RESUMO
Las enfermedades causadas por amebas de vida libre son infecciones oportunistas que pueden tener un curso fatal. Pueden producir afecciones diseminadas graves con compromiso del sistema nervioso central, como la encefalitis amebiana granulomatosa. Esta infección es cada vez más frecuente en América Latina, aunque se reconocen tardíamente debido a la similitud con otras patologías o porque es inusual incluirla en el diagnóstico diferencial. Comunicamos un caso fatal de una encefalitis amebiana granulomatosa por Balamuthia mandrillaris en una niña de 10 años. Destacamos la gravedad de la afectación cerebral y la falta de esquemas antimicrobianos validados para su tratamiento. Hoy en el mundo esta infección es considerada una enfermedad emergente, influenciada por el cambio climático, lo que llama a estar atentos a su presencia.
Diseases caused by free-living amoebae are opportunistic infections that can have a fatal course. They can cause very serious disseminated conditions with involvement of the central nervous system such as granulomatous amoebic encephalitis. This infection has become more common in Latin America, although its recognition is late due to the similarity with other pathological conditions or because it is unusual to include it in the differential diagnosis. We report a fatal case of granulomatous amoebic encephalitis due to Balamuthia mandrillaris in a 10-year-old girl. We highlight the severity of the brain involvement and the lack of validated schemes for its treatment. Today in the world this infection is considered an emerging disease, influenced by climate change, which calls for being attentive to its presence.
Assuntos
Humanos , Feminino , Criança , Encefalite Infecciosa/diagnóstico , Amebíase/diagnóstico , Tomografia Computadorizada por Raios X , Análise de Sequência de DNA , Evolução Fatal , Balamuthia mandrillaris/isolamento & purificação , Balamuthia mandrillaris/genética , Encefalite Infecciosa/diagnóstico por imagem , Amebíase/diagnóstico por imagemRESUMO
Granulomatous amoebic encephalitis caused by free-living amoebae is a rare condition that is difficult to diagnose and hard to treat, generally being fatal. Anti-amoebic treatment is often delayed because clinical signs and symptoms may hide the probable causing agent misleading the appropriate diagnostic test. There are four genera of free-living amoeba associated with human infection, Naegleria, Acanthamoeba sp., Balamuthia and Sappinia. Two boys were admitted with diagnosis of acute encephalitis. The history of having been in contact with swimming pools and rivers, supports the suspicion of an infection due to free-living amoebae. In both cases a brain biopsy was done, the histology confirmed granulomatous amoebic encephalitis with the presence of amoebic trophozoites.
Assuntos
Amebíase/diagnóstico , Encefalite Infecciosa/diagnóstico , Encefalite Infecciosa/etiologia , Adolescente , Amebíase/patologia , Evolução Fatal , Granuloma/etiologia , Humanos , Encefalite Infecciosa/patologia , Masculino , PeruRESUMO
Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus. Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.
Assuntos
Encefalite Infecciosa/diagnóstico , Meningite/diagnóstico , Meningoencefalite/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Encefalite Infecciosa/epidemiologia , Encefalite Infecciosa/microbiologia , Masculino , Meningite/epidemiologia , Meningite/microbiologia , Meningoencefalite/epidemiologia , Meningoencefalite/microbiologia , México , Técnicas Microbiológicas/métodos , Técnicas de Diagnóstico Molecular/métodosRESUMO
Resumen Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus.
