Update in Diagnostics of Toscana Virus Infection in a Hyperendemic Region (Southern Spain)

The sandfly fever Toscana virus (TOSV, genus Phlebovirus, family Phenuiviridae) is endemic in Mediterranean countries. In Spain, phylogenetic studies of TOSV strains demonstrated that a genotype, different from the Italian, was circulating. This update reports 107 cases of TOSV neurological infection detected in Andalusia from 1988 to 2020, by viral culture, serology and/or RT-PCR. Most cases were located in Granada province, a hyperendemic region. TOSV neurological infection may be underdiagnosed since few laboratories include this virus in their portfolio. This work presents a reliable automated method, validated for the detection of the main viruses involved in acute meningitis and encephalitis, including the arboviruses TOSV and West Nile virus. This assay solves the need for multiple molecular platforms for different viruses and thus, improves the time to results for these syndromes, which require a rapid and efficient diagnostic approach.

Fatal Case of COVID-19 Pneumonia Associated with Acute Myelopathy

In December 2019, a novel coronavirus outbreak with multiple system involvement started initially in Wuhan City, Hubei Province of China. Coronavirus disease 2019 (COVID-19) infection is a systemic disorder typically presenting with fever, fatigue, and upper and lower respiratory symptoms, although neurological manifestations are increasingly reported, but pathological mechanisms have yet to be established. The symptoms of infection with COVID-19 are dependent on the patient’s age and underlying medical illness, and on the condition of the immune system. Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. We herein report a patient infected with COVID-19 who developed pneumonia associated with acute progressive myelopathy. Neurological examination revealed progressive flaccid areflexic paralysis of lower limbs over 3 days with retention of urine and sensory level at 10th spinal thoracic segment (T10). The patient had a positive nasopharyngeal swab for COVID-19 at the onset of the neurological symptoms. This case of acute progressive myelopathy adds further evidence of the complications of severe COVID-19 infection, and we are dealing with a virus of unpredictable behavior. Since this virus neurotropism is not clear yet, further investigations should be conducted on the mechanism of possible neurological infection in patients with COVID-19.

Aseptic meningitis in children: seasonal variation and diagnostic problems as reflected in the authors’ experiences from 2017–2018

Meningitis is the most common infectious disease of the central nervous system both in children and in adults. The incidence of the disease in Poland, similar to Western Europe, is 6–8 cases per 100,000/year, with the highest figure for children up to 4 years of age. Aim of the study: The aim of the study was to make a detailed analysis of aseptic meningitis cases in children, with a focus on aetiology and course of the disease, and laboratory results. Materials and methods: A retrospective analysis was performed on a group of 59 children aged between 2.5 months and 17 years in whom aseptic meningitis was diagnosed based on clinical evaluation. Results: Between May and October 2018, 44 children aged 7.99 ± 3.93 were hospitalised with the diagnosis of nonpyogenic (aseptic) meningitis. In 9 patients (20.5%), enteroviral neurological infection was found, and in 8 (18.2%) Borrelia burgdorferi, in 5 (11.3%) EBV and in 2 (4.5%) HHV-7 neurological infection was diagnosed. For 20 children (45.5%), the cause of infection could not be established. The longest hospitalisation time was associated with Lyme neuroborreliosis. In the same months of 2017, 15 patients were hospitalised at our department with aseptic meningitis. The numbers of cases for different causes were: undetermined – 9 patients (60%), enteroviral – 2 (13%), EBV – 2 (13%), Parvovirus B19 – 1 patient (7%) and VZV – 1 patient (7%). Conclusions: In 2018, a threefold increase was observed in the number of hospitalisations associated with aseptic meningitis in relation to the same period of 2017, with a lasting predominance of boys. Most frequently, the aetiology was undetermined. Among the cases in which the cause was established, the most common aetiology was enteroviral. In 2018, unlike in 2017, cases of hospitalisation for neuroborreliosis were recorded. Incomplete utilisation of the polymerase chain reaction method was considered to be one of the causes of insufficient identification of neurotropic pathogens. A general examination of the cerebrospinal fluid did not differentiate between causes of aseptic meningitis.

