CMV-associated encephalitis and antineuronal autoantibodies - a case report

<p>Abstract</p> <p>Background</p> <p>Human cytomegalovirus (CMV) is an ubiquitous pathogen capable of modulating the host immune system. Immune dysfunction is common during CMV infection and includes autoimmune phenomena. Here we focus on a case of primary CMV infection associated with encephalopathy in a patient with a rudimentary spleen. We discuss diagnostic challenges and immunological aspects as well as the hypothesis that CMV may break tolerance and induce potentially encephalitogenic autoantibodies.</p> <p>Case presentation</p> <p>A 33-year-old woman was admitted with features of encephalitis, rapidly progressing into a catatonic state. The patient tested negative for presence of herpes simplex virus DNA in cerebrospinal fluid (CSF), and had elevated liver enzymes and hepatomegaly at computed tomography scan (CT) examination. CT scan and magnetic resonance imaging (MRI) showed only a rudimentary spleen. Initially, serum was negative for anti-CMV IgM, but borderline for anti-CMV IgG by enzyme-linked immunosorbent assay. However, a more sensitive assay resulted in a positive specific IgM Western blot profile and low IgG avidity, suggesting primary CMV infection. Further, CMV DNA was retrospectively detected in a CSF sample collected at admission. We also detected antineuronal autoantibodies, which stained GAD-positive neurons in the hippocampus. The patient was treated by a combination of prednisone, intravenous immunoglobulins (IVIg) and antivirals, which resulted in a dramatic amelioration of the patient’s neurological status. One year after admission the patient exhibited a nearly complete recovery with mild deficits in attention and memory.</p> <p>Conclusions</p> <p>A possible reason for the critical course of CMV infection could be the lack of a functional spleen in this patient, a condition previously associated with severe CMV infection. Prompt treatment with antiviral drugs, steroids and IVIg was most likely important for the positive outcome in this case and should be considered for similar cases of severe primary CMV infection associated with immunopathological phenomena.</p

Gerência de serviços de saúde: competências desenvolvidas e dificuldades encontradas na atenção básica Management of health services: developed competencies and difficulties found in basic attention

Este estudo tem como objetivo conhecer o perfil e verificar as competências, atribuições e habilidades gerenciais, no nível de estrutura da atenção básica; identificar as dificuldades e facilidades em relação às suas atribuições e em relação à gestão de pessoas. A pesquisa é um estudo de caso. O instrumento de coleta utilizado foi um questionário semi-estruturado e uma escala de Likert, aplicada às gerências das unidades básicas de saúde de Caxias do Sul (RS), no mês de novembro de 2006. Constatou-se que todas as gerentes possuem habilidades gerenciais, que abrangem a comunicação, a organização de tarefas, o planejamento de ações e a negociação. Entretanto, algumas descreveram como dificuldade para a realização de suas atribuições não ter formação específica em gerenciamento. Os problemas com maior evidência se relacionaram ao excesso de burocracia, à sobrecarga de atividades, à pequena área física, às dificuldades em manipular e trabalhar com equipamentos e à gestão de pessoas. Nota-se que há grande necessidade de informatizar a rede pública e de capacitar os profissionais para trabalhar com programas, a fim de efetivar o novo modelo assistencial e de reconhecer situações de vulnerabilidade social e em saúde.<br>The objective of this article is to know the profile and check the competencies, management attributions and abilities in the level of structure of Basic Attention; to identify the difficulties and easiness in relation to their attributions and management of people. The research is a subject of study. A semi-structured and a scale of Likert were used as the guide of research that was applied to the management of the basic units of health of Caxias do Sul, Rio Grande do Sul State, in November of 2006. It was evidenced that all managers have management skills that include communication, organization of tasks, planning of actions and negotiation. However, some described that the difficulty for the accomplishment of their attributions would be not having specific graduation in management. The problems in higher evidence were related to the bureaucracy excess, the overload of activities, the small physical area, the difficulties in manipulating and working with equipment as well as managing people. It has been noticed that there is a great need of computerizing the public system and enable professionals to work in programs, in order to accomplish the new assistance model and to recognize situations of social vulnerability and in health

BMC Infect Dis

Background Cytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. In 2016, the French High Council of Public Health was mandated to update recommendations regarding prevention of cytomegalovirus infection in pregnant women. We summarize a critical appraisal of knowledge and deterministic decision analysis comparing the current no-screening situation to serological screening during pregnancy, and to hygiene promotion. Methods Screening was defined as systematic serological testing, during the first trimester, with repeated tests as needed, to all pregnant women. Outcomes were: 1) severe sequela: intellectual deficiency with IQ ≤ 50 or hearing impairment < 70 dB or sight impairment (≤ 3/10 at best eye); 2) moderate sequela: any level of intellectual, hearing or sight deficiency; and 3) death or termination of pregnancy. We simulated the one-year course of cytomegalovirus infection in a cohort of 800,000 pregnant women. We developed a deterministic decision model, using best and min-max estimates, extracted from systematic reviews or original studies. Results Relevant data were scarce or imprecise. We estimated that 4352 maternal primary infections would result in 1741 foetal infections, and an unknown number of maternal reinfections would result in 1699 foetal infections. There would be 788 cytomegalovirus-related consequences, including 316 foetal deaths or terminations of pregnancy, and 424 moderate and 48 severe sequelae. Screening would result in a 1.66-fold increase of poor outcomes, mostly related to a 2.93-fold increase in deaths and terminations of pregnancy, not compensated by the decrease in severe symptomatic newborns. The promotion of hygiene would result in a 0.75-fold decrease of poor outcomes, related to both a decrease in severe sequelae among symptomatic newborns (RR = 0.75; min-max: 1.00–0.68), and in deaths and terminations of pregnancy (RR = 0.75; min-max: 0.97–0.68). Conclusions Prevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended

Imaging of congenital central nervous system infections.

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Congenital central nervous system (CNS) infections are a cause of significant morbidity and mortality. The recent Zika virus outbreak raised awareness of congenital CNS infections. Imaging can be effective in diagnosing the presence and severity of infection. In this paper we review the clinical presentations and imaging characteristics of several common and less common congenital CNS infections