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CNS Infection

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17041. Neuropathy of Leprosy (Follow-up)

and brainstem auditory evoked potentials have been reported in LL disease, suggesting central nervous system (CNS) involvement. [ ] Neurophysiological studies of ulnar nerves in patients with type 1 and type 2 reactions indicate axonal and demyelinating processes across the elbow. In type 2 reactions, changes of demyelination (ie, conduction block) is a primary event, occurring as an acute phenomenon, while in type 1 reactions, temporal dispersion, a subacute phenomenon, is seen. [ ] Previous Next: Nerve (...) and on the hands and fingers (see the images below). Absorption of fingers and toes may be noted. Plantar trophic ulcers in a patient with leprous neuropathy. Advanced lepromatous leprosy with amputation of toes and trophic ulceration. Abnormalities of autonomic nervous system Autonomic nerve involvement is manifest clinically as varying degrees of impaired sweating and possible anhidrosis. [ ] In general, visceral autonomic nerves are not involved, though conflicting experiences with cardiac dysautonomia have

2014 eMedicine.com

17042. Neuroimaging in Neurocysticercosis (Follow-up)

-Escutia, E. Host-parasite immune relationship in Taenia solium taeniosis and cysticercosis. Garcia HH, Martinez, SM eds. Taenia solium Taeniasis/Cysticercosis . 1999. 15-24. Davis L. Neurocysticercosis and seizures: Avoiding the cost of antihelminthic treatment. Neurology . 2002. 59:1669-71. Dixon HBF, Lipscomb FM. Cysticercosis: an analysis and follow up of 450 cases. Med Res Council Special Reports . 1961. 299:1-58. Escobar A. The pathology of neurocysticercosis. Cysticercosis of Central Nervous (...) activities should include the following: Advise on farm hygiene and on the importance of meat inspection Development of special educational programs for farmers and workers in the meat industry Ecological and environmental measures include the following: Improvement of sanitation throughout the country, particularly elimination of open-air defecation by farm workers and peasants Improvement of sewage systems Improvement of methods of animal husbandry Previous References Nash TE, Garcia HH. Diagnosis

2014 eMedicine.com

17043. Neurologic Complications of Organ Transplantation (Follow-up)

Engl J Med . 1998 Jun 11. 338(24):1741-51. . Fishman JA. Infections in immunocompromised hosts and organ transplant recipients: essentials. Liver Transpl . 2011 Nov. 17 Suppl 3:S34-7. . Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transpl Infect Dis . 2000 Sep. 2(3):101-11. . Potluri K, Holt D, Hou S. Neurologic complications in renal transplantation. Handb Clin Neurol . 2014. 121:1245-55. . Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Al-Dadah AS, Meyers BF (...) and peripheral nervous system immune mediated demyelinating disease after allogeneic hemopoietic stem cell transplantation for hematologic disease. J Neurooncol . 2012 Nov. 110(2):251-6. . Amato AA, Barohn RJ, Sahenk Z, Tutschka PJ, Mendell JR. Polyneuropathy complicating bone marrow and solid organ transplantation. Neurology . 1993 Aug. 43(8):1513-8. . Martín-Dávila P, Fortún J, López-Vélez R, Norman F, Montes de Oca M, Zamarrón P, et al. Transmission of tropical and geographically restricted infections

2014 eMedicine.com

17044. Multisystem Organ Failure of Sepsis (Follow-up)

sensory neuropathy Combined motor and sensory deficit aPTT = activated partial thromboplastin time; ARDS = acute respiratory distress syndrome; CNS = central nervous system; DIC = disseminated intravascular coagulation; F I O 2 = fraction of inspired oxygen; PEEP = positive end-expiratory pressure; PT = prothrombin time. Contributor Information and Disclosures Author Ali H Al-Khafaji, MD, MPH Professor of Critical Care Medicine, Director, Transplant Intensive Care Unit, Department of Critical Care (...) elevated to 2 × normal Jaundice with bilirubin 8-10 mg/dL Renal Oliguria (< 500 mL/day) or increasing creatinine (2-3 mg/dL) Dialysis Gastrointestinal Intolerance of gastric feeding for more than 5 days Stress ulceration with need for transfusion, acalculous cholecystitis Hematologic aPTT >125% of normal, platelets < 50-80,000 DIC Cardiovascular Decreased ejection fraction with persistent capillary leak Hyperdynamic state not responsive to pressors CNS Confusion Coma Peripheral nervous system Mild

