RESUMO
BACKGROUND: Limited data are available on childhood encephalitis in Latin America. Our study aimed to increase insight on clinical presentation, etiology and outcome of children with acute encephalitis in Costa Rica. METHODS: We conducted a prospective, observational study during an 8-month period at the Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" in Costa Rica. Case definition was according to "International Encephalitis Consortium" in children <13 years. We analyzed demographic characteristics, clinical symptoms, neurologic imaging, etiology, treatment and mortality. RESULTS: Forty patients were identified. Mean age was 5 years and 57.5% were male. Most frequently neurologic symptoms were altered mental status (100.0%), headache (57.5%) and seizures (52.5%). Etiology was determined in 52.5% of cases. Probable or confirmed viral etiology was identified in 6 cases (15.0%) and bacterial etiology in also 6 cases (15.0%). A possible etiology was identified in 7 cases (17.5%). Autoimmune encephalitis was diagnosed in 2 patients (5.0%). Enterovirus and Streptococcus pneumoniae were the most common confirmed agents. No cases of herpes simplex virus were found. Etiology of 19 cases (47.5%) remained unknown. Sequelae were reported in 45.0% of patients. Mortality rate was 15.0% (6 cases), 3 caused by virus (adenovirus, human herpesvirus 6, enterovirus), 2 by bacteria (S. pneumoniae, Haemophilus influenzae type b) and 1 of unknown etiology. Diffuse cerebral edema was the most important mortality predictor (P < 0.001). CONCLUSIONS: Acute encephalitis in our study was associated with significant morbidity and mortality. Early and aggressive antiviral, antibiotic and anticerebral edema treatment is necessary when acute encephalitis is suspected.
Assuntos
Encefalite/epidemiologia , Encefalite/microbiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Costa Rica/epidemiologia , Encefalite/imunologia , Encefalite/patologia , Enterovirus , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/virologia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Centros de Atenção TerciáriaRESUMO
One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.
Una de las principales causas de neumonía en niños entre 5 y 15 años es el Mycoplasma pneumoniae, una bacteria que causa manifestaciones clínicas atípicas como la miositis y encefalitis. Reportamos un caso de una niña de cinco años que presentó limitación funcional en extremidades inferiores precedida por una infección respiratoria superior. Posteriormente, se complicó con neumonía y encefalitis. Se administraron antibióticos y antivirales debido al deterioro clínico del paciente. La serología de inmunoglobulinas para Mycoplasma pneumoniae fue positiva; mientras que los demás estudios virales fueron negativos. El curso clínico fue favorable con disminución progresiva de la dificultad respiratoria, trastorno del sensorio y mejoría en la limitación funcional en las extremidades inferiores a los 15 días de tratamiento.
Assuntos
Encefalite/diagnóstico , Mycoplasma pneumoniae/isolamento & purificação , Miosite/diagnóstico , Pneumonia por Mycoplasma/diagnóstico , Doença Aguda , Antibacterianos/administração & dosagem , Pré-Escolar , Encefalite/tratamento farmacológico , Encefalite/microbiologia , Feminino , Humanos , Miosite/tratamento farmacológico , Miosite/microbiologia , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologiaRESUMO
Acute encephalitis is an important cause of mortality and morbidity in children. We retrospectively identified children (≤15 years of age) admitted with suspected encephalitis at the Intensive Care Unit of the Pediatric Department of Cayenne Hospital between January 2007 and December 2018. A total of 30 children with acute encephalitis were identified. The incidence rate varied from 0 to 10.40 cases/100000 children under 15 years. Proven encephalitis was diagnosed in 73% of patients. Nine cases of acute disseminated encephalomyelitis were diagnosed. The causes of infection (44%) were Haemophilus influenzae, followed by Cryptococcus spp and Varicella Zoster Virus. Four children (13%) died: one case of Streptococcus pneumoniae, one of Haemophilus influenzae, one of Mycobacterium tuberculosis and one with no identified cause. Seventeen percent of children had moderate to severe neurological sequelae. The only factor associated with poor outcome was young age at the time of hospitalization (p = 0.03). Conclusion: This study highlights both vaccine-preventable pathogens and acute disseminated encephalomyelitis as the leading causes of childhood encephalitis in French Guiana.
