MOG antibody associated disorder (MOGAD)

The existence of antibodies to myelin oligodendrocyte glycoprotein (MOG) in some patients with CNS demyelinating disease has been recognised for 30 years, but their clinical utility as biomarkers, and potential pathogenicity in humans has only become apparent in the past 15 years. The advent of more precise live cell-based assays for antibody detection in serum and cerebrospinal fluid (CSF) has greatly refined the clinical phenotype of demyelinating diseases associated with MOG antibodies. Distinct patterns of MOG antibody associated disorder (MOGAD) include acute disseminated encephalomyelitis (ADEM) in children; and overlap with neuromyelitis optica spectrum disorders (including classical Devic’s presentations), optic neuritis, transverse myelitis, and focal encephalitis in both children and adults. A number of other rare presentations have also been described. Here we summarise what is currently known of the pathophysiology, clinical presentation and management of MOGAD.

USUTU VIRUS: AN EMERGING FLAVIVIRUS IN EUROPE

Among various arthropod-borne viruses (arboviruses), the flaviviruses stand out with regard to their number, geographic distribution and importance in both human and veterinary medicine. West Nile virus is flavivirus, present endemic in many European countries as well as in Serbia where it circulates in horses, birds, humans and mosquitoes. Usutu virus (USUV) is flavivirus morphologically, antigenically, genetically and ecologically very similar to WNV, which circulates in neighbouring countries (Hungary, Croatia, Austria). The USUV is maintained in transmissible cycle between birds and mosquitoes mainly from the genus Culex. Mammals (humans, horses, rodents) can also be infected. Humans and other mammals are “dead end” hosts. Virus is isolated from numerous bird species. The USUV infections are asymptomatic in wild African birds, while for European birds, the virus is very virulent causing necrotizing focal encephalitis, degenerative myocarditis and fatal encephalitis. It is assumed that the virus was introduced into Europe by the migratory birds that have been infected by living or passing through endemic areas in Africa. First human cases were recorded in Italy in 2009. The genome of USUV was detected in cerebrospinal fluid of woman suffering from B-cell lymphoma with meningoencephalitis and in plasma of a female, who was subjected to a liver transplantation and subsequently developed fever, headache, and fulminant hepatitis which progressed to coma. In Austria, USUV infections were confirmed in people with a skin rash of unknown aetiology using plaque reduction neutralization test. The circulation of USUV has been proven in humans in many European countries by serological studies (Germany, Italy, and Croatia). Serological study performed in 2015 revealed that USUV is present in inhabitants of South Bačka District of Vojvodina, Serbia. Serum samples were tested using commercial ELISA IgG test for USUV and IgG antibodies against USUV were detected in 5% (4/88) of patients. The molecular investigation included 216 pools of mosquitoes collected in the period from June to September, in the South Bačka District. The USUV genome was detected in two mosquito pools (2/216). In human samples tested by RT PCR, USUV genome was not found.

Teaching Electroencephalography: Persistent Altered Sensorium with Ominous Appearing Electroencephalographic Activity

A 51-year-old man presented with persistent altered sensorium following a seizure. His magnetic resonance imaging (MRI) showed features of focal encephalitis involving the left temporal, parietal, and occipital regions. His electroencephalogram (EEG) showed ongoing epileptiform discharges over the left hemisphere. This article discusses dilemmas in the diagnosis of nonconvulsive status epilepticus in such a case scenario.

Focal Encephalitis, Meningitis, and Acute Respiratory Distress Syndrome Associated with Influenza A Infection

Objective: To present a case of influenza A infection complicated with focal encephalitis, meningitis, and acute respiratory distress syndrome. Clinical Presentation and Intervention: A 35-year-old woman presented with fever, headache, cough, and body aches. Seizures, altered consciousness, and dyspnea occurred later. A nasopharyngeal swab revealed a positive reaction for the influenza A antigen. Magnetic resonance imaging scans showed a T2 prolongation in the left frontoparietal subcortical white matter, which was consistent with focal encephalitis. She recovered after treatment with oseltamivir and antibiotics. Conclusion: This case report highlights focal encephalitis with concomitant pulmonary complications after influenza A infection.