2014 eMedicine.com

17045. Multiple Sclerosis (Follow-up)

) and/or how their eyes move together (efferent visual pathway disorders). Optic neuritis is an inflammatory injury of the optic nerve that causes vision loss, which is common in MS. Some individuals with MS also experience homonymous visual field defects caused by lesions in retrochiasmal or retrogeniculate regions of the afferent visual pathway. Efferent visual pathway lesions in the central nervous system (CNS) may create a perception of oscillopsia, a visual disturbance in which objects appear (...) , or leukocytosis Serum vitamin B-12 and folate levels (eg, bilateral central scotoma) Lyme titers (eg, endemic area, tick exposure, rash of erythema chronica migrans) Tuberculin skin testing, chest radiography, or QuantiFERON-TB testing (eg, tuberculosis [TB] exposure, endemic area) Fluorescent treponemal antibody (FTA) testing (eg, syphilis serology) or nontreponemal testing (eg, Venereal Disease Research Laboratories [VDRL] testing or rapid plasma reagin [RPR] testing) Antinuclear antibody (eg, systemic

2014 eMedicine.com

17046. Multiple Sclerosis (Follow-up)

, adhesion, invasion, and morphogenesis. The mechanism of action of fingolimod is incompletely understood but appears to be fundamentally different from other MS medications. Fingolimod-phosphate blocks the capacity of lymphocytes to egress from lymph nodes, reducing the number of lymphocytes in peripheral blood. Fingolimod promotes sequestration of lymphocytes within the lymph nodes, which may reduce lymphocyte migration into the central nervous system. [ ] Fingolimod can be associated with macular (...) secondary to autonomic GI dysfunction Lability of the autonomic nervous system may precipitate hypotension during anesthesia and surgery Spontaneous ventilation may be disrupted Previous Next: Treatment of Acute Relapses Methylprednisolone (Solu-Medrol) can hasten recovery from an acute exacerbation of MS. There is no clear evidence that it changes the overall disease progression. Plasma exchange (plasmapheresis) can be used short term for severe attacks if steroids are contraindicated or ineffective

2014 eMedicine.com

17047. Multiple Sclerosis (Follow-up)

, adhesion, invasion, and morphogenesis. The mechanism of action of fingolimod is incompletely understood but appears to be fundamentally different from other MS medications. Fingolimod-phosphate blocks the capacity of lymphocytes to egress from lymph nodes, reducing the number of lymphocytes in peripheral blood. Fingolimod promotes sequestration of lymphocytes within the lymph nodes, which may reduce lymphocyte migration into the central nervous system. [ ] Fingolimod can be associated with macular (...) secondary to autonomic GI dysfunction Lability of the autonomic nervous system may precipitate hypotension during anesthesia and surgery Spontaneous ventilation may be disrupted Previous Next: Treatment of Acute Relapses Methylprednisolone (Solu-Medrol) can hasten recovery from an acute exacerbation of MS. There is no clear evidence that it changes the overall disease progression. Plasma exchange (plasmapheresis) can be used short term for severe attacks if steroids are contraindicated or ineffective

