Neonatal meningoencephalitis caused by Bacillus cereus

The classic organisms associated with central nervous system infection in the neonate are herpes simplex, Listeria monocytogenes, Escherichia coli, and Streptococcus agalactiae; we describe an unusual case of neonatal meningoencephalitis caused by Bacillus cereus.     

Coxsackievirus B2 infection in a neonate with incontinentia pigmenti

Because of the concern for herpes simplex virus infection in the neonate, the presence of neonatal vesiculobullous lesions is a critical finding. However, there are other etiologies for these lesions. A case of a neonate with a vesicular rash and meningoencephalitis which was initially thought due to herpes is presented. The infant was ultimately determined to have incontinentia pigmenti and a concomitant coxsackievirus B2 infection.     

High intracranial pressure with the spreading of the cranial sutures as a leading symptom of herpes simplex meningitis

A four-year old girl developed signs of increased intracranial pressure (head-ache, vomiting, ataxia, tremor, papilledema, cranial suture spread). Abacterial meningoencephalitis due to herpes virus was diagnosed, while the initially suspected brain tumor was ruled out. Without specific therapy the patient recovered completely; even the cranial suture spread disappeared. This case report demonstrates an unusual and more benign course of central nervous herpes virus infection.     

Basal ganglia infarction associated with HHV-6 infection

A 6 year old boy presented with meningoencephalitis and was found to have serological evidence of acute human herpes virus-6 (HHV-6) infection. He did not develop symptomatic seizures or the rash of exanthum subitum (roseola). His course was marked by severe spastic quadriparesis associated with radiological evidence of basal ganglia infarction. HHV-6 infection should be considered in any child with acute meningoencephalitis.     

Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination

BACKGROUND: Mumps vaccine has not yet been included in the routine vaccination programme, for this reason mumps is still one of the most common infections for children in Turkey. One of the major complication of mumps is meningoencephalitis, which although usually heals spontaneously, it may cause neurologic complications. METHODS: This study was undertaken to investigate epidemiologic and demographic characteristics in children with mumps and mumps meningoencephalitis and clinical/laboratory findings in children with mumps meningoencephalitis diagnosed over a 11 year period. A total of 2422 mumps and 135 mumps meningoencephalitis cases were covered in this study which constitutes one of the largest series of mumps meningoencephalitis in the literature. The mean age of mumps and mumps meningoencephalitis cases were 6.6 +/- 2.7 and 7.6 +/- 2.6 years, respectively. RESULTS: There was a male predominance both among the cases of mumps and mumps meningoencephalitis. The age and seasonal distributions were similar in the mumps and mumps meningoencephalitis groups. The most common symptoms of mumps meningoencephalitis were fever (97%), vomiting (94%) and headache (88.8%). The mean cerebrospinal fluid (CSF) total cell count and lymphocyte count were 540 +/- 460/mm(3) and 300 +/- 330/mm(3), respectively. The mean CSF protein and glucose levels were found to be 56.97 +/- 27.94 mg/dL and 53.67 +/- 15.46 mg/dL, respectively. The mean of CSF/blood glucose ratio was 0.53 +/- 0.16. The mean duration of hospitalization in mumps meningoencephalitis cases was found to be 5.1 +/- 2.4 days and this was longer in boys (P < 0.05). CONCLUSION: In patients with mumps meningoencephalitis, higher CSF protein levels and lower CSF glucose/blood glucose ratio were associated with longer hospitalization periods. There was no death.     

Computerized tomography in infantile encephalitis.

Although computerized tomographic (CT) findings are well recognized in numerous neurologic diseases of children, CT scan abnormalities of encephalitis have only been associated with herpes simplex infection. We describe two infants, one with coxsackievirus B2 meningoencephalitis and one with clinical encephalitis, whose CT scans were similarly abnormal during the acute phase of their illness. In both infants, recovery of both neurologic and developmental deficits was accompanied by resolution of the abnormalities of the initial CT scan. Speculation is offered as to the role of the CT scan in the assistance of the physician who must evaluate both the diagnosis and prognosis of infants who have a clinical picture of encephalitis.     

