RESUMEN
We describe the first case of a patient with brain abscesses caused by Stenotrophomonas maltophilia as a complication after motor cortex stimulator implantation. Brain abscesses pose a challenge in diagnosis and treatment, because microbiological diagnosis is not always achieved, antibiotic drugs may not penetrate well into the CNS and some bacteria have resistances to typical empirical antibiotic drugs. In this case diagnosis was only made after removal of the stimulator and a long term treatment with antibiotic drugs was necessary. As neurostimulation devices become more common, formerly rare bacteria may become a more common complication. Bacteria with biofilm properties and a problematic resistance spectrum like Stenotrophomonas maltophilia should be included in the differential diagnosis, because they will not respond to the typical empirical treatment.
Asunto(s)
Absceso Encefálico/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Neuroestimuladores Implantables/efectos adversos , Corteza Motora/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Stenotrophomonas maltophilia/aislamiento & purificación , Anciano , Absceso Encefálico/etiología , Remoción de Dispositivos/métodos , Infecciones por Bacterias Gramnegativas/etiología , Humanos , Masculino , Corteza Motora/microbiología , Infecciones Relacionadas con Prótesis/etiologíaRESUMEN
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease and the main cause of motor neuron pathology. The etiology of the disease remains unknown, and no effective therapy exists to halt the disease or improve the quality of life. Here, we provide compelling evidence for the existence of fungal infection in ALS. Immunohistochemistry analysis using a battery of antifungal antibodies revealed fungal structures such as yeast and hyphae in the motor cortex, the medulla and the spinal cord, in eleven patients with ALS. Some fungal structures were localized intracellularly and even intranuclearly, indicating that this infection is not the result of post-mortem colonization. By contrast, this burden of fungal infection cannot be observed in several CNS areas of control subjects. PCR analysis and next generation sequencing of DNA extracted from frozen neural tissue identified a variety of fungal genera including Candida, Malassezia, Fusarium, Botrytis, Trichoderma and Cryptococcus. Overall, our present observations provide strong evidence for mixed fungal infections in ALS patients. The exact mixed infection varies from patient to patient consistent with the different evolution and severity of symptoms in each ALS patient. These novel findings provide a logical explanation for the neuropathological observations of this disease, such as neuroinflammation and elevated chitinase levels, and could help to implement appropriate therapies.
Asunto(s)
Esclerosis Amiotrófica Lateral/complicaciones , Esclerosis Amiotrófica Lateral/patología , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/patología , Adulto , Anciano , Anciano de 80 o más Años , Esclerosis Amiotrófica Lateral/microbiología , Femenino , Genómica , Humanos , Inmunohistoquímica , Masculino , Bulbo Raquídeo/microbiología , Bulbo Raquídeo/patología , Metagenoma , Persona de Mediana Edad , Corteza Motora/microbiología , Corteza Motora/patología , Neuronas/microbiología , Neuronas/patología , Reacción en Cadena de la Polimerasa , Análisis de Secuencia , Médula Espinal/microbiología , Médula Espinal/patologíaAsunto(s)
Absceso Encefálico/diagnóstico , Infartos del Tronco Encefálico/diagnóstico , Senos Etmoidales/patología , Meningitis Bacterianas/diagnóstico , Corteza Motora/fisiopatología , Enfermedades del Nervio Oculomotor/diagnóstico , Absceso Encefálico/microbiología , Absceso Encefálico/fisiopatología , Diagnóstico Diferencial , Empiema/diagnóstico , Empiema/microbiología , Empiema/fisiopatología , Encefalitis/diagnóstico , Encefalitis/microbiología , Encefalitis/fisiopatología , Resultado Fatal , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Corteza Motora/microbiología , Corteza Motora/patología , Nervio Oculomotor/microbiología , Nervio Oculomotor/patología , Nervio Oculomotor/fisiopatología , Enfermedades del Nervio Oculomotor/microbiología , Enfermedades del Nervio Oculomotor/fisiopatología , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico , Paresia/diagnóstico , Paresia/microbiología , Paresia/fisiopatología , Infecciones Estreptocócicas/complicacionesAsunto(s)
Corteza Motora/microbiología , Mioclonía/microbiología , Neurosífilis/complicaciones , Treponema pallidum/aislamiento & purificación , Enfermedad Aguda , Electroencefalografía , Electromiografía , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Mioclonía/fisiopatología , Neurosífilis/fisiopatología , Inducción de RemisiónRESUMEN
We examined the axonal transport of two strains of herpes simplex virus 1 (HSV-1) within the central nervous system of cebus monkeys. Each strain was injected into the "arm area" of the primary motor cortex. One strain, HSV-1(McIntyre-B), was transported transneuronally in the retrograde direction. It infected neurons at sites known to project to the arm area of the primary motor cortex (e.g., ventrolateral thalamus). In addition, "second-order" neurons were labeled in the deep cerebellar nuclei (dentate and interpositus) and in the globus pallidus (internal segment). This result supports the concept that the arm area of the primary motor cortex is a target of both cerebellar and basal ganglia output. In contrast, the other strain, HSV-1(H129), was transported transneuronally in the anterograde direction. It infected neurons at sites known to receive input from the arm area of the primary motor cortex (e.g., putamen, pontine nuclei). In addition, "third-order" neurons were labeled in the cerebellar cortex (granule and Golgi cells) and in the globus pallidus (largely the external segment). Our observations suggest that strain differences have an important impact on the direction of transneuronal transport of HSV-1. Furthermore, it should be possible to examine the organization of cerebellar and basal ganglia loops with cerebral cortex by exploiting transneuronal transport of HSV-1 and virus strain differences.