Assuntos
Encefalite/epidemiologia , Encefalite/etiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Cryptococcus/patogenicidade , Encefalite/diagnóstico , Encefalite/microbiologia , Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/diagnóstico , Encefalomielite Aguda Disseminada/epidemiologia , Guiana Francesa/epidemiologia , Haemophilus influenzae/patogenicidade , Herpesvirus Humano 3/patogenicidade , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Mycobacterium tuberculosis/patogenicidade , Prognóstico , Estudos Retrospectivos , Streptococcus pneumoniae/patogenicidadeRESUMO
Una de las principales causas de neumonía en niños entre 5 y 15 años es el Mycoplasma pneumoniae, una bacteria que causa manifestaciones clínicas atípicas como la miositis y encefalitis. Reportamos un caso de una niña de cinco años que presentó limitación funcional en extremidades inferiores precedida por una infección respiratoria superior. Posteriormente, se complicó con neumonía y encefalitis. Se administraron antibióticos y antivirales debido al deterioro clínico del paciente. La serología de inmunoglobulinas para Mycoplasma pneumoniae fue positiva; mientras que los demás estudios virales fueron negativos. El curso clínico fue favorable con disminución progresiva de la dificultad respiratoria, trastorno del sensorio y mejoría en la limitación funcional en las extremidades inferiores a los 15 días de tratamiento.
One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.
Assuntos
Humanos , Feminino , Pré-Escolar , Pneumonia por Mycoplasma/diagnóstico , Encefalite/diagnóstico , Mycoplasma pneumoniae/isolamento & purificação , Miosite/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/tratamento farmacológico , Doença Aguda , Encefalite/microbiologia , Encefalite/tratamento farmacológico , Antibacterianos/administração & dosagem , Miosite/microbiologia , Miosite/tratamento farmacológicoRESUMO
Harmful environmental stimuli during critical stages of development can profoundly affect behavior and susceptibility to diseases. Alzheimer disease (AD) is the most frequent neurodegenerative disease, and evidence suggest that inflammatory conditions act cumulatively, contributing to disease onset. Here we investigated whether infection early in life can contribute to synapse damage and cognitive impairment induced by amyloid-ß oligomers (AßOs), neurotoxins found in AD brains. To this end, wild-type mice were subjected to neonatal (post-natal day 4) infection by Escherichia coli (1 × 104 CFU/g), the main cause of infection in low-birth-weight premature infants in the US. E. coli infection caused a transient inflammatory response in the mouse brain starting shortly after infection. Although infected mice performed normally in behavioral tasks in adulthood, they showed increased susceptibility to synapse damage and memory impairment induced by low doses of AßOs (1 pmol; intracerebroventricular) in the novel object recognition paradigm. Using in vitro and in vivo approaches, we show that microglial cells from E. coli-infected mice undergo exacerbated activation when exposed to low doses of AßOs. In addition, treatment of infected pups with minocycline, an antibiotic that inhibits microglial pro-inflammatory polarization, normalized microglial response to AßOs and restored normal susceptibility of mice to oligomer-induced cognitive impairment. Interestingly, mice infected with by E. coli (1 × 104 CFU/g) during adolescence (post-natal day 21) or adulthood (post-natal day 60) showed normal cognitive performance even in the presence of AßOs (1 pmol), suggesting that only infections at critical stages of development may lead to increased susceptibility to amyloid-ß-induced toxicity. Altogether, our findings suggest that neonatal infections can modulate microglial response to AßOs into adulthood, thus contributing to amyloid-ß-induced synapse damage and cognitive impairment.
Assuntos
Disfunção Cognitiva/microbiologia , Encefalite/microbiologia , Infecções por Escherichia coli/complicações , Microglia/metabolismo , Sinapses/efeitos dos fármacos , Peptídeos beta-Amiloides , Animais , Animais Recém-Nascidos , Encéfalo/crescimento & desenvolvimento , Encéfalo/imunologia , Encéfalo/microbiologia , Células Cultivadas , Disfunção Cognitiva/induzido quimicamente , Suscetibilidade a Doenças/etiologia , Feminino , Masculino , Camundongos , Microglia/citologia , Microglia/efeitos dos fármacos , Sinapses/metabolismo , Sinapses/patologia , Fatores de TempoRESUMO
The aim of our study was to describe the clinical features, the etiologies, and the factors associated with poor outcome of encephalitis in French Guiana. Our study was retrospective, including all cases of encephalitis hospitalized in the Cayenne General Hospital, from January 2007 to July 2017. Patients were included through the 2013 encephalitis consortium criteria and the outcome was evaluated using the Glasgow outcome scale at 3 months from the diagnosis of encephalitis. We included 108 patients, giving an approximate incidence rate of four cases/100,000 inhabitants/year. The origin of the encephalitis was diagnosed in 81 cases (75%), and 72 of them (66.7%) were from an infectious origin. The most common infectious causes were Cryptococcus sp. (18.5%) independently of the immune status, Toxoplasma gondii (13.9%), and Streptococcus pneumoniae (5.5%). In the follow-up, 48 patients (46.6%) had poor outcome. Independent risk factors associated with poor outcome at 3 months were "coming from inside area of the region" (P = 0.036, odds ratio [OR] = 4.19; CI 95% = 1.09-16.06), need for mechanical ventilation (P = 0.002, OR = 5.92; CI 95% = 1.95-17.95), and age ≥ 65 years (P = 0.049, OR = 3.99; CI 95% = 1.01-15.89). The most identified cause of encephalitis in French Guiana was Cryptococcus. The shape of the local epidemiology highlights the original infectious situation with some local specific pathogens.
