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Journal of Pediatric Neurology 2017; 15(05): 228-240
DOI: 10.1055/s-0037-1604236
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Imaging of Atypical Brain Infections and Infection Mimics in Children

Gagandeep Choudhary
1   Division of Neuroradiology, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, United States
,
Jad Chokr
1   Division of Neuroradiology, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, United States
,
Unni K. Udayasankar
1   Division of Neuroradiology, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, United States
› Author Affiliations
Further Information

Publication History

17 April 2017

07 May 2017

Publication Date:
13 July 2017 (online)

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Abstract

Atypical brain infections in the pediatric age group are uncommon and different from the adult population; however, when present, they pose a diagnostic challenge and can result in serious and potentially fatal complications if not recognized and treated early in the course of the disease. Imaging plays a vital role because of relative inaccessibility to tissue sampling. This review article regroups the atypical pediatric brain infections (parasitic, fungal, viral, and bacterial) by age group (prenatal, perinatal, and post-neonatal period) and elucidates their characteristic imaging appearance, as well as focuses on their complications, in an aim to help clinicians (pediatricians/pediatric neuroradiologists/radiologists) better characterize, diagnose, and guide patient treatment. In addition, this review article also emphasizes on infection mimics of the central nervous system in order to empower our differential diagnosis, improve our diagnostic accuracy, and avoid unindicated patient management and treatment.

Keywords

atypical brain infections - infection mimics - CNS infections - pediatric infections - encephalitis
 

