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Sample records for meningeal arteries

  1. The Pharyngo-Tympano-Stapedial Variant of the Middle Meningeal Artery: A Case Report

    OpenAIRE

    Baltsavias, G.; Kumar, R; Valavanis, A.

    2012-01-01

    Atypical origin of the middle meningeal artery from the cervical internal carotid artery is a rare angiographic finding. We describe a case of the pharyngo-tympano-stapedial variant of the middle meningeal artery in a young patient. In this vascular variation the proximal segment of the middle meningeal artery, corresponding to an annexed inferior tympanic artery, originates from the cervical carotid artery. Then over the promontory it unites with the superior tympanic artery and continues wi...

  2. An undocumented variation involving auriculotemporal nerve, inferior alveolar nerve and middle meningeal artery

    Directory of Open Access Journals (Sweden)

    Sunita Kalra

    2014-08-01

    Full Text Available Auriculotemporal nerve typically has two roots, encircling the middle meningeal artery, one anterior to it and another posterior to it as well as maxillary artery. The middle meningeal artery is largest of the meningeal arteries, ascends between the sphenomandibular ligament and lateral pterygoid muscle and traverses between the roots of the auriculotemporal nerve before entering the cranial cavity through the foramen spinosum. The knowledge of the neurovascular relationships of the infratemporal region is significant in surgical practice. We present a case of unusual communication between the auriculotemporal nerve and inferior alveolar nerve together with an extraordinary change in relations with the middle meningeal artery. Some clinical implications that these relations may have on the development of the supplementary innervations and the surgical interventions in this region are discussed in this article. [Int J Res Med Sci 2014; 2(4.000: 1720-1722

  3. Pharmacological characterization of VIP and PACAP receptors in the human meningeal and coronary artery

    DEFF Research Database (Denmark)

    Chan, Kayi Y; Baun, Michael

    2011-01-01

    We pharmacologically characterized pituitary adenylate cyclase-activating polypeptides (PACAPs), vasoactive intestinal peptide (VIP) and the VPAC(1), VPAC(2) and PAC(1) receptors in human meningeal (for their role in migraine) and coronary (for potential side effects) arteries.

  4. Meningitis

    Centers for Disease Control (CDC) Podcasts

    2012-10-24

    This podcast gives a general overview of meningitis, including what it is, the five types, and the causes.  Created: 10/24/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 10/24/2012.

  5. Communicating root of auriculotemporal nerve with inferior alveolar nerve-looping around accessory meningeal artery

    Directory of Open Access Journals (Sweden)

    Shakuntala Nallagatla

    2015-06-01

    Results: It was seen that the auriculotemporal nerve had two roots of origin and they formed a loop to enclose the middle meningeal artery in all the 35 specimens except in one side of the cadaveric heads. In only one half of a cadaveric head it was found to arise by three roots which formed two nerve loops. The first and second nerve roots joined with each other to form a nerve loop. The third root joined with the inferior alveolar nerve and formed the second nerve loop. The accessory meningeal artery passed through the second nerve loop. The normal presentation of two roots enclosing the middle meningeal artery was not present. Instead the accessory meningeal artery was enclosed between the third root and the inferior alveolar nerve. The middle meningeal artery entered the skull through the foramen spinosum as usual but was not enclosed by the nerve roots. The trunk of the auriculo temporal nerve was seen between the middle meningeal artery and inferior alveolar nerve and the study reports the presence of variant nerve loops encircling the accessory meningeal artery. Conclusion: The variations in the roots of auriculotemporal nerve have been reported in the past and since it is important in the clinical implications of the region especially for the facio-maxillary surgeons and dental surgeons. The incidence of variation has to be documented as this helps in updating the clinical database for surgical procedures and treatment in the region of infratemporal fossa. [Int J Res Med Sci 2015; 3(3.000: 626-629

  6. Headache and prolonged dilatation of the middle meningeal artery by PACAP38 in healthy volunteers

    DEFF Research Database (Denmark)

    Amin, Faisal Mohammad; Asghar, Mohammad Sohail

    2012-01-01

    To explore a possible relationship between vasodilatation and delayed headache we examined the effect of pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) on the middle meningeal artery (MMA) and middle cerebral artery (MCA) using high resolution magnetic resonance angiography (MRA).

  7. [Malignant infarct of the middle cerebral artery in a patient with bacterial meningitis].

    Science.gov (United States)

    López, Mirta G; Mellado, Patricio T; Huete, Isidro L

    2004-10-01

    The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality. PMID:15631210

  8. Sacral meningeal arteriovenous fistula fed by branches of the hypogastric arteries and drained through medullary veins

    International Nuclear Information System (INIS)

    The authors report a new case of intra-spinal extra-medullary meningeal arteriovenous fistula draining through medullary veins. Discovered in a 33-year-old black man suffering from a cauda equina syndrome, this malformation suspected in myelography was confirmed by a selective angiographic procedure of both internal iliac arteries. This investigation specified the sacral site of the fistula as well as its feeding arteries from several branches of the left and right internal iliac arteries and its posterior and intra-meningeal venous medullary drainage. An embolization procedure followed by a surgical approach and a second embolization session brought a fair improvement to this young patient who could walk again. The acquired traumatic origin of the fistula is discussed for this patient who had been previously operated at his L5-S1 level. (orig.)

  9. Infarto maligno de la arteria cerebral media en una paciente con meningitis bacteriana Malignant middle cerebral artery territory infarct in one patient with bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Mirta López G

    2004-10-01

    Full Text Available The mortality of acute bacterial meningitis (BM has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality (Rev Méd Chile 2004; 132: 1217-20

  10. Accessory Meningeal Arterial Supply to the Posterior Nasal Cavity: Another Reason for Failed Endovascular Treatment of Epistaxis

    International Nuclear Information System (INIS)

    A patient with intractable posterior epistaxis was treated with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery. She continued to bleed despite a seemingly adequate embolization procedure. A second angiogram revealed a significant collateral blood supply to the posterior nasal cavity from the accessory meningeal artery not identified during the first procedure. This was then embolized with no further epistaxis encountered. This case demonstrates yet another collateral arterial pathway that might account for a failed embolization

  11. Infarto maligno de la arteria cerebral media en una paciente con meningitis bacteriana / Malignant middle cerebral artery territory infarct in one patient with bacterial meningitis

    Scientific Electronic Library Online (English)

    Mirta, López G; Patricio, Mellado T; Isidro, Huete L.

