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2. Clinical Metagenomic Next-Generation Sequencing for Diagnosis of Central Nervous System Infections: Advances and Challenges

Author

Su, LingHui David, Chiu, Charles Y, Gaston, David, Hogan, Catherine A, Miller, Steve, Simon, Dennis W, Thakur, Kiran T, Yang, Shangxin, and Piantadosi, Anne

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Infectious Diseases, Biotechnology, 4.2 Evaluation of markers and technologies, 4.1 Discovery and preclinical testing of markers and technologies, Infection, Good Health and Well Being, Pharmacology and Pharmaceutical Sciences, Oncology & Carcinogenesis, Pharmacology & Pharmacy, Pharmacology and pharmaceutical sciences
Abstract

Central nervous system (CNS) infections carry a substantial burden of morbidity and mortality worldwide, and accurate and timely diagnosis is required to optimize management. Metagenomic next-generation sequencing (mNGS) has proven to be a valuable tool in detecting pathogens in patients with suspected CNS infection. By sequencing microbial nucleic acids present in a patient's cerebrospinal fluid, brain tissue, or samples collected outside of the CNS, such as plasma, mNGS can detect a wide range of pathogens, including rare, unexpected, and/or fastidious organisms. Furthermore, its target-agnostic approach allows for the identification of both known and novel pathogens. This is particularly useful in cases where conventional diagnostic methods fail to provide an answer. In addition, mNGS can detect multiple microorganisms simultaneously, which is crucial in cases of mixed infections without a clear predominant pathogen. Overall, clinical mNGS testing can help expedite the diagnostic process for CNS infections, guide appropriate management decisions, and ultimately improve clinical outcomes. However, there are key challenges surrounding its use that need to be considered to fully leverage its clinical impact. For example, only a few specialized laboratories offer clinical mNGS due to the complexity of both the laboratory methods and analysis pipelines. Clinicians interpreting mNGS results must be aware of both false negatives-as mNGS is a direct detection modality and requires a sufficient amount of microbial nucleic acid to be present in the sample tested-and false positives-as mNGS detects environmental microbes and their nucleic acids, despite best practices to minimize contamination. Additionally, current costs and turnaround times limit broader implementation of clinical mNGS. Finally, there is uncertainty regarding the best practices for clinical utilization of mNGS, and further work is needed to define the optimal patient population(s), syndrome(s), and time of testing to implement clinical mNGS.

Published
2024

4. Neuroinfectious Diseases

Author

Diaz, Monica M., Boruah, Abhilasha P., Beauchamp, Morgan, Saylor, Deanna, Thakur, Kiran T., Ovbiagele, Bruce, editor, Lewis, Sharon, editor, Correa, Daniel José, editor, Thomas, Reena, editor, and CharlestonIV, Larry, editor

Published
2024
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6. Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Author

Paradkar, Mandar S, D, Bella Devaleenal, Mvalo, Tisungane, Arenivas, Ana, Thakur, Kiran T, Wolf, Lisa, Nimkar, Smita, Inamdar, Sadaf, Giridharan, Prathiksha, Selladurai, Elilarasi, Kinikar, Aarti, Valvi, Chhaya, Khwaja, Saltanat, Gadama, Daphne, Balaji, Sarath, Kattagoni, Krishna Yadav, Venkatesan, Mythily, Savic, Radojka, Swaminathan, Soumya, Gupta, Amita, Gupte, Nikhil, Mave, Vidya, Dooley, Kelly E, Agiwal, Shivali, Ahire, Rupali, Balasubramanian, Usha, Bendre, Manjushree, Chandane, Jyoti, Chopade, Kavita, Dalimbkar, Shamala, Deshpande, Prasad, Dhage, Rajendra, Ithape, Mahesh, Jadhav, Varsha, Kante, Sonali, Kapre, Pallavi, Khan, Nawshaba, Kulkarni, Vandana, Madewar, Renu, Meshram, Shashibhushan, Muttha, Kunal, Nadgeri, Vaishali, Nagargoje, Arti, Nagraj, Amita, Nijampurkar, Aparna, Onawale, Prerana, Pawar, Namrata, Pawar, Prashant, Pradhan, Neeta, Shaikh, Varsha, Shaikh, Zaheda, Shere, Dhananjay, Wani, Gouri, Kulkarni, Rajesh, Rajput, Uday, Ganesan, Mangalambal, Arasan, Gunasundari, Shankar, Shakila, Mary, S Stella, Karuppaiah, Sureshwari, Pauline, Leema, Pramila, Snegha Karunakaran, Arul, Priyadharshini, Ganesh, Sankar, Hanna, Luke Elizabeth, Ramesh, K, Kannan, M, Vijayakumar, Ruthra, Sivakumar, Surekha S, Devika, K, Radhakrishnan, A, Preethi, AR, Rajkumar, S, Saravanan, N, Ramachandran, Geetha, Kumar, AK Hemanth, Dharman, M, Sudha, V, Hissar, Syed, Nagarajan, Valarmathi, Jennifer, Linda, Supriya, R, Manimegalai, R, Kandan, Santhanam, Maniselvi, Archana, Puspha, Oli, Vaishnavi, S, Selvi, R, Neelakandan, Logeswari, Chiunda, Mary, Chunga, Moreen, Kamanga, Madalo, Kamthunzi, Portia, Kanthiti, Elizabeth, Mbewe, Abineli, Msiska, Emmie, Mumba, Noel, Phiri, Ian Zifa, Palichina, Victor, and Sichali, Dorothy