  • References

  • 1 Triulzi F, Doneda C, Parazzini C. Neuroimaging of pediatric brain infections. Expert Rev Anti Infect Ther 2011; 9 (06) 737-751
    CrossrefPubMedGoogle Scholar
  • 2 Blaser S, Jay V, Becker LE, Ford-Jones EL. “Neonatal brain infection.” MRI of the Neonatal Brain. London, UK: 2002. . Available at www.maryrutherfordimaging.co.uk
    Google Scholar
  • 3 Trimm F, Quiñonez JM. Congenital toxoplasmosis and congenital cytomegalovirus infection. Pediatr Med 2004; 2: 1-12
    PubMedGoogle Scholar
  • 4 Wallon M, Liou C, Garner P, Peyron F. Congenital toxoplasmosis: systematic review of evidence of efficacy of treatment in pregnancy. BMJ 1999; 318 (7197): 1511-1514
    CrossrefPubMedGoogle Scholar
  • 5 Chang L, Cornford ME, Chiang FL, Ernst TM, Sun NC, Miller BL. Radiologic-pathologic correlation. Cerebral toxoplasmosis and lymphoma in AIDS. Am J Neuroradiol 1995; 16 (08) 1653-1663
    PubMedGoogle Scholar
  • 6 Corey L, Whitley RJ, Stone EF, Mohan K. Difference between herpes simplex virus type I and type 2 neonatal encephalitis in neurological outcome. Lancet 1988; Jan; 331 (8575-8576): 1-4
    CrossrefPubMedGoogle Scholar
  • 7 Vossough A, Zimmerman RA, Bilaniuk LT, Schwartz EM. Imaging findings of neonatal herpes simplex virus type 2 encephalitis. Neuroradiology 2008; 50 (04) 355-366
    CrossrefPubMedGoogle Scholar
  • 8 Kurtz J, Anslow P. Infantile herpes simplex encephalitis: diagnostic features and differentiation from non-accidental injury. J Infect 2003; 46 (01) 12-16
    CrossrefPubMedGoogle Scholar
  • 9 Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am 2008; 18 (01) 53-84 , viii
    CrossrefPubMedGoogle Scholar
  • 10 Barkovich AJ. Pediatric Neuroimaging. Philadelphia, PA: Lippincott Williams & Wilkins; 2005
    Google Scholar
  • 11 Barnett EM, Jacobsen G, Evans G, Cassell M, Perlman S. Herpes simplex encephalitis in the temporal cortex and limbic system after trigeminal nerve inoculation. J Infect Dis 1994; 169 (04) 782-786
    CrossrefPubMedGoogle Scholar
  • 12 Ressler JA, Nelson M. Central nervous system infections in the pediatric population. Neuroimaging Clin N Am 2000; 10 (02) 427-443
    PubMedGoogle Scholar
  • 13 Parmar H, Ibrahim M. Pediatric intracranial infections. Neuroimaging Clin N Am 2012; 22 (04) 707-725
    CrossrefPubMedGoogle Scholar
  • 14 Lindegren ML, Byers Jr RH, Thomas P. , et al. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999; 282 (06) 531-538
    CrossrefPubMedGoogle Scholar
  • 15 Gavin P, Yogev R. Central nervous system abnormalities in pediatric human immunodeficiency virus infection. Pediatr Neurosurg 1999; 31 (03) 115-123
    CrossrefPubMedGoogle Scholar
  • 16 Volpe JJ. Neurology of the Newborn. Philadelphia, PA: Elsevier Health Sciences; 2008
    Google Scholar
  • 17 Bode H, Rudin C. Calcifying arteriopathy in the basal ganglia in human immunodeficiency virus infection. Pediatr Radiol 1995; 25 (01) 72-73
    CrossrefPubMedGoogle Scholar
  • 18 Shah SS, Zimmerman RA, Rorke LB, Vezina LG. Cerebrovascular complications of HIV in children. Am J Neuroradiol 1996; 17 (10) 1913-1917
    PubMedGoogle Scholar
  • 19 Thompson PM, Jahanshad N. Novel neuroimaging methods to understand how HIV affects the brain. Curr HIV/AIDS Rep 2015; 12 (02) 289-298
    CrossrefPubMedGoogle Scholar
  • 20 Soares de Oliveira-Szejnfeld P, Levine D, Melo AS. , et al. Congenital brain abnormalities and Zika virus: what the radiologist can expect to see prenatally and postnatally. Radiology 2016; 281 (01) 203-218
    CrossrefPubMedGoogle Scholar
  • 21 Singh RK, Dhama K, Malik YS. , et al. Zika virus – emergence, evolution, pathology, diagnosis, and control: current global scenario and future perspectives – a comprehensive review. Vet Q 2016; 36 (03) 150-175
    CrossrefPubMedGoogle Scholar
  • 22 Musso D, Roche C, Nhan TX, Robin E, Teissier A, Cao-Lormeau VM. Detection of Zika virus in saliva. J Clin Virol 2015; 68: 53-55
    CrossrefPubMedGoogle Scholar
  • 23 Cao-Lormeau V-M, Blake A, Mons S. , et al. Guillain–Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case–control study. Lancet 2016; 387 (10027): 1531-1539
    CrossrefPubMedGoogle Scholar
  • 24 Niemeyer B, Niemeyer R, Borges R, Marchiori E. Acute disseminated encephalomyelitis following Zika virus infection. Eur Neurol 2017; 77 (1-2): 45-46
    CrossrefPubMedGoogle Scholar
  • 25 Anagnostou T, Arvanitis M, Kourkoumpetis TK, Desalermos A, Carneiro HA, Mylonakis E. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore) 2014; 93 (01) 19-32
    CrossrefPubMedGoogle Scholar
  • 26 Kranick SM, Zerbe CS. Case report from the NIH Clinical Center: CNS nocardiosis. J Neurovirol 2013; 19 (05) 505-507
    CrossrefPubMedGoogle Scholar
  • 27 Zakaria A, Elwatidy S, Elgamal E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien) 2008; 150 (10) 1097-1101 , discussion 1101
    CrossrefPubMedGoogle Scholar
  • 28 Hector RF, Laniado-Laborin R. Coccidioidomycosis—a fungal disease of the Americas. PLoS Med 2005; 2 (01) e2
    CrossrefPubMedGoogle Scholar
  • 29 Rapini RP, Bolognia JL, Jorizzo JL. Dermatology: 2-Volume Set. St. Louis: Mosby; 2007: 1720
    Google Scholar
  • 30 Homans JD, Spencer L. Itraconazole treatment of nonmeningeal coccidioidomycosis in children: two case reports and review of the literature. Pediatr Infect Dis J 2010; 29 (01) 65-67
    CrossrefPubMedGoogle Scholar
  • 31 Galgiani JN, Ampel NM, Blair JE. , et al; Infectious Diseases Society of America. Coccidioidomycosis. Clin Infect Dis 2005; 41 (09) 1217-1223
    CrossrefPubMedGoogle Scholar
  • 32 Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies. Medicine (Baltimore) 2004; 83 (03) 149-175
    CrossrefPubMedGoogle Scholar
  • 33 Cortez KJ, Walsh TJ, Bennett JE. Successful treatment of coccidioidal meningitis with voriconazole. Clin Infect Dis 2003; 36 (12) 1619-1622
    CrossrefPubMedGoogle Scholar
  • 34 Arsura EL, Johnson R, Penrose J. , et al. Neuroimaging as a guide to predict outcomes for patients with coccidioidal meningitis. Clin Infect Dis 2005; 40 (04) 624-627
    CrossrefPubMedGoogle Scholar
  • 35 Erly WK, Bellon RJ, Seeger JF, Carmody RF. MR imaging of acute coccidioidal meningitis. Am J Neuroradiol 1999; 20 (03) 509-514
    PubMedGoogle Scholar
  • 36 McGahan JP, Graves DS, Palmer PE, Stadalnik RC, Dublin AB. Classic and contemporary imaging of coccidioidomycosis. Am J Roentgenol 1981; 136 (02) 393-404
    CrossrefPubMedGoogle Scholar
  • 37 Wrobel CJ, Meyer S, Johnson RH, Hesselink JR. MR findings in acute and chronic coccidioidomycosis meningitis. Am J Neuroradiol 1992; 13 (04) 1241-1245
    PubMedGoogle Scholar
  • 38 Hadley MN, Martin NA, Spetzler RF, Johnson PC. Multiple intracranial aneurysms due to Coccidioides immitis infection. Case report. J Neurosurg 1987; 66 (03) 453-456
    CrossrefPubMedGoogle Scholar
  • 39 Visudhiphan P, Bunyaratavej S, Khantanaphar S. Cerebral aspergillosis. Report of three cases. J Neurosurg 1973; 38 (04) 472-476
    CrossrefPubMedGoogle Scholar
  • 40 Harris DE, Enterline DS. Neuroimaging of AIDS. I. Fungal infections of the central nervous system. Neuroimaging Clin N Am 1997; 7 (02) 187-198
    PubMedGoogle Scholar
  • 41 Safder S, Carpenter JS, Roberts TD, Bailey N. The “Black Turbinate” sign: an early MR imaging finding of nasal mucormycosis. Am J Neuroradiol 2010; 31 (04) 771-774
    CrossrefPubMedGoogle Scholar
  • 42 Singhi P, Singhi S. Topical review: neurocysticercosis in children. J Child Neurol 2004; 19 (07) 482-492
