scholarly journals Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam

2021 ◽  
Vol 6 ◽  
pp. 133
Author(s):  
Nguyen Hoang Thien Huong ◽  
Nguyen Duc Toan ◽  
Du Tuan Quy ◽  
Truong Huu Khanh ◽  
Le Quoc Thinh ◽  
...  
Keyword(s):  
Autoimmune Encephalitis ◽  
Indirect Costs ◽  
Vaccination Strategy ◽  
Altered Mental Status ◽  
Clinical Syndrome ◽  
Clinical Samples ◽  
Southern Vietnam ◽  
Causative Agents ◽  
Incidence Of Hospitalization ◽  
Study Participants

Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children’s hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.

scholarly journals Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam

2021 ◽  
Vol 6 ◽  
pp. 133
Author(s):  
Nguyen Hoang Thien Huong ◽  
Nguyen Duc Toan ◽  
Du Tuan Quy ◽  
Truong Huu Khanh ◽  
Le Quoc Thinh ◽  
...  
Keyword(s):  
Autoimmune Encephalitis ◽  
Indirect Costs ◽  
Vaccination Strategy ◽  
Altered Mental Status ◽  
Clinical Syndrome ◽  
Clinical Samples ◽  
Southern Vietnam ◽  
Causative Agents ◽  
Incidence Of Hospitalization ◽  
Study Participants

Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children’s hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.

scholarly journals Bidirectional Relationship Between Subjective Age and Frailty: Findings From the NHATS

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 271-271
Author(s):  
Yuxiao Li ◽  
Minhui Liu ◽  
Christina Miyawaki ◽  
Xiaocao Sun ◽  
Tianxue Hou ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Syndrome ◽  
Community Dwelling ◽  
Chronological Age ◽  
Subjective Age ◽  
Bidirectional Relationship ◽  
Study Participants ◽  
Community Dwelling Older Adults ◽  
The Relationship ◽  
Hispanic White

Abstract Frailty is a clinical syndrome that becomes increasingly common as people age. Subjective age refers to how young or old individuals experience themselves to be. It is associated with many risk factors of frailty, such as increased depression, worse cognitive function, and poorer psychological wellbeing. In this study, we examined the relationship between subjective age and frailty using the 2011-2015 waves of the National Health and Aging Trends Study. Participants were community-dwelling older adults without frailty in the initial wave (N=1,165). Subjective age was measured by asking participants, “What age do you feel most of the time?” Based on the Fried five phenotypic criteria: exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength, frailty was categorized into robust=0, pre-frail=1 or 2; frail=3 or more criteria met. Participants were, on average, 74.1±6.5 years old, female (52%), and non-Hispanic White (81%). Eighty-five percent of the participants felt younger, and 3% felt older than their chronological age, but 41% of them were pre-frail/frail. Generalized estimating equations revealed that an “older” subjective age predicted a higher likelihood of pre-frailty and frailty (OR, 95%CI= 1.01, 1.01-1.02). In contrast, frailty predicted an “older” subjective age (OR, 95%CI= 2.97, 1.65-5.35) adjusting for demographics and health conditions. These findings suggest a bidirectional relationship between subjective age and frailty. Older people who feel younger than their chronological age are at reduced risk of becoming pre-frail/frail. Intervention programs to delay frailty progression should include strategies that may help older adults perceive a younger subjective age.

scholarly journals The autoantibody-mediated encephalitides: from clinical observations to molecular pathogenesis

2019 ◽  
Author(s):  
Sudarshini Ramanathan ◽  
Adam Al-Diwani ◽  
Patrick Waters ◽  
Sarosh R. Irani
Keyword(s):  
Cerebrospinal Fluid ◽  
Close Association ◽  
Autoimmune Encephalitis ◽  
Clinical Syndrome ◽  
Clinical Observations ◽  
Improved Outcomes ◽  
Clinical Syndromes ◽  
Specific Autoantibody ◽  
Autoantibody Detection

