Brucella meningoencephalitis with hydrocephalus masquerading as tuberculosis

Neurobrucellosis is a rare form of localized brucellosis usually with no systemic manifestations. We report a rare case of brucellosis presenting as meningoencephalitis associated with hydrocephalus.This patient had a lymphocytic predominant CSF and was initially treated with empirical anti tubercular therapy and steroids.A week later,when his CSF culture grew Brucella species,the treatment was changed to a combination of streptomycin,doxycycline and rifampicin and the patient improved with this therapy.This case illustrates the need to consider neurobrucellosis as a close differential diagnosis of neurotuberculosis in endemic areas when the patient presents with meningo encephalitis with lymphocytic CSF.

Primary Amebic Meningoencephalitis Caused by Naegleria fowleri in China: A Case Report

Naegleria fowleri is a thermophilic,free-living ameba that is commonly known as the“brain-eating ameba.”This parasite invades the central nervous system and causes an acute fulminant infection,which results in a fatal form of primary amebic meningoencephalitis(PAM).Here,we report a case of PAM by an unexpected transmission route.Regrettably,the patient deteriorated swiftly and passed away subsequent to diagnosis,despite our exhaustive efforts.Here,we compiled a summary of 11 cases of PAM survivors who have all been treated with amphotericin,rifampicin and triazoles.Beside this regimen,miltefosine was also used successfully to treat PAM in an adolescent.More precise understanding of the survival rate and contributing factors can be established with further validation on ad-ditional cases.

Magnetic resonance imaging of eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis following eating freshwater snails

Background Angiostrongyliasis cantonensis is a worldwide-existing parasitic disease. However, the relevant reports on its radiological appearances are limited. In this study, we investigated magnetic resonance imaging （MRI） features of eosinophilic meningoencephalitis in a group of consecutive patients caused by human infection with Angiostrongylus cantonensis after eating freshwater snails. Methods We performed brain MR imaging on 74 patients with angiostrongyliasis cantonensis. The scanner was a 0.5T unit. For each patient MR pulse sequences of $E Tl-weighted image （TlWl） and FSE T2-weighted image （T2Wl） were used. After intravenous administration of gadolinium chelate （Gd-DTPA） repeated Tl-weighted images were obtained. MRI features of the lesions in the brain and meninges were analyzed and recorded after observing initial and follow-up MR images. The classification of the types of angiostrongyliasis cantonensis infection was done on the basis of locations of the disorders. Results Forty-one （55%） normal and 33 （45%） abnormal MRI appearances in the brain were found. According to locations of the disorders, the types of angiostrongyliasis cantonensis infection were determined as follows： seventeen cases of type meningitis, three of type myeloencephalitis, one of type neuritis and twelve of mixed type （eight of type ventriculitis and five of type pneumonitis were among them）. In type meningitis, abnormal leptomeningeal enhancement was visualized. In type myeloencephalitis, lesions in the brain parenchyma may have iso- or slightly low signal intensity on TlWl and high signal intensity on T2Wl. Enhanced nodules in various shapes were shown on gadolinium-enhanced TlWl, a few lesions appeared as crescent enhancements and some lesions did not reveal abnormal enhancement. Other than brain lesions, an enhanced nodule was seen in the cervical spinal cord in one patient. In type ventriculitis, brain ventricular enlargement was demonstrated. In type neuritis, a nodule and abnormal enhancement in the right optic nerve was revealed. In type pneumonitis, patchy ground-glass opacity and consolidative lesions at the periphery of the lungs were seen. Follow-up results indicated that most lesions in the brain could resolve in 2 to 8 weeks. Conclusions Angiostrongyliasis cantonensis presented as both single type and mixed type. Nodular enhancing lesions in the brain and/or linear enhancement in the leptomeninges were the main findings, while crescent enhancement would be the characteristic sign of the disease on gadolinium-enhanced TlWI. Focal edematous changes without contrast enhancement in the brain could be seen on MRI in some cases.

Severe Infant Meningoencephalitis Caused by Salmonella Apeyeme: A Case Report

Salmonella enterica serovar Apeyeme is a rare pathogen that primarily affects poultry.However,there are limited data about this infection in humans.In this case,a 7-month-old infant presented with high-grade fever without diarrhea for 12 hours prior to admission.Upon admission,he developed seizures and was referred for further intervention.He was diagnosed with meningoencephalitis with complications of subdural effusion,empyema,and abscesses.Salmonella Apeyeme was found in cerebrospinal fluid culture,but no growth was detected in either blood or stool cultures.He was given meropenem,vancomycin,and ciprofloxacin,but later developed disseminated intravascular coagulation.His clinical condition deteriorated over time,and he died 18 days after admission.To conclude,Salmonella Apeyeme infection should be considered if a patient is diagnosed with meningoencephalitis and has a history of poultry exposure.

