In this dialogue, gender and women’s studies professors Toby Beauchamp (UIUC) and Ronak K. Kapadia (UIC) reflect on their early encounters with surveillance studies and the field’s shifting ...relationship to transnational feminist and queer of color scholarship. By exploring these alternative genealogies for surveillance scholarship, they also consider new directions in the field that engage the environmental humanities, queer and trans studies, and disability studies.
This review offers a contemporary clinical approach to the diagnosis of viral encephalitis and discusses recent advances in the field. The neurologic effects of coronaviruses, including COVID-19, as ...well as management of encephalitis are not covered in this review.
The diagnostic tools for evaluating patients with viral encephalitis are evolving quickly. Multiplex PCR panels are now in widespread use and allow for rapid pathogen detection and potentially reduce empiric antimicrobial exposure in certain patients, while metagenomic next-generation sequencing holds great promise in diagnosing challenging and rarer causes of viral encephalitis. We also review topical and emerging infections pertinent to neuroinfectious disease practice, including emerging arboviruses, monkeypox virus (mpox), and measles.
Although etiological diagnosis remains challenging in viral encephalitis, recent advances may soon provide the clinician with additional tools. Environmental changes, host factors (such as ubiquitous use of immunosuppression), and societal trends (re-emergence of vaccine preventable diseases) are likely to change the landscape of neurologic infections that are considered and treated in clinical practice.
Immune checkpoint inhibitors (ICIs) represent a major development in cancer treatment, allowing for improved survival and disease control in an expanding number of cancer types. Due to their ...mechanism of disrupting immunologic homeostasis, ICIs are frequently associated with adverse effects, termed immune related adverse effects (irAE). These side effects can affect any organ system, including the central and peripheral nervous systems.
We present a case of a 47 year old man with stage IIIc metastatic melanoma who received 3 cycles of nivolumab (a monoclonal antibody inhibitor of programmed cell death protein 1 (PD-1)). After completing the third cycle, he presented with a meningoencephalitis clinical picture with an inflammatory cerebrospinal fluid (CSF) and normal MRI. He was found to have a positive anti-glial fibrillary acidic protein (GFAP) autoantibody in his CSF by immunofluorescent assay (IFA) and cell based assay (CBA) which confirmed a diagnosis of anti-GFAP autoimmune encephalitis. He was treated with immunotherapy and made a full recovery. In this report, we present the first reported case of anti-GFAP autoimmune encephalitis associated with ICI therapy and provide a brief review of the literature.
Introduction
The development of new autoantigen discovery techniques, like programmable phage immunoprecipitation sequencing (PhIP-Seq), has accelerated the discovery of neural-specific ...autoantibodies. Herein, we report the identification of a novel biomarker for paraneoplastic neurologic syndrome (PNS), Sloan-Kettering-Virus-Family-Transcriptional-Corepressor-2 (SKOR2)-IgG, utilizing PhIP-Seq. We have also performed a thorough clinical validation using normal, healthy, and disease/cancer control samples.
Methods
Stored samples with unclassified staining at the junction of the Purkinje cell and the granule cell layers were analyzed by PhIP-Seq for putative autoantigen identification. The autoantigen was confirmed by recombinant antigen-expressing cell-based assay (CBA), Western blotting, and tissue immunofluorescence assay colocalization.
Results
PhIP-Seq data revealed SKOR2 as the candidate autoantigen. The target antigen was confirmed by a recombinant SKOR-2-expressing, and cell lysate Western blot. Furthermore, IgG from both patient samples colocalized with a commercial SKOR2–specific IgG on cryosections of the mouse brain. Both SKOR2 IgG-positive patients had central nervous system involvement, one presenting with encephalitis and seizures (Patient 1) and the other with cognitive dysfunction, spastic ataxia, dysarthria, dysphagia, and pseudobulbar affect (Patient 2). They had a refractory progressive course and were diagnosed with adenocarcinoma (Patient 1: lung, Patient 2: gallbladder). Sera from adenocarcinoma patients without PNS (n=30) tested for SKOR2-IgG were negative.
Discussion
SKOR2 IgG represents a novel biomarker for PNS associated with adenocarcinoma. Identification of additional SKOR2 IgG-positive cases will help categorize the associated neurological phenotype and the risk of underlying malignancy.
