Encefalitis anti-NMDA-R secundaria a infeccion por SARS-CoV-2 Anti-NMDA receptor encephalitis secondary to SARS-CoV-2 infection
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PROVIDER: S-EPMC7396884 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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| S-EPMC7546184 | biostudies-literature
Project description:The global impact of SARS-CoV-2 infection has raised concerns about secondary diseases beyond acute illness. This review explores the significance and potential underlying mechanisms of how SARS-CoV-2 infection might elicit an immune response targeting N-methyl-D-aspartate (NMDA) receptors, and its implications for autoimmune-driven neuropsychiatric manifestations. We identified 19 published case reports of NMDA receptor encephalitis associated with SARS-CoV-2 infection or vaccination by a systematic literature search. The significance of these reports was limited since it is not clear if a coincidental or causal relationship exists between SARS-CoV-2 infection or vaccination and manifestation of NMDA receptor encephalitis. The included studies were hampered by difficulties in establishing if these patients had pre-existing NMDA receptor antibodies which entered the brain by infection- or vaccination-associated transient blood-brain barrier leakage. In addition, four cases had comorbid ovarian teratoma, which is a known trigger for development of NMDA receptor encephalitis. Considering that billions of people have contracted COVID-19 or have been vaccinated against this virus, the publication of only 19 case reports with a possible link to NMDA receptor encephalitis, indicates that it is rare. In conclusion, these findings do not support the case that SARS-CoV-2 infection or vaccination led to an increase of existing or de novo encephalitis mediated by an autoimmune response targeting NMDA receptor function. Nevertheless, this work underscores the importance of ongoing vigilance in monitoring viral outbreaks and their potential impact on the central nervous system through basic, epidemiological and translational research.
| S-EPMC10923949 | biostudies-literature
Project description:ObjectiveTo describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalitis in patients ≥45 years old.MethodObservational cohort study.ResultsIn a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients ≥45 years old. Compared with younger adults (18-44 years), older patients were more often male (45% vs. 12%, p < 0.0001), had lower frequency of tumors (23% vs. 51%, p = 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p = 0.009) and treatment (7 vs. 4 weeks, p = 0.039), and had less favorable outcome (modified Rankin Scale score 0-2 at 2 years, 60% vs. 80%, p < 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05-0.39, p = 0.0001), early treatment (OR 0.60, CI 0.47-0.78, p < 0.0001), no need for intensive care (OR 0.09, CI 0.04-0.22, p < 0.0001), and longer follow-up (p < 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10-7.76, p = 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up.ConclusionsAnti-NMDAR encephalitis is less severe in patients ≥45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome.
| S-EPMC3795591 | biostudies-literature
Project description:Anti-N-methyl-d-aspartate (Anti-NMDA) receptor encephalitis is an acute autoimmune neurological disorder. The cause of this disease is often unknown, and previous studies revealed that it might be caused by a virus, vaccine or tumor. It occurs more often in females than in males. Several cases were reported to be related to vaccination such as the H1N1 vaccine and tetanus/diphtheria/pertussis and polio vaccines. In this study, we reported an anti-NMDA receptor encephalitis case that may be caused by Japanese encephalitis vaccination. To investigate the association between anti-NMDA receptor encephalitis and vaccination, we analyzed the phylogenetic relationship of the microRNAs, which significantly regulate these vaccine viruses or bacteria, and the phylogenetic relationship of these viruses and bacteria. This reveals that anti-NMDA receptor encephalitis may be caused by Japanese encephalitis vaccination, as well as H1N1 vaccination or tetanus/diphtheria/pertussis and polio vaccinations, from the phylogenetic viewpoint.
| S-EPMC5297824 | biostudies-literature
Project description:Introduction After the World Health Organization declared the COVID-19 outbreak a pandemic, the number of patients with confirmed SARS-CoV-2 infection (COVID-19) has increased exponentially, and gastroenterologists and other specialists most likely will be involved in the care of those patients. Aim To evaluate the knowledge Latin American gastroenterologists and endoscopists (staff physicians and residents) have about the characteristics of COVID-19, as well as the prevention measures to be taken during endoscopic procedures. Materials and methods We conducted a cross-sectional study that included gastroenterologists and endoscopists from 9 Latin American countries. An electronic questionnaire was applied that was designed to evaluate the knowledge of symptoms, risk groups for severe disease, prevention measures, and the reprocessing of endoscopes utilized in patients with COVID-19. Results Information was obtained from 133 physicians. Ninety-five percent of them correctly identified the most frequent symptoms of the virus, and 60% identified the 3 risk groups for severe disease. Sixty-six percent of those surveyed did not consider it necessary to use standard precautions during endoscopic procedures, and 30% did not consider contact precautions necessary. Forty-eight percent of the participants surveyed were not familiar with the protocol for reprocessing the endoscopes utilized in patients with COVID-19. Conclusion The majority of the gastroenterologists and endoscopists surveyed were familiar with the signs and symptoms of COVID-19 and the populations at risk for complications. There was a lack of knowledge about prevention measures (during clinical care and endoscopic procedures) and the reprocessing of endoscopic equipment by 70% and 48%, respectively, of those surveyed. Dissemination and teaching strategies that increase the knowledge of specific biosafety measures must be carried out.
