Fig 12 - uploaded by Hemant Parmar
Content may be subject to copyright.
Ventriculitis. Axial contrast-enhanced T1-weighted MR imaging in a neonate with intraventricular hemorrhage and secondary infection reveals thickening and enhancement of the ventricular lining, suggesting acute ventriculitis (arrows). Some debris is noted within the ventricles with ventriculomegaly. Small subdural empyema was also seen over the left temporal convexity (arrowheads).
Source publication
Infection of the central nervous system (CNS) in children is an important entity and early recognition is paramount to avoid long-term brain injury, especially in very young patients. The causal factors are different in children compared with adults and so are the clinical presentations. However, imaging features of CNS infection show similar featu...
Citations
... 1,2 Multiple causes can lead to the development of this condition, including congenital infections and genetic/epigenetic changes. 3,4 In Brazil, Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript. ...
The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.
... Late congenital syphilis presents after 2 years of age, characterized by chronic inflammatory changes with persistent infection, featured by facial deformities, hearing loss, ocular, cutaneous and skeletal abnormalities, 65 as well as mental retardation, and hemiplegia. 68 Signs of congenital neurosyphilis may appear in the early stage of the disease, due to meningovascular and perivascular space mononuclear cellular infiltration. Clinical features may include neurodevelopmental milestones regression, hydrocephalus, cranial nerve palsies, optic nerve atrophy, and seizure. ...
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.
... The TORCH "other" group of infections includes a miscellany of agents that can be vertically transmitted, such as Treponema pallidum, human immunodeficiency virus [HIV], parvovirus, Listeria monocytogenes, and varicella-zoster virus. These pathogens are related to a huge and non-specific spectrum of congenital neuronal injuries including meningitis, hydrocephalus, inflammatory vasculitis, sensorineural hearing loss from syphilis infection [67], meningitis and ventriculitis in Listeria infection [68], calcifications, brain atrophy and vasculitis in HIV infection [69], parenchymal calcifications, arterial infarction, cerebellar hemorrhage, and cortical malformations in parvovirus infection [70]. Recent literature underlined the importance of widening the spectrum of the "traditional TORCH" to include a variety of other congenital infectious etiologies, and proposed additional important direct diagnostic investigations, such as radiology, ophthalmology, audiology, microbiology, and PCR testing, to the serology-specific investigations included in the "TORCH screen" [71]. ...
Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.
... Görüntüleme bulguları; hidrosefali, dağınık subkortikal kalsifikasyonlar ve hidrosefalidir. CMV' den farklı olarak, toksoplazma enfeksiyonunda kortikal gelişimsel malformasyonlar nadirdir ve kalsifikasyonlar daha periferde lokalizedir (1,7). ...
... Furthermore, in bacterial meningitis, the bacteria usually reach the meninges by any of the following mechanisms: (1) hematogenous spread from systemic infection foci, (2) spread from nearby infected mastoid, middle ear, or paranasal sinuses, (3) through the choroid plexus, (4) the superficial parenchymal abscess flowing into the subarachnoid space, and (5) penetrating trauma on the skull (17). If the infection pathway cannot be determined, the diagnosis of "acute bacterial meningitis" should be suspected. ...
In China, a 9-year-old boy was transferred to the hospital with fever, vomiting, and headache. The disease rapidly deteriorated into vague consciousness. Applying conventional clinical examinations such as blood and cerebrospinal fluid (CSF) tests, the diagnosis of bacterial meningoencephalitis was first drawn, and expectant treatments were adopted immediately. However, the symptoms did not alleviate, adversely, this boy died 3 days after admission. Considering the skeptical points of the duration, such as the unknown infectious bacteria and the pathogen invasion path, blood and CSF samples were then sent for metagenomic next-generation sequencing (mNGS) to ascertain the cause of death. The 42,899 and 1,337 specific sequences of N. fowleri were detected by mNGS in the CSF sample and the blood sample, respectively. PCR results and pathological smear subsequently confirmed the mNGS detection. The patient was finally diagnosed as primary amoebic meningoencephalitis. Besides, in this article, 15 similar child infection cases in the past 10 years are summarized and analyzed to promote the early diagnosis of this rare disease.
... The parasite enters the fetus through the placental barrier after primary maternal infection. The risk of fetal transmission increases as gestational age increases but the severity of the disease decreases [12,13]. ...
Toxoplasma gondii infection, when acquired as an acute infection during pregnancy, can have substantial adverse effects on fetuses. We present the case of a 19-year-old pregnant woman with no previous relevant medical history. The ultrasound in the third trimester showed brain and abdominal abnormalities such as congenital hydrocephalus, volume loss of the brain parenchyma, and hepatosplenomegaly. The laboratory test showed positive IgM for Toxoplasma gondii. MRI was performed for better assessment and it shows the lesions in the central nervous system and other organs with more details.