Subjects
Pediatric, Clinical Trials and Supportive Activities, Clinical Research, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Adult, Child, Humans, Rifampin, Tuberculosis, Meningeal, Levofloxacin, Ethambutol, Antitubercular Agents, Standard of Care, pediatric tuberculous meningitis, neuropsychological, clinical trial, levofloxacin, high-dose rifampicin, TuBerculous Meningitis in Kids (TBM-KIDS) Study Team, Biological Sciences, Medical and Health Sciences, Microbiology
Abstract

BackgroundPediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM.MethodsTBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL).ResultsOf 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P

Published
2022

7. Chemokine-mediated cell migration into the central nervous system in progressive multifocal leukoencephalopathy

Author

Deffner, Marie, Schneider-Hohendorf, Tilman, Schulte-Mecklenbeck, Andreas, Falk, Simon, Lu, I-Na, Ostkamp, Patrick, Müller-Miny, Louisa, Schumann, Eva Maria, Goelz, Susan, Cahir-McFarland, Ellen, Thakur, Kiran T., De Jager, Philip L., Klotz, Luisa, Meyer zu Hörste, Gerd, Gross, Catharina C., Wiendl, Heinz, Grauer, Oliver M., and Schwab, Nicholas

Published
2024
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9. Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews

Author

Boruah, Abhilasha P., Thakur, Kiran T., Gadani, Sachin P., Kothari, Kavita U., Chomba, Mashina, Guekht, Alla, Heydari, Kimia, Hoo, Fan Kee, Hwang, Soonmyung, Michael, Benedict D., Pandit, Maya V., Pardo, Carlos A., Prasad, Kameshwar, Sardar, Zomer, Seeher, Katrin, Solomon, Tom, Winkler, Andrea S., Wood, Greta K., and Schiess, Nicoline

Published
2023
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10. Acute flaccid myelitis: cause, diagnosis, and management

Author

Murphy, Olwen C, Messacar, Kevin, Benson, Leslie, Bove, Riley, Carpenter, Jessica L, Crawford, Thomas, Dean, Janet, DeBiasi, Roberta, Desai, Jay, Elrick, Matthew J, Farias-Moeller, Raquel, Gombolay, Grace Y, Greenberg, Benjamin, Harmelink, Matthew, Hong, Sue, Hopkins, Sarah E, Oleszek, Joyce, Otten, Catherine, Sadowsky, Cristina L, Schreiner, Teri L, Thakur, Kiran T, Van Haren, Keith, Carballo, Carolina M, Chong, Pin Fee, Fall, Amary, Gowda, Vykuntaraju K, Helfferich, Jelte, Kira, Ryutaro, Lim, Ming, Lopez, Eduardo L, Wells, Elizabeth M, Yeh, E Ann, Pardo, Carlos A, group, AFM working, Salazar-Camelo, Andrea, Mithal, Divakar, Wilson-Murphy, Molly, Bauer, Andrea, Watkins, Colyn, Abzug, Mark, Dominguez, Samuel, Press, Craig, Yang, Michele, Ahsan, Nusrat, Ramos-Platt, Leigh, Tiongson, Emmanuelle, Seruya, Mitchel, Tilton, Ann, Katz, Elana, Kirschen, Matthew, Shah, Apurva, Ulloa, Erlinda, Yum, Sabrina, Mondok, Lileth, Blaufuss, Megan, Rosenfeld, Amy, Vargas, Wendy, Zucker, Jason, Yeshokumar, Anusha, Navis, Allison, Chao, Kristen, Hagen, Kaitlin, Melicosta, Michelle, Porter, Courtney, Tunney, Margaret, Scheuermann, Richard, Duggal, Priya, Pekosz, Andrew, Bayliss, Amy, Moore, Meghan, Belzberg, Allan, Bembea, Melania, O'Brien, Caitlin, Riggs, Rebecca, Nance, Jessica, Milstone, Aaron, Rice, Jessica, Garcia-Dominguez, Maria A, Flanagan, Eoin, Tillema, Jan-Mendelt, Bosques, Glendaliz, Bhatia, Sonal, Gordon-Lipkin, Eliza, Deike, Dawn, Revivo, Gadi, Zlotolow, Dan, deFiebre, Gabrielle, Lazerow, Peggy, Lotze, Timothy, Bitnun, Ari, Davidge, Kristen, Vajsar, Jiri, Moore, Amy, Konersman, Chamindra, Nash, Kendall, Strober, Jonathan, Gupta, Nalin, Chiu, Charles, Sweeney, Michael, and Jackson, William

