Wirusy Herpesviridae a stwardnienie rozsiane — powiązania etiopatogenetyczno-terapeutyczne

Stwardnienie rozsiane (SM, sclerosis multiplex) jest częstą chorobą ośrodkowego układu nerwowego (OUN), powodującą trwałą niesprawność młodych ludzi. Zwraca się uwagę na możliwość wpływu czynników zakaźnych, na przykład wirusów na zapoczątkowanie reakcji autoimmunologicznej prowadzącej do rozwoju SM. Wirusy z rodziny Herpesviridae po pierwotnej infekcji pozostają w organizmie w formie latentnej i uaktywniają się w sprzyjających immunologicznie warunkach. Niektóre z nich wykazują w grupie chorych na SM wyższą niż w populacji ogólnej seroprewalencję, świadczącą o kontakcie z wirusem. Nie ma ewidentnych dowodów na to, że wirusy te są czynnikiem rozpoczynającym reakcję autoimmunologiczną, czy że ich obecność świadczy jedynie o dysregulacji immunologicznej towarzyszącej chorobie. Choroba wiąże się z zaburzeniem równowagi immunologicznej, na którą dodatkowo wpływają leki stosowane w jej postaci rzutowo-remisyjnej. Istnieją doniesienia na temat ciężkiego klinicznie przebiegu zakażenia wirusami z rodziny Herpesviridae u pacjentów leczonych niektórymi lekami immunomodulacyjnymi

Impact of SARS-CoV-2 on the nervous system

Introduction. The ongoing COVID-19 pandemic is the largest global public health struggle. The spread of the novel coronavirus had resulted in almost 7 million deaths worldwide by January 2023. State of the art. The most common symptoms during the acute phase of COVID-19 are respiratory. However, many individuals present various neurological deficits at different stages of the infection. Furthermore, there are post-infectious complications that can be present within weeks after the initial symptoms. Both the central and peripheral nervous systems (CNS and PNS, respectively) can be affected. Many potential mechanisms and hypotheses regarding the neuropathology behind COVID-19 have been proposed. Clinical implications. The distribution of neurological symptoms during COVID-19 infection among studies differs greatly, which is mostly due to differing inclusion criteria. One of the most significant is incidence involving CNS circulation. In this review, we present basic information regarding the novel coronavirus, the possible routes along which the pathogen can reach the nervous system, neuropathology mechanisms, and neurological symptoms following COVID-19. Future directions. It seems that many factors, resulting both from the properties of the virus and from systemic responses to infection, play a role in developing neurological symptoms. The long-term effect of the virus on the nervous system is still unknown

Przypadki chorób nowotworowych rozpoznanych w czasie diagnostyki różnicowej w Klinice Chorób Zakaźnych i Neuroinfekcji Uniwersytetu Medycznego w Białymstoku

Wstęp. W przebiegu chorób zakaźnych i chorób nowotworowych często występują podobne, nieswoiste dolegliwości.Gorączka, powiększenie węzłów chłonnych, spadek masy ciała i anemizacja często wyprzedzają kliniczne ujawnieniesię choroby nowotworowej i wymagają jak najszybszej diagnostyki.Materiały i metody. Przeprowadzono analizę retrospektywną 36 historii chorób pacjentów hospitalizowanychw Klinice Chorób Zakaźnych i Neuroinfekcji Uniwersytetu Medycznego w Białymstoku w latach 2000–2010, u którychw czasie diagnostyki różnicowej chorób zakaźnych rozpoznano proces rozrostowy.Wyniki. Wśród chorych z rozpoznaniem ostatecznym lub podejrzeniem choroby nowotworowej przeważali mężczyźni— 25 (69,4%). Wiek pacjentów w czasie hospitalizacji mieścił się w przedziale 18–90 lat, średnia wieku 52 lata. Wśródwstępnych objawów klinicznych dominowały: znaczne osłabienie — 20 (55,6%), bóle kostno-stawowe i mięśniowe— 15 (41,7%), powiększenie węzłów chłonnych — 14 (38,9%) i gorączka — 12 (33,3%). Pacjentów przyjęto do Klinikim.in. z rozpoznaniem wstępnym zmian pasożytniczych w OUN — 4 (11,1%), boreliozy — 11 (30,6%), zapaleniemwęzłów chłonnych — 8 (22,2%) i gorączką o nieustalonej etiologii (FUO) — 7 (19,4%) do diagnostyki. Najczęściejrozpoznawanymi chorobami rozrostowymi były: chłoniaki — 11 (30,6%), białaczki — 5 (13,9%) i nowotwory ośrodkowegoukładu nerwowego — 5 (13,9%).Wnioski. Wśród chorych kierowanych do oddziałów chorób zakaźnych z podejrzeniem chorób zakaźnych istotnyodsetek stanowią chorzy, u których prezentowane objawy przysłaniają chorobę nowotworową. Objawy takie jak limfadenopatia,gorączka o nieustalonej etiologii, niedokrwistość, spadek masy ciała czy objawy neurologiczne wymagająpilnej diagnostyki z ukierunkowaniem na chorobę nowotworową już na poziomie podstawowej opieki medycznej

Post-mortem detection of six human herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV, HHV-6) in trigeminal and facial nerve ganglia by PCR

Background Among over 100 types of Herpesviridae viruses, eight can infect humans: herpes simplex viruses (HSV-1, HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesviruses 6, 7, and 8 (HHV-6, HHV-7, HHV-8). After initial infection, the viruses remain latent for the lifetime of the host. The aim of this study was to determine the distribution of six different herpesviruses: HSV-1, HSV-2, VZV, EBV, CMV, and HHV-6 in trigeminal and facial nerve ganglia among a random group of Polish population. Methods The studied group consisted of 47 individuals (40 male, seven female); mean age of 47.4 ± 16.5 years) who died of independent causes (suicide, traffic accident, and poisoning, among others). Bilateral trigeminal and facial nerve ganglia of each cadaver were collected during the autopsy. Herpesviruses were detected using multiplex polymerase chain reaction technique. Results Herpesviruses were found in trigeminal and/or facial ganglia in 30/47 (63.8%) of cadavers. HHV-6 was the most prevalent of the herpesviruses and was found in nearly half of cadavers (n = 22; 46.8%), followed by HSV-1 (n = 7; 14.9%), VZV (n = 4; 8.5%), EBV (n = 4; 8.5%), HSV-2 (n = 2; 4.3%), and CMV (n = 1; 2.1%). Facial nerve ganglia (n = 23; 48.9%) were more often infected than trigeminal ganglia (n = 13; 27.7%). Discussion The results of this study have revealed a common presence of the herpesviruses in trigeminal and facial nerve ganglia among a random group of Polish population. Furthermore, the data also demonstrate simultaneous infection of the ganglia with different herpesviruses. This study has contributed to the knowledge of prevalence and localization of herpesviruses in different structures of the nervous system

Meningitis, clinical presentation of tetanus.

Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease.Peer Reviewe

Meningitis, Clinical Presentation of Tetanus

Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies — the Polish experience

Introduction. The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited.Materials and methods. This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health.Results. There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used.Conclusions and clinical implications. Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs

Baza 2016 fibrynogen.xlsx

fibrinogen in stroke patient

Cerebrovascular Manifestations of Lyme Neuroborreliosis—A Systematic Review of Published Cases

BackgroundLyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA).Materials and methodsWe conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.ResultsThis study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%.ConclusionCerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause