摘要： Laboratory studies have shown that mosquito vectors can be simultaneously or sequentially infected with multiple arboviruses, and a combination of Zika, dengue, and chikungunya viruses was detected in the saliva of Aedes egypti mosquitoes.2 Data from epidemiological surveillance of the Zika outbreak in Colombia showed that among 23 871 processed samples only 0·14% had evidence of co-infection.1 However, co-infections were found in 71 (27%) of 263 patients with confirmed arboviral infection in Nicaragua, and mean viraemia in those patients was significantly lower in comparison with that of monoinfections.3 Chikungunya and dengue co-infection is commonly found, very likely because of the high number of outbreaks associated with these viruses.3 Concurrent co-infection with two or more arboviruses was previously reported in small case-series of patients with neurological disease,4,5 including those with Guillain-Barré syndrome and encephalitis.5 However, the full spectrum of neurological complications associated with these arboviruses and the role of dual infection and co-infections has not been systematically evaluated before in a prospective study. Four potential outcomes of co-infection have been proposed, including the enhancement or inhibition of both arboviruses, the competition between them, or the absence of effect.7 Competition between multiple infecting arboviruses might happen as they replicate in monocytes, and the faster-replicating virus could infect cells first and use cellular resources for its replication. [...]the role of dual infection on the severity of neurological complications and its effect on vulnerable populations—such as pregnant women, neonates, older people, and people with comorbidities—is still unclear.

摘要： Background Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity. Methods We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauracao, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics. Findings Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service;201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34-60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55

关键词： Coronavirus   CoViD-19   SARS-CoV-2  

关键词： Varicella-zoster virus   Immunosuppression   Encephalitis   Cranial neuropathy   Meningitis   Prognosis  

摘要： Immunosuppressed patients are at higher risk for developing herpes zoster (HZ), and neurological complications are frequent in them. However, the influence of immunosuppression (IS) on the severity and prognosis of neurological complications of varicella-zoster virus (VZV) reactivation is unknown. We studied retrospectively patients with neurological complications due to VZV reactivation who attended our hospital between 2004 and 2019. We aimed to assess the clinical spectrum, potential prognostic factors, and the influence of the immune status on the severity of neurological symptoms. A total of 98 patients were included (40% had IS). Fifty-five patients (56%) had cranial neuropathies which included Ramsay-Hunt syndrome (36 patients) and cranial multineuritis (23 patients). Twenty-one patients developed encephalitis (21%). Other diagnosis included radiculopathies, meningitis, vasculitis, or myelitis (15, 10, 6, and 4 patients, respectively). Mortality was low (3%). At follow-up, 24% of patients had persistent symptoms although these were usually mild. IS was associated with severity (defined as a modified Rankin scale greater than 2) (odds ratio, 4.23;95% confidence interval, 1.74-10.27), but not with prognosis. Shorter latency between HZ and neurologic symptoms was the only factor associated with an unfavorable course (death or sequelae) (odds ratio, 0.82;95% confidence interval, 0.71-0.95). In conclusion, the clinical spectrum of neurological complications in VZV reactivation is wide. Mortality was low and sequelae were mild. The presence of IS may play a role on the severity of neurological symptoms, and a shorter time between HZ and the onset of neurological symptoms appears to be a negative prognostic factor.

关键词： Nuclear medicine  

关键词： Dyspnea   COVID-19   dyspnea descriptors   arterial blood gas  

摘要： Introduction The relationship between dyspnea and COVID-19 is unknown. In COVID-19 patients, the higher prevalence of neurological symptoms and the lack of dyspnea may suggest common underlying pathogenetic mechanisms. The aim of this preliminary study is to address whether there is a lack of dyspnea in COVID-19 patients and if there is a relationship between neurological symptoms and the perception of dyspnea. Methods A structured interview regarding the occurrence of subjective neurological symptoms was performed and coupled with a questionnaire about the intensity and qualities of dyspnea. Respiratory rate (RR) and an arterial blood gas on room air were concurrently evaluated. Results Twenty-two patients (age 68.4 +/- 13.9 years, 13 males and 9 females) were included and divided into two groups according to the Borg dyspnea scale: dyspneic patients BU >= 1(DYSP) and non-dyspneic patients BU < 1 (NDYSP). The prevalence of dyspnea overall was 31.8%. The prevalence of neurological symptoms, dyspnea descriptors, RR, pH, PaCO2, PaO2, or lactate was similar between groups. Conclusion This study confirms that the prevalence of dyspnea is low in non-severe COVID-19 patients, but contrary to our hypothesis of a relationship between shortness of breath and neurological symptoms, we have not been able to find any evidence of an impairment in dyspnea perception, either in the DYSP or NDYSP group.

关键词： complex   applied intelligent system   diagnostics   pattern recognition   regularities   decision-making   fault-tolerant irredundant unconditional diagnostic tests   threshold logic   fuzzy logic   cognitive graphic tools   psychological safety   cognitive sphere  

摘要： This article is devoted the foundations for designing a complex of applied intelligent systems for the diagnostics of the psychological safety and cognitive sphere of patients with a neurological pathology (IS DIPSYS-COS). Creation of a complex of applied IS DIPSYS-COS based on intelligent instrumental software IMSLOG will allow revealing various kinds of regularities of the psychological safety and cognitive sphere of patients on the base of the parameters (features) that determine the hardness, psychological well-being, world assumptions, and peculiarities of the cognitive sphere and that are required for decision-making using the graphic tools (including the cognitive graphic tools).

关键词： Central nervous system infections   Diagnostic markers   Genetics research  

摘要： Over the past two decades, the diagnosis rate for patients with encephalitis has remained poor despite advances in pathogen-specific testing such as PCR and antigen assays. Metagenomic next-generation sequencing (mNGS) of RNA and DNA extracted from cerebrospinal fluid and brain tissue now offers another strategy for diagnosing neurological infections. Given that mNGS simultaneously assays for a wide range of infectious agents in an unbiased manner, it can identify pathogens that were not part of a neurologist's initial differential diagnosis either because of the rarity of the infection, because the microorganism has not been previously associated with a clinical phenotype or because it is a newly discovered organism. This Review discusses the technical advantages and pitfalls of cerebrospinal fluid mNGS in the context of patients with neuroinflammatory syndromes, including encephalitis, meningitis and myelitis. We also speculate on how mNGS testing potentially fits into current diagnostic testing algorithms given data on mNGS test performance, cost and turnaround time. Finally, the Review highlights future directions for mNGS technology and other hypothesis-free testing methodologies that are in development. This Review discusses the advantages and pitfalls of metagenomic next-generation sequencing (mNGS) in patients with encephalitis, meningitis and myelitis. The authors outline data on mNGS test performance, cost and turnaround time and highlight future directions for mNGS technology.