Although the etiology of encephalitis remains unknown in most cases, the recognition of discrete clinical profiles among patients with encephalitis should help focus our efforts toward understanding the etiology, pathogenesis, course, and management of this complex syndrome.

M. pneumoniae is the most common agent implicated in the California Encephalitis Project. Patients with M. pneumoniae-associated encephalitis are predominantly pediatric, and their presentations are clinically similar to enterovirus encephalitis, although they frequently require intensive care with prolonged hospitalizations. Given that M. pneumoniae infection is found more than any other pathogen, increased emphasis should be placed on elucidating the role and mechanism of M. pneumoniae in encephalitis.

Central nervous system tuberculosis (TB) was identifi ed in 20 cases of unexplained encephalitis referred to the California Encephalitis Project. Atypical features (encephalitic symptoms, rapid onset, age) and diagnostic challenges (insensitive cerebrospinal fl uid [CSF] TB PCR result, elevated CSF glucose levels in patients with diabetes, negative result for tuberculin skin test) complicated diagnosis.T uberculosis (TB) of the central nervous system (CNS) is classically described as meningitis. However, altered mental status, including encephalitis, is within the spectrum of clinical manifestations. Because early treatment can dramatically improve outcomes, consideration of TB as a potential pathogen in CNS infections, including encephalitis, is vital. The California Encephalitis Project (CEP), initiated in 1998 to study the causative agents, epidemiology, and clinical features of encephalitis, has identifi ed 20 cases of culture-confi rmed tuberculous encephalitis. In most instances, TB was not initially considered to be a likely cause. The StudyReferrals are received by the CEP statewide from clinicians seeking diagnostic testing for immunocompetent patients, including TB PCR testing when appropriate, who meet the CEP case defi nition of encephalitis (1). Mycobacterial testing was often also conducted by the referring hospital. Inclusion criteria for this report were a positive cerebrospinal fl uid (CSF) culture for Mycobacterium tuberculosis complex or a positive CSF TB PCR result. Clinical data were compiled from case history forms and other medical records when available. To evaluate differences among causes of encephalitis, TB patients were compared with CEP patients with cases of enterovirus and herpes simplex virus 1 (HSV-1) encephalitis. Demographic, clinical, and laboratory data were compared by using the Fisher exact test, χ 2 test, or Kruskal-Wallis test as appropriate (statistical signifi cance was set at α = 0.05).From June 1998 through October 2005, a total of 1,587 patients were enrolled in the CEP; 20 patients fulfi lled criteria as TB cases. Demographic and clinical information for the study population are detailed in the online Appendix Table (available from www.cdc.gov/EID/content/14/9/ 1473-appT.htm). Median age was 41 years (range 8 months to 77 years). The median time from symptom onset to fi rst lumbar puncture was 5 days (range 0-62 days). Seventeen patients (85%) had a second lumber puncture.In general, CSF values became more abnormal over time, with increasing leukocyte counts and protein levels and decreasing glucose levels (Appendix Table). Most patients had a CSF mononuclear cell predominance, although 4 patients (21%) had a neutrophil predominance. All patients had cranial neuroimaging, magnetic resonance imaging (18 of 20), and computed tomography (20 of 20) (Appendix Table; Table). Results of computed tomography scans were often normal (50%).Of patients in whom the results of a recent tuberculin skin test (TST) were known, 59% (10 of 17) had a negative result (Appendix Table). M...

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The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.

K-12 online learning can be advantageous in a variety of circumstances, including inclement weather days and emergency remote teaching. With the lessons learned from the COVID-19 pandemic, many K-12 districts may consider ways to incorporate online learning into their regular school plans after they resume face-to-face instruction. However, the most challenges to online learning seemed to take place at the elementary level. This brings up an important question: What should elementary online teaching and learning look like? We examined six award-winning K-6 teachers' perspectives on and experiences with online instruction and practices for elementary students. The teachers suggested that online instruction to support elementary students’ learning should be (a) organized, (b) engaging, and (c) interactive. Teachers also suggested that developmentally appropriate use of technology and parental involvement may foster elementary students’ online learning experiences.

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Acute disseminated encephalomyelitis (ADEM) is a demyelinating, autoimmune disease of the central nervous system (CNS). It causes motor and sensory deficits, altered mental status and other neurological symptoms. Though rarely fatal, it has been associated with residual motor and neurocognitive deficits. Our case consisted of a 4-year-old girl who presented with fatigue and unsteady gait after a respiratory illness. During her hospital course, she became progressively weaker and experienced seizures. Imaging showed sections of demyelination in the CNS, and appropriate treatment was started. Additional labs resulted in positive Mycoplasma pneumoniae serum serology. Antimyelin oligodendrocyte glycoprotein (anti-MOG) antibodies were also found, which is a risk factor for relapsing, multiphasic ADEM. To our knowledge, this is the first case of anti-MOG antibody-associated ADEM due to M. pneumoniae infection. Our patient has made a complete recovery. The parents only report slightly increased fatigue and irritability.