Eastern Equine Encephalitis: Case Series in Southern New England and Review of the Literature

2021 ◽  
pp. 10.1212/CPJ.0000000000001079
Author(s):  
Mayra Montalvo ◽  
Dana Ayoub ◽  
Michael McGary ◽  
Katrina Byrd ◽  
Leana Mahmoud ◽  
...  
Keyword(s):  
New England ◽  
Clinical Presentation ◽  
Case Series ◽  
Brain Dysfunction ◽  
Review Of The Literature ◽  
Eastern Equine Encephalitis ◽  
Southern New England ◽  
High Clinical Suspicion ◽  
The Us ◽  
Csf Pleocytosis

ABSTRACTPurposeof review: To describe the clinical presentation, diagnosis, management and outcomes of four confirmed Eastern Equine Encephalitis (EEE) cases and a review of the literatureRecent findings:There was a sharp rise in the number of EEE cases in the US in 2019, with 38 confirmed cases and 15 deaths. Our institution cared for 10% of patients with neuro-invasive EEE nationwide. These were the first cases seen locally since 2010.Summary:EEE virus causes one of the most lethal types of arboviral encephalitis in the US with a mortality of 30-40%. Manifestations of EEE infections can range from mild encephalopathy to coma. Common findings include CSF pleocytosis and involvement of the basal ganglia on MRI. Given the rarity of this disease and nonspecific findings, diagnosis can be challenging and a high clinical suspicion is important. Management is mainly supportive and the use of IVIg remains controversial. Two of our four patients died; these patients had coma within 48 hours, hyponatremia, involvement of bilateral thalami and brainstem, status epilepticus, and severe brain dysfunction in EEG.

scholarly journals Intraventricular neurocysticercosis: 18 consecutive patients and review of the literature

2002 ◽  
Vol 12 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Albert C. Cuetter ◽  
Russell J. Andrews
Keyword(s):  
Clinical Presentation ◽  
Case Series ◽  
Surgical Removal ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Fatal Disease ◽  
Effective Manner ◽  
Noncommunicating Hydrocephalus ◽  
The Brain ◽  
Prompt Diagnosis

Object The prognosis for intraventricular neurocysticercosis (IVNCC) is poorer than that for parenchymal NCC, making prompt diagnosis and treatment especially important. Although active, viable intraventricular cysts produce no reaction in the host; they can cause noncommunicating hydrocephalus, the onset of which is frequently abrupt. With the death of the larva comes a local granulomatous ependymitis, generalized ventriculitis, and meningoencephalitis. The authors report on 18 patients with IVNCC (accrued from a larger case series of 62 patients with NCC treated over an 11-year period), detailing clinical presentation, neuroimaging findings, treatment, and outcome. Methods All patients presented with hydrocephalus and/or meningitis. The most valuable diagnostic tests were magnetic resonance imaging of the brain and EITB of serum and/or cerebrospinal fluid. Treatment included albenda-zole and steroid therapy in all cases, and when necessary in cases requiring urgent or emergency ventriculostomy and/or surgical removal of the obstructing cyst (followed by shunt placement if indicated). Conclusions An extensive review of the literature on IVNCC has been prepared, with the goal of providing the reader with the information necessary to diagnose and treat this complex and potentially fatal disease in a timely and effective manner.

Lyme-associated uveitis: Clinical spectrum and review of literature

2019 ◽  
Vol 30 (5) ◽  
pp. 874-885 ◽  
Author(s):  
Alexia Bernard ◽  
Pascal Seve ◽  
Amro Abukhashabh ◽  
Chantal Roure-Sobas ◽  
Andre Boibieux ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Retinal Vasculitis ◽  
Case Series ◽  
Posterior Uveitis ◽  
Posterior Segment ◽  
University Hospital ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Autoimmune Reaction ◽  
Risk Of Exposure