Abstract The autoimmune encephalitis (AE) syndromes have been characterised by the detection of autoantibodies in serum and/or cerebrospinal fluid which target the extracellular domains of specific neuroglial antigens. The clinical syndromes have phenotypes which are often highly characteristic of their associated antigen-specific autoantibody. For example, the constellation of psychiatric features and the multi-faceted movement disorder observed in patients with NMDAR antibodies are highly distinctive, as are the faciobrachial dystonic seizures observed in close association with LGI1 antibodies. These typically tight correlations may be conferred by the presence of autoantibodies which can directly access and modulate their antigens in vivo. AE remains an under-recognised clinical syndrome but one where early and accurate detection is critical as prompt initiation of immunotherapy is closely associated with improved outcomes. In this review of a rapidly emerging field, we outline molecular observations with translational value. We focus on contemporary methodologies of autoantibody detection, the evolution and distinctive nature of the clinical phenotypes, generalisable therapeutic paradigms, and finally discuss the likely mechanisms of autoimmunity in these patients which may inform future precision therapies.

scholarly journals Genetic survey of alveolar and cystic echinococcoses in Romania: first molecular evidence of Echinococcus multilocularis in humans in the country

2017 ◽  
Vol 54 (3) ◽  
pp. 189-198 ◽  
Author(s):  
V. Šnábel ◽  
C. Calma ◽  
S. O. Georgescu ◽  
S. Cavallero ◽  
S. D’Amelio ◽  
...  
Keyword(s):  
Echinococcus Multilocularis ◽  
Mandatory Reporting ◽  
Clinical Samples ◽  
Molecular Evidence ◽  
Intermediate Hosts ◽  
Nucleotide Substitutions ◽  
European Variant ◽  
North Eastern ◽  
Causative Agents ◽  
Western Romania

Summary Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are considered as one of the most important zoonotic diseases in Romania, where they are subject to mandatory reporting. To obtain more knowledge about the genetic diversity of Echinococcus causative agents of these diseases, 11 isolates from humans and ungulate intermediate hosts from the two regions of Romania were genotyped using mitochondrial markers. In clinical samples of five patients from north-eastern Romania (Iasi, Botosani, Vaslui counties), Echinococcus multilocularis was identified as causal agent by cox1 sequence analysis. To the best of our knowledge this finding presents the first molecular evidence of E. multilocularis in humans from Romania. Only two cases of AE in patients were previously documented in the country by serological methods. In our four patients the most widespread European variant E5 of E. multilocularis was recorded, whereas in isolate from Vaslui county three nucleotide substitutions were detected as compared to the most related E5 haplotype. One of these mutations (411T/G) matched N1 and N2 haplotypes described previously from North America. In six CE samples retrieved from western Romania (Caras-Severin and Timis counties), two human isolates were diagnosed as Echinococcus canadensis G7, one as E. granulosus s.s. G1 and one as E. granulosus s.s. G3 using atp6 and rrnS sequencing. In ungulates, the cattle isolate was allocated to E. granulosus s.s. G1 and pig isolate to E. canadensis G7. The two G7 findings in humans reinforced the recent view that G7 was underestimated as compared to the E. granulosus s.s. regarding human CE threat that can be further employed for identifying sources of infections and establishing suitable preventive measures.

scholarly journals IDENTIFYING OF HUMAN METAPNEUMOVIRUS AND ITS PHENOTYPE AS A CAUSATIVE AGENTS OF PNEUMONIA IN CHILDREN

2018 ◽  
Vol 11 (4) ◽  
pp. 450 ◽  
Author(s):  
Abbas Mohammed Hussein Al-shebani ◽  
Adnan Hamad Aubaid
Keyword(s):  
Phylogenetic Tree ◽  
Respiratory Illness ◽  
Human Metapneumovirus ◽  
Clinical Samples ◽  
Phylogenetic Tree Analysis ◽  
Causative Agents ◽  
Respiratory Tract Illness ◽  
Respiratory Syncytial Viruses ◽  
Ncbi Blast ◽  
Tree Method