Asunto(s)
Encéfalo/microbiología , Neuronas/microbiología , Simplexvirus/clasificación , Animales , Transporte Biológico , Encéfalo/citología , Encéfalo/metabolismo , Cebus , Corteza Cerebelosa/citología , Corteza Cerebelosa/metabolismo , Corteza Cerebelosa/microbiología , Corteza Cerebral/citología , Corteza Cerebral/metabolismo , Corteza Cerebral/microbiología , Globo Pálido/citología , Globo Pálido/metabolismo , Globo Pálido/microbiología , Corteza Motora/citología , Corteza Motora/metabolismo , Corteza Motora/microbiología , Neuronas/citología , Neuronas/metabolismo , Putamen/citología , Putamen/metabolismo , Putamen/microbiologíaRESUMEN
It is generally accepted that, the younger an animal is, the more susceptible it is to Japanese encephalitis virus (JEV) infection. A time-kinetic study of JEV antigen in the developing rat brain after infection disclosed that in the motor cortex, neurons were diffusely infected with JEV until the age of 5 days. However, on exposure from the 6th to 7th day, only the neurons of the upper layers were infected; those of the deeper layers remained uninfected. On the 8th day, the infection was limited to the superficial neurons, and from the 9th day onward, no neurons were infected. Since neuronal maturation in the motor cortex begins in the deeper layers and extends to the upper layers, it seems that JEV targets immature neurons. Fifteen-day-old rats, which were resistant to JEV infection, received intracerebral transplants of neurons taken from 19th-day embryos. When these animals were infected with JEV at 3 days after transplantation, viral antigen was detected only in the transplanted neurons; the host neurons were negative. However, when animals were infected with JEV at 9 days after transplantation, neither host neurons nor donor neurons became infected. This showed that JEV attacked embryonal neurons only early after transplantation into young-adult brains. JEV infectivity limited to the immature neurons was also confirmed by in vitro explant culture experiments. It can be concluded from these experiments that the susceptibility to JEV infection in the rat brain is closely associated with neuronal immaturity.
Asunto(s)
Corteza Cerebral/crecimiento & desarrollo , Virus de la Encefalitis Japonesa (Especie) , Encefalitis Japonesa/patología , Animales , Corteza Cerebral/microbiología , Susceptibilidad a Enfermedades , Encefalitis Japonesa/microbiología , Corteza Motora/microbiología , Neuronas/patología , RatasRESUMEN
Complement-fixing antibody response to eleven different viruses were measured in amyotrophic lateral sclerosis (ALS) patients, contacts of ALS patients, neurological controls, and normal controls. The normal controls showed a decreased response to adeno-associated virus and an increased response to adenovirus when compared to the other groups. Levels of interferon-like substances also were investigated in sera and cerebrospinal fluids of ALS patients and neurological controls. Responses were of a low titer and were not increased in the ALS group. Explant cultures were established from tissues of 24 ALS autopsy cases. Cultures were investigated directly or following fusion to various indicator cell lines for viral-like agents. Techniques such as interference assays, 5-bromodeoxyuridine (BudR) induction, hemadsorption, and fluorescent antibody staining failed to detect virus. By addition of helper adenovirus to primary explant cultures, adeno-associated virus was isolated from 2 of 11 ALS cases.
Asunto(s)
Adenovirus Humanos/inmunología , Esclerosis Amiotrófica Lateral/microbiología , Anticuerpos Antivirales/análisis , Corteza Motora/microbiología , Médula Espinal/microbiología , Adenovirus Humanos/aislamiento & purificación , Esclerosis Amiotrófica Lateral/sangre , Animales , Técnicas de Cultivo , Humanos , Interferones/sangre , RatonesRESUMEN
A patient with a 14 year history of sarcoidosis developed a progressive left cerebral hemisphere lesion. The clinical diagnosis of progressive multifocal leucoencephalopathy was confirmed by brain biopsy and remission occurred after treatment with cytosine arabinoside.