1/22. The west nile virus outbreak of 1999 in New York: the flushing Hospital experience.west nile virus (WNV) is a mosquito-borne flavivirus, which has been known to cause human infection in africa, the middle east, and southwestern asia. It has also been isolated in australia and sporadically in europe but never in the americas. Clinical features include acute fever, severe myalgias, headache, conjunctivitis, lymphadenopathy, and a roseolar rash. Rarely is encephalitis or meningitis seen. During the month of August 1999, a cluster of 5 patients with fever, confusion, and weakness were admitted to the intensive care unit of the same hospital in new york city. Ultimately 4 of the 5 developed flaccid paralysis and required ventilatory support. Three patients with less-severe cases presented shortly thereafter. With the assistance of the new york city and New York State health departments and the Centers for disease Control and Prevention, these were documented as the first cases of WNV infection on this continent.- - - - - - - - - - ranking = 1keywords = encephalitis (Clic here for more details about this article) |
2/22. Chronic parvovirus B-19 meningoencephalitis with additional detection of Epstein-Barr virus dna in the cerebrospinal fluid of an immunocompetent patient.parvovirus B19 dna was detected by polymerase chain reaction in the brain biopsy specimen from a 67-year-old immunocompetent woman with severe chronic lymphocytic meningoencephalitis. In addition to parvovirus B19, Epstein-Barr virus dna was identified in the CSF. Genomic material from Epstein-Barr virus was absent in the brain tissue. Clinical symptoms and CSF pleocytosis improved under long-term corticosteroid-treatment. The aetio-pathogenetic role of parvovirus B19 and the possible meaning of the additionally detected Epstein-Barr virus dna are discussed.- - - - - - - - - - ranking = 5keywords = encephalitis (Clic here for more details about this article) |
3/22. Varicella zoster meningitis preceeded by thrombophlebitis in a patient with Hodgkin's disease.Varicella zoster (V-Z) infections are common among patients with hematological malignancies, particularly Hodgkin's disease (HD). The common denominator in both HD and V-Z infections is immunosuppression. Most of V-Z infections occur in patients with HD during the remission period, who have mixed cellularity sub-type, with stage III disease and who have received combined chemo-radiation therapy. Involvement of the central nervous system usually manifests as post-herpetic neuralgia or encephalitis. Angiitis has also been found in association with V-Z infections. The authors describe a case of HD who developed V-Z meningitis preceeded by superficial thrombophlebitis of upper extremities during the period of active chemotherapy.- - - - - - - - - - ranking = 1keywords = encephalitis (Clic here for more details about this article) |
4/22. case reports of viral meningitis/encephalitis.The purpose of this paper is to present three case reports of patients who presented to a local hospital in Northern louisiana with symptoms of viral meningitis and encephalitis. It also updates physicians on the signs and symptoms of persons infected with west nile virus (WNV), a new and emerging infection in the Western Hemisphere. Beginning in June 2002, persons in louisiana, particularly the southern part of the state, started presenting to health facilities with symptoms of infection with the WNV. By August 2002, persons in the northern part of the state were also experiencing symptoms that include neurologic presentations of the disease. After completing recommended diagnostic measures for possible infection with flaviviruses, the three cases presented here were positive for viral meningitis/encephalitis. Beginning in June 2002, the state experienced an outbreak of WNV of epidemic proportions. Consequently, clinicians need to be mindful of the symptoms, diagnostic measures, treatment, prevention, and reporting of meningitis/encephalitis.- - - - - - - - - - ranking = 7keywords = encephalitis (Clic here for more details about this article) |
5/22. Combined and alternating ganciclovir and foscarnet in acute and maintenance therapy of human immunodeficiency virus-related cytomegalovirus encephalitis refractory to ganciclovir alone. A case report and review of the literature.cytomegalovirus (CMV) causes life-threatening disseminated infections and in particular vision-threatening infections of the retina in patients with the acquired immunodeficiency syndrome. ganciclovir currently represents the most frequently used therapy for CMV retinitis. However, cases of ganciclovir-resistant CMV strains have been described, in which foscarnet seems to be an effective alternative. Both drugs have serious toxicities, and relapses frequently occur during maintenance therapy. In a patient with CMV encephalitis, we administered a 3-week combination ganciclovir/foscarnet induction therapy (ganciclovir 5 mg/kg every 12 h; foscarnet 60 mg/kg every 8 h), followed by an alternating maintenance administration of both drugs every other day (ganciclovir 5 mg/kg, foscarnet 120 mg/kg) to reduce toxicity and resistance. This regimen was tolerated well and seemed to be more effective than ganciclovir alone in a patient with CMV encephalitis.- - - - - - - - - - ranking = 6keywords = encephalitis (Clic here for more details about this article) |
6/22. Molecular evidence of persistent echovirus 13 meningoencephalitis in a patient with relapsed lymphoma after an outbreak of meningitis in 2000.Enteroviral meningoencephalitis was diagnosed in a patient with an immunodeficiency syndrome acquired after treatment with rituximab for a relapsed primary B-cell lymphoma. A second meningoencephalitic episode was diagnosed 6 months later and was successfully treated with a combination of immunoglobulins and pleconaril. The infection was persistent since the enterovirus genome was detected in five sequential specimens of cerebrospinal fluid collected over 9 months. An echovirus 13 isolate was isolated in the first three samples. The viral sequence encoding the VP1 capsid protein of the three isolates was determined and was compared with that of four control viruses. The virus isolates recovered from the patient shared >99% nucleotide sequence similarity with one another. In a phylogenetic tree, they were directly related to a control virus obtained from a patient hospitalized in 2000 during an outbreak of enterovirus meningitis. The epidemiological origin of a chronic echovirus infection in a patient with immune deficiency suggests that the echovirus had been continuously circulating in the general population after the outbreak that had revealed its emergence.- - - - - - - - - - ranking = 5keywords = encephalitis (Clic here for more details about this article) |
