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CNS Infection

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1. Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity. (Abstract)

Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity. Central nervous system (CNS) relapse following R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) occurs in 2-5% of patents with diffuse large B-cell lymphoma (DLBCL). Many patients aged ≥70 years are unsuitable for high-dose methotrexate (HDMTX (...) -CHOP-treated DLBCL patients, with the highest risk in those with CNS-IPI 6 and R/A involvement. We observed no clear benefit for stand-alone intrathecal prophylaxis but observed an independent increased risk of infection-related admission during R-CHOP when intrathecal prophylaxis was administered.© 2019 British Society for Haematology and John Wiley & Sons Ltd.

2019 British journal of haematology

2. Novel Central Nervous System (CNS)-Targeting Protease Inhibitors for Drug-Resistant HIV Infection and HIV-Associated CNS Complications. Full Text available with Trip Pro

Novel Central Nervous System (CNS)-Targeting Protease Inhibitors for Drug-Resistant HIV Infection and HIV-Associated CNS Complications. Presently, no specific therapeutics for the HIV-1-related central nervous system (CNS) complications exists. Here we report that three newly-designed CNS-targeting HIV-1 protease inhibitors (PIs), GRL-083-13, -084-13, and -087-13, which contain P1-3,5-bis-fluorophenyl- or P1-para-monofluorophenyl-ring, and P2-bis-tetrahydrofuran (bis-THF) or P2-tetrahydropyrano (...) AIDS patients, who no longer responded to existing antiviral regimens after long-term therapy. Long-term drug-selection experiments revealed that the emergence of resistant-HIV-1 against these CNS-targeting PIs was substantially delayed. In addition, the CNS-targeting PIs showed the most favorable CNS-penetration properties among the tested compounds including various FDA-approved anti-HIV-1 drugs, as assessed with the in vitro blood-brain barrier reconstruction system. Crystallographic analysis

2019 Antimicrobial Agents and Chemotherapy

3. Central nervous system infections produced by varicella zoster virus. (Abstract)

Central nervous system infections produced by varicella zoster virus. Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment.The most common CNS manifestation of VZV infection is vasculopathy that presents as headache, cognitive decline, and/or focal neurological deficits (...) to intravenous acyclovir with corticosteroids.VZV produces a wide spectrum of CNS disorders that may be missed as some cases do not have an associated rash or a CSF pleocytosis. Clinicians must be vigilant in including VZV in their differential diagnosis of CNS infections as VZV is a ubiquitous pathogen; importantly, VZV CNS infections are treatable with intravenous acyclovir therapy and corticosteroids.

2020 Current Opinion in Infectious Diseases

4. Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection. Full Text available with Trip Pro

Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection. Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment (...) , antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria

2018 PLoS ONE

5. Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. Full Text available with Trip Pro

Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. Central nervous system (CNS) viral infections are important causes of morbidity and mortality worldwide but the systematic survey of patients admitted to hospitals with CNS infections in many countries, including Indonesia, is limited. To obtain more information regarding the causes of CNS infections in Indonesia, this study was performed to detect and identify viral agents associated with CNS (...) infections amongst in-patients at a referral hospital in Manado, North Sulawesi, Indonesia. Adult patients admitted to R.D. Kandou General Hospital with presumed CNS infection were enrolled. Cerebrospinal fluid, serum, and throat swab samples were collected and tested using molecular, serological, and virus isolation assays. A confirmed viral etiology was established in three and a probable/possible in 11 out of 74 patients. The most common was herpes simplex virus 1 (7/74, 9.5%), followed by Epstein

2018 PLoS ONE

6. ACR–ASNR–SPR Practice Parameter for the Performance and Interpretation of Magnetic Resonance (MR) Spectroscopy of the Central Nervous System

