagnostic evaluations.

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1417. Detection of Human Herpesviruses DNA in Cerebrospinal Fluids of Patients Suspected with Central Nervous System Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1281 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S516-S516

Author(s):

Yuki Higashimoto ◽

Soichiro Ishimaru ◽

Hiroki Miura ◽

Kei Kozawa ◽

Masaru Ihira ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brain Mri ◽

Central Nervous System Infection ◽

Clinical Manifestations ◽

Rflp Analysis ◽

Cns Infection ◽

Characteristic Change ◽

Human Herpesviruses ◽

Hsv 1

Abstract Background Of the nine human herpesviruses (HHVs), most viruses have neurovirulence. Clinical manifestations of central nervous system (CNS) complications caused by some of the HHVs are well examined in children and immunocompromised adults; however, information of EBV and β-herpesviruses in an immunocompetent adult is limited. Methods Between April 2013 and March 2018, 322 patients (median age; 51.6 years old, male/female; 196/126) suspected to CNS infection were enrolled in this study. Patients with unconsciousness or characteristic change lasting more than 24 hours and abnormal brain MRI or EEG were defined as encephalitis. Real-time PCRs for detection of the 7 HHVs DNA including HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-7 were carried out in DNA extracted from 200 μL CSF. HHV-6 was discriminated between HHV-6A and HHV-6B using RFLP analysis. Results Herpesviruses DNA was detected in 33 (10.2%) of the 322 patients. The most frequently detected HHVs was VZV (19 cases) and followed by HHV-6B (4 cases), HSV-1 (3 cases), HSV-2 (3 cases), and EBV (2 cases). Multiple HHVs DNAs were detected from the 2 patients (case A; HSV-2, HHV-6, and EBV, case B; EBV and HHV-6B). No CMV and HHV-7 DNAs were detected in any of the samples. Eleven cases were assigned as encephalitis, and other 22 cases were non-encephalitis. Although all 3 patients with positive HSV-1 DNA were encephalitis, all 3 patients with positive HSV-2 DNA were meningitis. Fourteen (13 patients had zoster) of the 19 patients with positive VZV DNA were meningitis, and the remaining 5 patients (4 patients had zoster) were encephalitis. Two of the 4 HHV-6B-positive patients were non-encephalitis, one patient was diagnosed Orbital apex syndrome and another patient was myelitis. One of the 2 encephalitis patient was chromosomally integrated (ci) HHV-6. Additionally, case B was also ciHHV-6. Conclusion Approximately 10% of the samples were positive of HHVs DNA. VZV was the most frequently detected viral DNA in this cohort. Thirty-three percent of the patients were encephalitis, remaining patients were non-encephalitis such as meningitis and myelitis. As suggested, ciHHV-6 can cause miss-diagnosis of patients suspected with CNS infection. Disclosures All authors: No reported disclosures.

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Anidulafungin Treatment of Candidal Central Nervous System Infection in a Murine Model

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00646-09 ◽

2009 ◽

Vol 53 (8) ◽

pp. 3576-3578 ◽

Cited By ~ 13

Author(s):

Cheol-In Kang ◽

Mark S. Rouse ◽

Jayawant N. Mandrekar ◽

James M. Steckelberg ◽

Robin Patel

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Candida Albicans ◽

Brain Tissue ◽

Amphotericin B ◽

Murine Model ◽

Potential Role ◽

Central Nervous System Infection ◽

Cns Infection ◽

Fungal Burden

ABSTRACT We established a murine model of Candida albicans central nervous system (CNS) infection and evaluated the efficacy of anidulafungin. Ten milligrams/kg/day anidulafungin, amphotericin B, or voriconazole significantly reduced mortality and fungal burden in brain tissue, although amphotericin B and 10 mg/kg/day anidulafungin reduced fungal burden in brain tissue to a greater extent than did voriconazole. This suggests a potential role for anidulafungin in the treatment of candidal CNS infection.

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Central Nervous System Infection in Patients with Postirradiated Nasopharyngeal Carcinoma: A Case-Controlled Study

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3336 ◽

2009 ◽

Vol 23 (4) ◽

pp. 417-421 ◽

Cited By ~ 8

Author(s):

Kai-Li Liang ◽

Rong-San Jiang ◽

Jin-Ching Lin ◽

Yu-Jung Chiu ◽

Jiun-Yih Shiao ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Nasopharyngeal Carcinoma ◽

Skull Base ◽

Sinus Thrombosis ◽

Central Nervous System Infection ◽

Controlled Study ◽

Cns Infection ◽

Control Group ◽

Significant Difference

Background It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection. Objective The purpose of this study was to better understand this clinical entity. Methods From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated. Results The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001). Conclusions Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.

