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Erschienen in: Current Neurology and Neuroscience Reports 1/2016

01.01.2016 | Infection (J Halperin, Section Editor)

Infection and Stroke: an Update on Recent Progress

verfasst von: Eliza C. Miller, Mitchell S. V. Elkind

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 1/2016

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Abstract

The role of infection in cerebrovascular disease is complex and remains incompletely understood. Over the last 5 years, investigators have made notable inroads in untangling this thorny topic. In this review, we examine these recent developments, concentrating on four aspects of the relationship between infection and stroke. We first discuss specific infectious agents as direct causes of stroke, focusing on recent work implicating herpesviruses and HIV in cerebral vasculopathy. We then discuss systemic infection of any type as a stroke trigger, focusing on the relationship of infection to timing of acute stroke, both in children and adults, as well as the role of vaccination in stroke prevention. We examine the evidence for chronic infection or “infectious burden” as a stroke risk factor. Finally, we discuss recent work on infection as a risk factor for increased morbidity after stroke, possible mechanisms mediating this effect, and the evidence for prophylactic antibiotics.
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Zurück zum Zitat Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, et al. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology. 2014;83:1705–11. This retrospective cohort study used billing data to compare rates of ICH in HIV-infected and uninfected patients. The incidence of ICH was higher in the HIV-infected patients (unadjusted incidence rate ratio of 1.85, 95%CI 1.37-2.47, p < 0.001). In the multivariable model, the effect was more pronounced in young patients and in women.PubMedPubMedCentralCrossRef Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, et al. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology. 2014;83:1705–11. This retrospective cohort study used billing data to compare rates of ICH in HIV-infected and uninfected patients. The incidence of ICH was higher in the HIV-infected patients (unadjusted incidence rate ratio of 1.85, 95%CI 1.37-2.47, p < 0.001). In the multivariable model, the effect was more pronounced in young patients and in women.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol. 2015. Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol. 2015.
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Zurück zum Zitat Sweeney EM, Thakur KT, Lyons JL, Smith BR, Willey JZ, Cervantes-Arslanian AM, et al. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. Eur J Neurol. 2014;21:1394–9.PubMedCrossRef Sweeney EM, Thakur KT, Lyons JL, Smith BR, Willey JZ, Cervantes-Arslanian AM, et al. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. Eur J Neurol. 2014;21:1394–9.PubMedCrossRef
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Zurück zum Zitat Gutierrez J, Glenn M, Isaacson RS, Marr AD, Mash D, Petito C. Thinning of the arterial media layer as a possible preclinical stage in HIV vasculopathy: a pilot study. Stroke. 2012;43:1156–8.PubMedCrossRef Gutierrez J, Glenn M, Isaacson RS, Marr AD, Mash D, Petito C. Thinning of the arterial media layer as a possible preclinical stage in HIV vasculopathy: a pilot study. Stroke. 2012;43:1156–8.PubMedCrossRef
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Zurück zum Zitat Gutierrez J, Elkind MSV, Petito C, Chung DY, Dwork AJ, Marshall RS. The contribution of HIV infection to intracranial arterial remodeling: a pilot study. Neuropathology. 2013;33:256–63. This pathological study examined a measure of arterial remodeling by comparing the ratio of arterial lumen diameter to wall thickness in 51 cerebral arteries from 5 HIV-infected and 13 uninfected brain donors. Arteries from HIV-infected donors had significantly higher ratios, suggesting an association of HIV infection with brain outward arterial remodeling.PubMedPubMedCentralCrossRef Gutierrez J, Elkind MSV, Petito C, Chung DY, Dwork AJ, Marshall RS. The contribution of HIV infection to intracranial arterial remodeling: a pilot study. Neuropathology. 2013;33:256–63. This pathological study examined a measure of arterial remodeling by comparing the ratio of arterial lumen diameter to wall thickness in 51 cerebral arteries from 5 HIV-infected and 13 uninfected brain donors. Arteries from HIV-infected donors had significantly higher ratios, suggesting an association of HIV infection with brain outward arterial remodeling.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Gutierrez J, Rosoklija G, Murray J, Chon C, Elkind MSV, Goldman J, et al. A quantitative perspective to the study of brain arterial remodeling of donors with and without HIV in the Brain Arterial Remodeling Study (BARS). Front Physiol. 2014;5:56.PubMedPubMedCentral Gutierrez J, Rosoklija G, Murray J, Chon C, Elkind MSV, Goldman J, et al. A quantitative perspective to the study of brain arterial remodeling of donors with and without HIV in the Brain Arterial Remodeling Study (BARS). Front Physiol. 2014;5:56.PubMedPubMedCentral
