Daily Life and Challenges Faced By Households With Permanent Childhood Developmental Disability in Rural Tanzania – A Qualitative Study

Severe developmental disability in children affects the life of the child and entire household. We conducted a qualitative study to understand how caregivers manage severe developmental disabilities in children in rural Africa. Families and six children (out of 15 children) who had serious permanent sequelae from a cerebral infection in Handeni, Tanzania, were contacted and invited to a workshop to recount their experience living with severe developmental disabilities. After consent, individual interviews were conducted first through recording of individual digital stories and then through individual semi-structured interviews. Pre-determined key categories were used to analyse the data. Our results showed that developmental disabilities required constant care and reduced the autonomy of the children. Schooling had not been attempted or was halted because of learning problems or inability to meet specialized school costs. Parents were under constant physical, emotional and financial stress. Their occupational earnings decreased. Some families sold their assets to survive. Others began to rely on relatives. Understanding the consequences of developmental disability helps to identify where social support should be focused and improved.

COVID-19 related Psychotic Disorder: Symptomatology in Infected and Uninfected Patients

Introduction: Psychotic disorder has been rarely reported in patients with COVID-19 infection and also in patients affected by the pandemic but who do not have COVID-19 infection. It is unclear if the disorder occurs due to the stress of the pandemic or is due to a cerebral infection of the virus.Methods: on PubMed we searched for all reports of patients who developed a new psychosis during the COVID-19 pandemic to review their symptomatology.Results: Psychotic symptoms were similar in onset, description, duration and severity in patients who had been infected and those who were affected by the pandemic but did not have the infection. In both groups, most patients were young, without previous psychiatric history, had experienced severe external stress due to the pandemic, had an abrupt onset of symptoms, had severe hallucinations and delusions and needed psychiatric hospitalization. The disorder commonly lasted about a week, after which anti-psychotic medications could be stopped.Conclusion: External psychological stress and not cerebral COVID-19 infection is the likely cause of psychotic disorder in both infected and uninfected patients.

The Added Value of Cerebral Imaging in Patients With Pyogenic Spinal Infection

Background: The incidence of pyogenic spinal infection has increased in recent years. In addition to treatment of the spinal infection, early diagnosis and therapy of coexisting infections, especially of secondary brain infection, are important. The aim of this study is to elucidate the added value of routine cerebral imaging in the management of these patients.Methods: This was a retrospective single-center study. Cerebral imaging consisting of cerebral magnetic resonance imaging (cMRI) was performed to detect brain infection in patients with a primary pyogenic spinal infection.Results: We analyzed a cohort of 61 patients undergoing cerebral imaging after diagnosis of primary pyogenic spinal infection. The mean age in this cohort was 68.7 years and the gender distribution consisted of 44 males and 17 females. Spinal epidural abscess was proven in 32 (52.4%) patients. Overall positive blood culture was obtained in 29 (47.5%) patients, infective endocarditis was detected in 23 (37.7%) patients and septic condition at admission was present in 12 (19.7%) Patients. Coexisting brain infection was detected in 2 (3.3%) patients. Both patients revealed clinical signs of severe sepsis, reduced level of consciousness (GCS score 3), were intubated, and died due to multi-organ failure.Conclusions: Brain infection in patients with spinal infection is very rare. Of 61 patients with pyogenic spinal infection, two patients had signs of cerebral infection shown by imaging, both of whom were in a coma (GCS 3), and sepsis.

Dental Management of a Patient with a Left Temporal Brain Abscess: A Case Report

Cerebral abscesses of odontogenic origin are uncommon. Cerebral abscesses are often caused by cardiac and pulmonary disease or infections such as skin or abdominal infections. However, there have been some reported incidences of cerebral abscesses caused by odontogenic infection. This paper aims to discuss a case report whereby an odontogenic infection was the most probable cause of a cerebral abscess in a paediatric patient. CPD/Clinical Relevance: To discuss the importance of oral disease as a potential causative factor for cerebral infection.

“Proposals for Amendments in the Diagnosis and Treatment of Encephalitis caused by Free-living Amoebae”

Encephalitis caused by Free-living amoebae (FLA) has a mortality rate of around 95- 98%, a fraction that has not changed in the past decades. Pathogenic FLA include Acanthamoeba, Balamuthia mandrillaris, and Naegleria fowleri that are known to target the brain after an extra cerebral infection in the case of Acanthamoeba and Balamuthia mandrillaris, or directly the brain, as in the case of the Naegleria fowleri. The Acanthamoeba spp. and Balamuthia mandrillaris cause granulomatous amoebic encephalitis (GAE) while Naegleria fowleri, the so termed “brain eating amoeba” causes primary amoebic meningoencephalitis (PAM). The attempts to obtain a speedy diagnosis and an aggressive treatment protocol are the areas where advances can make a difference and reduce the mortality rates. At first, we highlight the reasons behind the diagnostic delays and treatment failures and provide proposals to establish a quick diagnosis in both PAM and GAE. Secondly, we emphasize the use of a transcribrial device, and a prompt, but vigilant surgical reduction of the intracranial pressure in these patients which could be life-saving. We also debate that an exudate obtained from the olfactory region by irrigation via a modified transcribrial device or by conventional methods, instead of a cerebrospinal fluid sample, could serve as a source of obtaining amoeba in PAM for a real-time polymerase chain reaction-based definitive diagnosis of PAM. Also, introduced is the rationale that has the potential to deliver the drugs to the brain in patients with PAM and the GAE localized to the frontal lobe of the brain, by bypassing the blood brain barrier. We put forward these proposals for debate and deliberation to our fellow colleagues in order to spot the potential of their application to reduce the mortality rates caused by the rare but fatal encephalitis caused by these FLA.

Isavuconazole therapy of disseminated and encephalic Saprochaete capitata infection in an acute myeloid leukemia patient treated with midostaurin.

BACKGROUND Saprochaete capitata is a rare and emerging opportunistic fungus, involving immunocompromised hosts, in particular neutropenic patients after chemotherapy. CASE REPORT We report a case of disseminated and cerebral infection by Saprochaete capitata, in a 68-year-old woman affected by acute myeloid leukemia that was successfully managed with liposomal amphotericin B and isavuconazole. CONCLUSION this case illustrates the feasibility of isavuconazole therapy in the treatment of a S.capitata infection when co-administered with midostaurin.

Phaeohyphomycosis

Phaeohyphomycosis refers to infections due to a large group of heterogenous organisms called “dematiaceous” or “melanized” fungi. These fungi are distinguished by the predominance of melanin in their cell walls, which likely acts as a virulence factor. Virtually, everyone is exposed to dematiaceous fungi through inhalation, as they are ubiquitous in the environment, although the development of infection is extremely uncommon. Invasive disease is rare but remains important due to the ability to cause serious disease in immunocompetent and immunocompromised hosts, unlike other fungal infections such as aspergillosis. A large variety of invasive manifestations can be caused by these organisms, including deep local infections, pulmonary infection, cerebral infection, and disseminated disease, which is associated with high mortality. While advances in molecular techniques are promising, they have still not replaced histology and culture as the primary diagnostic tools. Therapy is not standardized and is based primarily on clinical experience from descriptive case reports.