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PubMedDate not supplied

[Chronic eosinophilic meningoencephalitis due to Candida guillermondii].

INTRODUCTION: Eosinophilic meningoencephalitis is characterized by a meningeal syndrome and an eosinophilic reaction of the cerebrospinal fluid (CSF). When these symptoms persist for more than four weeks, it is said to be chronic. Both eosinophilic meningoencephalitis and chronic meningoencephalitis are of multiple aetiologies, including fungi. CLINICAL CASE: We report a case in which chronic meningoencephalitis occurred, with persistence of leukocytes, mainly eosinophils, in the CSF. The patient complained of intense, generalized headache and a temperature of 37 degrees C. On physical examination, the only unusual finding was slight neck stiffness. During the clinical course there were focal motor signs and evidence of intracranial hypertension. On CSF culture Candida guillermondii was grown. Treatment with amphotericin B was given, and the neurological disorder remitted completely. CONCLUSION: Candida guillermondii may be the etiological agent in chronic eosinophilic meningoencephalitis.

Adolescent↗

PubMed2002

Acute meningoencephalitis as initial presentation of human immunodeficiency virus infection: report of two cases.

Since the advent of pandemic of the human immunodeficiency virus infection, the possible pathogens responsible for acute meningoencephalitis have broadened. Human immunodeficiency virus itself can cause acute meningoencephalitis, and the immunocompromise associated with human immunodeficiency virus infection predisposes the infected patients to acute meningoencephalitis caused by a variety of other infectious or non-infectious etiologies. Here reported are 2 cases of acute meningoencephalitis with history of blood transfusion and travel to southeast Asia; both are positive for screening tests of human immunodeficiency virus infection. One of the pathogen causing central nervous system infection, Mycobacterium tuberculosis, was identified by polymerase chain reaction; the other left undiagnosed. It is known that patients of human immunodeficiency virus infection or acquired immunodeficiency syndrome can present with acute central nervous system infection. The need for routine screening of human immunodeficiency virus antibody is currently under debate; nevertheless, the possibility of human immunodeficiency virus infection has to be kept in mind in patients with acute meningoencephalitis.

Acute Disease↗

PubMedDate not supplied

[Effectiveness of Soviet derivatives of phosphonic acid and their combination with interferon inducers in cell cultures and in a model of herpetic meningoencephalitis in mice].

Nationally synthesized chemopreparations: phosphonoacetic (PAA), phosphonoformic (PFA) acids and acycloguanosine (Acg) exhibit a marked antiherpetic effect in cell cultures and marked protective effect in herpes meningoencephalitis in mice induced by intraperitoneal inoculation of herpes simplex virus type 1 (HSV-1) (43% PFA, 33% PAA, 25% Acg). Both in vitro and in vivo (mouse meningoencephalitis), PFA (its trisodium salt) on the whole proved to be less toxic than PAA but exerted a higher or similar antiherpetic effect. The combined use of pyrophosphate analogues (PAA, PFA) with Acg is more effective that their use separately both in vitro and in herpes meningoencephalitis in mice an produces an additive effect or one similar to it. Systemic inoculation of interferon inducers, lafarine or ridostine, is effective in herpes meningoencephalitis in mice induced by intraperitoneal inoculation of HSV-1 (the protective effect 33% and 26%, respectively). The combined use of ridostine and PAA in herpes meningoencephalitis in mice led to synergistic effect.

Acyclovir↗

PubMed1998

Alteration of cerebral blood flow in patients with bacterial and viral meningoencephalitis.