Abstract Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Encefalite Infecciosa/diagnóstico , Meningite/diagnóstico , Meningoencefalite/diagnóstico , Estudos Transversais , Técnicas Microbiológicas/métodos , Técnicas de Diagnóstico Molecular/métodos , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Encefalite Infecciosa/microbiologia , Encefalite Infecciosa/epidemiologia , Hospitais , Meningite/microbiologia , Meningite/epidemiologia , Meningoencefalite/microbiologia , Meningoencefalite/epidemiologia , MéxicoRESUMO
Background: Candida spp. are pleomorphic fungi that are commensal inhabitants of the oral, gastrointestinal, upper respiratory and urogenital mucosa of mammals. Candida albicans is described as the most important species. This opportunistic pathogen may produce local or systemic infections in dogs. Local infections have been reported in several tissues and systemic infection is rare in dogs with few reports in the literature describing this presentation. The aim of the present study was to report two cases of cerebral Candida albicans infection in dogs in Brazil.Case: Two cases of cerebral Candida albicans infection in dogs that showed nervous signs are described. In both cases, the brain showed marked asymmetry of the telencephalic hemispheres with multifocal to coalescing yellowish or reddish areas and a partial loss of distinction between gray and white matter. In Case 1, the mediastinal, tracheobronchial and mesenteric lymph nodes, as well as the right kidney and adrenal gland, showed altered architecture due to numerous whitish gray nodules. Histological lesions were characterized by granulomatous (case 1) or pyogranulomatous (case 2) necrotizing meningoencephalitis with intralesional fungal organisms. In case 1, similar granulomatous infiltrate with intralesional fungal organisms was also seen in the lymph nodes, kidney and adrenal gland. In case 2, there was evidence consistent with an underlying infection of canine distemper virus. Were observed lymphoplasmocytic interstitial pneumonia, lymphoid rarefaction in lymph nodes, and viral intracytoplasmic inclusion bodies in the epithelial cells of the stomach and vesical urothelium. In these two cases, the fungal organisms displayed three different morphological patterns. The first pattern was characterized by delicate tubular structures with thin parallel walls that were rarely septate and tended to undulate slightly, and measured approximately 4-20 µm (true hyphae).[...]
Assuntos
Animais , Cães , Candida albicans/patogenicidade , Candidíase/complicações , Candidíase/veterinária , Encefalite Infecciosa/diagnóstico , Encefalite Infecciosa/veterináriaRESUMO
Background: Candida spp. are pleomorphic fungi that are commensal inhabitants of the oral, gastrointestinal, upper respiratory and urogenital mucosa of mammals. Candida albicans is described as the most important species. This opportunistic pathogen may produce local or systemic infections in dogs. Local infections have been reported in several tissues and systemic infection is rare in dogs with few reports in the literature describing this presentation. The aim of the present study was to report two cases of cerebral Candida albicans infection in dogs in Brazil.Case: Two cases of cerebral Candida albicans infection in dogs that showed nervous signs are described. In both cases, the brain showed marked asymmetry of the telencephalic hemispheres with multifocal to coalescing yellowish or reddish areas and a partial loss of distinction between gray and white matter. In Case 1, the mediastinal, tracheobronchial and mesenteric lymph nodes, as well as the right kidney and adrenal gland, showed altered architecture due to numerous whitish gray nodules. Histological lesions were characterized by granulomatous (case 1) or pyogranulomatous (case 2) necrotizing meningoencephalitis with intralesional fungal organisms. In case 1, similar granulomatous infiltrate with intralesional fungal organisms was also seen in the lymph nodes, kidney and adrenal gland. In case 2, there was evidence consistent with an underlying infection of canine distemper virus. Were observed lymphoplasmocytic interstitial pneumonia, lymphoid rarefaction in lymph nodes, and viral intracytoplasmic inclusion bodies in the epithelial cells of the stomach and vesical urothelium. In these two cases, the fungal organisms displayed three different morphological patterns. The first pattern was characterized by delicate tubular structures with thin parallel walls that were rarely septate and tended to undulate slightly, and measured approximately 4-20 µm (true hyphae).[...](AU)
Assuntos
Animais , Cães , Candida albicans/patogenicidade , Candidíase/complicações , Candidíase/veterinária , Encefalite Infecciosa/diagnóstico , Encefalite Infecciosa/veterináriaRESUMO
Early recognition and prompt specific treatment are crucial factors influencing the outcome of patients with acute encephalitis. The aim of this study was to determine the main causes of acute encephalitis in our population and to find predictors that may lead to specific diagnosis. Adult patients admitted to our hospital with suspected diagnosis of encephalitis in the period 2006-2013 were included. One hundred and five medical records were analyzed. Eighty-two patients with infectious encephalitis were identified (78% of total cases), 53 (65%) men and 29 (35%) women, mean age 47.8 years. The most common microorganisms identified were: HSV-1 (11%), VZV (10%), HSV-2 (5%) and EBV (5%). Twenty-three patients (22% of the series) had non-infectious encephalitis. Headache (p < 0.0001) and fever (p = 0.008) were more frequent in encephalitis of infectious origin. Protein levels and white blood cell counts in the cerebrospinal fluid were significantly higher in patients affected by infectious encephalitis than in those affected by noninfectious encephalitis (OR 95% CI 12.3 [2.9-51.7] and OR 95% CI 7.4 [2-27], respectively). Identifying specific causal agents of acute encephalitis remains a major challenge. Cerebrospinal fluid markers, as well as specific clinical findings, may however contribute to initial differentiation between infectious and noninfectious causes.
