scholarly journals The Use of Adjunctive Steroids in Central Nervous Infections

2020 ◽  
Vol 10 ◽  
Author(s):  
Shalini Gundamraj ◽  
Rodrigo Hasbun
Keyword(s):  
Steroid Therapy ◽  
Pneumococcal Meningitis ◽  
Autoimmune Encephalitis ◽  
Mortality Rates ◽  
Disease Diagnosis ◽  
Cns Infections ◽  
Neurological Morbidity ◽  
Virus West Nile ◽  
Simplex Virus ◽  
Tuberculosis Meningitis

Central nervous system (CNS) infections continue to be associated with significant neurological morbidity and mortality despite various existing therapies. Adjunctive steroid therapy has been employed clinically to reduce inflammation in the treatment of CNS infections across various causative pathogens. Steroid therapy can potentially improve clinical outcomes including reducing mortality rates, provide no significant benefit, or cause worsened outcomes, based on the causative agent of infection. The data on benefits or harms of adjunctive steroid therapy is not consistent in outcome or density through CNS infections, and varies based on the disease diagnosis and pathogen. We summarize the existing literature on the effects of adjunctive steroid therapy on outcome for a number of CNS infections, including bacterial meningitis, herpes simplex virus, West Nile virus, tuberculosis meningitis, cryptococcal meningitis, Angiostrongylus cantonensis, neurocysticercosis, autoimmune encephalitis, toxoplasmosis, and bacterial brain abscess. We describe that while steroid therapy is beneficial and supported in pathogens such as pneumococcal meningitis and tuberculosis, for other diseases, like Listeria monocytogenes and Cryptococcus neoformans they are associated with worse outcomes. We highlight areas of consistent and proven findings and those which need more evidence for supported beneficial clinical use of adjunctive steroid therapy.

scholarly journals Epidemiology, Outcomes and Prognosis of Central Nervous System Infections in Singapore. Preliminary results from The Singapore Neurologic Infections Programme (SNIP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S303-S304
Author(s):  
Fu Zi Yvonne Chan ◽  
Limin Wijaya ◽  
Kevin Tan ◽  
Monica Chan ◽  
Derek Soon ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Demographic Data ◽  
Altered Mental Status ◽  
Diagnostic Tools ◽  
Inclusion Criteria ◽  
Cns Infections ◽  
Tertiary Hospitals ◽  
Simplex Virus ◽  
A Prospective Study

Abstract Background Central Nervous System (CNS) infections frequently result in devastating consequences although the aetiology is seldom definitively identified. To address this knowledge gap, we conducted a prospective study to describe the epidemiology of CNS infections in Singapore. Methods Patient enrollment was conducted in 5 adult tertiary hospitals in Singapore, between August 2013 and December 2016. Patients aged ≥16 years who met the inclusion criteria were enrolled. Demographic data, neuroimaging, neurophysiology and biochemical results were collected. Cases were classified as “Confirmed” or “Probable” depending on whether the aetiological agent was detected by either culture or molecular methods in the CSF. The modified Rankin Scale (mRS) was recorded at enrollment, 2 weeks and 6 months, with scores of 0–2 classified as good and 3–6 as poor outcome. Results A total of 2061 patients were screened, of whom 199 met the inclusion criteria. A total of 106 (53.2%), 65 (32.7%) and 28 (14%) cases of meningitis, meningoencephalitis and encephalitis were diagnosed, respectively. An aetiologic agent was identified in 119 (60%) of cases. Mycobacterium tuberculosis (MTb) was the most common cause of meningitis and meningoencephalitis with 23 (13.5%) cases. Herpes simplex virus was the most common aetiology for encephalitis with 3 (10.7%) cases. Immune-mediated aetiologies accounted for 8 (4%) of the total cases. Fatal outcomes were observed in 7 (3.5%) patients. The absence of focal weakness (aOR 0.024 95% CI 0.001–0.535 P = 0.018) and absence of altered mental status (aOR 0.03; 95% CI 0.002–0.43; P = 0.009) at admission predicted good outcomes at 6 months. Vomiting was associated with poor prognosis (aOR 17.91; 95% CI 1.12–286.04; P = 0.041). Conclusion It is surprising that MTb was the most common aetiologic agent although none were fatal. Our study identified aetiologic diagnoses, clinical and biochemical results that correlated with outcome of CNS infections although it also underscores the need for better diagnostic tools for aetiologic confirmation. Disclosures All authors: No reported disclosures.

scholarly journals P.007 Autoimmune Encephalitis Timing and Incidence: the Manitoba Experience