PURPOSE: Our purpose was to investigate cerebral blood flow disturbances in patients with bacterial and viral meningoencephalitis. METHODS: Forty-two patients with acute bacterial and viral meningoencephalitis and 14 control subjects were studied using 99mTc-hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). SPECT images were evaluated semiquantitatively. The results were compared with clinical severity of the meningoencephalitis assessed at the time of the SPECT study with the Hunt and Hess scale, with separately recorded focal clinical signs, and with the Glasgow outcome scale (GOS) after 3 weeks. RESULTS: Count density values were significantly reduced in patients with bacterial meningoencephalitis as compared with the control subjects. Inhomogeneous tracer accumulation assessed by asymmetry indexes was significantly greater in patients than in the control group. With increasing Hunt and Hess scores, the count density values decreased and the asymmetry indexes increased. Patients with a poor outcome (GOS 1 to 3) had significantly higher asymmetry indexes and lower CDV values than did patients with a good outcome. CONCLUSION: Global and focal alterations of cerebral perfusion are frequent in bacterial and viral meningoencephalitis and correlate with acute clinical state.

Adult↗

PubMed2002

Cryptococcus neoformans meningoencephalitis in African children with acquired immunodeficiency syndrome.

BACKGROUND: The number of children with AIDS in Africa is high. Such children may be at risk for cryptococcal meningoencephalitis, but data are scarce regarding this disease in our population. METHODS: We examined records of HIV-infected children (< or =16 years) diagnosed with cryptococcal meningoencephalitis in Harare, Zimbabwe, between 1995 and 2000. To elucidate features unique to pediatric disease, the children were compared with adult patients with HIV-associated cryptococcal meningoencephalitis. RESULTS: Thirteen children presented to our institution with headache (85%), nuchal rigidity (69%), vomiting (46%), impaired mental status (38%), convulsions (38%) and focal neurologic signs (23%). The mean duration of symptoms before diagnosis was 9 days. Cerebrospinal fluid examination revealed normal white blood cell counts in 64%, protein value in 67% and glucose concentration in 57% of patients. Children were more likely than adults to have seizures (38% vs. 11%, P = 0.02) and normal cerebrospinal fluid protein (67% vs. 10%, P < 0.01). The in-hospital mortality was 43%. Convulsions (P = 0.05) and impaired mental status (P < 0.01) were associated with increased mortality CONCLUSIONS: Cryptococcal meningoencephalitis in African children presents acutely or subacutely, can have a fulminant picture and is consistent with progressive meningoencephalitis.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Neuro-ophthalmic features in pediatric tubercular meningoencephalitis.

PURPOSE: To examine the neuro-ophthalmic profile in childhood tubercular meningoencephalitis and assess its prognostic importance. METHODS: One hundred consecutive patients with tubercular meningoencephalitis underwent evaluation for optic nerve functions, supra- and infranuclear oculomotor involvement, and raised intracranial tension. Patients underwent follow-up for 9 months. RESULTS: In 100 patients with tubercular meningoencephalitis, 67 had neuro-ophthalmic features. Common findings were retrobulbar neuritis (32) and gaze palsy (20). Others, in decreasing prevalence, were third and sixth nerve palsy, conjugate deviation, primary optic atrophy, and complete ophthalmoplegia. Raised intracranial tension was associated with neuro-ophthalmic features in 53 of 67 patients (P<.05). Complete ophthalmoplegia was significantly associated with mortality on logistic regression analysis (relative risk, 6.35; P=.012). By 6 months, 56% of patients with retrobulbar neuritis progressed to optic atrophy. CONCLUSION: Neuro-ophthalmic features, in association with raised intracranial tension, often are a part of pediatric tubercular meningoencephalitis presentation. The type of neuro-ophthalmic features may have prognostic value. Optic nerve involvement is the most common finding in tubercular meningoencephalitis.

Child↗

PubMed2005

[Hepatitis caused by tick-borne meningoencephalitis virus (TBEV)--a rare clinical manifestation outside the central nervous system involvement].