    CrossrefPubMedGoogle Scholar
  • 43 Shandera WX, Kass JS. Neurocysticercosis: current knowledge and advances. Curr Neurol Neurosci Rep 2006; 6 (06) 453-459
    CrossrefPubMedGoogle Scholar
  • 44 Teitelbaum GP, Otto RJ, Lin M. , et al. MR imaging of neurocysticercosis. Am J Roentgenol 1989; 153 (04) 857-866
    CrossrefPubMedGoogle Scholar
  • 45 Kimura-Hayama ET, Higuera JA, Corona-Cedillo R. , et al. Neurocysticercosis: radiologic-pathologic correlation. Radiographics 2010; 30 (06) 1705-1719
    CrossrefPubMedGoogle Scholar
  • 46 Sheth TN, Pillon L, Keystone J, Kucharczyk W. Persistent MR contrast enhancement of calcified neurocysticercosis lesions. Am J Neuroradiol 1998; 19 (01) 79-82
    PubMedGoogle Scholar
  • 47 Arora SK, Aggarwal A, Datta V. Giant primary cerebral hydatid cyst: a rare cause of childhood seizure. J Pediatr Neurosci 2014; 9 (01) 73-75
    CrossrefPubMedGoogle Scholar
  • 48 Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiographics 2000; 20 (03) 795-817
    CrossrefPubMedGoogle Scholar
  • 49 Kızılca O, Altaş M, Senol U, Oztek MA. Hydatid disease located in the cerebellomedullary cistern. Case Rep Med 2014; 2014: 271365 . Doi: 10.1155/2014/271365
    PubMedGoogle Scholar
  • 50 Rumboldt Z, Jednacak H, Talan-Hranilović J, Rumboldt T, Kalousek M. Unusual appearance of a cisternal hydatid cyst. Am J Neuroradiol 2003; 24 (01) 112-114
    PubMedGoogle Scholar
  • 51 Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. Radiographics 2003; 23 (02) 475-494 , quiz 536–537
    CrossrefPubMedGoogle Scholar
  • 52 Sreedhar M. Disseminated hydatid disease. A case report with MR spectroscopic correlation. Ind J Radiol Imag 2006; Oct; 16 (04) 771-774
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Chand K, Kanodia AK, Manpreet G, Neeraj A. In vivo proton magnetic resonance spectroscopy in a known case of intracranial hydatid cyst. Neurol India 2005; 53 (03) 337-338
    CrossrefPubMedGoogle Scholar
  • 54 Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect 2010; 138 (07) 968-975
    CrossrefPubMedGoogle Scholar
  • 55 Movahedi Z, Shokrollahi MR, Aghaali M, Heydari H. Primary amoebic meningoencephalitis in an Iranian infant. Case Rep Med 2012; 2012: 782854 . Doi: 10.1155/2012/782854
    PubMedGoogle Scholar
  • 56 Shih RY, Koeller KK. Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives: from the radiologic pathology archives. Radiographics 2015; 35 (04) 1141-1169
    CrossrefPubMedGoogle Scholar
  • 57 Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections. J Protozool 1990; 37 (04) 25S-33S
    CrossrefPubMedGoogle Scholar
  • 58 Centers for Disease Control and Prevention (CDC). Balamuthia amebic encephalitis–California, 1999-2007. Morb Mortal Wkly Rep 2008; 57 (28) 768-771
    PubMedGoogle Scholar
  • 59 Combs Jr FJ, Erly WK, Valentino CM, Rance NE. Best cases from the AFIP: Balamuthia mandrillaris amebic meningoencephalitis. Radiographics 2011; 31 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 60 Brenton JN, Goodkin HP. Antibody-mediated autoimmune encephalitis in childhood. Pediatr Neurol 2016; 60: 13-23
    CrossrefPubMedGoogle Scholar
  • 61 Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. Am J Neuroradiol 2017; 38 (06) 1070-1078
    CrossrefPubMedGoogle Scholar
  • 62 Krupp LB, Banwell B, Tenembaum S. ; International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007; 68 (16) (Suppl. 02) S7-S12
    CrossrefPubMedGoogle Scholar
  • 63 Honkaniemi J, Dastidar P, Kähärä V, Haapasalo H. Delayed MR imaging changes in acute disseminated encephalomyelitis. Am J Neuroradiol 2001; 22 (06) 1117-1124
    PubMedGoogle Scholar
  • 64 Salehiomran MR, Nooreddini H, Baghdadi F. Acute necrotizing encephalopathy of childhood; a case report. Iran J Child Neurol 2013; 7 (02) 51-54
