RESUMEN
A healthy patient presented to Klinikum Altmühlfranken Weißenburg Hospital, Germany, with two morning attacks of painful muscle spasm in the left upper and lower limbs, without altered consciousness. Full examinations, radiological imaging, electroencephalography, lumbar puncture, and autoimmune profile were either normal or not consistent with patient's complaint. Subsequent epileptic episodes were observed on admission day and the following days; thus, the patient was diagnosed with focal epilepsy. The patient started to develop a fever and severe cough on day 4, and SARS-coronavirus-2 was confirmed through a nasopharyngeal swap. She received anticonvulsants and symptomatic treatments and completely recovered. This report emphasizes the potential nervous system involvement in severe acute respiratory syndrome-coronavirus-2 pathogenesis.
Asunto(s)
COVID-19/complicaciones , Epilepsias Parciales/complicaciones , SARS-CoV-2/patogenicidad , Acetaminofén/uso terapéutico , Acetilcisteína/uso terapéutico , Anciano , Ambroxol/uso terapéutico , Anticonvulsivantes/uso terapéutico , COVID-19/diagnóstico por imagen , COVID-19/virología , Tos/diagnóstico , Tos/fisiopatología , Dipirona/uso terapéutico , Epilepsias Parciales/diagnóstico por imagen , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/virología , Femenino , Fiebre/diagnóstico , Fiebre/fisiopatología , Humanos , Nasofaringe/virología , Radiografía Abdominal , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19RESUMEN
Human Parvovirus B19 (PVB19), the etiological agent of the fifth disease, is associated with a large spectrum of pathologies, among which is encephalitis. Since it has been detected from the central nervous system in children or in immunocompromised patients, its causative role in serious neurological manifestations is still unclear. Here we report the case of an 18-year-old healthy boy who developed encephalitis complicated by prolonged status epilepticus. The detection of PVB19 DNA in his serum and, subsequently, in his cerebrospinal fluid supports the hypothesis that this virus could potentially play a role in the pathogenesis of neurological complications. In addition, the detection of viral DNA and the presence of specific IgM and IgG antibodies in serum, together with clinical findings such as skin rash, support the presence of a disseminated viral infection. In the presence of neurological disorders, especially when there are no specific signs, but seizures and rash are present, it is important to search for PVB19 both in immunocompromised and immunocompetent patients. Moreover, the introduction of the PVB19 DNA test into diagnostic protocols of neuropathies, especially those undiagnosed, could clarify the etiological agent that otherwise could remain unrecognized.
Asunto(s)
Encefalitis/virología , Epilepsias Parciales/virología , Infecciones por Parvoviridae/complicaciones , Parvovirus B19 Humano/aislamiento & purificación , Adolescente , Sangre/virología , Líquido Cefalorraquídeo/virología , ADN Viral/genética , Encefalitis/inmunología , Epilepsias Parciales/inmunología , Humanos , Masculino , Infecciones por Parvoviridae/inmunología , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/inmunología , Sensibilidad y EspecificidadRESUMEN
Toscana virus (TOSV) infection may often cause symptomatic meningitides and encephalitides. These usually subside in few days and their sequelae do not last for more than few weeks. We here report the case of a 49-year-old man who developed encephalitis after being bitten by phlebotomi in a region near southern Tuscany, where TOSV is endemic, and who developed postencephalitic seizures and subsequently, persistent personality alterations, characterized by sexually dissolute behavior and aggressiveness. One year after infection, the patient needs a combination of an SSRI antidepressant and a mood stabilizer/anticonvulsant to obtain less than optimal symptom improvement. This points to the need of establishing better preventive measures in Tuscany and nearby regions.
Asunto(s)
Infecciones por Bunyaviridae/psicología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/etiología , Encefalitis Viral/psicología , Meningitis Aséptica/psicología , Personalidad , Virus de Nápoles de la Fiebre de la Mosca de los Arenales/aislamiento & purificación , Agresión , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/líquido cefalorraquídeo , Anticonvulsivantes/uso terapéutico , Antimaníacos/uso terapéutico , Encéfalo/patología , Infecciones por Bunyaviridae/epidemiología , Infecciones por Bunyaviridae/patología , Infecciones por Bunyaviridae/virología , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/etiología , Trastorno Depresivo/psicología , Trastorno Depresivo/virología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/tratamiento farmacológico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/psicología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/virología , Encefalitis Viral/patología , Encefalitis Viral/virología , Enfermedades Endémicas , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/etiología , Epilepsias Parciales/virología , Gliosis/etiología , Gliosis/patología , Humanos , Italia/epidemiología , Imagen por Resonancia Magnética , Masculino , Meningitis Aséptica/patología , Meningitis Aséptica/virología , Persona de Mediana Edad , Exposición Profesional , Prevalencia , Virus de Nápoles de la Fiebre de la Mosca de los Arenales/inmunología , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Conducta SexualRESUMEN
The aims of the present study are to identify predisposing factors of febrile seizures in influenza A infection and to clarify the special characteristics of febrile seizures in children with influenza A infection. Between January and July 2005, children hospitalized because of febrile seizures and subsequently confirmed influenza A infection were enrolled as subjects. Age-matched control subjects were those admitted as a result of influenza A infection but no febrile seizures (control 1) and children who developed febrile seizures with negative viral studies (control 2). Significant factors for the development of febrile seizures include: history of febrile seizures, family history of seizure disorders, and coexisting gastroenteritis. Independent risk factor for febrile seizures was history of febrile seizures (odds ratio 7.58, 95% confidence interval CI 1.48 to 38.84, P = 0.015). When compared with children who developed febrile seizures with negative virus studies, children who developed febrile seizures in influenza A infection had a significantly higher maximum body temperature, shorter duration of fever before seizure onset, and more frequent occurrence of partial seizures. Current episode represented first seizure in 26.5% of children infected with influenza A as compared with 50% of children whose virus studies were negative (P = 0.04). The findings suggest that effective vaccination may prevent development of febrile seizures, especially in those patients with past history of febrile seizures. Rapid diagnostic testing for influenza infection in the management of complex febrile seizures, especially during influenza season, is cost-effective.