Background: Clinical presentation of Lyme-associated uveitis is poorly described. We reported here a case series of seven patients with uveitis related to Lyme disease and a review of the literature. Methods: A retrospective study in our university hospital between 1 May 2003 and 31 July 2016 on 1006 uveitis patients and review of Pubmed library. Results: Seven patients (71.4% male, mean age = 53 (38–70)) were diagnosed with a Lyme-associated uveitis. All anatomical types of uveitis were found (four intermediate, three anterior, and three posterior uveitis); most were unilateral (n = 6; 85.7%), one granulomatous and two with synechiae. Peripheral retinal vasculitis was present in four patients. They all had a risk of exposure or extra-ophthalmological symptoms. Antibiotic and steroid treatment was rapidly effective in all patients. Four patients presented recurrences of uveitis, of whom two received a second antibiotic treatment, which is quite common in literature. Persistent or recurrence of symptoms can be explained by three hypotheses: (1) reinfection, (2) relapse of original infection, and (3) autoimmune reaction. Conclusion: Lyme-associated uveitis appears varied. Hyalitis and involvement of the posterior segment and retinal vasculitis seem to be rather frequent. Its prognosis is mainly good, even if inflammation can be resistant or recurring.

Silicone breast implantation-induced scleroderma: description of four patients and a critical review of the literature

Lupus ◽  
2009 ◽  
Vol 18 (13) ◽  
pp. 1226-1232 ◽  
Author(s):  
Y. Levy ◽  
P. Rotman-Pikielny ◽  
M. Ehrenfeld ◽  
Y. Shoenfeld
Keyword(s):  
Autoimmune Diseases ◽  
Critical Review ◽  
Case Reports ◽  
Breast Implant ◽  
Case Series ◽  
Breast Implants ◽  
Review Of The Literature ◽  
The Us ◽  
Breast Implantation ◽  
Silicone Breast Implantation

Since the early 1980s, case reports and case series describe an association between silicon breast implants and the appearance of autoimmune diseases, particularly scleroderma. The publication of those cases led to a large number of studies to investigate this association. The conclusion of those studies is that most probably there has not been an increased incidence of autoimmune diseases in women with silicon breast implants. Nevertheless, the US Food and Drug Administration determined that silicone gel breast implants are not completely safe, only that they are ‘reasonably safe.’ The debate continues regarding this association. In this article we present new cases of silicon breast implant-induced scleroderma and review the literature on this subject. Lupus (2009) 18, 1226—1232.

scholarly journals P.081 Penetrating brain injury, recent case series of a single institution and literature review

2016 ◽  
Vol 43 (S2) ◽  
pp. S39-S39
Author(s):  
P Lavergne ◽  
M D’Astous ◽  
H Khuong
Keyword(s):  
Brain Injury ◽  
Clinical Presentation ◽  
Case Series ◽  
Review Of The Literature ◽  
Single Institution ◽  
Rare Injury ◽  
Penetrating Brain Injury ◽  
Radiological Data ◽  
Work Up ◽  
Nail Gun Injury

Background: Penetrating brain injury is a rare entity. Furthermore, clinical presentation can be highly variable and management difficult, especially when the foreign body is retain in the skull Methods: We present a serie of three recent cases of penetrating brain injury that happened at our institutionm including clinical and radiological data. We discuss management of those challenging cases and present a brief review of the literature. Results: Our cases (3) encompassed different mechanisms: bilateral nail gun injury, knife and aircraft propeller. All patients were male, with a median age of 37 years old. Work-up was negative for intracranial vascular injury. All patients were treated with initial craniectomy (bilateral in one case) and a course of antibiotics. Cranioplasty was later performed. All patients survived and evolved in favorable fashion. Conclusions: Penetrating brain injury is a rare injury, requiring individualized surgical and medical management. A few recommendations may be found in the literature but are often based on literature from blunt traumatic brain injury or war-related injuries.

scholarly journals Emerging Cases of Powassan Virus Encephalitis in New England: Clinical Presentation, Imaging, and Review of the Literature

2015 ◽  
Vol 62 (6) ◽  
pp. 707-713 ◽  
Author(s):  
Anne Piantadosi ◽  
Daniel B. Rubin ◽  
Daniel P. McQuillen ◽  
Liangge Hsu ◽  
Philip A. Lederer ◽  
...  
Keyword(s):  
New England ◽  
Clinical Presentation ◽  
Review Of The Literature ◽  
Virus Encephalitis ◽  
Powassan Virus

scholarly journals Lucio’s phenomenon: A report of two cases and review of the literature

