Introduction: More than half of patients with central nervous system tuberculosis (CNS TB) die or are left with severe neurological deficits despite receiving anti-TB treatment. Aims of the study: This study examined ...Introduction: More than half of patients with central nervous system tuberculosis (CNS TB) die or are left with severe neurological deficits despite receiving anti-TB treatment. Aims of the study: This study examined risk factors associated with poor response to initial treatment with four anti-TB drug regimens or three drug regimens with steroids as adjuvant therapy. Methods: This study analyzed medical records from two tertiary hospitals in Busan, Korea, between January 2009 and March 2012. The subjects were non-human immunodeficiency virus (HIV)-infected patients aged ≥16 years with clinical CNS TB. The subjects were divided into two groups according to response to treatment. Results: In totally, 52 patients with CNS TB were included. Of these, 14 (26%) and 38 (73%) showed poor and good responses, respectively. Of the patients with poor response, nine had stage III disease (64.3%) according to the British Medical Research Council (BMRC) staging system. A significantly higher proportion was seen in the good response group (p < 0.05). Patients with positive cerebrospinal fluid (CSF) acid-fast bacillus (AFB) culture, positive sputum AFB culture, positive CSF TB polymerase chain reaction (PCR) results, and brain tuberculoma had poorer responses (p < 0.05). Multivariate analysis to determine risk factors associated with poor response to anti-TB therapy revealed that a poor response was associated with stage III clinical signs upon diagnosis (odds ratio [OR] 32.122;95% confidence interval [CI] 2.221 - 464.605), positive sputum AFB culture (OR 13.624;95% CI 1.066 - 174.149), and tuberculoma on brain images (OR 45.714;95% CI 1.893 - 1104.018). Conclusions: The results demonstrate the importance of identifying the severity of CNS TB and promptly administering anti-TB drugs. It is necessary to perform drug susceptibility testing for anti-TB drugs. Further studies are needed to confirm the correlations between risk factors associated with poor response and anti-TB drug resistance and the other risk factors.展开更多
Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain met...Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain metabolites but also contribute to antigen delivery and immune cell activation. The advent of novel genomic technologies has enabled rapid progress in the characterization of myeloid and lymphoid cells and their interactions with meningeal lymphatic vessels within the central nervous system. In this review, we provide an overview of the multifaceted roles of meningeal lymphatic vessels within the context of the central nervous system immune network, highlighting recent discoveries on the immunological niche provided by meningeal lymphatic vessels. Furthermore, we delve into the mechanisms of crosstalk between meningeal lymphatic vessels and immune cells in the central nervous system under both homeostatic conditions and neurodegenerative diseases, discussing how these interactions shape the pathological outcomes. Regulation of meningeal lymphatic vessel function and structure can influence lymphatic drainage, cerebrospinal fluid-borne immune modulators, and immune cell populations in aging and neurodegenerative disorders, thereby playing a key role in shaping meningeal and brain parenchyma immunity.展开更多
Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,0...Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.展开更多
Central nervous system (CNS) infections are associated with high mortality rates. The clinical presentation of many CNS infections by different pathogens is difficult to distinguish, but the definite diagnosis of the ...Central nervous system (CNS) infections are associated with high mortality rates. The clinical presentation of many CNS infections by different pathogens is difficult to distinguish, but the definite diagnosis of the etiology is critical for effective therapy and prognosis. The aim of this study was to explore the etiology of CNS infections with definite diagnoses based on data from a clinical microbiology laboratory in Tongji Hospital, a teaching hospital in China, obtained over a six-year period. We conducted a retrospective study on all cerebrospinal fluid (CSF) specimens submitted to our clinical microbiology