A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication

Background Granulomatous amoebic encephalitis (GAE) is a rare central nervous system infection caused by the Balamuthia mandrillaris or Acanthamoeba species. Diagnosis is challenging because of the non-specific clinical presentation, cerebrospinal fluid analysis, and radiological features. There is no effective treatment for GAE to date. Case presentation A 54-year-old male was admitted to hospital after experiencing acute onset of numbness and weakness on his left limb. Due to the initial consideration of intracranial tumor, surgical removal of the right parietal lesion was performed. However, the patient had a headache accompanied by diplopia, difficulty walking and a new lesion was found in the left occipital-parietal lobe two weeks after the first operation. High-throughput next-generation sequencing (NGS) detected the presence of high copy reads of the B. mandrillaris genome sequence in the patient’s blood, cerebral spinal fluid (CSF), and brain tissue. Pathological investigation of the brain tissue showed granulomatous changes and amoebic trophozoite scattered around blood vessels under high magnification. The patient was re-operated due to developing progressive confusion caused by subfalcine herniation of the left cerebral hemisphere. The lesions of the right parietal lobe were obviously decreasing in size after the first surgery, and the lesions of the left occipital lobe and the sunfalcine herniation didn’t ameliorate two months after the second surgery. The patient was transferred to local hospital for continuous treatment with sulfamethoxazole and azithromycin. After five months of the second surgery, the patient showed good recovery with mild headache. Conclusions This is the first report of a patient with B. mandrillaris encephalitis initially confirmed by NGS and have experienced two excisions, responding favorably to the combination of surgeries and medications. Early surgical resection of intracranial lesions combined with drug treatment may offer the chance of a cure.

PROFILE OF HISTORY OF FEBRILE SEIZURE IN PATIENTS WITH EPILEPSY

Background: Febrile seizure is convulsions with fever (temperature ³38°C) with no central nervous system infection that commonly found in children (6-60 months). Febrile seizures do not always mean the child has epilepsy. However, febrile seizures can be a possible long-term risk factor for epilepsy. Objective: The objective of this study is to know the profile of febrile seizure in patients with epilepsy. Methods: A retrospective descriptive study on 23 patients with epilepsy in the EEG Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia in the period 2018-2019 based on inclusion and exclusion criteria. The total number of epilepsy patients is 849 patients, 216 of whom had a history of febrile seizure. Among 216 epilepsy patients who had a history of febrile seizures, 23 of them were qualified as the sample. The sampling technique used was total population sampling. The instrument of this research is the patients’ medical record. Data analysis is carried out descriptively. Results: The characteristics of the history of febrile seizures that found in patients with epilepsy are more patients are male, have the age of onset on less than 2 years old, have the body temperature more than 38.3°C, have the seizure duration less than 15 minutes, have focal seizures, have recurrent seizures in 24 hours, have a history of more than one febrile seizure, have accompanying neurological disorders, and have no family history of epilepsy. Conclusion: Febrile seizure is still becoming a concern because there is a possibility that it may develop into epilepsy. Even though, not all children who experience febrile seizure will generate epilepsy.

Primary Central Nervous System Infection by Histoplasma in an Immunocompetent Adult: A Case Report

Histoplasma capsulatum infection is endemic in many regions around the world, including Latin America [1]. However, cerebral presentation occurs in less than 25% of patients with disseminated histoplasmosis and even rarer as a stand-alone presentation. Three forms are described: meningeal, miliary granulomatous and parenchymal with formation of “histoplasmoma” [2]. Due to the rarity of the case and unusual clinical presentation and topography we describe the case below.

Central Nervous System Infections Due to Streptococcus anginosus Group: A Single-Center Case Series

Background The Streptococcus anginosus group is known for its pathogenicity and tendency for abscess formation. The S anginosus group also causes brain abscesses, yet few studies describe this presentation in the pediatric neurology literature. We describe 5 patients with central nervous system infection due to S anginosus group evaluated by child neurologists at the University of Iowa from 2014 to 2020. Methods We performed a retrospective case series review of electronic medical records detailing the clinical presentation and course of pediatric patients with S anginosus group–associated central nervous system infection. Results We identified 4 males and 1 female (8, 11, 14, 16, and 21 years). Brain imaging showed abscesses in 4 cases and empyema in 1. All underwent neurosurgical intervention and antibiotic treatment. Cultures obtained during the neurosurgical procedure grew S anginosus group (4 cases with Streptococcus intermedius and 1 with Streptococcus constellatus). An 8-year-old boy with a delayed diagnosis died from brain herniation. Conclusions Central nervous system infections due to the S anginosus group can be life-threatening. Neuroimaging plays a key role in the early identification of abscesses. Prompt surgical intervention and timely initiation of antibiotics are critical for optimal outcomes.

Intrathecal Colistin and Intravenous Fosfomycin as a combination therapy for the treatment of Acinetobacter baumannii Ventriculitis and meningitis: a case report from Nepal

Treatment of central nervous system infection may be troublesome due to multi-drug resistance. Colistin is less successful as a treatment option due to poor CNS penetration when used intravenously. We present the successful management of a case with ventriculitis and meningitis due to MDR Acinetobacter baumannii species with the combined intraventricular administration of colistin and IV fosfomycin after the initial regimen of colistin given alone through both IVT and IV routes had failed.

Cerebral Abscess with Cranial Hypertension in Young Infants: A Case Report and Systematic Review

Objective: To report a Central Nervous System infection evolving with brain abscess and to address aspects of the treatment of the disease. Results: even with advances in treatment and diagnosis, the pathology has a high mortality. However, the best prognosis is noticed when there is a suspicion through the clinic, neuroradiological images readily available, antimicrobial therapy against commonly encountered agents, and surgical drainage procedures. One study, which combined antibiotic therapy and surgery to drain the abscess, in most of the cases, studied, demonstrated a mortality rate of 12%, and another study, a 42% mortality rate when using antibiotic therapy alone. Another reference suggests the use of antibiotic therapy alone in less severe cases with less neurological impairment. Neurological clinical sequelae can be found in up to 30% of cases. The time of antibiotic therapy still needs to be debated, as well as the surgical indication for drainage. Final Considerations: Pediatric brain abscess is an uncommon disease, still with high morbidity and mortality. Surgical drainage or excision of pediatric abscesses remains the basis of treatment both to relieve the mass effect and to provide a microbiological diagnosis. The literature demonstrates that broad-spectrum antibiotics and access to CT and MRI images decrease the rates of morbidity and mortality. It is concluded that the therapeutic approach involves the administration of broad-spectrum intravenous antibiotics and surgical drainage in more complex cases.