Viral encephalitis Silva, Marcus Tulius T
Arquivos de Neuro-Psiquiatria,
09/2013, Letnik:
71, Številka:
9B
Journal Article
Recenzirano
Odprti dostop
While systemic viral infections are exceptionally common, symptomatic viral infections of the brain parenchyma itself are very rare, but a serious neurologic condition. It is estimated that viral ...encephalitis occurs at a rate of 1.4 cases per 100.000 inhabitants. Geography is a major determinant of encephalitis caused by vector-borne pathogens. A diagnosis of viral encephalitis could be a challenge to the clinician, since almost 70% of viral encephalitis cases are left without an etiologic agent identified. In this review, the most common viral encephalitis will be discussed, with focus on ecology, diagnosis, and clinical management.
The HTLV-1 neurological complex Araujo, Abelardo QC; Silva, Marcus Tulius T
Lancet neurology,
12/2006, Letnik:
5, Številka:
12
Journal Article
Recenzirano
Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects about 20 million people worldwide and causes immune-mediated diseases of the nervous system. The classic neurological ...presentation of HTLV-1 infection is a myelopathy called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, HAM/TSP is not the only neurological outcome that can result from HTLV-1 infection. In this Personal View, we show that HTLV-1 has a broader neurological spectrum than the names HAM/TSP suggest and that people infected with this virus can present with various isolated or assorted syndromes.
Anosmia has been recognized as a prevalent and early symptom by many COVID-19 patients. However, most researchers have recorded smell dysfunction solely as present or absent and based on subjective ...evaluation by patients. We described the results of 57 consecutive COVID-19 patients seen at FIOCRUZ, Rio de Janeiro, Brazil, from April to May 2020. Data about the presence of smell loss, the onset of smell loss and other COVID-19 symptoms such as ageusia and nasal congestion or rhinorrhea were recorded. All patients at the initial consultation and 34 healthy controls underwent the Q-SIT, which is a quick disposable three-item smell identification test, by a trained physician. We compared three groups: healthy controls, COVID+ patients with reported smell loss (COVID w/ SL) and COVID+ patients without smell loss (COVID+ w/o SL). The mean age of patients was 41.4 years (SD ± 10.4), and 54.4% were women. Smell loss was reported by 40.4% of COVID-19 patients. We observed a gradual effect with higher Q-SIT scores in healthy controls, followed by COVID+ w/o SL and COVID+ w/ SL (medians = 3, 2 and 0; respectively, p < 0.001). Anosmia or severe microsmia (Q-SIT≤1) was present in 11.1% (CI: 3.1%–26.1%) of controls, 32.4% (CI: 17.4%–50.5%) of COVID-19 w/o SL and 87% (CI: 66.4%–97.2%) of COVID+ w/ SL (p < 0.001). This study provides evidence that olfactory dysfunction in COVID-19 is common and more prevalent than what is perceived by patients. Q-SIT is a quick and reliable screening test for the detection of smell dysfunction during the pandemics.
•Smell dysfunction is frequent in COVID-19 patients.•Subtle olfactory dysfunction is frequently not perceived by patients when inquired during medical visits.•Q-SIT is a quick and reliable screening test for the detection of smell dysfunction during the pandemics.
Recent reports have demonstrated that human T lymphotropic virus type 1 (HTLV-1) is associated with other neurological abnormalities in addition to HTLV-1-associated myelopathy/tropical spastic ...paraparesis (HAM/TSP). It has been well established that high HTLV-1 proviral loads are associated with the development of HAM/TSP. We now demonstrate, for the first time, to our knowledge, that HTLV-1 proviral loads in patients with other neurological abnormalities are also significantly higher than in asymptomatic HTLV-1 carriers.
Progressive multifocal leukoencephalopathy (PML) is lytic infection of oligodendrocytes caused by JC virus (JCV). While PML incidence in developing countries has decreased after the introduction of ...combination antiretroviral therapy (cART), data in developing countries is scarce and limited to few cohorts. We described the epidemiological and clinical profile of a group of Brazilian HIV infected patients with PML in the cART era. A total of 27 patients were included in the study. The median age at PML onset was 42years (range: 27–67years) and 18 (66.7%) were men. The median CD4+ T cell count at the time of diagnosis was 67cells/mm3 and the median HIV viral load was 27,000copies/ml. Motor deficits were the most common early manifestations (44%). Seizures occurred in 37% of the patients and 9 (33.3%) had PML associated with immune reconstitution inflammatory syndrome (IRIS). Mortality was 33% and lower age at PML onset was associated with survival (p: 0.013). Our results are in accordance with previous published series of PML cases. Factors such as genetic background, regional JCV subtype differences, death from other diseases and underdiagnosis may explain the low prevalence of reported PML cases in developing countries.
•Brazilian PML patients have similar clinical characteristics as patients from developed countries.•Older age at onset was associated with mortality.•1/3 of PML patients developed immune reconstitution inflammatory syndrome.
HIV-associated neurocognitive disorders (HAND) remain prevalent in highly active antiretroviral therapy (HAART) era. Tests to detect HAND are needed for early diagnosis and treatment. Validity of ...International HIV Dementia Scale (IHDS) has been determined in different countries. The aims of this study were validate IHDS in a Brazilian cohort of HIV-patients and verify if IHDS can be reliably administered by a non-clinician health professional. One hundred and eighty-seven (187) patients were submitted to a full neuropsychological assessment. IHDS was administered twice to each patient (by a non-clinician and by a neurologist). HAND was diagnosed in 98 individuals (68 on HAART). IHDS had sensitivity of 55% and specificity of 80%. IHDS had fair agreement with neuropsychological tests (k 0.355) and moderate-to-strong agreement between different evaluators (interclass correlation coefficient (ICC) 0.684). HAND is prevalent nowadays. IHDS is quick and easy to administer, but has marginal sensitivity for the detection of HIV cognitive impairment other than dementia.
Abstract Many HIV infected patients are at risk for HTLV-I co-infection worldwide. These patients exhibit abnormally high CD4 + T lymphocyte counts that are not a reliable parameter of the immune ...status. We report a HIV/HTLV co-infected patient who developed progressive multifocal leukoencephalopathy despite of a high CD4 + T lymphocyte count emphasizing that this situation can be observed in regions around the world where HTLV-I infection is prevalent.
Sporotrichosis is a fungal disease usually restricted to the cutaneous and lymphatic systems. Visceral involvement is unusual. To date, only 21 cases of sporotrichosis meningitis have been reported, ...some of these associated with immunosuppression. According to the reported cases, difficulty establishing the correct diagnosis is almost the rule which, undoubtedly, is associated with a worse prognosis. In this report, two HIV infected patients are described who developed meningitis due to Sporothrix schenckii associated with immune reconstitution inflammatory syndrome. This is the first report of sporotrichosis meningitis associated with immune reconstitution inflammatory syndrome in AIDS patients.
Microspheres of polymethyl-methacrylate (PMMA) are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Some reports of side effects of this procedure are ...basically in respect to dermal reaction, with late-onset granulomatous lesion with giant cells and vacuoles. We report blindness and total ophthalmoplegia after PMMA injection into glabellar area in a healthy woman and review the literature.
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