laboratory from September, 2012 to December, 2018. The etiology of CNS infections caused by Cryptococcus neoformans, Mycobacterium tuberculosis and common bacteria was analyzed. Antimicrobial susceptibility testing was conducted on all isolates. The results showed that 1972 cases of CNS infections were identified from 18 300 CSF specimens. Common bacterial meningitis (BM), cryptococcal meningitis (CM) and tuberculous meningitis (TM) accounted for 86.3%(677/785), 9.4%(74/785) and 4.3%(34/785) respectively of cases over the six-year period. BM was the most common among the different age groups, followed by CM. Of the TM cases, 44.1%(15/34) were distributed within the age group of 15-34 years, whereas for CM cases, 52.7%(39/74) occurred within the 35-54-year age group, and the age distribution of BM cases was fairly even. Among the bacterial pathogens isolated, Staphylococcus epidermidis was the most common, accounting for 12.5%(98/785), followed by Acinetobacter baumannii (ABA) and Staphylococcus aureus (SAU), accounting for 11.8%(93/785) and 7.6%(60/785) respectively. The resistance rates to antibiotics were >75%, with the exception of the resistance rate of ABA to tegafycline, which was <3%. More than 60% of SAU strains displayed resistance to penicillin, oxacillin, ampicillin/sulbactam, cefazolin, cefuroxime, gentamycin, tobramycin, erythromycin and levofloxacin, whereas more than 90% of SAU strains showed susceptibility to trimethoprim/ sulfamethoxazole, tegafycline, vancomycin, teicoplanin and linezolid. For C. neoformans, the susceptibility rates to amphotericin B, 5-fluorocytosine, fluconazol and voriconazole were >95%. Analysis of samples from patients with CNS infection in a clinical microbiology laboratory at a teaching hospital in China over a six-year period indicated that the most common etiological agents were the bacteria ABA and SAU. The antibiotic resistance levels of ABA were found to be high and of concern, whereas isolates of C. neoformans were found to be sensitive to antifungal antibiotics.展开更多
The lymphatic vasculature forms an organized network that covers the whole body and is involved in fluid homeostasis,metabolite clearance,and immune surveillance.The recent identification of functional lymphatic vesse...The lymphatic vasculature forms an organized network that covers the whole body and is involved in fluid homeostasis,metabolite clearance,and immune surveillance.The recent identification of functional lymphatic vessels in the meninges of the brain and the spinal cord has provided novel insights into neurophysiology.They emerge as major pathways for fluid exchange.The abundance of immune cells in lymphatic vessels and meninges also suggests that lymphatic vessels are actively involved in neuroimmunity.The lymphatic system,through its role in the clearance of neurotoxic proteins,autoimmune cell infiltration,and the transmission of pro-inflammatory signals,participates in the pathogenesis of a variety of neurological disorders,including neurodegenerative and neuroinflammatory diseases and traumatic injury.Vascular endothelial growth factor C is the master regulator of lymphangiogenesis,a process that is critical for the maintenance of central nervous system homeostasis.In this review,we summarize current knowledge and recent advances relating to the anatomical features and immunological functions of the lymphatic system of the central nervous system and highlight its potential as a therapeutic target for neurological disorders and central nervous system repair.展开更多
<strong>Background:</strong> Sub-Saharan Africa is the region most affected by the Human Immunodeficiency Virus (HIV) with an increasing prevalence of related cognitive impairments. Magnetic Resonance Imag...<strong>Background:</strong> Sub-Saharan Africa is the region most affected by the Human Immunodeficiency Virus (HIV) with an increasing prevalence of related cognitive impairments. Magnetic Resonance Imaging (MRI) plays an important role in the early detection of lesions. This work aimed to describe the MRI aspects of different brain lesions occurred in HIV positive patients in our practice. <strong>Methods:</strong> This was a descriptive cross-sectional study that took place from June 2014 to July 2016 in the medical imaging department of the EL RAPHA private Polyclinic in Libreville, Gabon. It included all patients referred for imaging for the exploration of a Central Nervous