2021 ◽  
Vol 48 (s3) ◽  
pp. S22-S22
Author(s):  
DH Nguyen ◽  
C Xu ◽  
M Ng
Keyword(s):  
Chart Review ◽  
Autoimmune Encephalitis ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Early Group ◽  
Intensive Care Admission ◽  
Receive Treatment ◽  
Late Group

Background: Early treatment of autoimmune encephalitis (AE) can improve outcomes. Despite expert recommendation, it remains unclear if suspected AE patients consistently receive empiric treatments prior to availability of antibody results. Methods: Retrospective chart review of patients referred for AE testing in Manitoba. Primary outcomes were the proportion of patients treated empirically prior to the availability of antibody results. Incidence, clinical presentation, investigations, complications, mortality rates, and hospital course were secondary outcome measures. Results: We identified 151 patients from 2012-2018. 43 patients met inclusion criteria. The annual incidence of AE in Manitoba was 0.37/100,000. 28/43 (65%) patients were treated prior to availability of antibody results (“Early group”). 15/43 (35%) patients did not receive treatment (“Late group”). Significantly more Early group patients had repeat immunotherapy (p=0.001), abnormal MRI (p=0.027), and investigations for malignancy (p=0.015). Durations of hospital and intensive care admission, complication rates, and mortality rates were not different between the two groups. Conclusions: This is the first-ever AE incidence, timing, and management study of a comprehensive Canadian geopolitical and medical catchment area. Just over 1/3 of suspected AE over seven years were not treated prior to antibody results becoming available. Patients treated earlier did not experience greater complication rates.

scholarly journals Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management

2021 ◽  
Vol 12 ◽  
Author(s):  
Elia Sechi ◽  
Eoin P. Flanagan
Keyword(s):  
Checkpoint Inhibitors ◽  
Autoimmune Encephalitis ◽  
Herpes Simplex Virus Encephalitis ◽  
Cns Disorders ◽  
Neurologic Disorders ◽  
Cns Autoimmunity ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Simplex Virus ◽  
Clinical Mri

Antibody-mediated disorders of the central nervous system (CNS) are increasingly recognized as neurologic disorders that can be severe and even life-threatening but with the potential for reversibility with appropriate treatment. The expanding spectrum of newly identified autoantibodies targeting glial or neuronal (neural) antigens and associated clinical syndromes (ranging from autoimmune encephalitis to CNS demyelination) has increased diagnostic precision, and allowed critical reinterpretation of non-specific neurological syndromes historically associated with systemic disorders (e.g., Hashimoto encephalopathy). The intracellular vs. cell-surface or synaptic location of the different neural autoantibody targets often helps to predict the clinical characteristics, potential cancer association, and treatment response of the associated syndromes. In particular, autoantibodies targeting intracellular antigens (traditionally termed onconeural autoantibodies) are often associated with cancers, rarely respond well to immunosuppression and have a poor outcome, although exceptions exist. Detection of neural autoantibodies with accurate laboratory assays in patients with compatible clinical-MRI phenotypes allows a definite diagnosis of antibody-mediated CNS disorders, with important therapeutic and prognostic implications. Antibody-mediated CNS disorders are rare, and reliable autoantibody identification is highly dependent on the technique used for detection and pre-test probability. As a consequence, indiscriminate neural autoantibody testing among patients with more common neurologic disorders (e.g., epilepsy, dementia) will necessarily increase the risk of false positivity, so that recognition of high-risk clinical-MRI phenotypes is crucial. A number of emerging clinical settings have recently been recognized to favor development of CNS autoimmunity. These include antibody-mediated CNS disorders following herpes simplex virus encephalitis or occurring in a post-transplant setting, and neurological autoimmunity triggered by TNFα inhibitors or immune checkpoint inhibitors for cancer treatment. Awareness of the range of clinical and radiological manifestations associated with different neural autoantibodies, and the specific settings where autoimmune CNS disorders may occur is crucial to allow rapid diagnosis and early initiation of treatment.

scholarly journals GP45 Autoimmune encephalitis triggered by herpes simplex virus 1 infection

2019 ◽  
Author(s):  
Ancuta Bilasco ◽  
Szidonia Florea ◽  
Ramona Cirt ◽  
Anca Draganescu ◽  
Magda Vasile ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Autoimmune Encephalitis ◽  
Herpes Simplex Virus 1 ◽  
Simplex Virus

scholarly journals Differential Diagnosis of Autoimmune Encephalitis from Infectious Lymphocytic Encephalitis by Analysing the Lymphocyte Subsets of Cerebrospinal Fluid