    1217-12-01

    Full Text Available [...] Abstract in english The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admiss [...] ion to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality (Rev Méd Chile 2004; 132: 1217-20)

  12. Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

    DEFF Research Database (Denmark)

    Grände, Gustaf; Labruijere, Sieneke

    2014-01-01

    BACKGROUND: Migraine attacks occur spontaneously in those who suffer from the condition, but migraine-like attacks can also be induced artificially by a number of substances. Previously published evidence makes the meninges a likely source of migraine related pain. This article investigates the effect of several vasodilators on meningeal arteries in order to find a connection between the effect of a substance on a meningeal vessel and its ability to artificially induce migraine. METHODS: A myograph setup was used to test the vasodilator properties of the substances acetylcholine (ACh), sodium nitroprusside (SNP), sildenafil, prostaglandin E2 (PGE2), pituitary adenylate cyclase activating peptide-38 (PACAP-38), calcitonin gene-related peptide (CGRP) and NaCl buffer on meningeal arteries from human and rat. An unpaired t-test was used to statistically compare the mean Emax(%) at the highest concentration of each substance to the Emax(%) of NaCl buffer. RESULTS: In the human experiments, all substances except PACAP-38 had an Emax (%) higher than the NaCl buffer, but the difference was only significant for SNP and CGRP. For the human samples, clinically tested antimigraine compounds (sumatriptan, telcagepant) were applied to the isolated arteries, and both induced a significant decrease of the effect of exogenously administrated CGRP. In experiments on rat middle meningeal arteries, pre-contracted with PGF2?, similar tendencies were seen. When the pre-contraction was switched to K+ in a separate series of experiments, CGRP and sildenafil significantly relaxed the arteries. CONCLUSIONS: Still no definite answer can be given as to why pain is experienced during an attack of migraine. No clear correlation was found between the efficacy of a substance as a meningeal artery vasodilator in human and the ability to artificially induce migraine or the mechanism of action. Vasodilatation could be an essential trigger, but only in conjunction with other unknown factors. The vasculature of the meninges likely contributes to the propagation of the migrainal cascade of symptoms, but more research is needed before any conclusions can be drawn about the nature of this contribution.

  13. Stroke Secondary to Aseptic Meningitis After Endovascular Treatment of a Giant Aneurysm with Parent Artery Occlusion

    International Nuclear Information System (INIS)

    Aseptic meningitis related to hydrogel-coated coils is a known complication, but it is extremely rare after platinum bare coil aseptic meningitis. Here we report the development of aseptic meningitis causing brain stem and cerebellar infarct in a patient with a giant aneurysm treated with bare platinum coils. We conclude that aneurysm size is an important factor affecting the occurrence of aseptic meningitis associated with stroke.

  14. Expression and Characterization of Purinergic Receptors in Rat Middle Meningeal Artery–Potential Role in Migraine

    DEFF Research Database (Denmark)

    Haanes, Kristian Agmund; Edvinsson, Lars

    2014-01-01

    The dura mater and its vasculature have for decades been central in the hypothesis of migraine and headache pathophysiology. Although recent studies have questioned the role of the vasculature as the primary cause, dural vessel physiology is still relevant in understanding the complex pathophysiology of migraine. The aim of the present study was to isolate the middle meningeal artery (MMA) from rodents and characterize their purinergic receptors using a sensitive wire myograph method and RT-PCR. The data presented herein suggest that blood flow through the MMA is, at least in part, regulated by purinergic receptors. P2X1 and P2Y6 receptors are the strongest contractile receptors and, surprisingly, ADP?S caused contraction most likely via P2Y1 or P2Y13 receptors, which is not observed in other arteries. Adenosine addition, however, caused relaxation of the MMA. The adenosine relaxation could be inhibited by SCH58261 (A2A receptor antagonist) and caffeine (adenosine receptor antagonist). This gives one putativemolecular mechanism for the effect of caffeine, often used as an adjuvant remedy of cranial pain. Semi-quantitative RT-PCR expression data for the receptors correlate well with the functional findings. Together these observations could be used as targets for future understanding of the in vivo role of purinergic receptors in the MMA.

  15. Expression and characterization of purinergic receptors in rat middle meningeal artery-potential role in migraine

    DEFF Research Database (Denmark)

    Haanes, Kristian Agmund; Edvinsson, Lars

    2014-01-01

    The dura mater and its vasculature have for decades been central in the hypothesis of migraine and headache pathophysiology. Although recent studies have questioned the role of the vasculature as the primary cause, dural vessel physiology is still relevant in understanding the complex pathophysiology of migraine. The aim of the present study was to isolate the middle meningeal artery (MMA) from rodents and characterize their purinergic receptors using a sensitive wire myograph method and RT-PCR. The data presented herein suggest that blood flow through the MMA is, at least in part, regulated by purinergic receptors. P2X1 and P2Y6 receptors are the strongest contractile receptors and, surprisingly, ADP?S caused contraction most likely via P2Y1 or P2Y13 receptors, which is not observed in other arteries. Adenosine addition, however, caused relaxation of the MMA. The adenosine relaxation could be inhibited by SCH58261 (A2A receptor antagonist) and caffeine (adenosine receptor antagonist). This gives one putativemolecular mechanism for the effect of caffeine, often used as an adjuvant remedy of cranial pain. Semi-quantitative RT-PCR expression data for the receptors correlate well with the functional findings. Together these observations could be used as targets for future understanding of the in vivo role of purinergic receptors in the MMA.

  16. Transcranial Direct Middle Meningeal Artery Puncture for the Onyx Embolization of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus

    Science.gov (United States)

    Oh, Jae-Sang; Shim, Jai-Joon; Bae, Hack-Gun

    2015-01-01

    A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx. PMID:25674345

  17. The preservation of middle meningeal artery in surgical revascularization for moyamoya disease

    International Nuclear Information System (INIS)

    We present the preservation of middle meningeal artery (MMA) in surgical revascularization for moyamoya disease. We examined 10 patients with moyamoya disease and performed surgical revascularization. The mean age of the patients was 27.8 years. We presurgically evaluated the three-dimensional (3-D) relationships of MMA and cranial sutures in the pterion by volumetric imaging of 3-D contrast enhanced computed tomography (CT). The 3-D anatomies were visualized by adjusting the window width, window level, and opacity level of the specific CT value for each structure, and the relationship of the MMA and the suture. This visualization was crucial for drilling to perform craniotomies. The MMA from bone to dura is exposed for drilling around the pterion. The preservation of the MMA with this method was achieved in all patients with moyamoya disease. Presurgical evaluation using volumetric imaging of 3-D CT is a convenient and valuable method for obtaining the anatomic information. The usefulness of the drilling distal to the pterion in patients with moyamoya disease to preserve MMA was confirmed. (author)

  18. Central projections of the sensory innervation of the rat middle meningeal artery

    DEFF Research Database (Denmark)