Assuntos
Encefalite/líquido cefalorraquidiano , Encefalite/diagnóstico , Encefalite Infecciosa/líquido cefalorraquidiano , Encefalite Infecciosa/diagnóstico , Adolescente , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Anticorpos , Antivirais/uso terapêutico , Diferenciação Celular , Líquido Cefalorraquidiano , Diagnóstico Diferencial , Diagnóstico Precoce , Encefalite/tratamento farmacológico , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/diagnóstico , Encefalite Viral/tratamento farmacológico , Feminino , Humanos , Encefalite Infecciosa/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
Early recognition and prompt specific treatment are crucial factors influencing the outcome of patients with acute encephalitis. The aim of this study was to determine the main causes of acute encephalitis in our population and to find predictors that may lead to specific diagnosis. Adult patients admitted to our hospital with suspected diagnosis of encephalitis in the period 2006-2013 were included. One hundred and five medical records were analyzed. Eighty-two patients with infectious encephalitis were identified (78% of total cases), 53 (65%) men and 29 (35%) women, mean age 47.8 years. The most common microorganisms identified were: HSV-1 (11%), VZV (10%), HSV-2 (5%) and EBV (5%). Twenty-three patients (22% of the series) had non-infectious encephalitis. Headache (p < 0.0001) and fever (p = 0.008) were more frequent in encephalitis of infectious origin. Protein levels and white blood cell counts in the cerebrospinal fluid were significantly higher in patients affected by infectious encephalitis than in those affected by noninfectious encephalitis (OR 95% CI 12.3 [2.9-51.7] and OR 95% CI 7.4 [2-27], respectively). Identifying specific causal agents of acute encephalitis remains a major challenge. Cerebrospinal fluid markers, as well as specific clinical findings, may however contribute to initial differentiation between infectious and noninfectious causes.
El reconocimiento temprano y la instauración del tratamiento adecuado son dos elementos de gran relevancia en el pronóstico de las encefalitis agudas. El objetivo del presente trabajo es determinar las principales causas de encefalitis aguda en nuestro medio, así como buscar predictores que permitan orientar a un diagnóstico determinado. Se revisaron de manera retrospectiva las historias clínicas de todos los pacientes adultos que consultaron en nuestro centro entre 2006 y 2013 con el diagnóstico presuntivo de encefalitis. Ciento cinco pacientes fueron finalmente incluidos en nuestro estudio. Se identificaron 82 pacientes con encefalitis de origen infeccioso (78%), 53 (65%) fueron hombres y 29 (35%) mujeres, con una edad promedio de 47.8 años. Los agentes infecciosos más frecuentes fueron virus: HSV-1 12 (11%), VZV 11 (10%), HSV-2 5 (5%) y EBV 5 (5%). Se diagnosticó encefalitis no infecciosa en 23 (22%) pacientes. La cefalea (p < 0.0001) y la fiebre (p = 0.008) fueron más frecuentes en las encefalitis de origen infeccioso. Además, los niveles de proteínas y células en el LCR fueron significativamente mayores en los casos de etiología infecciosa que en los de etiología no infecciosa (OR 12.3 95%CI [2.9-51.7] y OR 7.4 95%CI [2-27], respectivamente). La identificación de la etiología específica de las encefalitis agudas continúa siendo un gran desafío y en la mayoría de los casos no se identifica el agente causal. Determinados marcadores en el LCR pueden contribuir a la identificación inicial de las encefalitis de etiología infecciosa versus no infecciosa.