Neurologic Complications of Influenza B Virus Infection in Adults, Romania.
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ABSTRACT:
SUBMITTER: Popescu CP
PROVIDER: S-EPMC5367398 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceThere are no prospective cohort studies assessing the incidence and spectrum of neurologic manifestations secondary to Zika virus (ZIKV) infection in adults.ObjectiveTo evaluate the rates of acute ZIKV infection among patients hospitalized with Guillain-Barré syndrome (GBS), meningoencephalitis, or transverse myelitis.Design, setting, and participantsA prospective, observational cohort study was conducted at a tertiary referral center for neurological diseases in Rio de Janeiro, Brazil, between December 5, 2015, and May 10, 2016, among consecutive hospitalized adults (>18 years of age) with new-onset acute parainfectious or neuroinflammatory disease. All participants were tested for a series of arbovirosis. Three-month functional outcome was assessed.InterventionsSamples of serum and cerebrospinal fluid were tested for ZIKV using real-time reverse-transcriptase-polymerase chain reaction and an IgM antibody-capture enzyme-linked immunosorbent assay. Clinical, radiographic (magnetic resonance imaging), electrophysiological, and 3-month functional outcome data were collected.Main outcomes and measuresThe detection of neurologic complications secondary to ZIKV infection.ResultsForty patients (15 women and 25 men; median age, 44 years [range, 22-72 years]) were enrolled, including 29 patients (73%) with GBS (90% Brighton level 1 certainty), 7 (18%) with encephalitis, 3 (8%) with transverse myelitis, and 1 (3%) with newly diagnosed chronic inflammatory demyelinating polyneuropathy. Of these, 35 patients (88%) had molecular and/or serologic evidence of recent ZIKV infection in the serum and/or cerebrospinal fluid. Of the patients positive for ZIKV infection, 27 had GBS (18 demyelinating, 8 axonal, and 1 Miller Fisher syndrome), 5 had encephalitis (3 with concomitant acute neuromuscular disease), 2 had transverse myelitis, and 1 had chronic inflammatory demyelinating polyneuropathy. Admission to the intensive care unit was required for 9 patients positive for ZIKV infection (26%), and 5 (14%) required mechanical ventilation. Compared with admission during the period from December 5, 2013, to May 10, 2014 (before the Brazilian outbreak of ZIKV), admissions for GBS increased from a mean of 1.0 per month to 5.6 per month, admissions for encephalitis increased from 0.4 per month to 1.4 per month, and admissions for transverse myelitis remained constant at 0.6 per month. At 3 months, 2 patients positive for ZIKV infection (6%) died (1 with GBS and 1 with encephalitis), 18 (51%) had chronic pain, and the median modified Rankin score among survivors was 2 (range, 0-5).Conclusions and relevanceIn this single-center Brazilian cohort, ZIKV infection was associated with an increase in the incidence of a diverse spectrum of serious neurologic syndromes. The data also suggest that serologic and molecular testing using blood and cerebrospinal fluid samples can serve as a less expensive, alternative diagnostic strategy in developing countries, where plaque reduction neutralization testing is impractical.
| S-EPMC5710239 | biostudies-literature
Project description:OBJECTIVE: We sought to determine the range and extent of neurologic complications due to pandemic influenza A (H1N1) 2009 infection (pH1N1'09) in children hospitalized with influenza. METHODS: Active hospital-based surveillance in 6 Australian tertiary pediatric referral centers between June 1 and September 30, 2009, for children aged <15 years with laboratory-confirmed pH1N1'09. RESULTS: A total of 506 children with pH1N1'09 were hospitalized, of whom 49 (9.7%) had neurologic complications; median age 4.8 years (range 0.5-12.6 years) compared with 3.7 years (0.01-14.9 years) in those without complications. Approximately one-half (55.1%) of the children with neurologic complications had preexisting medical conditions, and 42.8% had preexisting neurologic conditions. On presentation, only 36.7% had the triad of cough, fever, and coryza/runny nose, whereas 38.7% had only 1 or no respiratory symptoms. Seizure was the most common neurologic complication (7.5%). Others included encephalitis/encephalopathy (1.4%), confusion/disorientation (1.0%), loss of consciousness (1.0%), and paralysis/Guillain-Barré syndrome (0.4%). A total of 30.6% needed intensive care unit (ICU) admission, 24.5% required mechanical ventilation, and 2 (4.1%) died. The mean length of stay in hospital was 6.5 days (median 3 days) and mean ICU stay was 4.4 days (median 1.5 days). CONCLUSIONS: Neurologic complications are relatively common among children admitted with influenza, and can be life-threatening. The lack of specific treatment for influenza-related neurologic complications underlines the importance of early diagnosis, use of antivirals, and universal influenza vaccination in children. Clinicians should consider influenza in children with neurologic symptoms even with a paucity of respiratory symptoms.
