Search Results (70)

Encephalitis is a potentially life-threatening condition with long-term neurological sequelae. However, data on early clinical, demographic, and diagnostic predictors of functional outcomes remain limited. We performed a retrospective monocentric study including 98 patients diagnosed with infectious encephalitis of various etiologies treated in the University Hospital Ulm between January 2014 and December 2024. Ordinal logistic regression models were applied to evaluate associations between admission characteristics and functional outcome at discharge, as measured by the modified Rankin Scale. Three multivariate models incorporating clinical, demographic, and MRI/EEG variables explained up to 53% of the variance in mRS at discharge (p < 0.001), outperforming models based solely on CSF parameters. Key predictors of poor functional outcome included ‘altered consciousness’ (OR 7.08, p < 0.001), higher ‘mRS at admission’ (OR 0.03–0.07 across categories, p < 0.001), ‘focal/generalized EEG slowing’ (OR 9.97, p < 0.001), ‘epileptiform EEG activity’ (OR 17.49, p < 0.001), ‘MRI: myelitis’ (OR 16.44, p = 0.004), and ‘intrathecal IgM synthesis’ (OR 8.93, p = 0.018). Conversely, ‘longer hospitalization’ (OR 0.13–0.17 for different intervals, p < 0.006) and ‘intrathecal IgG synthesis’ (OR 0.05, p = 0.03) were associated with more favorable outcomes. Despite the single-center and retrospective aspects of this study, our findings underscore a multifactorial pattern of outcome determinants in infectious encephalitis, highlighting the prognostic relevance of initial neurological status, electrophysiological abnormalities, and neuroimaging features. Full article

Diabetes, as one of the most common diseases of civilization, is a significant factor of mortality worldwide. Undiagnosed and improperly treated, it leads to the development of a number of complications, including diabetic foot syndrome (DFS) and Charcot neuroarthropathy (CN). Charcot neuroarthropathy is a complex and devastating disease characterized by the presence of neuropathy, progressive deformities, and joint destruction. Risk factors and epidemiological data emphasize the high prevalence of CN in the diabetic population, drawing attention to typical predisposing factors for the development of this disease. Serious complications, such as foot ulcers or amputations, show the scale of the negative impact of CN and DFS on the quality of life of patients. Background/Objectives: The aim of the study was to assess the treatment of foot ulcers in patients with DFS and CN using ozone therapy with simultaneous negative pressure wound therapy (NPWT). Methods: The study included 30 patients aged 39 to 87 years with DFS and 30 patients with CN. Ozone therapy and negative pressure wound therapy were used for the treatment of chronic wounds. Results: The analysis of the results showed a significant reduction in the wound size in both study groups; in patients with DFS, a reduction from 5 cm³ to 0.40 cm³ observed after 3 weeks and to 0.002 cm³ after 6 weeks of therapy, while in patients with CN, a reduction from 8 cm³ to 1.50 cm³ was observed after 3 weeks and to 0.004 cm³ after 6 weeks of therapy. No statistically significant differences were observed in median wound sizes between the DFS and CN groups. Ozone therapy with a value of 70 μg/mL is an effective method in the treatment of chronic diseases of soft tissue and the skeletal system. In combination with NPWT after cleansing the wound of bone sequestrum, the process increased the density of capillaries by accelerating the synthesis of proteins and collagen and reduced bacterial colonization in the wound. Conclusions: The use of ozone therapy procedures at 70 μg/mL with negative pressure therapy is effective in the prevention and treatment of infectious bone complications in diabetes, such as diabetic foot syndrome and Charcot neuroarthropathy. Full article

Molecules from animals or plant species have been investigated with the aim of treating diseases of epidemiological importance, such as rabies, which is a viral, acute, and infectious disease with approximately 100% lethality. Rabies has been one of the main causes of death in humans concerning infectious diseases. This work investigated the action and preliminary mechanisms of the alkaloid bufotenine in an in vivo model with the rabies virus. A wild-type virus was titrated and injected into mice for the determination of DL50 in the presence or absence of bufotenine. The results reveal that bufotenine has possible action in modulating the immune response of the studied host, suggesting interference in delaying symptom manifestation. Regarding the histological analysis of the CNS of the animals, bufotenine possibly prevented the presence of mononuclear cell inflammatory infiltrate in the meninx’s region compared to the positive control and possibly contributed to reducing neuronal degeneration. The use of the bufotenine extracted from the seed of white angico, a plant representative of Brazilian flora, contributed to antiviral activity with effects on the immunological aspects of the host infected by the rabies virus. Full article

