Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

Kenfak, Alain; Epéron, Gilles; Schibler, Manuel; Lamoth, Frédéric; Vargas, Maria Isabel; Stahl, Jean-Paul

doi:10.1016/j.cmi.2019.01.008

Cited by 14 publications

(14 citation statements)

References 80 publications

(77 reference statements)

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“…The underlying origins of encephalitis are multitude, and include infectious causes, comprising viral, bacterial, fungal, and parasitic agents, but also toxic, metabolic, (para)neoplastic and autoimmune or rarely post-immunization etiologies [ 29 , 40 , 42 ]. World travellers for example may be exposed to a variety of neurotropic pathogens leading to ‘exotic’ causes of central nervous system (CNS) infections [ 22 ]. Interestingly, increasing evidence points to genetic reasons of mild encephalitis which may often escape recognition until progressed age [ 17 , 20 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, increasing evidence points to genetic reasons of mild encephalitis which may often escape recognition until progressed age [ 17 , 20 , 37 ]. In about 50–70% of encephalitis cases, an etiologic agent is never identified, presumably due to the broad range of possible underlying origins and limitations in contemporary diagnostic testing, but likely also because of continuing pathogenetic dynamics in the absence of the formerly inducing agent [ 22 , 29 , 40 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

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Inducing sterile pyramidal neuronal death in mice to model distinct aspects of gray matter encephalitis

Wilke

Hindermann

Moussavi

et al. 2021

acta neuropathol commun

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Up to one person in a population of 10,000 is diagnosed once in lifetime with an encephalitis, in 50–70% of unknown origin. Recognized causes amount to 20–50% viral infections. Approximately one third of affected subjects develops moderate and severe subsequent damage. Several neurotropic viruses can directly infect pyramidal neurons and induce neuronal death in cortex and hippocampus. The resulting encephalitic syndromes are frequently associated with cognitive deterioration and dementia, but involve numerous parallel and downstream cellular and molecular events that make the interpretation of direct consequences of sudden pyramidal neuronal loss difficult. This, however, would be pivotal for understanding how neuroinflammatory processes initiate the development of neurodegeneration, and thus for targeted prophylactic and therapeutic interventions. Here we utilized adult male NexCreERT2xRosa26-eGFP-DTA (= ‘DTA’) mice for the induction of a sterile encephalitis by diphtheria toxin-mediated ablation of cortical and hippocampal pyramidal neurons which also recruits immune cells into gray matter. We report multifaceted aftereffects of this defined process, including the expected pathology of classical hippocampal behaviors, evaluated in Morris water maze, but also of (pre)frontal circuit function, assessed by prepulse inhibition. Importantly, we modelled in encephalitis mice novel translationally relevant sequelae, namely altered social interaction/cognition, accompanied by compromised thermoreaction to social stimuli as convenient readout of parallel autonomic nervous system (dys)function. High resolution magnetic resonance imaging disclosed distinct abnormalities in brain dimensions, including cortical and hippocampal layering, as well as of cerebral blood flow and volume. Fluorescent tracer injection, immunohistochemistry and brain flow cytometry revealed persistent blood–brain-barrier perturbance and chronic brain inflammation. Surprisingly, blood flow cytometry showed no abnormalities in circulating major immune cell subsets and plasma high-mobility group box 1 (HMGB1) as proinflammatory marker remained unchanged. The present experimental work, analyzing multidimensional outcomes of direct pyramidal neuronal loss, will open new avenues for urgently needed encephalitis research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inducing sterile pyramidal neuronal death in mice to model distinct aspects of gray matter encephalitis

Wilke

Hindermann

Moussavi

et al. 2021

acta neuropathol commun

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“…1 Infeksi pada meningens disebut meningitis, 1 infeksi pada jaringan otak disebut ensefalitis 2 dan apabila mengenai jaringan otak dan meningens maka disebut meningoensefalitis. 3 Terdapat beberapa etiologi untuk meningitis seperti bakteri, virus atau jamur walaupun etiologi jamur lebih jarang ditemukan. 4 Insiden meningitis bakterial diperkirakan 3-5 per 100.000 orang setiap tahunnya dan hampir setengah meninggal walaupun telah mendapat penanganan yang tepat.…”