ACR–ASNR–SPR Practice Parameter for the Performance and Interpretation of Magnetic Resonance (MR) Spectroscopy of the Central Nervous System PRACTICE PARAMETER MR Spectroscopy / 1 The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve (...) training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2013 (Resolution 7)* ACR–ASNR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF MAGNETIC RESONANCE SPECTROSCOPY OF THE CENTRAL NERVOUS SYSTEM PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care

2019 American Society of Neuroradiology

7. Systematic literature review to summarise current evidence for the application of mass-spectrometry to identify biomarkers for central nervous system (CNS)infections

Systematic literature review to summarise current evidence for the application of mass-spectrometry to identify biomarkers for central nervous system (CNS)infections Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g

2018 PROSPERO

8. Blood and cerebrospinal fluid characteristics in neonates with a suspected central nervous system infection. Full Text available with Trip Pro

Blood and cerebrospinal fluid characteristics in neonates with a suspected central nervous system infection. Clinical signs and symptoms of central nervous system (CNS) infections in neonates are often nonspecific. Therefore, cerebrospinal fluid (CSF) analysis is performed to diagnose CNS infections. Data on combined microbiological results and their correlation with biochemical characteristics in CSF and blood in infants younger than 90 days are limited. This study provides an overview (...) of microbiological test results, CSF- and hematological characteristics among infants with a clinically suspected CNS infection.This retrospective study included infants younger than 90 days, with a clinically suspected CNS infection who underwent a diagnostic lumbar puncture between January 2012 and January 2014. Data on the presence of microbiological pathogens in CSF, CSF inflammation markers (white blood cell [WBC] counts, protein levels and glucose CSF/serum ratio) and blood inflammatory responses (WBC

2019 Medicine

9. Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics. (Abstract)

Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics. Fungal infections of the central nervous system (CNS) are relatively uncommon but associated with significant morbidity and mortality. We reviewed recent literature highlighting new approaches to management of these complex patients.Fungal infections are increasingly recognized as important causes of CNS disease in both immunocompromised and immunocompetent hosts. Globally, cryptococcal (...) meningitis remains a leading cause of death in HIV-infected persons in resource-limited settings. Emerging fungal pathogens with increased virulence and resistance to numerous classes of antifungal agents have been identified and represent a management challenge. Newer diagnostic techniques focused on antigen detection or molecular amplification of fungal pathogens offer promise in the expediated diagnosis and treatment of CNS fungal infections.Meningitis and brain abscess because of invasive fungal

2019 Current Opinion in Infectious Diseases

10. Advances in molecular diagnostic testing for central nervous system infections. (Abstract)

Advances in molecular diagnostic testing for central nervous system infections. Central nervous system (CNS) infections present an ongoing diagnostic challenge for clinicians, with an aetiological agent remaining unidentified in the majority of cases even in high-income settings. This review summarizes developments in a range of diagnostic methods published in the past 18 months.Several commercial assays exist for the detection of viral, bacterial and fungal pathogens using single multiplex PCR (...) . Multicentre validation of the Biofire FilmArray panel illustrated high sensitivity for bacterial and fungal pathogens, but poor results for Cryptococcus species detection. The development of microarray cards for bacterial CNS pathogens shows promise but requires further validation. Few developments have been made in proteomics and transcriptomics, contrasted with significant increase in the use of metagenomic (or unbiased) sequencing. Novel viruses causing CNS infection have been described using

2019 Current Opinion in Infectious Diseases

11. Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches. Full Text available with Trip Pro

Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches. The etiology of infections of the central nervous system (CNS) in Nepal often remains unrecognized because of underdeveloped laboratory facilities. The aim of this study was to investigate the etiology of CNS infections in a rural area of Nepal using molecular methods. From November 2014 to February 2016, cerebrospinal fluid (CSF) was collected from 176 consecutive patients presenting at United (...) Mission Hospital in Tansen, Nepal, with symptoms of possible CNS infection. After the CSF samples were stored and transported frozen, polymerase chain reaction (PCR) was performed in Sweden, targeting a total of 26 pathogens using the FilmArray® ME panel (BioFire, bioMerieux, Salt Lake City, UT), the MeningoFinder® 2SMART (PathoFinder, Maastricht, The Netherlands), and an in-house PCR test for dengue virus (DENV), Japanese encephalitis virus (JEV), and Nipah virus (NiV). The etiology could