    Liu, Yi; Broman, Jonas

    2008-01-01

    Headaches, especially migraine, involve not only pain but also aspects such as vasodilation of cranial vessels and sensitization of nerve endings, processes dependent on and connected to the central nervous system. To understand pathogenic mechanisms of headache, it is important to elucidate the central projections of sensory nerves that innervate cranial vessels, of which the middle meningeal artery (MMA) is the largest artery supplying the dura mater. In this study, cholera toxin subunit b (CTb) or wheat germ agglutinin-horseradish peroxidase conjugate (WGA-HRP) was applied on the adventitia of MMA. After perfusion fixation, the brainstem, the C1-C4 spinal segments and the trigeminal and C2 dorsal root ganglia were removed and sections from these tissues were processed to visualize transported tracers. Labeled cell bodies were seen ipsilaterally in the trigeminal and C2 dorsal root ganglia. Labeled nerve terminations were found ipsilaterally in the lateral part of the spinal dorsal horn of segments C1-C3 and in the caudal and interpolar parts of the spinal trigeminal nucleus. WGA-HRP labeled terminations were mainly located in laminae I and II, whereas CTb labeled terminations located in laminae III-V. These results indicate that sensory information from the MMA is transmitted through both trigeminal and cervical spinal nerve branches to a region in the central nervous system extending rostrally from the C3 dorsal horn to the interpolar part of the spinal trigeminal nucleus. Our data further substantiates that the sensory innervation of the MMA, in addition to putative nociceptive afferents, include a population of large caliber afferents with an as yet unclear but presumably non-nociceptive role.

  19. Dilation by CGRP of middle meningeal artery and reversal by sumatriptan in normal volunteers

    DEFF Research Database (Denmark)

    Asghar, M S; Hansen, A E

    2010-01-01

    BACKGROUND: Calcitonin gene-related peptide (CGRP) plays a fundamental role in the pathophysiology of neurovascular headaches. CGRP infusion causes headache and dilation of cranial vessels. However, it is unknown to what extent CGRP-induced vasodilation contributes to immediate head pain and whether the migraine-specific abortive drug sumatriptan, a 5-hydroxytryptamine 1B/1D agonist, inhibits CGRP-induced immediate vasodilation and headache. METHODS: We performed a double-blind, randomized, placebo-controlled, crossover study in 18 healthy volunteers. We recorded circumference changes of the middle meningeal artery (MMA) and middle cerebral artery (MCA) using magnetic resonance angiography before and after infusion (20 minutes) of 1.5 µg/min human aCGRP or placebo (isotonic saline) as well as after a 6-mg sumatriptan subcutaneous injection. RESULTS: Compared with placebo, CGRP caused significant dilation of MMA (p = 0.006) and no dilation of MCA (p = 0.69). Sumatriptan caused a marked contraction of MMA (15%-25.2%) and marginal contraction of MCA (3.9% to 5.3%). Explorative analysis revealed that sumatriptan had a more selective action on MMA compared with MCA on the CGRP day (p <0.0001) and on the placebo day (p = 0.007). CONCLUSION: These data suggest that exogenous CGRP dilates extracranial vessels and not intracranial, and that sumatriptan exerts part of its antinociceptive action by constricting MMA and not MCA. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that IV GCRP causes dilation of the MMA but not the MCA in healthy volunteers, and that sumatriptan reverses the dilation of the MMA caused by CGRP.

  20. Traumatic pseudoaneurysm of the middle meningeal artery with an arteriovenous fistula on a non-fractured site.

    Science.gov (United States)

    Ko, Jung Ho; Kim, Young-Joon

    2014-01-01

    We describe a rare case of a combined traumatic pseudoaneurysm and arteriovenous fistula (AVF) of the middle meningeal artery (MMA) on a non-fractured site. A 24-year-old man was admitted to our hospital with head trauma. He underwent a craniotomy and removal of an epidural hematoma on the right side. Twenty-five days later, he complained of pulsatile tinnitus on the left non-fractured side. Angiography revealed a markedly dilated proximal MMA with flow shunting to the pterygoid plexus. We performed proximal occlusion on the proximal MMA for the traumatic pseudoaneurysm and the AVF of the MMA using coils. Although immediate angiography showed retrograde contrast filling from the collateral vessels into the distal part of the pseudoaneurysm, follow-up angiography revealed that the lesion had successfully disappeared. PMID:24976099

  1. Meningitis bacteriana / Bacterial meningitis

    Scientific Electronic Library Online (English)

    Ana Teresa, Alvarado Guevara; Lizzie Marie, Castillo Solano.

    2006-03-01

    Full Text Available En Costa Rica la meningitis bacteriana se ha convertido en un tema prioritario en lo que a vigilancia epidemiológica se refiere, en los últimos meses se ha dado un aumento en la atención pública de este tema, debido a este fenómeno se hace necesario realizar una revisión del tema. La meningitis es u [...] na inflamación de las leptomeninges y colonización del líquido cefalorraquídeo (LCR) debido a diferentes agentes, lo cual produce síntomas meníngeos (Ej., cefalea, rigidez nucal, fotofobia) y pleocitosis a nivel de LCR. Dependiendo de las variables se pueden agrupar en diferentes clasificaciones, tomando en cuenta el tiempo de evolución se pueden dividir en agudas o crónicas, a las primeras con pocas horas o días de inicio de la sintomatología, mientras que la crónica presenta un curso mas larvado de la enfermedad de aproximadamente 4 semanas de instauración. Existe también diferencia según su etiología, pueden ser infecciosas y no infecciosas. Causas no infecciosas incluyen: drogas antiinflamatorias, antibióticos y carcinomatosis. A su vez existe una clasificación según el agente causal. La meningitis bacteriana aguda remarca el origen bacteriano de este síndrome, el cual se caracteriza por el inicio agudo de sus síntomas y pleocitosis de predominio neutrofílico. Cada uno de los agentes bacterianos, parasíticos o fúngicos terminan por categorizar las diferentes presentaciones de este cuadro clínico (Ej., meningitis meningocóccica, meningitis criptocóccica). Es en este grupo en específico de etiología en el cual se basara el siguiente artículo. Por último pero no menos importante tenemos la meningitis aséptica, denominada de esta forma debido a una respuesta celular no pirógena causada por muchos tipos de agentes. Los pacientes muestran un inicio agudo de síntomas meníngeos, fiebre y pleocitosis pero de predominio linfocítico. Después de análisis especializados, se da pro concluido que la mayoría de los agentes causales son virales lo cual conlleva a las diferentes sub-clasificaciones. También en ciertos casos puede ser ocasionada por hongos, bacterias atípicas, micobacterias y parásitos. Abstract in english In Costa Rica the bacterial meningitis had turn into a high-priority subject in which to monitoring epidemiologist. It had been talked about in the last months, to dice an increase in the attention is published of this subject, due to this phenomenon it becomes necessary to make a revision of topic. [...] Meningitis is an inflammation of leptomeninges and colonization of the subarachnoid cerebrospinal fluid (LCR) due to different agents, which produces meningeal symptoms (ex. migraine, neck rigidity, and photophobia) and pleocytosis in LCR. De pending on the variables to take into account is possible to group it in different classifications, taking into account the time of evolution are possible to be divided in acute or chronic, to first with few hours or days of beginning of the symptoms, whereas the chronicle also presents a silence course but of the disease of approximately 4 weeks of instauration. There is a difference according to its etiologic agent; they can be infectious and non-infectious. Examples of common non-infectious causes include medications (ex, nonsteroidal anti-inflammatory drugs, and antibiotics) and carcinomatosis. A classification exists as well according to the causal agent. The acute bacterial meningitis remarks a bacterial origin of the syndrome, which characterizes by the by an acute onset of meningeal symptoms and neutrophilic pleocytosis. Each one of the bacteriological agents, parasitic or fungus finishes by characterizing the different presentations of the clinical features (ex, meningocóccica meningitis, Cryptococcus meningitis). Finally, there is also the aseptic meningitis, denominated in this form because it’s nonpyogenic cellular response caused by many types of agents. The patients show an acute beginning of symptoms, fever and lymphocytic pleocytosis. After specialized analyses, concluded that majority cause

