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La Leishmaniose est une anthropozoonose causée par un protozoaire du genreleishmania transmis à l’homme par la piqure du phlébotome femelle infesté.Trois formes cliniques sont décrites selon le tropisme des leishmanies : la leishmanioseviscérale ou Kala-azar (LV), la leishmaniose cutanée (LC) qui peutêtre localisée ou diffuse et la leishmaniose cutanéo-muqueuse (LCM). L’Algérieest située dans une zone endémique (pourtour méditerranéen) où l’incidencemoyenne de la maladie est de 0,54 cas pour 100 000 habitants [1]. La formecutanée est la plus fréquente. Elle est principalement causée par le type Leishmaniamajor. Les manifestations neurologiques sont rares. Nous décrivons le casd’une enfant qui a présenté une encéphalite deux ans après une leishmaniosecutanée frontale. Abstract Leishmaniasis (L) is a cutaneous, mucocutaneous, or visceral disease caused by intracellular Leishmania protozoan parasites that are transmitted by the bite of female sand flies. Algeria is located in an endemic area (mediterranean pond), in which, cutaneous form is the most frequent and caused by Leishmania ma-jor. Neurological manifestations are rare. We describe the case of a child who presented encephalitis two years after frontal cutaneous leishmaniasis.

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Résumé: La question de la réalité des infections humaines par les Bornaviridae (et plus précisément par les Orthobornavirus des mammifères BoDV-1 ou BoDV-2) a longtemps constitué un point de controverse. Des données récentes ont cependant profondément remanié les cartes et permettent désormais d'avoir quelques données solides en la matière. Il n'en reste pas moins que plusieurs aspects restent mal compris. Cette revue vise à faire le point, au vu de nos connaissances à ce jour. The reality of human infections by Bornaviridae (and particularly by mammalian Orthobornaviruses BoDV-1 and BoDV-2) has long been the centre of debate and controversies. New data, however, have profoundly modified the game by providing strong and unambiguous pieces of evidence, even if many points still need to be clarified. This review aims at presenting the current state of the question, based on today's knowledge. [ABSTRACT FROM AUTHOR]

Leishmaniasis (L) is a cutaneous, mucocutaneous, or visceral disease caused by intracellular Leishmania protozoan parasites that are transmitted by the bite of female sand flies. Algeria is located in an endemic area (mediterranean pond), in which, cutaneous form is the most frequent and caused by Leishmania major. Neurological manifestations are rare. We describe the case of a child who presented encephalitis two years after frontal cutaneous leishmaniasis.

Limbic encephalitis (LE) is a rare disease often of paraneoplastic origin. It is frequently associated with bronchopulmonary cancer. Diagnosis is based on brain magnetic resonance imaging (MRI). We here report the case of a 54-year-old female patient with a history of active smoking, presenting with chronic dry cough. Chest X-ray showed suspicious right lung opacity. Bronchial fibroscopy and bronchial biopsies were not contributory. Thoracoabdomino-pelvic computed tomography (CT)-scan and brain CT-scan showed a mass in the right upper lobe classified as T4N2M1a. CT-guided lung biopsy confirmed the diagnosis of bronchopulmonary adenocarcinoma. The patient had reported a recent history of memory disturbances associated with depressed mood, anxiety and paroxysmal confusion. Metabolic screening and tests for detecting infection were normal and brain MRI suggested limbic encephalitis. The evolution was characterized by rapid disease progression; the patient died in about ten days. [ABSTRACT FROM AUTHOR]

West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, progressing into epidemics in many countries. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases, presenting as meningitis, encephalitis, or acute flaccid paralysis, have been reported, even in children. However, few neonatal cases have been described in literature. West Nile Virus neuroinvasive disease can lead to severe neurological disability or death, especially in infant. We report the first tunisian case of West Nile Virus meningoencephalitis in a newborn and its outcome.

Introduction: central nervous system (CNS) infections such as meningitis and encephalitis currently represent a real diagnostic and therapeutic challenge. The objective of this study is to evaluate the contribution of the syndromic approach in the rapid and targeted diagnosis of meningitis and meningoencephalitis at the University Hospital of Marrakech. Methods: this is a prospective study conducted over a period of one year (February 2018 - February 2019), including all patients with lumbar puncture with a cytology greater than 5 elements/mm3 and patients admitted for suspicion of meningoencephalitis. Results: during this period, 176 lumbar punctures were performed that met the criteria to multiplex PCR, 101 cases for suspicion of meningo-encephalitis and 75 cases for suspicion of meningitis. The etiology was confirmed in 23% of the LCS treated for suspicion of meningitis. Bacterial etiology dominated the pattern in 70.5% of cases followed by viral (23.5%) and fungal (6%) etiology. The etiology was confirmed in 14% of the LCS treated for suspicion of meningoencephalitis. Viral etiology dominated the pattern in 81% of cases followed by bacterial (12.5%) and fungal (6%) etiology. Conclusion: their rapid and efficient diagnosis made it possible to set up an appropriate treatment by avoiding the unnecessary prescription of antibiotics