Encephalitis in adults caused by herpes simplex virus Kapadia, Ronak K; Tyler, Kenneth L; Pastula, Daniel M
CMAJ. Canadian Medical Association journal,
2020-Aug-10, 2020-08-10, 20200810, Letnik:
192, Številka:
32
Journal Article
Recenzirano
Odprti dostop
Kapadia et al present facts about encephalitis in adults caused by herpes simplex virus (HSV). The virus is the most commonly identified cause of sporadic acute encephalitis. HSV causes the only ...viral encephalitis with an effective antiviral treatment. The diagnosis should be considered in any patient who presents with an acute altered mental status for more than 24 hours or new seizures, typically with fever. Accompanying headache or focal neurologic signs are common. After starting treatment, investigations for HSV encephalitis and alternative diagnoses can be performed like lumbar puncture, magnetic resonance imaging (MRI) of the brain with gadolinium and an electroencephalogram EEG). Although acyclovir administered intravenously has substantially improved outcomes for HSV encephalitis, 35% of those who survive still have long-term neuropsychiatric disabilities including cognitive and seizure disorders.
Abstract
With increasing use of rituximab and other B-cell depleting monoclonal antibodies for multiple indications, infectious complications are being recognized. We summarize clinical findings of ...patients on rituximab with arboviral diseases identified through literature review or consultation with the Centers for Disease Control and Prevention. We identified 21 patients on recent rituximab therapy who were diagnosed with an arboviral disease caused by West Nile, tick-borne encephalitis, eastern equine encephalitis, Cache Valley, Jamestown Canyon, and Powassan viruses. All reported patients had neuroinvasive disease. The diagnosis of arboviral infection required molecular testing in 20 (95%) patients. Median illness duration was 36 days (range, 12 days to 1 year), and 15/19 (79%) patients died from their illness. Patients on rituximab with arboviral disease can have a severe or prolonged course with an absence of serologic response. Patients should be counseled about mosquito and tick bite prevention when receiving rituximab and other B-cell depleting therapies.
In patients on rituximab, arboviral infections can cause atypical, severe, and prolonged disease with high fatality. Diagnosis usually requires molecular testing. Counseling patients about mosquito and tick bite prevention is important when prescribing rituximab and other B-cell depleting therapies.
This essay examines contemporary South Asian diasporic feminist visual art practices in response to the U.S. military’s global carceral archipelago. I analyze collaborative works by the Index of the ...Disappeared (Brooklyn-based artists Chitra Ganesh and Mariam Ghani) and solo works by Berlin-based American artist Rajkamal Kahlon, focusing on their aesthetic incorporation of declassified documents detailing widespread abuses in military practices of imprisonment, torture, and interrogation. Unlike the state’s quest for abstraction, the artists affix warmth, touch, and sound to otherwise “cold” data, thereby transforming the administrative violence of the security state into an imaginative alternative archive of the disappeared. In so doing, their archives of “warm data” conjure alternate modes of knowing and feeling how empire’s gendered-racialized others resist and reiterate the U.S. forever warfare.
We present the case of a young woman being treated with rituximab for rheumatoid arthritis who developed a severe enteroviral meningoencephalitis and acute flaccid myelitis (AFM). Cerebrospinal fluid ...(CSF) and stool reverse transcription-polymerase chain reaction (RT-PCR) testing confirmed the diagnosis and additional sequencing studies performed at the CDC further characterized the enterovirus as enterovirus A71 (EV-A71). After treatment with intravenous immunoglobulin (IVIg) and fluoxetine (based on previous reports of possible efficacy) the patient experienced a remarkable improvement over time. This case highlights the importance of considering enteroviral infection in patients treated with rituximab, depicts a possible clinical course of enteroviral meningoencephalitis and AFM, and illustrates the importance of testing multiple sites for enterovirus infection (CSF, stool, nasopharyngeal swab, blood). Here we present the case with a brief review of the literature pertaining to EV-A71.
Display omitted
•Enteroviruses have diverse clinical manifestations ranging from mild URIs to meningoencephalitis and AFM.•Enteroviral neurological infections can complicate immunosuppressive that affect humoral immune response.•Enteroviral disease of the CNS in immunosuppressed patients can present acutely or have a chronic, relapsing course.•We report case of enterovirus A71 associated meningoencephalitis and AFM in an adult receiving rituximab for RA.
Usutu virus is an emerging mosquito-borne flavivirus initially identified in South Africa in 1959 that is now circulating throughout parts of Africa, Europe, and the Middle East. It is closely ...related to West Nile virus, and has similar vectors, amplifying bird hosts, and epidemiology. Usutu virus infection can occur in humans and may be asymptomatic or cause systemic (e.g., fever, rash, and hepatitis) or neuroinvasive (e.g., meningitis and encephalitis) disease. Given few reported cases, the full clinical spectrum is not known. No anti-viral treatment is available, but it can be largely prevented by avoiding mosquito bites. Because of similar mosquitoes, birds, and climate to Europe, the potential for introduction to North America is possible.
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