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Infeksi Susunan Saraf Pusat pada Anak: Sebuah Studi Potong Lintang Deskriptif Selama Lima Tahun

Octavius

Raditya²,

Kimberly³

et al. 2021

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Latar belakang. Infeksi susunan saraf pusast memiliki morbiditas dan mortalitas apabila tidak ditangani secara tepat. Penanganan yang tidak sesuai juga berisiko tinggi untuk menimbulkan kecacatan pada kemudian hari. Tipe-tipe infeksi susunan saraf pusat dapat berupa meningitis, ensefalitis dan meningoensefalitis yang memiliki etiologi dan manifestasi klinis yang beragam.Tujuan. Penelitian ini bertujuan untuk mendeskripsikan karakteristik klinis pada setiap infeksi sistem saraf pusat baik dari segi manifestasi klinis, radiologis, serta terapi pada setiap pasien.Metode. Anak berusia 0-18 tahun yang didiagnosis meningitis, ensefalitis dan meningoensefalitis dari Januari 2015 hingga September 2019 diinklusikan pada studi potong lintang ini. Data diambil melalui rekam medis.Hasil. Terdapat 45 pasien yang memenuhi kriteria inklusi dan eksklusi dan laki-laki mendominasi pada studi ini (57,8%). Meningitis ditemukan pada 37,8% pasien, ensefalitis pada 22,2% pasien, dan meningoensefalitis pada 40% pasien. Tuberkulosis menjadi etiologi tersering yang ditemukan pada studi ini sebesar 71,1%. Median durasi rawat inap terpanjang ditemukan pada pasien dengan meningoensefalitis (15,5 hari) dan kortikosteroid merupakan pengobatan yang sering digunakan untuk mengatasi infeksi susunan saraf pusat.Kesimpulan. Infeksi SSP lebih sering terjadi pada anak di bawah <5 tahun. Sebagian besar anak-anak datang dengan penurunan kesadaran akut dan TB masih merupakan penyebab utama dari infeksi SSP. Pasien dengan meningitis TB atau meningoensefalitis TB datang dengan derajat MRC 2-3 yang berkorelasi dengan morbiditas dan mortalitas tinggi sehingga diagnosis dan tatalaksana yang tepat diperlukan oleh para klinisi untuk memperbaiki luaran pasien.

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“…A general diagnostic approach in returning travelers with neurological symptoms is applied to investigate the etiology of infection according to country of travel, duration of the trip, and timing and duration of symptoms. 7 In this context, we consider that major attention should be addressed to MuV in the investigation of neurotropic agents when extensive screening for travel-related etiologies is considered.…”

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confidence: 99%

A case of mumps encephalitis imported to Italy from India

Baggieri

Rovida

Marchi

et al. 2020

Journal of Medical Virology

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To the Editor, On 3rd December 2018, a 33-year-old man presented at the Emergency Department of the ASST of Cremona, Italy, with persistent fever, headache, vomiting and periorbital edema with a red rash on his face. This patient reported that he had been in India for 3 months to visit his family and returned to Italy on 3rd December. Neurologic examination was unremarkable, except for very intense headache without other signs of meningitis. Blood was drawn and a spinal tap was performed. All hemato-chemical tests were normal (including white blood cell count). Cerebrospinal fluid (CSF) analysis showed pleocytosis (1,960 WBC/mm3, 87.7% monocytes), glucose of 65.4 mg/dL (reference range, 40-70 mg/dL), and proteins of 96 mg/dL (reference range, 20-45 mg/dL). Encephalitis was suspected. The patient was hospitalized in the Infectious Diseases Department. Empiric antiviral and antibacterial therapies with acyclovir and ampicillin were promptly started for prophylaxis. CSF was tested using Biofire Filmarray Meningitis/Encephalitis panel (BioFire Diagnostics) for the following neurotropic agents:

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Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

Cited by 14 publications

References 80 publications

Inducing sterile pyramidal neuronal death in mice to model distinct aspects of gray matter encephalitis

Inducing sterile pyramidal neuronal death in mice to model distinct aspects of gray matter encephalitis

Infeksi Susunan Saraf Pusat pada Anak: Sebuah Studi Potong Lintang Deskriptif Selama Lima Tahun

A case of mumps encephalitis imported to Italy from India

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