    PubMedGoogle Scholar
  • 65 Campistol J, Gassió R, Pineda M, Fernandez-Alvarez E. Acute necrotizing encephalopathy of childhood (infantile bilateral thalamic necrosis): two non-Japanese cases. Dev Med Child Neurol 1998; 40 (11) 771-774
    PubMedGoogle Scholar
  • 66 Wong AM, Simon EM, Zimmerman RA, Wang HS, Toh CH, Ng SH. Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. Am J Neuroradiol 2006; 27 (09) 1919-1923
    PubMedGoogle Scholar
  • 67 Voudris KA, Skaardoutsou A, Haronitis I, Vagiakou EA, Zeis PM. Brain MRI findings in influenza A-associated acute necrotizing encephalopathy of childhood. Eur J Paediatr Neurol 2001; 5 (05) 199-202
    CrossrefPubMedGoogle Scholar
  • 68 Yagishita A, Nakano I, Ushioda T, Otsuki N, Hasegawa A. Acute encephalopathy with bilateral thalamotegmental involvement in infants and children: imaging and pathology findings. Am J Neuroradiol 1995; 16 (03) 439-447
    PubMedGoogle Scholar
  • 69 Kim JH, Kim IO, Lim MK. , et al. Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome. Korean J Radiol 2004; 5 (03) 171-177
    CrossrefPubMedGoogle Scholar
  • 70 Rasmussen T, Olszewski J, Lloydsmith D. Focal seizures due to chronic localized encephalitis. Neurology 1958; 8 (06) 435-445
    CrossrefPubMedGoogle Scholar
  • 71 Rogers SW, Andrews PI, Gahring LC. Autoantibodies to glutamate receptor GIuR3 in Rasmussen's encephalitis. Science 1994; 265 (5172): 648-651
    CrossrefPubMedGoogle Scholar
  • 72 Cook SW, Nguyen ST, Hu B. , et al. Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg 2004; 100 (2, Suppl Pediatrics) 125-141
    CrossrefPubMedGoogle Scholar
  • 73 Bhatjiwale MG, Polkey C, Cox TC, Dean A, Deasy N. Rasmussen's encephalitis: neuroimaging findings in 21 patients with a closer look at the basal ganglia. Pediatr Neurosurg 1998; 29 (03) 142-148
    CrossrefPubMedGoogle Scholar
  • 74 Fiorella DJ, Provenzale JM, Coleman RE, Crain BJ, Al-Sugair AA. (18)F-fluorodeoxyglucose positron emission tomography and MR imaging findings in Rasmussen encephalitis. Am J Neuroradiol 2001; 22 (07) 1291-1299
    PubMedGoogle Scholar
  • 75 Majoie HJ, de Baets M, Renier W, Lang B, Vincent A. Antibodies to voltage-gated potassium and calcium channels in epilepsy. Epilepsy Res 2006; 71 (2-3): 135-141
    CrossrefPubMedGoogle Scholar
  • 76 Kotsenas AL, Watson RE, Pittock SJ. , et al. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. Am J Neuroradiol 2014; 35 (01) 84-89
    CrossrefPubMedGoogle Scholar
  • 77 Florance NR, Davis RL, Lam C. , et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009; 66 (01) 11-18
    CrossrefPubMedGoogle Scholar
  • 78 Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011; 10 (01) 63-74
    CrossrefPubMedGoogle Scholar
  • 79 Irani SR, Bera K, Waters P. , et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain 2010; 133 (Pt 6): 1655-1667
    CrossrefPubMedGoogle Scholar
  • 80 Azizyan A, Albrektson JR, Maya MM, Pressman BD, Moser F. Anti-NMDA encephalitis: an uncommon, autoimmune mediated form of encephalitis. J Radiol Case Rep 2014; 8 (08) 1-6
    CrossrefPubMedGoogle Scholar
  • 81 Hughes RAC, Cornblath DR. Guillain–Barré syndrome. Lancet 2005; 366 (9497): 1653-1666
    CrossrefPubMedGoogle Scholar
  • 82 Fulbright RK, Erdum E, Sze G, Byrne T. Cranial nerve enhancement in the Guillain–Barré syndrome. Am J Neuroradiol 1995; 16 (4, Suppl) 923-925
    PubMedGoogle Scholar
  • 83 Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956; 255 (02) 57-65
    CrossrefPubMedGoogle Scholar
  • 84 Saremi F, Helmy M, Farzin S, Zee CS, Go JL. MRI of cranial nerve enhancement. Am J Roentgenol 2005; 185 (06) 1487-1497
    CrossrefPubMedGoogle Scholar