  2. PACAP-38 infusion causes sustained vasodilation of the middle meningeal artery in the rat : Possible involvement of mast cells

    DEFF Research Database (Denmark)

    Bhatt, Deepak K; Gupta, Saurabh

    2014-01-01

    BACKGROUND: In healthy human volunteers and in migraineurs, pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38) infusion caused sustained vasodilation of the middle meningeal artery (MMA) and an immediate as well as a delayed headache. All the study subjects experienced facial flushing. Mast cells (MCs) might have a role in the long-lasting effect of PACAP-38 infusion. We hypothesized that in mast cell-depleted (MCD) rats the vascular responses to PACAP-38 would be lesser than in control rats because of a lack of vasodilatory products released during MC degranulation. METHODS: MCs were depleted by chronic treatment with compound 48/80. The effect of 20 minutes' intravenous (i.v.) infusion of calcitonin gene-related peptide (CGRP), PACAP-38, PACAP(6-38) (PAC-1 receptor antagonist) and PACAP-27 on the diameter of the MMA and on mean arterial blood pressure (MABP) in control and MCD rats was recorded by using the genuine closed-cranial window (CCW) model. Vasoactive intestinal polypeptide (VIP) infusion was given only in control rats. A combination of the histamine H1 receptor antagonist mepyramine (4 mg kg(-1) i.v.) and the H2 receptor antagonist famotidine (1 mg kg(-1) i.v.) was given 10 minutes prior to PACAP-38 infusion. Increasing doses of PACAP-38, PACAP-27 and VIP were infused through the intracarotid artery (i.c.) in control and MCD rats to see the direct effects of these peptides on MMA diameter change. RESULTS: There was no significant change in CGRP-induced MMA diameter increase in control and MCD rats, and the dilated MMA immediately returned back to baseline after stopping the infusion. The delayed MMA dilation induced by PACAP-38 was abolished in MCD and antihistamine (AH)-pretreated rats. Compared to PACAP-38, the PACAP-27 i.v. infusion gave smaller peak dilation of MMA in control rats. In MCD rats, PACAP-27 did not induce any significant dilation. VIP i.v. infusion reduced MABP but did not dilate MMA significantly. PACAP(6-38), which is a potent MC degranulator, also gave a significantdelayed dilation of MMA. PACAP-38 i.c. responses (direct receptor mediated response) were not affected by MC depletion. Only the maximum response (% E max) value of PACAP-27 (i.c.) was significantly lower in MCD rats compared to control rats. CONCLUSIONS: The delayed MMA dilatory responses to PACAP-38 infusion were attenuated in MCD and AH-pretreated rats, indicating a role of the MC mediator-histamine in PACAP-38-induced delayed dilation of MA.

  3. PACAP-38 infusion causes sustained vasodilation of the middle meningeal artery in the rat : possible involvement of mast cells

    DEFF Research Database (Denmark)

    Bhatt, Deepak K; Gupta, Saurabh

    2014-01-01

    BACKGROUND: In healthy human volunteers and in migraineurs, pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38) infusion caused sustained vasodilation of the middle meningeal artery (MMA) and an immediate as well as a delayed headache. All the study subjects experienced facial flushing. Mast cells (MCs) might have a role in the long-lasting effect of PACAP-38 infusion. We hypothesized that in mast cell-depleted (MCD) rats the vascular responses to PACAP-38 would be lesser than in control rats because of a lack of vasodilatory products released during MC degranulation. METHODS: MCs were depleted by chronic treatment with compound 48/80. The effect of 20 minutes' intravenous (i.v.) infusion of calcitonin gene-related peptide (CGRP), PACAP-38, PACAP(6-38) (PAC-1 receptor antagonist) and PACAP-27 on the diameter of the MMA and on mean arterial blood pressure (MABP) in control and MCD rats was recorded by using the genuine closed-cranial window (CCW) model. Vasoactive intestinal polypeptide (VIP) infusion was given only in control rats. A combination of the histamine H1 receptor antagonist mepyramine (4 mg kg(-1) i.v.) and the H2 receptor antagonist famotidine (1 mg kg(-1) i.v.) was given 10 minutes prior to PACAP-38 infusion. Increasing doses of PACAP-38, PACAP-27 and VIP were infused through the intracarotid artery (i.c.) in control and MCD rats to see the direct effects of these peptides on MMA diameter change. RESULTS: There was no significant change in CGRP-induced MMA diameter increase in control and MCD rats, and the dilated MMA immediately returned back to baseline after stopping the infusion. The delayed MMA dilation induced by PACAP-38 was abolished in MCD and antihistamine (AH)-pretreated rats. Compared to PACAP-38, the PACAP-27 i.v. infusion gave smaller peak dilation of MMA in control rats. In MCD rats, PACAP-27 did not induce any significant dilation. VIP i.v. infusion reduced MABP but did not dilate MMA significantly. PACAP(6-38), which is a potent MC degranulator, also gave a significantdelayed dilation of MMA. PACAP-38 i.c. responses (direct receptor mediated response) were not affected by MC depletion. Only the maximum response (% E max) value of PACAP-27 (i.c.) was significantly lower in MCD rats compared to control rats. CONCLUSIONS: The delayed MMA dilatory responses to PACAP-38 infusion were attenuated in MCD and AH-pretreated rats, indicating a role of the MC mediator-histamine in PACAP-38-induced delayed dilation of MA.

  4. Meningococcal Meningitis

    Science.gov (United States)

    ... 217 million persons have received meningococcal A conjugate vaccine in 15 countries of the African belt. Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane. It can cause severe brain damage and is fatal in 50% of cases if ...

