Breitschwerdt Edward B, Maggi Ricardo G, Robveille Cynthia, Kingston Emily
From the Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
J Cent Nerv Syst Dis. 2025 Mar 12;17:11795735251322456. doi: 10.1177/11795735251322456. eCollection 2025.
In conjunction with more sensitive culture and molecular diagnostic testing modalities, simultaneous or sequential infection with more than 1 vector borne zoonotic pathogen is being increasingly documented in human patients. On a frequent basis, many people are exposed to apparently healthy, but infected, domestic and wild animals, the arthropod vectors with which these animals have co-evolved, and the bacterial, protozoal and other pathogens for which various animals are reservoirs. Unsuspected zoonotic transmission by scratch, bite, or vector exposures can result in chronic, indolent, or potentially life-threatening infections.
In December 2016, at 2 years of age, a male child residing in Ontario, Canada received facial scratches from a feral cat. In August 2018, seizures began 8 days after the child developed a focal, suspected insect bite rash. In June 2019, potential mold toxicity in the child's bedroom was assessed by fungal culture and urinary mycotoxin assays. Beginning in January 2022, spp. serology (indirect fluorescent antibody assays), polymerase chain reaction (PCR) amplification, DNA sequencing, and enrichment blood and brain cultures were used on a research basis to assess spp. bloodstream and central nervous system (brain biopsy) infection. In 2024, using recently developed PCR and DNA sequencing targets, species infection was retrospectively assessed due to the rash observed in 2018.
Although there was historical cat and suspected tick exposures, serological testing for and were repeatedly negative. Sequential neurodiagnostic testing partially supported a diagnosis of Rasmussen's encephalitis. Astrogliosis was the only brain biopsy histopathological abnormality. DNA was amplified and sequenced from enrichment cultures of brain tissue. Retrospectively, and -like MO-1 infections were confirmed by amplification and sequencing of DNA extracted from enrichment blood cultures processed in January 2022, from blood and brain tissue cultures in June 2022, and blood in January and June 2023.
Infection with . , . , and . -like MO-1, complicated by mycotoxin exposure, created a complex clinical scenario for this child, his parents, and his doctors.
随着培养和分子诊断检测方法越来越灵敏，人类患者同时或先后感染多种媒介传播的人畜共患病原体的情况越来越多地被记录下来。很多人经常接触看似健康但已感染的家养和野生动物、与这些动物共同进化的节肢动物媒介，以及以各种动物为宿主的细菌、原生动物和其他病原体。因抓伤、咬伤或接触媒介而发生的未被察觉的人畜共患病传播，可能导致慢性、隐匿性或潜在危及生命的感染。
2016年12月，一名居住在加拿大安大略省的男童在2岁时被一只野猫抓伤脸部。2018年8月，该儿童出现局部疑似昆虫叮咬皮疹8天后开始癫痫发作。2019年6月，通过真菌培养和尿液霉菌毒素检测评估了儿童卧室中潜在的霉菌毒性。从2022年1月开始，基于研究目的，使用 spp. 血清学（间接荧光抗体检测）、聚合酶链反应（PCR）扩增、DNA测序以及富集血培养和脑培养，来评估 spp. 血液和中枢神经系统（脑活检）感染情况。2024年，由于2018年观察到的皮疹，使用最近开发的PCR和DNA测序靶点对 物种感染进行回顾性评估。
尽管有接触猫和疑似蜱虫的既往史，但针对 和 的血清学检测多次呈阴性。系列神经诊断检测部分支持了拉斯穆森脑炎的诊断。星形胶质细胞增生是唯一的脑活检组织病理学异常。从脑组织富集培养物中扩增并测序了 DNA。回顾性分析发现，通过对2022年1月处理的富集血培养物、2022年6月的血液和脑组织培养物以及2023年1月和6月的血液中提取的DNA进行扩增和测序，证实了 和 类MO - 1感染。
感染 . 、. 和 . 类MO - 1，并伴有霉菌毒素暴露，给这名儿童及其父母和医生带来了复杂的临床情况。