Study of virus isolation from pharyngeal swabs in children with varicella

We performed virus isolations from the pharyngeal swabs in 117 children with varicella who were aged from 22 days to 15 years and 70 healthy children who were aged from 3 months to 15 years, by using human embryonic lung cell cultures. Viral isolates were confirmed by an indirect immunofluorescence method or by neutralization with well-characterized antibodies. Five varicella-zoster virus isolates (4.3%), 23 cytomegalovirus isolates (19.7%), five herpes simplex virus isolates (4.3%), and one respiratory syncytial virus isolate (0.9%) were found in the patients with varicella. Ten cytomegalovirus isolates (14.3%), two herpes simplex virus isolates (2.9%), one respiratory syncytial virus isolate (1.4%), and one poliovirus isolate (1.4%) were found in the swabs of the healthy control children. The varicella-zoster virus isolation rate from the pharyngeal swabs in children with varicella was low as compared with the rate from those pharyngeal swabs in the children with cytomegalovirus and herpes simplex virus. No varicella-zoster virus isolates could be found in the swabbed materials after filtration (0.45 microns). On the other hand, cytomegalovirus and herpes simplex virus could be isolated from the filtrated swabs, as well as from the unfiltrated swabs. The method of testing by filtration could have affected the results.     

Coxsackie B2 virus fatal meningoencephalitis in a student

OBJECTIVE: To present the case of a girl who was previously healthy but had fatal evolution due to Coxsackie B2 viral meningoencephalitis.METHODS: The authors describe the case of a female child with fatal meningoencephalitis caused by Coxsackie B2 virus and present a review of the literature (Medline and Lilacs).RESULTS: The girl was eight years old when she presented meningoencephalitis with bad evolution, leading to death on the 32nd day of internation. The exams showed positive serologic reaction to Coxsackie B2. The virus taken from two stool samples was isolated. The CRF exam showed an increase four times higher on Coxsackie B2 titulation.CONCLUSION: The death of healthy patients with enteroviral encephalitis, as described here, is rarely dealt with in the medical literature, perhaps because of lack of clinic suspicion. This case tries to drive attention to the importance of an early etiologic diagnosis in the meningoencephalities and the search for specific etiological treatment.     

Herpes simplex encephalitis: MRI findings in two cases confirmed by polymerase chain reaction assay

Herpes simplex virus (HSV) type I causes a fulminant necrotising meningoencephalitis distinguished from other encephalitides by its focal and often haemorrhagic nature. Specific antiviral therapy with acyclovir can significantly improve the prognosis. We present MRI findings of two cases of herpes simplex encephalitis (HSE) confirmed by PCR analysis, focusing on the serial changes after acyclovir therapy: gyral swelling, high signal intensity on T2-weighted images in the subfrontal region, temporal lobe and insula in the initial stage, then regional extension with enhancement and haemorrhage despite appropriate acyclovir therapy, and finally encephalomalacia and brain atrophy. Received: 3 October 2000 Accepted: 20 March 2001     

Autopsy findings of Serratia meningoencephalitis in infants

Serratia meningoencephalitis is often a fatal disease that causes widespread destruction of brain tissue despite aggressive antibiotic treatment. The autopsy findings of 2 cases are described. In a case caused by S. liquefaciens, previously not reported as the causative organism of meningoencephalitis, suppurative meningitis, ventriculitis, vasculitis, and extensive necrotic process of the brain matter were found. In the other case, caused by S. marcescens, the findings were those of acute and subacute abscesses with hemorrhagic necrosis.     

Inhalational, gastrointestinal, and cutaneous anthrax in children: a systematic review of cases: 1900 to 2005

OBJECTIVE: To systematically review all published case reports of children with anthrax to evaluate the predictors of disease progression and mortality. DATA SOURCES: Fourteen selected journal indexes (1900-1966), MEDLINE (1966-2005), and the bibliographies of all retrieved articles. STUDY SELECTION: Case reports (any language) of anthrax in persons younger than 18 years published between January 1, 1900, and December 31, 2005. Main Exposures Cases with symptoms and culture or Gram stain or autopsy evidence of anthrax infection. MAIN OUTCOME MEASURES: Disease progression, treatment responses, and mortality. RESULTS: Of 2499 potentially relevant articles, 73 case reports of pediatric anthrax (5 inhalational cases, 22 gastrointestinal cases, 37 cutaneous cases, 6 cases of primary meningoencephalitis, and 3 atypical cases) met the inclusion criteria. Only 10% of the patients were younger than 2 years, and 24% were girls. Of the few children with inhalational anthrax, none had nonheadache neurologic symptoms, a key finding that distinguishes adult inhalational anthrax from more common illnesses, such as influenza. Overall, observed mortality was 60% (3 of 5) for inhalational anthrax, 65% (13 of 20) for gastrointestinal anthrax, 14% (5 of 37) for cutaneous anthrax, and 100% (6 of 6) for primary meningoencephalitis. Nineteen of the 30 children (63%) who received penicillin-based antibiotics survived, and 9 of the 11 children (82%) who received anthrax antiserum survived. CONCLUSIONS: The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.     

