scholarly journals Differences and diversity of autoimmune-mediated encephalitis in 77 cases from a single tertiary care center

2019 ◽  
Author(s):  
Abhinbhen Wasontiwong Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Numerical Data ◽  
Clinical Findings ◽  
Exact Test ◽  
Abnormal Movements ◽  
Surface Antibody ◽  
Surface Antibodies

Abstract Background Since the discovery of N-methyl-D-aspartate receptor (NMDAr) antibody in 2007, the incidence of autoantibody-mediated encephalitis has risen globally. Here we analyzed and compared groups of autoantibody-associated encephalitis patients based on clinical findings and laboratory results in order to find differences between two major groups of autoantibody-mediated encephalitis: intracellular and neuronal surface antibodies. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital (KCMH) between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Categorical data was analyzed using chi-square and Fisher’s exact test. Unpaired, two-tailed t-test was performed to analyze numerical data. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDA receptor antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%), abnormal movements (29%) and psychosis/mood disorder (23%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioral change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were significantly younger (35 vs 48 years old, p=0.04) and were more likely to present with behavioral change (45% vs 16%, p=0.02). Mortality rate was higher in the intracellular group although this was statistically insignificant (16% vs 3.2%, p=0.09). No significant differences were detected in magnetic resonance imaging and cerebrospinal fluid (CSF) profile. Conclusions The prevalence of neuronal surface antibody group was much higher than the intracellular group. In the earlier stages of the disease, both groups have comparable clinical outcomes. Furthermore, it is difficult to distinguish autoantibody-associated encephalitis patients based on clinical data, neuroimaging and CSF profile. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

scholarly journals Differences and diversity of autoimmune-mediated encephalitis in 77 cases from a single tertiary care center

2019 ◽  
Author(s):  
Abhinbhen Wasontiwong Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Numerical Data ◽  
Clinical Findings ◽  
Exact Test ◽  
Abnormal Movements ◽  
Surface Antibody ◽  
Surface Antibodies

Abstract Background Since the discovery of N-methyl-D-aspartate receptor (NMDAr) antibody in 2007, the incidence of autoantibody-mediated encephalitis has risen globally. Here we analyzed and compared groups of autoantibody-associated encephalitis patients based on clinical findings and laboratory results in order to find differences between two major groups of autoantibody-mediated encephalitis: intracellular and neuronal surface antibodies. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital (KCMH) between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Categorical data was analyzed using chi-square and Fisher’s exact test. Unpaired, two-tailed t-test was performed to analyze numerical data. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDA receptor antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%), abnormal movements (29%) and psychosis/mood disorder (23%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioral change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were significantly younger (35 vs 48 years old, p=0.04) and were more likely to present with behavioral change (45% vs 16%, p=0.02). Mortality rate was higher in the intracellular group although this was statistically insignificant (16% vs 3.2%, p=0.09). No significant differences were detected in magnetic resonance imaging and cerebrospinal fluid (CSF) profile. Conclusions The prevalence of neuronal surface antibody group was much higher than the intracellular group. In the earlier stages of the disease, both groups have comparable clinical outcomes. Furthermore, it is difficult to distinguish autoantibody-associated encephalitis patients based on clinical data, neuroimaging and CSF profile. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

scholarly journals Differences and diversity of autoimmune encephalitis in 77 cases from a single tertiary care center

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abhinbhen W. Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Behavioural Change ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Motor Weakness ◽  
Abnormal Movements ◽  
Clinical Presentations ◽  
Magnetic Resonance Imaging Mri ◽  
Surface Antibodies

Abstract Background The incidence of autoimmune encephalitis has risen globally. There are two general categories of disease-associated antibodies that can be tested for: neuronal surface and intracellular. However, testing both groups of autoantibodies are costly. This study aims to identify differences between groups by comparing clinical presentations, radiological findings and CSF profile of patients, and determine if any parameters are indicative of one group of autoantibodies over another. Additionally, we aim to report the local incidence of less common groups of disease-associated antibodies as well. Methods Seventy-seven records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDAr antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%) and abnormal movements (29%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioural change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were younger (35 vs 48 years old, p = 0.04) and more likely to present with behavioral change (45% vs 16%, p = 0.02). Mortality rate was higher in the intracellular group (16% vs 3.2%, p = 0.09). No differences were detected in magnetic resonance imaging (MRI) and CSF profile. Conclusions In the early stages of the disease, both groups have comparable clinical outcomes. Although there were significant differences in age and percentage of patients with behavioral change, both groups of autoimmune encephalitis still shared many clinical features and could not be distinguished based on MRI and CSF profiles. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

scholarly journals Differences and diversity of autoimmune-mediated encephalitis in 77 cases from a single tertiary care center