2019 American Journal of Tropical Medicine & Hygiene

12. Association between Use of Methadone, Other Central Nervous System Depressants, and QTc Interval-Prolonging Medications and Risk of Mortality in a Large Cohort of Women Living with or at Risk for Human Immunodeficiency Virus Infection. (Abstract)

Association between Use of Methadone, Other Central Nervous System Depressants, and QTc Interval-Prolonging Medications and Risk of Mortality in a Large Cohort of Women Living with or at Risk for Human Immunodeficiency Virus Infection. To evaluate the association between use of methadone, other central nervous system (CNS) depressants, and QTc interval-prolonging medications and risk of mortality among human immunodeficiency virus (HIV)-infected and at-risk HIV-uninfected women.Multicenter (...) to estimate hazard ratios (HRs) for all-cause mortality in HIV-infected and -uninfected women and non-acquired immunodeficiency syndrome (AIDS) deaths in HIV-infected women. A total of 1046 deaths were identified, of which 429 were considered non-AIDS deaths. Use of benzodiazepines, CNS depressants (excluding methadone), and number of medications with conditional QTc interval-prolonging effects were each associated with all-cause mortality in multivariate models of HIV-infected women: hazard ratio (HR

2019 Pharmacotherapy

13. Outcomes measures in children after acute central nervous system infections and malaria. (Abstract)

Outcomes measures in children after acute central nervous system infections and malaria. Acute central nervous system (CNS) infections in children result in significant mortality and neurologic morbidity worldwide. This article summarizes the recent pediatric literature published on outcomes measures used after acute infectious meningitis, encephalitis, and cerebral malaria, and highlights ongoing research efforts to standardize outcomes measurements. Search terms were geared toward functional (...) , cognitive, behavioral, and other outcome assessments.Recent data suggest that, depending on microbiological cause, there are differences in currently used outcome measures following acute CNS infections. Outcomes assessments include a variety of formal psychological tests (structured interviews and neuropsychological tests of cognitive and motor functioning) and dichotomized or ordinal scales. Standardization of outcome measures, however, is lacking. Global efforts to standardize outcomes that encompass

2019 Current opinion in pediatrics

14. Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection. Full Text available with Trip Pro

Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection. Performing cranial imaging prior to lumbar punctures (LPs) in patients with suspected central nervous system (CNS) infections has been associated with delayed treatments and poor outcomes. Various guidelines provide different criteria for cranial imaging prior to LP.We describe the use of cranial imaging in a cohort of adult patients with suspected CNS infections, and evaluated adherence (...) to the recommendations made in the Infectious Disease Society of America (IDSA), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Swedish, and Dutch guidelines. We also analyzed the association between cranial imaging and the time between emergency department entrance and intravenous antibiotic administration.From 2012-2015, 203 patients with suspected CNS infections were included, of whom 56 (27%) were diagnosed with CNS infections and 16 were diagnosed with bacterial meningitis (8

2019 Clinical Infectious Diseases

15. Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011. Full Text available with Trip Pro

Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011. During 2003-2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3 (...) %], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic

2019 Emerging Infectious Diseases

16. Human Immune System Mice for the Study of Human Immunodeficiency Virus-Type 1 Infection of the Central Nervous System Full Text available with Trip Pro

to recapitulate critical aspects of human immune responses to HIV-1 infection, and such studies have informed our knowledge of HIV-1 persistence and latency in the context of combination antiretroviral therapy. The central nervous system (CNS) is a unique, immunologically privileged compartment susceptible to HIV-1 infection, replication, and immune-mediated damage. The unique, neural, and glia-rich cellular composition of this compartment, as well as the important role of infiltrating cells of the myeloid (...) Human Immune System Mice for the Study of Human Immunodeficiency Virus-Type 1 Infection of the Central Nervous System Immunodeficient mice transplanted with human cell populations or tissues, also known as human immune system (HIS) mice, have emerged as an important and versatile tool for the in vivo study of human immunodeficiency virus-type 1 (HIV-1) pathogenesis, treatment, and persistence in various biological compartments. Recent work in HIS mice has demonstrated their ability

