The Experts below are selected from a list of 270 Experts worldwide ranked by ideXlab platform
Apostolos Papandreou - One of the best experts on this subject based on the ideXlab platform.
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an unusual presentation of paediatric Listeria Meningitis with selective spinal grey matter involvement and acute demyelinating polyneuropathy
European Journal of Paediatric Neurology, 2016Co-Authors: Apostolos Papandreou, A Hedrerafernandez, Marios Kaliakatsos, W K Chong, Sanjay BhateAbstract:Abstract Background Paediatric Listeria Meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications. Methods We report an unusual case of Listeria Meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident. Results Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery. Conclusion Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria -related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
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PP10.14 – 2620: An unusual presentation of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement
European Journal of Paediatric Neurology, 2015Co-Authors: A. Hedrera-fernández, Apostolos Papandreou, W K Chong, Sanjay BhateAbstract:Objective Report an unusual case of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods Review of clinical records. Results A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of Meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions Listeria monocytogenes causes 5% of neonatal Meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.
Sanjay Bhate - One of the best experts on this subject based on the ideXlab platform.
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an unusual presentation of paediatric Listeria Meningitis with selective spinal grey matter involvement and acute demyelinating polyneuropathy
European Journal of Paediatric Neurology, 2016Co-Authors: Apostolos Papandreou, A Hedrerafernandez, Marios Kaliakatsos, W K Chong, Sanjay BhateAbstract:Abstract Background Paediatric Listeria Meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications. Methods We report an unusual case of Listeria Meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident. Results Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery. Conclusion Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria -related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
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PP10.14 – 2620: An unusual presentation of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement
European Journal of Paediatric Neurology, 2015Co-Authors: A. Hedrera-fernández, Apostolos Papandreou, W K Chong, Sanjay BhateAbstract:Objective Report an unusual case of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods Review of clinical records. Results A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of Meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions Listeria monocytogenes causes 5% of neonatal Meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.
Antonios Bayas - One of the best experts on this subject based on the ideXlab platform.
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Listeria Meningitis complicating alemtuzumab treatment in multiple sclerosis report of two cases
International Journal of Molecular Sciences, 2015Co-Authors: Michael Lang, Andreas Harth, Markus Naumann, Frank Weber, Hayrettin Tumani, Antonios BayasAbstract:Alemtuzumab, a humanized monoclonal antibody targeting the surface molecule CD52, leads to a rapid depletion of immune cells in the innate and adaptive immune system. In phase 2 and 3 trials in multiple sclerosis (MS), infections have been reported more frequently in alemtuzumab than in interferon beta treated patients. Here we report two patients treated with alemtuzumab for MS developing Listeria Meningitis few days after the first infusion cycle. Both patients recovered completely after prompt diagnosis and adequate treatment. Physicians and patients should be aware of this serious, but treatable complication.
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Listeria Meningitis Complicating Alemtuzumab Treatment in Multiple Sclerosis—Report of Two Cases
International Journal of Molecular Sciences, 2015Co-Authors: Michael Lang, Andreas Harth, Markus Naumann, Frank Weber, Hayrettin Tumani, Antonios BayasAbstract:Alemtuzumab, a humanized monoclonal antibody targeting the surface molecule CD52, leads to a rapid depletion of immune cells in the innate and adaptive immune system. In phase 2 and 3 trials in multiple sclerosis (MS), infections have been reported more frequently in alemtuzumab than in interferon beta treated patients. Here we report two patients treated with alemtuzumab for MS developing Listeria Meningitis few days after the first infusion cycle. Both patients recovered completely after prompt diagnosis and adequate treatment. Physicians and patients should be aware of this serious, but treatable complication.
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Listeria Meningitis complicating alemtuzumab treatment for multiple sclerosis p3 265
Neurology, 2015Co-Authors: Antonios Bayas, Andreas Rank, Markus NaumannAbstract:Objective / background: Alemtuzumab, an antibody directed against CD52, is approved for the treatment of relapsing-remitting multiple sclerosis (MS) in Europe. Potential side effects include an increased infection rate. Methods:We describe a patient, who developed Listeria monocytogenes Meningitis few days after receiving the first alemtuzumab infusions. Results: First MS symptoms in the 43 years old, female Caucasian patient occured in February 2014 with thoracal myelitis resulting in a progressive deterrioration of gait with loss of the ability to stand without assistance. A cranial and thoracal MRI revealed multiple lesions, some of them with gadolinium enhancement. Repeated glucocorticosteroid pulse therapies, followed by immune adsorption resulted in a relevant, however incomplete recovery. In May 2014 the second relapse occured with swallowing difficulties. Repeated cranial and spinal MRI controls revealed new and / or active lesions at each examination. Due to the high disease activity, in June 2014 the patient received alemtuzumab 12 mg daily over 5 days. Treatment was well tolerated apart from an exanthema. On the fourth day after the last infusion the patient developed fever until 104,7 °F. At admission CRP was 16,7 mg/dl (normal range 0-0,5), urine analysis as well as a CT-scan of the chest and abdominal ultrasound did not reveal an underlying cause. Empircally an antiinfective treatment was initiated. Eight days after the last alemtuzumab infusion, the patient developed headache and meningism. The cerebrospinal fluid revealed a pleocytosis of 195 leucocytes/µl, predominantely neutrophils (72[percnt]), in CSF and blood cultures Listeria monocytogenes could be detected. The patient was treated with ampicillin and gentamycine for 3 weeks. The patient´s condition improved rapidly and she finally recovered completely. Conclusions:To our knowledge this is the third case of a Listeria Meningitis after alemtuzumab treatment worldwide. Physicians and patients should be aware of this serious, but treatable complication. Disclosure: Dr. Bayas has received personal compensation for activities with Merck Serono, Biogen Idec, Novartis, and Sanofi, and Genzyme as a consultant and/or speaker. Dr. Rank has nothing to disclose. Dr. Naumann has nothing to disclose.