Résumé: Les virus herpes simplex 1 (HSV-1) et 2 (HSV-2) causent des infections du système nerveux central de fréquence et de gravité très différentes. Le HSV-1 est responsable de la quasi-totalité des encéphalites herpétiques (EH), qui représentent environ 5 % à 15 % des encéphalites de l'enfant et de l'adulte. Malgré la disponibilité du diagnostic moléculaire et d'un traitement antiviral spécifique, le pronostic de l'EH reste très mauvais. Outre la mortalité et les séquelles immédiates, des encéphalites auto-immunes peuvent être déclenchées par l'apparition, dans un quart des cas, d'anticorps dirigés contre des composants neuronaux. Des rechutes d'EH avec multiplication virale ont été associées dans quelques cas à des défauts génétiques altérant la réponse immune intrinsèque des cellules neuronales. Les méningites herpétiques sont fréquentes, quasi exclusivement associées au HSV-2 et à l'herpès génital, parfois récidivantes et très majoritairement bénignes, sauf en cas d'immunodépression. Enfin, des cas exceptionnels de myélites par propagation ascendante du HSV-2 dans le SNC ont été rapportés. Cette revue n'inclut pas les infections néonatales. Central nervous system (CNS) infections caused by herpes simplex viruses 1 (HSV-1) and 2 (HSV-2) greatly vary in frequency and severity. HSV-1 causes mostly herpes simplex encephalitis (HSE) which represents 5% to 15% of infectious encephalitis in children and adults. Despite available molecular diagnosis tools and antiviral drugs, the prognosis of HSE remains unacceptably low. In addition to mortality and immediate sequelae, auto-immune encephalitis (AIE) may occur, associated with the development of anti-neuronal antibodies in 1/4 of cases. Replicative relapses have been associated in few cases with genetic defects altering the innate immune response of neuronal cells. Herpetic meningitis is frequent, mostly associated with HSV-2 and genital herpes, sometimes recurrent and, mostly benign, except in immunocompromised individuals. Finally, exceptional cases of myelitis have been reported, due to ascending propagation of HSV-2 in the CNS. This review does not include neonatal infections. [ABSTRACT FROM AUTHOR]

Résumé De nombreux virus peuvent être responsables d’atteintes du système nerveux central (SNC). Il s’agit de virus neurotropes, pouvant traverser la barrière hémato-encéphalique, qui sont directement responsables des lésions touchant le SNC. Le diagnostic dans ce cas repose essentiellement sur la mise en évidence du virus responsable dans le liquide céphalorachidien. Les entérovirus représentent la cause la plus fréquente des méningites virales alors que le virus herpes simplex type 1 (HSV-1) est la cause la plus fréquente des encéphalites virales dans les pays occidentaux. À côté de ces virus neurotropes, un certain nombre d’infections virales peuvent déclencher un processus immunopathologique responsable du développement de lésions inflammatoires démyélinisantes du système nerveux. Il s’agit d’atteintes post-infectieuses, sous forme d’encéphalites, de myélites (myélite transverse) ou de névrites (syndrome de Guillain-Barré). L’agent pathogène en cause reste souvent non identifié dans ces atteintes post-infectieuses. Summary Many viruses can cause central nervous system (CNS) damages. They are neurotropic viruses, which can cross the blood-brain barrier, and which are directly responsible for lesions affecting the CNS. The diagnosis in this case is essentially based on the detection of the virus in a cerebrospinal fluid sample. Enteroviruses are the most common cause of viral meningitis, whereas herpes simplex virus type 1 (HSV-1) is the most common cause of viral encephalitis in Western countries. Besides these neurotropic viruses, a number of viral infections can trigger an immunopathological process involved in the development of inflammatory demyelinating lesions of the nervous system. These post-infectious diseases are represented by encephalitis, myelitis (transverse myelitis) or neuritis (Guillain-Barré syndrome). The pathogen involved in these post-infectious diseases remains often unidentified. [ABSTRACT FROM AUTHOR]