OBJECTIVE: North part of Croatia, especially the Koprivnica-Krizevci County has been a well-known endemic area of tick-borne encephalitis (TBE) for more than 50 years. To date, this disease caused by tick-borne encephalitis virus (TBEV) has retained the leading position among inflammatory diseases of the central nervous system (CNS), with an average morbidity of 19 patients per year. In 88% of patients the infection manifested with signs of meningitis or meningoencephalitis with a biphasic course. TBE may take a more severe course with different neurologic dysfunction or even lethal outcome. There have been isolated reports on some rare clinical manifestations outside CNS involvement caused by TBEV, including transient hepatitis, pancreatitis, and myocarditis. These manifestations have been most frequently detected during the initial stage of disease but also as a complication, or as an individually separate clinical entity. The incidence rate of these manifestations is not known. Until now, such clinical manifestations outside CNS have not been reported in the county. It was the reason to present the characteristics of liver failure in our patients suffering from TBE. Purpose of Work: To determine the frequency of elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with TBEV infection, to note the time from the detection to disappearance of elevated AST and to investigate and establish whether the degree of liver failure influences the course and outcome of TBE. PATIENTS AND METHODS: The study was conducted from January 1991 until September 2004, and included patients with TBEV infection and elevated AST and ALT, examined at the Department of Infectious Diseases, Koprivnica General Hospital. Study patients were of all age groups and occupation. On their first examination detailed epidemiologic and patient history data were collected, with special reference to the history of alcohol abuse, disease of the liver or biliary tract, or any other apparent cause of liver failure. Clinical examination and laboratory tests were performed. Patients were classified into four groups as suffering from meningitis, meningoencephalitis, meningoencephalomyelitis, or abortive form of disease. The acute stage of meningoencephalitis was classified as mild, moderate or severe, depending on meningeal symptoms and severity of clinical signs of encephalitis, and presence of focal CNS signs. ELISA test was used to detect specific IgM and IgG antibodies. Serum samples were tested for other tick-borne diseases, including human monocyte and granulocyte ehrlichiosis. Oral consent was obtained from all patients enrolled in the study. RESULTS AND DISCUSSION: During the study, recent infection with TBEV was proven in 261 patients. Liver function tests were done in 115 (44%) patients. Elevated AST and ALT activity was found in 25 (22%) patients, without bilirubin and alkaline phosphatase increase. All these were County residents, with a male sex predominance, aged 28-70 (median 41) years, and none had received TBE vaccination. Elevated AST and ALT activities were detected during the first stage of TBE in 16 (64%) and during the second stage of meningoencephalitis in 9 (36%) patients suffering from TBE. Elevated activity of AST was observed in 76% and of ALT in 96% of study patients. The most frequently observed elevated AST and ALT activity was two- or threefold the usual normal values. The time of the first detection of elevated AST and ALT activity could not be precisely determined, since all laboratory findings were performed during the first examination of patients. In the initial stage of disease, patients were mostly tested between 2-5 days from the onset of disease, and during the first week in the second stage of meningoencephalitis. Elevated AST and ALT activities were transient and normalized in 3-4 weeks. The importance of elevated AST and ALT activity for the course and prognosis of TBE was not verified in this study. CONCLUSION: The first patients with hepatitis as one of the possible manifestation outside CNS involvement caused by TBEV are described. The prevalence and new concepts on this type of the disease were investigated in the study.

Adult↗

PubMed1977

Meningoencephalitis due to Acanthamoeba SP. Pathogenesis and clinico-pathological study.

Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are infectious diseases essentially confined to the Central Nervous System (CNS) and caused by free-living amebas of the genus Acanthamoeba (A.) and Naegleria (N.) respectively. AM due to A. sp. (Acanthamoeba castellanii and Acanthamoeba culbertsoni) have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, or in immunologically impaired patients without a history of recent swimming in contrast to cases due to N. sp. which usually occurs in healthy, young individuals with a recent history of swimming in man-made lakes or heated swimming pools. AM due to A.sp. is characterized by a subacute or chronic granulomatous meningoencephalitis involving mainly the midbrain, basal areas of the temporal and occipital lobes and posterior fossa structures. CNS lesions in AM are perhaps secondary and the portal of entry in humans is probably from the lower respiratory tract, genitourinary system or skin reaching the CNS by hematogenous spread. The predominant host reaction is usually composed of lymphocytes, plasma cells, monocytes and multinucleated foreign body giant cells. Necrosis is moderate and hemorrhage scant or absent. Cysts as well as trophozoites may be seen within the CNS lesions. PAM is due to Naegleria fowleri and is characterized by an hemorrhagic necrotizing meningoencephalities with an acute inflammatory response. Only trophozoites are found in lesions. The portal of entry is through the olfactory neuroepithelium. CNS tissues fixed in formalin may be used for further identification and taxonomical classification of the causative protoza using immunofluorescent antibody techniques (IFAT) and electron microscopic methods.