7/22. Community-acquired west nile virus infection in solid-organ transplant recipients.BACKGROUND: west nile virus (WNV) is rapidly spreading through north america. In the general population, the majority of WNV infections are asymptomatic. During 2002, an outbreak of WNV occurred in Toronto, canada. We observed four cases of severe symptomatic community-acquired WNV infection in our organ-transplant population. methods: Patient data were obtained from chart review. WNV was diagnosed by acute and convalescent serology. incidence was compared with data obtained from a population-based surveillance program. RESULTS: Four transplant patients had WNV encephalitis (n=3) or meningitis (n=1). Mean age was 44.5 (range 26-58) years and transplant type included kidney (n=2), liver (n=1), and heart (n=1). The mean time posttransplant was 3.8 years (range 2 months-8 years). The presenting symptoms were fever (4/4), confusion (3/4), headache (4/4), and weakness (2/4). cerebrospinal fluid showed a pleocytosis in all patients and elevated protein in three of four. All patients had identifiable occupational or recreational risk factors. There was no evidence that the infection was acquired by transfusion or the transplanted organ. Outcomes were full recovery (2/4), lower limb paralysis (1/4), and death (1/4). On the basis of active population surveillance data, the rate of WNV meningoencephalitis in the general population in the Toronto area was approximately 5 per 100,000. This compares to four cases in a transplant population of 2,000 patients (rate 200 per 100,000) (P<0.001). CONCLUSIONS: Transplant patients are likely at greater risk of severe neurologic disease caused by community-acquired WNV compared with the general population. Prevention of transmission and patient education may be more important in this population.- - - - - - - - - - ranking = 2keywords = encephalitis (Clic here for more details about this article) |
8/22. Isolation and molecular characterization of a novel type 3 reovirus from a child with meningitis.Mammalian reoviruses are non-enveloped viruses that contain a segmented, double-stranded rna genome. Reoviruses infect most mammalian species, although infection with these viruses in humans is usually asymptomatic. We report the isolation of a novel reovirus strain from a 6.5-week-old child with meningitis. hemagglutination and neutralization assays indicated that the isolate is a serotype 3 strain, leading to the designation T3/Human/colorado/1996 (T3C/96). sequence analysis of the T3C/96 S1 gene segment, which encodes the viral attachment protein, sigma 1, confirmed the serotype assignment for this strain and indicated that T3C/96 is a novel reovirus isolate. T3C/96 is capable of systemic spread in newborn mice after peroral inoculation and produces lethal encephalitis. These results suggest that serotype 3 reoviruses can cause meningitis in humans.- - - - - - - - - - ranking = 1keywords = encephalitis (Clic here for more details about this article) |
9/22. Calgary experience with west nile virus neurological syndrome during the late summer of 2003.BACKGROUND: Between August 25 and September 25, 2003 seven patients with west nile virus neurological manifestations were identified through the hospital neurology consultation services in Calgary, alberta, canada. Three of the seven patients were treated with interferon alpha-2b (IFN alpha-2b). In this report we document the clinical characteristics of these seven cases. methods: Clinical and laboratory information was obtained from a retrospective review of patient hospital and clinic charts. patients were included if they had serological evidence of west nile virus infection and had clinical evidence of aseptic meningitis, encephalomyelitis, cerebellar syndrome or motor neuronopathy. Three patients received a treatment course of three million units IFN alpha-2b, administered by subcutaneous injection once per day for 14 days. RESULTS: Four patients had cerebellar signs without change in consciousness, two had both encephalitis and neuromuscular weakness, and one patient had focal lower motor neuron arm weakness. The mean age was 52 (range 24 - 73). All patients had flu-like illness and fever as presenting symptoms and six had severe headaches. Two patients were immunocompromised prior to infection. Two patients with cerebellar signs (one with opsoclonus-myoclonus) improved spontaneously and exhibited only mild residual deficits on discharge. The other two patients with cerebellar findings developed brainstem involvement, one coinciding with and one subsequent to the cerebellar symptoms. Within one week of treatment with IFN alpha-2b these latter two patients showed marked improvement. One patient with encephalitis and neuromuscular weakness, was treated with IFN alpha-2b and subsequently recovered. INTERPRETATION: In this case review of seven patients, multiple neurological symptoms occurred in each patient and the neurological presentation was varied. Four patients had predominant cerebellar findings and one patient had opsoclonus-myoclonus, not previously reported. The marked improvement in three patients who received IFN alpha-2b raises preliminary optimism towards this potential treatment.- - - - - - - - - - ranking = 2keywords = encephalitis (Clic here for more details about this article) |
10/22. Possible tick-borne human enterovirus resulting in aseptic meningitis.enterovirus-specific genetic sequences were isolated from two Amblyomma americanum tick pools. Identical genetic sequences were later obtained from cerebrospinal fluid of a patient with aseptic meningitis and a recent history of tick attachment. These observations suggest the possibility of an emerging tick-borne human enterovirus associated with aseptic meningitis.- - - - - - - - - - ranking = 2.2510445180509keywords = tick-borne (Clic here for more details about this article) |
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