Ilheus virus is an arbovirus with the potential for central nervous system involvement. Accurate diagnosis is a challenge due to similar clinical symptoms and serologic cross-reactivity with other flaviviruses. Here, we describe the first documented case of a fatal outcome following the identification of Ilheus virus in the cerebrospinal fluid (CSF) of a patient with cerebral encephalitis in Brazil.

Enterovirus (EV) is commonly associated with central nervous system (CNS) syndromes. Recently, gastroenteric viruses, including rotavirus (RVA), human astrovirus (HAstV), and norovirus (NoV), have also been associated with CNS neurological disorders. The aim of the present study was to investigate the presence of EV, RVA, HAst, and NoV associated to CNS infections with undiagnosed etiology in Northwest region of São Paulo State, Brazil, and to conduct the molecular characterization of the positive samples detected. A total of 288 cerebrospinal fluid samples collected from July to December 2017 were tested for EV and NoV by quantitative real‐time polymerase chain reaction (RT‐qPCR), HAstV by conventional RT‐PCR, and RVA by enzyme‐linked immunosorbent assay. Positive‐EV samples were inoculated in cells lines, amplified by RT‐PCR and sequenced. RVA, NoV, and HAstV were not detected. EV infection was detected in 5.5% (16/288), and five samples successful genotyped: echovirus 3 (E3) (1/5), coxsackie virus A6 (CVA6) (1/5), and coxsackie virus B4 (CVB4) (3/5). Meningitis was the main syndrome observed (12/16; 75%). CVA6, CVB4, and E3 were identified associated with aseptic meningitis. Reports of CVA6 associated with aseptic meningitis are rare, E3 had not been previously reported in Brazil, and epidemiological data on CVB4 in the country is virtually unknown. The present investigation illustrates the circulation of diverse EV types in a small regional sample set and in a short period of time, highlighting the importance of an active EV surveillance system in CNS infections. Enhanced understanding of undiagnosed CNS infections will assist in public health and health care planning.

Two polymerase chain reaction (PCR) protocols showed low sensitivity (36% and 53% for TB AMPLICOR and MPB64 nested PCR, respectively), when compared with classic microbiological methods (73% and 54% for Ziehl-Neelsen staining and culture, respectively), in the diagnosis of tuberculous meningitis in 91 patients in southeastern Brazil. Only three PCR-positive, microbiologically negative patients were found. Analysis of sequential cerebrospinal fluid samples by nested PCR detected Mycobacterium tuberculosis DNA up to 29 days after the introduction of antituberculosis chemotherapy. Key-words: Diagnosis of tuberculous meningitis. PCR. Mycobacterium tuberculosis.Resumo Dois protocolos de reação em cadeia da polimerase (PCR) apresentaram baixa sensibilidade (36% e 53%, respectivamente), para TB AMPLICOR e PCR aninhado baseado no gene MPB64), quando comparados aos métodos microbiológicos clássicos (73% e 54% respectivamente para baciloscopia e cultura), no diagnóstico de meningite tuberculosa em 91 pacientes do sudeste do Brasil. Somente três pacientes apresentaram PCR positiva e microbiologia negativa. A análise de amostras seqüenciais de líquor com a PCR aninhada detectou DNA de Mycobacterium tuberculosis até 29 dias após a introdução de tratamento. Palavras-chaves: Diagnóstico da meningite tuberculosa. PCR. Mycobacterium tuberculosis.

Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.

Arbovirus infections are increasingly important causes of disease, whose spectrum of neurological manifestations are not fully known. This study sought to retrospectively assess the incidence of arboviruses in cerebrospinal fluid samples of patients with neurological symptoms to inform diagnosis of central and peripheral nervous system disorders. A total of 255 cerebrospinal fluid (CSF) samples collected from January 2016 to December 2017 were tested for dengue virus (DENV 1-4), Zika virus (ZIKV), and Chikungunya virus (CHIKV) in addition to other neurotropic arboviruses of interest, using genetic and serologic assays. Of the 255 CSF samples analyzed, 3.53% (09/255) were positive for arboviruses presenting mainly as meningitis, encephalitis, and cerebrovascular events, of which ZIKV was detected in 2.74% (7/255), DENV in 0.78% (2/255), in addition to an identified ILHV infection that was described previously. All the cases were detected in adults aged 18 to 74 years old. Our findings highlight the scientific and clinical importance of neurological syndromes associated with arboviruses and demonstrate the relevance of specific laboratory methods to achieve accurate diagnoses as well as highlight the true dimension of these diseases to ultimately improve public health planning and medical case management.

Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage HIV infection who commenced antiretroviral treatments. Virtually, any opportunistic pathogen can provoke this type of immune restoration disorders. In this review, we focus on recent development in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the diagnosis of cryptococcal meningitis IRIS. We assess the utility of these biomarkers to identify putative host-based targets, which may justify a clinical need for improvement in monitoring a patient’s laboratory results and adjusting treatment modalities in AIDS patients co-infected with Cryptococcus.

