Neonatal Central Nervous System Infection

Abstract

In this review article, neuroimaging features of common bacterial, viral, fungal, and parasitic infections of the pediatric central nervous system (CNS) are discussed. Imaging modalities used by pediatric neuroradiologists include cranial ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). After a brief discussion of the clinical presentation of each disease entity, imaging strategies and findings are reviewed. The role of advanced neuroimaging techniques is discussed wherever appropriate.

Keywords

neonatal intracranial infection - pediatric - ultrasound - CT - magnetic resonance imaging

• References

• 1 Bale Jr JF, Murph JR. Congenital infections and the nervous system. Pediatr Clin North Am 1992; 39 (04) 669-690
• 2 Blaser S, Jay V, Becker LE, Ford-Jones EL. Neonatal brain infection. In: Rutherford M. , ed. MRI of the Neonatal Brain. London: WB Saunders; 2002: 201-223
• 3 Epps RE, Pittelkow MR, Su WP. TORCH syndrome. Semin Dermatol 1995; 14 (02) 179-186
• 4 Ford-Jones EL. An approach to the diagnosis of congenital infections. Paediatr Child Health 1999; 4 (02) 109-112
• 5 Aicardi J. Diseases of the Nervous System in Childhood. Oxford: MacKeith Press; 1992
• 6 Friede RL. Developmental Neuropathology. 2nd ed. Berlin: Springer; 1989
• 7 Nathan L, Twickler DM, Peters MT, Sánchez PJ, Wendel Jr GD. Fetal syphilis: correlation of sonographic findings and rabbit infectivity testing of amniotic fluid. J Ultrasound Med 1993; 12 (02) 97-101
• 8 Hunter JV, Morriss MC. Neuroimaging of central nervous system infections. Semin Pediatr Infect Dis 2003; 14 (02) 140-164
• 9 Patel DV, Holfels EM, Vogel NP. , et al. Resolution of intracranial calcifications in infants with treated congenital toxoplasmosis. Radiology 1996; 199 (02) 433-440
• 10 Becker LE. Infections of the developing brain. Am J Neuroradiol 1992; 13 (02) 537-549
• 11 Bowie WR, King AS, Werker DH. , et al; The BC Toxoplasma Investigation Team. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet 1997; 350 (9072): 173-177
• 12 Foulon W, Villena I, Stray-Pedersen B. , et al. Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol 1999; 180 (2 Pt 1): 410-415
• 13 Friedman S, Ford-Jones LE, Toi A, Ryan G, Blaser S, Chitayat D. Congenital toxoplasmosis: prenatal diagnosis, treatment and postnatal outcome. Prenat Diagn 1999; 19 (04) 330-333
• 14 Fitz CR. Inflammatory disease. In: Gonzalez CF, Grossman CB, Masdeu JC. , eds. Head and Spine Imaging. New York, NY: Wiley; 1985: 537-538
• 15 Bale Jr JF, Murph JR. Infections of the central nervous system in the newborn. Clin Perinatol 1997; 24 (04) 787-806
• 16 Chantler JK, Smyrnis L, Tai G. Selective infection of astrocytes in human glial cell cultures by rubella virus. Lab Invest 1995; 72 (03) 334-340
• 17 Friedman S, Ford-Jones EL. Congenital cytomegalovirus infection – an update. Paediatr Child Health 1999; 4 (01) 35-38
• 18 Frey TK. Neurological aspects of rubella virus infection. Intervirology 1997; 40 (2-3): 167-175
• 19 Hwa HL, Shyu MK, Lee CN, Wu CC, Kao CL, Hsieh FJ. Prenatal diagnosis of congenital rubella infection from maternal rubella in Taiwan. Obstet Gynecol 1994; 84 (03) 415-419
• 20 Lane B, Sullivan EV, Lim KO. , et al. White matter MR hyperintensities in adult patients with congenital rubella. Am J Neuroradiol 1996; 17 (01) 99-103
• 21 Lim KO, Beal DM, Harvey Jr RL. , et al. Brain dysmorphology in adults with congenital rubella plus schizophrenialike symptoms. Biol Psychiatry 1995; 37 (11) 764-776