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Significance of Radio-Pathological Correlations: Differentiating Severe Central Nervous System Infection from Acute Embolic Infarction

The Neuroradiology Journal ◽

10.1177/197140090802100612 ◽

2008 ◽

Vol 21 (6) ◽

pp. 824-829

Author(s):

A.M. Tokumaru ◽

T. Hasebe ◽

H. Terada ◽

Y. Saito ◽

K. Kanemaru ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Mr Imaging ◽

Central Nervous System Infection ◽

Cns Infection ◽

Imaging Studies ◽

Septic Emboli

We describe two educational autopsy cases of severe central nervous system (CNS) infection and septic emboli, such cases having been difficult to differentiate from acute infarctions via emergency MR imaging studies. We briefly discuss the pathology and MR findings along with radiopathological correlation.

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Reactivity and Increased Proliferation of NG2 Cells Following Central Nervous System Infection With Theiler’s Murine Encephalomyelitis Virus

10.21203/rs.3.rs-84477/v1 ◽

2020 ◽

Author(s):

Laura A Bell ◽

Glenna J Wallis ◽

Karen S Wilcox

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Glial Cell ◽

Central Nervous System Infection ◽

Cns Infection ◽

Total Field ◽

Cell Reactivity ◽

Ki 67 ◽

Functional Connections ◽

Ng2 Cells

Abstract BackgroundNeuron-Glial Antigen 2 (NG2) cells are a glial cell type tiled throughout the grey and white matter of the Central Nervous System (CNS). NG2 cells are known for their ability to differentiate into oligodendrocytes and are commonly referred to as oligodendrocyte precursor cells. However, recent investigations have begun to identify additional functions of NG2 cells in CNS health and pathology. NG2 cells form physical and functional connections with neurons and other glial cell types throughout the CNS, allowing them to monitor and respond to the neural environment. Growing evidence indicates that NG2 cells become reactive under pathological conditions, though their specific roles are only beginning to be elucidated. While reactive microglia and astrocytes are well-established contributors to neuroinflammation and the development of epilepsy following CNS infection, the dynamics of NG2 cells remain unclear. Therefore, we investigated NG2 cell reactivity in a viral-induced mouse model of temporal lobe epilepsy. MethodsC57BL6/J mice were injected intracortically with Theiler’s Murine Encephalomyelitis 36 Virus (TMEV) or PBS. Mice were graded twice daily for seizures between 3–7 days post-injection (dpi). At 4 and 14 dpi, brains were fixed and stained for NG2, the microglia/macrophage marker IBA1, and the proliferation marker Ki-67. Confocal z-stacks were acquired in both the hippocampus and the overlying cortex. Total field areas stained by each cell marker and total field area of colocalized pixels between NG2 and Ki67 were compared between groups. ResultsBoth NG2 cells and microglia/macrophages displayed increased immunoreactivity and reactive morphologies in the hippocampus of TMEV-injected mice. While increased immunoreactivity for IBA1 was also present in the cortex, there was no significant change in NG2 immunoreactivity in the cortex following TMEV-infection. Colocalization analysis for NG2 and Ki-67 revealed a significant increase in overlap between NG2 and Ki-67 in the hippocampus of TMEV-injected mice at both timepoints, but no significant differences in cortex.ConclusionsNG2 cells acquire a reactive phenotype and proliferate in response to TMEV-infection. These results suggest that NG2 cells alter their function in response to viral encephalopathy, making them potential targets to prevent the development of epilepsy following viral infection.