Cysticercosis of the fourth ventricle is characterized by manifestations of a posterior fossa hypertension. Its isolated enlargement constitutes a clinical-pathological entity denominated isolated fourth ventricle which pathophysiology remains controversial. There are few reports on the methodology for the diagnosis of an isolated dilation of the fourth ventricle. The objectives of the present study were to propose a pattern of normality of representative indexes of the fourth ventricle dimensions in patients with normal computerized tomography (CT) of the skull and to study characteristics of these indexes in patients with neurocysticercosis (NCC).In normal CT scans of 114 patients (control group, CG) and in CT scans of 80 patients with diagnosis of NCC (NCC group, NG) the following measures were performed: distance between frontal horns (FH) of lateral ventricles, inner cranial diameter (IC), anteroposterior (AP) and laterolateral (LL) diameters of the fourth ventricle. Six indexes were established: FH/IC, AP/IC, LL/IC, AP/FH, LL/FH and AP/LL. After statistical analysis, the most representative parameters of fourth ventricle dimensions were the indexes AP/IC and AP/FH and AP/LL. Based on these three indexes 51 patients with NCC (NG-IV th ) who presented at least one of these indexes with value above two standard deviations of the statistical average obtained in the CG were selected. This group of patients was analysed in more detail.In The study of NG-IV th showed that epilepsy prevailed (55.9%) among patients with good evolution (GEv), and intracranial hypertension (75%) in those with sequels (SEv) and in all of those who died (DEv). In most (82.5%) of the patients with GEv the indexes were within normal values in at least one of the evolution CT scans. The association between FH/IC with one or more of the three representative indexes was higher (77.8%) in patients with DEv -essentially to AP/LL. When presence of ventriculoperitoneal shunt (VPS) in patients with DEv was considered, there was a preponderance (66.7%) of these three indexes, even before shunt procedure.AP/LL index > 1 was found in: 95.2% of patients with VPS; 87.7% of those with depression; 81.6% of patients who had two or more clinical manifestations; and 78.6% of patients who presented Parinaud syndrome. This AP/LL index characteristics was also detected in: 73.5% of patients who had GEv; 87.5% of those with SEv; and all patients who died.Depressive manifestations were seen in 38.2% of patients with GEv and in all of those with SEv and DEv; men were more frequently (56.7%) affected and the onset of these manifestations were more common (88.9%) after VPS also in patients with DEv. The classic syndrome of cerebrospinal fluid (CSF) in NCC occurred in 66.7% of patients with DEv; normal CSF was more frequent (29.4%) in those with GEv.Possible implications of AP/IC, AP/FH and AP/LL indexes for the diagnosis of fourth ventricle enlargement -either isolated or not -in NCC are discussed.It is concluded that: AP/LL index may be considered as the fourth ...

Introdução: Síndrome Inflamatória da Reconstituição Imune (SIRI) se apresenta como uma resposta imune exagerada que ocorre durante uma restauração imune desregulada em pacientes imunocomprometidos em estágio avançado da infecção pelo HIV quando iniciam tratamento com antirretrovirais. Qualquer patógeno oportunista pode provocar este tipo de desordem durante a restauração imune. Objetivo: Identificar os recentes avanços nos fatores de risco e nos biomarcadores moleculares de prognóstico e diagnóstico da Síndrome Inflamatória da Reconstituição Imune associada à meningite criptococócica para melhor compreender sua imunopatogênese. Método: Revisão de escopo conforme a proposta de Joana Briggs Institute. A busca foi realizada por dois pesquisadores independentes, nas bases de dados PubMed e do Google Acadêmico, por meio de descritores e/ou seus sinônimos. Resultados: A busca resultou em 240 artigos. Destes, 36 foram excluídos por serem repetidos; 1 utilizou modelos animais; 3 eram sobre pacientes soronegativos para o HIV; 8 não eram sobre Cryptococcus; 3 falavam sobre tuberculose e 1 sobre criptococose pulmonar. Foram destacados estudos que analisaram fatores de risco e biomarcadores, no sangue / plasma e líquido cefalorraquidiano, que podem esclarecer a imunopatogênese da Síndrome Inflamatória da Reconstituição Imune associada à criptococose. Conclusão: Apresentamos uma revisão dos estudos realizados sobre fatores de risco em biomarcadores no sangue e líquido cefalorraquidiano que podem auxiliar no diagnóstico de Síndrome Inflamatória da Reconstituição Imune na meningite criptococócica. Esses fatores de risco e biomarcadores podem ser usados para identificar pacientes que seriam submetidos a um monitoramento clínico mais rigoroso e com ajuste dos protocolos de tratamento em pacientes com AIDS coinfectados com Cryptococcus.