• 22 Sugita K, Ando M, Makino M, Takanashi J, Fujimoto N, Niimi H. Magnetic resonance imaging of the brain in congenital rubella virus and cytomegalovirus infections. Neuroradiology 1991; 33 (03) 239-242
• 23 Tomà P, Magnano GM, Mezzano P, Lazzini F, Bonacci W, Serra G. Cerebral ultrasound images in prenatal cytomegalovirus infection. Neuroradiology 1989; 31 (03) 278-279
• 24 Yoshimura M, Tohyama J, Maegaki Y. , et al. [Computed tomography and magnetic resonance imaging of the brain in congenital rubella syndrome]. No To Hattatsu 1996; 28 (05) 385-390
• 25 Bauman NM, Kirby-Keyser LJ, Dolan KD. , et al. Mondini dysplasia and congenital cytomegalovirus infection. J Pediatr 1994; 124 (01) 71-78
• 26 Tong KA, Ashwal S, Obenaus A, Nickerson JP, Kido D, Haacke EM. Susceptibility-weighted MR imaging: a review of clinical applications in children. Am J Neuroradiol 2008; 29 (01) 9-17
• 27 de Vries LS, Gunardi H, Barth PG, Bok LA, Verboon-Maciolek MA, Groenendaal F. The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics 2004; 35 (02) 113-119
• 28 Barkovich AJ, Lindan CE. Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations. Am J Neuroradiol 1994; 15 (04) 703-715
• 29 Hayward JC, Titelbaum DS, Clancy RR, Zimmerman RA. Lissencephaly-pachygyria associated with congenital cytomegalovirus infection. J Child Neurol 1991; 6 (02) 109-114
• 30 Schneider JF. Neonatal brain infections. Pediatr Radiol 2011; 41 (Suppl. 01) S143-S148
• 31 Whitley RJ. Herpes simplex virus infections. In: Remington JS, Klein JO. , eds. Infectious Disease of the Fetus and Newborn Infant. Philadelphia, PA: Saunders; 1990: 282-285
• 32 Benator RM, Magill HL, Gerald B, Igarashi M, Fitch SJ. Herpes simplex encephalitis: CT findings in the neonate and young infant. Am J Neuroradiol 1985; 6 (04) 539-543
• 33 Cleveland RH, Herman TE, Oot RF, Kushner DC. The evolution of neonatal herpes encephalitis as demonstrated by cranial ultrasound with CT correlation. Am J Perinatol 1987; 4 (03) 215-219
• 34 Corey L, Whitley RJ, Stone EF, Mohan K. Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome. Lancet 1988; 1 (8575-6): 1-4
• 35 Enzmann D, Chang Y, Augustyn G. MR findings in neonatal herpes simplex encephalitis type II. J Comput Assist Tomogr 1990; 14 (03) 453-457
• 36 Gray PH, Tudehope DI, Masel J. Cystic encephalomalacia and intrauterine herpes simplex virus infection. Pediatr Radiol 1992; 22 (07) 529-532
• 37 Herman TE, Cleveland RH, Kushner DC, Taveras JM. CT of neonatal herpes encephalitis. Am J Neuroradiol 1985; 6 (05) 773-775
• 38 Jay V, Becker LE, Blaser S. , et al. Pathology of chronic herpes infection associated with seizure disorder: a report of two cases with tissue detection of herpes simplex virus 1 by the polymerase chain reaction. Pediatr Pathol Lab Med 1995; 15 (01) 131-146
• 39 Kubota T, Kusaka H, Hirano A, Llena J. Ultrastructural study of early stage of calcification in herpes simplex encephalitis. Acta Neuropathol 1985; 68 (01) 77-79
• 40 Tien RD, Felsberg GJ, Osumi AK. Herpesvirus infections of the CNS: MR findings. Am J Roentgenol 1993; 161 (01) 167-176
• 41 Bale Jr JF, Andersen RD, Grose C. Magnetic resonance imaging of the brain in childhood herpesvirus infections. Pediatr Infect Dis J 1987; 6 (07) 644-647
• 42 Baskin HJ, Hedlund G. Neuroimaging of herpesvirus infections in children. Pediatr Radiol 2007; 37 (10) 949-963
• 43 Vossough A, Zimmerman RA, Bilaniuk LT, Schwartz EM. Imaging findings of neonatal herpes simplex virus type 2 encephalitis. Neuroradiology 2008; 50 (04) 355-366
• 44 Kubota T, Ito M, Maruyama K. , et al. Serial diffusion-weighted imaging of neonatal herpes encephalitis: a case report. Brain Dev 2007; 29 (03) 171-173
• 45 Kastrup O, Wanke I, Maschke M. Neuroimaging of infections of the central nervous system. Semin Neurol 2008; 28 (04) 511-522
• 46 Barkovich AJ. Pediatric Neuroimaging. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012
• 47 Tortori-Donati P, Rossi A, Biancheri R. Infectious disease. In: Tortori Donati P, Rossia A. . eds. Pediatric Neuroradiology. 1st ed. Berlin: Springer; 2005
• 48 Griffith BP, Booss J. Neurologic infections of the fetus and newborn. Neurol Clin 1994; 12 (03) 541-564
• 49 Harty MP, Markowitz RI, Rutstein RM, Hunter JV. Imaging features of human immunodeficiency virus infection in infants and children. Semin Roentgenol 1994; 29 (03) 303-314
• 50 Morriss MC, Rutstein RM, Rudy B, Desrochers C, Hunter JV, Zimmerman RA. Progressive multifocal leukoencephalopathy in an HIV-infected child. Neuroradiology 1997; 39 (02) 142-144
• 51 Patsalides AD, Wood LV, Atac GK, Sandifer E, Butman JA, Patronas NJ. Cerebrovascular disease in HIV-infected pediatric patients: neuroimaging findings. Am J Roentgenol 2002; 179 (04) 999-1003
• 52 Barker PB, Lee RR, McArthur JC. AIDS dementia complex: evaluation with proton MR spectroscopic imaging. Radiology 1995; 195 (01) 58-64
• 53 Belman AL. AIDS and pediatric neurology. Neurol Clin 1990; 8 (03) 571-603
• 54 Cortey A, Jarvik JG, Lenkinski RE, Grossman RI, Frank I, Delivoria-Papadopoulos M. Proton MR spectroscopy of brain abnormalities in neonates born to HIV-positive mothers. Am J Neuroradiol 1994; 15 (10) 1853-1859
• 55 Lu D, Pavlakis SG, Frank Y. , et al. Proton MR spectroscopy of the basal ganglia in healthy children and children with AIDS. Radiology 1996; 199 (02) 423-428
• 56 Pavlakis SG, Lu D, Frank Y. , et al. Brain lactate and N-acetylaspartate in pediatric AIDS encephalopathy. Am J Neuroradiol 1998; 19 (02) 383-385
• 57 Campos GS, Bandeira AC, Sardi SI. Zika virus outbreak, Bahia, Brazil. Emerg Infect Dis 2015; 21 (10) 1885-1886
• 58 Duffy MR, Chen TH, Hancock WT. , et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009; 360 (24) 2536-2543
• 59 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
• 60 Mlakar J, Korva M, Tul N. , et al. Zika virus associated with microcephaly. N Engl J Med 2016; 374 (10) 951-958
• 61 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects— reviewing the evidence for causality. N Engl J Med 2016; 374 (20) 1981-1987
• 62 Besnard M, Eyrolle-Guignot D, Guillemette-Artur P. , et al. Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia. Euro Surveill 2016;21(13)
• 63 de Paula Freitas B, de Oliveira Dias JR, Prazeres J. , et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol 2016; 134 (05) 529-535
• 64 Miranda-Filho DdeB, Martelli CM, Ximenes RA. , et al. Initial description of the presumed congenital Zika syndrome. Am J Public Health 2016; 106 (04) 598-600
• 65 Nonaka H, Akima M, Hatori T, Nagayama T, Zhang Z, Ihara F. The microvasculature of the cerebral white matter: arteries of the subcortical white matter. J Neuropathol Exp Neurol 2003; 62 (02) 154-161
• 66 Estroff JA, Parad RB, Teele RL, Benacerraf BR. Echogenic vessels in the fetal thalami and basal ganglia associated with cytomegalovirus infection. J Ultrasound Med 1992; 11 (12) 686-688