T lymphocytes infiltrate the CNS in response to murine cytomegalovirus (MCMV) infection and form a pool of long-lived brain tissue-resident memory T-cells (bT_RMs), which display markers of residency (i.e., CD103, CD69, CD49a). However, the functional role of these bT_RMs is still unknown. By 30 days postinfection, a latent viral brain infection was established, as indicated by absence of viral transcripts (IE1, E1, and gB) produced during productive infection. Following intracerebroventricular injection of either depleting α-CD8 Ab (clone YTS169.4) or α-CD103-sap (clone IT50) into the brain, 90–95% T-cell depletion was achieved. Using luciferase-expressing mice, we observed recommenced imaging signals indicative of de novo MCMV IE promoter activity in depleted animals. Surprisingly, using an explant assay, we efficiently recovered reactivatable, infectious virus from untreated, latent animals, but not from those depleted of bT_RMs (viral recovery in explants was reduced from 100% to 50% by day 21). We identified Lgals3 (galectin 3), Gpnmb (glycoprotein nonmetastatic melanoma protein B) and Hmox1 (heme oxygenase 1) as genes that were most upregulated in bT_RM-depleted groups. When bT_RMs were depleted, there was transient expression of viral IE genes which resulted in antiviral microglia with a phagocytic, disease-associated (DAM) or neurodegenerative (MGnD) phenotype. These data provide new insights into the role of bT_RMs in controlling both CNS reactivation and driving microglial phenotypes. Full article

Neurological symptoms involving the central nervous system (CNS) and peripheral nervous system (PNS) are common complications of acute COVID-19 as well as post-COVID conditions. Most research into these neurological sequalae focuses on the CNS, disregarding the PNS. Guinea pigs were previously shown to be useful models of disease during the SARS-CoV-1 epidemic. However, their suitability for studying SARS-CoV-2 has not been experimentally demonstrated. To assess the suitability of guinea pigs as models for SARS-CoV-2 infection and the impact of SARS-CoV-2 infection on the PNS, and to determine routes of CNS invasion through the PNS, we intranasally infected wild-type Dunkin-Hartley guinea pigs with ancestral SARS-CoV-2 USA-WA1/2020. We assessed PNS sensory neurons (trigeminal ganglia, dorsal root ganglia), autonomic neurons (superior cervical ganglia), brain regions (olfactory bulb, brainstem, cerebellum, cortex, hippocampus), lungs, and blood for viral RNA (RT-qPCR), protein (immunostaining), and infectious virus (plaque assay) at three- and six-days post infection. We show that guinea pigs, which have previously been used as a model of SARS-CoV-1 pulmonary disease, are not susceptible to intranasal infection with ancestral SARS-CoV-2, and are not useful models in assessing neurological impacts of infection with SARS-CoV-2 isolates from the early pandemic. Full article

Background: Cytotoxic lesions of the corpus callosum (CLOCCs) are a rare disorder of various etiologies referred to as transient lesions of the splenium of the corpus callosum, with a usually mild clinical course. Epstein–Barr virus (EBV) is one of the factors potentially responsible for triggering this abnormality. Results: The authors present the case of a 15-year-old girl, so far without any health burden, who suffered from severe CLOCCs with the etiology of EBV. The patient was admitted to hospital because of hepatosplenomegaly and hypertransaminasemia. Her condition rapidly deteriorated—she had seizures with respiratory failure, requiring treatment in the PICU. The first MRI (magnetic resonance imaging) scan showed changes in the hippocampus, and, in the early control, changes like those of CLOCCs; in follow-up studies (one and three months after the onset of respiratory failure), a gradual incomplete regression of the changes in the corpus callosum was seen. Her clinical condition improved quickly, with no seizures during the follow-up and no signs of focal CNS deficits. Cases of CLOCCs are reported as a secondary syndrome connected with many disease entities (e.g., toxic, infectious, and metabolic). The clinical presentation ranges from asymptomatic to severe cases demanding intensive treatment. The diagnosis is determined via an MRI examination. Conclusions: The general prognosis for CLOCCs is good, though the normalization of a brain MRI can take several months. As the only method of showing CLOCCs, MRI is the imaging gold standard. Still, clinical abnormalities often precede radiological changes, as was the case with the reported patient. Full article

