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Central Nervous System Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Meningoencephalitis is defined as inflammation of both the meninges and the brain. Most organisms that can cause meningitis or encephalitis can cause meningoencephalitis. Rarer aetiologies to consider include primary amoebic meningoencephalitis, which is associated with swimming in warm fresh water, and Naegleria fowleri, which is transmitted intranasally, leading to CNS invasion. Meningoencephalitis presents with fever, meningism and convulsions.
An approach to pathogen discovery for viral infections of the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Prashanth S. Ramachandran, Michael R. Wilson
However, this practice is liable to errors of omission or commission. It relies on the clinician having comprehensive knowledge of all possible neuroinvasive pathogens in their geographic region. However, viral epidemiology and evolution are dynamic, and this dynamism is only enhanced in the modern era by the globalization of travel and trade and by a changing climate [6]. These changes cannot be detected in a timely manner based on conventional diagnostic methods that are largely hypothesis-driven and pathogen-specific (e.g., pathogen-specific polymerase chain reaction (PCR), antigen or serologic testing). For example, in 2016, South America saw a sharp rise in the incidence of microcephaly and Guillain–Barré syndrome. Using conventional methods, Zika virus was discovered to be the etiologic pathogen 2 years after its introduction to the continent with the delay in recognition stemming from the fact that the Zika virus was not previously known to circulate in South America and was not known to cause neurologic disease [7]. Even in a fixed region with a stable environmental virome, our understanding of all potential causes of neuroinvasive diseases is poor. Multiple studies assessing the etiology of meningoencephalitis have consistently found 40%–60% of cases are due to unknown causes [8,9].
The nervous system and the eye
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
James A.R. Nicoll, William Stewart, Fiona Roberts
This rare form of encephalitis occurs mainly between the ages of 4 and 20 years and has a prolonged clinical course. It occurs some years after an apparently uncomplicated bout of measles and appears to be due to re-activation of latent measles virus. There are high levels of both IgM and IgG antibodies in the blood and CSF. Microscopic examination shows subacute meningoencephalitis. Neuronophagia is common, and residual neurons may contain intranuclear and/or cytoplasmic inclusion bodies. There is considerable gliosis in the white matter.
The rare manifestations in tuberculous meningoencephalitis: a review of available literature
Published in Annals of Medicine, 2023
Rong li He, Yun Liu, Quanhui Tan, Lan Wang
Microglia release TNF-α And IL-1β and other cytokines play an important role in thrombosis. Leiden mutation of coagulation factor V is the most common cause of hereditary thrombosis. The decrease of anticoagulants and the increase of procoagulant factor (mainly factor V III) activity in patients with TBM lead to blood hypercoagulability and thrombosis [10]. In addition, TBM directly compresses the venous sinus by forming granulation tissue or abscess, and it can also lead to thrombosis by changing hemodynamics [11]. The clinical diagnosis of intracranial venous thrombosis depends on imaging examination [12]. Abnormal high density was found in the lesion area on CT, and related lesions could be seen on MRV. Vein imaging is limited. This disease can be diagnosed by imaging examination. The sensitivity of cranial MRV was about 84% [12]. Patients with tuberculous meningoencephalitis may suddenly have worsening headache, deepening consciousness and seizures during the course of the disease. The possibility of intracranial venous thrombosis should not be ignored [13].
Optic nerve infiltration in systemic non Hodgkin lymphoma
Published in Orbit, 2023
Cassie A. Cameron, Valerie Juniat, Jessica Y. Tong, John L. Crompton, Garry Davis, Sandy Patel, Dinesh Selva
Ophthalmic examination revealed evidence of bilateral optic neuropathy, with a visual acuity of 20/30 OD and 20/60 OS. The left eye showed a relative afferent pupillary defect, impaired colour vision, brightness desaturation to 70%, and superonasal field loss. There was bilateral disc swelling, more pronounced on the left. There was no evidence of anterior or posterior segment inflammation. Magnetic resonance imaging (MRI) revealed dilated optic nerve sheaths bilaterally without evidence of orbital lesions (Figure 1A,B). A lumbar puncture revealed increased opening pressure of 43 cmH2O, and cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and elevated protein. The patient was diagnosed and treated for unspecified viral meningoencephalitis. His examination was stable at 4 months follow-up.
Viral metagenomic sequencing in the diagnosis of meningoencephalitis: a review of technical advances and diagnostic yield
Published in Expert Review of Molecular Diagnostics, 2021
Ellen C. Carbo, Ivar Blankenspoor, Jelle J. Goeman, Aloys C.M. Kroes, Eric C.J. Claas, Jutte J.C. De Vries
Meningoencephalitis is a severe inflammation of the brain tissue and meninges, with an overall mortality of 30% and long-term residual sequelae in the majority of the patients that survive [1]. All age groups can be affected and immunocompromised patients are at higher risk of infection with unexpected and novel viral pathogens [2]. Disease outcome improves with a proper and timely diagnosis and correct identification of disease etiology [3]. Strikingly, more than 30% of cases remain without identified etiologic agent [4]. A wide range of causative agents can be involved, and besides host immune status, the etiology is also dependent on geographical location, as exemplified by tick-born encephalitis, Toscana virus encephalitis, and Japanese encephalitis. The clinical severity of the disease in combination with frequent negative routine qPCR panel results and a wide range of causative agents makes this type of patients attractive candidates for metagenomic next-generation sequencing (mNGS), as mNGS can detect all pathogens, including rare and novel pathogens not included in conventional testing.