Amebiasis↗

PubMed1992

Chronic enteroviral meningoencephalitis in agammaglobulinemia: case report and literature review.

Chronic enteroviral meningoencephalitis is a well-recognized complication in patients with X-linked agammaglobulinemia (XLA). The majority of published cases refers to its occurrence in patients on no replacement therapy or on only intramuscular immunoglobulin. The advent of intravenous immunoglobulin (IVIg) in the early 1980s and its widespread use in XLA was thought to have virtually eradicated enteroviral meningoencephalitis in these patients. We describe the development of echovirus meningoencephalitis in an 11-year-old boy on regular IVIg replacement whose serum IgG levels were maintained at between 6 and 8 g/L (NR 6-13 g/L). Treatment with daily high-dose IVIg was commenced, with significant clinical improvement being noted within a few weeks in association with a reduction in blood-brain barrier permeability. The persistence of live virus, however, necessitated the use of intraventricular immunoglobulin. The virus proved resistant to two courses of specific intraventricular immunoglobulin and a 6-week course of oral ribavirin and eventually proved fatal 5 months after presentation. In view of the therapeutic uncertainties we have reviewed the use of immunoglobulin in the treatment of enteroviral meningoencephalitis over the past 6 years.

Acyclovir↗

PubMedDate not supplied

An outbreak of anthrax meningoencephalitis.

We report a common-source outbreak of anthrax meningoencephalitis in Chittoor district in Andhra Pradesh, southern India, in October 1990. The source of infection was the carcass of a sheep. Of 5 persons who skinned and cut up its meat for human consumption, 4 developed anthrax meningoencephalitis and one a malignant pustule. Another person who wrapped the meat in a cloth and carried it home on his head developed a malignant pustule on his forehead and also meningoencephalitis. All subjects with anthrax meningoencephalitis died, but the one with only a malignant pustule recovered. A large number of people who cooked or ate the cooked meat of the dead sheep remained well. The medical, public health and veterinary authorities were alerted and sheep, goats and cattle in the locality were immunized with anthrax vaccine. Although rules against consumption of meat of dead animals exist, their violation shows a lack of public awareness. Health education should be undertaken to correct this situation.

Adult↗

PubMed1992

Study of brain and vascular plexus gangliosides in meningoencephalitis of various etiology.

The content of brain and vascular plexus gangliosides and their composition have been studied in 15 cases of meningoencephalitis of various etiology and degree of disease. The most pronounced decrease of ganglioside concentration was found in brain of children, who died from herpes virus infection. Decrease of ganglioside content was revealed in brain grey matter of patients with influenza virus or meningococcus infection, but not in cases of mycoplasma infection. These data provide evidence of nerve cell destruction due to meningoencephalitis of various etiology. The biochemical data obtained are in good agreement with the results of the brain of children infection by herpes virus (increase of GD1b content in grey matter). Ganglioside content in vascular plexes of patients with meningoencephalitis was found to be, on the contrary, much higher (ca 4 times) than in the controls. The higher the lesion of choroid plexes in meningoencephalitis is, the higher the ganglioside content in them is.

Brain↗

PubMed2006

Greyhound meningoencephalitis: PCR-based detection methods highlight an absence of the most likely primary inducing agents.

