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Toxoplasma gondii
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
Brain biopsy is essential for the diagnosis of toxoplasmic encephalitis in the non AIDS immunocompromised host for several reasons. Although toxoplasmic encephalitis occurs with greater frequency in patients with various underlying immunocompromising conditions, it is the etiological agent of central nervous system infection in only a small minority of non-AIDS immunocompromised patients. Toxoplasmic encephalitis comprised 5% of intracerebral infections in patients with malignancy seen at the Memorial Sloan-Kettering Cancer Center between 1955 and 1972 (31) and approximately 2% of central nervous system infections in immunocompromised patients from 1969 to 1979 at Massachusetts General Hosptial (32). As mentioned, serological test results are not reliable indicators of active clinical toxoplasma infection because titers rise with certain forms of immunosuppression without active disease and do not rise in others in which there is fulminant disease. Furthermore, radiological changes that occur with T. gondii infection are not pathognomonic but may occur with various infectious and noninfectious intracerebral processes that occur more commonly than Toxoplasma in the non-AIDS immunocompromised host. Therefore, it is strongly suggested that accessible intracerebral lesions in a non-AIDS immunocompromised host be biopsied.
Epidemiology of fungal infections: What, where, and when
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Frederic Lamoth, Sylvia F. Costa, Barbara D. Alexander
Scedosporium has been frequently implicated as the cause of CNS infection including meningoencephalitis, encephalitis, and cerebral abscesses. S. apiospermum infection of the CNS has been reported after near-drowning episodes, in patients with hematologic malignancy, after BMT, SOT, and penetrating trauma of the foot complicated by osteomyelitis [119,137,152–160]. Central nervous system infection with S. prolificans has been reported in the setting of disseminated infection [115,122,130,161]. For both organisms, patients may present with variable neurologic findings, such as headache, confusion, disorientation, agitation, cognitive decline, progressive lethargy, hemiparesis, or tonic–clonic seizures. Although typically present, the absence of ring enhancement has been reported [152,156,158,159].
Sinus headache and nasal disease
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
The roof of the sphenoid sinus is related to the middle cranial fossa and the pituitary gland in the sella turcica; lateral is the cavernous sinus; posterior is the clivus and pons; anterior are the posterior nasal cavity, posterior ethmoid cells, and cribriform plate; and inferior is the nasopharynx. The cavernous sinus (which is lateral to the sphenoid sinus) contains the internal carotid arteries and the illrd, IVth, Vth, and Vlth cranial nerves. The maxillary division of the Vth nerve may indent the wall of the sphenoid sinus. The sphenoid walls can be extremely thin, and sometimes the sinus cavity is separated from the adjacent structure by just a thin mucosal barrier. Because of the close proximity to the cortical venous system, cranial nerves, and meninges, infection may spread to these structures and present as a central nervous system infection or neurological catastrophe.2,37
Micafungin injection for the treatment of invasive candidiasis in pediatric patients under 4 months of age
Published in Expert Review of Anti-infective Therapy, 2022
Nahed Abdel-Haq, Stephanie M. Smith, Basim I. Asmar
The pathogenesis of infection includes hematogenous spread from initial site of infection. Central nervous system infection likely starts with infection of the choroid plexus leading to spread into cerebrospinal fluid (CSF) and inflammation of the meninges. The incidences of Candida meningitis is 5–15% of neonates with candidemia [5]. However, diagnosis of meningoencephalitis in neonates with candidemia remains challenging. Blood culture is positive in only 50% of neonates with ME. In addition, CSF analysis may be normal, and culture may be negative [12–14]. All neonates and infants with candidemia should be evaluated for deep sites of infections including ophthalmologic examination. Tests to determine organ system involvement may include imaging studies such as ultrasound of the kidneys and bladder, liver and spleen, echocardiography, and neuroimaging. Serial beta-D-glucan assays may also be used. However, the correlation of B-D-glucan with neonatal candidiasis requires further evaluation and is not currently a standard test [15]. Lumbar puncture should be performed if systemic candidiasis identified in any neonate. Performing lumbar puncture and neuroimaging studies such as brain magnetic resonance imaging (MRI) may not be feasible in sick neonates and ultrasound imaging provides limited evaluation of extent of brain and meningeal involvement. Thus, treatment of neonatal candidiasis is often empirical and entails presumptive CNS and ocular involvement [12]. In addition, CNS involvement should be assumed in any neonate with candidemia and symptoms of meningoencephalitis regardless of the CSF findings.
Factor structure of the Modified Mini Mental State (3MS) exam among participants in inpatient neurorehabilitation
Published in Brain Injury, 2021
Daniel W. Klyce, Mickeal Pugh, Paul B. Perrin
Participants with an incomplete administration of the 3 MS were only excluded from analysis if the discontinuation was due to (a) concerns about validity of the assessment given limited English proficiency or (b) severity of cognitive/linguistic dysfunction (i.e., aphasia) that became apparent during the assessment. Of participants included, incomplete administration reasons involved refusal or behavioral challenges that interfered with specific tasks (e.g., agitation); motor, verbal, or visuospatial challenges affecting 3MS administration (e.g., impaired visual ability; upper extremity fractures); or extremely slow task completion due to impaired processing speed. Data missing for these reasons were imputed at the item level using expectation maximization procedures differentially and based on either having a diffuse (e.g., widespread effects; n = 116) or a focal (e.g., specific/localized effects; n = 71) injury; this differential imputation approach was meant to account for possible different patterns in item scores across the two groups. Given the variety of diagnoses represented in the total sample, the decision to form groups based on injury distribution was made to reduce diagnostic heterogeneity within groups for the imputation procedure. Examples of diffuse injury include closed TBI, anoxic brain injury, or other encephalopathies such as normal pressure hydrocephalus or a central nervous system infection. Examples of focal injuries include stroke, brain tumors, penetrating TBI, or other encephalopathies clearly related to a focal lesion noted on radiographic imaging.
Actinomyces odontolyticus causing meningitis and cervical abscess
Published in Baylor University Medical Center Proceedings, 2021
Hanish Jain, Garima Singh, Ambika Eranki
Actinomycosis is a chronic suppurative infection characterized by abscess formation caused by Actinomyces spp. It typically resides in mucosal areas mainly in the oral cavity, alimentary tract, and genital tracts. It can rarely cause central nervous system infections, mainly through translocation of the bacteria from adjacent sites such as paranasal areas or through hematogenous seeding from a dental abscess, lungs, and cervicofacial areas. Central nervous system involvement mainly consists of spinal and epidural abscess, brain abscess, and meningitis. In one study of 70 cases, central nervous system infection presented as brain abscess in 67% of the patients, meningitis or meningoencephalitis in 13%, actinomycosis in 7%, subdural empyema in 6%, and epidural abscess in 6%.9A. israelii comprises almost 70% of the orocervicofacial infections.10 Less common species include A. naeslundii, A. odontolyticus, A. viscosus, A. meyeri, A. turicensis, and A. radingae.1,11 Twenty-five cases of A. odontolyticus bacteremia have been reported, according to one literature review, of which only one was a brain abscess.12