The kappa index is a well-established marker of intrathecal synthesis (IS) of immunoglobulin (Ig). Routinely used for diagnostic aims, IgG IS, which can be assessed quantitatively (ad hoc formulas) or qualitatively (oligoclonal bands, OCBs), may fail in detecting a humoral immune response within the central nervous system (CNS). The main aim of this study was to evaluate the kappa index for its ability to detect the presence of CNS humoral immunity and to associate it with a distinct group of disorders, in the absence of IgG IS/OCBs. Within the kappa index-positive, IgG OCB-negative (Kappa+OCB-) patient group, we also examined whether IgM/IgA IS, determined with the IgM/IgA index and CSF IgM OCBs, could contribute to disease group stratification. Diagnoses were classified as multiple sclerosis (MS), or other inflammatory (INFL), infectious (INFECT), or non-inflammatory (Other) central/peripheral nervous system disorders. Sixty-nine Kappa+OCB- patients and 50 controls (24 Kappa-OCB- and 26 Kappa+OCB+ patients) were included in this study. The most frequent diagnosis in the Kappa+OCB- group was MS (27/69), followed by INFECT (16/69). Additional evidence of IS was demonstrated through an elevated IgG/IgM/IgA index or by the presence of IgM OCBs in 59%, and through only IgM/IgA IS in 52% of cases. In INFECT patients, the median IgM/IgA indexes were higher (p < 0.001) than in other groups, with 18 patients (95%) presenting an elevated IgM index, 11 patients (58%) presenting CSF IgM OCBs, and 10 patients (53%) presenting an elevated IgA index. The vast majority of all INFECT (16/19) belonged to the Kappa+OCB- group. Our data confirm that the kappa index performs at the highest level in assessing intrathecal humoral immunity and supporting the diagnosis of both MS and CNS infectious disorders, which are also characterized by the intrathecal production of IgM and IgA. Full article

Evaluating altered mental status and suspected meningeal disorders in children often begins with imaging, typically before a lumbar puncture. The challenge is that meningeal enhancement is a common finding across a range of pathologies, making diagnosis complex. This review proposes a categorization of meningeal diseases based on their predominant imaging characteristics. It includes a detailed description of the clinical and imaging features of various conditions that lead to leptomeningeal or pachymeningeal enhancement in children and adolescents. These conditions encompass infectious meningitis (viral, bacterial, tuberculous, algal, and fungal), autoimmune diseases (such as anti-MOG demyelination, neurosarcoidosis, Guillain-Barré syndrome, idiopathic hypertrophic pachymeningitis, and NMDA-related encephalitis), primary and secondary tumors (including diffuse glioneuronal tumor of childhood, primary CNS rhabdomyosarcoma, primary CNS tumoral metastasis, extracranial tumor metastasis, and lymphoma), tumor-like diseases (Langerhans cell histiocytosis and ALK-positive histiocytosis), vascular causes (such as pial angiomatosis, ANCA-related vasculitis, and Moyamoya disease), and other disorders like spontaneous intracranial hypotension and posterior reversible encephalopathy syndrome. Despite the nonspecific nature of imaging findings associated with meningeal lesions, narrowing down the differential diagnoses is crucial, as each condition requires a tailored and specific treatment approach. Full article

Objectives: Various measures have been attempted to prevent infectious diseases in calves, such as environmental improvement and vaccine administration. Probiotics are commonly used to improve the body condition of newborn calves and prevent disease. In our previous research, Lactiplantibacillus plantarum RGU-LP1 (LP1) suppressed the expression of inflammatory cytokines in PBMCs of cattle fed it in the diet. In this study, we evaluated the effect of LP1 on the weights and number of treatments of the calves. Methods: Twenty-six one-week-old Holstein bull calves were divided into two groups (thirteen each), the LP1 group (LP1-treated) and the CN group (no LP1 fed), and tested as follows. The LP1 group was fed lyophilized LP1 (10⁹ CFU/head/day) in milk replacer for 40 days. The CN group was fed the same diet only. Calves were followed for 63 days. The average treatment costs for the LP1 during the period were recorded. Feces and blood were collected from each calf during this period. Feces were examined for gut microbiota, and blood for immune assay and cytokine gene expression. Results: The LP1-treated group showed a decrease in disease incidence and an increase in body weights compared to controls. The average treatment cost during the observation period was significantly reduced compared to the CN group. The expression of TGFβ and IL10, inhibitory cytokines of inflammation, was significantly increased. The simultaneous expression of this set of inhibitory molecules resulted in low serum IL1β levels during the growth period. Conclusions: The Th1-type cytokine IFNγ was also significantly increased in LP1-treated calves. By reducing the amount of disease treatments and increasing dairy gain, LP1 is effective in preventing infectious diseases in calves. In addition, the increase in IFNγ by LP1 indicates improved Th1-type immunity in calves. These results show that LP1 has effects on the regulated inflammatory response and growth of calves. Full article