Greyhound meningoencephalitis is currently classified as a breed-associated idiopathic central nervous system inflammatory disorder. The non-suppurative inflammatory response can be distinguished from the other breed-associated disorders based on histopathology and lesion topography, however the nature of the response primarily suggests a viral infection. In the present study PCR and RT-PCR technologies were employed on frozen cerebral tissue from confirmed cases of meningoencephalitis to target specific viruses and protozoa likely to be implicated and to exclude the presence of bacterial 16SrRNA. Secondly, degenerate primers were used to detect viruses of the herpesvirus and flavivirus families. In addition cerebral tissues were probed for West Nile Virus. Viral nucleic acid sequences to Borna disease virus, to louping ill, tick borne encephalitis, West Nile and other flaviviruses were not detected. Canine distemper virus was detected in one animal with 97% homology to strain A75/15. Degenerate PCR for herpesviruses detected viral amplification products in one animal with 90% homology to canine herpesvirus DNA polymerase gene. Protozoal amplification products were only detected in a single dog with pathological confirmation of a combination of lesions of greyhound meningoencephalitis and a protozoal encephalomyelitis. Neospora was confirmed with sequence homology to Austrian strain 1. Bacterial 16SrRNA was not detected. The present study supports previous observations that many of the known microbial causes of canine meningoencephalitis are not involved. Findings could reflect that the causal agent was not specifically targeted for detection, or that the agent is at undetectable levels or has been eliminated from brain tissue. The potential roles of genetics and of molecular mimicry also cannot be discounted.

Animals↗

PubMed1999

Risk factors for West Nile virus infection and meningoencephalitis, Romania, 1996.

In 1996, an epidemic of 393 cases of laboratory-confirmed West Nile meningoencephalitis occurred in southeast Romania, with widespread subclinical human infection. Two case-control studies were performed to identify risk factors for acquiring infection and for developing clinical meningoencephalitis after infection. Mosquitoes in the home were associated with infection (reported by 37 [97%] of 38 asymptomatically seropositive persons compared with 36 [72%] of 50 seronegative controls, P<.01) and, among apartment dwellers, flooded basements were a risk factor (reported by 15 [63%] of 24 seropositive persons vs. 11 [30%] of 37 seronegative controls, P=.01). Meningoencephalitis was not associated with hypertension or other underlying medical conditions but was associated with spending more time outdoors (meningoencephalitis patients and asymptomatically seropositive persons spent 8.0 and 3.5 h [medians] outdoors daily, respectively, P<.01). Disease prevention efforts should focus on eliminating peridomestic mosquito breeding sites and reducing peridomestic mosquito exposure.

Adult↗

PubMed2002

Mumps meningoencephalitis effect on hearing.

Sensorineural hearing loss is an important complication of mumps. Audiologic tests of 26 children with mumps meningoencephalitis, 25 uncomplicated mumps cases and 20 control cases were performed, and hearing level thresholds at speech and high frequencies were determined. The mean hearing level thresholds in the mumps meningoencephalitis group were higher than those of mumps cases at frequencies from 6,000 to 18,000 Hz in the right ear and at 250 and from 4,000 to 18,000 Hz in the left ear (P < 0.05). Mumps meningoencephalitis cases had higher mean hearing thresholds than did control groups at all frequencies other than 125 and 250 Hz in the right ear and 10,000 Hz in the left ear. The mean hearing thresholds of mumps cases were higher than those of control group at frequencies of 1,000 and 4,000 Hz in the right ear and 1,000 and 10,000 Hz in the left ear (P < 0.05). These results show that mumps meningoencephalitis causes a higher risk of hearing loss than does mumps.

Age Distribution↗

PubMed1996

Cerebrospinal fluid soluble L-selectin (sCD62L) in meningoencephalitis.

The leucocyte adhesion molecule L-selectin (CD62L) is rapidly cleaved off proteolytically after cell activation, generating soluble L-selectin (sCD62L) molecules. sCD62L concentrations were determined in 185 cerebrospinal fluid (CSF) samples obtained from children aged 1 month to 17 years. In 36 CSF samples of children with meningoencephalitis, sCD62L was significantly higher (median 209 fmol/ml) than in samples of children with other febrile diseases (n = 67, median 50 fmol/ml) or non-febrile disorders (n = 82, median 44 fmol/ml). There was a positive correlation between CSF protein and CSF sCD62L (rS = 0.68), suggesting that a disturbed blood-brain barrier contributes to raised sCD62L concentrations in the CSF. However, the CSF sCD62L/protein ratio of children with meningoencephalitis was significantly higher than in children with other febrile diseases or non-febrile disorders, indicating that sCD62L concentrations in children with meningoencephalitis were higher than expected from plasma leakage alone. It is concluded that both an impaired blood-brain barrier and the generation of sCD62L by infiltrating leucocytes contribute to raised CSF sCD62L concentrations in children with meningoencephalitis.

