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meningitis pathophysiology

Amy Kunchok, Anastasia Zekeridou, Andrew McKeon
PURPOSE OF REVIEW: To describe a recently characterized autoimmune, inflammatory central nervous system (CNS) disorder known as autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy. RECENT FINDINGS: Affected patients present with symptoms of one or more of meningitis (headache and neck ache), encephalitis (delirium, tremor, seizures, or psychiatric symptoms), and myelitis (sensory symptoms and weakness). Optic disc papillitis (blurred vision) is common...
February 4, 2019: Current Opinion in Neurology
Kurt-Wolfram Sühs, Natalia Novoselova, Maike Kuhn, Lena Seegers, Volkhard Kaever, Kirsten Müller-Vahl, Corinna Trebst, Thomas Skripuletz, Martin Stangel, Frank Pessler
Background: The tryptophan-kynurenine-NAD+ pathway is closely associated with regulation of immune cells toward less inflammatory phenotypes and may exert neuroprotective effects. Investigating its regulation in CNS infections would improve our understanding of pathophysiology and end-organ damage, and, furthermore, open doors to its evaluation as a source of diagnostic and/or prognostic biomarkers. Methods: We measured concentrations of kynurenine (Kyn) and tryptophan (Trp) in 220 cerebrospinal fluid samples from patients with bacterial and viral (herpes simplex, varicella zoster, enteroviruses) meningitis/encephalitis, neuroborreliosis, autoimmune neuroinflammation (anti-NMDA-R encephalitis, multiple sclerosis), and noninflamed controls (Bell's palsy, normal pressure hydrocephalus, Tourette syndrome)...
February 5, 2019: Journal of Infectious Diseases
Tomáš Radovnický, Robert Bartoš, Petr Vachata, Martin Sameš
Transethmoidal encephalocele is a rare condition in adult patients. It is usually diagnosed during childhood by cerebrospinal fluid (CSF) rhinorrhea, meningitis, a nasal mass, or seizures. We present a case of an adult woman with CSF rhinorrhea following resection of an occipital meningioma. The cribriform plate defect containing the encephalocele was diagnosed by computed tomography and magnetic resonance imaging. Transcranial surgery using a patch was performed successfully. We also discuss the possible pathophysiologic mechanisms of encephalocele and treatment options...
December 24, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Marcel Gebhardt, Peter Kropp, Frank Hoffmann, Uwe K Zettl
AIMS: Headaches have not been considered a typical symptom of multiple sclerosis (MS), although since 2000, almost every study showed high prevalence. We screened 50 MS patients at the time of first occurrence of neurological symptoms and found the highest prevalence of headache in MS that was ever recorded (78%). Postmortem histological analyses of MS patients' brains revealed lymphoid follicle-like structures in the cerebral meninges and a pathophysiological link between headache, and high inflammatory activity especially in the initial phase of MS could be suspected...
October 26, 2018: European Neurology
A Balasko, Y Keynan
OBJECTIVES: The aim of this work was to review current treatment options and propose alternatives for immune reconstitution inflammatory syndrome (IRIS) in HIV-infected individuals with cryptococcal meningitis (CM) (termed 'HIV-CM IRIS'). As a consequence of the immunocompromised state of these individuals, the initial immune response to CM is predominantly type 2 T helper (Th2) /Th17 rather than Th1, leading to inefficient fungal clearance at the time of antiretroviral initiation, and a subsequent overexaggeration of the Th1 response and life-threatening IRIS development...
January 2019: HIV Medicine
Yasunori Iida, Hiroyuki Wakiguchi, Fumiko Okazaki, Tamaki Nakamura, Hiroki Yasudo, Makoto Kubo, Kazuma Sugahara, Hiroshi Yamashita, Yutaka Suehiro, Naoko Okayama, Kunio Hashimoto, Naoki Iwamoto, Atsushi Kawakami, Yoshiharu Aoki, Hidetoshi Takada, Shouichi Ohga, Shunji Hasegawa
Cryopyrin-associated periodic syndrome (CAPS) is one of the autoinflammatory disorders caused by mutations in NLRP3 gene. The over-production of interleukin (IL)-1β induced by NLRP3 gene mutations plays an important role in the pathophysiology of CAPS. We diagnosed 3 patients with CAPS, who were lineal family members having a novel mutation of NLRP3 gene. The objective of this report is to compare the characteristics of symptoms and differences in the therapeutic responses of them, who had the same mutation...