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Infectious Diseases, Rehabilitation, Rare Diseases, Neurosciences, Infection, Good Health and Well Being, Central Nervous System Viral Diseases, Child, Enterovirus Infections, Global Health, Humans, Magnetic Resonance Imaging, Muscle Hypotonia, Muscle Weakness, Myelitis, Neuromuscular Diseases, Patient Outcome Assessment, AFM working group, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

Published
2021

11. Antibodies to Enteroviruses in Cerebrospinal Fluid of Patients with Acute Flaccid Myelitis

Author

Mishra, Nischay, Ng, Terry Fei Fan, Marine, Rachel L, Jain, Komal, Ng, James, Thakkar, Riddhi, Caciula, Adrian, Price, Adam, Garcia, Joel A, Burns, Jane C, Thakur, Kiran T, Hetzler, Kimbell L, Routh, Janell A, Konopka-Anstadt, Jennifer L, Nix, W Allan, Tokarz, Rafal, Briese, Thomas, Oberste, M Steven, Lipkin, W Ian, Whitley, Richard, and Jacobson, Steven

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Brain Disorders, Clinical Research, Rare Diseases, Neurosciences, Prevention, 2.1 Biological and endogenous factors, Aetiology, Infection, Good Health and Well Being, Adolescent, Adult, Antibodies, Viral, Antigens, Viral, Central Nervous System Viral Diseases, Child, Enterovirus D, Human, Enterovirus Infections, Female, High-Throughput Nucleotide Sequencing, Humans, Male, Middle Aged, Myelitis, Neuromuscular Diseases, Protein Array Analysis, RNA, Viral, Young Adult, VirCapSeq-VERT, acute flaccid myelitis, antibodies, enterovirus, enterovirus D-68, peptide array, serology, Microbiology, Biochemistry and cell biology, Medical microbiology
Abstract

Acute flaccid myelitis (AFM) has caused motor paralysis in >560 children in the United States since 2014. The temporal association of enterovirus (EV) outbreaks with increases in AFM cases and reports of fever, respiratory, or gastrointestinal illness prior to AFM in >90% of cases suggest a role for infectious agents. Cerebrospinal fluid (CSF) from 14 AFM and 5 non-AFM patients with central nervous system (CNS) diseases in 2018 were investigated by viral-capture high-throughput sequencing (VirCapSeq-VERT system). These CSF and serum samples, as well as multiple controls, were tested for antibodies to human EVs using peptide microarrays. EV RNA was confirmed in CSF from only 1 adult AFM case and 1 non-AFM case. In contrast, antibodies to EV peptides were present in CSF of 11 of 14 AFM patients (79%), significantly higher than controls, including non-AFM patients (1/5 [20%]), children with Kawasaki disease (0/10), and adults with non-AFM CNS diseases (2/11 [18%]) (P = 0.023, 0.0001, and 0.0028, respectively). Six of 14 CSF samples (43%) and 8 of 11 sera (73%) from AFM patients were immunoreactive to an EV-D68-specific peptide, whereas the three control groups were not immunoreactive in either CSF (0/5, 0/10, and 0/11; P = 0.008, 0.0003, and 0.035, respectively) or sera (0/2, 0/8, and 0/5; P = 0.139, 0.002, and 0.009, respectively).IMPORTANCE The presence in cerebrospinal fluid of antibodies to EV peptides at higher levels than non-AFM controls supports the plausibility of a link between EV infection and AFM that warrants further investigation and has the potential to lead to strategies for diagnosis and prevention of disease.

Published
2019

12. Clinical Significance of Positive Results of the BioFire Cerebrospinal Fluid FilmArray Meningitis/Encephalitis Panel at a Tertiary Medical Center in the United States

Author

Waldrop, Greer, Zucker, Jason, Boubour, Alexandra, Radmard, Sara, Green, Daniel A., and Thakur, Kiran T.