2014 eMedicine.com

17048. Mucous Cyst (Follow-up)

more common in the patients younger than 30 years than in older patients. [ ] with liquid nitrogen spray or cryoprobe is an alternative therapeutic modality. [ , ] After day 4 to week 1, a necrotic surface is observed in the treated area. The latter separates from the surrounding mucosa in 1-2 weeks, exposing a new epithelialized surface. The advantages of the procedure include a simple application, minor discomfort during the procedure, and a low incidence of complications (eg, secondary infection (...) laser vaporization (940 nm in contact mode) was used successfully in one reported patient with an extravasation-type mucocele of the lower lip. [ ] Microwave ablation has been used with good results in a small number of patients. [ ] Previous Next: Consultations Possible consultations may include the following: Dermatologist Dermatologic surgeon Oral medicine specialist Oral surgeon Previous Next: Complications Secondary infection and local bleeding are rare complications. Traumatic neuroma may

2014 eMedicine.com

17049. Mucormycosis (Follow-up)

Kontoyiannis DP, Lewis RE. Agents of mucormycosis and Entomophthoramycosis. Mandell GL, Bennett GE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, Pa: Churchill Livingstone; 2010. 3257-69. Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis . 2012 Feb. 54 Suppl 1:S8-S15. . Mohindra S, Mohindra S, Gupta R, Bakshi J (...) . 2012 Dec 6. 367(23):2214-25. . Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev Anti Infect Ther . 2012 Jan. 10(1):95-104. . Roilides E, Kontoyiannis DP, Walsh TJ. Host defenses against zygomycetes. Clin Infect Dis . 2012 Feb. 54 Suppl 1:S61-6. . Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis

2014 eMedicine.com

17050. Mucormycosis (Follow-up)

Kontoyiannis DP, Lewis RE. Agents of mucormycosis and Entomophthoramycosis. Mandell GL, Bennett GE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, Pa: Churchill Livingstone; 2010. 3257-69. Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis . 2012 Feb. 54 Suppl 1:S8-S15. . Mohindra S, Mohindra S, Gupta R, Bakshi J (...) . 2012 Dec 6. 367(23):2214-25. . Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev Anti Infect Ther . 2012 Jan. 10(1):95-104. . Roilides E, Kontoyiannis DP, Walsh TJ. Host defenses against zygomycetes. Clin Infect Dis . 2012 Feb. 54 Suppl 1:S61-6. . Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis

2014 eMedicine.com

17051. Mycobacterium Kansasii (Follow-up)

in a similar manner to those with pulmonary disease. Treatment for CNS disease is similar to the pulmonary infection and includes rifampin or rifabutin, with ethambutol, and either isoniazid or clarithromycin. CNS infection due to M kansasii has been reported to have high rates of morbidity despite treatment. [ ] Next: Surgical Care Surgical treatment is unnecessary in M kansasii infection, as it responds very well to antimycobacterial therapy. Previous Next: Consultations See the list below: Infectious (...) of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: , , , , , Florida Infectious Diseases Society Disclosure: Nothing to disclose. Additional Contributors Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research

2014 eMedicine.com

17052. Mycobacterium Haemophilum (Follow-up)

haemophilum: a rare cause of endophthalmitis. Retina . 2007 Oct. 27(8):1148-51. . Keller M, Mak A, Thibert L, Rene P, Klein MB. Mycobacterium haemophilum epididymal abscess in a renal transplant patient. J Clin Microbiol . 2008 Jul. 46(7):2459-60. . . Buppajarntham A, Apisarnthanarak A, Rutjanawech S, Khawcharoenporn T. Central nervous system infection due to Mycobacterium haemophilum in a patient with acquired immunodeficiency syndrome. Int J STD AIDS . 2015 Mar. 26 (4):288-90. . Merkler AE, Parlitsis G (...) Ctries . 2015 Mar 15. 9 (3):313-6. . Gao W, Chen H, Wang H, Jiang H, Liu W, Hao D, et al. Bilateral Sporotrichoid Cutaneous Infection by Mycobacterium haemophilum in a Chinese Patient with Systemic Lupus Erythematosus. Acta Derm Venereol . 2015 Jun 24. 95 (6):760-1. . Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Prins JM. First case of an oculofacial lesion due to Mycobacterium haemophilum infection in an immunocompetent child. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2006 Jun

