Psychiatric syndromes secondary to central nervous system infection

LETTER TO THE EDITORS

Psychiatric syndromes secondary to central nervous system infection

Antonio Lucio Teixeira^I; Tatiana Barichello^II

^INeuropsychiatric Branch, Neurology Unit, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil

^IILaboratório de Microbiologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil

Dear Editor,

We read with interest the case report by Baldaçara et al.¹ who described an adult woman with autistic behavioral tendencies possibly linked to pneumococcal meningoencephalitis in her childhood.¹ This is a unique case as it is possibly the first reported autistic syndrome after pneumococcal meningoencephalitis. As the authors properly stated, late complications of central nervous system can mimic complex psychiatric disorders such as autism, depression and psychosis.²

Nevertheless, the understanding of the pathogenesis of behavioral syndromes in this context is complex. For instance, in an experimental model of pneumococcal meningoencephalitis, infected rats developed depressive-like behavioral changes in parallel with alteration of TNF-alpha levels in the prefrontal cortex (but not hippocampus).³ Imipramine - a tricyclic antidepressant - was capable of reverting this behavioral phenotype and normalizing TNF-alpha levels.⁴

Based on the coronal magnetic resonance imaging as well as cognitive and behavioral symptoms reported, the patient seems to present diffuse cortical lesion, making it difficult to assume localized or circumscribed cerebral damage (i.e. amygdala-hippocampal). Therefore, it is complicated to conclude that "this case illustrates the importance of medial temporal lobe in social development." Moreover, it would be quite interesting to have information on how behavioral changes evolved in this patient after the meningoencephalitis episode, as well as its severity.

• 1. Baldaçara L, Diniz T, Parreira B, Milhomem J, Baldaçara R. Organic mental disorder after pneumococcal meningoencephalitis with autism-like symptoms. Rev Bras Psiquiatr. 2011;33(4):410-1.
• 2. Teixeira AL, Malheiros JA, Oliveira JT, Nicolato R, Correa H. Limbic encephalitis manifesting as a psychotic disorder. Rev Bras Psiquiatr. 2006;28(2):163-4.
• 3. Barichello T, Dos Santos I, Savi GD, Simões LR, Generoso JS, Comim CM, Sachs D, Teixeira AL, Quevedo J. Depressive-like-behavior and proinflamatory interleukine levels in the brain of rats submitted to pneumococcal meningitis. Brain Res Bull. 2010;82(5-6):243-6.
• 4. Barichello T, Milioli G, Generoso JS, Cipriano AL, Costa CS, Moreira AP, Vilela MC, Comim CM, Teixeira AL, Quevedo J. Imipramine reverses depressive-like parameters in pneumococcal meningitis survivor rats. J Neural Transm. 2011; [Epub ahead of print] PMID: 22160551.

Publication Dates

• Publication in this collection
  19 June 2012
• Date of issue
  June 2012