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Résumé Les pathologies auto-immunes sont de plus en plus observées, décrites et reconnues chez les enfants et les adolescents, que ce soit des maladies comme le lupus érythémateux disséminé (LED), les thyroïdites auto-immunes, ou les encéphalites auto-immunes dont les formes sont volontiers plus sévères et plus agressives que celle décrites chez l’adulte. L’aspect psychiatrique de ces tableaux cliniques est souvent au premier plan. En effet, les symptômes psychiatriques sont nombreux, aigus, sévères, ubiquitaires et pour la plupart atypiques. En conséquence, de nombreux patients atteints de pathologies auto-immunes sous-jacentes sont pris en charge en pédopsychiatrie devant l’apparition brutale et bruyante de symptômes psychiatriques. Parmi ces symptômes figure la catatonie de l’enfant et l’adolescent qui prend une place particulière. L’objet de cet article est de présenter des exemples de pathologies auto-immunes pouvant conduire à des tableaux psychiatriques chez l’enfant et l’adolescent, à travers une revue de la littérature. Nous détaillerons également le type de symptômes neuropsychiatriques rencontrés dans ces pathologies auto-immunes, ainsi que le rôle important de la catatonie comme symptôme de « porte d’entrée ». Puis enfin nous aborderons les aspects et les enjeux diagnostiques et thérapeutiques de ces pathologies. Notre discussion est illustrée par deux vignettes cliniques. In the last twenty years, autoimmune disorders have been clearly described in child and adolescents, from systemic erythematous lupus, auto-immune thyroiditis to auto-immune encephalitis, which are more aggressive and severe than in adults. The psychiatric features met in these autoimmune conditions are often at the front. Indeed, psychiatric symptoms are likely to be various, acute, severe, random, and for most of them atypical. Hence, many patients suffering from autoimmune conditions end up being taken care by psychiatrist for acute and severe psychiatric presentation. Among these psychiatric symptoms, catatonia takes a specific and important place. The aim of this article is to present a few examples of autoimmune disorders which can lead to psychiatric presentation. We emphasize on the type of neuropsychiatric symptoms, which are likely to appear in autoimmune conditions, and also on the role of catatonia as a key symptom. Then we underline the therapeutic options and challenge of autoimmune disorders. Our discussion is illustrated with two case reports. [ABSTRACT FROM AUTHOR]

Competing Interests: Intérêts concurrents: Laura Powe déclare avoir reçu une rémunération d’Otsuka Canada Pharmaceutique pour une présentation orale. Adrian Budhram déclare être membre du comité consultatif de la pratique du JAMC. Le Dr Budhram est titulaire de la chaire en recherche d’anticorps antineuronaux contre les maladies neuro-inflammatoires du London Health Sciences Centre et de la fondation London Health Sciences, et reçoit du financement du Fonds d’intégration du régime de financement non conventionnel du Centre universitaire des sciences de la santé de l’Academic Medical Organization of Southwestern Ontario. Aucun autre intérêt concurrent n’a été déclaré.

