Low antioxidant status of patients with central nervous system infections

Aim:The pathogenesis of central nervous system infections(CNSI)has not been fully understood;some studies indicated that reactive oxygen species may induce brain damage.The aim of our study was to investigate serum antioxidant status in patients with CNSI.Methods:The serum levels of uric acid(UA),bilirubin and albumin of 548 individuals were enrolled in our study,comprising of 114 healthy controls(HC)and 434 patients with five different kinds of CNSI,which including viral meningitis and/or meningoencephalitis,cysticercosis of brain,tuberculous meningitis and/or meningoencephalitis,cryptococcus meningitis and/or meningoencephalitis,and bacterial meningitis and/or meningoencephalitis.Results:The data suggested that there were reducing levels of oxidation state(serum UA,bilirubin and albumin)in CNSI patients when compared with HC.Likewise,similar results were observed when cohorts were divided into male and female subgroups.Conclusion:The authors demonstrated that serum antioxidant status in patients with CNSI was lower;the reason may be due to exhaustion of antioxidant capacity.Therefore,enhancing antioxidant power and keeping oxidative stress and antioxidants in balance may be beneficial to the patients with CNSI.

Application of metagenomic next-generation sequencing in the diagnosis of infectious diseases of the central nervous system after empirical treatment

BACKGROUND The diagnostic value of metagenomic next-generation sequencing(mNGS)in central nervous system(CNS)infectious diseases after empirical treatment has not been reported.AIM To investigate the diagnostic value of mNGS of cerebrospinal fluid(CSF)in the empirically treated CNS infectious diseases.METHODS A total of 262 CSF samples from patients with suspected CNS infections were collected between August 2020 and December 2021.Both mNGS and conventional methods were used for testing.The conventional methods included microbial culture,smear,polymerase chain reaction,etc.RESULTS Among 262 suspected cases,183 cases(69.84%)were diagnosed as CNS infection,including 86 cases of virus infection(47.00%),70 cases of bacterial infection(38.25%)and 27 cases of fungal infection(14.76%).The sensitivity and specificity of mNGS were 65.6%(95%CI:58.2%-72.3%)and 89.6%(95%CI:79.1%-95.3%),respectively.The PPV of mNGS was 94.5%(95%CI:88.6%-97.6%),and the NPV was 48.8%(95%CI:39.7%–57.9%).The pathogen detective sensitivity and accuracy of mNGS were higher than those of conventional methods(Sensitivity:65.6%vs 37.2%;P<0.001;Accuracy:72.0%vs 50%,P<0.001).The results showed that compared with conventional methods,mNGS technology was a more sensitive method for the diagnosis of CNS infection after empirical treatment.CONCLUSION mNGS can be a better method applied in the diagnosis of CNS infection after empirical treatment.

Prevotella oris-caused meningitis and spinal canal infection:A case report

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.

The relationship between serum levels of uric acid and prognosis of infection in critically ill patients

Serum uric acid level is associated with some chronic diseases and prognosis of severe infection. This study aimed to investigate the relationship between serum uric acid （SUA） and prognosis of infection in critically ill patients. The data from 471 patients with infection admitted from January 2003 to April 2010 were analyzed retrospectively at Huashan Hospital Affiliated to Fudan University, Shanghai, China. The data of SUA, serum creatinine, blood urea nitrogen （BUN） and other relevant examinations within 24 hours after admission were recorded and the levels of SUA in those patients were described, then Student＇s t test was used to evaluate the relationship between SUA and pre-existing disorders. Different levels of SUA were graded for further analysis. The Chi-square test was used to examine the difference in the prognosis of infection. The mean initial level of SUA within 24 hours after admission was 0.232±0.131 mmol/L and the median was 0.199 mmol/L. Remarkable variations in the initial levels of SUA were observed in patients with pre-existing hypertension （t=-3.084, P=0.002）, diabetes mellitus （t=-2.487, P=0.013）, cerebral infarction （t=-3.061, P=0.002）, renal insufficiency （t=-4.547, P〈0.001）, central nervous system infection （t=5.096, P〈0.001） and trauma （t=2.875, P=0.004）. SUAwas linearly correlated with serum creatinine and BUN （F=159.470 and 165.059, respectively, P〈0.001）. No statistical correlation was found between the initial levels of SUA and prognosis of infection （X^2=60.892, P=0.100）. The current study found no direct correlation between the initial levels of SUA after admission and prognosis of infection in critically ill patients.

Cauda equina arachnoiditis–a rare manifestation of West Nile virus neuroinvasive disease:A case report

BACKGROUND Data regarding the neuroradiology features of the West Nile virus neuroinvasive disease(WNV NID)is rather scarce.To contribute to the knowledge of the WNV NID,we present a patient with a combination of encephalitis and acute flaccid paresis,with cauda equina arachnoiditis as the main magnetic resonance(MR)finding.CASE SUMMARY A 72-year-old female patient was admitted due to fever,headache and gait instability.During the first several days she developed somnolence,aphasia,urinary incontinence,constipation,and asymmetric lower extremities weakness.Cerebrospinal fluid analysis indicated encephalitis.Native brain computed tomography and MR were unremarkable,while spinal MR demonstrated cauda equina enhancement without cord lesions.Virology testing revealed WNV IgM and IgG antibodies in serum and cerebrospinal fluid,which confirmed acute WNV NID.The treatment was supportive.After two months only a slight improvement was noticed but cognitive impairment,loss of sphincter control and asymmetric inferior extremities weakness remained.The patient died after a month on chronic rehabilitation.CONCLUSION Cauda equina arachnoiditis is a rare,but possible neuroradiological feature in acute flaccid paresis form of WNV NID.

Non-traumatic coma in young children in Benin:are viral and bacterial infections gaining ground on cerebral malaria?

Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to describe the etiology of non-traumatic comas in young children in Benin,as well as their management and early outcomes,and to identify factors associated with death.Methods:From March to November 2018,we enrolled all HIV-negative children aged between 2 and 6 years,with a Blantyre Coma Score≤2,in this prospective observational study.Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex PCR.To determine factors associated with death,univariate and multivariate analyses were performed.Results:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial co-infection.Six children had a non-malarial infection or no identified cause.The mortality rate was 29.8%(25/84),with 20 children dying in the first 24 h.Co-infected children appeared to have a poorer prognosis.Of the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral therapy.Predictors of early death were jaundice or increased bilirubin[odd ratio(OR)=8.6;95% confidential interval(CI):2.03-36.1]and lactate>5 mmol/L(OR=5.1;95%CI:1.49-17.30).Antibiotic use before admission(OR=0.1;95%CI:0.02-0.85)and vaccination against yellow fever(OR=0.2,95%CI:0.05-0.79)protected against mortality.Conclusions:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic coma.Missed opportunities to receive early effective antimalarial treatment were common.Other central nervous system infections must be considered in their management.Some factors that proved to be protective against early death were unexpected.

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.