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Submitted
December 21, 2020
Accepted
October 4, 2021
Published
December 11, 2021
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Abstract
Neuroinfectious diseases continue to have a profound public health impact, particularly in resource-limited settings. Here we summarize the new research into pathophysiology, diagnosis, and treatment modalities for some of the most frequent and lethal infections affecting the central nervous system, including tuberculosis, malaria, and arboviral infections. Implementation of clinical trials targeting neuroinfectious diseases in resource-limited settings has unique challenges not found when identical research is performed in resource-rich areas. Travel, communications, and technology have improved the mobility of populations worldwide. Immigration and increased international travel make it likely that clinicians worldwide will see patients affected by infectious diseases such as malaria, tuberculosis, zika, dengue, chikungunya, and Ebola. Such infections may have devastating consequences for both the individual and the society, particularly if clinicians are not familiar with disease presentation and treatment.
Keywords
Keywords: CNS infection; Malaria; Tuberculosis; Zika; Dengue; Chikungunya; Clinical trials
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Copyright (c) 2021 Maria Teresa Acosta, Arushi Gahlot Saini, Douglas Postels, Marco T Medina, Alfredo Cerisola, Pratibha Singhi
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How to Cite
Acosta, M. ., Saini, A. G., Postels, D. ., Medina, M., Cerisola, A. ., & Singhi , P. . (2021). Tropical Infections of the CNS: A worldwide problem: Tropical CNS Infections. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2021.224
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References
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128.
2. Singhi P, Saini AG. Fungal and Parasitic CNS Infections. Indian J Pediatr. 2019;86(1):83-90.
3. Singhi P, Saini AG. Pediatric Neurocysticercosis. Indian J Pediatr. 2019;86(1):76-82.
4. Singhi P. Central Nervous System Infections in Children: An Ongoing Challenge! Indian J Pediatr. 2019;86(1):49-51.
5. Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2014;14(10):947-57.
6. Thwaites GE, Tran TH. Tuberculous meningitis: many questions, too few answers. Lancet Neurol. 2005;4(3):160-70.
7. Marais S, Thwaites G, Schoeman JF, Torok ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803-12.
8. Sharawat IK, Saini AG, Vyas S, Sankhyan N. "Encased brain" in hypertrophic pachymeningitis. Childs Nerv Syst. 2019;35(4):585-7.
9. Kusum S, Aman S, Pallab R, Kumar SS, Manish M, Sudesh P, et al. Multiplex PCR for rapid diagnosis of tuberculous meningitis. J Neurol. 2011;258(10):1781-7.
10. Pormohammad A, Nasiri MJ, McHugh TD, Riahi SM, Bahr NC. A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis. J Clin Microbiol. 2019;57(6).
11. Kay AW, Gonzalez Fernandez L, Takwoingi Y, Eisenhut M, Detjen AK, Steingart KR, et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database Syst Rev. 2020;8:CD013359.
12. Guidance for national tuberculosis programmes on the management of tuberculosis in children – 2nd ed. 2014.
13. van Toorn R, Solomons R. Update on the diagnosis and management of tuberculous meningitis in children. Semin Pediatr Neurol. 2014;21(1):12-8.
14. Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011;303(1-2):22-30.
15. Rizvi I, Garg RK, Malhotra HS, Kumar N, Uniyal R. Role of Aspirin in Tuberculous Meningitis: A Systematic Review and Meta-analysis. Neurol India. 2019;67(4):993-1002.
16. Sharma R, Saini AG, Katoch D, Bhatia V. Never Forget the Optic Fundi in Tuberculosis! J Pediatr. 2018;195:305.
17. Sinha MK, Garg RK, Anuradha H, Agarwal A, Singh MK, Verma R, et al. Vision impairment in tuberculous meningitis: predictors and prognosis. J Neurol Sci. 2010;290(1-2):27-32.
18. Singanamalla B, Saini AG, Sidana V, Saini L, Sankhyan N, Singh P. Progressive quadriparesis and inflammation: A common disease, a rare presentation. Indian J Tuberc. 2020;67(3):336-9.
19. Saini AG, Verma S, Sodhi KS. Tubercular Dactylitis in a Young Boy. J Pediatr. 2018;195:304- e1.
20. Kumar A, Gupta D, Nagaraja SB, Singh V, Sethi GR, Prasad J, et al. Updated national guidelines for pediatric tuberculosis in India, 2012. Indian Pediatr. 2013;50(3):301-6.
21. National Collaborating Centre for Chronic Conditions (UK); Centre for Clinical Practice at NICE (UK). Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. London: National Institute for Health and Clinical Excellence (UK); 2011 Mar. PMID: 22720337.
22. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2019.
Licence: CC BY-NC-SA 3.0 IGO.
23. Ettehad D, Schaaf HS, Seddon JA, Cooke GS, Ford N. Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(6):449-56.
24. Torok ME, Nguyen DB, Tran TH, Nguyen TB, Thwaites GE, Hoang TQ, et al. Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. PLoS One. 2011;6(12):e27821.
25. Marais S, Pepper DJ, Marais BJ, Torok ME. HIV-associated tuberculous meningitis--diagnostic and therapeutic challenges. Tuberculosis (Edinb). 2010;90(6):367-74.