Development of subdural empyema from subdural effusion after suppurative encephalitis:A case report

BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdural empyema(SDE)caused by Streptococcus pneumoniae.CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache,vomiting,and disturbed consciousness.Computed tomography(CT)revealed a bilateral subdural effusion at the top left side of the frontal lobe.Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis,which improved after anti-infective therapy.However,the patient then presented with acute cognitive dysfunction and right limb paralysis.Repeat CT showed an increase in left frontoparietal subdural effusion,disappearance of the left lateral ventricle,and a shift of the midline to the right.Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae.His condition improved after adequate drainage and antibiotic treatment.CONCLUSION Patients with unexplained subdural effusion,especially asymmetric subdural effusion with intracranial infection,should be assessed for chronic SDE.Early surgical treatment may be beneficial.

Neurologic complications after liver transplantation

Neurologic complications are relatively common after solid organ transplantation and affect 15%-30%of liver transplant recipients.Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections.Most common complications include seizures and encephalopathy,and occurrence of central pontine myelinolysis is relatively specific for liver transplant recipients.Delayed allograft function may precipitate hepatic encephalopathy and neurotoxicity of calcineurin inhibitors typically manifests with tremor,headaches and encephalopathy.Reduction of neurotoxic immunosuppressants or conversion to an alternative medication usually result in clinical improvement.Standard preventive and diagnostic protocols have helped to reduce the prevalence of opportunistic central nervous system(CNS)infections,but viral and fungal CNS infections still affect 1%of liver transplant recipients,and the morbidity and mortality in the affected patients remain fairly high.Critical illness myopathy may also affect up to 7%of liver transplant recipients.Liver insufficiency is also associated with various neurologic disorders which may improve or resolve after successful liver transplantation.Accurate diagnosis and timely intervention are essential to improve outcomes,while advances in clinical management and extended post-transplant survival are increasingly shifting the focus to chronic post-transplant complications which are often encountered in a community hospital and an outpatient setting.

An updated systematic review of Zika virus-linked complications

Objective: To determine the breadth of Zika virus(ZIKV)-associated brain anomalies in neonates and adults. Methods: Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement using electronic databases ScienceDirect, Pubmed, Medline, Scopus, and Global Health Library.Only those research articles, case studies, case-control studies, case-cohort studies, crosssectional studies, and organizational survey reports were included in the study that reported any fetal outcomes for pregnant women who had infected with ZIKV during the gestational period and ZIKV-related neurological complications in adults as well. Results: Out of total 72 retrieved articles, 50 met the inclusion criteria. We estimated a significant increase in incidence of neural abnormalities such as Guillain-Barre syndrome and microcephaly in the regions that are experiencing ZIKV outbreaks. Other neurological malformations found in ZIKV patients include hydrancephaly/hydrops fetalis, myasthenia gravis,meningoencephalitis and myelitis. Conclusion: Our systematic analysis provides the broad spectrum of neurological malformations in ZIKV infected patients and these data further support the causal link of ZIKV with neurological disorders.

Tuberculous Meningitis and COVID-19 Co-Infection: About a Case

We report the case of an adult patient diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis. The most destructive type of extrapulmonary tuberculosis is tuberculous meningitis, in which the consequences are severe, resulting in death or disability in almost half of all sufferers despite anti-tuberculosis chemotherapy. The aim of this study was to assess the clinical and paraclinical features and laboratory findings and outcome of a patient with tuberculous meningitis and COVID-19 coinfection. Infection of COVID-19 and lymphopenia promotes the development of the severe form of tuberculosis. On the other hand, TBM increased the risk of infection with coronavirus due to the weakened immune system in addition to other immunosuppressive factors (older age and comorbidities such as low socioeconomic status and malnutrition). The patient had a good recovery even if he required intensive neurorehabilitation for a month due to poor feeding and weakness. Treatment, both anti-mycobacterial and anti-inflammatory, early started, guaranteed good recovery.

Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease

Among various genera of free-living amoebae prevalent in nature,some members are identified as causative agents of human encephalitis,in which Naegleria fowleri followed by Acanthamoeba spp.and Balamuthia mandrillaris have been successively discovered.As the three dominant genera responsible for infections,Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals,whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease.Due to the lack of typical symptoms and laboratory findings,all these amoebic encephalitic diseases are difficult to diagnose.Considering that subsequent therapies are also affected,all these brain infections cause significant mortality worldwide,with more than 90%of the cases being fatal.Along with global warming and population explosion,expanding areas of human and amoebae activity in some regions lead to increased contact,resulting in more serious infections and drawing increased public attention.In this review,we summarize the present information of these pathogenic free-living amoebae,including their phylogeny,classification,biology,and ecology.The mechanisms of pathogenesis,immunology,pathophysiology,clinical manifestations,epidemiology,diagnosis,and therapies are also discussed.