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Zurück zum Zitat Gutierrez J, Goldman J, Dwork AJ, Elkind MSV, Marshall RS, Morgello S. Brain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV. Neurology. 2015;85:1–8. Expanding on prior work (see ref 65), this study examined 1,878 cerebral artery segments from 284 HIV-infected and uninfected brain donors. HIV infection was associated with two extremes of arterial remodeling: inward remodeling with accelerated cerebral atherosclerosis causing ischemic infarcts, and outward remodeling causing dolichoectasia and otherwise unexplained infarcts. The dolichoectatic subtype predominated in more immunosuppressed patients.CrossRef Gutierrez J, Goldman J, Dwork AJ, Elkind MSV, Marshall RS, Morgello S. Brain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV. Neurology. 2015;85:1–8. Expanding on prior work (see ref 65), this study examined 1,878 cerebral artery segments from 284 HIV-infected and uninfected brain donors. HIV infection was associated with two extremes of arterial remodeling: inward remodeling with accelerated cerebral atherosclerosis causing ischemic infarcts, and outward remodeling causing dolichoectasia and otherwise unexplained infarcts. The dolichoectatic subtype predominated in more immunosuppressed patients.CrossRef
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Zurück zum Zitat Lavallee PC, Labreuche J, Fox KM, Lavados P, Mattle H, Steg PG, et al. Influenza vaccination and cardiovascular risk in patients with recent TIA and stroke. Neurology. 2014;82:1905–13. This meta-analysis pooled data from 2 prospective cohort studies and one randomized trial (total 23,110 patients) to examine whether influenza vaccination was associated with reduced risk of major vascular events in patients with recent TIA or ischemic stroke. After adjusting for baseline characteristics, influenza vaccination was not associated with a reduction in vascular event rate. Subgroup analysis similarly showed no reduction in stroke or MI separately.PubMedCrossRef Lavallee PC, Labreuche J, Fox KM, Lavados P, Mattle H, Steg PG, et al. Influenza vaccination and cardiovascular risk in patients with recent TIA and stroke. Neurology. 2014;82:1905–13. This meta-analysis pooled data from 2 prospective cohort studies and one randomized trial (total 23,110 patients) to examine whether influenza vaccination was associated with reduced risk of major vascular events in patients with recent TIA or ischemic stroke. After adjusting for baseline characteristics, influenza vaccination was not associated with a reduction in vascular event rate. Subgroup analysis similarly showed no reduction in stroke or MI separately.PubMedCrossRef
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Zurück zum Zitat Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, de Diego C, Satue E. Ineffectiveness of pneumococcal vaccination in cardiovascular prevention: the CAPAMIS study. JAMA Intern Med. 2013;173:1918–20. This prospective cohort study followed 27,204 patients over age 60 in primary care practices in Spain, to assess the effect of pneumococcal vaccination on hospitalization for stroke, MI and community acquired pneumonia. At 3 year follow-up, there was no protective effect of vaccination on any of these measures, in contrast to interim analysis that had shown such an effect.PubMed Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, de Diego C, Satue E. Ineffectiveness of pneumococcal vaccination in cardiovascular prevention: the CAPAMIS study. JAMA Intern Med. 2013;173:1918–20. This prospective cohort study followed 27,204 patients over age 60 in primary care practices in Spain, to assess the effect of pneumococcal vaccination on hospitalization for stroke, MI and community acquired pneumonia. At 3 year follow-up, there was no protective effect of vaccination on any of these measures, in contrast to interim analysis that had shown such an effect.PubMed