System (CNS) lesions at MRI, based on clinical and/or paraclinical arguments. <strong>Results:</strong> Among the 39 patients included, 19 (48.7%) had a previous brain CT scan, 11 of which were normal (28.2%). Thirty-five (89.74%) patients had a pathological MRI. The main etiologies found were toxoplasmosis (37.14%), tuberculosis (17.14%), cerebral atrophy (17.14%) and HIV encephalitis (14.28%). Among the eleven patients with a normal Computer Tomography scan, the MRI found 7 abnormalities including 1 case of toxoplasmosis, 3 cases of HIV encephalitis and 3 cases of Progressive Multifocal Leukoencephalopathy (PML). <strong>Conclusion:</strong> MRI played an important role in the diagnosis of CNS disorders in HIV-infected individuals. It can be used to differentiate and characterize various brain lesions. Improving its accessibility in sub-Saharan Africa should contribute to better care for people living with HIV.展开更多
Endogenous endophthalmitis is a rare condition with a poor long-term visual prognosis and significant mortality, often associated with the hematogenous spread of intravitreal infections and subsequent disruption of th...Endogenous endophthalmitis is a rare condition with a poor long-term visual prognosis and significant mortality, often associated with the hematogenous spread of intravitreal infections and subsequent disruption of the blood-ocular barrier. Its anatomical proximity to the central nervous system (CNS) poses a high risk of infection dissemination, although cases documented in the literature are rare, and endogenous endophthalmitis is typically described as secondary to neuroinfections. We report the case of an 82-year-old female patient with a history of hypertension who presented with fever, decreased visual acuity, severe headache, chemosis, and conjunctival injection. Endogenous endophthalmitis was diagnosed, and antimicrobial treatment was initiated alongside surgical intervention by the ophthalmology service. However, the patient’s condition worsened neurologically, and Streptococcus pneumoniae was identified in cerebrospinal fluid cultures. Despite intensive medical treatment, the patient’s clinical course was poor, leading to death.展开更多
BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a ...BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.展开更多
BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation ...BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.展开更多
BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced centr...BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.展开更多
BACKGROUND Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving thecentral nervous system is uncommon;among these cases, spinal intramedullaryTB is even more rare. The clinical manifestations of...BACKGROUND Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving thecentral nervous system is uncommon;among these cases, spinal intramedullaryTB is even more rare. The clinical manifestations of spinal intramedullary TB aresimilar to those of intramedullary spinal cord tumors. Therefore, it is necessary tomake a careful differential diagnosis of spinal intramedullary lesions to achievethe appropriate treatment and favorable prognosis. We report a rare case of ayoung male patient with paraplegia due to spinal intramedullary TB, which isuncommon and regrettable.CASE SUMMARY A 23-year-old male presented with fever accompanied by nausea and vomitinglasting for 2 mo and was then diagnosed with tubercular meningitis. After anti-TBtreatment, his symptoms were significantly improved. However, 2 mo after thediagnosis of tubercular meningitis, the patient felt numbness below the costal archlevel, which lasted for 1 wk, and he paid no attention to this symptom. Whatfollowed was paraplegia and urine/fecal incontinence. Magnetic resonanceimaging of the thoracic spine showed a ring-enhanced intramedullary cord lesionat T8-T9. Lesion exploration showed enlargement of the spinal cord at T8-T9, andthe lesion could be observed by incision. The lesion was adhered to the peripheraltissue and was grayish-white and tough with a poor blood supply and a diameterof approximately 0.8 cm. The lesion was resected completely. The results ofpathological examination by both hematoxylin-eosin staining and acid-fast bacillistaining confirmed TB, accompanied by acute and chronic suppurativeinflammation and granulation tissue formation. The patient was instructed tocontinue anti-TB treatment after the operation, but he did not follow the medicaladvice. Follow-up continued for ten years, the patient had persistent paraplegia,the numbness disappeared and urine/fecal sensation recovered.CONCLUSION Although TB is a kind of benign disease, some cases progress rapidly. Moreover,spinal intramedullary TB may seriously endanger quality of life and still needstimely diagnosis and proper treatment.展开更多
Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic reson...Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic resonance imaging (MRI)manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). Methods:A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study.All the patients had MRI data and clinical data.The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease.Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test,Chi-square test,Mann-Whitney test and Spearman rank correlation analysis. Results:In all 65 patients,41 cases (41/65,63.1%;Group 1)had normal immunity and 24 cases (24/65,36.9%;Group 2)had at least one identifiable underlying disease.Fever,higher percentage of neutrophil (NEUT)in white blood cell (WBC),and increased cell number of cerebral spinal fluid (CSF)were much common in patients with underlying disease (Group 1 vs.Group 2:Fever:21/41 vs.21/24,x^2 =8.715,P =0.003;NEUT in WBC:73.15%vs.79.60%,Z=-2.370,P =0.018;cell number of CSF:19 vs.200,Z=-4.298,P <0.001;respectively).Compared to the patients with normal immunity,the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs.Group 2:20/41 vs.20/24,x^2 =7.636,P =0.006).The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r =-0.472,P =0.031,r =0.779,P =0.039;respectively). Conclusions:With the increased number of the involved brain areas in patients with identifiable underlying disease,the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.展开更多
BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have...BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.展开更多
目的:探讨中枢神经受累的系统性血管炎与结核性脑膜和(或)脑炎的头颅M R I的差别。方法:回顾性收集32例中枢神经系统血管炎,34例结核性脑膜和(或)脑炎。对比两组患者的M R I表现。结果:中枢神经系统血管炎顶叶病灶明显多于结核组(P<0...目的:探讨中枢神经受累的系统性血管炎与结核性脑膜和(或)脑炎的头颅M R I的差别。方法:回顾性收集32例中枢神经系统血管炎,34例结核性脑膜和(或)脑炎。对比两组患者的M R I表现。结果:中枢神经系统血管炎顶叶病灶明显多于结核组(P<0.05),其他病变部位无区别;中枢神经系统血管炎的病灶强化中的条索样强化多见于结核(P<0.05),其余病灶强化类型无区别;中枢神经系统血管炎的脑膜强化连续性的少于结核组,非连续性的强化多于结核组(P<0.01)。脑出血形式差异无显著性。结论:中枢神经系统性血管炎的病灶在顶叶较结核多见,病灶条索样增强较多见,脑膜强化多为非连续性的,通过上述表现可帮助鉴别两病。展开更多
文摘Introduction: More than half of patients with central nervous system tuberculosis (CNS TB) die or are left with severe neurological deficits despite receiving anti-TB treatment. Aims of the study: This study examined risk factors associated with poor response to initial treatment with four anti-TB drug regimens or three drug regimens with steroids as adjuvant therapy. Methods: This study analyzed medical records from two tertiary hospitals in Busan, Korea, between January 2009 and March 2012. The subjects were non-human immunodeficiency virus (HIV)-infected patients aged ≥16 years with clinical CNS TB. The subjects were divided into two groups according to response to treatment. Results: In totally, 52 patients with CNS TB were included. Of these, 14 (26%) and 38 (73%) showed poor and good responses, respectively. Of the patients with poor response, nine had stage III disease (64.3%) according to the British Medical Research Council (BMRC) staging system. A significantly higher proportion was seen in the good response group (p < 0.05). Patients with positive cerebrospinal fluid (CSF) acid-fast bacillus (AFB) culture, positive sputum AFB culture, positive CSF TB polymerase chain reaction (PCR) results, and brain tuberculoma had poorer responses (p < 0.05). Multivariate analysis to determine risk factors associated with poor response to anti-TB therapy revealed that a poor response was associated with stage III clinical signs upon diagnosis (odds ratio [OR] 32.122;95% confidence interval [CI] 2.221 - 464.605), positive sputum AFB culture (OR 13.624;95% CI 1.066 - 174.149), and tuberculoma on brain images (OR 45.714;95% CI 1.893 - 1104.018). Conclusions: The results demonstrate the importance of identifying the severity of CNS TB and promptly administering anti-TB drugs. It is necessary to perform drug susceptibility testing for anti-TB drugs. Further studies are needed to confirm the correlations between risk factors associated with poor response and anti-TB drug resistance and the other risk factors.