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Résumé La culture et le séquençage du génome de Tropheryma whipplei ont, grâce à l’apport de nouveaux outils, rationalisé l’approche diagnostique et thérapeutique de la maladie de Whipple. La maladie de Whipple atteint principalement l’homme caucasien de plus de 50 ans souffrant d’arthralgies intermittentes, de perte de poids et de diarrhée. Le tableau clinique, souvent aggravé par des immunosuppresseurs, est amélioré par des antibiotiques prescrits pour une infection intercurrente. Des tableaux cliniques évocateurs de lymphome ou de sarcoïdose sont des modes d’entrée plus rares. Les PCR spécifiques sur la salive et les selles sont un élément important du dépistage. Le diagnostic est fait par une coloration périodique à l’acide de Schiff ou une immuno-histochimie positive sur une biopsie duodénale. Les atteintes chroniques isolées sont définies par l’absence d’atteinte duodénale histologique. L’endocardite est typiquement décrite chez l’homme de 60 ans souffrant d’arthralgies, d’insuffisance cardiaque aiguë ou de complication embolique. L’encéphalite entraîne des manifestations neuropsychiatriques et parfois une démence, une ataxie et une prise de poids. Uvéites et arthrites sont classiquement chroniques et résistantes (voire aggravées) aux immunosuppresseurs. La PCR et la culture (LCR) sur les différents tissus ou fluides sont les éléments clés du diagnostic des atteintes isolées. Le traitement recommandé est l’association doxycycline (200 mg/j) et hydroxychloroquine (600 mg/j). Dans la maladie de Whipple, après 12 mois de traitement, une prophylaxie à vie par doxycycline est préconisée en raison du risque de réinfection. Le traitement des infections chroniques isolées dure 12 à 18 mois et est suivi d’une surveillance à vie. Tropheryma whipplei culture and genome sequencing have, thanks to new tools, rationalized both diagnosis and treatment of Whipple's disease. Whipple's disease involves mainly Caucasian male, approximately 50-years-old, suffering from arthralgia, weight loss and diarrhea. A worsening of clinical manifestations after immunosuppressive therapy is frequently observed while antibiotics prescribed for another infection improves the clinical status. Clinical manifestations may more rarely suggest lymphoma or sarcoidosis. Positive T. whipplei performed on both saliva and stool samples are strongly suggestive of Whipple's disease. The diagnosis is confirmed by positive periodic acid Schiff staining or immunohistochemistry performed on small-bowel biopsies. Localized chronic infections are defined by the absence of histological duodenal involvement. Endocarditis mainly occurs in 60-years-old men with arthralgia, cardiac failure or embolic events. Encephalitis causes mainly cognitive and psychiatric involvement, and sometimes dementia, ataxia and weight gain. Uveitis and arthritis evolve chronically, and are frequently resistant to immunosuppressive treatment. PCR and culture (particularly for cerebrospinal fluid) performed on various tissues and fluids allow the localized infections diagnosis. In classic Whipple's disease, the treatment with doxycycline (200 mg/day) and hydroxychloroquine (600 mg/day) for a length of 12 months followed by a lifetime treatment by doxycycline (200 mg/day) should be recommended to avoid reinfection. In localized infections, a treatment with doxycycline (200 mg/day) and hydroxychloroquine (600 mg/day) is proposed for 12 to 18 months followed by a lifetime follow-up. [ABSTRACT FROM AUTHOR]

Résumé: Dans la population occidentale et en particulier en France, la plupart des cas de grippe sévère sont observés chez des adultes. On recense également quelques cas pédiatriques, notamment des cas d’encéphalite grippale. En revanche, la littérature japonaise abonde de telles observations. Nous décrivons trois cas d’encéphalite liée au Myxovirus influenzae chez des enfants hospitalisés en unité de réanimation pédiatrique au cours de l’hiver 2012–2013. L’histoire de la maladie n’avait pas toujours débuté par un syndrome grippal et l’atteinte neurologique était au premier plan. Deux enfants avaient un syndrome de défaillance multiviscérale similaire aux tableaux observés au Japon. L’évolution avait été variable, entre une bonne récupération ou le décès. Ces trois histoires cliniques nous rappellent que les formes graves de grippe communes au Japon existent également en France. [ABSTRACT FROM AUTHOR]

Résumé: L’encéphalopathie aiguë nécrosante (EAN) est une maladie neurologique rare déclenchée à la suite d’une fièvre le plus souvent d’origine virale affectant des nourrissons ou des enfants jusque là en bonne santé. L’évolution clinique se caractérise par une détérioration rapide de l’état neurologique aboutissant presque toujours à un coma et nécessitant une prise en charge en réanimation. Le diagnostic est conforté par l’imagerie par résonance magnétique (IRM) cérébrale qui montre des lésions spécifiques de nécrose symétrique et focale des thalami. L’EAN a été associée dans de récentes études à l’existence d’une mutation autosomique dominante du gène de la protéine RAN-binding protein 2. Nous rapportons le cas d’une fratrie (trois enfants) d’origine tunisienne dans laquelle deux enfants ont présenté de façon certaine une EAN à l’âge de 9 mois dans les suites immédiates d’une infection virale. L’étude moléculaire a mis en évidence une mutation faux-sens du gène RAN-binding protein 2 chez les deux enfants pour lesquels un prélèvement était disponible. Parmi les tableaux d’encéphalopathie aiguë de l’enfant, la reconnaissance de cette nouvelle entité neurologique, rare, permet non seulement une prise en charge symptomatique précoce, mais aussi un conseil génétique plus précis. [ABSTRACT FROM AUTHOR]