Subjects
Meningitis -- Diagnosis, Encephalitis -- Diagnosis, Diagnostic equipment (Medical) -- Evaluation, Molecular diagnostic techniques -- Evaluation, Polymerase chain reaction -- Usage, Spine -- Puncture, Health
Abstract

* Context.--The FilmArray Meningitis/Encephalitis (ME) panel is the first US Food and Drug Administration-cleared multiplex polymerase chain reaction panel for the detection of central nervous system infections. While the assay's [...]

Published
2022
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16. Disorders of Consciousness in Hospitalized Patients with COVID-19: The Role of the Systemic Inflammatory Response Syndrome

Author

Boehme, Amelia K., Doyle, Kevin, Thakur, Kiran T., Roh, David, Park, Soojin, Agarwal, Sachin, Velazquez, Angela G., Egbebike, Jennifer A., Der Nigoghossian, Caroline, Prust, Morgan L., Rosenberg, Jon, Brodie, Daniel, Fishkoff, Katherine N., Hochmann, Beth R., Rabani, Leroy E., Yip, Natalie H., Panzer, Oliver, and Claassen, Jan

Published
2022
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17. Chronic Meningitis.

Author

Thakur, Kiran T and Wilson, Michael R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Clinical Research, Neurosciences, Aetiology, 2.1 Biological and endogenous factors, Infection, Good Health and Well Being, Chronic Disease, Humans, Meningitis, Neurology & Neurosurgery
Abstract

Purpose of reviewThis article describes the clinical presentation, diagnostic approach (including the use of novel diagnostic platforms), and treatment of select infectious and noninfectious etiologies of chronic meningitis.Recent findingsIdentification of the etiology of chronic meningitis remains challenging, with no cause identified in at least one-third of cases. Often, several serologic, CSF, and neuroimaging studies are indicated, although novel diagnostic platforms including metagenomic deep sequencing may hold promise for identifying organisms. Infectious etiologies are more common in those at risk for disseminated disease, specifically those who are immunocompromised because of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), transplantation, or immunosuppressant medications. An important step in identifying the etiology of chronic meningitis is assembling a multidisciplinary team of individuals, including those with specialized expertise in ophthalmology, dermatology, rheumatology, and infectious diseases, to provide guidance regarding diagnostic procedures.SummaryChronic meningitis is defined as inflammation involving the meninges that lasts at least 4 weeks and is associated with a CSF pleocytosis. Chronic meningitis has numerous possible infectious and noninfectious etiologies, making it challenging to definitively diagnose patients. Therefore, a multifaceted approach that combines history, physical examination, neuroimaging, and laboratory analysis, including novel diagnostic platforms, is needed. This article focuses on key aspects of the evaluation of and approach to patients with chronic meningitis. Specific infectious etiologies and differential diagnoses of subacute and chronic meningitis, including noninfectious etiologies, are addressed.