  5. Tuberkuløs meningitis

    DEFF Research Database (Denmark)

    Huth, Sebastian von; Pedersen, Court

    2015-01-01

    Tuberculous meningitis (TBM) denotes infection of the meninges with Mycobacterium tuberculosis complex. In Denmark, TBM is rare, but requires correct handling and rapid treatment. We describe a case of TBM in a previously healthy 19-year-old man from Somalia, whose primary symptoms were fever, headache and altered mental state.

  6. Falso aneurisma da artéria meníngea média importância do diagnóstico angiográfico: relato de caso False aneurysm of the middle meningeal artery: importance of angiographic diagnosis (case report

    Directory of Open Access Journals (Sweden)

    Carlos A. M. Melro

    1993-09-01

    Full Text Available É objetivo deste artigo relatar o caso de um paciente com falso aneurisma da artéria meníngea média e fazer breve revisão da literatura sobre o assunto. O paciente, etilista e vítima de quedas frequentes, foi internado para investigação de sindrome convulsiva. Dentre os exames realizados observou-se, ao raio-X do crânio, fratura do osso temporal e, na carótido-angiografia comum, presença de dilatação aneurismática na artéria meníngea média em íntima relação com a fratura. O relato do caso se justifica visto a baixa frequência desta patologia e sua analogia com hematomas intracranianos de evolução atípica, bem como para salientar o papel da carótido-angiografia na avaliação de alguns casos de traumatismo crânio-encefálico.The purpose of this paper is to report a case of false aneurysm of the middle meningeal artery. The authors emphasize the value of «common» carotid angiopraphy in diagnosis and treatment of this rare lesion.

  7. Cryptococcal Meningitis

    Science.gov (United States)

    ... yeast infections (such as thrush , vaginitis, or severe candida infection of the throat) that are resistant to ... If you get meningitis, early diagnosis might allow treatment with less toxic drugs. Contact your health care ...

  8. Bacterial Meningitis

    Science.gov (United States)

    ... Healthcare Professionals Related Links Vaccine Schedules Preteen & Teen ... people with meningitis recover, it can cause serious complications, such as brain damage, hearing loss, or learning disabilities. There are several ...

  9. Neonatal meningitis.

    OpenAIRE

    A. A. Al-Harthi; K. A. Dagriri; Asindi, A A; Bello, C S

    2000-01-01

    OBJECTIVES To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998. METHODS Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied. RESULTS There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates. Klebsiella pneumoniae (31%) and...

  10. K-ATP channel expression and pharmacological in vivo and in vitro studies of the K-ATP channel blocker PNU-37883A in rat middle meningeal arteries

    DEFF Research Database (Denmark)

    Ploug, K.B.; Boni, L.J.

    2008-01-01

    Background and purpose: Dilatation of cerebral and dural arteries causes a throbbing, migraine-like pain, indicating that these structures are involved in migraine. Clinical trials suggest that adenosine 5'-triphosphate-sensitive K+ (K-ATP) channel opening may cause migraine by dilatating intracranial arteries, including the middle meningeal artery (MMA). We studied the K-ATP channel expression profile in rat MMA and examined the potential inhibitory effects of the K-ATP channel blocker PNU-37883A on K-ATP channel opener-induced relaxation of the rat MMA, using the three K-ATP channel openers levcromakalim, pinacidil and P-1075. Experimental approach: mRNA and protein expression of K-ATP channel subunits in the rat MMA were studied by quantitative real-time PCR and western blotting, respectively. The in vivo and in vitro effects of the K-ATP channel drugs on rat MMA were studied in the genuine closed cranial window model and in myograph baths, respectively. Key results: Expression studies indicate that inwardly rectifying K+ (Kir)6.1/sulphonylurea receptor (SUR) 2B is the major K-ATP channel complex in rat MMA. PNU-37883A (0.5 mg kg(-1)) significantly inhibited the in vivo dilatory effect of levcromakalim (0.025 mg kg(-1)), pinacidil (0.38 mg kg(-1)) and P-1075 (0.016 mg kg(-1)) in rat MMA. In vitro PNU-37883A significantly inhibited the dilatory responses of the three K-ATP channel openers in rat MMA at 10(-7) and 3 x 10(-7) M. Conclusions and implications: We suggest that Kir6.1/SUR2B is the major functional K-ATP channel complex in the rat MMA. Furthermore, we demonstrate the potent in vivo and in vitro blocking potentials of PNU-37883A on K-ATP channel opener-induced relaxation of the rat MMA Udgivelsesdato: 2008/5

  11. Meningeal hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    Guang-zhi YANG

    2015-03-01

    Full Text Available Objective To investigate the clinical, neuroimaging and pathological features of meningeal hemangiopericytoma.  Methods One case of meningeal hemangiopericytoma was reported, and the relevant literatures were also reviewed.  Results A 40-year-old male had caught a headache for about 3 months with muscle weakness in the left limb, and became progressively serious for 2 weeks. Brain MRI displayed a space-occupying lesion in the right temporal lobe with equal signals in T1WI, mixed signals in T2WI and obvious enhancements. In surgery, the tumor was found to be located in the cranial fossa, and was completely removed. The tumor was large, with rich blood supply, and had no capsule. In histology, the neoplasm was composed of dense spindle cells with mild atypia. The boundary of the tumor cells was unclear. The nuclei were circular, oval or spindle with obvious mitoses (4/10 HPF. There were plenty of thick-wall blood vessels and blood sinuses with characteristic "staghorn" shape. In immunohistochemistry, CD34 and vimentin (Vim were positive, epithelial membrane antigen (EMA was focally positive and Ki-67 labeling index was 17%-20%. Postoperative radiotherapy was adopted and no relapse was found during the 20-month follow-up period. Conclusions The meningeal hemangiopericytoma is easy to be misdiagnosed as meningioma, however, the prognosis of meningeal hemangiopericytoma is quite worse, thus the differential diagnosis is very important. A clear diagnosis often depends on pathological examination. DOI: 10.3969/j.issn.1672-6731.2015.03.011

  12. The in vivo effect of VIP, PACAP-38 and PACAP-27 and mRNA expression of their receptors in rat middle meningeal artery

    DEFF Research Database (Denmark)