Résumé: L’encéphalopathie associée au sepsis (EAS) est un dysfonctionnement cérébral diffus induit par la réponse systémique à une infection. Elle est bien décrite chez l’adulte, mais seulement 3 cas pédiatriques ont été publiés à notre connaissance. Nous rapportons le cas d’une enfant de 4ans adressée pour trouble de la vigilance dans un contexte de fièvre depuis 48h. L’hypothèse initiale avait été celle d’une encéphalite infectieuse mais le bilan étiologique était négatif. L’imagerie par résonance magnétique (IRM) avait révélé un œdème cérébral diffus et l’activité électrique de l’électroencéphalogramme (EEG) était globalement ralentie. L’origine du sepsis était une péritonite appendiculaire. En l’absence d’arguments pour un sepsis localisé au système nerveux central, le diagnostic final retenu était une EAS d’origine digestive. Cette entité se traduit par des troubles de conscience ou de vigilance, dans un contexte de sepsis avéré, sans signe de choc, après exclusion de toutes autres causes. Le plus souvent, les lésions constatées à l’imagerie et à l’EEG ne sont pas spécifiques et sont diffuses. Le traitement est la prise en charge étiologique du sepsis et symptomatique des signes neurologiques. L’évolution neurologique est lentement favorable. Les hypothèses physiopathologiques sont vasculaire, immunologique et embolique. [ABSTRACT FROM AUTHOR]

Résumé: L’encéphalite est une complication rare de la rubéole. Nous en rapportons 9 observations colligées durant l’épidémie de rubéole ayant sévi en Tunisie durant la période mai–juin 2011. Il s’agissait de 8 garçons et 1 fille non vaccinés contre la rubéole. L’âge moyen était de 11,6ans. Le délai moyen entre l’exanthème et les manifestations neurologiques était de 3j. Les crises épileptiques avaient été le symptôme inaugural dans les 9 cas. Un ralentissement du rythme de fond à l’électroencéphalogramme (EEG) avait été noté chez 8 enfants. L’imagerie par résonance magnétique (IRM) cérébrale était normale chez 8 enfants. Un séjour en réanimation avait été nécessaire chez 4 enfants. Ces observations d’encéphalite rubéolique illustrent la gravité potentielle de cette affection. La survenue d’une épidémie est expliquée par l’insuffisance de couverture vaccinale et l’émergence virale (phénomène multifactoriel). Au décours de cette épidémie, le programme vaccinal a été révisé et il sera élargi aux garçons en Tunisie. [ABSTRACT FROM AUTHOR]

Résumé: Les complications neurologiques des affections respiratoires de l’enfant liées au virus respiratoire syncytial (VRS) ont été rapportées dans la littérature avec des résultats variables allant de 1 à près de 40 % des cas. Elles sont essentiellement composées d’apnées centrales, souvent inaugurales de l’infection, de complications anoxo-ischémiques de malaises graves rencontrés chez les jeunes nourrissons et de tableaux de convulsions ou de troubles de la conscience parfois associés à des déficits neurologiques focalisés, traduisant une atteinte encéphalitique. Nous rapportons un cas de rhombencéphalite clinique chez un garçon de 7ans atteint d’une rhinopharyngite à VRS de type A. Une méningite prouvée par une réaction par polymérisation en chaîne (PCR) positive dans le liquide céphalorachidien (LCR) et des anomalies observées à l’imagerie par résonance magnétique (IRM) cérébrale permettent d’évoquer une encéphalite par réplication virale. Nous discutons à partir d’une revue de la littérature l’épidémiologie et la physiopathologie des principales complications neurologiques du VRS qui ne bénéficient pas pour la plupart d’investigations neurologiques paracliniques complètes et parmi lesquelles les encéphalites ont été très peu décrites. Concernant les apnées, le plus souvent considérées comme centrales, une hypothèse expérimentale chez l’animal évoque un mécanisme qui pourrait être d’origine périphérique. [ABSTRACT FROM AUTHOR]

Abstract: Anti-N-methyl-D-aspartate of the glutamate receptor encephalitis (NMDA-R) is a severe disorder, recently described, especially in young patients. The diagnosis is based on a clinical set of three associating seizure psychiatric disorders, epilepsy and anterograde amnesia, on irregularities on cerebral MRI and on a presence of antibody anti-NMDA in the blood and the cerebrospinal fluid. The treatment consists of the resection of the tumor in paraneoplasic cases and the prescription of immunosuppresseurs. We report the observation of a young 17-year-old patient admitted in urgency for faintness initially attribute to a viral meningitis self-limited biologically. Clinically, the patient presents behavior disorders with agitation, hypomania alternating with periods of catatonia and massive anxiety requiring the prescription of psychotropic drugs and orientation in psychiatry unity. The diagnosis of limbic encephalitis is made only three weeks later, further to the appearance of severe epileptic seizure requiring a passage in recovery unit. A treatment by antiepileptics and immunosuppressive drugs is setting up. Then, after clinical improvement, a medical care in rehabilitation center is initiated. After a neurobiological reminder, we describe the clinical catatonia and its evolution in DSM-V, then we approach the diagnostic complexity. [Copyright &y& Elsevier]

The reality of human infections by Bornaviridae (and particularly by mammalian Orthobornaviruses BoDV-1 and BoDV-2) has long been the centre of debate and controversies. New data, however, have profoundly modified the game by providing strong and unambiguous pieces of evidence, even if many points still need to be clarified. This review aims at presenting the current state of the question, based on today’s knowledge.