2014 eMedicine.com

17053. Lymphoma, B-Cell (Follow-up)

not responded to or who have relapsed after at least two other kinds of treatment. Approved uses include DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel is not indicated for the treatment of primary central nervous system lymphoma. [ ] In May 2018, a second CAR T-cell therapy, tisagenlecleucel (Kymriah), was approved for adults with relapsed or refractory DLBCL who are ineligible for or relapsed after autologous (...) of choice in early stage indolent lymphoma and has a role in consolidation of treatment in localized aggressive lymphoma. A surgical consultation is indicated when central venous access devices are employed, especially when stem cell or bone marrow transplantation is considered. Previous Next: Transfer Patients with lymphoma who are being managed at peripheral health care facilities may require their care to be transferred to a tertiary care or research institute for access to clinical trials

2014 eMedicine.com

17054. Lymphoma, Malignant Anaplastic (Ki 1+) (Follow-up)

progressive. These patients demonstrate an increased frequency of bone marrow involvement (30%) and extranodal involvement, including skin (21%), bone (17%), soft tissues (17%), lung (11%), liver (8%), rarely, gastrointestinal tract and central nervous system. [ ] Extranodal involvement is more common in anaplastic lymphoma kinase (ALK)–positive ALCL than in ALK-negative ALCL. ALK-negative ALCL has a predilection for the skin, liver, lung, and GI tract. Breast ALCL is also ALK-negative. Breast ALK (...) . Cutaneous presentation of ALK-positive anaplastic large cell lymphoma following insect bites: evidence for an association in five cases. Haematologica . 2010 Mar. 95(3):449-55. . . Madray MM, Greene JF Jr, Butler DF. Glatiramer acetate-associated, CD30+, primary, cutaneous, anaplastic large-cell lymphoma. Arch Neurol . 2008 Oct. 65(10):1378-9. . Williams D, Mori T, Reiter A, et al. Central nervous system involvement in anaplastic large cell lymphoma in childhood: Results from a multicentre European

2014 eMedicine.com

17055. Lymphoma, Mantle Cell (Follow-up)

, in 40% of patients Generalized lymphadenopathy Abdominal distention from hepatosplenomegaly Fatigue from anemia or bulky disease Less common symptoms caused by extranodal involvement of gastrointtestinal (GI) tract, lungs, and central nervous system (CNS) Physical examination Physical examination findings include the following: Generalized lymphadenopathy in 90% of patients Splenomegaly in 60% (may be massive) Hepatomegaly in 30% Poor performance status in 20% Less commonly, palpable masses in skin (...) , and the age range at presentation is 35-85 years, with a median of 68 years. Findings on the history include the following: Stage IV disease in 70% of patients B symptoms, which include fever, night sweats, and weight loss, in 40% of patients Generalized lymphadenopathy Abdominal distention from hepatosplenomegaly Fatigue from anemia or bulky disease Less common symptoms caused by extranodal involvement of GI tract, lungs, and CNS Physical examination findings include the following: Generalized

2014 eMedicine.com

17056. Lymphoma, Non-Hodgkin (Follow-up)

2017, FDA approved axicabtagene ciloleucel (Yescarta) for treatment of large B-cell lymphoma after at least two other kinds of therapy have failed. Approved uses include diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel is not indicated for the treatment of patients with primary central nervous system lymphoma. [ ] Approval was based on the results from the ZUMA-1 study (...) oral feedings. Previous Next: Activity Restriction The following restrictions apply to patients who are neutropenic, thrombocytopenic, or both: Avoid exposure to or contact with other patients with communicable or infectious diseases Use a soft toothbrush during episodes of neutropenia and thrombocytopenia Do not shave with a razor Ideally, patients with neutropenia should be admitted directly to a private room and should not stay long in the emergency department for evaluation. All medical