Assuntos
Criptococose/epidemiologia , Encefalite/epidemiologia , Meningoencefalite/epidemiologia , Infecções Pneumocócicas/epidemiologia , Toxoplasmose/epidemiologia , Adolescente , Adulto , Criptococose/microbiologia , Criptococose/mortalidade , Cryptococcus/isolamento & purificação , Cryptococcus/patogenicidade , Encefalite/microbiologia , Encefalite/mortalidade , Encefalite/parasitologia , Feminino , Guiana Francesa/epidemiologia , Escala de Resultado de Glasgow , Humanos , Incidência , Masculino , Meningoencefalite/microbiologia , Meningoencefalite/mortalidade , Meningoencefalite/parasitologia , Pessoa de Meia-Idade , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/mortalidade , Respiração Artificial , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Análise de Sobrevida , Toxoplasma/isolamento & purificação , Toxoplasma/patogenicidade , Toxoplasmose/mortalidade , Toxoplasmose/parasitologiaRESUMO
Some authors have reported the association between CMC and brain aneurysms. In this paper it is reported a fusiform brain aneurysm associated to CMC and the vessel wall MRI findings.
Assuntos
Candidíase Mucocutânea Crônica/diagnóstico , Encefalite/microbiologia , Aneurisma Intracraniano/microbiologia , Adolescente , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/microbiologia , Artéria Carótida Interna , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Encefalite/diagnóstico , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética/métodos , Imagem Multimodal/métodosRESUMO
A pastured 2-y-old cross-breed bull developed brainstem encephalitis (rhombencephalitis); Listeria monocytogenes was isolated from the brain. In the brainstem, there was perivascular cuffing, multiple microabscesses, and positive immunostaining for L. monocytogenes. Samples of bovine feces, water, feedstuffs, milking parlor soil, and bulk tank milk were collected from the dairy farm. Seven isolates of the genus Listeria were obtained, 6 of L. innocua and 1 of L. monocytogenes, which was found in the pasture where the bull grazed. Both isolates belonged to serotype 4b and were positive for internalins A, C, and J. According to the DNA fragment patterns of pulsed-field gel electrophoresis, the isolates were closely related. The source of infection was the pasture, implying that listeriosis should not be discounted in cases with compatible clinical signs but the absence of silage feeding.
Assuntos
Doenças dos Bovinos/diagnóstico , Encefalite/diagnóstico , Listeria monocytogenes/isolamento & purificação , Listeriose/veterinária , Ração Animal/microbiologia , Criação de Animais Domésticos , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Diagnóstico Diferencial , Eletroforese em Gel de Campo Pulsado/veterinária , Encefalite/microbiologia , Listeria monocytogenes/genética , Listeriose/diagnóstico , MasculinoRESUMO
This article describes the clinical, pathological, and immunohistochemical findings associated with Cryptococcus neoformans var. grubii in a 4-year-old female Boxer dog from Uberlândia, Minas Gerais, Southeastern Brazil. Clinically, there was a swelling at the right metatarsal region and the hock joint with enlargement of regional lymph nodes. Radiographical evaluation revealed lysis of the tarsal bone; cytology demonstrated cryptococcal intralesional organisms at the swollen joint. Despite empirical antifungals therapeutic, the animal developed neurological cryptococcosis and died spontaneously. Significant pathological alterations included arthritis, lymphadenitis, and encephalitic cryptococcomas associated with numerous intralesional narrow-necked budding encapsulated yeasts. Immunohistochemistry utilising monoclonal antibodies that label C. neoformans sp. complex capsule, characterised the yeasts as C. neoformans var. grubii. Collectively, the pathological and immunohistochemical findings of this dog indicate that the intralesional organisms observed within the articular surface of the hock joint, lymph nodes, and the brain were C. neoformans var. grubii, confirming the participation of this fungal pathogen in the development of cryptococcal arthritis. In this case, the most likely pathogenesis was percutaneous inoculation with resultant abscess-like lesion, which resulted in the draining sinus, swelling of the right hind limb with progression to the articular disease. Thereafter, the fungal pathogen probably compromised the adjacent lymph nodes with subsequent haematogenous distribution to the brain, terminating with cryptococcal arthritis, lymphadenitis, and encephalitis.
