Encephalitis

BECKHAM, J. DAVID; TYLER, KENNETH L.

doi:10.1016/b978-0-443-06839-3.00087-4

Cited by 9 publications

(12 citation statements)

References 201 publications

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“…In certain circumstances, acute meningitis can be clinically indistinguishable from acute encephalitis, which refers to inflammation of the brain parenchyma in association with neurologic dysfunction (52). Encephalitis is typically characterized by headache with an acute confusional state, with or without seizures.…”

Section: Encephalitismentioning

confidence: 99%

“…Enteroviruses, varicella-zoster virus, Epstein-Barr virus, measles virus, and arboviruses, such as Japanese encephalitis virus, West Nile virus, and Murray Valley encephalitis virus, have also been implicated as causes of encephalitis (6,7,54,55). Beckham and Tyler provided a comprehensive list of other important and emerging viral causes of encephalitis (52). L. monocytogenes may cause meningoencephalitis, a syndrome where features of both meningitis and encephalitis are present.…”

Section: Encephalitismentioning

confidence: 99%

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Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

et al. 2014

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SUMMARY The brain is well protected against microbial invasion by cellular barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB). In addition, cells within the central nervous system (CNS) are capable of producing an immune response against invading pathogens. Nonetheless, a range of pathogenic microbes make their way to the CNS, and the resulting infections can cause significant morbidity and mortality. Bacteria, amoebae, fungi, and viruses are capable of CNS invasion, with the latter using axonal transport as a common route of infection. In this review, we compare the mechanisms by which bacterial pathogens reach the CNS and infect the brain. In particular, we focus on recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.

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Section: Encephalitismentioning

confidence: 99%

Section: Encephalitismentioning

confidence: 99%

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

et al. 2014

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“…requires a combination of tests, including serology from serum and CSF, NAT, and specialized culture techniques (6,(36)(37)(38)(39). Testing for these agents should be guided by clinical signs and symptoms, exposures, risk factors, and the duration and severity of illness (6,13,16).…”

Section: Current Diagnostic Test Methodsmentioning

confidence: 99%

“…Patients with meningitis typically present with some combination of fever, headache, meningeal irritation, and altered mental status, but CSF analysis is required to confirm the diagnosis and determine the underlying cause (1,3,5,13). In contrast, encephalitis is defined as inflammation of the brain parenchyma with focal or global neurologic dysfunction, regardless of meningeal involvement (6,16). In an effort to standardize the diagnosis and minimize overlap with other conditions, recent diagnostic criteria require altered mental status as a major criterion and two or more minor criteria (fever, seizures, focal neurologic findings, CSF WBC count of Ն5 cells/mm 3 , abnormal brain imaging, or electroencephalogram) for encephalitis diagnosis (6).…”

Section: Clinical Definitions Manifestations and Epidemiology Overviewmentioning

confidence: 99%

“…Other viruses and bacteria are less common, but the number of potential causes is extensive, requiring multiple tests for diagnosis (6). Immunocompromised patients have additional agents that should be considered, including CMV, HHV-6/7, HIV, Toxoplasma gondii, M. tuberculosis, and fungi (6,16,25). Finally, encephalitis is similar to meningitis in that the likelihood of many infectious agents varies with host and geographic factors, season, and exposures, making it critical to consider local epidemiology and risk factors when selecting tests (6,8).…”

Section: Clinical Definitions Manifestations and Epidemiology Overviewmentioning

confidence: 99%

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State-of-the-Art Microbiologic Testing for Community-Acquired Meningitis and Encephalitis

Polage

Cohen

2016

J Clin Microbiol

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Meningitis and encephalitis are potentially life-threatening diseases with a wide array of infectious, postinfectious, and noninfectious causes. Diagnostic testing is central to determining the underlying etiology, treatment, and prognosis, but many patients remain undiagnosed due to suboptimal testing and lack of tests for all pathogens. In this article, we summarize the epidemiology, barriers to diagnosis, and current best tests for meningitis and encephalitis in developed countries. We end with a brief discussion of new test methods, such as multiplex panel-based tests and metagenomic sequencing, which are likely to alter diagnostic strategies for these conditions in the near future.

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A Metagenomics – Based Diagnostic Approach for Central Nervous System Infections in Hospital Acute Care Setting

Hasan

Sundararaju

Tang

et al. 2019

Preprint

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24The etiology of central nervous system (CNS) infections such as meningitis and 25 encephalitis remains unknown in a large proportion of cases partly because the diversity of 26 pathogens that may cause CNS infections greatly outnumber available test methods. Here we 27 present a metagenomic next generation sequencing (mNGS) based approach for broad-range 28 detection of pathogens associated with CNS infections, which is suitable for application in the 29 acute care hospital setting. Using an Illumina MiSeq benchtop sequencer and the IDseq pipeline 30 for identifying pathogens in metagenomic sequence data, we show that the analytical sensitivity 31 of mNGS to detect pathogens is comparable to that of PCR in simulated cerebrospinal fluid 32 (CSF) specimens. We then applied this method for pathogen detection in 74 CSF specimens 33 from patients with suspected CNS infections that were previously tested by culture and/or PCR. 34Diagnostic accuracy, sensitivity and specificity of mNGS approach with reference to 35 conventional methods were all 95%. Furthermore, confirmatory testing on specimens that gave 36 discrepant results were mostly in favor of the mNGS assay. The clinical application of mNGS 37 holds promise to benefit patients with CNS infections of unknown etiology. 38 39 40 41 42 43 44 45 46 47 Central nervous system (CNS) infections such as meningitis and encephalitis are 48 potentially life threatening diseases caused by a myriad of infectious pathogens. Besides high 49 rates of mortality, meningitis and encephalitis are major causes of morbidity, and permanent 50 disabilities such as brain damage, hearing loss, and learning disabilities can result from CNS 51 infections (1-5). A specific etiologic agent cannot be identified in 15-60% of cases of meningitis 52 and up to 70% of encephalitis (6, 7). Clinical management of meningitis and encephalitis is 53 highly dependent on early and rapid detection of underlying causes of the disease, so that 54 appropriate antimicrobial or anti-viral therapy can be instituted in a timely manner. Specific 55 diagnosis is also important to avoid unnecessary treatment and hospitalization of patients with 56 self-limiting forms of viral meningitis to minimize potential harm and unnecessary cost to 57 patients (6).58 Current diagnostic test methods for CNS infections include CSF Gram staining, CSF cell 59 count, glucose, and protein measurements and biomarkers such as procalcitonin (PCT) and 60 lactate. These tests are generally performed to distinguish between bacterial versus viral 61 infections, and they are not specific for any causative pathogens. Bacteriological culture or PCR 62 testing to detect specific pathogens in cerebrospinal fluid (CSF) are currently the most important 63 methods for the diagnosis of CNS infections. However, a large number pathogens known to 64 cause meningitis and encephalitis cannot be routinely cultured, and most molecular tests are 65 targeted to common pathogens only. A broad-range, unbiased method to identify all pathogens in 66 CSF would m...

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Encephalitis

Cited by 9 publications

References 201 publications

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

State-of-the-Art Microbiologic Testing for Community-Acquired Meningitis and Encephalitis

A Metagenomics – Based Diagnostic Approach for Central Nervous System Infections in Hospital Acute Care Setting

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