Summary: Cat scratch disease (CSD) is usually a benign, self-limited regional lymphadenopathy, caused by Bartonella henselae. However, systemic complications have been described. We report on 2 children who developed neurological symptoms of acute encephalitis or neuroretinitis. Cat scratch disease should be suspected when neurological symptoms of undetermined cause occur in children, whether or not anamnesis is significant. [ABSTRACT FROM AUTHOR]

Abstract: We report here two cases of autoimmune encephalitis associated with antibodies against the N -methyl-D-aspartate receptor. The primary cause was an ovarian teratoma in one case. The outcomes were good. The first case was a late diagnosis, despite a typical clinical presentation. The clinical presentation of this disease remains unknown, especially in the intensive care unit. The treatment was recently codified and transformed the prognosis of this encephalitis. The second case was early treated in the course of the disease, due to the experience related to the previous case. In case of unexplained acute or subacute encephalitis or psychiatric-like disorders without prior medical history, the determination of the level of expression of antibodies against the N -methyl-D-aspartate receptors and other antineuroreceptors antibodies can help to identify this diagnosis. The initial picture of the disease, its variability and the unawareness of the recent reports on this encephalitis may lead to a wrong diagnosis and inappropriate management. [Copyright &y& Elsevier]

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Abstract: Introduction: N-methyl-D-aspartate receptor antibody (anti-NMDA-r AB) encephalitis has been recently identified. We report two cases illustrating the clinical features, response to immunomodulatory treatment and involvement of B-lymphocytes that characterizes this disorder. Case reports: These patients illustrated the classic clinical features of anti-NMDA-r AB encephalitis including occurrence in young female, presence of severe neurological and psychiatric manifestations with confusion, seizures, mutism, hypovigilence and involuntary movements, and inflammatory cerebrospinal fluid. Both patients improved after immunotherapy. In case 1, the encephalitis was associated with an ovarian teratoma containing neuronal elements. In case 2, there was no tumor identified. A brain biopsy showed prominent perivascular B-cells infiltrates with some T-cells distributed in the brain parenchyma. Conclusion: Anti-NMDA-r AB encephalitis is certainly not rare and needs to be promptly recognized and treated. An associated neoplasia is inconstant and the pathophysiology involves humoral immunity. [Copyright &y& Elsevier]

Summary: Introduction: Human parvovirus B19 (PVB19) causes erythema infectiosum or 5th disease in childhood, which mainly affects children between 3 and 15 years of age. PVB19 infections have also been described in association with a variety of neurologic manifestations including encephalitis. Case report: This 3-year 8-month-old boy developed febrile encephalitis (mental status change with seizures and left limb hypertonia) associated with a rash. The electroencephalographs revealed focal slowing with some spikes in front of the left centro-temporo-occipital areas ; bacteriological and biochemical cerebrospinal fluid (CSF) analysis were normal, brain radiologic studies (tomography and magnetic resonance imaging) were normal. The diagnosis of encephalitis associated with PVB19 primo infection was based on viral DNA detection in the serum and CSF using PCR and on the specific immunoglobulin M (without immunoglobulin G) detection in the serum. Discussion: In France, encephalitis etiology is unknown in 48% of the cases. PVB19 accounts for 4.3% of undiagnosed meningoencephalitis in children. Although there is no specific sign, seizures and rash are reported in about one-half and one-quarter of cases, respectively. Conclusion: Even if PVB19 research is not cited in the French or American infectious disease society recommendations on the diagnosis and management of infectious encephalitis, this virus may be responsible, especially in cases of child febrile rash. Therefore, PVB19 research seems reasonable if the clinical presentation is concordant in children due to its diagnostic simplicity and efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Whipple''s disease is a rare systemic infectious disorder. It may present with a wide range of clinical manifestations and therefore its diagnosis may be challenging. Case report: We report a 45-year-old man who presented with acute encephalitis related to Whipple''s disease. Despite the negativity of the polymerase chain reaction (PCR) test in cerebrospinal fluid, diagnosis was obtained by histopathology, PCR tests and immunohistochemistry in multiple samples. The outcome with antibiotherapy was considered as “spectacular”. Conclusion: Whipple''s disease is a rare cause of encephalitis. Its diagnosis needs the confrontation of histology and PCR tests in multiple samples. The outcome with an adapted antibiotherapy may be very successful. [Copyright &y& Elsevier]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The pathogenicity of human herpesvirus 6 (HHV-6) still raises numerous questions. Acute HHV-6 infections correspond to primary infections, reactivations or exogenous reinfections. The expression of related clinical symptoms is highly variable but may be extremely severe, particularly among immunocompromised patients. The prototypic severe disease associated with these infections is limbic encephalitis occurring in stem cell transplant recipients. The diagnosis of acute HHV-6 infections relies on the quantitation of viral load in whole blood by means of quantitative PCR. The demonstration of HHV-6 causative role in the genesis of clinical symptoms requires additional investigations such as the search for HHV-6 DNA in cerebrospinal fluid in case of encephalitis. The chromosomal integration of HHV-6 DNA is a rare event among HHV-6-infected subjects but may alter the interpretation of virological results. Therapy with ganciclovir, foscarnet or cidofovir has not yet clear indications but, at the current stage of knowledge, only concerns the treatment of highly symptomatic infections. The usefulness of prophylactic or pre-emptive antiviral chemotherapy has not yet been convincingly demonstrated. Treatment efficacy must be checked through a clinical and virological follow up, based in part on quantitative PCR approaches. Controlled studies are urgently needed with the goal of evaluating the cost-effectiveness of HHV-6 follow up and therapy in different clinical situations. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: We report a case of herpetic encephalitis in 2-year-old girl. Diagnosis was made at 1st by clinical symptoms and MRI and confirmed by lumbar puncture. Forty days later, new neurologic symptoms appeared and MRI diagnosed acute disseminated encephalomyelitis. MRI better demonstrates CNS abnormalities in herpetic encephalitis and may play a major role as a 1st step in early diagnosis, in particular for acute disseminated encephalomyelitis. [ABSTRACT FROM AUTHOR]