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.     

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.     

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.     

脊髓灰质炎样综合征的临床特征与诊断要点

目的探讨脊髓灰质炎样综合征(PS)的临床特点与诊断要点。方法对15例PS患儿的临床资料包括神经系统表现、实验室及辅助检查、诊断及误诊原因、治疗和转归进行分析。结果15例PS患儿平均起病年龄3.3岁,11例(73%)发病前1~2周或发病时有急性上呼吸道感染或腹泻病史,均表现为肢体急性迟缓性瘫痪,单肢受累者12例(80%)。血清学检查发现柯萨奇病毒IgM阳性4例,EB病毒、单纯疱疹病毒、支原体IgM阳性各1例。患儿肌电图检查均呈神经源性损害肌电图。4例住院期间肌力提高一个等级。结论本征常累及5岁以下儿童,发病前1~2周或发病时多有呼吸道或消化道感染病史,呈急性弛缓性瘫痪,以单肢受累多见,病原多为肠道病毒,肌电图检查有助于明确诊断。     

Disseminated neonatal herpes simplex virus (HSV) type 2 infection diagnosed by HSV DNA detection in blood and successfully managed by liver transplantation

We report a case of neonatal herpes presenting with liver failure and disseminated coagulopathy which followed unrecognised maternal primary genital herpes and was diagnosed by herpes simplex virus DNA detection in blood by polymerase chain reaction 2 weeks after initiation of empiric intravenous aciclovir. The child underwent liver transplantation while receiving suppressive antiviral therapy and remains well after 10 months of follow-up. Conclusion:our case highlights potential pitfalls in the diagnosis of neonatal herpes and indicates a role for blood herpes simplex virus polymerase chain reaction as a sensitive diagnostic tool in disseminated infection. It is one of very few reports where liver transplantation has been successfully carried out in a neonate with herpes simplex virus-induced liver failure.Abbreviations HSV herpes simplex virus - PCR polymerase chain reaction     

BK virus nephropathy complicated with meningoencephalitis after kidney transplantation

BK disease is an opportunistic infection in organ transplant recipients and patients with other cellular immunodeficiencies. To the best of our knowledge, we report the second case of BK meningoencephalitis associated with nephropathy in a kidney transplant recipient. A 15‐yr‐old boy underwent a cadaveric kidney transplant without complications; however, 11 wk after the transplantation, he was admitted to the hospital for graft dysfunction and cytopenia, which were confirmed by BK nephropathy (plasma viral replication and histological evidence). Four days after his hospital admission, he developed a high‐grade fever and headache. CSF analysis revealed pleocytosis with a positive PCR for BK virus. Reduction in immunosuppression and supportive care conducting cycles of immunoglobulin and cidofovir were successful in treating the patient. BK meningoencephalitis should be considered in kidney transplant recipients who present with signs and symptoms of meningoencephalitis.     

Lymphocytic choriomeningitis virus: reemerging central nervous system pathogen

Lymphocytic choriomeningitis virus (LCMV), a human zoonosis caused by a rodent-borne arenavirus, has been associated with both postnatal and intrauterine human disease. Infection in man is acquired after inhalation, ingestion, or direct contact with virus found in the urine, feces, and saliva of infected mice, hamsters, and guinea pigs. Congenital LCMV infection is a significant, often unrecognized cause of chorioretinitis, hydrocephalus, microcephaly or macrocephaly, and mental retardation. Acquired LCMV infection, asymptomatic in approximately one third of individuals, is productive of central nervous system manifestations in one half of the remaining cases. Aseptic meningitis or meningoencephalitis are the predominant syndromes, although transverse myelitis, a Guillain-Barré-type syndrome, as well as transient and permanent acquired hydrocephalus have also been reported. Fatalities are rare. We report a patient with meningoencephalitis attributable to LCMV and discuss the spectrum of central nervous system disease, newer diagnostic modalities, and preventive strategies. lymphocytic choriomeningitis virus, aseptic meningitis, meningoencephalitis, zoonosis, hydrocephalus, arenavirus.     

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. Received: 4 September 2000 and in revised form: 2 December and 23 December 2000 /  Accepted: 27 December 2000