| S-EPMC4098823 | biostudies-other
Project description:People with diabetes mellitus are susceptible to both cardiovascular disease and severe influenza A virus infection. We hypothesized that diabetes also increases risks of influenza-associated cardiac complications. A murine type 1 (streptozotocin-induced) diabetes model was employed to investigate influenza-induced cardiac distress. Lung histopathology and viral titres revealed no difference in respiratory severity between infected control and diabetic mice. However, compared with infected control mice, infected diabetic mice had increased serum cardiac troponin I and creatine-kinase MB, left ventricular structural changes and right ventricular functional alterations, providing the first experimental evidence of type I diabetes increasing risks of influenza-induced cardiovascular complications.
| S-EPMC8476859 | biostudies-literature
Project description:Purpose of reviewThis article reviews the current understanding of sepsis, a critical and often fatal illness that results from infection and multiorgan failure and impacts the brain, peripheral nervous system, and muscle.Recent findingsEncephalopathy occurs early in association with sepsis, and its severity correlates with mortality. Neuroimaging in patients with CNS manifestations is typically normal. EEG is nonspecific. EMG is commonly diagnostic, showing a combination of nerve and muscle injury already early in the clinical course. Rapid recognition and correction of reversible causes of encephalopathy and avoidance of risk factors for intensive care unit-acquired weakness may limit sequelae. Major deficiencies in our understanding of the complications of sepsis remain. Studies to improve the recognition and rehabilitation of these patients are imperative in a clinical syndrome affecting countless patients each year.SummaryThe risk of later cognitive and physical disability may be increased after sepsis; therefore, attention to neurologic complications is urgent.
| S-EPMC10563989 | biostudies-literature
Project description:Diagnosis of influenza A infection is currently based on clinical symptoms and pathogen detection. Use of host peripheral blood gene expression data to classify individuals with influenza A virus infection represents a novel approach to infection diagnosis We used microarrays to assay peripheral blood gene expression at baseline and every 8 hours for 7 days following intranasal influenza A H1N1 or H3N2 inoculation in healthy volunteers. We determined groups of coexpressed genes that classified symptomatic influenza infection. We then tested this gene expression classifier in patients with naturally acquired respiratory illness.
2013-11-16 | GSE52428 | GEO
Project description:Diagnosis of influenza A infection is currently based on clinical symptoms and pathogen detection. Use of host peripheral blood gene expression data to classify individuals with influenza A virus infection represents a novel approach to infection diagnosis We used microarrays to assay peripheral blood gene expression at baseline and every 8 hours for 7 days following intranasal influenza A H1N1 or H3N2 inoculation in healthy volunteers. We determined groups of coexpressed genes that classified symptomatic influenza infection. We then tested this gene expression classifier in patients with naturally acquired respiratory illness. We experimentally inoculated healthy volunteers with intranasal influenza A H1N1 and H3N2. Symptoms were documented and peripheral blood samples drawn into PAXgene RNA tubes for RNA isolation. We further enrolled patients presenting to the Emergency Department with naturally acquired respiratory illness, and documented symptoms and collected PAXgene RNA samples for RNA isolation.
2013-11-16 | E-GEOD-52428 | biostudies-arrayexpress
Project description:Emergence of Toscana virus in Romania: meningoencephalitis case series in 2017-18
| PRJEB35101 | ENA
Project description: Not available
| S-EPMC5544116 | biostudies-literature
Project description:BACKGROUND AND PURPOSE:The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients. METHODS:All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables. RESULTS:In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications. CONCLUSIONS:Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.
| S-EPMC4596114 | biostudies-literature
Project description:Neurologic complications of HIV infection are unfortunately common, even in the era of effective antiretroviral treatment (ART). The consulting neurologist is often asked to distinguish among neurologic deterioration due to opportunistic infection (OI), immune reconstitution, or the effect of the virus itself, and to comment on the role of immunomodulatory agents in patients with HIV infection. Additionally, as successful virologic control has extended the life span of patients with HIV infection, neurologists are called upon to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy.Despite the use of ART, significant numbers of patients continue to be affected by HIV-associated neurocognitive disorders, although with milder forms compared to the pre-ART era. Regimens of ART have been ranked according to CNS penetration and are being studied with regard to neuropsychological outcomes. Nucleoside analogs with the greatest potential for peripheral neurotoxicity are no longer considered first-line agents for HIV treatment. Efavirenz, a non-nucleoside reverse transcriptase inhibitor, has the greatest frequency of neurologic side effects among newer ART regimens. The spectrum of clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) continues to grow, including IRIS without underlying OI. A greater understanding of pathophysiology and risk factors has shown that while HIV should be treated early to prevent severe immunocompromise, delayed initiation of ART may be helpful while treating OIs.This article reviews the neurologic complications of HIV infection, or its treatment, most commonly encountered by neurologists.
| S-EPMC3760534 | biostudies-other