Feline cryptococcosis: a retrospective evaluation

1997 ◽  
Vol 33 (2) ◽  
pp. 118-122 ◽  
Author(s):  
S Gerds-Grogan ◽  
B Dayrell-Hart
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cryptococcus Neoformans ◽  
Clinical Pathology ◽  
Fungal Disease ◽  
University Of Pennsylvania ◽  
Retrospective Evaluation ◽  
Cns Involvement ◽  
The University ◽  
Veterinary Hospital

Cryptococcus neoformans causes the most common form of feline systemic fungal disease. Nineteen cats with cryptococcosis were seen at the Veterinary Hospital of the University of Pennsylvania between April 1986 and May 1995. Compared to other studies, these 19 cases showed increased neurological and ophthalmological involvement. Males were affected more often than females. Season and environment appeared to influence time of onset or presentation to the hospital. Clinical pathology did not show typical changes. It is possible that the organism was present frequently in the urine but was mistaken for fat droplets. Treatment with ketoconazole was unrewarding in cases with central nervous system (CNS) involvement.

The Incidence of Central Nervous System Involvement in AML: A SAL-Tor Vergata Analysis

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4236-4236
Author(s):  
Nael Alakel ◽  
Maria Ilaria Del Principe ◽  
Friedrich Stölzel ◽  
Brigitte Mohr ◽  
Uta Oelschlaegel ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Initial Diagnosis ◽  
Chromosome 8 ◽  
Study Group ◽  
Event Free Survival ◽  
Cns Involvement ◽  
Free Survival ◽  
Significant Difference ◽  
The University

Abstract Abstract 4236 Background: Acute myeloid leukemia (AML) involves infrequently the central nervous system (CNS). However, most studies examined paediatric patients. Thus little is known regarding CNS-involvement in adult AML. Therefore, we analyzed the data of patients with AML treated in SAL study group and Tor Vergata study group for CNS involvement. Methods: In this retrospective analysis in adult AML patients included in the prospective AML96- (NCT00180115), AML2003- (NCT00180102), AML60+ trials (NCT00180167) of the SAL study group and patients that were admitted to the University Hospital of Rome Tor Vergata from 2005 to 2011, 3863 patients were evaluated for CNS involvement of AML. The median age of the patients was 49 years (range, 18 –74 years). A total of 30 patients had CNS involvement at time of initial presentation and 30 patients had CNS involvement at first, second or third relapse. CNS involvement was proven depending on morphology and/ or flow cytometry of the Cerebrospinal fluid (CSF). Clinical variables of statistical significance were compared using the χ2-test for dichotomized variables and the Mann-Whitney U-test for continuous variables. The method of Kaplan Meier was used to estimate OS and event-free survival (EFS). Survival distributions were compared using the log-rank test. Results: 21 of 1862 patients (1%) in the AML96-trial, 26 patients of 1182 (2.2%) in the AML2003 trial, 3 of 486 patients (0.6%) in the AML60+ trial, and 10 of 270 patients (3.7%) in the University of Rome Tor Vergata studies had CNS involvement resulting to a total of 60 patients with a combined overall incidence of 1.6%. 30 patients had CNS involvement at the initial presentation and 30 patients at relapse of AML. The majority of patients (n=53, 88%) had de novo AML. Data from the Tor Vergata study group need further analysis therefore in this abstract patients from SAL study group were included. Extramedullary AML other than CNS involvement was observed in 21 patients (42 %) as compared to 246 (7%) in patients without CNS involvement, p < 0.001. Complex aberrant karyotype was not significantly higher in patients with CNS involvement as compared to those without, whereas patients with CNS involvement had a higher tendency for trisomy of chromosome 8 (n=8, 16%) in comparison with patients without CNS involvement (n= 277, 8%), p=0.03. AML FAB M5 occurred more frequently in patients with CNS involvement (n= 15, 30%) as compared to those without (n=459, 13%), p=0.01. Patients with CNS involvement at diagnosis had significantly higher lactate dehydrogenase (LDH) levels (1318 vs. 665 IE/l, p< 0.001) and higher white blood cell count (WBC) (64 vs. 35 Gpt/l, p<0.001). Only 7 of 30 patients (23%) with CNS involvement at initial diagnosis developed relapse and none of them had CNS involvement at the time of relapse, whereas almost all patients with CNS involvement at relapse developed again systemic and CNS-relapse. On the other hand, there was no significant difference in the number of patients who achieved complete remission between these two groups. Comparing patients with CNS involvement with patients without CNS involvement at the initial diagnosis no significant difference in overall survival at 2 years (40% vs. 41%) and event free survival at 2 years (20% vs. 26%) was observed. Conclusion: CNS involvement in AML is a rare entity and it is accompanied with higher incidence of other extramedullary AML. This represents the largest analysis of AML patients with CNS involvement studied in the literature. Factors associated with an increased risk of CNS involvment include: trisomy of chromosome 8, FAB M5, higher LDH levels and higher WBC count at diagnosis. Patients with CNS disease at initial diagnosis of AML have similar survival outcomes as compared to those without CNS disease if treated by intrathecal therapy, whereas extramedullary relapse within the CNS is associated with poor outcome. Disclosures: No relevant conflicts of interest to declare.