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Qiao-quan Zhang ◽  
Yan-fang Zhang ◽  
Nian Yu ◽  
Xing-jian Lin ◽  
Qing Di
Keyword(s):  
Cerebrospinal Fluid ◽  
B Lymphocytes ◽  
Lymphocyte Subsets ◽  
Developmental Stages ◽  
Autoimmune Encephalitis ◽  
Herpes Simplex Virus Encephalitis ◽  
Pathophysiological Mechanism ◽  
Diagnostic Values ◽  
Simplex Virus ◽  
Cd Markers

This study is aimed at investigating the lymphocyte subsets of cerebrospinal fluid (CSF) to provide possible differential diagnostic values and better understand the pathophysiological mechanism underlying autoimmune encephalitis (AE) and infectious lymphocytic encephalitis. A series of CD markers, including CD3/4/8/20 representing different types and developmental stages of lymphocytes, were used to count the corresponding subpopulations of CSF from clinical and laboratory confirmed cases of anti-N-methyl-D-aspartate receptor AE (NMDAR-AE), herpes simplex virus encephalitis (HSVE), and tuberculous meningitis (TBM). The percentages of lymphocytes observed and the CD4 : CD8 ratios were compared between the three groups. There were no significant differences of the percentage of total lymphocytes, CD3 cells, and CD4 cells of CSF among each group. However, there were strongly statistical differences of the CD4 : CD8 ratio in CSF of each group with 0.6 : 1 in NMDAR-AE, 0.9 : 1 in HSVE, and 3.2 : 1 in TBM. The percentage of CD20 B lymphocytes in NMDAR-AE was statistically higher than that of other groups. The distinct percentages of lymphocyte subpopulations of CSF appeared to be characteristic and could potentially serve as diagnostic indicators. Further verification and research will be necessary to clarify the significance and nature of CD4 : CD8 ratios and B lymphocytes in CSF between AE and the infectious lymphocytic encephalitis.

scholarly journals Anti-NMDAR Encephalitis Following Herpes Simplex Virus Encephalitis: 2 Cases From Portugal

2019 ◽  
Vol 10 (2) ◽  
pp. 133-138
Author(s):  
Ana Brás ◽  
Ana André ◽  
Laura Sá ◽  
João Carvalho ◽  
Anabela Matos ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Specific Treatment ◽  
Autoimmune Encephalitis ◽  
Herpes Simplex Virus Encephalitis ◽  
Virus Encephalitis ◽  
Nmdar Encephalitis ◽  
Initial Improvement ◽  
Simplex Virus

Herpes simplex virus encephalitis (HSVE) usually presents as a monophasic disease. Symptomatic HSVE relapsing with seizures, encephalopathy, or involuntary movements associated with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis have been recently reported. We report 2 cases of adult post-HSVE anti-NMDAR encephalitis from Portugal. Two female patients aged 50 years and 30 years were diagnosed with herpes simplex virus type 2 and type 1 encephalitis, respectively. After the initial improvement with specific treatment and despite virologic negativization, both patients suffered clinical, electroencephalographic, and imaging deterioration. The autoimmune encephalitis hypothesis was confirmed with the demonstration of anti-NMDAR antibodies in both cerebrospinal fluid and serum. Both responded to human immunoglobulin and methylprednisolone, with progressive gain of autonomy along the follow-up period. Thymectomy for thymic hyperplasia diagnosed during follow-up was performed in 1 patient. Although being rare, post-HSVE anti-NMDAR encephalitis should be considered in all cases of symptomatic recrudescence after HSVE, since adequate immune-modulating treatment improves the outcome. The role of thyme hyperplasia in autoimmune encephalitis pathogenesis needs better understanding.

Etiological and Clinical Profile of Acute Nonbacterial Encephalitis in Children: A Single-Center Prospective Study

2021 ◽  
Author(s):  
Ali Bülent Cengiz ◽  
Ceren Günbey ◽  
Mehmet Ceyhan ◽  
Gülay Korukluoğlu ◽  
Sevgen Tanır Başaranoğlu ◽  
...  
Keyword(s):  
Prospective Study ◽  
Clinical Laboratory ◽  
Autoimmune Encephalitis ◽  
Unfavorable Outcome ◽  
Neurological Deficits ◽  
Varicella Zoster ◽  
Acute Encephalitis ◽  
High Erythrocyte Sedimentation Rate ◽  
Simplex Virus ◽  
Hsv 1