Objectives: The present investigational study was aimed to detect and identify the genotypes of Human metapneumovirus (hMPV) and its phylogeny with respiratory syncytial viruses (RSV) that cause pulmonary inflammation.Material and Methods: A total of 250 samples of patients who were clinically diagnosed respiratory tract illness were collected from Maternity and Children Hospital in Al Diwaniyah city, Iraq. The clinical samples were nasopharyngeal, nasal and throat swabs. The current study screened the presence of hMPV and RSV (A and B) genotypes from nasopharyngeal specimens of children aged from several days to 10 years old.Results: The results revealed that 6% were infected with hMPV, 8% of respiratory syncytial viruses type A (RSV-A) and 14% of respiratory syncytial virus’s type B (RSV-B) from children who are suffering from respiratory illness. Phylogenetic tree analysis of hMPV based on the partial sequences of the fusion protein (F) gene was used for genotyping and detection. The phylogenetic tree was constructed using maximum likelihood tree method in MEGA 6.0 version. The local hMPV isolates (S1) were closely related to NCBI-Blast hMPV genotype A1 (KM408076.1), the local hMPV isolates (S2, S3, and S5) were closely related to NCBI-Blast hMPV genotype B1 (KJ196323.1), and the local hMPV isolates (S4) were closely related to NCBI-Blast hMPV genotype B2 (JQ041689.1).Conclusions: The prevalence rate of hMPV is less than RSV, and both subtypes of hMPV, A and B may exist and circulate in one season, and the predominant sublineage of hMPV shifts in progressive season. 

CONGENITAL ENCEPHALO-OPHTHALMIC DYSPLASIA

PEDIATRICS ◽  
1948 ◽  
Vol 1 (3) ◽  
pp. 315-326
Author(s):  
THEODORE H. INGALLS
Keyword(s):  
Genetic Factor ◽  
Clinical Syndrome ◽  
Multiple Births ◽  
Second Trimester ◽  
Permanent Damage ◽  
Causative Mechanism ◽  
Vascular Tissues ◽  
Epidemiologic Evidence ◽  
Stage Of Development ◽  
Causative Agents

While the causative agents of encephalo-ophthalmic dysplasia are relatively numerous, the causative mechanisms are fewer in number and operate during or shortly after the second trimester of pregnancy. Causative agents include placental abnormalities and hemorrhages; conditions leading to or associated with premature and multiple births; and possibly certain intercurrent infections of the mother. There is no evidence of a genetic factor. Clinical, pathologic and epidemiologic evidence suggests that lack of oxygen to the fetus may be the most important causative mechanism leading to permanent damage of vascular tissues. Special features of the clinical syndrome are due to the stage of development of the host at the time the injurious agent acted. They are also dependent upon the site and extent of injury, and are modified greatly by secondary changes.

scholarly journals [18F]-Fluoro-Deoxy-Glucose Positron Emission Tomography Scan Should Be Obtained Early in Cases of Autoimmune Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
C. R. Newey ◽  
A. Sarwal ◽  
S. Hantus
Keyword(s):  
Positron Emission Tomography ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Brain Mri ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Altered Mental Status ◽  
Emission Tomography ◽  
Positron Emission ◽  
Mesial Temporal Lobe

