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PubMed1994

Successful treatment of meningoencephalitis caused by Mycobacterium avium intracellulare in AIDS.

A wide variety of pathologies afflicting the CNS is see in patients infected with the human immunodeficiency virus. We report the case of relapsing meningoencephalitis caused by Mycobacterium avium intracellulare (MAI) in a homosexual male with the acquired immunodeficiency syndrome in whom repeated use of polymerase chain reaction was required to detect MAI-specific DNA in the cerebrospinal fluid. Successful responses to early empirical antibiotic combination treatment, including the drugs clarithromycin and rifabutin, were demonstrated by clinical, EEG, and CSF improvement during an 8-month period. To our knowledge, this study presents the first known patient with the acquired immunodeficiency syndrome effectively treated for MAI meningoencephalitis and suggests that modern antimycobacterial combination therapy may improve the poor prognosis of CNS infections with nontuberculous mycobacteria.

AIDS-Related Opportunistic Infections↗

PubMed1979

An unusual form of measles meningoencephalitis. A report of two cases.

Two patients are reported with a chronic progressive illness characterized by dementia, ataxia and spasticity. There were no myoclonic jerks and both had normal electroencephalograms (EEG). Pathological findings in three brain biopsies were those of viral meningoencephalitis with perivenous demyelination. Serological data in both patients indicated the presence of measles virus infection. Intracytoplasmic structures resembling measles virus nucleocapsids were found in the brain biopsy of one patient. Immunofluorescent staining showed antibody in the temporal lobe biopsy of both patients. It is suggested that these patients are examples of a chronic form of measles meningoencephalitis hitherto undescribed.

Adult↗

PubMed1982

Three novel manifestations of chlamydia trachomatis infection- endometritis, perihepatitis and meningoencephalitis.

The present communication discusses the possibility of endometritis, perihepatitis and meningoencephalitis being three conditions associated with Chlamydia trachomatis infection. Chlamydial infection of the endometrium can occur as one manifestation of an ascending genital infection also affecting the Fallopian tubes. Perihepatitis may be another manifestation in cases of acute chlamydial salpingitis. However, both chlamydia-associated endometritis and chlamydia-associated perihepatitis can occur in the absence of tubal infection. In cases of meningoencephalitis, evidence of infection with TRIC agents (C. trachomatis) have been documented.

Chlamydia Infections↗

PubMed1995

Fatal meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a child with lymphoblastic leukemia.

A fatal case of meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a 5-year-old boy with acute myeloblastic leukemia who was given intrathecal treatment is reported. Itraconazole treatment was ineffective. The fungus was identified on brain sections at autopsy and was not observed in any other organ. As no other portal of entry was detected, meningoencephalitis may have originated via direct introduction of the fungus at therapeutic lumbar puncture.

Child, Preschool↗

PubMedDate not supplied

Prolonged meningoencephalitis due to Epstein-Barr virus with favorable outcome in a young infant.

We present a case of meningoencephalitis due to EBV in a 2-month-old infant, without mononucleosis, which persisted for more than 5 months. Evidence for persistence of the infection was provided by a convulsive disorder and prolonged CSF pleocytosis, combined with persistent moderate anemia. Despite the persistence of the infection, the child continued to develop normally. This case demonstrates that EBV meningoencephalitis occurring in young patients may present with only subtle clinical findings and may have a favorable prognosis.

Female↗

PubMed1987

Successful treatment of echovirus meningoencephalitis in sex-linked agammaglobulinaemia by intrathecal and intravenous injection of high titre gammaglobulin.

A 7-year-old boy with sex-linked agammaglobulinaemia developed meningoencephalitis caused by echovirus type 11. He had convulsions, right hemiplegia, cortical motor aphasia, left abducens nerve paralysis, left hypoglossal nerve paralysis, and later became unconscious. Treatment by intravenous injection of conventional gammaglobulin and intrathecal alpha-interferon brought no clinical improvement, but intrathecal administration together with intravenous injection of gammaglobulin containing a high titre of anti-echovirus type 11 antibody was associated with a dramatic improvement in his clinical symptoms. After subsequent periodical (once or twice a week) administration of specific gammaglobulin for 8 months, the echovirus in his cerebrospinal fluid was no longer detected. These findings suggest that intrathecal injection combined with intravenous injection of high titre anti-echovirus type 11 antibody was effective in treating this case of echovirus meningoencephalitis in sex-linked agammaglobulinaemia.

Child↗

PubMed2000

[Generalized brain edema in non-purulent meningoencephalitis. The anti-edema effect of therapy with dexamethasone].

We report about two female inpatients aged 58 and 24, suffering from non-purulent meningoencephalitis, in the first case caused by varizella-zoster-virus, in the second case probably due to viral infection. Both patients developed a diffuse brain edema associated with a progressive loss of consciousness. The adjunctive treatment with dexamethasone led to rapid improvement of clinical symptoms. Computed tomography revealed a significant reduction of brain edema. These results of these two cases support the efficacy of corticosteroids as adjunctive treatment of diffuse brain edema caused by non-purulent meningoencephalitis. The pathophysiological mechanisms are discussed.