October 18, 2018: Clinical Rheumatology
T Koutangni, P Crépey, M Woringer, S Porgho, B W Bicaba, H Tall, J E Mueller
The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals...
September 28, 2018: Epidemiology and Infection
C Zamora, S-C Hung, C Tomingas, C Atkinson, M Castillo
We describe the prevalence and potential significance of deep medullary vein engorgement on SWI in patients with neurosarcoidosis, a finding that has not been described previously. Engorgement was evaluated for possible associations with meningeal or perivascular disease, intracranial hemorrhage, and venous thrombosis, as well as with modified Rankin Scale scores at the time of MR imaging and at follow-up. Deep medullary vein engorgement was seen in 7 of 21 patients and was more common in men. Patients with venous engorgement had a significantly increased incidence of microhemorrhages, perivascular disease, and hydrocephalus...
November 2018: AJNR. American Journal of Neuroradiology
Linmei Wang, Yanli Zhang, Ying Zhao, Charles Marshall, Ting Wu, Ming Xiao
The imbalance between production and clearance of amyloid-beta (Aβ) is a key step in the onset and development of Alzheimer's disease (AD). Therefore, reducing Aβ accumulation in the brain is a promising therapeutic strategy for AD. The recently discovered glymphatic system and meningeal lymphatic vasculature have been shown to be critical for the elimination of interstitial waste products, especially Aβ, from the brain. In the present study, ligation of deep cervical lymph nodes was performed to block drainage of this system and explore the consequences on Aβ-related pathophysiology...
September 7, 2018: Brain Pathology
Maxime Woringer, Nadège Martiny, Souleymane Porgho, Brice W Bicaba, Avner Bar-Hen, Judith E Mueller
BACKGROUND: Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic...
September 2018: Environmental Health Perspectives
Calvin Green, Christine Ann Moore, Akhilesh Mahajan, Kailash Bajaj
Streptococcus pneumoniae is a bacterium responsible for a spectrum of diseases including lobar pneumonia, meningitis, otitis media, and sinusitis. Invasive pneumococcal disease is responsible for significant morbidity and mortality across the world. Concerted efforts led to the development of two vaccinations, Pneumova × 23 and Prevnar 13, for the prevention of pneumococcal disease. The Advisory Committee on Immunization Practices of the US Centers for Disease Control and Prevention provides vaccination schedules for predisposed adults, but the proposed schedules remain a challenge to health-care providers...
July 2018: Journal of Global Infectious Diseases
Lukas Muri, Denis Grandgirard, Michelle Buri, Michael Perny, Stephen L Leib
BACKGROUND: Pneumococcal meningitis is associated with high mortality and morbidity rates. Up to 50% of survivors show neurologic sequelae including hearing loss, cognitive impairments and learning disabilities, being particularly detrimental in affected infants and children where adjuvant therapy with dexamethasone has no proven beneficial effect. We evaluated the effect of concomitantly targeting specific pathophysiological mechanisms responsible for brain damage-i.e. matrix-metalloproteinase (MMP) activity and the exacerbated cerebral inflammation provoked through antibiotic-induced bacterial lysis...
August 21, 2018: Journal of Neuroinflammation
Francesco Brigo, Alberto Vogrig, Arianna Bratti, Veronica Tavernelli, Raffaele Nardone, Eugen Trinka
Epilepsia partialis continua (EPC) is a rare form of focal status epilepticus. We describe a 22-year-old woman with EPC manifesting with isolated toe movements, prevalent over the left side and initially misdiagnosed as psychogenic, clinically almost indistinguishable from those observed in "painful legs and moving toes syndrome". The continuous involuntary movements with EMG correlates of twitches lasting <100 ms, the sharp waves over fronto-central regions on EEG, and the marked asymmetry in somatosensory evoked potentials with higher cortical amplitude over the right side following peripheral stimulation over the left foot confirmed the epileptic nature of the symptoms, leading to the diagnosis of EPC...
August 1, 2018: Epileptic Disorders: International Epilepsy Journal with Videotape
Elva Bonifácio Andrade, Ana Magalhães, Ana Puga, Madalena Costa, Joana Bravo, Camila Cabral Portugal, Adília Ribeiro, Margarida Correia-Neves, Augusto Faustino, Arnaud Firon, Patrick Trieu-Cuot, Teresa Summavielle, Paula Ferreira
Group B streptococcal (GBS) meningitis remains a devastating disease. The absence of an animal model reproducing the natural infectious process has limited our understanding of the disease and, consequently, delayed the development of effective treatments. We describe here a mouse model in which bacteria are transmitted to the offspring from vaginally colonised pregnant females, the natural route of infection. We show that GBS strain BM110, belonging to the CC17 clonal complex, is more virulent in this vertical transmission model than the isogenic mutant BM110∆cylE, which is deprived of hemolysin/cytolysin...
