Central Nervous System Infections in the Elderly

Abstract Central nervous system (CNS) infections are a major cause of morbidity and mortality among the elderly. Meningitis and encephalitis are two common presentations of CNS infection, and have distinct clinical presentations that frequently require prompt diagnosis and treatment. In elderly patients with acute bacterial meningitis, empiric antimicrobial therapy with vancomycin, ampicillin, and a third-generation cephalosporin (either cefotaxime or ceftriaxone), along with adjunctive dexamethasone therapy in those with suspected pneumococcal meningitis, is the recommended approach. In those patients with suspected viral encephalitis, improved diagnostics (such as the use of polymerase chain reaction for herpes simplex encephalitis) have enabled the rapid and accurate identification of the causative pathogen. Prompt initiation of empiric acyclovir therapy is another cornerstone of care for elderly patients with presumed herpes simplex encephalitis, in order to prevent the substantial morbidity, mortality, and, in many cases, chronic neurologic sequelae that can be associated with untreated disease.
Source: Current Geriatrics Reports - Category: Geriatrics Source Type: research

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Lancet Reg Health West Pac. 2022 Jan 3;20:100361. doi: 10.1016/j.lanwpc.2021.100361. eCollection 2022 Mar.ABSTRACTBACKGROUND: Acute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China.METHODS: Nation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods.FINDINGS: Between 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 pat...
Source: Herpes - Category: Infectious Diseases Authors: Source Type: research
We describe clinical characteristics, treatment decisions, and outcomes in children with discordant results between MEP and conventional testing.METHODS: We conducted a multisite review of patients ≤ 18 years with suspected central nervous system infection and positive results by MEP or conventional testing (cerebrospinal fluid [CSF] culture, herpes simplex virus [HSV] polymerase chain reaction (PCR), and enterovirus [EV] PCR). Descriptive results are provided for patients with discordant results. Comparison between group 1 (MEP and CSF culture positive) and group 2 (MEP positive, CSF culture negative, or showing a diff...
Source: Herpes - Category: Infectious Diseases Authors: Source Type: research
In conclusion, HHVs were associated with approximately 10% of neuroinfectious diseases in this cohort. VZV was the most common pathogen, probably due to the large number of VZV meningitis patients. In addition, patients with VZV-associated meningitis were significantly younger than patients with VZV-associated encephalitis.PMID:34970721 | DOI:10.1007/s13365-021-01040-5
Source: Herpes - Category: Infectious Diseases Authors: Source Type: research
CONCLUSIONS: In the Bern region, Switzerland, TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequelae, most importantly cognitive impairment, fatigue and headache, were frequently self-reported not only in encephalitis and meningoencephalitis survivors but also in viral meningitis survivors up to 40 months after acute infection.PMID:34872509 | DOI:10.1186/s12883-021-02502-3
Source: Herpes - Category: Infectious Diseases Authors: Source Type: research
This study aimed to assess the clinical manifestations, laboratory findings, and outcomes in patients with human herpes simplex virus 1 (HSV-1), human herpes simplex virus 2 (HSV-2), and varicella-zoster virus (VZV) CNS infections. We identified cases of HSV-1, HSV-2, and VZV CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with HSV-1, HSV-2, and VZV polymerase chain reaction positivity in cerebrospinal fluid (CSF) who visited Pusan National University Hospital between 2010 and 2018. During the 9-year study period, a total of 727 CSF samples were ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
e Henrik Zetterberg Tomas Bergström Herpes simplex virus 1 (HSV-1) and 2 (HSV-2) can infect the central nervous system (CNS) with dire consequences; in children and adults, HSV-1 may cause focal encephalitis, while HSV-2 causes meningitis. In neonates, both viruses can cause severe, disseminated CNS infections with high mortality rates. Here, we differentiated human induced pluripotent stem cells (iPSCs) towards cortical neurons for infection with clinical CNS strains of HSV-1 or HSV-2. Progenies from both viruses were produced at equal quantities in iPSCs, neuroprogenitors and cortical neurons. HSV-1 and HSV-...
Source: Viruses - Category: Virology Authors: Tags: Article Source Type: research
Viruses are a major cause of central nervous system (CNS) infection worldwide. Meningitis and encephalitis commonly present with headache and fever. Encephalitis also causes neurological deficits, reflecting the involvement of the brain parenchyma. Meningitis affects the meninges alone. Enteroviruses are the most common cause of meningitis in the UK, and herpes simplex virus 1 (HSV)-1 is the most common cause of encephalitis. However, the epidemiology of viral meningitis and encephalitis varies widely across the world, with many arboviruses responsible for CNS infection.
Source: Medicine - Category: Internal Medicine Authors: Tags: Nervous system infections Source Type: research
Abstract Herpes simplex virus 1 (HSV-1) is a human DNA virus that causes cold sores, keratitis, meningitis, and encephalitis. Ubiquitination is a post-translational protein modification essential for regulation of cellular events, such as proteasomal degradation, signal transduction, and protein trafficking. The process is also involved in events for establishing viral infection and replication. The first step in ubiquitination involves ubiquitin (Ub) binding with Ub-activating enzyme (E1, also termed UBE1) via a thioester linkage. Our results show that HSV-1 infection alters protein ubiquitination pattern in host...
Source: The Biochemical Journal - Category: Biochemistry Authors: Tags: Biochem J Source Type: research
ujimuro Herpes simplex virus-1 (HSV-1) is the causative agent of cold sores, keratitis, meningitis, and encephalitis. HSV-1-encoded ICP5, the major capsid protein, is essential for capsid assembly during viral replication. Ubiquitination is a post-translational modification that plays a critical role in the regulation of cellular events such as proteasomal degradation, protein trafficking, and the antiviral response and viral events such as the establishment of infection and viral replication. Ub-activating enzyme (E1, also named UBE1) is involved in the first step in the ubiquitination. However, it is still unknown wh...
Source: Viruses - Category: Virology Authors: Tags: Article Source Type: research
We describe that while steroid therapy is beneficial and supported in pathogens such as pneumococcal meningitis and tuberculosis, for other diseases, like Listeria monocytogenes and Cryptococcus neoformans they are associated with worse outcomes. We highlight areas of consistent and proven findings and those which need more evidence for supported beneficial clinical use of adjunctive steroid therapy.
Source: Frontiers in cellular and infection microbiology - Category: Microbiology Source Type: research
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