Abstract: The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. Objective: The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. Design: A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August15 to November15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. Results: Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. Conclusions: These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventives measures and epidemiological surveillance are necessary. [ABSTRACT FROM AUTHOR]

Abstract: Anti-NMDA-receptor encephalitis has been described only recently among other causes of paraneoplastic and auto-immune limbic encephalitis. Its frequency is probably underestimated. The very characteristic clinical presentation, the severity of symptoms frequently leading to the intensive care unit, the therapeutic implications of the diagnosis whatever the cause, paraneoplastic or not and, once treated, the possibility of a full recovery or mild sequels in the majority of cases justify a surveillance either in neurology wards or in infectious, psychiatric, intensive care, or pediatric units. The authors review the history of this disease, the available epidemiological data, the characteristic clinical presentation of patients, the differential diagnosis, and the suggested treatment according to an up-to-date literature review. [Copyright &y& Elsevier]

Abstract: Meningoencephalitis is a disease with many drawbacks: it is usually severe and its etiology will frequently remain unsolved even with thorough investigations. Pathogen diversities and the wide range of differential diagnosis are further limitations, while there are neither guidelines nor conferences consensus available, in France and elsewhere. However, there are many valuable data in the literature and major advances have already been obtained, the most striking being advances in imaging techniques and molecular biology, as illustrated by the significant impact of HSV PCR advent in patient management. On emergency settings, physicians have to recognize and initiate appropriate treatment for patients who may have herpes simplex meningoencephalitis, and to consider bacteria for which prompt treatment has a positive prognostic impact. At this stage, intravenous acyclovir and amoxicillin should be widely prescribed, even with limited suspicion. Then, physicians will have to collect pertinent information and diagnostic tests results, and may seek expertise from other specialties when needed. Continuous improvements in diagnostic tests should allow significant progress in pathogen identification in meningoencephalitis, thus leading to better patients management. We also have to be prepared for changes, as the recent emergence of four agents of encephalitis reminded us (West Nile, Nipah, Hendra and Japanese encephalitis). [Copyright &y& Elsevier]

Abstract: Patients with acute brain injuries or susceptibility to post-surgery stroke are a major therapeutic challenge for intensive care and anaesthesiology medicine. The control of systemic stress involved in brain damage is necessary to reduce the frequency and severity of secondary brain lesions. Inflammation is known to be directly involved in acute brain lesions. The brain is a major participant in inflammation control through activation or inhibition effects. The exact mechanisms involved in deleterious effects following acute brain injuries due to inflammation are still unknown. This non-exhaustive study will expose the principal processes involved in inflammatory brain disease and explain the consequences of peripheral inflammation for the brain. Neuroprotection strategies in acute neuroinflammation will be reported with a focus on anaesthetic agents and the inflammation cascade. [Copyright &y& Elsevier]