2019 ◽  
Author(s):  
Abhinbhen Wasontiwong Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Behavioural Change ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Motor Weakness ◽  
Abnormal Movements ◽  
Clinical Presentations ◽  
Magnetic Resonance Imaging Mri ◽  
Surface Antibodies

Abstract Background The incidence of autoimmune encephalitis has risen globally. There are two general categories of disease-associated antibodies that can be tested for: neuronal surface and intracellular. However, testing both groups of autoantibodies are costly. This study aims to identify differences between groups by comparing clinical presentations, radiological findings and CSF profile of patients, and determine if any parameters are indicative of one group of autoantibodies over another. Additionally, we aim to report the local incidence of less common groups of disease-associated antibodies as well. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDAr antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%) and abnormal movements (29%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioural change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were younger (35 vs 48 years old, p=0.04) and more likely to present with behavioral change (45% vs 16%, p=0.02). Mortality rate was higher in the intracellular group (16% vs 3.2%, p=0.09). No differences were detected in magnetic resonance imaging (MRI) and CSF profile. Conclusions In the early stages of the disease, both groups have comparable clinical outcomes. Although there were significant differences in age and percentage of patients with behavioral change, both groups of autoimmune encephalitis still shared many clinical features and could not be distinguished based on MRI and CSF profiles. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

scholarly journals Differences and diversity of autoimmune-mediated encephalitis in 77 cases from a single tertiary care center

2019 ◽  
Author(s):  
Abhinbhen Wasontiwong Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Behavioural Change ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Motor Weakness ◽  
Abnormal Movements ◽  
Clinical Presentations ◽  
Magnetic Resonance Imaging Mri ◽  
Surface Antibodies

Abstract Background The incidence of autoimmune encephalitis has risen globally. There are two general categories of disease-associated antibodies that can be tested for: neuronal surface and intracellular. However, testing both groups of autoantibodies are costly. This study aims to identify differences between groups by comparing clinical presentations, radiological findings and CSF profile of patients, and determine if any parameters are indicative of one group of autoantibodies over another. Additionally, we aim to report the local incidence of less common groups of disease-associated antibodies as well. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDAr antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%) and abnormal movements (29%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioural change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were younger (35 vs 48 years old, p=0.04) and more likely to present with behavioral change (45% vs 16%, p=0.02). Mortality rate was higher in the intracellular group (16% vs 3.2%, p=0.09). No differences were detected in magnetic resonance imaging (MRI) and CSF profile. Conclusions In the early stages of the disease, both groups have comparable clinical outcomes. Although there were significant differences in age and percentage of patients with behavioral change, both groups of autoimmune encephalitis still shared many clinical features and could not be distinguished based on MRI and CSF profiles. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

scholarly journals Anti- NMDAR Autoimmune Encephalitis Presenting as Acute Psychosis: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 59-61
Author(s):  
Bibek Rajbhandari ◽  
Minani Gurung
Keyword(s):  
Behavioral Change ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
Clinical Findings ◽  
Acute Psychosis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Long Time ◽  
Autonomic Instability

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. We present a case of a 13-year old who presented with noticeably chirpiness, excessive talking with unknown people and wandering around the neighborhood without purpose.The main symptoms of the patient and the important clinical findings were irrelevant talking which later developed into slurring of speech, abnormal movements and memory loss.This case is an example of how easily we are misled towards diagnosis based on the present symptoms. The patient suffered the unnecessary stigma of a psychiatric illness, which might stay imprinted on her for a long time. In this report we call for attention to the inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis. It adds on to show that NMDAR might present in the most unexpected and unpredictable ways, sometimes misleading the patient away from medical help.Prompt diagnosis is critical as early immunotherapy and tumor removal could dramatically affect outcomes.

scholarly journals An Unusual Visit from an Old Foe: Oral Presentation of Syphilis in a Teenage Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Bedirhan Tarhan ◽  
Sydur Rahman ◽  
Diana Halloran ◽  
Jeremy Sites ◽  
Avni Bhatt ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Adolescent Females ◽  
Clinical Findings ◽  
Secondary Syphilis ◽  
Pediatric Hospital ◽  
Syphilis Infection ◽  
Macular Rash ◽  
Inguinal Lymphadenopathy

