Aseptic Meningoencephalitis Syndrome (AMS) In Adults

描述(由申请人提供)： 这项对之前提交的K23拨款提案的最终修订包括一项指导以患者为导向的研究计划，使用由初步数据形成的新方案，并确保相关的教学培训，以扩大候选人成为跨学科临床研究的独立研究员的能力。临床研究建议的重点是无菌脑膜脑炎综合征(AMS)，这是一种由多种病因组成的临床实体，其中一些需要紧急治疗。由于在急性护理环境中缺乏有效的手段来区分具有紧急可治疗条件的患者和那些早期并发症风险较低的患者，AMS仍然是一个关键的诊断挑战。此外，使用目前的诊断方法，经过标准评估，近70%的患者仍然没有病因诊断。这项建议的总体目标是建立一种简单且经济有效的算法，用于对向急诊科(ED)就诊的患者进行早期诊断和有效管理。主要目标是使用选定的新奥尔良医院，得出并验证一个临床预测指数，该指数将确定在向急诊室就诊的AMS患者中，具有紧急可治疗原因的低风险亚组。次要目标是：(1)描述AMS的变化和新出现的流行病学和自然病史，使用改进的诊断方法来识别难以诊断的病毒、立克次体、支原体、细菌、螺旋体、巴氏杆菌、分枝杆菌、真菌和寄生病原体；(2)描述AMS特定亚组的神经认知和生活质量；以及(3)在精神状态改变和/或局部神经学表现的脑病AMS患者中，神经成像与神经认知结果之间的关联。这位候选人致力于中枢神经系统感染患者的临床研究。为了培养他从事跨学科临床研究的能力，他的计划包括通过分子诊断学、神经心理学和神经放射学的正式和非正式培训，学习临床微生物学中的分子诊断学原理、神经认知测试以及临床与神经成像的相关性。此外，他还将完成NIH资助的K30临床研究课程奖励计划，并在杜兰大学获得临床研究硕士学位。

DESCRIPTION (provided by applicant): This final revision of a previously submitted K 23 grant proposal includes a plan for mentored patient oriented research, using a new protocol shaped by preliminary data, and assures relevant didactic training to expand the candidate's capacity to become an independent investigator in cross-disciplinary clinical research. The clinical research proposal is focused on the aseptic meningoencephalitis syndrome (AMS), a clinical entity comprised of diverse group of etiologies of which some require urgent treatment. Due to lack of effective means in the acute care setting for differentiating patients with an urgent treatable condition from those at low risk for early complications, AMS remains a critical diagnostic challenge. Further, using present diagnostic methods, after standard evaluation nearly 70% of patients remain without an etiological diagnosis. The overall goal of this proposal is to establish a simple and cost-effective algorithm for early diagnosis and effective management of the AMS in patients presenting to the Emergency Department (ED). The primary objective is to derive and validate a clinical predictive index that will identify the subgroup at low risk of having an urgent treatable cause among AMS patients presenting to EDs, using selected New Orleans hospitals. The secondary objectives are: (1) to describe the changing and emerging epidemiology and natural history of the AMS using improved diagnostic methods to identify difficult-to-diagnose viral, rickettsial, mycoplasmal, bacterial, spirochetal, bartonellal, mycobacterial, fungal and parasitic pathogens; (2) to describe the neurocognitive and quality of life outcomes for selective subgroups of AMS; and (3) to correlate neuroimaging with neurocognitive findings in encephalopathic AMS patients who present with altered mental status and/or focal neurological findings. The candidate is committed to a career in clinical investigation of patients with central nervous system infections. To develop his capacity to engage in cross-disciplinary clinical research, his plan includes learning the principles of molecular diagnostics in clinical microbiology, neurocognitive testing and clinical correlations with neuroimaging through formal and informal training in molecular diagnostics, neuropsychology and neuroradiology. In addition, he will complete the NIH funded K30 Clinical Research Curriculum Award Program and obtain a Master's in Clinical Research degree at Tulane University.