Published
2018

18. Primary stroke prevention worldwide: translating evidence into action

Author

Abanto, Carlos, Abera, Semaw Ferede, Addissie, Adamu, Adebayo, Oluwadamilola, Adeleye, Amos Olufemi, Adilbekov, Yerzhan, Adilbekova, Bibigul, Adoukonou, Thierry Armel, Aguiar de Sousa, Diana, Ajagbe, Temitope, Akhmetzhanova, Zauresh, Akpalu, Albert, Álvarez Ahlgren, Jhon, Ameriso, Sebastián, Andonova, Silva, Awoniyi, Foloruso Emmanuel, Bakhiet, Moiz, Barboza, Miguel, Basri, Hamidon, Bath, Philip, Bello, Olamide, Bereczki, Dániel, Beretta, Simone, Berkowitz, Aaron, Bernabé-Ortiz, Antonio, Bernhardt, Julie, Berzina, Guna, Bisharyan, Mher, Bovet, Pascal, Budincevic, Hrvoje, Cadilhac, Dominique, Caso, Valeria, Chen, Christopher, Chin, Jerome, Chwojnicki, Kamil, Conforto, Adriana, Cruz, Vitor Tedim, D'Amelio, Marco, Danielyan, Kristine, Davis, Stephen, Demarin, Vida, Dempsey, Robert, Dichgans, Martin, Dokova, Klara, Donnan, Geoffrey, Elkind, Mitchell S., Endres, Matthias, Fischer, Urs, Gankpé, Fortuné, Gaye Saavedra, Andrés, Gil, Artyom, Giroud, Maurice, Gnedovskaya, Elena, Hachinski, Vladimir, Hafdi, Melanie, Hamadeh, Randah, Hamzat, T. Kolapo, Hankey, Graeme, Heldner, Mirjam, Ibrahim, Etedal Ahmed, Ibrahim, Norlinah Mohamed, Inoue, Manabu, Jee, Sungju, Jeng, Jiann-Shing, Kalkonde, Yogesh, Kamenova, Saltanat, Karaszewski, Bartosz, Kelly, Peter, Khan, Taskeen, Kiechl, Stefan, Kondybayeva, Aida, Kõrv, Janika, Kravchenko, Michael, Krishnamurthi, Rita V., Kruja, Jera, Lakkhanaloet, Mongkol, Langhorne, Peter, Lavados, Pablo M., Law, Zhe Kang, Lawal, Abisola, Lazo-Porras, Maria, Lebedynets, Dmytro, Lee, Tsong-Hai, Leung, Thomas, Liebeskind, David S., Lindsay, Patrice, López-Jaramillo, Patricio, Lotufo, Paulo Andrade, Machline-Carrion, Julia, Makanjuola, Akintomiwa, Markus, Hugh Stephen, Marquez-Romero, Juan Manuel, Medina, Marco, Medukhanova, Sabina, Mehndiratta, Man Mohan, Merkin, Alexandr, Mirrakhimov, Erkin, Mohl, Stephanie, Moscoso-Porras, Miguel, Müller-Stierlin, Annabel, Murphy, Sean, Musa, Kamarul Imran, Nasreldein, Ahmed, Nogueira, Raul Gomes, Nolte, Christian, Noubiap, Jean Jacques, Novarro-Escudero, Nelson, Ogun, Yomi, Oguntoye, Richard Ayobami, Oraby, Mohammed Ibrahim, Osundina, Morenike, Ovbiagele, Bruce, Orken, Dilek Necioglu, Ozdemir, Atilla Özcan, Ozturk, Serefnur, Paccot, Melanie, Phromjai, Jurairat, Piradov, Piradov, Platz, Thomas, Potpara, Tatjana, Ranta, Annemarei, Rathore, Farooq, Richard, Edo, Sacco, Ralph L., Sahathevan, Ramesh, Santos Carquín, Irving, Saposnik, Gustavo, Sarfo, Fred Stephen, Sharma, Mike, Sheth, Kevin, Shobhana, A., Suwanwela, Nijasri, Svyato, Irina, Sylaja, P.N., Tao, Xuanchen, Thakur, Kiran T., Toni, Danilo, Topcuoglu, Mehmet Akif, Torales, Julio, Towfighi, Amytis, Truelsen, Thomas Clement, Tsiskaridze, Alexander, Tulloch-Reid, Marshall, Useche, Nicolás, Vanacker, Peter, Vassilopoulou, Sophia, Vukorepa, Gorana, Vuletic, Vladimira, Wahab, Kolawole W., Wang, Wenzhi, Wijeratne, Tissa, Wolfe, Charles, Yifru, Yared Mamushet, Yock-Corrales, Adriana, Yonemoto, Naohiro, Yperzeele, Laetitia, Zhang, Puhong, Owolabi, Mayowa O, Thrift, Amanda G, Mahal, Ajay, Ishida, Marie, Martins, Sheila, Johnson, Walter D, Pandian, Jeyaraj, Abd-Allah, Foad, Yaria, Joseph, Phan, Hoang T, Roth, Greg, Gall, Seana L, Beare, Richard, Phan, Thanh G, Mikulik, Robert, Akinyemi, Rufus O, Norrving, Bo, Brainin, Michael, and Feigin, Valery L

Published
2022
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19. Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

Author

Triki, Chahnez Charfi, Leonardi, Matilde, Mallouli, Salma Zouari, Cacciatore, Martina, Karlshoej, Kimberly Coard, Magnani, Francesca Giulia, Newton, Charles R., Pilotto, Andrea, Saylor, Deanna, Westenberg, Erica, Walsh, Donna, Winkler, Andrea Sylvia, Thakur, Kiran T., Okubadejo, Njideka U., and Garcia-Azorin, David

Published
2022
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20. Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

Author

Thakur, Kiran T., Tamborska, Arina, Wood, Greta K., McNeill, Emily, Roh, David, Akpan, Imo J., Miller, Eliza C., Bautista, Alyssa, Claassen, Jan, Kim, Carla Y., Guekht, Alla, Pardo, Carlos A., Williams, Olajide, García-Azorín, David, Prasad, Kameshwar, Schmutzhard, Erich, Michael, Benedict D., Chou, Sherry H.-Y., Winkler, Andrea S., Solomon, Tom, and Elkind, Mitchell S.

