RESUMO
Infectious diseases emerge and reemerge over the years, and many of them can cause neurologic disease. Several factors contribute to the emergence and reemergence of these conditions, including human population growth, an increase in international travel, the geographic expansion of recognized pathogens to areas where they were previously nonendemic, and greater contact with wild animal reservoirs. The antivaccination social movement has played an important role in the reemergence of infectious diseases, especially some viral conditions. The authors review different viral (arboviruses such as dengue, chikungunya, and Zika virus; enterovirus 71; measles; and influenza), bacterial (syphilis, Lyme disease, and listeriosis), and parasitic (Chagas disease) diseases, focusing primarily on their neurologic complications. Although there are several additional infectious diseases with central nervous system manifestations that could be classified as emergent or reemergent, those listed here are the most relevant from an epidemiologic standpoint and are representative of important public health issues on all continents. The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified at CT and MRI, and radiology is central to the diagnosis and follow-up of such conditions. Given the increasing relevance of emerging and reemerging infections in clinical practice and public health scenarios, radiologists should be familiar with these infections. Online supplemental material is available for this article. ©RSNA, 2019.
Assuntos
Infecções Bacterianas do Sistema Nervoso Central/diagnóstico por imagem , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico por imagem , Viroses do Sistema Nervoso Central/diagnóstico por imagem , Doenças Transmissíveis Emergentes/diagnóstico por imagem , Neuroimagem , Adulto , Idoso , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Adulto JovemRESUMO
Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations. However, the foregoing does not yet have sufficient bases to be able to support it. The present review was carried out with the aim of contributing to an early diagnosis and treatment of ventriculitis associated with extra ventricular drainage in neurocritical patients, and in this way to contribute to improve survival and prevent fatal outcomes in these patients.
La ventriculitis posterior a un drenaje extraventicular constituye una complicación neuroquirúrgica muy importante en las unidades de cuidados neurocríticos. Se hace necesario realizar un diagnóstico precoz, dado que la morbimortalidad secundaria a esta puede ser variable y complicar la evolución de los pacientes neurocríticos. A pesar de esto, la ventriculostomía continúa siendo un pilar importante en el monitoreo y el tratamiento. Ante la urgencia de ventriculitis asociadas a gérmenes multirresistentes han surgido nuevos fármacos antimicrobianos como parte del tratamiento, al igual que se han propuesto vías intraventriculares dentro de las nuevas investigaciones. Sin embargo, lo anterior aún no tiene bases suficientes para poder sustentarlo. La presente revisión se realizó con el objetivo de contribuir a un diagnóstico precoz y al tratamiento de la ventriculitis asociada a drenaje extraventricular en pacientes neurocríticos, y de esta forma poder mejorar la sobrevida y prevenir desenlaces fatales en estos pacientes.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central , Ventriculite Cerebral , Drenagem/efeitos adversos , Ventriculostomia/efeitos adversos , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Ventriculite Cerebral/líquido cefalorraquidiano , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/microbiologia , Ventriculite Cerebral/terapia , Estado Terminal , Drenagem/métodos , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva , Infecções Relacionadas à Prótese/líquido cefalorraquidiano , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologiaRESUMO
O presente trabalho tem como objetivo descrever um caso clínico de Meningoencefalite Supurativa Bacteriana multifocal em um equino que apresentava relutância em andar, pouco reflexo ocular do lado esquerdo e incoordenação motora, com diminuição proprioceptiva e paresia. O diagnóstico inicial dado pelo médico veterinário responsável foi de mieloencefalopatia protozoária equina (MEP), o qual foi descartado pelo exame histopatológico. Este animal foi tratado conforme indicação da literatura, com leve melhora e posterior óbito.
The objective of this study was to describe a clinical case of suppurative bacterial multifocal meningoencephalitis in an equine that was reluctant to walk, had little ocular reflex on the left side and motor incoordination, with proprioceptive decrease and paresis. The initial diagnosis given by the veterinarian responsible was equine protozoal myeloencephalopathy (EPM), which was discarded by histopathological examination. This animal was treated as indicated in the literature, in which slight improvement and subsequent death.