The authors report an atypical case of secondary syphilis in an adolescent female presenting to a tertiary-care center with fever, weight loss, oral sores, painful inguinal lymphadenopathy, and transient macular rash. Given the lower prevalence of syphilis in adolescent females, this infection was not included on the initial differential diagnosis. The evolving presentation of syphilis over time complicates the diagnosis and management of these infections, as it did for the patient in this report. The authors provide a detailed discussion of the patient’s clinical findings, including the protean features of syphilis infection. This case is particularly relevant to the fields of general pediatrics and pediatric hospital medicine.

scholarly journals Prevalence of ear cleaning and its characteristic physical findings in patients visiting tertiary care center in Bhutan

2018 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Tika Ram Adhikari ◽  
Sonam Jamtsho
Keyword(s):  
External Auditory Canal ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Clinical Findings ◽  
Tertiary Care Center ◽  
Ear Canal ◽  
Cross Sectional ◽  
Bony Canal ◽  
Physical Findings

Introduction: Many studies have been done on prevalence and complications of ear bud across the globe but very few talk about the characteristics physical findings associated with ear cleaning. We aim to find the prevalence and characteristic physical findings of cotton bud usage in patients visiting a tertiary care center in Bhutan. Methods: A cross sectional study in a tertiary care center in Bhutan over a period of one month. Results: The prevalence of ear cleaning was 92.15%. The most common physical finding was shiny external auditory canal (66%), excoriations in the external auditory canal (longitudinal furrowing along the floor or Circular scratch marks)(52%), erythema and edema of ear canal (46.6%), wax in the bony canal near tympanic membrane(9.3%), stenosed external auditory canal (3.8%), cotton wool remnants in ear canal(2.8%). Conclusions: It is important to recognize these characteristic clinical findings of cleaning the ear so that proper counseling can be given against its usage and prevent undue complications associated with it.

Mycoplasma Genitalium And Streptococcus Agalactiae Colonization In Pregnant Women: An Emerging Relationship

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
K Hummel ◽  
J Dunn ◽  
K Muldrew ◽  
S Gogia ◽  
E Kravitz ◽  
...  
Keyword(s):  
Black Women ◽  
Pregnant Women ◽  
Streptococcus Agalactiae ◽  
Trichomonas Vaginalis ◽  
Care Center ◽  
Tertiary Care ◽  
Treponema Pallidum ◽  
Mycoplasma Genitalium ◽  
Transmitted Infection ◽  
Exact Test

Abstract Introduction/Objective Mycoplasma genitalium has been identified as an emerging sexually transmitted infection (STI) causing cervicitis, pelvic inflammatory disease and other gynecologic pathology. The prevalence of M. genitalium in pregnant women has not been determined, nor has frequency of co-infection with Streptococcus agalactiae (GBS). Neonatal sepsis caused by GBS is associated with black race and young maternal age with approximately 10%-30% of pregnant women colonized. The aim of this retrospective study was to investigate the possible association between M. genitalium infection and colonization with GBS in a large cohort of pregnant women from a tertiary care center in Houston, Texas. Methods Remnant endocervical samples collected from pregnant women attending clinics at the Baylor College of Medicine between September 2019 and December 2019 were screened for M. genitalium by transcription mediated amplification (Hologic, Inc. Marlborough, MA). Demographic, STI co-infection [Human papillomavirus (types 16,18), Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and Herpes simplex virus], and GBS status data were recorded. Fisher’s exact test was performed for statistical analysis. Results 719 total samples were collected and tested for M. genitalium. Of these, 41 (5.7%) were positive. The mean age of infected women was younger than noninfected women (24.9 vs. 28.1 years respectively p = 0.0004). More black women (34.2%) were infected with M. genitalium compared to white (14.6%) or other (51.2%) (p = 0.0003). Rates of GBS colonization was significantly higher among women infected with M. genitalium compared to women who tested negative (58.3% vs. 16.1% respectively p = 0.002) and increased compared to national reported rates of GBS colonization. M. genitalium also showed a significant association with T. vaginalis (p=0.03), but no other STI co- infections studied. Conclusion Our data demonstrates that infection with M. genitalium may be associated with persistent GBS colonization. Further prospective studies are needed to further elucidate this relationship.

scholarly journals Utility of lung ultrasound in childhood pneumonia in a tertiary care center

2020 ◽  
Vol 7 (6) ◽  
pp. 1237
Author(s):  
Niharika Shetty ◽  
Sarala Sabapathy ◽  
Mallesh K.
Keyword(s):  
Lung Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Findings ◽  
Childhood Mortality ◽  
Mortality And Morbidity ◽  
Childhood Pneumonia ◽  
Inter Observer Variability ◽  
Ultrasound Findings ◽  
Valuable Role

Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.

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