26. Meintjes G, Stek C, Blumenthal L, Thienemann F, Schutz C, Buyze J, et al. Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS. The New England journal of medicine. 2018;379(20):1915-25.
27. Keeley AJ, Parkash V, Tunbridge A, Greig J, Collini P, McKane W, et al. Anakinra in the treatment of protracted paradoxical inflammatory reactions in HIV-associated tuberculosis in the United Kingdom: a report of two cases. Int J STD AIDS. 2020;31(8):808-12.
28. Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12(10):999-1010.
29. Andronikou S, Smith B, Hatherhill M, Douis H, Wilmshurst J. Definitive neuroradiological diagnostic features of tuberculous meningitis in children. Pediatr Radiol. 2004;34(11):876-85.
30. Saini AG, Dogra S, Kumar R, Nada R, Singh M. Primary tuberculous cerebellar abscess: case report. Ann Trop Paediatr. 2011;31(4):367-9.
31. Saini AG, Dogra S, Devidayal, Kumar R, Singh P. Cervical intramedullary conglomerate tuberculomas with tuberculous meningitis--rapid response to medical therapy. Paediatr Int Child Health. 2012;32(3):171-3.
32. Donovan J, Cresswell FV, Thuong NTT, Boulware DR, Thwaites GE, Bahr NC, et al. Xpert MTB/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward. Clin Infect Dis. 2020;71(8):2002-5.
33. Cresswell FV, Tugume L, Bahr NC, Kwizera R, Bangdiwala AS, Musubire AK, et al. Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study. Lancet Infect Dis. 2020;20(3):308-17.
34. Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM, Jr. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2003;3(10):633-43.
35. Agarwal S, Saini AG, Dhawan S, Khadwal A, Sharma K, Singhi P. Comparative evaluation of IS6110 and protein antigen b PCR in cerebrospinal fluid for rapid diagnosis of tuberculous meningitis in children. J Med Microbiol. 2020;69(7):979-85.
36. Tuon FF, Higashino HR, Lopes MI, Litvoc MN, Atomiya AN, Antonangelo L, et al. Adenosine deaminase and tuberculous meningitis--a systematic review with meta-analysis. Scand J Infect Dis. 2010;42(3):198-207.
37. World Malaria Report 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
38. Severe malaria. Trop Med Int Health. 2014;19 Suppl 1:7-131.
39. Saini A DS, Devidayal, Nada R, Ramachandran R, Doraiswamy A. Glomerular thrombotic microangiopathy caused by Plasmodium vivax infection. Journal of Pediatric Sciences ; . 2012;4:e123.
40. Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JS, Fosiko NG, et al. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med. 2004;10(2):143-5.
41. Barrera V, Hiscott PS, Craig AG, White VA, Milner DA, Beare NA, et al. Severity of retinopathy parallels the degree of parasite sequestration in the eyes and brains of malawian children with fatal cerebral malaria. J Infect Dis. 2015;211(12):1977-86.
42. Postels DG, Osei-Tutu L, Seydel KB, Xu Q, Li C, Taylor TE, et al. Central Nervous System Virus Infection in African Children with Cerebral Malaria. Am J Trop Med Hyg. 2020;103(1):200-5.
43. Christensen SS, Eslick GD. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2015;109(4):233-8.
44. Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012(6):CD005967.
45. Idro R, Jenkins NE, Newton CR. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol. 2005;4(12):827-40.
46. Crawley J, Waruiru C, Mithwani S, Mwangi I, Watkins W, Ouma D, et al. Effect of phenobarbital on seizure frequency and mortality in childhood cerebral malaria: a randomised, controlled intervention study. Lancet. 2000;355(9205):701-6.
47. Gwer SA, Idro RI, Fegan G, Chengo EM, Mpoya A, Kivaya E, et al. Fosphenytoin for seizure prevention in childhood coma in Africa: a randomized clinical trial. J Crit Care. 2013;28(6):1086-92.
48. Birbeck GL, Herman ST, Capparelli EV, Dzinjalamala FK, Abdel Baki SG, Mallewa M, et al. A clinical trial of enteral Levetiracetam for acute seizures in pediatric cerebral malaria. BMC pediatrics. 2019;19(1):399.
49. Enwere G. A review of the quality of randomized clinical trials of adjunctive therapy for the treatment of cerebral malaria. Trop Med Int Health. 2005;10(11):1171-5.
50. Seydel KB, Kampondeni SD, Valim C, Potchen MJ, Milner DA, Muwalo FW, et al. Brain swelling and death in children with cerebral malaria. The New England journal of medicine. 2015;372(12):1126-37.
51. Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med. 2020;17(10):e1003359.
52. State of the Tropics (2020) State of the Tropics 2020 Report. James Cook University, Townsville, Australia. .
53. Medina M, Meshram C, England J. Tropical Neurology Education: a World Federation of Neurology outstanding priority J Neurol Sciences In Press. 2020.
54. Beckham JD, Tyler KL. Arbovirus Infections. Continuum (Minneap Minn). 2015;21(6 Neuroinfectious Disease):1599-611.
55. Peltier DC, Lazear HM, Farmer JR, Diamond MS, Miller DJ. Neurotropic arboviruses induce interferon regulatory factor 3-mediated neuronal responses that are cytoprotective, interferon independent, and inhibited by Western equine encephalitis virus capsid. J Virol. 2013;87(3):1821-33.
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