    Boni, L.J.; Ploug, Kenneth Beri

    2009-01-01

    The parasympathetic nervous system is probably involved in migraine pathogenesis. Its activation releases a mixture of signalling molecules including vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP), which subsequently stimulate VPAC(1), VPAC(2) and PAC(1) receptors. The objective of the present study was to investigate the in vivo effect of VIP, PACAP-27, PACAP-38, the selective VPAC(1) agonist ([Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27)) and a PAC(1) agonist, maxadilan on rat middle meningeal artery (MMA) diameter using the closed cranial window model. Selective antagonists were used for further characterization of the responses. Reverse transcriptase-polymerase chain reaction experiments were also conducted to determine expression of mRNA of PACAP receptors in the MMA. The results showed that VIP, PACAP-38, PACAP-27 and the VPAC(1) specific agonist evoked significant dilations with the rank order of potency; VIP = PACAP-38 > PACAP-27 = [Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27). Significant inhibition of dilation was only observed for the VPAC(1) antagonist PG97-269 on PACAP-38-induced dilation of MMA. The VPAC(2) antagonist PG99-465 and PAC(1) antagonist PACAP(6-38) did not significantly block VIP- or PACAP-induced dilation. Expression of mRNA of all three receptors was detected in the MMA. In conclusion, the VPAC(1) receptor seems to be predominant in mediating MMA dilation. A selective VPAC(1) antagonist may be a candidate molecule in the treatment of migraine headacheThe parasympathetic nervous system is probably involved in migraine pathogenesis. Its activation releases a mixture of signalling molecules including vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP), which subsequently stimulate VPAC(1), VPAC(2) and PAC(1) receptors. The objective of the present study was to investigate the in vivo effect of VIP, PACAP-27, PACAP-38, the selective VPAC(1) agonist ([Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27)) and a PAC(1) agonist, maxadilan on rat middle meningeal artery (MMA) diameter using the closed cranial window model. Selective antagonists were used for further characterization of the responses. Reverse transcriptase-polymerase chain reaction experiments were also conducted to determine expression of mRNA of PACAP receptors in the MMA. The results showed that VIP, PACAP-38, PACAP-27 and the VPAC(1) specific agonist evoked significant dilations with the rank order of potency; VIP = PACAP-38 > PACAP-27 = [Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27). Significant inhibition of dilation was only observed for the VPAC(1) antagonist PG97-269 on PACAP-38-induced dilation of MMA. The VPAC(2) antagonist PG99-465 and PAC(1) antagonist PACAP(6-38) did not significantly block VIP- or PACAP-induced dilation. Expression of mRNA of all three receptors was detected in the MMA. In conclusion, the VPAC(1) receptor seems to be predominant in mediating MMA dilation. A selective VPAC(1) antagonist may be a candidate molecule in the treatment ofmigraine headache Udgivelsesdato: 2009

  13. Cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    DING Wen-ting

    2013-01-01

    Full Text Available Cryptococcus neoformans is a kind of encapsulated fungal organism that widely exists in the nature. Because of its neurotropic nature, the central nervous system becomes its major target organ. Cryptococcus neoformans can use "transcellular pathway", "paracellular pathway" and "Trojan horse approach" to cross blood-brain barrier, and then make the devastating diffusion. Despite antifungal therapy, the mortality rate remains between 10% and 25% in patients with cryptococcal meningitis (CM and acquired immunodeficiency syndrome (AIDS, and at least one-third of patients have experienced failure of antifungal therapy. Consequently, it is very important for us to understand the pathogenesis of CM, to diagnose as soon as possible and to explore more reasonable treatment.

  14. Meningitis complicating transsphenoidal hypophysectomy.

    OpenAIRE

    Romanowski, B.; Tyrrell, D. L.; Weir, B. K.; Goldsand, G.

    1981-01-01

    The case records of 98 patients who underwent a transsphenoidal hypophysectomy between 1969 and 1979 were examined to establish the frequency of postoperative cerebrospinal rhinorrhea and meningitis. There were seven cases of rhinorrhea and six of meningitis following the procedure. Five of the six patients with meningitis had diabetes mellitus and three of the seven with rhinorrhea had meningitis; thus, both diabetes and rhinorrhea were established as significant risk factors (P less than 0....

  15. Primary Spinal Meningeal Melanocytoma

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho [Dong-A University, Busan (Korea, Republic of)

    2009-12-15

    Primary meningeal melanocytic neoplasms are rare lesions that originate from leptomeningeal melanocytes. An intradural meningeal melanocytoma in the thoracic spine is less common than a malignant melanoma, which is its malignant counterpart. We report a case of a histopathologically confirmed primary intradural meningeal melanocytoma in the thoracic spine along with a literature.

  16. Medicininduceret aseptisk meningitis

    DEFF Research Database (Denmark)

    Farr, Katherina Podlekareva; Backer Mogensen, Christian

    2010-01-01

    Drug-induced aseptic meningitis is a rare adverse effect of some drugs. We report a patient with four episodes of meningitis caused by ibuprofen. In all episodes the patient had taken ibuprofen for pain, and subsequently developed fever and cerebrovascular symptoms. Drug-induced meningitis cannot be distinguished from meningitis caused by other agents. Diagnosis is therefore based on close association between drug administration and onset of symptoms, as well as negative microbiology tests results, especially if previous episodes of drug-induced meningitis have occurred.

  17. MR angiography in tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Kalita, Jayantee; Prasad, Sreeram; Maurya, Pradeep K.; Misra, Usha K. (Dept. of Neurology, Sanjay Gandhi Post Graduate Inst. of Medical Sciences, Lucknow (India)), Email: drukmisra@rediffmail.com; Kumar, Sunil (Dept. of Radiodiagnosis, Sanjay Gandhi Post Graduate Inst. of Medical Sciences, Lucknow (India))

    2012-04-15

    Background: Infarctions in tuberculous meningitis (TBM) are common but there is a paucity of studies on MR angiography (MRA). Purpose: To evaluate the pattern and predictors of MRA abnormality in patients with TBM. Material and Methods: Sixty-seven patients with TBM were subjected to clinical, laboratory, magnetic resonance imaging (MRI), and MRA evaluation. The severity of meningitis, focal deficit, CSF findings, and stroke co-morbidities were recorded. Presence of exudates, infarction, hydrocephalous, and tuberculoma on MRI were noted. On intracranial MRA, occlusion or more than 50% narrowing of proximal middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA), and basilar artery were considered abnormal. The MRA abnormality was correlated with clinical, laboratory, and MRI findings. Results: Sixty-seven patients, aged 3-75 years (median 34 years) were included. MRI was abnormal in 61 (91%) patients; basal exudates in 24, hydrocephalous in 23, tuberculoma in 33, and infarction in 40. MRA was abnormal in 34 (50.7%); MCA was most commonly involved (n = 21), followed by PCA (n = 14), ICA (n = 8), ACA (n 5), basilar artery (n = 5), and vertebral and superior cerebellar artery (1 each). One-fourth of the patients had abnormality in both anterior and posterior circulations. MRA abnormality was related to hydrocephalous and infarction; corresponding infarct was present in 61.8% patients; 41.7% patients with abnormal MRA developed infarct at 3 months but none with normal MRA. Conclusion: Half the patients with TBM had MRA abnormality involving both anterior and posterior circulations and 61.8% of them had corresponding infarcts

  18. Antibiotic induced meningitis.

    OpenAIRE

    River, Y.; Averbuch-heller, L.; Weinberger, M.; Meiner, Z.; Mevorach, D.; Schlesinger, I.; Argov, Z.