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Central Nervous System Infections

10.2310/em.4706 ◽

2016 ◽

Author(s):

Nicholas J. Johnson ◽

David F. Gaieski

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Bacterial Meningitis ◽

Lumbar Puncture ◽

Clinical Manifestations ◽

Empirical Therapy ◽

Cns Infection ◽

Cns Infections ◽

Associated Conditions

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections. This review contains 8 highly rendered figures, 7 tables, and 94 references

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Nghiên cứu đặc điểm lâm sàng và cận lâm sàng nhiễm trùng thần kinh trung ương ở trẻ em

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2021.73.2 ◽

2021 ◽

Author(s):

Vinh Phu Tran

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Infection ◽

Clinical Manifestations ◽

Inverse Correlation ◽

Altered Mental Status ◽

Cns Infection ◽

Common Disease ◽

Psychological Consequences ◽

Cns Infections

Đặt vấn đề: Nhiễm trùng thần kinh trung ương (NTTKTW) là bệnh lý thường gặp, để lại nhiều hậu quả về sức khỏe cũng như tâm lý nặng nề cho từng gia đình cũng như toàn xã hội. Bệnh có tỉ lệ tử vong cao, đặc biệt là trẻ em. Biểu hiện lâm sàng nhiễm trùng thần kinh trung ương ở trẻ em rất đa dạng và thay đổi theo lứa tuổi. Việc phát hiện triệu chứng nghi ngờ để chẩn đoán sớm có ý nghĩa quan trọng, góp phần cải thiện tiên lượng bệnh qua việc quyết định điều trị sớm. Đối tượng: 61 trường hợp bệnh nhi được chẩn đoán và điều trị NTTKTW tại Trung tâm Nhi khoa Bệnh viện Trung ương Huế. Phương pháp nghiên cứu: Mô tả cắt ngang. Kết quả: NTTKTW hay gặp nhất ở nhóm trẻ > 5 tuổi (chiếm 52,5%); Các triệu chứng cơ năng thường gặp là ăn, bú kém (62,8% VMN, 98,9% viêm não), đau đầu (34,9% VMN, 61,1% viêm não), nôn (48,8% VMN, 38,9% viêm não); Các dấu hiêu thực thể thường gặp là sốt (79,1% VMN, 73,3% viêm não), rối loạn tri giác (79% VMN, 22,7% viêm não), hội chứng tăng áp lực nội sọ (65,1% VMN, 72,2% viêm não), hội chứng kích thích màng não (36,6% VMN, 22,2% viêm não), co giật (14% VMN, 44,4% viêm não, p < 0,05). Có mối tương quan nghịch giữa sự biến đổi tri giác ban đầu của bệnh nhi (đánh giá bằng thang điểm glasgow) với tần số tim (r = -0,412), tần số thở (r = -0,33), thời gian nằm viện (r = -0,612) và số lượng tế bào trong dịch não tủy (VMNM r = -0,575); VMN tăng lympho r = -0,686, VN r = -0,804). Kết luận: Biểu hiện lâm sàng của các nhóm bệnh lý nhiễm trùng thần kinh khá đa dạng, biến đổi tri giác ban đầu bệnh nhi là yếu tố tiên lượng bệnh. Từ khóa: Lâm sàng, cận lâm sàng, nhiễm trùng thần kinh trung ương trẻ em. ABSTRACT CLINICAL AND SUBCLINICAL CHARACTERISTICS OF CENTRAL NERVOUS SYSTEM INFECTION IN CHILDREN Background: Central nervous system infection (CNS) is a common disease, leading to many serious health and psychological consequences for each family’s patient as well as the whole society. The disease has a high mortality rate, especially in children. Clinical manifestations of CNS infections in children are variable, depending on age.Detecting suspicious symptoms for early diagnosis is important, contributing to improving prognosis through early treatment decisions. Subjects: 61 cases of patients diagnosed and treated at Pediatrics Center in Hue Central Hospital. Methods: Prospective observational study. Results:It showed that CNS infections are most common in children > 5 years old (52.5%); Commonsymptoms were poor feeding (62.8% meningitis, 98.9% encephalitis), headache (34.9% meningitis, 61.1% encephalitis), vomiting (48.8% meningitis, 38.9% encephalitis); Commonsigns are fever (79.1% meningitis, 73.3% encephalitis), altered mental status (79% meningitis, 22.7% encephalitis), increased intracranial pressure syndrome (65.1% meningitis,72.2% encephalitis), convulsions (14% meningitis, 44.4% encephalitis, p < 0.05). There is an inverse correlation between the change in the patient’s initial consciousness (assessed by the glasgow scale) with heart rate (r = -0.412), respiratory rate (r = -0.33), duration of hospitalization(r = -0.612) and the number of cells in the cerebrospinal fluid. Conclusions: Clinical manifestations of CNS infection are variable, the initial change in the patient’s consciousness is a predictor of the disease. Key words: Clinical, subclinical, Central Nervous System Infections.

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