Published
2021
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23. Risk Factors for New Neurologic Diagnoses in Hospitalized Patients with COVID-19: A Case-Control Study in New York City

Author

Thakur, Kiran T., Chu, Victoria, Hughes, Christy, Kim, Carla Y., Fleck-Dardarian, Shannon, Barrett, Katherine, Matthews, Elizabeth, Balbi, Alanna, Bilski, Amanda, Chomba, Mashina, Lieberman, Ori, Jacobson, Samuel, Agarwal, Sachin, Roh, David, Park, Soojin, Ssonko, Vivian, Silver, Wendy, Vargas, Wendy, Geneslaw, Andrew, Bell, Michelle, Waters, Brandon, Rao, Agam, Claassen, Jan, Boehme, Amelia, Willey, Joshua, Elkind, Mitch, Sobieszcyzk, Magdalena, Zucker, Jason, McCollum, Andrea, and Sejvar, Jim

Published
2022
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24. Acute flaccid myelitis: cause, diagnosis, and management

Author

Salazar-Camelo, Andrea, Mithal, Divakar, Wilson-Murphy, Molly, Bauer, Andrea, Watkins, Colyn, Abzug, Mark, Dominguez, Samuel, Press, Craig, Yang, Michele, Ahsan, Nusrat, Ramos-Platt, Leigh, Tiongson, Emmanuelle, Seruya, Mitchel, Tilton, Ann, Katz, Elana, Kirschen, Matthew, Shah, Apurva, Ulloa, Erlinda, Yum, Sabrina, Mondok, Lileth, Blaufuss, Megan, Rosenfeld, Amy, Vargas, Wendy, Zucker, Jason, Yeshokumar, Anusha, Navis, Allison, Chao, Kristen, Hagen, Kaitlin, Melicosta, Michelle, Porter, Courtney, Tunney, Margaret, Scheuermann, Richard, Duggal, Priya, Pekosz, Andrew, Bayliss, Amy, Moore, Meghan, Belzberg, Allan, Bembea, Melania, O'Brien, Caitlin, Riggs, Rebecca, Nance, Jessica, Milstone, Aaron, Rice, Jessica, Garcia-Dominguez, Maria A., Flanagan, Eoin, Tillema, Jan-Mendelt, Bosques, Glendaliz, Bhatia, Sonal, Gordon-Lipkin, Eliza, Deike, Dawn, Revivo, Gadi, Zlotolow, Dan, deFiebre, Gabrielle, Lazerow, Peggy, Lotze, Timothy, Bitnun, Ari, Davidge, Kristen, Vajsar, Jiri, Moore, Amy, Konersman, Chamindra, Nash, Kendall, Strober, Jonathan, Gupta, Nalin, Chiu, Charles, Sweeney, Michael, Jackson, William, Simon, Dennis, Thakkar, Kavita, Cheng, Jonathan, Luce, John, Das, Suman, Vogt, Matthew, Vu, NgocHanh, Gofshteyn, Jacqueline, Makhani, Naila, Patel, Payal, Murphy, Olwen C, Messacar, Kevin, Benson, Leslie, Bove, Riley, Carpenter, Jessica L, Crawford, Thomas, Dean, Janet, DeBiasi, Roberta, Desai, Jay, Elrick, Matthew J, Farias-Moeller, Raquel, Gombolay, Grace Y, Greenberg, Benjamin, Harmelink, Matthew, Hong, Sue, Hopkins, Sarah E, Oleszek, Joyce, Otten, Catherine, Sadowsky, Cristina L, Schreiner, Teri L, Thakur, Kiran T, Van Haren, Keith, Carballo, Carolina M, Chong, Pin Fee, Fall, Amary, Gowda, Vykuntaraju K, Helfferich, Jelte, Kira, Ryutaro, Lim, Ming, Lopez, Eduardo L, Wells, Elizabeth M, Yeh, E Ann, and Pardo, Carlos A

Published
2021
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25. Neurological issues in children with COVID-19

Author

Lin, Jieru E., Asfour, Arsenoi, Sewell, Taylor B., Hooe, Benjamin, Pryce, Patrice, Earley, Chelsea, Shen, Min Ye, Kerner-Rossi, Mallory, Thakur, Kiran T., Vargas, Wendy S., Silver, Wendy G., and Geneslaw, Andrew S.

Published
2021
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26. Sociodemographic and Clinical Factors Associated With Clinical Outcome in Neuroinfectious Diseases: A Multicenter Retrospective Cohort Study.