    1994-01-01

    Three patients with antibiotic induced meningitis, one following penicillin with seven episodes, are reported on--the first well documented description of penicillin induced meningitis. In this patient episodes of headache and nuchal rigidity appeared with and without CSF pleocytosis. Two patients had a total of five episodes of antibiotic induced meningitis after trimethoprim-sulphamethoxazole (co-trimoxazole) administration. The features common to all three patients were myalgia, confusion ...

  19. Meningitis presenting as hypertension.

    OpenAIRE

    Waters, K; GILLIS, J

    1987-01-01

    A 21 month old girl who presented with what seemed to be hypertensive encephalopathy is described. Although her encephalopathy resolved with antihypertensive treatment, subsequent investigations revealed haemophilus meningitis.

  20. Localized basal meningeal enhancement in tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Theron, Salomine; Andronikou, Savvas; Grobbelaar, Marie; Steyn, Freda; Mapukata, Ayanda; Plessis, Jaco du [University of Stellenbosch, Department of Radiology, Tygerberg Hospital, P.O. BOX 19063, Tygerberg (South Africa)

    2006-11-15

    Focal basal meningeal enhancement may produce a confusing CT picture in children with suspected tuberculous meningitis (TBM). To demonstrate the incidence, distribution and appearance of localized basal meningeal enhancement in children with TBM. CT scans of patients with definite (culture proven) and probable (CSF suggestive) TBM were retrospectively evaluated by two observers. Localized basal enhancement was documented as involving: unilateral cistern of the lateral fossa (CLF), unilateral sylvian fissure, unilateral CLF and sylvian fissure in combination, unilateral CLF and sylvian fissure with ipsi- or contralateral ambient cistern and isolated quadrigeminal plate cistern. The study included 130 patients with TBM (aged 2 months to 13 years 9 months). Focal basal enhancement was seen in 11 patients (8.5%). The sylvian fissure was involved most commonly, followed by the lateral fossa cistern. The ambient cistern was involved in three patients and the quadrigeminal plate cistern in one. Focal areas of enhancement corresponded to the areas of infarction in every patient. Focal basal meningeal enhancement is common (8.5%) in paediatric TBM. This must be kept in mind when evaluating CT scans in children presenting with focal neurological findings, seizures or meningism in communities where TBM is endemic. (orig.)

  1. Meningitis Immunization for Adolescents

    Centers for Disease Control (CDC) Podcasts

    2008-08-06

    In this podcast, adolescent vaccine recommendations for meningococcal disease, also known as meningitis, are discussed.  Created: 8/6/2008 by National Center for Infectious and Respiratory Disease (NCIRD), Division of Bacterial Disease (DBD), Meningitis and Vaccine Preventable Diseases Branch (MVPD).   Date Released: 8/7/2008.

  2. MR imaging and angiography in tuberculous meningitis

    International Nuclear Information System (INIS)

    MRI was performed on 26 patients with tuberculous meningitis, with particular reference to document the cranial nerve abnormalities. MR angiography (MRA) was performed in 20 of the patients. Meningeal enhancement in the basal cisterns or over the convexity of brain was seen in all patients; two show ependymal enhancement. Tuberculomas, single (3), multiple (12) or military (2) were detected in 17 patients. Of the 9 patients with cranial nerve palsies, 7 showed contrast enhancement with or without thickening of the involved nerve. Abnormality signal intensity of the involved nerve was seen on proton density and T2-weighted images in one of these patients. MRA revealed focal arterial narrowing in 10 patients, the vessels commonly affected being the terminal segment of the internal carotid artery and the proximal segments of the middle and anterior cerebral arteries. One patient also had a small aneurysm of the proximal middle cerebral artery. Infarcts, haemorrhagic (8) or bland (6), were detected in 14 patients; most were the basal ganglia and internal capsules, large middle or anterior cerebral arterial territory infarcts being seen in only two cases. (orig.)

  3. Meningitis bacteriana aguda / Acute bacterial meningitis

    Scientific Electronic Library Online (English)

    Marcela, Castro R; Jaime, Cordero T.

    1998-08-01

    Full Text Available Objetivo: describir las causas, evolución y complicaciones de la meningitis bacteriana aguda. Pacientes y método: en una encuesta retrospectiva a 14 unidades de cuidados intensivos pediátricos se registraron 358 pacientes que reunión los criterios de diagnostico de meningitis bacteriana aguda (MBA) [...] durante 1996. Resultados: en 36,6% la etiologia fue Neisseria meilngifidis, Streptococcus pneumonioe en 19,8% y Haemophilus influenzae tipo b en  6%. En 21% no se aisló el agente. La letalidad fue 3,5% para N meningitidis-, 14% para S. pneumonioe y 3% para H. influenzae tipo b. De los 358 pacientes, 21% se hospitalizaron en sola común durante toda su evolución. Las complicaciones mas frecuentes fueron falla circulatoria o cheque (35%), convulsiones (22%) e hipertensión intracraneala (18%). Se uso asistencia respiratoria mecánica en 31% de los pacientes, variando su empleo de 9 o 71% Según centre. Fallecieron 23 pacientes 16,3%), 40% antes de 24 h desde el ingresa, 60,8% por hipertensión intracraneana y enclavamiento encefálico, 30,8% por falla circulatoria. Conclusión: los niños con meningitis bacteriana aguda deben ingresar a unidades de cuidados intensivos en las primeras 24 horas. Se requiere uniformar criterios de asistencia mecánico a la respiración. Abstract in english Objective: to describe etiology and evolution of bacterial meningitis as seen from pediatric intensive care units. Patients and methods: a retrospective survey was done to 358 patients who met diagnostic criteria of acute bacterial meningitis and were odmited Jo 14 chilean hospitals along year 1996. [...] Results: most frequently isolated bacteriae were: Neisseria meningitidis (36,6%), Streptococcus pneumoniae (19,8%) end Haemophilus influenzae type b (16%). In 2 1 % of the coses no etiology was identified. Specific mortality was 3,5% for N. meningitidis, 14% for 5. pneumonioe and 3% for H. influenzae type b. One in five patients was never admitted to an intensive care unit JICU). Shock (35%), seizures (22%) and int-acraneal hypertension (13%) were the most frecuent complications. Mechanical ventilation was used en 31% patients (9 to 71% depending of center; 23% patients died, 40% ofthern in the first 24hours after admission. Main causes of death were inlracraneal hypertension (61%] and shock (30,8%). Conclusion: most patients with acute bacterial meningitis should be admitted to inlensive care units. Uniform criteriae for mechanical respiratory assistance must be settled.

  4. Iatrogenic meningitis / Meningites iatrogenicas

    Scientific Electronic Library Online (English)

    Eduardo Genaro, Mutarelli; Tarso, Adoni.