El presente trabajo tiene como objetivo describir un caso clínico de meningoencefalitis bacteriana multifocal en un equino que presentó reticencia a caminar, poco reflejo ocular en el lado izquierdo e incoordinación motora, con disminución de la propioceptivo Y loharía. La diagnosis inicial dada por el médico veterinario responsable era Mieloencefalopatia protozoo equino (MEP), que fue desechado por el examen histopatológico. Este animal fue tratado como una indicación de la literatura, con la mejora suave y la muerte subsecuente.
Assuntos
Feminino , Animais , Cavalos , Infecções Bacterianas do Sistema Nervoso Central/veterinária , Meningoencefalite/diagnóstico , Meningoencefalite/veterináriaRESUMO
O presente trabalho tem como objetivo descrever um caso clínico de Meningoencefalite Supurativa Bacteriana multifocal em um equino que apresentava relutância em andar, pouco reflexo ocular do lado esquerdo e incoordenação motora, com diminuição proprioceptiva e paresia. O diagnóstico inicial dado pelo médico veterinário responsável foi de mieloencefalopatia protozoária equina (MEP), o qual foi descartado pelo exame histopatológico. Este animal foi tratado conforme indicação da literatura, com leve melhora e posterior óbito.(AU)
The objective of this study was to describe a clinical case of suppurative bacterial multifocal meningoencephalitis in an equine that was reluctant to walk, had little ocular reflex on the left side and motor incoordination, with proprioceptive decrease and paresis. The initial diagnosis given by the veterinarian responsible was equine protozoal myeloencephalopathy (EPM), which was discarded by histopathological examination. This animal was treated as indicated in the literature, in which slight improvement and subsequent death.(AU)
El presente trabajo tiene como objetivo describir un caso clínico de meningoencefalitis bacteriana multifocal en un equino que presentó reticencia a caminar, poco reflejo ocular en el lado izquierdo e incoordinación motora, con disminución de la propioceptivo Y loharía. La diagnosis inicial dada por el médico veterinario responsable era Mieloencefalopatia protozoo equino (MEP), que fue desechado por el examen histopatológico. Este animal fue tratado como una indicación de la literatura, con la mejora suave y la muerte subsecuente.(AU)
Assuntos
Animais , Feminino , Cavalos , Meningoencefalite/diagnóstico , Meningoencefalite/veterinária , Infecções Bacterianas do Sistema Nervoso Central/veterináriaRESUMO
Cryptococcus neoformans is an opportunistic pathogenic yeast that causes serious infections, most commonly of the central nervous system (CNS). C. neoformans is mainly found in the environment and acquired by inhalation. It could be metaphorically imagined that cryptococcal disease is a "journey" for the microorganism that starts in the environment, where this yeast loads its suitcase with virulence traits. C. neoformans first encounters the infected mammalian host in the lungs, a site in which it must choose the right elements from its "virulence suitcase" to survive the pulmonary immune response. However, the lung is often only the first stop in this journey, and in some individuals the fungal trip continues to the brain. To enter the brain, C. neoformans must "open" the main barrier that protects this organ, the blood brain barrier (BBB). Once in the brain, C. neoformans expresses a distinct set of protective attributes that confers a strong neurotropism and the ability to cause brain colonisation. In summary, C. neoformans is a unique fungal pathogen as shown in its ability to survive in the face of multiple stress factors and to express virulence factors that contribute to the development of disease.
Assuntos
Barreira Hematoencefálica , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Criptococose/microbiologia , Cryptococcus neoformans/patogenicidade , Animais , Modelos Animais de Doenças , Humanos , Virulência/fisiologiaRESUMO
"Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies. We present a case of a 10-year-old girl who presented with headache and fever and was found to have intracranial extension of sinusitis despite lack of typical sinus or chronic upper respiratory tract infection symptoms. This case illustrates the need in the emergency department or urgent care to keep a broad differential diagnosis for pediatric headache, especially when initial interventions are unsuccessful. We also review the epidemiology of pediatric sinusitis, age at sinus development, and associated intracranial complications.