| S-EPMC7261444 | biostudies-literature
Project description: Not available
| S-EPMC9234054 | biostudies-literature
Project description:Introducción La artritis reactiva (ReA) es una monoartritis u oligoartritis que compromete principalmente las extremidades, y se puede relacionar con infecciones bacterianas o virales. En la actualidad, la COVID-19 se ha relacionado con el desarrollo de artropatías debido a su componente inflamatorio. Objetivos Llevar a cabo una revisión exploratoria de la literatura que describa las características clínicas de la ReA en pacientes sobrevivientes a la infección por SARS-CoV-2. Materiales y métodos Revisión sistemática exploratoria basada en las guías para comunicar revisiones sistemáticas adaptadas para las revisiones exploratorias Prisma-P y pasos propuestos por Arksey y ajustados por Levan. Se incluyeron estudios de tipo experimental y observacional publicados en PubMed y Scopus, en inglés y español, que respondieran las preguntas de investigación planteadas. Resultados Se incluyeron 25 documentos que describen las principales manifestaciones clínicas de la ReA en 27 pacientes con antecedente de infección por SARS-CoV-2. El tiempo desde el inicio de los síntomas o diagnóstico microbiológico de la COVID-19 hasta el desarrollo de manifestaciones articulares o extraarticulares compatibles con ReA osciló entre 7 y 120 días. Las manifestaciones articulares clínicas descritas fueron las artralgias y el edema de predominio en articulaciones de las rodillas, los tobillos, los codos, las interfalángicas, las metatarsofalángicas y las metacarpofalángicas. Conclusiones Las artralgias en las extremidades son el principal síntoma de la ReA en pacientes con antecedente de COVID-19. Sus síntomas se pueden presentar en un periodo de días a semanas, desde el inicio de los síntomas clínicos o el diagnóstico microbiológico de la infección por SARS-CoV-2.
| S-EPMC10235672 | biostudies-literature
Project description:Introducción en 2019 surgió el SARS-CoV-2, causante de la pandemia por la COVID-19 que se extendió rápidamente alrededor del mundo; en casos graves, este puede desencadenar un síndrome de tormenta de citoquinas y conllevar a la muerte. Las manifestaciones cutáneas pueden asociarse a la expresión del receptor ACE2 en queratinocitos, estas se han descrito en la literatura de diversos países. La presente revisión busca documentar las presentaciones cutáneas que se han descrito en los pacientes con COVID-19 en América Latina. Metodología realizamos una búsqueda en 9 bases de datos de artículos en español, portugués e inglés, hasta el 10 de marzo del 2021, utilizando los términos: «Skin», «Cutaneous manifestations», «COVID 19», «SARS-CoV-2», asociándolos al nombre de los países latinoamericanos. Se obtuvieron los datos básicos de los pacientes incluidos, luego se creó una tabla en Microsoft Excel para analizar y comparar los datos. Resultados se identificaron 22 publicaciones de 9 países. Obtuvimos información de 92 pacientes, predominantemente de sexo femenino y edad promedio de 31,6 años. Fueron documentadas 99 lesiones dermatológicas, en orden de frecuencia correspondieron a erupciones cutáneas, habones, petequias-púrpura y pápulas. En 70 pacientes se describió el segmento corporal afectado, principalmente el tronco, los miembros inferiores y superiores. Encontramos 39 fotografías y 5 histopatologías. Los tratamientos más comunes fueron los corticoides, los antipalúdicos y el interferón recombinante. Conclusiones se observan diferencias en las manifestaciones cutáneas por la COVID-19, entre las publicaciones latinoamericanas en comparación a los demás países. Parece haber un patrón propio, donde predomina la erupción cutánea eritematosa con habones, mientras que la pseudo-perniosis fue menos representativa.
| S-EPMC8995250 | biostudies-literature
Project description: Not available
| S-EPMC7327341 | biostudies-literature
Project description:ObjectiveTo evaluate the therapeutic potential of bortezomib, a proteasome inhibitor that target plasma cells, in order to revive stalled recovery in patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis who remain bedridden even after aggressive immunotherapy.MethodsWe consecutively enrolled patients with anti-NMDA receptor encephalitis who remained bedridden after first-line immunotherapy (steroids and intravenous immunoglobulin), second-line immunotherapy (rituximab), and tocilizumab treatment, and treated them with subcutaneous bortezomib. Clinical response, functional recovery, and changes in antibody titer in the serum and cerebrospinal fluid were measured.ResultsBefore the bortezomib treatment, the five patients with severe refractory anti-NMDA receptor encephalitis were in a vegetative state. During the 8 months of follow-up period, three patients improved to minimally conscious states within 2 months of bortezomib treatment, one failed to improve from a vegetative state. However, no patient achieved functional recovery as measured by the modified Rankin Scale score (mRS). Three patients advanced to a cyclophosphamide with bortezomib and dexamethasone regimen, which only resulted in additional adverse events, without mRS improvement. Among the four patients whose antibody titer was followed, two demonstrated a twofold decrease in the antibody titer in serum and/or cerebrospinal fluid after 2 cycles of bortezomib.InterpretationAlthough there were some improvements in severe refractory patients, clinical response to bortezomib was limited and not clearly distinguishable from the natural course of the disease. The clinical benefit of bortezomib in recent studies requires further validation in different clinical settings.
| S-EPMC5945964 | biostudies-literature