Atypical presentation of right-sided native valve infective endocarditis

A previously healthy 55-year-old man presented to hospital with 10 days of progressive dyspnea with fever, night sweats, and a productive cough and no history of recreational drug use or occupational or animal exposures. His wife had developed similar symptoms 2 weeks earlier but had since recovered. Physical exam revealed a new systolic murmur best heard at the left lower sternal border. Transesophageal echocardiogram demonstrated severe tricuspid regurgitation with a small vegetation. Blood cultures were positive for non-typeable Haemophilus influenzae. This case illustrates the necessity of both timely and proficient diagnosis of H. influenzae infection and the unique challenges associated with detecting H. influenzae–related pathology. Clinicians should be aware of the variable presentations of Haemophilus infection, including respiratory infection, neurological infection, and infective endocarditis. Given the fastidious nature of H. influenzae and variability between subtype pathogenicity, microbiology laboratories require tools to culture and differentiate Haemophilus species.

A Patient of Neurocysticercosis Misdiagnosed as Tuberculous Meningitis for 26 Years: a Case Report

Background: Neurocysticercosis (NCC) is a neurological infection caused by the larval stage of the tapeworm Taenia solium (T. solium). The diagnosis of NCC can be challenging because of heterogeneity in clinical manifestation. Neurocysticercosis is easily misdiagnosed as tuberculous meningitis (TBM).Case presentation: We describe a case of subarachnoid neurocysticercosis with 28 years illness course misdiagnosed as TBM for 26 years. The patient presented with symptoms of repeated headache, fever, serious low back and legs pain, and vomiting, occasional seizure and lose of consciousness. The neurological assessments revealed stiff neck and right plantar and saddle numbness. Lumbar puncture results revealed obvious intracranial hypertension, pleocytosis, elevated protein level, and decreased glucose level. Magnetic resonance imaging showed meningeal enhancement of brain, cystlike structure in the lumbosacral sac and the clumping of the nerve roots of the cauda equina. Five recurrent episodes occurred in twenty-eight years. TBM was considered as a probable etiology and was treated for tuberculosis empirically with adjunctive corticosteroids for 26 years. In the first three hospitalizations, During this period, the patient was hospitalized three times. In 2016, The local hypertrophic pachymeningitis were considered as a probable etiology. She was treated with steroid pulse therapy. At her fifth relapse, in 2018, next-generation sequencing of cerebrospinal fluid (CSF) identified the patient was NCC, T. solium infection. Her symptoms and CSF examination were relieved after etiological treatment. Conclusions: Neurocysticercosis is easily misdiagnosed as TBM. Meanwhile, adjunctive corticosteroids therapy can alleviate the symptom of TBM and NCC. So we suggest that NCC should be considered in the differential diagnosis of TBM. NGS of CSF is a promising tool for the diagnosis of NCC.

Infection of Brain Organoids and 2D Cortical Neurons with SARS-CoV-2 Pseudovirus

Since the global outbreak of SARS-CoV-2 (COVID-19), infections of diverse human organs along with multiple symptoms continue to be reported. However, the susceptibility of the brain to SARS-CoV-2, and the mechanisms underlying neurological infection are still elusive. Here, we utilized human embryonic stem cell-derived brain organoids and monolayer cortical neurons to investigate infection of brain with pseudotyped SARS-CoV-2 viral particles. Spike-containing SARS-CoV-2 pseudovirus infected neural layers within brain organoids. The expression of ACE2, a host cell receptor for SARS-CoV-2, was sustained during the development of brain organoids, especially in the somas of mature neurons, while remaining rare in neural stem cells. However, pseudotyped SARS-CoV-2 was observed in the axon of neurons, which lack ACE2. Neural infectivity of SARS-CoV-2 pseudovirus did not increase in proportion to viral load, but only 10% of neurons were infected. Our findings demonstrate that brain organoids provide a useful model for investigating SARS-CoV-2 entry into the human brain and elucidating the susceptibility of the brain to SARS-CoV-2.

Neuroinfections: Presentation, Diagnosis, and Treatment of Meningitis and Encephalitis

Neuroinfections cause significant morbidity, mortality, and long-term disability. These infections rarely present with the classic signs and symptoms taught in textbooks. Due to the similarities in presentation between neuroinfections and many other disease processes, delayed diagnosis is common. Thus, it is important that care providers have a high clinical suspicion for potential cases because early diagnosis and treatment can significantly improve outcomes. This article serves as a review of the approach to a patient with suspected neurological infection with an emphasis on clinical presentation, diagnosis, and treatment of the major causes of meningitis and encephalitis. Additionally, patients in an immunocompromised state are vulnerable to a whole host of additional neuroinfections that present atypically and will also be addressed.