August 7, 2018: Nature Communications
A Leonard, M Lalk
Streptococcus pneumoniae, a Gram-positive bacterium, can cause a broad range of severe diseases including pneumonia, septicemia and meningitis. The pneumococcal pathophysiology is highly dependent on host nutrients such as purines, pyrimidines, amino acids and carbon sources. The study of S. pneumoniae metabolism is essential for understanding the adaption strategies that are required to deal with the host environment during infection and to identify possible new drug targets. By using a combination of high analytical techniques, such as nuclear magnetic resonance (NMR), liquid chromatography (LC) and/or gas chromatography (GC) coupled with mass spectroscopy (MS) the metabolism of S...
August 1, 2018: Cytokine
Simon Grandjean Lapierre, Xin Dang, Danielle Gilbert, Sylvie Lauzier, Igor J Koralnik, Louiselle LeBlanc
JC virus is the etiological agent of progressive multifocal leukoencephalopathy, a white matter demyelinating disease that mostly affects immunocompromised patients. JC virus can also infect neurons and meningeal cells and cause encephalitis, meningitis and granule cell neuronopathy. We report a patient with JC virus granule cell neuronopathy, without concomitant progressive multifocal leukoencephalopathy, presenting as inaugural acquired immune deficiency syndrome-related illness. This patient's human immunodeficiency virus infection remained undiagnosed for several months after neurological symptoms onset...
July 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Florence Abravanel, Julie Pique, Elisabeth Couturier, Florence Nicot, Chloé Dimeglio, Sébastien Lhomme, Julie Chiabrando, Karine Saune, Jean-Marie Péron, Nassim Kamar, Solène Evrard, Henriette de Valk, Pascal Cintas, Jacques Izopet
OBJECTIVES: Hepatitis E virus (HEV) is a major cause of acute hepatitis worldwide. However, our understanding of the source of contamination is incomplete and the frequency of neurological manifestations in still unknown. METHODS: 200 eligible cases reported to the French National Reference Center from January 2015 to December 2015 were prospectively included in this case-control study (1 case: 1 control, matched for sex, age and area of living) to investigate the risk of infection...
September 2018: Journal of Infection
Lidia Garcia-Bonilla, David Brea, Corinne Benakis, Diane A Lane, Michelle Murphy, Jamie Moore, Gianfranco Racchumi, Xinran Jiang, Costantino Iadecola, Josef Anrather
Exposure to low-dose lipopolysaccharide (LPS) before cerebral ischemia is neuroprotective in stroke models, a phenomenon termed preconditioning (PC). Although it is well established that LPS-PC induces central and peripheral immune responses, the cellular mechanisms modulating ischemic injury remain unclear. Here, we investigated the role of immune cells in the brain protection afforded by PC and tested whether monocytes may be reprogrammed by ex vivo LPS exposure, thus modulating inflammatory injury after cerebral ischemia in male mice...
July 25, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Desmond P Kidd
OBJECTIVE: Neurological complications of systemic sarcoidosis are uncommon and the natural history and optimal treatments under-researched. With the advent of modern biological therapies, it is important to define the clinical characteristics and immunopathology of the disease. METHODS: Patients referred to and treated within the Centre for Neurosarcoidosis over a 15 year period who had biopsy-proven "highly probable" disease of the central nervous system were studied prospectively...
August 2018: Journal of Neurology
Anália Cirqueira Milhomem, Amanda Juliana Soaris de Souza, Hidelberto Matos Silva, Marina Clare Vinaud, Milton Adriano Pelli de Oliveira, Juliana Reis Machado, Ruy de Souza Lino Júnior
Neurocysticercosis (NCC) is one of the parasitic infections that most affects the central nervous system. The knowledge regarding its immunopathogenesis and pathophysiology needs broadening. Taenia crassiceps cysticerci are used as the NCC experimental model. The aim of this work was to describe the general pathological processes and the in situ cytokine profile in C57BL/6 mice inoculated intracranially with viable T. crassiceps cysticerci. The histopathology analysis showed cysticerci in the extraparenchymal and intraventricular region, mononuclear inflammatory infiltration surrounding the parasite, microgliosis and meningitis...
May 2018: Arquivos de Neuro-psiquiatria
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