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Zurück zum Zitat Espinola-Klein C, Rupprecht HJ, Blankenberg S, Bickel C, Kopp H, Victor A, et al. Impact of infectious burden on progression of carotid atherosclerosis. Stroke. 2002;33:2581–6.PubMedCrossRef Espinola-Klein C, Rupprecht HJ, Blankenberg S, Bickel C, Kopp H, Victor A, et al. Impact of infectious burden on progression of carotid atherosclerosis. Stroke. 2002;33:2581–6.PubMedCrossRef
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Zurück zum Zitat Katan M, Moon YP, Paik MC, Sacco RL, Wright CB, Elkind MSV. Infectious burden and cognitive function: the Northern Manhattan Study. Neurology. 2013;80:1209–15. A composite index of infectious burden was previously shown to be associated with stroke risk and atherosclerosis in this multi-ethnic urban cohort. In this study, the same measure was found to be associated with worse performance on cognitive assessments, even after adjusting for vascular risk factors. The measure was not associated with cognitive decline over time.PubMedPubMedCentralCrossRef Katan M, Moon YP, Paik MC, Sacco RL, Wright CB, Elkind MSV. Infectious burden and cognitive function: the Northern Manhattan Study. Neurology. 2013;80:1209–15. A composite index of infectious burden was previously shown to be associated with stroke risk and atherosclerosis in this multi-ethnic urban cohort. In this study, the same measure was found to be associated with worse performance on cognitive assessments, even after adjusting for vascular risk factors. The measure was not associated with cognitive decline over time.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Lord AS, Langefeld CD, Sekar P, Moomaw CJ, Badjatia N, Vashkevich A, et al. Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study. Stroke. 2014;45:3535–42. This retrospective study of 800 patients with ICH found that post-ICH infections were more likely to occur in patients with larger and deeper hemorrhages, and in black patients. Patients with infections had higher discharge mortality (16% vs 8%, p=0.001) and worse 3-month functional outcomes.PubMedPubMedCentralCrossRef Lord AS, Langefeld CD, Sekar P, Moomaw CJ, Badjatia N, Vashkevich A, et al. Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study. Stroke. 2014;45:3535–42. This retrospective study of 800 patients with ICH found that post-ICH infections were more likely to occur in patients with larger and deeper hemorrhages, and in black patients. Patients with infections had higher discharge mortality (16% vs 8%, p=0.001) and worse 3-month functional outcomes.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Westendorp WF, Vermeij J-D, Zock E, Hooijenga IJ, Kruyt ND, Bosboom HJLW, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385:1519–26. This PROBE-design trial randomly assigned 2550 patients in the first 24 hours after acute stroke admitted to stroke units to IV ceftriaxone for 4 days vs usual care. In the intention-to-treat analysis, antibiotic treatment did not improve functional outcomes at three months.PubMedCrossRef Westendorp WF, Vermeij J-D, Zock E, Hooijenga IJ, Kruyt ND, Bosboom HJLW, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385:1519–26. This PROBE-design trial randomly assigned 2550 patients in the first 24 hours after acute stroke admitted to stroke units to IV ceftriaxone for 4 days vs usual care. In the intention-to-treat analysis, antibiotic treatment did not improve functional outcomes at three months.PubMedCrossRef
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Metadaten
Titel
Infection and Stroke: an Update on Recent Progress
verfasst von
Eliza C. Miller
Mitchell S. V. Elkind
Publikationsdatum
01.01.2016
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 1/2016
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-015-0602-9

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Schwindelursache: Massagepistole lässt Otholiten tanzen

14.05.2024 Benigner Lagerungsschwindel Nachrichten

Wenn jüngere Menschen über ständig rezidivierenden Lagerungsschwindel klagen, könnte eine Massagepistole der Auslöser sein. In JAMA Otolaryngology warnt ein Team vor der Anwendung hochpotenter Geräte im Bereich des Nackens.

Schützt Olivenöl vor dem Tod durch Demenz?

10.05.2024 Morbus Alzheimer Nachrichten

Konsumieren Menschen täglich 7 Gramm Olivenöl, ist ihr Risiko, an einer Demenz zu sterben, um mehr als ein Viertel reduziert – und dies weitgehend unabhängig von ihrer sonstigen Ernährung. Dafür sprechen Auswertungen zweier großer US-Studien.

Update Neurologie

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