Adult↗

PubMed2006

Meningoencephalitis due to anthrax: CT and MR findings.

Anthrax is primarily a disease of herbivores, but it also causes cutaneous, respiratory and gastrointestinal infections in humans. Bacillus anthracis is an uncommon cause of meningitis and generally produces a haemorrhagic meningoencephalitis. We present the CT and MR findings of anthrax meningoencephalitis due to the cutaneous form of anthrax in a 12-year-old boy. They showed focal intracerebral haemorrhage with leptomeningeal enhancement.

Anthrax↗

PubMed2003

Adenovirus meningoencephalitis in a patient with large B-cell lymphoma.

We report a case of a 58-year-old female with neuromeningeal relapse of a large B-cell lymphoma which developed a meningoencephalitis due to adenovirus (ADV). Diagnosis of suspected viral meningoencephalitis was based on computed tomography (CT) scan radiological pictures, which were atypical for CNS neoplastic infiltrations, and it was confirmed by direct immunofluorescence performed on cerebrospinal fluid. Cultural exams identified adenovirus type 7. The ADV infection resolved after treatment with total four doses of cidofovir. Unfortunately, the hematological disease progressed and the patient died 2 months later from disseminated lymphoma.

Adenovirus Infections, Human↗

PubMed2000

Human herpesvirus 6-meningoencephalitis in an HIV patient with progressive multifocal leukoencephalopathy.

Human herpesvirus 6 (HHV6) has been reported as a rare cause of meningoencephalitis and leukoencephalitis. We present an HIV-infected patient with lesions of progressive multifocal leukoencephalopathy (PML), but also meningoencephalitis apparently due to HHV6. Immunohistochemistry for HHV6 antigens and in situ polymerase chain reaction for HHV6 genome showed many positive lymphocytes and microglia in the meningeal and cortical lesions. More importantly, dead and dying neurons were conspicuous; some were undergoing neuronophagia and some displayed evidence of HHV6 infection. A pathogenic role for this almost universal, and usually commensal, virus in inflammatory brain lesions and PML is briefly discussed.

Adult↗

PubMed2001

Late clinical manifestation of cerebral tuberculomas in two children with tuberculous meningoencephalitis.

UNLABELLED: We report on two children with cerebral tuberculomas leading to late dramatic clinical exacerbation after appropriate antituberculous chemotherapy and high-dose corticosteroids. A 6-year-old girl with tuberculous meningoencephalitis initially fully recovered. However, after 9 months of continuous therapy she presented with acute increased intracranial pressure caused by tuberculomas requiring rapid drainage of CSF. A 16-year-old boy with miliary pulmonary tuberculosis and severe meningoencephalitis had reached a stable condition for more than 10 months although still suffering from a left-dominant spasticity and motor dysphasia. Fifteen months after initiation of therapy he presented with an acute central paralysis of the left facial nerve, progressive hemiplegia, severe ataxia and increasing lethargy caused by a cerebral tuberculoma with a perifocal oedema. Prolonged treatment with antituberculous chemotherapy and high-dose corticosteroids led to complete recovery in the younger patient and marked improvement in the older patient who remains severely handicapped. CONCLUSION: Patients with initially successful treatment of central nervous system tuberculosis should undergo an alert follow-up for the development of late cerebral tuberculomas. Treatment should consist of prolonged courses of antituberculous chemotherapy and high-dose corticosteroids.

Adolescent↗

PubMed1984

Chlorambucil in the treatment of uveitis and meningoencephalitis of Behçet's disease.

Among 21 patients with Behçet's disease, the results of various treatments were assessed. Treatment with chlorambucil, 0.1 mg/kg daily, compared favorably with corticosteroids. Uveitis and visual acuities improved in five of seven eyes when the patients were treated with chlorambucil, whereas improvement was observed in only four of 13 eyes when treatment consisted of corticosteroids. In 19 treatment courses among 14 patients with meningoencephalitis or recurrent meningitis, eight of nine patients treated with chlorambucil had remission of their disease; eight of 10 treatment courses with other agents--generally, corticosteroids--failed to induce remission in any of eight patients. Elevated cerebrospinal fluid cell counts returned to normal in five of nine patients treated with chlorambucil but remained elevated in five of six patients treated with corticosteroids. Two patients died, one who was taking prednisone plus cyclophosphamide and the other after prednisone plus multiple immunosuppressive treatments. Toxicity from chlorambucil included leukopenia (two patients), thrombocytopenia (one), bronchopneumonia (one), and amenorrhea (two). The duration of chlorambucil therapy averaged 1.8 years both for patients with uveitis and for those with meningoencephalitis.

Adolescent↗

PubMed1984

Primary amoebic meningoencephalitis in a young male from northwestern Mexico.