Author

Boubour, Alexandra, Kim, Carla Y., Torres, Sarah, Jia, Dan T., Hess, Evan, Liu, Sibei, Sun, Yifei, Fong, Kathryn, Epstein, Samantha, Yan, Helena, Luche, Nicole, Gao, Kerry, Glassberg, Brittany, Harmon, Michael, Hoang, Hai, Navis, Allison, Schorr, Emily, Gofshteyn, Jacqueline S., Yeshokumar, Anusha K., and Thakur, Kiran T.

Published
2024
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27. Clinical Characteristics and Risk Factors for Cryptococcal Meningitis in Diverse Patient Populations in New York City.

Author

Sardar, Zomer, Kim, Carla Y, and Thakur, Kiran T

Subjects
CHRONIC lymphocytic leukemia, IMMUNOCOMPROMISED patients, HIV, SYSTEMIC lupus erythematosus, HIV-positive persons
Abstract

Background Cryptococcal meningitis (CM) is responsible for 15%–20% of human immunodeficiency virus (HIV)–associated mortalities. CM prevalence has also increased in other immunocompromised populations of transplant recipients, patients with cancer, and individuals on immunomodulatory medication. Methods This retrospective review included 51 definitive patients with CM hospitalized at a tertiary academic medical center in New York City between 2010 and 2023. We assessed clinical features and outcomes of CM, with additional analysis of factors related to antiretroviral therapy (ART) adherence in HIV-infected cases and immunomodulatory medication history of HIV-negative cases. Results The cohort had a mean (standard deviation) age of 47.1 ± 15.1 years, and was predominantly male (37, 72.5%). Of 32 patients with HIV, 3 (9.4%) were newly diagnosed with HIV at the time of CM hospitalization, 5 (15.6%) had recurrent CM, and 2 (6.3%) had a CM relapse. The majority (30, 93.8%) of patients with HIV were ART nonadherent. Of 19 HIV-negative patients, 8 (42.1%) were solid-organ transplant recipients, 5 (26.3%) had autoimmune conditions of sarcoidosis or systemic lupus erythematosus, and 3 (15.8%) had chronic lymphocytic leukemia. Six (11.8%) patients died during hospitalization, 4 of whom had HIV. Conclusions The burden of CM in people with HIV and immunocompromised patients continues even in settings with accessible standard antifungal treatment though interventions of increased ART adherence for those with HIV and antifungal prophylaxis may improve morbidity and mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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33. Clinical and Diagnostic Features of West Nile Virus Neuroinvasive Disease in New York City.

Author

Roberts, Jackson A., Kim, Carla Y., Dean, Amy, Kulas, Karen E., St. George, Kirsten, Hoang, Hai E., and Thakur, Kiran T.

Subjects
WEST Nile fever, FEVER, ACUTE flaccid paralysis, IMMUNOGLOBULIN M, WEST Nile virus, MAGNETIC resonance imaging, ACADEMIC medical centers
Abstract

West Nile virus (WNV) neuroinvasive disease (WNND) occurs in approximately 1 percent of WNV-infected patients and typically presents as encephalitis, meningitis, or acute flaccid paralysis (AFP). WNND remains a difficult inpatient diagnosis, creating significant challenges for prognostication and therapy selection. We characterized the clinical and diagnostic features of WNND cases at two major academic medical centers in New York City in routine clinical practice. We retrospectively reviewed the charts of thirty-six patients with WNND, including twenty-six encephalitis, four meningitis, and six AFP cases. The most common presenting symptoms were fever (86.1%) and gastrointestinal symptoms (38.9%) in addition to altered mental status (72.2%), lethargy (63.9%), gait disturbances (46.2%), and headache (44.4%). Fourteen (48.3%) patients displayed acute magnetic resonance imaging (MRI) findings, particularly T2 hyperintensities in the bilateral thalami, brainstem, and deep white matter. New York State Department of Health WNV CSF IgM testing was utilized for diagnosis in 58.3% of patients; however, just 38.1% had the result by discharge, compared to 85.6% of those who underwent serum IgM testing. The median length of stay was 13.5 days, 38.9% were intubated, and three patients (8.9%) died during acute hospitalization. Our findings underscore the morbidity, mortality, and diagnostic challenges of WNND, suggesting the potential utility of serum IgM testing in combination with confirmatory CSF testing to expedite diagnosis in the acute setting. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis

Author

Misra, Shubham, Kolappa, Kavitha, Prasad, Manya, Radhakrishnan, Divya, Thakur, Kiran T., Solomon, Tom, Michael, Benedict Daniel, Winkler, Andrea Sylvia, Beghi, Ettore, Guekht, Alla, Pardo, Carlos A., Wood, Greta Karen, Hsiang-Yi Chou, Sherry, Fink, Ericka L., Schmutzhard, Erich, Kheradmand, Amir, Hoo, Fan Kee, Kumar, Amit, Das, Animesh, Srivastava, Achal K., Agarwal, Ayush, Dua, Tarun, and Prasad, Kameshwar