Introduction. Autoimmune encephalitis (AE) is a clinically challenging diagnosis with nonspecific neurological symptoms. Prompt diagnosis is important and often relies on neuroimaging. We present a case series of AE highlighting the importance of an early [18F]-fluoro-deoxy-glucose positron emission tomography (FDG-PET) scan.Methods. Retrospective review of seven consecutive cases of autoimmune encephalitis.Results. All patients had both magnetic resonance imaging (MRI) and FDG-PET scans. Initial clinical presentations included altered mental status and/or new onset seizures. Six cases had serum voltage-gated potassium channel (VGKC) antibody and one had serum N-methyl-D-aspartate (NMDA) antibody. MRI of brain showed mesial temporal lobe hyperintensity in five cases of VGKC. The other two patients with VGKC or NMDA AE had restiform body hyperintensity on MRI brain or a normal MRI, respectively. Mesial temporal lobe hypermetabolism was noted in three cases on FDG-PET, despite initial unremarkable MRI. Malignancy workup was negative in all patients.Conclusion. A high index of suspicion for AE should be maintained in patients presenting with cognitive symptoms, seizures, and limbic changes on neuroimaging. In cases with normal initial brain MRI, FDG-PET can be positive. Additionally, extralimbic hyperintensity on MRI may also be observed.

scholarly journals Diagnosis and Management of Cervicofacial Actinomycosis: Lessons from Two Distinct Clinical Cases

Antibiotics ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 139 ◽  
Author(s):  
Anette Stájer ◽  
Barrak Ibrahim ◽  
Márió Gajdács ◽  
Edit Urbán ◽  
Zoltán Baráth
Keyword(s):  
Clinical Course ◽  
Epidemiological Data ◽  
Clinical Samples ◽  
Ionization Mass ◽  
Tissue Destruction ◽  
Isolation And Identification ◽  
Gram Positive Bacteria ◽  
Causative Agents ◽  
Medical Histories ◽  
Specific Symptoms

Members of the Actinomyces genus are non-spore-forming, anaerobic, and aerotolerant Gram-positive bacteria that are abundantly found in the oropharynx. They are the causative agents of actinomycosis, a slowly progressing (indolent) infection with non-specific symptoms in its initial phase, and a clinical course of extensive tissue destruction if left untreated. Actinomycoses are considered to be rare; however, reliable epidemiological data on their prevalence is lacking. Herein, we describe two representative and contrasting cases of cervicofacial actinomycosis, where the affected patients had distinctively different backgrounds and medical histories. Identification of the relevant isolates was carried out using matrix-assisted laser desorption/ionization mass spectrometry; antimicrobial susceptibility was performed using E-tests. Cervicofacial actinomycoses are the most frequent form of the disease; isolation and identification of these microorganisms from relevant clinical samples (with or without histological examination) is the gold standard for diagnosis. The therapy of these infections includes surgical debridement and antibiotic therapy, mainly with a penicillin-derivative or clindamycin.

Clinical Use of a Rapid Collagen Binding Assay for von Willebrand Factor Cleaving Protease in Patients with Thrombotic Thrombocytopenic Purpura

2002 ◽  
Vol 88 (10) ◽  
pp. 598-604 ◽  
Author(s):  
Stephan Moll ◽  
Mark Taylor ◽  
Dennis Krizek ◽  
Gilbert White ◽  
David Aronson ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Predictive Value ◽  
Protease Activity ◽  
Binding Assay ◽  
Clinical Syndrome ◽  
Clinical Samples ◽  
Activity Levels ◽  
Collagen Binding ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryA simple collagen binding assay (CBA) for measuring activity of the von Willebrand factor cleaving protease in clinical samples is described, and results of fifty masked plasmapheresis samples from patients with TTP/HUS and other diseases are presented.There was 97.5% concordance between the CBA and a multimer gel assay. The CBA identified low protease activity in 78% of patients who had a clinical syndrome consistent with TTP/HUS and in 2 of 10 sick controls, giving it a positive predictive value of 0.94. The heterogeneity regarding the presence or absence of vWF protease activity in patients with TTP/HUS was confirmed by finding a low negative predictive value of 0.50 with the CBA. The CBA detected inhibitors of the protease in 26 of 29 patients (90%) with TTP/HUS and low protease activity levels. The CBA is a useful clinical assay for examining von Willebrand factor protease activity and detecting inhibitors against the protease.

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