Human Herpesviruses (HHVs) play a significant role in neurological diseases such as encephalitis and meningitis, adding significant morbidity. This study aims to retrospectively analyze the effect of HHVs on patients with neurological symptoms, focusing on the Herpesviridae family’s contributions to central nervous system (CNS) infections. Methods: This retrospective cohort study included 895 patients suspected of viral CNS infections, utilizing molecular diagnosis via qPCR to identify HHVs in cerebrospinal fluid (CSF) samples. This was conducted at a reference tertiary care hospital for infectious diseases in the western Brazilian Amazon from January 2015 to December 2022, focusing on the Herpesviridae family’s clinical repercussions and of Cytomegalovirus in CNS infections. Results: The findings revealed that 7.5% of the analyzed samples tested positive for HHVs, with Human Cytomegalovirus (HCMV) and Epstein–Barr Virus (EBV) being the most prevalent. A significant association was found between HHVs and neurological diseases such as encephalitis and meningitis, especially among people living with HIV/AIDS (PLWHA), highlighting the opportunistic nature of these viruses. The study underscores the critical role of CSF analysis in diagnosing CNS infections and the complexity of managing these infections in HIV patients due to their immunocompromised status. Conclusions: The results emphasize the need for comprehensive diagnostic approaches and tailored treatment strategies for CNS infections in immunocompromised individuals. The study calls for ongoing research and advancements in clinical practice to improve patient outcomes facing CNS infections, particularly those caused by HHVs. Full article

Rabies is a fatal neurological infectious disease caused by rabies virus (RABV), which invades the central nervous system (CNS). RABV with varying virulence regulates chemokine expression, and the mechanisms of signaling pathway activation remains to be elucidated. The relationship between Toll-like receptors (TLRs) and immune response induced by RABV has not been fully clarified. Here, we investigated the role of TLR7 in the immune response induced by RABV, and one-way analysis of variance (ANOVA) was employed to evaluate the data. We found that different RABV strains (SC16, HN10, CVS-11) significantly increased CCL2, CXCL10 and IL-6 production. Blocking assays indicated that the TLR7 inhibitor reduced the expression of CCL2, CXCL10 and IL-6 (p < 0.01). The activation of the Myd88 pathway in BV-2 cells stimulated by RABV was TLR7-dependent, whereas the inhibition of Myd88 activity reduced the expression of CCL2, CXCL10 and IL-6 (p < 0.01). Meanwhile, the RABV stimulation of BV-2 cells resulted in TRL7-mediated activation of NF-κB and induced the nuclear translocation of NF-κB p65. CCL2, CXCL10 and IL-6 release was attenuated by the specific NF-κB inhibitor used (p < 0.01). The findings above demonstrate that RABV-induced expression of CCL2, CXCL10 and IL-6 involves Myd88 and NF-κB pathways via the TLR7 signal. Full article

Background: Human herpesvirus 6 (HHV-6) is considered a ubiquitous virus, with many countries reporting a seroprevalence of more than 80–90% among the general population. However, this virus is unique among herpesviruses in its ability to integrate into the genetic material of the host’s cells. Thus, there are three ways by which HHV-6 can cause an active infection–primary infection, reactivation of a latent acquired infection, or activation of iciHHV-6 (inherited chromosomally integrated HHV-6). Whole blood quantitative polymerase chain reaction (qPCR) is very useful in distinguishing between iciHHV-6 and primary infection/reactivation. Our aim is to assess the role of HHV-6 in the aetiology of central nervous system (CNS) infections in adults and children, to describe all HHV-6-positive cases in an attempt to determine the susceptible population and to identify potential risk factors that can be linked to HHV-6 meningoencephalitis. Methods: We performed a retrospective study involving patients that were admitted to Prof. Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, with a diagnosis of meningitis or encephalitis. We only selected the clinical records of patients that had a multiplex PCR Biofire^® FilmArray^® meningitis/encephalitis panel. Results: We report a 5% HHV-6 positivity in the cerebrospinal fluid (CSF) of patients with CNS infections tested with a commercial multiplex PCR M/E (meningitis/encephalitis) panel. Additionally, 2% to 4% of the total study population (n = 100) had active HHV-6 infections, which denotes 40 to 80% of the HHV-6-positive samples. We did not observe any statistically significant correlation between HHV-6 positivity in the CSF and variables such as age, sex, or comorbidities, including obesity, diabetes, hypertension, immunosuppression, or oncologic disease. Therefore, no risk factors could be linked with HHV-6 positivity in the CSF. Conclusions: although multiplex qualitative PCR is highly useful for providing rapid results and identifying nearly every pathogen that can cause meningitis/encephalitis, we have to be aware of this type of test’s limitations. All patients with HHV-6 detectable in their CSF via a multiplex PCR test should also undergo qPCR testing from both CSF and blood to prevent over-diagnosing HHV-6 CNS infections, to avoid unnecessary antiviral treatments, and ensure the accurate identification of the true diagnosis. Full article