基金supported by the National Natural Science Foundation of China, No.82274616the Key Laboratory Project for General Universities in Guangdong Province, No.2019KSYS005Guangdong Province Science and Technology Plan International Cooperation Project, No.2020A0505100052 (all to QW)。
文摘Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain metabolites but also contribute to antigen delivery and immune cell activation. The advent of novel genomic technologies has enabled rapid progress in the characterization of myeloid and lymphoid cells and their interactions with meningeal lymphatic vessels within the central nervous system. In this review, we provide an overview of the multifaceted roles of meningeal lymphatic vessels within the context of the central nervous system immune network, highlighting recent discoveries on the immunological niche provided by meningeal lymphatic vessels. Furthermore, we delve into the mechanisms of crosstalk between meningeal lymphatic vessels and immune cells in the central nervous system under both homeostatic conditions and neurodegenerative diseases, discussing how these interactions shape the pathological outcomes. Regulation of meningeal lymphatic vessel function and structure can influence lymphatic drainage, cerebrospinal fluid-borne immune modulators, and immune cell populations in aging and neurodegenerative disorders, thereby playing a key role in shaping meningeal and brain parenchyma immunity.
文摘Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.
文摘Central nervous system (CNS) infections are associated with high mortality rates. The clinical presentation of many CNS infections by different pathogens is difficult to distinguish, but the definite diagnosis of the etiology is critical for effective therapy and prognosis. The aim of this study was to explore the etiology of CNS infections with definite diagnoses based on data from a clinical microbiology laboratory in Tongji Hospital, a teaching hospital in China, obtained over a six-year period. We conducted a retrospective study on all cerebrospinal fluid (CSF) specimens submitted to our clinical microbiology laboratory from September, 2012 to December, 2018. The etiology of CNS infections caused by Cryptococcus neoformans, Mycobacterium tuberculosis and common bacteria was analyzed. Antimicrobial susceptibility testing was conducted on all isolates. The results showed that 1972 cases of CNS infections were identified from 18 300 CSF specimens. Common bacterial meningitis (BM), cryptococcal meningitis (CM) and tuberculous meningitis (TM) accounted for 86.3%(677/785), 9.4%(74/785) and 4.3%(34/785) respectively of cases over the six-year period. BM was the most common among the different age groups, followed by CM. Of the TM cases, 44.1%(15/34) were distributed within the age group of 15-34 years, whereas for CM cases, 52.7%(39/74) occurred within the 35-54-year age group, and the age distribution of BM cases was fairly even. Among the bacterial pathogens isolated, Staphylococcus epidermidis was the most common, accounting for 12.5%(98/785), followed by Acinetobacter baumannii (ABA) and Staphylococcus aureus (SAU), accounting for 11.8%(93/785) and 7.6%(60/785) respectively. The resistance rates to antibiotics were >75%, with the exception of the resistance rate of ABA to tegafycline, which was <3%. More than 60% of SAU strains displayed resistance to penicillin, oxacillin, ampicillin/sulbactam, cefazolin, cefuroxime, gentamycin, tobramycin, erythromycin and levofloxacin, whereas more than 90% of SAU strains showed susceptibility to trimethoprim/ sulfamethoxazole, tegafycline, vancomycin, teicoplanin and linezolid. For C. neoformans, the susceptibility rates to amphotericin B, 5-fluorocytosine, fluconazol and voriconazole were >95%. Analysis of samples from patients with CNS infection in a clinical microbiology laboratory at a teaching hospital in China over a six-year period indicated that the most common etiological agents were the bacteria ABA and SAU. The antibiotic resistance levels of ABA were found to be high and of concern, whereas isolates of C. neoformans were found to be sensitive to antifungal antibiotics.