Role of Positron Emission Tomography for Central Nervous System Involvement in Systemic Autoimmune Diseases: Status and Perspectives

2018 ◽  
Vol 25 (26) ◽  
pp. 3096-3104 ◽  
Author(s):  
Daniele Mauro ◽  
Gaetano Barbagallo ◽  
Salvatore D`Angelo ◽  
Pasqualina Sannino ◽  
Saverio Naty ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Central Nervous System ◽  
Nervous System ◽  
Autoimmune Diseases ◽  
Pet Imaging ◽  
Emission Tomography ◽  
Cns Involvement ◽  
Systemic Autoimmune Diseases ◽  
Positron Emission

In the last years, an increasing interest in molecular imaging has been raised by the extending potential of positron emission tomography [PET]. The role of PET imaging, originally confined to the oncology setting, is continuously extending thanks to the development of novel radiopharmaceutical and to the implementation of hybrid imaging techniques, where PET scans are combined with computed tomography [CT] or magnetic resonance imaging[MRI] in order to improve spatial resolution. Early preclinical studies suggested that 18F–FDG PET can detect neuroinflammation; new developing radiopharmaceuticals targeting more specifically inflammation-related molecules are moving in this direction. Neurological involvement is a distinct feature of various systemic autoimmune diseases, i.e. Systemic Lupus Erythematosus [SLE] or Behcet’s disease [BD]. Although MRI is largely considered the gold-standard imaging technique for the detection of Central Nervous System [CNS] involvement in these disorders. Several patients complain of neuropsychiatric symptoms [headache, epilepsy, anxiety or depression] in the absence of any significant MRI finding; in such patients the diagnosis relies mainly on clinical examination and often the role of the disease process versus iatrogenic or reactive forms is doubtful. The aim of this review is to explore the state-of-the-art for the role of PET imaging in CNS involvement in systemic rheumatic diseases. In addition, we explore the potential role of emerging radiopharmaceutical and their possible application in aiding the diagnosis of CNS involvement in systemic autoimmune diseases.

scholarly journals Treatment of secondary central nervous system involvement in systemic aggressive B cell lymphoma using R-MIADD chemotherapy: a single-center study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuchen Wu ◽  
Xuefei Sun ◽  
Xueyan Bai ◽  
Jun Qian ◽  
Hong Zhu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Involvement ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Cns Involvement ◽  
The Central Nervous System ◽  
Secondary Central Nervous System

Abstract Background Secondary central nervous system lymphoma (SCNSL) is defined as lymphoma involvement within the central nervous system (CNS) that originated elsewhere, or a CNS relapse of systemic lymphoma. Prognosis of SCNSL is poor and the most appropriate treatment is still undetermined. Methods We conducted a retrospective study to assess the feasibility of an R-MIADD (rituximab, high-dose methotrexate, ifosfamide, cytarabine, liposomal formulation of doxorubicin, and dexamethasone) regimen for SCNSL patients. Results Nineteen patients with newly diagnosed CNS lesions were selected, with a median age of 58 (range 20 to 72) years. Out of 19 patients, 11 (57.9%) achieved complete remission (CR) and 2 (10.5%) achieved partial remission (PR); the overall response rate was 68.4%. The median progression-free survival after CNS involvement was 28.0 months (95% confidence interval 11.0–44.9), and the median overall survival after CNS involvement was 34.5 months. Treatment-related death occurred in one patient (5.3%). Conclusions These single-centered data underscore the feasibility of an R-MIADD regimen as the induction therapy of SCNSL, further investigation is warranted.