Asunto(s)
Virus de la Influenza A , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Convulsiones Febriles/epidemiología , Convulsiones Febriles/virología , Niño , Niño Hospitalizado/estadística & datos numéricos , Preescolar , Epilepsias Parciales/epidemiología , Epilepsias Parciales/prevención & control , Epilepsias Parciales/virología , Femenino , Fiebre/epidemiología , Fiebre/prevención & control , Fiebre/virología , Humanos , Lactante , Vacunas contra la Influenza , Gripe Humana/prevención & control , Masculino , Factores de Riesgo , Convulsiones Febriles/prevención & controlRESUMEN
The clinical, virological and immunocytochemical features of three children who recovered from acute herpes simplex encephalitis (HSE) before the age of 2 years, and who developed secondary severe focal epilepsy after a symptom-free period, leading to neurosurgery 3-10 years later are described. In one child, relapse of HSE occurred immediately after surgery. In all three patients, brain sample biopsies showed abundant CD3-positive T lymphocytes with a majority of CD8 cells, and abundant activated macrophage-microglial cells, a pattern similar to that found in acute HSE. Herpes simplex virus DNA was retrieved from the tissue biopsy in one case. The long-term persistent cerebral inflammatory process observed after HSE differed from that observed in another chronic viral disease, subacute sclerosing panencephalitis. This inflammatory reaction may be a result either of low-grade viral expression or self-induced immune activation. The role of inflammation in triggering epilepsy remains hypothetical. Solving these issues should have major therapeutic implications. Herpes simplex virus DNA latency in brain may be the source of replicative HSE relapse.
Asunto(s)
Encéfalo/inmunología , Encéfalo/virología , Encefalitis por Herpes Simple/inmunología , Epilepsias Parciales/inmunología , Epilepsias Parciales/virología , Biopsia , Encéfalo/patología , Complejo CD3/análisis , Niño , Preescolar , Enfermedad Crónica , ADN Viral/análisis , Encefalitis por Herpes Simple/diagnóstico por imagen , Encefalitis por Herpes Simple/patología , Epilepsias Parciales/patología , Femenino , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Simplexvirus/genética , Simplexvirus/aislamiento & purificación , Panencefalitis Esclerosante Subaguda/inmunología , Panencefalitis Esclerosante Subaguda/patología , Panencefalitis Esclerosante Subaguda/virología , Linfocitos T/inmunología , Linfocitos T/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To determine whether herpes simplex virus causes monofocal epilepsy and to assess the presence of herpes simplex virus 1 (HSV-1) and HSV-2 in surgical specimens from patients with epilepsy by using polymerase chain reaction and Southern blot analysis. BACKGROUND: Herpes simplex virus is a common neurotropic virus capable of latency within the central nervous system; it has a predilection for the temporal lobe. Central nervous system infection with HSV has been associated with seizure activity. DESIGN AND METHODS: Surgical specimens were removed from 50 patients as part of a treatment protocol for monofocal epilepsy. Neuropathological classification was done, and adjacent sections were screened for HSV by using polymerase chain reaction. Tissues obtained post mortem from the temporal lobe cortex of persons with Alzheimer disease (n=17), Parkinson disease (n=14), or nonneurological disease (n=17) served as controls. RESULTS: Twenty (40%) of the 50 epilepsy cases and 2 (4%) of the 48 control cases had at least one sample that tested positive for HSV (P<.001). Sixty-seven percent (8/12) of the epilepsy cases with heterotopia were positive for HSV. CONCLUSIONS: There was a statistically significant difference in the frequency of HSV-positive surgical specimens from monofocal seizure epicenters compared with nonepilepsy control specimens. These data suggest an association of the virus with seizure activity. All specimens positive for HSV (surgical specimens and control specimens) should be examined to determine the activity or latency state of the virus and cellular localization.
Asunto(s)
Epilepsias Parciales/virología , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Southern Blotting , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaRESUMEN
PURPOSE: To describe the clinical features of new-onset seizures in HIV-1-infected persons with progressive multifocal leukoencephalopathy (PML), and to discuss potential mechanisms. PATIENTS AND METHODS: Forty-nine consecutive HIV-1-infected patients with PML attended our institutions between January 1988 and September 1993. We retrospectively analyzed cases with seizures as the presenting symptom of PML. RESULTS: Twenty percent of the HIV-1-infected patients with PML presented with new-onset seizures of various types, generalized or partial. None of them met the criteria of the AIDS dementia complex or had a concomitant opportunistic infection. Their mean CD4 cell count was < 60/mm3. Brain magnetic resonance imaging showed areas of increased signal intensity on T2-weighted images in 9 cases, and atrophy in only 1 case. Lesions most often involved subcortical white matter in parieto-occipital or frontal lobes, but 2 patients had posterior fossa lesions. Image-guided stereotactic brain biopsies in 8 cases and postmortem examination in 2 confirmed the diagnosis of PML. Typical histological lesions were observed in all cases, and positive immunolabelling of oligodendroglial nuclei was obtained in all cases with the polyclonal antibody directed against late SV40 antigens. Putative causative factors for the seizures include demyelinated lesions adjacent to the cerebral cortex acting as irritative foci, axonal conduction abnormalities, or disturbances of the neuron-glia balance. CONCLUSION: These cases illustrate that PML should be considered as a possible cause of new-onset seizures in patients with HIV-1 infection.