2018 Frontiers in immunology

17. Diagnosis and management of primary central nervous system diffuse large B?cell lymphoma Full Text available with Trip Pro

Irrelevant No new ocular disease Persistent PD 25% increase in lesion Irrelevant Recurrent or new ocular disease Recurrent or new disease Any new site of disease: CNS or systemic From Abrey et al . ( ). Reprinted with permission. ©2005 American Society of Clinical Oncology. All rights reserved. CNS, central nervous system; CR, complete response; CRu, unconfirmed complete response; CSF, cerebrospinal fluid; PR, partial response; PD, progressive disease; RPE, retinal pigment epithelium; SD, stable disease (...) Diagnosis and management of primary central nervous system diffuse large B?cell lymphoma Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma - Fox - 2019 - British Journal of Haematology - Wiley Online Library Search within Search term Search term The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Guideline Free Access Guidelines for the diagnosis and management of primary central nervous system

2018 British Committee for Standards in Haematology

18. Occam’s razor need not apply: Advanced HIV infection presenting with five simultaneous opportunistic infections and central nervous system lymphoma Full Text available with Trip Pro

Occam’s razor need not apply: Advanced HIV infection presenting with five simultaneous opportunistic infections and central nervous system lymphoma Patients with Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) are at risk for multiple infectious and oncologic complications. In such cases, Occam's razor need not apply: multiple infections and malignancies are often present concurrently upon presentation to care. A patient off anti-retroviral therapy (...) (ART) for several years developed advanced HIV infection (CD4 count 19 cells/uL) and presented with five simultaneous opportunistic infections including Pneumocystis jiroveci pneumonia (PJP), cytomegalovirus (CMV) retinitis, Mycobacterium avium complex (MAC) bloodstream infection, chronic hepatitis B virus (HBV), and Epstein-Barr virus (EBV) viremia. Simultaneously, he was found to have primary central nervous system (CNS) B-cell lymphoma. Treatment decisions for such patients are often complex

2018 IDCases

19. Central Nervous System Inflammation and Infection during Early, Nonaccelerated Simian-Human Immunodeficiency Virus Infection in Rhesus Macaques Full Text available with Trip Pro

Central Nervous System Inflammation and Infection during Early, Nonaccelerated Simian-Human Immunodeficiency Virus Infection in Rhesus Macaques Studies utilizing highly pathogenic simian immunodeficiency virus (SIV) and simian-human immunodeficiency virus (SHIV) have largely focused on the immunopathology of the central nervous system (CNS) during end-stage neurological AIDS and SIV encephalitis. However, this may not model pathophysiology in earlier stages of infection. In this nonaccelerated (...) common. Furthermore, new interventions, such as monoclonal antibodies and therapeutic vaccinations, target HIV envelope. We therefore describe a new model of central nervous system involvement in rhesus macaques infected with SHIV expressing HIV envelope in earlier, less aggressive stages of disease. Here, we demonstrate that SHIV mimics the early clinical course in humans and that early neurologic inflammation is characterized by predominantly T cell-mediated inflammation accompanied by SHIV

2018 Journal of virology

20. Correction: Occurrence of Leishmania infantum in the central nervous system of naturally infected dogs: Parasite load, viability, co-infections and histological alterations. Full Text available with Trip Pro

Correction: Occurrence of Leishmania infantum in the central nervous system of naturally infected dogs: Parasite load, viability, co-infections and histological alterations. [This corrects the article DOI: 10.1371/journal.pone.0175588.].

2017 PLoS ONE

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