Published
2021
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35. Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort

Author

Bustos, Javier A., primary, Arroyo, Gianfranco, additional, Del Brutto, Oscar H., additional, Gonzales, Isidro, additional, Saavedra, Herbert, additional, Guzman, Carolina, additional, Sanchez-Boluarte, Sofia S., additional, Thakur, Kiran T., additional, Coyle, Christina, additional, O’Neal, Seth E., additional, and Garcia, Hector H., additional

Published
2023
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38. Neurologic manifestations in an infant with COVID-19

Author

Dugue, Rachelle, Cay-Martínez, Karla C., Thakur, Kiran T., Garcia, Joel A., Chauhan, Lokendra V., Williams, Simon H., Briese, Thomas, Jain, Komal, Foca, Marc, McBrian, Danielle K., Bain, Jennifer M., Lipkin, W. Ian, and Mishra, Nischay

Published
2020
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43. List of contributors

Author

Boubour, Alexandra, primary, Chin, Jerome H., additional, Cresswell, Fiona V., additional, Johansson Århem, Katarina M., additional, Musubire, Abdu K., additional, Paradkar, Mandar, additional, Ssengooba, Willy, additional, Ssenyonga, Peter, additional, and Thakur, Kiran T., additional

Published
2020
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45. Building Equitable Neuroscience Research Collaborations in Resource-limited Settings.

Author

Asukile, Melody T., Zunt, Joseph R., and Thakur, Kiran T.

Subjects
RESOURCE-limited settings, TRAINING of scientists, CAPACITY building, INSTITUTIONAL review boards, NEUROSCIENCES, NON-communicable diseases
Abstract

The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience research aimed at defining the burden of neurological diseases across the lifespan, as well as optimizing diagnosis and treatment strategies, is fundamental to improving neurological health in resource-limited settings. One of the key factors to advancing neuroscience research in LMICs is the establishment of effective collaborations based on responsible and trustworthy partnerships between local scientists in LMICs and international collaborators. LMIC researchers face many logistical, institutional, and individual level challenges as they embark on their neuroscience research journey. Despite these challenges, there are opportunities for improving LMIC investigator-led research that should focus on human and institutional infrastructure development. With regard to human capacity building, potential areas for offering support include enhancing research methodology training, offering instruction in manuscript and grant-writing, institutionalizing mentorship programs, and providing opportunities to conduct funded, mentored research to disseminate in high-impact journals. The foundational elements required for implementing and optimizing neuroscience research within an institution include an institutional review board, mentorship programs, data management, research administration, and laboratory facilities. This institutional capacity varies significantly across and within countries, and many rely on collaborations with better-resourced institutions to initiate research. Successful equitable collaborations ensure the engagement of all local and international stakeholders, as well as implementation of a self-sustaining long-term program. Building research capacity in LMICs is an essential endeavor that requires ongoing commitment to training independent scientists. As research capacity increases, LMIC institutions and governments should consider developing competitive research grant programs to support innovative studies led by local researchers, foster regional collaborations, and hence create a sustainable and independent neuroscience research environment. [ABSTRACT FROM AUTHOR]

Published
2024
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47. Preparing a neurology department for SARS-CoV-2 (COVID-19): Early experiences at Columbia University Irving Medical Center and the New York Presbyterian Hospital in New York City

Author

Waldman, Genna, Mayeux, Richard, Claassen, Jan, Agarwal, Sachin, Willey, Joshua, Anderson, Emily, Punzalan, Patricia, Lichtcsien, Ryan, Bell, Michelle, Przedborski, Serge, Ulane, Christina, Roberts, Kirk, Williams, Olajide, Lassman, Andrew B., Lennihan, Laura, and Thakur, Kiran T.

Published
2020
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48. A structured evaluation of cryopreservation in generating single-cell transcriptomes from cerebrospinal fluid

Author

Touil, Hanane, primary, Roostaei, Tina, additional, Calini, Daniela, additional, Diaconu, Claudiu, additional, Epstein, Samantha, additional, Raposo, Catarina, additional, Onomichi, Kaho, additional, Thakur, Kiran T., additional, Craveiro, Licinio, additional, Callegari, Ilaria, additional, Bryois, Julien, additional, Riley, Claire S., additional, Menon, Vilas, additional, Derfuss, Tobias, additional, De Jager, Philip L., additional, and Malhotra, Dheeraj, additional

Published
2023
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