Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an important cause of encephalitis worldwide. While some cases are associated with neoplasms, in the remaining cases the etiology is unclear. Re...Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an important cause of encephalitis worldwide. While some cases are associated with neoplasms, in the remaining cases the etiology is unclear. Recent literature suggests that viral brain infections, mainly of the herpesviridae family, may be associated and/or trigger NMDAR encephalitis. Case Report: A 34-year-old woman with a 1-month-long history of progressive behavioral and language deterioration came to emergency department after a first unprovoked seizure followed by a focal status epilepticus. Brain computerized tomography was normal, but electroencephalography showed epileptiform activity over the left fronto-temporal region. She was admitted to the intensive care unit. Brain magnetic resonance imaging showed subtle T2 hypersignal in the parietal, fronto-opercular and insular regions. Cerebrospinal fluid (CSF) was positive for Epstein Barr virus (EBV) DNA whilst anti-NMDA antibodies were identified both in the CSF and blood. No tumors were detected after thorough investigation. Following intravenous steroids, plasma exchange and rituximab treatment she slowly improved being discharged home and at a 3-month follow-up she was sequels free. Conclusion: Despite the clear association between herpes virus simplex and NMDAR encephalitis, no such unequivocal relation has been reported for other virus, namely EBV. We report a case of NMDAR encephalitis which might be associated and triggered by EBV infection, identified by polymerase chain reaction.展开更多
BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systemati...BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection.展开更多
文摘Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an important cause of encephalitis worldwide. While some cases are associated with neoplasms, in the remaining cases the etiology is unclear. Recent literature suggests that viral brain infections, mainly of the herpesviridae family, may be associated and/or trigger NMDAR encephalitis. Case Report: A 34-year-old woman with a 1-month-long history of progressive behavioral and language deterioration came to emergency department after a first unprovoked seizure followed by a focal status epilepticus. Brain computerized tomography was normal, but electroencephalography showed epileptiform activity over the left fronto-temporal region. She was admitted to the intensive care unit. Brain magnetic resonance imaging showed subtle T2 hypersignal in the parietal, fronto-opercular and insular regions. Cerebrospinal fluid (CSF) was positive for Epstein Barr virus (EBV) DNA whilst anti-NMDA antibodies were identified both in the CSF and blood. No tumors were detected after thorough investigation. Following intravenous steroids, plasma exchange and rituximab treatment she slowly improved being discharged home and at a 3-month follow-up she was sequels free. Conclusion: Despite the clear association between herpes virus simplex and NMDAR encephalitis, no such unequivocal relation has been reported for other virus, namely EBV. We report a case of NMDAR encephalitis which might be associated and triggered by EBV infection, identified by polymerase chain reaction.
文摘BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection.