Assuntos
Artrite/veterinária , Criptococose/veterinária , Cryptococcus neoformans/isolamento & purificação , Doenças do Cão/diagnóstico , Doenças do Cão/patologia , Encefalite/veterinária , Animais , Artrite/diagnóstico , Artrite/microbiologia , Artrite/patologia , Brasil , Criptococose/diagnóstico , Criptococose/microbiologia , Criptococose/patologia , Técnicas Citológicas , Doenças do Cão/microbiologia , Cães , Encefalite/diagnóstico , Encefalite/microbiologia , Encefalite/patologia , Feminino , Histocitoquímica , Imuno-Histoquímica , MicroscopiaRESUMO
Introducción: El estudio etiológico de las infecciones del sistema nervioso central se ha realizado tradicionalmente con cultivos bacterianos y con reacción en cadena de la polimerasa (PCR) para virus herpes simple (VHS). Los cultivos bacterianos pueden disminuir su rendimiento en pacientes que hayan usado antibióticos previos a la toma de muestra, y el solicitar PCR solo para virus VHS reduce el diagnóstico etiológico a un solo agente. El objetivo de este trabajo fue determinar las causas infecciosas en meningitis y encefalitis en niños, utilizando conjuntamente la microbiología convencional y la biología molecular, con el fin de mejorar el diagnóstico etiológico de estas enfermedades. Pacientes y método: Se estudiaron 19 pacientes con sospecha de meningitis y encefalitis, de manera prospectiva, hospitalizados en el hospital Luis Calvo Mackenna en Santiago de Chile, entre el 1 de marzo de 2011 y el 30 de marzo de 2012. Luego de obtener el consentimiento informado, a las muestras de LCR se les realizó examen citoquímico, cultivo, PCR múltiple bacteriana (N. meningitidis, S. pneumoniae, H. influenzae) y PCR en tiempo real para HSV-1 y 2, VVZ, VEB, CMV, VHH-6 y enterovirus. Se recabaron datos clínicos y epidemiológicos desde la ficha clínica del paciente. Resultados: De los 19 pacientes analizados 2 (10%) fueron diagnosticados por métodos microbiológicos convencionales y 7 (37%) al adicionar biología molecular (p = 0,02). Tres pacientes presentaron meningitis por S. pneumoniae, uno por Enterobacter cloacae, 2 pacientes meningoencefalitis por VHS-1 y uno meningitis por VVZ. Conclusiones: La adición de la PCR a los métodos microbiológicos convencionales de diagnóstico en las infecciones del sistema nervioso central aumenta significativamente la probabilidad de detectar el agente causal. La incorporación rutinaria del diagnóstico molecular permitiría un manejo más oportuno y racional.
Introduction: The aetiological study of infections of the central nervous system has traditionally been performed using bacterial cultures and, more recently, using polymerase chain reaction (PCR) for herpes simplex virus (HSV). Bacterial cultures may not have good performance, especially in the context of patients who have received antibiotics prior to sampling, and a request for HSV only by PCR reduces the information to only one aetiological agent. The aim of this study is to determine the infectious causes of meningitis and encephalitis, using traditional microbiology and molecular biology to improve the aetiological diagnosis of these diseases. Patients and method: A prospective study was conducted on 19 patients with suspected meningitis, admitted to the Luis Calvo Mackenna Hospital in Santiago, Chile, from March 1, 2011 to March 30, 2012. After obtaining informed consent, the CSF samples underwent cytochemical study, conventional culture, multiplex PCR for the major producing bacterial meningitis (N. meningitidis, S. pneumoniae, H. influenzae), real-time single PCR for HSV-1 and 2, VZV, EBV, CMV, HHV-6 and enterovirus. Clinical and epidemiological data were also collected from the clinical records. Results: Of the 19 patients analysed, 2 were diagnosed by conventional methods and 7 by adding molecular biology (increase to 37%). Three patients had meningitis due to S. pneumoniae, one due to Enterobacter cloacae, 2 patients meningoencephalitis HSV-1, and one VZV meningitis. Conclusions: The addition of PCR to conventional diagnostic methods in CNS infections increases the probability of finding the causal agent. This allows a more adequate, timely and rational management of the disease.