• 67 Picone O, Simon I, Benachi A, Brunelle F, Sonigo P. Comparison between ultrasound and magnetic resonance imaging in assessment of fetal cytomegalovirus infection. Prenat Diagn 2008; 28 (08) 753-758
• 68 Moinuddin A, McKinstry RC, Martin KA, Neil JJ. Intracranial hemorrhage progressing to porencephaly as a result of congenitally acquired cytomegalovirus infection—an illustrative report. Prenat Diagn 2003; 23 (10) 797-800
• 69 Teissier N, Fallet-Bianco C, Delezoide AL. , et al. Cytomegalovirus-induced brain malformations in fetuses. J Neuropathol Exp Neurol 2014; 73 (02) 143-158
• 70 Kanamalla US, Ibarra RA, Jinkins JR. Imaging of cranial meningitis and ventriculitis. Neuroimaging Clin N Am 2000; 10 (02) 309-331
• 71 Snyder RD. Bacterial infections of the nervous system. In: Adam JH, Corsellis JAN, Duchen LW. , eds. Greenfield's Pathology. 4th ed. New York: Wiley; 1984: 236-259
• 72 Dunn DW, Daum RS, Weisberg L, Vargas R. Ischemic cerebrovascular complications of hemophilus influenza meningitis. Arch Neurol 1982; 39: 650-652
• 73 Kremer S, Abu Eid M, Bierry G. , et al. Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 2006; 33 (05) 285-291
• 74 Egelhof JC. Infections of the central nervous system. In: Ball WS. , ed. Pediatric Neuroradiology. Philadelphia: Lippincott-Raven; 1997: 273-318
• 75 Weingarten K, Zimmerman RD, Becker RD, Heier LA, Haimes AB, Deck MD. Subdural and epidural empyemas: MR imaging. Am J Roentgenol 1989; 152 (03) 615-621
• 76 Woods Jr CR, Mason Jr EO, Kaplan SL. Interaction of Citrobacter diversus strains with HEp-2 epithelial and human umbilical vein endothelial cells. J Infect Dis 1992; 166 (05) 1035-1044
• 77 Daneman A, Lobo E, Mosskin M. Periventricular band of increased echogenicity: edema or calcification?. Pediatr Radiol 1998; 28 (02) 83-85
• 78 Mathews VP, Kuharik MA, Edwards MK, D'Amour PG, Azzarelli B, Dreesen RG. Dyke award. Gd-DTPA-enhanced MR imaging of experimental bacterial meningitis: evaluation and comparison with CT. Am J Roentgenol 1989; 152 (01) 131-136
• 79 Syrjänen J. Infection as a risk factor for cerebral infarction. Eur Heart J 1993; 14 (Suppl K): 17-19
• 80 Chang YC, Huang CC, Wang ST, Chio CC. Risk factor of complications requiring neurosurgical intervention in infants with bacterial meningitis. Pediatr Neurol 1997; 17 (02) 144-149
• 81 Felderhoff-Mueser U, Rutherford M, Squier W. , et al. Relation between magnetic resonance images and histopathological findings of the brain in extremely sick preterm infants. Am J Neuroradiol 1999; 20: 1349-1357
• 82 Huang CC, Chen CY, Yang HB. , et al. CNS candidiasis in very low-birth-weight premature neonates and infants: US characteristics and histopathologic and MR imaging correlates in five patients. Radiology 1998; 209: 49-56
• 83 Incesu L, Akan H, Arslan A. Neonatal cerebral candidiasis: CT findings and clinical correlation. J Belge Radiol 1994; 77 (06) 278-279
• 84 Yamaguchi K, Goto N. [An autopsy case of brain candidiasis in premature infant: morphology and intraparenchymal distribution of Candida foci]. No To Hattatsu 1993; 25 (04) 369-373
• 85 Christophe C, Azzi N, Bouché B, Dan B, Levivier M, Ferster A. Magnetic resonance imaging and angiography in cerebral fungal vasculitis. Neuropediatrics 1999; 30 (04) 218-220
• 86 Kang GH, Chi JG. Congenital tuberculosis—report of an autopsy case. J Korean Med Sci 1990; 5 (01) 59-64