基金supported by the Key Program of the National Natural Science Foundation of ChinaNo.82030071+1 种基金the Science and Technology Major Project of ChangshaNo.kh2103008 (both to JZH)
文摘The lymphatic vasculature forms an organized network that covers the whole body and is involved in fluid homeostasis,metabolite clearance,and immune surveillance.The recent identification of functional lymphatic vessels in the meninges of the brain and the spinal cord has provided novel insights into neurophysiology.They emerge as major pathways for fluid exchange.The abundance of immune cells in lymphatic vessels and meninges also suggests that lymphatic vessels are actively involved in neuroimmunity.The lymphatic system,through its role in the clearance of neurotoxic proteins,autoimmune cell infiltration,and the transmission of pro-inflammatory signals,participates in the pathogenesis of a variety of neurological disorders,including neurodegenerative and neuroinflammatory diseases and traumatic injury.Vascular endothelial growth factor C is the master regulator of lymphangiogenesis,a process that is critical for the maintenance of central nervous system homeostasis.In this review,we summarize current knowledge and recent advances relating to the anatomical features and immunological functions of the lymphatic system of the central nervous system and highlight its potential as a therapeutic target for neurological disorders and central nervous system repair.
文摘<strong>Background:</strong> Sub-Saharan Africa is the region most affected by the Human Immunodeficiency Virus (HIV) with an increasing prevalence of related cognitive impairments. Magnetic Resonance Imaging (MRI) plays an important role in the early detection of lesions. This work aimed to describe the MRI aspects of different brain lesions occurred in HIV positive patients in our practice. <strong>Methods:</strong> This was a descriptive cross-sectional study that took place from June 2014 to July 2016 in the medical imaging department of the EL RAPHA private Polyclinic in Libreville, Gabon. It included all patients referred for imaging for the exploration of a Central Nervous System (CNS) lesions at MRI, based on clinical and/or paraclinical arguments. <strong>Results:</strong> Among the 39 patients included, 19 (48.7%) had a previous brain CT scan, 11 of which were normal (28.2%). Thirty-five (89.74%) patients had a pathological MRI. The main etiologies found were toxoplasmosis (37.14%), tuberculosis (17.14%), cerebral atrophy (17.14%) and HIV encephalitis (14.28%). Among the eleven patients with a normal Computer Tomography scan, the MRI found 7 abnormalities including 1 case of toxoplasmosis, 3 cases of HIV encephalitis and 3 cases of Progressive Multifocal Leukoencephalopathy (PML). <strong>Conclusion:</strong> MRI played an important role in the diagnosis of CNS disorders in HIV-infected individuals. It can be used to differentiate and characterize various brain lesions. Improving its accessibility in sub-Saharan Africa should contribute to better care for people living with HIV.
文摘Endogenous endophthalmitis is a rare condition with a poor long-term visual prognosis and significant mortality, often associated with the hematogenous spread of intravitreal infections and subsequent disruption of the blood-ocular barrier. Its anatomical proximity to the central nervous system (CNS) poses a high risk of infection dissemination, although cases documented in the literature are rare, and endogenous endophthalmitis is typically described as secondary to neuroinfections. We report the case of an 82-year-old female patient with a history of hypertension who presented with fever, decreased visual acuity, severe headache, chemosis, and conjunctival injection. Endogenous endophthalmitis was diagnosed, and antimicrobial treatment was initiated alongside surgical intervention by the ophthalmology service. However, the patient’s condition worsened neurologically, and Streptococcus pneumoniae was identified in cerebrospinal fluid cultures. Despite intensive medical treatment, the patient’s clinical course was poor, leading to death.
文摘BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.
文摘BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.