Alzheimer’s Disease is among the major chronic neurodegenerative diseases that affects more than 50 million people worldwide. This disease irreversibly destroys memory, cognition, and the overall daily activities which occur mainly among the elderly. Few drugs are approved for Alzheimer’s Disease management despite its high prevalence. To date, the available drugs in the market cannot reverse the damage of neurons caused by the disease leading to the exacerbation of symptoms and possibly death. Medicinal plants are considered a rich source of chemical constituents and have been contributing to modern drug discovery in many therapeutic areas including cancer, infectious, cardiovascular, neurodegenerative and Central Nervous System (CNS) diseases. Moreover, essential oils that are extracted from plant organs have been reported for a wide array of biological activities, and their roles as antioxidants, antiaging, cytotoxic, anti-inflammatory, antimicrobial, and enzyme inhibitory activities. This article highlights the promising potential of plants’ essential oils in the discovery of novel therapeutic options for Alzheimer’s Disease and halting its progression. In this article, 428 compounds were reported from the essential oils isolated from 21 plants. A comparative study is carried out by employing a variety of machine learning techniques, validation, and evaluation metrics, to predict essential oils’ efficacy against Alzheimer’s Disease progression. Extensive experiments on essential oil data suggest that a prediction accuracy of up to 82% can be achieved given the proper data preprocessing, feature selection, and model configuration steps. This study underscores the potential of integrating machine learning with natural product research to prioritize and expedite the identification of bioactive essential oils that could lead to effective therapeutic interventions for Alzheimer’s Disease. Further exploration and optimization of machine learning techniques could provide a robust platform for drug discovery and development, facilitating faster and more efficient screening of potential treatments. Full article

Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left upper limb, after achieving leukaemia remission and while on voriconazole. Magnetic resonance imaging (MRI) showed oedematous CNS lesions with a haemorrhagic component in the right hemisphere with lepto-meningitis. After 2 weeks of antibiotics and amphotericin-B, brain biopsy revealed chronic inflammation with abscess and necrosis, while cultures were negative. Clinical recovery was attained, he was discharged on isavuconazole and allogeneic transplant was postponed, introducing azacitidine as a maintenance therapy. After initial improvement, MRI worsened; brain biopsy was repeated, showing similar histology; and 16S metagenomics sequencing analysis was positive (Veilonella, Pseudomonas). Despite 1 month of meropenem, MRI did not improve. The computer tomography and PET scan excluded extra-cranial infectious–inflammatory sites, and auto-immune genesis (sarcoidosis, histiocytosis, CNS vasculitis) was deemed unlikely due to the histological findings and unilateral lesions. We hypothesised possible IFD with peri-lesion inflammation and methyl-prednisolone was successfully introduced. Steroid tapering is ongoing and isavuconazole discontinuation is planned with close follow-up. In conclusion, the management of CNS complications in immunocompromised patients needs an interdisciplinary approach. Full article

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder affecting millions worldwide. Emerging research has challenged the conventional notion of a direct correlation between amyloid deposition and neurodegeneration in AD. Recent studies have suggested that amyloid and Tau deposition act as a central nervous system (CNS) innate immune driver event, inducing chronic microglial activation that increases the susceptibility of the AD brain to the neurotoxicity of infectious insults. Although modifiable risk factors account for up to 50% of AD risk, the mechanisms by which they interact with the core process of misfolded protein deposition and neuroinflammation in AD are unclear and require further investigation. This update introduces a novel perspective, suggesting that modifiable risk factors act as external insults that, akin to infectious agents, cause neurodegeneration by inducing recurrent acute neurotoxic microglial activation. This pathological damage occurs in AD pathology-primed regions, creating a “hit and run” mechanism that leaves no discernible pathological trace of the external insult. This model, highlighting microglia as a pivotal player in risk factor-mediated neurodegeneration, offers a new point of view on the complex associations of modifiable risk factors and proteinopathy in AD pathogenesis, which may act in parallel to the thoroughly studied amyloid-driven Tau pathology, and strengthens the therapeutic rationale of combining immune modulation with tight control of risk factor-driven insults. Full article