Abstract: Any person travelling in countries where yellow fever (YF) is endemic and without presenting contra-indication for the vaccination against YF may be vaccinated. This vaccination can very rarely induce a potentially lethal neurotropic or viscerotropic disease. In severely immunodeficient patients, the vaccination is contra-indicated because postvaccinal encephalitis may occur after the vaccination, due to vaccine strain pathogenecity. It is important to evaluate the general health status in elderly individuals before vaccinating because of the increased risk of viscerotropic disease in people of 60 years of age and over. Pregnant women should not be vaccinated, except if departure to an endemic zone is unavoidable. YF vaccination is contra-indicated for newborns under six months of age. Solid organ grafts, congenital immunodeficiency, leukemia, lymphoma, cancer, and immunosuppressive treatments are contra-indications for this vaccination. Nevertheless, YF immunization is possible after a bone marrow graft and a two-year period without graft-versus-host disease or immunosuppressive treatment. There is no data to support that immunization of the donor prior to the graft could confer protection against yellow fever to the recipient. Low doses, short courses of corticosteroids either as systemic treatment or intra-articular injections are not contra-indications for YF vaccination. Patients infected with HIV with stable clinical status and T CD4-cell count above 200 cells per millimetre cube may be vaccinated. Thymic diseases, including thymoma and thymectomy, are contra-indications for YF vaccination. Finally, a substantial residual level of antibodies beyond 10 years after the latest vaccination could confer protection, thus avoiding a new vaccination when it is an issue. [Copyright &y& Elsevier]

Abstract: The neurological and psychiatric manifestations of Borrelia burgdorferi sensu lato are so numerous that Borrelia is also called the “new great imitator”. Thus knowing about the multiple clinical aspects of neuroborreliosis is necessary for the clinician. We reviewed literature for “classical” neuroborreliosis such as acute meningoradiculitis or chronicle encephalomyelitis, but also for encephalitis, myelitis, polyneuritis, radiculitis and more controversial disorders such as chronic neurological disorders, ischemic and hemorrhagic stroke, and motor neuron disease. We specified every time on which basis each disorder was attributed to Lyme disease, particularly if European or American criteria were met. Every part of the nervous system can be involved: from central to peripheral nervous system, and even muscles. In endemic areas, Lyme serology must be assessed in case of unexplained neurological or psychiatric disorder. In case of positive serology, CSF assessment with intrathecal anti-Borrelia antibody index will be more efficient to prove the diagnosis. [Copyright &y& Elsevier]

Abstract: We report 32 cases of acute encephalitis consecutively hospitalized in one hospital, from January 1991 to December 2002. The causative agent was identified in 26 cases (81%). The main associated viruses were varicella–zoster (10 children; 31%), Herpes simplex (6 children; 19%), and enteroviruses (4 children; 13%). At the acute phase, the most relevant biological findings were electroencephalogram results and CSF analysis. The initial encephalic imaging was primarily helpful to exclude other acute neurological diseases whereas long-term imaging was a prognostic factor for necrotizing encephalitis. The microbiological diagnosis required several days or weeks to be determined. It did not influence the initial management. In addition to the 6 cases of herpetic encephalitis, 19 children (78% altogether) were then treated by acyclovir before a definitive diagnosis was made. Twenty-two children (69%) had a favorable outcome, 2 (6%) had moderate sequels, 2 (6%) had important ones, and 5 (16%) had major ones. One (3%) child died. The outcome was highly dependant on the causative agent and the mechanism of encephalitis. This series gives information on the epidemiology of encephalitis in children in our region over a period of 12 years. [Copyright &y& Elsevier]

Abstract: Many virus and bacteria can cause encephalitis but are rarely identified as the aetiological agent by individual diagnosis. In France, the only continuous source of information about encephalitis is the national hospital medical database (NHMD). Data from the VIH-negative patients recorded in mainland France between 2000 and 2002 with a diagnosis of encephalitis were extracted and analysed according to demographic, geographical and temporal distribution. Hospitalisation details were described. An average of 1200 patients was recorded each year. They were residents of all French districts and equally hospitalized in university hospitals and non university hospitals. Their mean age was 38, and most were men. The aetiological diagnosis was unknown for 80%. The most frequent aetiological diagnosis was herpes simplex virus in adults, and VZV virus in children. These results give us some clues to design a national study on encephalitis. The study will be implemented in mainland France in 2007 and will last one year. We invite all voluntary hospitals to include their encephalitic patients in our study. [Copyright &y& Elsevier]