文摘BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.
文摘BACKGROUND Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving thecentral nervous system is uncommon;among these cases, spinal intramedullaryTB is even more rare. The clinical manifestations of spinal intramedullary TB aresimilar to those of intramedullary spinal cord tumors. Therefore, it is necessary tomake a careful differential diagnosis of spinal intramedullary lesions to achievethe appropriate treatment and favorable prognosis. We report a rare case of ayoung male patient with paraplegia due to spinal intramedullary TB, which isuncommon and regrettable.CASE SUMMARY A 23-year-old male presented with fever accompanied by nausea and vomitinglasting for 2 mo and was then diagnosed with tubercular meningitis. After anti-TBtreatment, his symptoms were significantly improved. However, 2 mo after thediagnosis of tubercular meningitis, the patient felt numbness below the costal archlevel, which lasted for 1 wk, and he paid no attention to this symptom. Whatfollowed was paraplegia and urine/fecal incontinence. Magnetic resonanceimaging of the thoracic spine showed a ring-enhanced intramedullary cord lesionat T8-T9. Lesion exploration showed enlargement of the spinal cord at T8-T9, andthe lesion could be observed by incision. The lesion was adhered to the peripheraltissue and was grayish-white and tough with a poor blood supply and a diameterof approximately 0.8 cm. The lesion was resected completely. The results ofpathological examination by both hematoxylin-eosin staining and acid-fast bacillistaining confirmed TB, accompanied by acute and chronic suppurativeinflammation and granulation tissue formation. The patient was instructed tocontinue anti-TB treatment after the operation, but he did not follow the medicaladvice. Follow-up continued for ten years, the patient had persistent paraplegia,the numbness disappeared and urine/fecal sensation recovered.CONCLUSION Although TB is a kind of benign disease, some cases progress rapidly. Moreover,spinal intramedullary TB may seriously endanger quality of life and still needstimely diagnosis and proper treatment.
文摘Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic resonance imaging (MRI)manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). Methods:A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study.All the patients had MRI data and clinical data.The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease.Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test,Chi-square test,Mann-Whitney test and Spearman rank correlation analysis. Results:In all 65 patients,41 cases (41/65,63.1%;Group 1)had normal immunity and 24 cases (24/65,36.9%;Group 2)had at least one identifiable underlying disease.Fever,higher percentage of neutrophil (NEUT)in white blood cell (WBC),and increased cell number of cerebral spinal fluid (CSF)were much common in patients with underlying disease (Group 1 vs.Group 2:Fever:21/41 vs.21/24,x^2 =8.715,P =0.003;NEUT in WBC:73.15%vs.79.60%,Z=-2.370,P =0.018;cell number of CSF:19 vs.200,Z=-4.298,P <0.001;respectively).Compared to the patients with normal immunity,the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs.Group 2:20/41 vs.20/24,x^2 =7.636,P =0.006).The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r =-0.472,P =0.031,r =0.779,P =0.039;respectively). Conclusions:With the increased number of the involved brain areas in patients with identifiable underlying disease,the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.
文摘BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.
文摘目的:探讨中枢神经受累的系统性血管炎与结核性脑膜和(或)脑炎的头颅M R I的差别。方法:回顾性收集32例中枢神经系统血管炎,34例结核性脑膜和(或)脑炎。对比两组患者的M R I表现。结果:中枢神经系统血管炎顶叶病灶明显多于结核组(P<0.05),其他病变部位无区别;中枢神经系统血管炎的病灶强化中的条索样强化多见于结核(P<0.05),其余病灶强化类型无区别;中枢神经系统血管炎的脑膜强化连续性的少于结核组,非连续性的强化多于结核组(P<0.01)。脑出血形式差异无显著性。结论:中枢神经系统性血管炎的病灶在顶叶较结核多见,病灶条索样增强较多见,脑膜强化多为非连续性的,通过上述表现可帮助鉴别两病。
