Encephalitis and Brain Abscess

Venkatesan, Arun

doi:10.1212/con.0000000000001006

Cited by 8 publications

(11 citation statements)

References 127 publications

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“…The rapid diagnosis of pus pathogens in infected sites has always been an urgent problem in clinical practice. 9 mNGS has been used to detect pathogens in a variety of infectious diseases, including encephalitis, 10 prosthetic joint infection 11 and infection in immunocompromised patients. 12 , 13 However, the detection of pathogens by mNGS in pus specimens from infected patients has not been well studied.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Metagenomic Next-Generation Sequencing Results of 25 Pus Samples

Shi¹,

Wu²,

Liu³

et al. 2022

IDR

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To explore the clinical value of detecting pathogens in pus samples by metagenomic next-generation sequencing (mNGS). Methods: The 25 pus samples from infected patients were collected in this research. The positive rate and consistency of pathogenic bacteria detected by mNGS and conventional methods were compared. The pathogen types detected by the two methods were analyzed. Furthermore, the modifications of antibiotic treatment therapy were also evaluated based on mNGS results. Results:The sensitivity of mNGS method in detecting pathogenic bacteria in pus samples was better than that of conventional method (96% vs 40%; P < 0.01). Only 10 samples were detected pathogens by conventional methods, but 24 samples were detected by mNGS method. In specific, the results of conventional methods showed 10 samples had 11 kinds of pathogenic bacteria, of which 9 samples were single pathogen and 1 sample had two kinds of pathogenic bacteria. The results of mNGS method showed 24 samples were detected with 54 kinds of pathogenic bacteria, of which 15 samples were detected with single pathogen, and 9 samples were detected with two or more kinds of pathogenic bacteria. The two methods had 9(36%) consistent results, 14 (56%) completely different results, and 2 (8%) partially consistent results, and the kappa value was 0.19. Notably, mNGS could detect viruses, anaerobic bacteria, and other uncommon pathogens simultaneously. Conclusion:The application of mNGS in the detection of pus specimens from different parts not only have high accuracy rate and also reduce the turnaround time of diagnosis. In addition, the performance of mNGS detection of anaerobic bacteria and caustic bacteria is better than conventional methods. The mNGS diagnosis in pus sample may play an important role in clinical diagnosis and treatment strategy decisions.

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Section: Discussionmentioning

confidence: 99%

Analysis of Metagenomic Next-Generation Sequencing Results of 25 Pus Samples

Shi¹,

Wu²,

Liu³

et al. 2022

IDR

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“…In viral meningoencephalitis, parenchymal abnormalities are common 30 . For further discussion, refer to “Encephalitis and Brain Abscess” by Arun Venkatesan, MD, PhD, 31 in this issue of Continuum .…”

Section: Acute Meningitismentioning

confidence: 99%

Meningitis

Aksamit¹,

Berkowitz²

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWThis article reviews the diagnosis and treatment of infectious meningitis, including updates on newer molecular diagnostic techniques for microbiological diagnosis.RECENT FINDINGSNew polymerase chain reaction (PCR)-based molecular diagnostic techniques have improved the timeliness of microbiological diagnosis in meningitis, but clinicians must be aware of the limitations of such tests. Next-generation sequencing can now be applied to CSF, allowing for diagnosis of infections not identifiable by conventional means.SUMMARYInfectious meningitis can be caused by a broad range of organisms. The clinician must be aware of the test characteristics of new molecular techniques for microbiological diagnosis as well as traditional techniques to tailor antimicrobial therapy appropriately in patients with meningitis.

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“…Intracranial abscesses due to more common bacterial pathogens such as Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia are notably rare in patients who are immunocompromised, accounting for just 0.61% of brain abscesses in liver transplant recipients and 0.65% of those in bone marrow transplant recipients. [109][110][111] For more information about intracranial abscesses in patients who are immunocompetent, refer to the article "Encephalitis and Brain Abscess" by Arun Venkatesan, MD, 45 in this issue of Continuum.…”

Section: Case 12-3mentioning

confidence: 99%

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

Anand¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWBoth broadly immunosuppressive medications and selective immunomodulatory agents that act on particular components of the immune system are increasingly used in the treatment of neurologic and non-neurologic diseases. These therapies predispose patients to particular infections, some of which may affect the nervous system. Therefore, familiarity with the clinical and radiologic features of neurologic infections associated with specific immunomodulatory therapies is of importance for the practicing neurologist. This article reviews these neuroinfectious conditions, as well as other neurologic complications unique to transplant recipients and other patients who are immunocompromised.RECENT FINDINGSDiagnosis of infectious pathogens in patients who are immunocompromised may be particularly challenging because a decreased immune response can lead to atypical imaging or laboratory findings. Next-generation sequencing and other novel diagnostic modalities may improve the rate of early identification of neurologic infections in patients who are immunocompromised and ultimately ameliorate outcomes in this vulnerable population.SUMMARYA broad range of bacterial, viral, fungal, and parasitic infections of the nervous system can complicate solid organ and hematopoietic cell transplantation as well as other forms of immunocompromise. In addition to neurologic infections, such patients are at risk of neurotoxic and neuroinflammatory complications related to immunomodulatory and immunosuppressive therapies. Early recognition of infectious and noninfectious complications of immunocompromise is essential to guide appropriate treatment, which can include antimicrobial therapy and, in some cases, withdrawal of the predisposing medication with a transition to an alternative regimen.

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Encephalitis and Brain Abscess

Cited by 8 publications

References 127 publications

Analysis of Metagenomic Next-Generation Sequencing Results of 25 Pus Samples

Analysis of Metagenomic Next-Generation Sequencing Results of 25 Pus Samples

Meningitis

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

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