Acute Disease↗

PubMed1978

Primary amoebic meningoencephalitis.

As a serendipitous by-product of polio virus research, a highly fatal amoebic meningoencephalitis was recognized in animals. The causative microorganisms, contaminants of the viral cultures, were identified as small soil amoebae. These organisms, previously considered non-pathogenic, are prevalent throughout the world. Based on animal studies, the original investigators suggested the possibility of a similar disease in humans. Seven years later, human cases of amoebic meningoencephalitis were reported from widely separated areas of the world. Since 1965, a total of 79 cases have been reported. The literature of primary amoebic meningoencephalitis is presented. The history of the discovery and elucidation of this disease is reviewed. The 79 cases reported in the world literature are divided into two groups, those diagnosed retrospectively after reviewing previous deaths from meningoencephalitis, and those diagnosed at the time of the illness. The classification, morphology, pathogenicity, virulence and distribution of pathogenic soil amoebae are reviewed. The presenting clinical findings, diagnostic procedures, pathology, and management of this recently recognized, highly fatal, human disease is presented along with a report of a new case. Otolaryngologists should become familiar with this serious disorder with a transnasal portal of entry.

Amebiasis↗

PubMed2001

Magnetic resonance imaging findings in tuberculous meningoencephalitis.

OBJECTIVE: To evaluate the efficacy of magnetic resonance imaging (MRI) for distinguishing tuberculosis from other types of meningoencephalitis. PATIENTS AND METHODS: MRIs of 100 patients with tuberculous (50), pyogenic (33), viral (14), or fungal (3) meningoencephalitis were analyzed independently by 2 radiologists. Number, size, location, signal characteristics, surrounding edema, and contrast enhancement pattern of nodular lesions; location and pattern of meningeal enhancement; extent of infarct or encephalitis and hydrocephalus were evaluated. RESULTS: Contrast-enhancing nodular lesions were detected in patients with tuberculous (43 of 50 patients), pyogenic (9 of 33), and fungal (3 of 3) infections. No nodules were detected in patients with viral meningoencephalitis. Using the criteria of 1 or more solid rim or homogeneously enhancing nodules smaller than 2 cm, the sensitivity, specificity and accuracy for diagnosing tuberculous meningitis were 86.0%, 90.0% and 88.0%, respectively. CONCLUSION: Magnetic resonance imaging is useful in distinguishing tuberculous from pyogenic, viral and fungal meningoencephalitis.

Adolescent↗

PubMed1992

[Acute meningoencephalitis caused by Coxiella burnetii with periodic EEG complexes].

Q fever is a zoonosis found worldwide and is produced by Coxiella burnetii. It may be acute or chronic with neurological manifestations being infrequent. Several cases of acute encephalitis or meningoencephalitis have been described, generally with an evolution towards cure regardless of the use of selective antibiotic treatment. Recently the authors had the opportunity to study a 33 year old male presenting acute meningoencephalitis in which the clinical manifestations, CSF findings (increase in cellularity with lymphocytic predominance and excess proteins ) and neurophysiological findings (appearance of periodic bilateral complexes in the EEG) suggested the diagnosis of herpetic meningoencephalitis. Treatment with acyclovir was initiated. However, serologic studies demonstrated, a posteriori, that the germ responsible had been Coxiella burnetii. The patient evolved satisfactorily with no specific treatment and the EEG anomalies disappeared within a few days. The authors insist on the need to include Q Fever in the diagnostic differential of acute meningoencephalitis and emphasize the possibility that germs of a non viral nature may produce periodic EEG complexes in all that similar to those found in herpetic encephalitis.

Acute Disease↗