scholarly journals CENTRAL NERVOUS SYSTEM INVOLVEMENT IN ADULT ACUTE LYMPHOBLASTIC LEUKEMIA: DIAGNOSTIC TOOLS, PROPHYLAXIS AND THERAPY

2014 ◽  
Vol 6 (1) ◽  
pp. e2014075 ◽  
Author(s):  
Maria Ilaria Del Principe ◽  
Luca Maurillo ◽  
Francesco Buccisano ◽  
Giuseppe Sconocchia ◽  
Mariagiovanna Cefalo ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Intrathecal Injection ◽  
False Negative ◽  
Diagnostic Tools ◽  
Positive Finding ◽  
Cns Involvement ◽  
Hematopoietic Stem

In adult patients with acute lymphoblastic leukemia (ALL), Central Nervous System (CNS) involvement is associated with a very poor prognosis. The diagnostic assessment of this condition relies on the use of neuroradiology, conventional cytology (CC) and flow cytometry (FCM). Among these approaches, which is the gold standard it is still a matter of debate. Neuroradiology and CC have a limited sensitivity with a higher rate of false negative results. FCM demonstrated a superior sensitivity over CC, particularly when low levels of CNS infiltrating cells are present. Although prospective studies of large series of patients are still awaited, a positive finding by FCM appears to anticipate an adverse outcome even if CC shows no infiltration. Current strategies for adult ALL CNS-directed prophylaxis or therapy involve systemic and intrathecal chemotherapy and radiation therapy. Actually, early and frequent intrathecal injection of cytostatic combined with systemic chemotherapy is the most effective strategy to reduce the frequency of CNS involvement. In patients with CNS overt ALL, at diagnosis or upon relapse, allogenic hematopoietic stem cell transplantation might be considered. This review will discuss risk factors, diagnostic techniques for identification of CNS infiltration and modalities of prophylaxis and therapy to manage it. 

scholarly journals Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China

2021 ◽  
Vol 49 (2) ◽  
pp. ???
Author(s):  
Xinying Xue ◽  
Xuelei Zang ◽  
Lifeng Wang ◽  
Dongliang Lin ◽  
Tianjiao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Features ◽  
Central Nervous System Involvement ◽  
Pulmonary Cryptococcosis ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Presenting Symptoms

Objective This study aimed to compare the clinical features of pulmonary cryptococcosis (PC) in patients with and without central nervous system (CNS) involvement. Methods We retrospectively reviewed demographics, presenting symptoms, radiographic features, and laboratory findings of patients diagnosed with PC in 28 hospitals from 2010 to 2019. Risk factors for CNS involvement were analyzed using logistic regression models. Result A total of 440 patients were included, and 36 (8.2%) had CNS involvement. Significant differences in fever, headache, and chills occurred between the two groups (overall and with/without CNS involvement) for fever (17.8% [78/440]; 52.8% vs. 14.6% of patients, respectively), headache (4.5% [20/440]; 55.6% vs. 0% of patients, respectively), and chills (4.3% [19/440]; 13.9% vs. 3.5% of patients, respectively). The common imaging manifestation was nodules (66.4%). Multivariate analysis showed that cavitation (adjusted odds ratio [AOR] = 3.552), fever (AOR = 4.182), and headache were risk factors for CNS involvement. Routine blood tests showed no differences between the groups, whereas in cerebrospinal fluid the white blood cell count increased significantly and glucose decreased significantly. Conclusion In patients with PC, the risk of CNS involvement increases in patients with headache, fever, and cavitation; these unique clinical features may be helpful in the diagnosis.

scholarly journals Central nervous system involvement in Chagas' disease: an updating

1993 ◽  
Vol 35 (2) ◽  
pp. 111-116 ◽  
Author(s):  
José Eymard Homem Pittella
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Chagas Disease ◽  
Acute Phase ◽  
Central Nervous System Involvement ◽  
Cns Infection ◽  
Cns Involvement ◽  
Anatomical Basis ◽  
Immunosuppressed Patients ◽  
Acute Form

A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.

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