2019 ◽  
Vol 6 (2) ◽  
pp. 15 ◽  
Author(s):  
Gustavo Alexis Lemus-Barrios ◽  
Julian Andrés Hoyos-Pulgarín ◽  
Carlos Eduardo Jimenez-Canizales ◽  
Diana Melisa Hidalgo-Zambrano ◽  
Fredy Escobar-Montealegre ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Mycobacterium Leprae ◽  
Clinical Suspicion ◽  
World Health ◽  
Necrotizing Vasculitis ◽  
Review Of The Literature ◽  
Peripheral Nerve Damage ◽  
High Clinical Suspicion ◽  
Health Organization ◽  
Lucio’S Phenomenon

Introduction: Leprosy is a chronic, multisystemic granulomatous infection caused by Mycobacterium leprae. Lucio’s phenomenon is an uncommon reaction consisting of a severe chronic necrotizing vasculitis. The purpose of this article is to present two cases of Lucio’s phenomenon and a review of the literature on its clinical presentation and management.Case Presentation: Two middle-aged men presented with ulcers and ecchymosis in lower extremities, with simultaneous peripheral nerve damage and leonine facies. Both were treated according to World Health Organization recommendations, with a favorable clinical response.Discussion: The clinical characteristics presented in this article make part of the classical description. A proper history and physical examination allowed for a correct diagnostic approach and prompt confirmation of diagnosis, despite the unspecific nature of these signs and symptoms.Conclusions: Leprosy and Lucio’s phenomenon are infrequent conditions that are difficult to diagnose. We suspect this condition to be under-registered. Awareness and a high clinical suspicion are necessary in endemic regions.

scholarly journals Clinical Presentation of COVID-19: Case Series and Review of the Literature

2020 ◽  
Vol 17 (14) ◽  
pp. 5062 ◽  
Author(s):  
Margherita Macera ◽  
Giulia De Angelis ◽  
Caterina Sagnelli ◽  
Nicola Coppola ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Clinical Presentation ◽  
Clinical Laboratory ◽  
Case Series ◽  
Pulmonary Involvement ◽  
Laboratory Monitoring ◽  
Review Of The Literature ◽  
Asymptomatic Patients ◽  
At Home

COVID-19 infection has a broad spectrum of severity ranging from an asymptomatic form to a severe acute respiratory syndrome that requires mechanical ventilation. Starting with the description of our case series, we evaluated the clinical presentation and evolution of COVID-19. This article is addressed particularly to physicians caring for patients with COVID-19 in their clinical practice. The intent is to identify the subjects in whom the infection is most likely to evolve and the best methods of management in the early phase of infection to determine which patients should be hospitalized and which could be monitored at home. Asymptomatic patients should be followed to evaluate the appearance of symptoms. Patients with mild symptoms lasting more than a week, and without evidence of pneumonia, can be managed at home. Patients with evidence of pulmonary involvement, especially in patients over 60 years of age, and/or with a comorbidity, and/or with the presence of severe extrapulmonary manifestations, should be admitted to a hospital for careful clinical-laboratory monitoring.

scholarly journals Clinical presentation and management strategies for yolk sac tumor. A case series and review of the literature

2020 ◽  
Author(s):  
Caiyun Nie ◽  
Huifang Lv ◽  
Yishu Xing ◽  
Tao Song ◽  
Wen Feng ◽  
...  
Keyword(s):  
Germ Cell ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Case Series ◽  
Yolk Sac ◽  
Yolk Sac Tumor ◽  
Optimal Management ◽  
Review Of The Literature ◽  
Study Population ◽  
Sinus Tumor

Abstract Background: Yolk sac tumor (YST), also known as endodermal sinus tumor, is a highly malignant germ cell-derived tumor. As a rare disease, the diagnosis, prognostic factors, and optimal management of yolk sac tumor are difficult. The present study aims to investigate the clinicopathological features and optimal management strategies of yolk sac tumor. Results: We retrospectively investigated seventeen patients with yolk sac tumor in our institute between January 2010 to December 2019. The median age of the study population was 24 years (range 6–50 years). Most cases were female (11/17, 64.7%). Among the seventeen cases of YSTs, 8 cases were ovarian YSTs, 3 cases were mediastinum YSTs, 2 cases were testis YSTs. 94.1% patients had a markedly raised AFP. Surgery and chemotherapy were the main treatment methods for YST and improved the prognosis of patients. Conclusions: YST is a highly malignant and rare germ cell tumor, ovarian YST is the most common type. Early diagnosis and reasonable treatment can improve the prognosis of YST. These cases highlight the tumor’s characteristics. As more experience is gathered with this rare malignant tumor, the more likely we are to cure this disease.

