1/18. The application of the polymerase chain reaction of cerebrospinal fluid in the clinical management of AIDS-related CNS disorders.In AIDS patients central nervous system (CNS) illness may be caused by hiv disease itself or by opportunistic agents, resulting in serious morbidity such as behavioral and motor disturbances, meningitis or encephalitis, among other disorders. early diagnosis can allow specific treatment (e.g., antimicrobial treatment) that may prevent, ameliorate, or slow the catastrophic sequelae of infection, as well as reduce the need for expensive diagnostic procedures. Conventional microbiology techniques have proven inadequate for the diagnosis of most AIDS-related CNS diseases. However, the development in the past decade of the application of polymerase chain reaction (PCR) to clinical specimens has facilitated the early diagnosis of a number of infectious diseases in these patients. The technique permits the amplification of target nucleic acids such that common laboratory methods may then be used for diagnosis. The application of PCR to cerebrospinal fluid for early diagnosis of AIDS-related neurologic complications has been an impressive example of the application of PCR and may form the basis of new algorithms for diagnosis and possibly the evaluation of treatment protocols.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
2/18. Human herpes virus type 7 dna in the cerebrospinal fluid of children with central nervous system diseases.Human herpes virus type 7 (HHV-7) has been associated with unspecific febrile syndrome, exanthem subitum (ES), viral rashes and Epstein-Barr virus (EBV) like syndrome. Neurological complications such as hemiplegia or seizures have been described in a few children with ES. Whether HHV-7 may also affect the CNS in the absence of ES is unknown. In this study, we investigated CSF samples from children with different neurological diseases for the presence of HHV-7 specific dna. A HHV-7 specific nested polymerase chain reaction (PCR) was established amplifying a 478 bp dna sequence of the glycoprotein U23 of HHV-7 strain SB. 68 children with CNS diseases with inflammatory CSF findings (n = 24), CNS diseases without inflammatory CSF findings (n = 18) and febrile seizures (n = 26) were examined. A total of 26 children with infectious diseases in the absence of neurological disease and 11 children without signs of a peripheral infection and without neurological disease served as controls. The CSF samples of six children from the study groups were HHV-7 PCR positive, but none from the controls. These children were diagnosed with aseptic meningitis (n = 1), viral encephalitis/meningoencephalitis (n = 2), facial palsy (n = 1), vestibular neuritis (n = 1) and febrile seizure (n = 1). CONCLUSION: These results indicate that human herpes virus type 7 infection is associated with central nervous system disease in children and should be considered in children whether inflammation in the cerebrospinal fluid is present or not.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
3/18. rotavirus and central nervous system symptoms: cause or contaminant? case reports and review.rotavirus is a common cause of severe gastroenteritis in children. In 2 patients with rotavirus gastroenteritis who developed encephalopathy, rotavirus rna was detected in the cerebrospinal fluid (CSF) by reverse transcription-polymerase chain reaction; in 1 patient, rotavirus rna was detected on 2 occasions 3 weeks apart. There are increasing reports of cases in which patients who have seizures after an episode of rotavirus diarrhea have evidence of rotavirus in their CSF. A search of 2 large hospital discharge databases suggested that seizures are noted as part of the discharge diagnosis in the records of, at most, <4% of patients with rotavirus diarrhea versus 7% of patients with bacterial diarrhea. Although evidence suggesting that rotavirus is a cause of central nervous system sequelae remains inconclusive, the 2 case reports presented in this study further illustrate a possible association. Further study is required to determine whether detection of rotavirus in CSF represents a true pathogen, CSF contamination that occurs at the time of lumbar puncture or in the laboratory, or carriage of rotavirus rna in trafficking lymphocytes.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
4/18. Parainfectious encephalomyeloradiculitis associated with herpes simplex virus 1 dna in cerebrospinal fluid.We describe a patient with acute encephalomyeloradiculitis associated with herpes simplex virus 1 (HSV-1) dna in the cerebrospinal fluid (CSF), and we also review 4 similar cases previously reported from japan. A 59-year-old man presented with acute encephalitis and urinary retention. Initially, coma and CSF pleocytosis improved with acyclovir treatment, but brain stem encephalitis, transverse myelitis, and lumbosacral polyradiculitis subsequently occurred. These conditions responded to corticosteroid therapy and immunoadsorption plasmapheresis. polymerase chain reaction detected HSV-1 dna in the CSF during acute encephalitis but not thereafter. Serial magnetic resonance imaging revealed transient lesions in the thalamus and basal ganglia on both sides of the brain and in the pons, spinal cord, and cauda equina. Acute encephalomyeloradiculitis is a unique neurological syndrome that may be caused by HSV-1 infection of the central nervous system.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