... These findings may also be found in congenital infections known by the mnemonic TORCH (Toxoplasmosis, Rubella, Cytomegalovirus (CMV) and Herpes. However, the distribution of intracranial calcifications differs in each congenital infection: typically larger, denser and subcortical in congenital ZIKV, punctate and periventricular or cortical in CMV, diffuse and widely distributed in congenital toxoplasmosis and at basal ganglia in rubella [41, [109][110][111]. Besides that it should be noted that some neurological changes (calcifications and cerebral atrophy) in congenital Zika syndrome are similar to other syndromes of infectious and also genetic etiology, such as Aicardi-Goutières syndrome [112]. ...
Background
The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome.
Methods and findings
A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age.
Conclusions
Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.
... We recommend that neuroimaging be considered in patients with prolonged symptoms of sinusitis who have not improved with antibiotic therapy. MRI scans are more sensitive and specific than CT scans in the detection of intracranial infection [25][26][27], and MRI would be preferred as long as the patient is clinically stable and performing the MRI does not delay a needed surgical intervention. If neuroimaging identifies a lesion that is concerning for intracranial infection, antibiotic therapy should be initiated promptly and surgical drainage should be considered. ...
... Some have advocated for early transition to oral therapy in suppurative central nervous system infections, though it has not been rigorously studied in a prospective trial [28]. We have Report of altered mental status, n (%) 4 (33) 11 (26) .63 ...
Background:
Suppurative intracranial complications of sinusitis are rare events in children and can lead to harmful neurologic sequelae and significant morbidity. We sought to review the presentation and management of patients admitted at our hospital with these conditions.
Methods:
This was a retrospective study of pediatric patients admitted to a quaternary children's hospital from 2007 to 2019 for operative management of sinusitis with intracranial extension. Clinical characteristics, including surgical and microbiological data, were collected and analyzed.
Results:
Fifty-four patients were included; the median age was 11.0 years, and there was a male predominance. Eighty-nine percent of patients had prior healthcare visits for the current episode of sinusitis; 46% of patients had an abnormal neurologic exam on admission. Epidural abscess and subdural empyema were the most common complications, and subdural empyema was associated with repeat surgical intervention. The dominant pathogens were Streptococcus anginosus group organisms (74%). The majority of patients completed treatment parenterally, with a median duration of therapy of 35 days. Neurological sequelae, including epilepsy or ongoing focal deficits, occurred in 22% of patients. History of seizure or an abnormal neurological exam at admission were associated with neurological sequelae.
Conclusions:
Clinicians should consider intracranial complications of sinusitis in patients with symptoms of sinusitis for >1 week. Patients should undergo urgent neuroimaging, as neurosurgical intervention is essential for these patients. Subdural empyema was associated with repeat neurosurgical intervention. Neurological sequelae occurred in 22% of patients, and new onset seizure or an abnormal neurological exam at admission were associated with neurological sequelae.
... 17,18 Infarctions are also known to be a complication of acute meningitis in pediatric patients, and several retrospective studies have found that in the setting of acute meningitis, the rate of infarction is approximately 5%-10% in the pediatric population. [19][20][21]30 While the mechanism by which bacterial meningitis leads to vasospasm and stroke is incompletely understood, it is thought that an interaction between cerebral blood vessels and inflammatory mediators may play a role. 22,29 Supporting this hypothesis is the finding that elevated levels of the proinflammatory cytokines interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNFα) in the CSF and blood of patients with bacterial meningitis are correlated with high cerebral blood flow velocities in basal cerebral arter- ies. ...
Arachnoid cysts are relatively common and benign intraarachnoid membrane outpouchings containing CSF-like fluid. The majority of arachnoid cysts remain stable and asymptomatic and do not require intervention in the pediatric population. Here, the authors present the first reported case of an infected arachnoid cyst in a pediatric patient resulting in severe vasospasm of the left terminal internal carotid artery, left A 1 segment, and left M 1 branches with a left middle cerebral artery infarct. Their experience suggests that close monitoring is warranted for this condition and that the pediatric population may be at higher risk for vasospasm.
... Many parallels can be drawn between clinical signs of congenital ZIKV with those associated with congenital cytomegalovirus and congenital toxoplasmosis [3]. We previously showed that clinical signs in congenital toxoplasmosis are associated with epigenetically regulated genes involved in severe inherited forms of ocular disease [4]. ...
The recent increase in babies born with brain and eye malformations in Brazil is associated with Zika virus (ZIKV) infection in utero. ZIKV alters host DNA methylation in vitro. Using genome-wide DNA methylation profiling we compared 18 babies born with congenital ZIKV microcephaly with 20 controls. We find ZIKV-associated alteration of host methylation patterns, notably at RABGAP1L that is important in brain development, at viral host immunity genes MX1 and ISG15, and in an epigenetic module containing the causal microcephaly gene MCPH1. Our data support the hypothesis that clinical signs of congenital ZIKV are associated with changes in DNA methylation.
