Enzephalitis bei Legionella-Bozemanii-Pneumonie

Platzeck, C; Ec, Foerster; Mu, Schneider; Lang, Christina; Ehret, W.; Arenander, H; Rödl, W; Domschke, W

doi:10.1055/s-2008-1065249

Cited by 8 publications

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“…Two patients who presented with seizures following acute LD were found to have bilateral mesial temporal FLAIR hyper intensities [8]. A 44-year-old man with Legionella bozemanii pneumonia was found to have bilaterally symmetrical foci of demyelination in the brainstem [9]. Reversible lesions of the posterior corpus callosum have been described with a variety of disorders such as Marchiafava-Bingnami disease, haemolyticuraemic syndrome, rotavirus infection, acute cerebellitis and High altitude cerebral oedema (HACE) [10].…”

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Reversible dentate nucleus and corpus callosum lesions in acute Legionnaires’ Disease

Tarasaria¹,

Prasad²

2018

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A 41-year-old man presented with a two-day history of fever, malaise and diarrhoea. He was disoriented to time and situation with mild dysarthria on neurologic examination. He was found to be hyponatremic (132 mmol/L) and a chest X-ray showed left lower lobe consolidation. He was started on broad-spectrum antibiotics including two doses of Metronidazole. MRI of the brain without contrast showed T2/FLAIR hyper intensities within bilateral DN and in the central aspect of the splenium of the corpus callosum (CC) (Figure 1). His urine Legionella Pneumophila serogroup-1 antigens came back positive and antibiotics were de-escalated to Levofloxacin for two weeks. On his five-week posthospitalization follow-up, he was noted to have persistent dysarthria for which he continued to work with speech therapy twice a week. Repeat MRI brain with and without contrast six weeks from his initial MRI scan showed a complete resolution of the previously noted abnormal signal hyperintensity within the dentate nuclei and the corpus callosum. He was subsequently seen in clinic ten weeks from discharge and was noted to be asymptomatic.

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Reversible dentate nucleus and corpus callosum lesions in acute Legionnaires’ Disease

Tarasaria¹,

Prasad²

2018

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Die Legionelleninfektion

Ruckdeschel¹,

Ehret

1993

Ergebnisse Der Inneren Medizin Und Kinderheilkunde / Advances in Internal Medicine and Pediatrics

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Rhombencephalitis / Brainstem Encephalitis

Jubelt

Mihai

et al. 2011

Curr Neurol Neurosci Rep

158

139

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Rhombencephalitis (RE) is a syndrome of multiple causes and multiple outcomes. Most authors now use the terms "rhombencephalitis" and "brainstem encephalitis" interchangeably even though anatomically they are slightly different. The etiologic categories of RE include infections, autoimmune diseases, and paraneoplastic syndromes (PNS). Listeria is the most common cause of infectious RE. Listeria RE primary occurs in healthy young adults. It usually occurs as a biphasic time course with a flu-like syndrome followed by brainstem dysfunction; 75% of patients have a cerebrospinal fluid (CSF) pleocytosis, and almost 100% have an abnormal brain MRI scan. Positive CSF and blood cultures are the most specific for diagnosis. Treatment primarily is with ampicillin. Enterovirus 71 is probably the second most common infectious cause of RE; however, 95% of cases have occurred in the Asian-Pacific region and there is no specific treatment. Herpes simplex virus (HSV) is the third most common infectious cause of RE, and about 80% of cases are caused by HSV1 and 20% by HSV2. About 50% only had involvement of the brainstem whereas the other 50% also had supratentorial involvement of the temporal and frontal lobes. Mortality with acyclovir treatment was 22% versus those not on acyclovir 75%. Epstein-Barr virus (EBV) and human herpesvirus 6 (HHV6) have caused a few cases. The most common autoimmune etiology is Behçet disease. Over 90% of those with Behçet RE had abnormal MRI scans and 94% had a CSF pleocytosis. Treatment is with corticosteroids and immunosuppressive agents, but only 25% have complete recovery. Paraneoplastic causes are the third category of RE. Brain MRIs are usually normal; there is usually a CSF pleocytosis but the protein is usually normal. Often anti-neuronal antibodies can be found. Prognosis is poor and treatment is only partially beneficial. Because Listeria and HSV are the most common treatable acute causes of RE, we recommend empiric therapy with ampicillin and acyclovir for all cases after samples have been obtained from CSF and blood for cultures and the polymerase chain reaction (PCR). Antibiotics can be changed based upon MRI, culture results, PCR results, and antibody studies.

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Enzephalitis bei Legionella-Bozemanii-Pneumonie

Cited by 8 publications

References 0 publications

Reversible dentate nucleus and corpus callosum lesions in acute Legionnaires’ Disease

Reversible dentate nucleus and corpus callosum lesions in acute Legionnaires’ Disease

Die Legionelleninfektion

Rhombencephalitis / Brainstem Encephalitis

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