Markus Naumann - One of the best experts on this subject based on the ideXlab platform.
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Listeria Meningitis complicating alemtuzumab treatment in multiple sclerosis report of two cases
International Journal of Molecular Sciences, 2015Co-Authors: Michael Lang, Andreas Harth, Markus Naumann, Frank Weber, Hayrettin Tumani, Antonios BayasAbstract:Alemtuzumab, a humanized monoclonal antibody targeting the surface molecule CD52, leads to a rapid depletion of immune cells in the innate and adaptive immune system. In phase 2 and 3 trials in multiple sclerosis (MS), infections have been reported more frequently in alemtuzumab than in interferon beta treated patients. Here we report two patients treated with alemtuzumab for MS developing Listeria Meningitis few days after the first infusion cycle. Both patients recovered completely after prompt diagnosis and adequate treatment. Physicians and patients should be aware of this serious, but treatable complication.
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Listeria Meningitis Complicating Alemtuzumab Treatment in Multiple Sclerosis—Report of Two Cases
International Journal of Molecular Sciences, 2015Co-Authors: Michael Lang, Andreas Harth, Markus Naumann, Frank Weber, Hayrettin Tumani, Antonios BayasAbstract:Alemtuzumab, a humanized monoclonal antibody targeting the surface molecule CD52, leads to a rapid depletion of immune cells in the innate and adaptive immune system. In phase 2 and 3 trials in multiple sclerosis (MS), infections have been reported more frequently in alemtuzumab than in interferon beta treated patients. Here we report two patients treated with alemtuzumab for MS developing Listeria Meningitis few days after the first infusion cycle. Both patients recovered completely after prompt diagnosis and adequate treatment. Physicians and patients should be aware of this serious, but treatable complication.
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Listeria Meningitis complicating alemtuzumab treatment for multiple sclerosis p3 265
Neurology, 2015Co-Authors: Antonios Bayas, Andreas Rank, Markus NaumannAbstract:Objective / background: Alemtuzumab, an antibody directed against CD52, is approved for the treatment of relapsing-remitting multiple sclerosis (MS) in Europe. Potential side effects include an increased infection rate. Methods:We describe a patient, who developed Listeria monocytogenes Meningitis few days after receiving the first alemtuzumab infusions. Results: First MS symptoms in the 43 years old, female Caucasian patient occured in February 2014 with thoracal myelitis resulting in a progressive deterrioration of gait with loss of the ability to stand without assistance. A cranial and thoracal MRI revealed multiple lesions, some of them with gadolinium enhancement. Repeated glucocorticosteroid pulse therapies, followed by immune adsorption resulted in a relevant, however incomplete recovery. In May 2014 the second relapse occured with swallowing difficulties. Repeated cranial and spinal MRI controls revealed new and / or active lesions at each examination. Due to the high disease activity, in June 2014 the patient received alemtuzumab 12 mg daily over 5 days. Treatment was well tolerated apart from an exanthema. On the fourth day after the last infusion the patient developed fever until 104,7 °F. At admission CRP was 16,7 mg/dl (normal range 0-0,5), urine analysis as well as a CT-scan of the chest and abdominal ultrasound did not reveal an underlying cause. Empircally an antiinfective treatment was initiated. Eight days after the last alemtuzumab infusion, the patient developed headache and meningism. The cerebrospinal fluid revealed a pleocytosis of 195 leucocytes/µl, predominantely neutrophils (72[percnt]), in CSF and blood cultures Listeria monocytogenes could be detected. The patient was treated with ampicillin and gentamycine for 3 weeks. The patient´s condition improved rapidly and she finally recovered completely. Conclusions:To our knowledge this is the third case of a Listeria Meningitis after alemtuzumab treatment worldwide. Physicians and patients should be aware of this serious, but treatable complication. Disclosure: Dr. Bayas has received personal compensation for activities with Merck Serono, Biogen Idec, Novartis, and Sanofi, and Genzyme as a consultant and/or speaker. Dr. Rank has nothing to disclose. Dr. Naumann has nothing to disclose.
W K Chong - One of the best experts on this subject based on the ideXlab platform.
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an unusual presentation of paediatric Listeria Meningitis with selective spinal grey matter involvement and acute demyelinating polyneuropathy
European Journal of Paediatric Neurology, 2016Co-Authors: Apostolos Papandreou, A Hedrerafernandez, Marios Kaliakatsos, W K Chong, Sanjay BhateAbstract:Abstract Background Paediatric Listeria Meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications. Methods We report an unusual case of Listeria Meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident. Results Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery. Conclusion Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria -related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
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PP10.14 – 2620: An unusual presentation of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement
European Journal of Paediatric Neurology, 2015Co-Authors: A. Hedrera-fernández, Apostolos Papandreou, W K Chong, Sanjay BhateAbstract:Objective Report an unusual case of Listeria Meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods Review of clinical records. Results A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of Meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions Listeria monocytogenes causes 5% of neonatal Meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.