Primary meningoencephalitis caused by Naegleria fowleri was documented in a 16-year-old male from Mexicali in the state of Baja California in Mexico. In August 1978, seven days after sustaining moderate head trauma while swimming in a shallow, stagnant irrigation ditch on a hot summer day, the patient presented an acute illness with severe headache, fever and convulsions rapidly progressing into a comatose state. Actively moving trophozoites were observed in the spinal fluid on admission. The patient died shortly after admission to hospital on the third day of symptoms. Post-mortem examination revealed a meningoencephalitis with extensive destruction, haemorrhage and numerous parasites involving structures of the posterior fossa. Immunoperoxidase strains of trophozoites in meningeal and cerebellar tissue were positive for N. fowleri KUL and negative for N. gruberi, N. australiensis and Acanthamoeba rhysodes. This appears to be the first documented case of the disease in Mexico.

Adolescent↗

PubMed1986

Curative properties of muramyl dipeptide in experimental Naegleria meningoencephalitis.

Naegleria fowleri is a free-living amoeba which causes a fatal meningoencephalitis in man. Mice injected with the immunostimulant MDP or an attenuated 11RX strain of Salmonella enteritidis showed some resistance to an intranasal challenge with N. fowleri. In addition it was observed that some of the mice infected with N. fowleri and showing symptoms of naegleria meningoencephalitis, given a single injection of MDP were cured of this disease. Our findings suggest that the use of immunostimulants could be a new approach in the quest for therapeutic agents for this disease.

Acetylmuramyl-Alanyl-Isoglutamine↗

PubMed1989

Sequestration of virus-specific T cells in the cerebrospinal fluid of a patient with varicella zoster viral meningoencephalitis.

The frequency of virus-specific T cells in the cerebrospinal fluid of a patient with viral infection of the brain and meninges was determined by using a single-T-cell cloning technique where a representative sampling of T cells was cloned from the cerebrospinal fluid of a patient with varicella zoster viral (VZV) meningoencephalitis. That the derived T-cell clones were in fact clonal was shown by demonstrating, on Southern blot analyses, unique rearrangements of the T-cell antigen-receptor beta-chain genes of each clone. Five out of the 15 of the T4+ (CD4), 0/4 of the T8+ (CD8), and 0/1 of the T4+T8+ T-cell clones proliferated to VZV, while no clones proliferated to mumps virus or myelin basic protein. There was no clonal expansion of any VZV-reactive T cell in this patient's cerebrospinal fluid. As VZV meningoencephalitis is thought to be due to the reactivation of a dormant herpes zoster viral infection, it can be regarded as a secondary immune response. The presence of different T-cell receptor beta-chain gene rearrangements in each T-cell clone suggests that the T-cell response was polyclonal. These results demonstrate that a high frequency of polyclonal, T4+ antigen-specific T cells can be found in a naturally occurring, localized, immune response.

Antigens, Differentiation, T-Lymphocyte↗

PubMed1993

Successful treatment of amoebic meningoencephalitis in a Chinese living in Hong Kong.

Primary amoebic meningoencephalitis due to Naegleria fowleri was found in a 38-year-old Chinese man living in Hong Kong who presumably acquired the infection from swimming in a hot spring in neighbouring China. Amoebic cysts were identified in tissue taken from a brain abscess. The patient responded to surgical drainage and a 6-week course of amphotericin B, rifampicin and chloramphenicol. This is one of 6 cases of successful treatment of primary amoebic meningoencephalitis documented in the medical literature.

Adult↗

PubMed2005

Meningoencephalitis associated with passive immunization of a transgenic murine model of Alzheimer's amyloidosis.

Immunization against the Abeta peptide reverses the pathologic and behavioral manifestations of Alzheimer's disease in murine models. Since active immunization is associated with an autoimmune meningoencephalitis in a subset of humans, passive transfer of anti-Abeta immunoglobulin is being pursued as a potentially safer alternative. We have identified cases of meningoencephalitis subsequent to peripheral and intracerebral passive immunization of Tg2576 mice. The vasocentric mononuclear infiltrate localized only to brain regions affected by Abeta amyloid deposits suggesting that the inflammatory reaction was Abeta specific. This report indicates that current passive immunization in humans should proceed with careful regard for autoimmune complications.

Alzheimer Disease↗

PubMed2005

Reversible cortical lesions in primary Sjögren's syndrome presenting with meningoencephalitis as an initial manifestation.

We report a 50-year-old woman with primary Sjögren's syndrome (SjS) who initially showed forgetfulness, and later developed disturbance of consciousness. In addition to aseptic meningoencephalitis revealed by cerebrospinal fluid examination and magnetic resonance imaging (MRI), the presence of serum anti-SS-A and anti-SS-B antibodies and inflammatory findings in lip biopsy indicated primary SjS. Fluid attenuated inversion recovery (FLAIR) of MRI revealed well defined small, high signal intensity areas in the cortex involving the subcortical white matter. Corticosteroid therapy resulted in rapid and nearly complete resolution of the cortical lesions with marked improvement of the clinical manifestations. Memory disturbance is a rare initial manifestation in meningoencephalitis associated with SjS. Our patient with SjS showed inflammatory cortical lesions on MRI, which were reversed by corticosteroid therapy.

Anti-Inflammatory Agents↗