Assuntos
Infecções Bacterianas do Sistema Nervoso Central/etiologia , Sinusite/complicações , Infecções Estreptocócicas/complicações , Antibacterianos/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/terapia , Criança , Diagnóstico Diferencial , Feminino , Febre/etiologia , Cefaleia/etiologia , Humanos , Sinusite/tratamento farmacológico , Sinusite/cirurgia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Streptococcus anginosus/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Cryptococcus neoformans is an opportunistic pathogenic yeast that causes serious infections, most commonly of the central nervous system (CNS). C. neoformans is mainly found in the environment and acquired by inhalation. It could be metaphorically imagined that cryptococcal disease is a "journey" for the microorganism that starts in the environment, where this yeast loads its suitcase with virulence traits. C. neoformans first encounters the infected mammalian host in the lungs, a site in which it must choose the right elements from its "virulence suitcase" to survive the pulmonary immune response. However, the lung is often only the first stop in this journey, and in some individuals the fungal trip continues to the brain. To enter the brain, C. neoformans must "open" the main barrier that protects this organ, the blood brain barrier (BBB). Once in the brain, C. neoformans expresses a distinct set of protective attributes that confers a strong neurotropism and the ability to cause brain colonisation. In summary, C. neoformans is a unique fungal pathogen as shown in its ability to survive in the face of multiple stress factors and to express virulence factors that contribute to the development of disease.
Assuntos
Animais , Criptococose , Cryptococcus neoformans/patogenicidade , Modelos Animais de Doenças , Barreira Hematoencefálica , Infecções Bacterianas do Sistema Nervoso Central/microbiologiaRESUMO
Resumen La actinomicosis diseminada es muy infrecuente, así como la afección del sistema nervioso central (SNC) asociada, con mortalidad de hasta 28%. Sus manifestaciones pueden ser similares a cuadros infecciosos de otras etiologías, por lo que el conocimiento de la entidad aumenta la sospecha clínica y permite brindar un tratamiento oportuno. Se presenta el caso clínico de un adulto con edema en una extremidad superior como manifestación de una tromboflebitis y una lesión abscedada axilar, en que se confirmó una infección por actinomicetos. Presentó una diseminación hematógena con compromiso de SNC, de evolución fatal.
Actinomycosis is very rare, as well as the central nervous system (CNS) condition associated with it, presenting a mortality up to 28%. Its manifestations could be similar to infectious conditions from other etiologies, thus, having a better understanding of the entity increases clinical suspicion and also it can provide a timely treatment. The clinical case of an adult with edema in an upper extremity is presented as a manifestation of thrombophlebitis and an abscessed axillary lesion, in which actinomycetes infection was confirmed. He presented a haematogenous spread with CNS involvement, with fatal ending.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Encefálico/microbiologia , Abscesso Encefálico/diagnóstico por imagem , Actinomicose/microbiologia , Actinomicose/diagnóstico por imagem , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico por imagem , Biópsia , Abscesso Encefálico/patologia , Actinomyces/isolamento & purificação , Actinomicose/patologia , Imageamento por Ressonância Magnética , Tomógrafos Computadorizados , Infecções Bacterianas do Sistema Nervoso Central/patologiaRESUMO
Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.
Assuntos
Calcitonina/sangue , Calcitonina/líquido cefalorraquidiano , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Craniotomia/efeitos adversos , APACHE , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Proteína C-Reativa/análise , Infecções Bacterianas do Sistema Nervoso Central/sangue , Infecções Bacterianas do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Diagnóstico Precoce , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/líquido cefalorraquidiano , Complicações Pós-Operatórias/microbiologia , Prognóstico , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Fatores de TempoRESUMO
Actinomycosis is very rare, as well as the central nervous system (CNS) condition associated with it, presenting a mortality up to 28%. Its manifestations could be similar to infectious conditions from other etiologies, thus, having a better understanding of the entity increases clinical suspicion and also it can provide a timely treatment. The clinical case of an adult with edema in an upper extremity is presented as a manifestation of thrombophlebitis and an abscessed axillary lesion, in which actinomycetes infection was confirmed. He presented a haematogenous spread with CNS involvement, with fatal ending.