5/18. Multifocal vasculopathy due to Varicella-Zoster Virus (VZV): serial analysis of VZV dna and intrathecal synthesis of VZV antibody in cerebrospinal fluid.Recognition of multifocal vasculopathy due to varicella-zoster virus (VZV) is often problematic. We describe a human immunodeficiency virus-infected patient who had progressive central nervous system disease for >3 months. Both VZV dna and antibody were detected in cerebrospinal fluid (CSF) specimens; serial polymerase chain reaction analyses confirmed the diagnosis and guided the duration of therapy. Reduced ratios of VZV antibody in serum to that in CSF were also demonstrated.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
6/18. Neurologic presentation of whipple disease: report of 12 cases and review of the literature.We report 12 cases of whipple disease in patients with prominent neurologic symptoms, along with 122 cases of whipple disease with nervous system involvement reported in the literature. We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease. whipple disease is a multisystemic infectious disease due to tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system. Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier. cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative. Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR. When all examinations are negative, if whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed. Treating whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
7/18. Three cases of central nervous system complications associated with mycoplasma pneumoniae.We report three new cases of acute central nervous system disease occurring shortly after mycoplasma pneumoniae infection. The clinical phenotypes were characterized by encephalopathy (n = 2), optic neuritis (n = 1), transverse myelitis (n = 1), and seizures (n = 1). Although there was strong supportive evidence of preceding M. pneumoniae infection, cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative in all three patients. We propose that these cases resulted from a para-infectious immune-mediated process rather than parenchymal invasion by the microorganism. The two patients treated with steroids improved rapidly, and all three patients have made a full recovery. We review the literature regarding M. pneumoniae central nervous system complications and discuss the proposed pathologic mechanisms; para-infectious immune-mediated disease and parenchymal invasion of the central nervous system. Systematic investigation to discriminate between these two processes will be essential to select appropriate antibiotic and immunomodulatory therapies.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
8/18. Recurrent optic neuritis associated with chlamydia pneumoniae infection of the central nervous system.It has been suggested that chlamydia pneumoniae (C. pneumoniae) is involved in the pathogenesis of diverse diseases of the central nervous system (CNS), including multiple sclerosis. We report the case of a 12-year-old male with isolated recurrent optic neuritis and an associated CNS infection with C. pneumoniae. The patient presented with three attacks of optic neuritis within 5 months. A positive polymerase chain reaction for C. pneumoniae in the cerebrospinal fluid led to the diagnosis of a CNS infection with C. pneumoniae. After treatment with the antibiotic rifampicin, he experienced no further attacks during the follow-up period of 6 years. These findings suggest the possibility of a C. pneumoniae infection as a contributing factor or even causative event for the development of optic neuritis.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
9/18. Central nervous system abnormalities in lyme neuroborreliosis.Intrathecal production of anti-borrelia burgdorferi antibody occurs frequently in CNS Lyme, yet reliable diagnosis of neuroborreliosis is still considered difficult and controversial. Therefore, we assessed the utility of this measurement in 103 Lyme patients. Among 15 patients with Lyme meningoradiculitis and 41 controls, diagnostic specificity was 93% and sensitivity 87%. Application of this method permits the identification of a rare B burgdorferi-associated multifocal encephalitis (brain infection) and its differentiation from a milder encephalopathy, or confusional state; the latter may not require CNS bacterial invasion. The encephalitis involves white matter more often than gray; severity varies widely. Of six patients with this antibiotic-responsive encephalitis, five were positive for HLA DQw3(DQw7). We conclude that (1) measurement of intrathecal antibody production is a reliable indicator of CNS infection, (2) North American neuroborreliosis includes the same spectrum of neurologic dysfunction as described in europe, and (3) HLA typing may be useful in furthering our understanding of severe CNS involvement.- - - - - - - - - - ranking = 125.33312775094keywords = burgdorferi (Clic here for more details about this article) |
10/18. Latent lyme neuroborreliosis: presence of borrelia burgdorferi in the cerebrospinal fluid without concurrent inflammatory signs.borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was isolated from the CSF of a patient with elevated serum IgG antibody titers against B burgdorferi and a history of multiple tick bites. The absence of concurrent inflammatory signs of CSF as well as intrathecal antibody production indicates a phase of latent lyme neuroborreliosis in which no tissue infection or reaction has yet occurred. Bilateral tinnitus was the only clinical symptom in this patient. The persistence of the bilateral tinnitus after antibiotic therapy did not support a causal relationship between this symptom and the borrelial infection.- - - - - - - - - - ranking = 386.23056920981keywords = burgdorferi, borrelia (Clic here for more details about this article) |
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