The Nipah virus is an important emerging infectious disease that is still included in the list of disease to be surveillance by WHO. The neurological involvement in Nipah virus infection is an important clinical manifestation. This pathogenic virus of this disease was firstly detected and reported by professor Bing from Malaysia, a Southeast Asian country. Here, the authors would like to discuss the present situation of Nipah virus infection in Thailand, a Southeast Asian country next to Malaysia. At present, Nipah virus infection is still under the closed surveillance from Thailand public health ministry.
According to a recent report on pathogen causing neurological infection, the Nipah virus is still not observed as a cause of neurological infection in Thai patients with neuro infections. Nevertheless, there are some reports on the survey of prevalence of Nipah virus in several animals, especially for bats, in Thailand. According to the survey in bats, the prevalence of Nipah virus contamination was seen in 6.29% of bats collected from several regions in Thailand. Of interest, although bat is proved to be the carrier of several pathogenic virus such rabies, the bat has never been the problem of zoonosis in Thailand.
Sand-fly fever viruses (SFVs) are arthropod transmitted viruses that belong to the Phlebovirus genus of the Bunyaviridae family. SFVs, maintained and transmitted by various Phlebotomines, are divided into two serogroups, the Sand-fly Sicilian viruses (SFSV) and the Sandfly Naples viruses (SFNV). Most of the SFVs cause acute influenza-like illness (“Pappataci fever”, “3 days fever”). Some SFVs, most notably the Toscana virus (TOSV), belonging to the SFNV serogroup, are also associated with neuro-invasive illness, including aseptic meningitis and meningoencephalitis.
In a 1999 report, a 2-year-old boy developed acute truncal ataxia and horizontal nystagmus that prevented him from walking or maintaining a sitting position. These symptoms were followed four days later by erythema infectiosum. B19 infection was confirmed by genomic DNA and anti-B19 antibodies (IgM and IgG) in serum. The ataxia and nystagmus dissipated within one week, and there were no neurological sequelae in this case. A vascular reaction to the B19 infection in the cerebellum was hypothesized to contribute to the ataxia.
Two more cases of ataxia were reported by Barah, et al.. Ages were 27 months (female) and 13 years (male). B19 DNA was positive in the CSF. Both children died and were found to have cerebellar pathology at autopsy.
Meningitis is a frequent neurological cause of morbidity and mortality worldwide including Indian subcontinent. Among the various etiologies, pyogenic type is the most predominant. Despite clinical diagnosis, imaging is often required to rule out coexisting focal lesions; detection and extent of other complications or when clinical diagnosis is in doubt . In majority of cases, plain or non-contrast computed tomography (NCCT) or contrast-enhanced computed tomography (CECT) brain is the initial and only imaging studies required with latter involving intravenous contrast injection allowing detection of areas with breach in blood brain barrier.
However, in difficult cases magnetic resonance imaging (MRI) brain or contrastenhanced MRI (CEMRI) is preferred as a problem solving tool with latter involving intravenous contrast injection and delineates area of breach in blood brain barrier. This article describes unusual form of pyogenic meningitis associated with septic vasculitis and infarcts where NCCT brain mimicked leukodystrophy and contrast-enhanced MRI (CEMRI) revealed signs of unusual meningitis. In usual form, there may be leptomeningeal enhancement or basilar exudate enhancement but in unusual form which is more severe, meningitis leads to septic vasculitis leading to necrosis of vessel wall and luminal thrombus formation and subsequent infarction.
Infections to the Central Nervous System (CNS) are notable for their diversity; Infections that affect the CNS can be catastrophic and potentially lethal. They range from common to rare, acute to chronic, benign to fatal. Although some are self-limited or are easily cured with modern treatment, others are relentlessly progressive despite treatment, or have no known treatment. Central nervous system infections (CNS) limited to the meninges or with brain parenchyma involvement are common causes of hospital admissions. Infection of the central nervous system (CNS) can be viral, bacterial, fungal, or parasitic in origin. Infectious microorganisms most often enter the CNS by direct penetration after trauma or by travelling in the bloodstream. People who are immune compromised from conditions such as AIDS, cancer, steroid use, diabetes or alcoholism may be at risk for opportunistic infections which would not ordinarily affect persons with normal immune defenses. Sodium disorders are associated with considerable morbidity and mortality. Hyponatremia is a common electrolyte disturbance and is a common finding in patients with acute cerebral insult.
Hyponatremia in CNS infection could be due to two mechanisms, first one is Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) and other one is Cerebral Salt wasting syndrome (CSW). SIADH is a volume-expanded state because of antidiuretic hormone-mediated renal water retention. CSW is characterized by a contracted effective arterial blood volume (EABV) resulting from renal salt wasting. Making an accurate diagnosis is important because the treatment of each condition is quite different.
Antiviral agents confer significant prophylactic and therapeutic benefits during seasonal Influenza outbreaks and unexpected Influenza pandemics. The development and occurrence of antiviral drug resistance in human Influenza viruses has been extensively studied over the last decade. Initial analysis of Influenza A (H1N1) pdm 09 revealed that the virus was resistant to the Adamantanes class of drugs that inhibit the M2 ion channel.
We know that families, schools, peer groups, and communities are dramatically impacted when young people engage in suicidal behavior. Youth suicide might be prevented by earlier recognition and treatment of mental illness. Family physicians can and should screen for mental illness in youth; there are many diagnostic and treatment resources available to assist with this. Earlier detection and treatment of mental illness are the most important ways family physicians can reduce morbidity and mortality for youth who are contemplating suicide.