2014 eMedicine.com

17057. Lymphocytic Choriomeningitis (Follow-up)

. Meningitis. Schlossberg D, ed. Central Nervous System Infections . New York, NY: Springer-Verlag; 1990. Farmer TW, Janeway CA. Infection with the virus of lymphocytic choriomeningitis. Medicine (Baltimore) . 1942. 2:11. McKee KT Jr. Hemorrhagic fever virus. Infectious Diseases . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998. 2249-65. Seregin A, Yun Nadezhda, Paessler S. Lymphocytic Choriomeningitis, Lassa Fever, and the South American Hemorrhagic Fevers (Arenaviruses). Bennett JE, Dolin R, Blaser MJ (...) . Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015. 2031-2037. Wilson MR, Peters CJ. Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses. Handb Clin Neurol . 2014. 123:671-81. . Souders HT, Byler D, Marupudi N, Patel R, McSherry G. Protracted symptoms in lymphocytic choriomeningitis: a case report. J Child Neurol . 2015 Apr. 30 (5):644-7. . Oldstone MB. Lessons learned

2014 eMedicine.com

17058. Lymphoma, Diffuse Mixed (Follow-up)

kinds of therapy have failed. Approved uses include diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel is not indicated for the treatment of patients with primary central nervous system lymphoma. [ ] Approval was based on the results from the ZUMA-1 study, an open-label, multicenter trial enrolling of 111 patients from 22 institutions. Patients in ZUMA-1 received the target (...) was a predictor factor for CNS relapse. [ ] Recommendations for intrathecal chemotherapy Routine intrathecal chemotherapy is strongly recommended in patients with DLBCL with the following characteristics: Two or more extranodal sites of disease Testicular or breast involvement, regardless stage Lymphoblastic variants Oropharyngeal or paraspinal sites of involvement Bone marrow involvement Concomitant infection with the human immunodeficiency virus (HIV) Previous Next: CAR T-cell Therapy Chimeric antigen

2014 eMedicine.com

17059. Lymphoma, Diffuse Large Cell (Follow-up)

kinds of therapy have failed. Approved uses include diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel is not indicated for the treatment of patients with primary central nervous system lymphoma. [ ] Approval was based on the results from the ZUMA-1 study, an open-label, multicenter trial enrolling of 111 patients from 22 institutions. Patients in ZUMA-1 received the target (...) was a predictor factor for CNS relapse. [ ] Recommendations for intrathecal chemotherapy Routine intrathecal chemotherapy is strongly recommended in patients with DLBCL with the following characteristics: Two or more extranodal sites of disease Testicular or breast involvement, regardless stage Lymphoblastic variants Oropharyngeal or paraspinal sites of involvement Bone marrow involvement Concomitant infection with the human immunodeficiency virus (HIV) Previous Next: CAR T-cell Therapy Chimeric antigen

2014 eMedicine.com

17060. Lyme Disease (Follow-up)

the inflammatory arthritis in the involved joint. Neurologic manifestations of Lyme disease in both adults and children respond well to penicillin, ceftriaxone, cefotaxime, and doxycycline. Although most studies of neuroborreliosis have used intravenous antibiotics, European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, or radiculitis, with intravenous regimens reserved for patients with parenchymal central nervous system (CNS) involvement, other severe neurologic (...) . This allergic/inflammatory response may manifest in the skin, mucous membranes, viscera, or nervous system. In endemic areas, antibiotic prophylaxis may be appropriate for selected patients with a recognized tick bite (see Prevention). Prophylactic antibiotics are not routinely recommended, however, as tick bites rarely result in Lyme disease, and if infection does develop, early antibiotic treatment has excellent efficacy. Several groups have published Lyme disease guidelines. The Infectious Diseases

2014 eMedicine.com

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