Babesiosis: An Underdiagnosed Disease of Children

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1045-1048 ◽  
Author(s):  
Peter J. Krause ◽  
Sam R. Telford ◽  
Richard J. Pollack ◽  
Raymond Ryan ◽  
Peter Brassard ◽  
...  
Keyword(s):  
New York ◽  
Lyme Disease ◽  
New England ◽  
Clinical Presentation ◽  
Age Groups ◽  
Immunofluorescence Assay ◽  
Babesia Microti ◽  
Enzyme Linked Immunosorbent Assay ◽  
Southern New England ◽  
Adults And Children

Babesiosis is a malaria-like illness caused by the intraerythrocytic parasite Babesia microti and is transmitted by the same tick that transmits Borrelia burgdorferi, the causative agent of Lyme disease. Babesiosis is well recognized in adult residents of southern New England and New York but has been described in only five children. To determine whether children are infected with B microti less often than are adults, a prospective serosurvey was carried out on Block Island, RI, where babesiosis is endemic. Randomly recruited subjects completed a questionnaire and provided a blood sample. Antibodies against B microti and B burgdorferi were measured using a standard indirect immunofluorescence assay and enzyme-linked immunosorbent assay, respectively. Of 574 subjects, 9% tested positive for B microti, including 12% of the 52 children (7 months through 16 years) and 8% of the 522 adults (not significant, P < .6). Although babesiosis had not been diagnosed in any of the Babesia-seropositive subjects, 25% of the children and 20% of the adults reported symptoms compatible with this infection during the previous year. Of the 6 children and 45 adults seropositive for B burgdorferi, 17% and 14%, respectively, were also seropositive for B microti. It is concluded that children are infected with B microti no less frequently than are adults and that this infection is underdiagnosed in all age groups. Physicians who practice where Lyme disease is endemic should become familiar with the clinical presentation and diagnosis of babesiosis, both in adults and children.

scholarly journals Mesenteric panniculitis in Merseyside: a case series and a review of the literature

2010 ◽  
Vol 92 (6) ◽  
pp. e31-e34 ◽  
Author(s):  
JA Nicholson ◽  
D Smith ◽  
M Diab ◽  
MH Scott
Keyword(s):  
World Wide ◽  
Case Series ◽  
Mesenteric Panniculitis ◽  
Review Of The Literature ◽  
Palpable Mass ◽  
Abdominal Symptoms ◽  
The Us ◽  
The World ◽  
The Uk ◽  
Rare Diagnosis

Mesenteric panniculitis (also known as mesenteric manifestation of Weber–Christian disease, isolated lipodystrophy and mesenteric lipogranuloma), a benign inflammatory or fibrotic change in the mesentery of the bowel, is a rare diagnosis, particularly in the UK. Some 213 cases have been reported in the world-wide literature, just six from the UK. We present four cases of mesenteric panniculitis in Merseyside and review the literature surrounding this poorly understood phenomenon. Four patients who attended surgical out-patients with vague abdominal symptoms, and in two cases a palpable mass, were sent for abdominal computed tomography (CT) scan. One patient was admitted as an emergency with abdominal pain. In each patient there were clear signs of mesenteric panniculitis, first described in 1924. The ’classical’ signs of mesenteric panniculitis seen on CT have been argued by some to be pathognemonic of the disease. In two cases, the patients underwent laparoscopic biopsies to confirm the diagnosis. We discuss the literature relating to mesenteric panniculitis, theories about its aetiology, confirmation of the diagnosis and consider the possibility that it is not actually as rare as we think. We suggest that it is rather under diagnosed due to the relative ignorance of the condition amongst both surgeons and radiologists the UK compared to the US, where mesenteric panniculitis is far more widely reported.

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