AbstractEncephalitis is a serious neurological syndrome caused by inflammation of the brain. The diagnosis can be challenging and etiology remains unidentified in about half of the pediatric cases. We aimed to investigate demographic, clinical, laboratory, electroencephalographic and neuroimaging findings, and outcome of acute encephalitis of nonbacterial etiology. This prospective study included children hospitalized with the diagnosis of acute encephalitis between 2017 and 2019. Microbiological investigations of the cerebrospinal fluid (CSF) were recorded. All CSF specimens were tested for anti-N methyl D-aspartate receptor (NMDAR) antibodies. In total, 31 children aged 10 months to 17 years (median = 6 years) were included. Pathogens were confirmed in CSF in three patients (9.7%): varicella zoster virus, herpes simplex virus type 1 (HSV-1), and both HSV-1 and NMDAR antibodies. Presenting features included encephalopathy (100%), fever (80.6%), seizure (45.2%), focal neurological signs (29%), and ataxia (19.4%). On clinical follow-up of median 9 (6–24) months, six patients showed neurological deficits: together with two patients who died in hospital, total eight (25.8%) patients were considered to have unfavorable outcome. Need for intubation, receiving immunomodulatory treatment, prolonged hospitalization, and high erythrocyte sedimentation rate at admission were associated with unfavorable outcome. The etiology of encephalitis remains unexplained in the majority of children. HSV-1 is the most frequently detected virus, consistent with the literature. The fact that anti-NMDAR encephalitis was detected in one child suggests autoimmune encephalitis not being rare in our center. The outcome is favorable in the majority while about one-fifth of cases suffer from sequelae.

Development of a Multiplex Droplet Digital PCR Assay for Detection of Enterovirus, Parechovirus, Herpes Simplex Virus 1 and 2 Simultaneously for Diagnosis of Viral CNS Infections

2021 ◽  
Author(s):  
Xunhua Zhu ◽  
Pengcheng Liu ◽  
Lijuan Lu ◽  
Huaqing Zhong ◽  
Menghua Xu ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Pathogen Detection ◽  
Dynamic Range ◽  
Detection System ◽  
Digital Pcr ◽  
Droplet Digital Pcr ◽  
Herpes Simplex Virus 1 ◽  
Cns Infections ◽  
Simplex Virus

Abstract Background: Enterovirus (EV), parechovirus (HPeV), herpes simplex virus 1 and 2 (HSV1/2) are common viruses leading to viral central nervous system (CNS) infections which are increasingly predominant but exhibit deficiency in definite pathogen diagnosis with gold-standard quantitative PCR method. Previous studies have shown that droplet digital PCR (ddPCR) has great potential in pathogen detection and quantification especially in low concentration samples.Methods: Targeting four common viruses of EV, HPeV, HSV1, and HSV2 in cerebrospinal fluid (CSF), we developed a multiplex ddPCR assay using probe ratio-based multiplexing strategy, analyzed the performance, and evaluated it in 97 CSF samples collected from patients with suspected viral CNS infections on a two-channel ddPCR detection system.Results: The four viruses were clearly distinguished by their corresponding fluorescence amplitude. The limits of detection for EV, HPeV, HSV1, and HSV2 were 5, 10, 5, and 10 copies per reaction, respectively. The dynamic range was at least four orders of magnitude spanned from 2000 to 2 copies per reaction. The results of 97 tested clinical CSF specimens were identical to those deduced from qPCR/qRT-PCR assays using commercial kits.Conclusion: The multiplex ddPCR assay was demonstrated to be an accurate and robust method which could detect EV, HPeV, HSV1, and HSV2 simultaneously. It provides a useful tool for clinical diagnosis and disease monitoring of viral CNS infections.

Pneumococcal Meningitis in Mother and Neonate

PEDIATRICS ◽  
1974 ◽  
Vol 53 (5) ◽  
pp. 759-760
Author(s):  
Bruce Tempest
Keyword(s):  
Antibiotic Therapy ◽  
Causative Agent ◽  
Pneumococcal Meningitis ◽  
Neonatal Period ◽  
Mortality Rates ◽  
Neonatal Meningitis ◽  
Newborn Period ◽  
Meningeal Irritation ◽  
Unusual Occurrence ◽  
Symptoms And Signs

Recent reports have stressed several features of meningitis in the newborn period: high mortality rates despite antibiotic therapy, the absence of symptoms and signs of meningeal irritation and the frequency with which enteric bacilli are the causative agent. The observation that obstetrical complications increase the incidence of neonatal meningitis and that the majority of these infants develop their disease before the sixth day of life suggest that the infection is acquired during parturition. The following case is of interest because of the unusual occurrence in both mother and infant of meningitis due to pneumococci, an organism which is an infrequent cause of meningitis in the neonatal period.

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