Fatality Case in a Tuberculous Meningoencephalitis Patient Coinfected with COVID-19

: Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.

Cytomegalovirus Encephalitis with Decreased Vision in Immunocompromised Patients Treated with Valganciclovir: Case Report

Introduction: Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in patients with Acquired Immune Deficiency Syndrome (AIDS). Almost all Human Immunodeficiency Virus (HIV) infected patients develop CMV rapidly with manifestation in the central nervous system. Most CMV encephalitis is preceded by the presence of CMV in other places. Therefore, immediate therapy will be more effective and the delay in therapy can be detrimental. Case: A 40-year-old man with the major complaint of vision decrease in both eyes for 3 months claimed that he felt worse after 7 days, accompanied by headache and fever. This patient was diagnosed with HIV 2 years ago. The examination obtained GCS 456, negative meningeal sign, headache with NRS 7. The visual acuity of the right eye was negative light perception and in the left eye of vision 1/300. The patient experienced clinical improvement after oral Valganciclovir therapy with a dose of 2x450 mg. Conclusion: CMV encephalitis must be considered to diagnose earlier in HIV patients with complaints of decreased vision. With valganciclovir 2x450 mg tablets improve reduction of headache scale NRS from 7 to 2, increasing left eye vision from 1/300 to 6/60. Keywords: Encephalitis CMV, HIV, Valganciclovir.

Multiple Viral Co-infections in a Pediatric Patient of Acute Encephalitis Syndrome (AES) - An Unique Case Report

The occurrence of viral co-infection is always a challenging issue in pediatrics which indicates underestimation of causal viral pathogens. A 6-year-old girl child from Patna had diagnosed a rare case of multi-viral co-infection in February 2020. She was manifested with oblivion along with high-grade fever, weakness, nasal bleed, headache, and body ache. She had altered sensorium with mildly dilated pupils. Her three classical meningeal sign i.e. Kernig's sign, Brudzinski's sign, and nuchal rigidity were found positive. She clinically investigated with a strong suspicion of viral infectivity. Awfully, she was diagnosed with multi-viral co-infection including Japanese Encephalitis, Dengue, Chikungunya, Cytomegalovirus, and Rubella where as HSV and VZV detected borderline. The IgM detection for JE using the CSF sample was found equivocal. The infection was also confirmed by CECT brain scanning. She got proper medication including antiemetic, antipyretic, antiepileptic drugs, antibiotics, anti-viral drugs, and 20% Mannitol for reducing the intra cranial pressure. After medication under proper clinical supervision, she improved completely with any seizures and viral infections. She advised for follow-up after a month. Such occurrences of multi-viral co-infections deserve proper attention and awareness among the healthcare experts about the severity of drugs.

Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India

ABSTRACTCentral nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. Aims and objectives: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis. Methods and Materials: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test). Results: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction. Conclusion: Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.