    2013-09-01

    Full Text Available As meningites iatrogênicas podem ser provocadas por uma série de mecanismos. Os recentes relatos de casos de meningite por fungos após a aplicação de injeção epidural de metilprednisolona causou alerta na comunidade médica. Os casos foram causados por lotes contaminados de metilprednisolona produzid [...] os por uma única farmácia de produção. Diversos medicamentos podem causar meningite por provável mecanismo de hipersensibilidade. Neurologistas devem ficar alerta para a recente descrição do uso de lamotrigina e o desenvolvimento de meningite asséptica. Abstract in english Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Sever [...] al medications can cause meninigitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.

  5. Eosinophilic meningitis due to Angiostrongylus cantonensis

    OpenAIRE

    Panackel C; Vishad; Cherian G; Vijayakumar K; Sharma R

    2006-01-01

    Angiostrongylus cantonensis is a nematode parasite that inhabits the pulmonary arteries and heart of rodents. It is one of the causative agents of fatal eosinophilic meningoencephalitis in man. We present five cases of eosinophilic meningitis presumably due to infection with Angiostrongylus cantonensis . All the five patients gave history of ingestion of monitor lizard within ten days of onset of symptoms.

  6. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur in a patient with otitis media.

  7. Carcinomatose das meninges / Carcinomatosis of the meninges

    Scientific Electronic Library Online (English)

    Oswaldo Ricciardi, Cruz.

    1959-03-01

    Full Text Available Registro de um caso de carcinomatose das leptomeninges secundária a carcinoma sólido do estômago. Células carcinomatosas foram encontradas no liqüido cefalorraquidiano colhido tanto por via suboccipital como no ventrículo lateral. O exame histopatológico mostrou invasão neoplásica das leptomeninges. [...] Não foram encontradas metástases encefálicas. A disposição e a morfologia das células carcinomatosas das leptomeninges eram semelhantes às da neoplasia primária. Abstract in english A case of carcinomatosis of the meninges, metastatic from a gastric carcinoma, is presented. Tumoral cells were found in the suboccipital and ventricular fluid. Macrocoscopic encephalic metastases were not found. The disposition and the morphology of the tumoral cells detected in the leptomeninges w [...] ere similar to those of the primary tumor.

  8. Stroke patterns in neonatal group B streptococcal meningitis.

    Science.gov (United States)

    Hernández, Marta I; Sandoval, Carmen C; Tapia, Jose L; Mesa, Tomas; Escobar, Raul; Huete, Isidro; Wei, Xing-Chang; Kirton, Adam

    2011-04-01

    Neonatal group B streptococcus meningitis causes neurologic morbidity and mortality. Cerebrovascular involvement is a common, poorly studied, and potentially modifiable pathologic process. We hypothesized that imaging patterns of focal brain infarction are recognizable in neonatal group B streptococcal meningitis. A consecutive case series included term neonates with the following: (1) bacterial meningitis, (2) acute group B streptococcal infection (positive cerebrospinal fluid/blood culture), (3) brain magnetic resonance imaging within 14 days, and (4) acute intraparenchymal focal infarctions (restricted diffusion). Lesions within known arterial territories were classified as arterial ischemic stroke. Clinical presentations, investigations, and neurologic outcomes were recorded. Eight newborns (50% female) with focal infarction were identified. Five presented early (<1 week), and all manifested clinical shock and elevated acute-phase reactants. Less than 50% had prenatal group B streptococcal screening, while 2 of 3 screened were negative. Two distinct patterns of focal infarction were identified: (1) deep perforator arterial stroke to basal ganglia, thalamus, and periventricular white matter (7/8, 88%), and (2) superficial injury with patchy, focal infarctions of the cortical surface (6/8, 75%). Outcomes (mean 23.8 months) were poor, with severe disability or death in 6/8 (75%). Recognizable stroke patterns contribute to severe neurologic outcomes and represent a potentially modifiable pathophysiologic process in neonatal group B streptococcal meningitis. PMID:21397170

  9. Fibrosarcoma of the meninges

    Directory of Open Access Journals (Sweden)

    Ishwar Chand Premsagar

    2010-03-01

    Full Text Available Meningeal fibrosarcomas are rare tumors. Only 41 cases have been reported in the literature to date. Primary central nervous system fibrosarcomas are very aggressive neoplasms and have a poor prognosis. Hence they need to be correctly diagnosed. This is a case of a 13-year old boy with intracranial space occupying lesion. The mass was completely removed and histological examination was characteristic of meningeal fibrosarcoma. The pathological diagnosis is usually made on routine light microscopic examination; however, occasionally these may be difficult to distinguish from other malignant neoplasms such as gliomas, meningiomas and metastases. The diagnosis of fibrosarcoma is based on the identification of a predominant herringbone architectural pattern, the overall uniformity of the spindle cell population, the prominent vimentin positivity, and the presence of pericellular reticulin fibre network. IHC helps to exclude other diagnoses.

  10. Meningeal hemangiopericytoma in childhood

    International Nuclear Information System (INIS)

    Meningeal hemangiopericytoma (MHP) is extremely rare in childhood. Mean age at diagnosis is between 38 and 43 years. We present an 8-year-old boy with MHP of the middle cranial fossa. Imaging findings were indistinguishable from an aggressive bone tumor such as Ewing's sarcoma. Imaging findings are presented and discussed. Our case indicates that MHP should be considered in the differential diagnosis of skull-base tumors despite the fact that MHP is extremely rare in childhood. (orig.)

  11. Natalizumab and HSV meningitis

    OpenAIRE

    Shenoy, Erica Seiguer; Mylonakis, Eleftherios; Hurtado, Rocio M.; Venna, Nagagopal

    2011-01-01

    Natalizumab (Tysabri, Biogen Idec and Elan Pharmaceuticals) is a monoclonal antibody approved for use in patients with relapsing multiple sclerosis (MS) as well as moderate to severe Crohn’s disease. We report the first case of a patient with a history of MS, on monthly natalizumab, who developed HSV-2 meningitis. We discuss the mechanism of action of natalizumab and review what is known about the reactivation of herpes infection in association with this medication. The question of herpes s...

  12. Candida lusitaniae causing fatal meningitis.

    OpenAIRE

    Sarma, P. S.; Durairaj, P.; Padhye, A.A.

    1993-01-01

    Fatal meningitis due to Candida lusitaniae in a 35 year old previously healthy man is described. C. lusitaniae is an opportunistic fungal pathogen reported infrequently in the English literature. This is the third case report of meningitis and the first fatal infection in an adult from Central India due to C. lusitaniae known to the authors.

  13. Meningitis sifilítica aguda / Acute syphilitic meningitis

    Scientific Electronic Library Online (English)

    Efraín, Riveros; Fred, Manrique-Abril; Manuel, Bustamante.

    2011-09-01

    Full Text Available Se trata de un paciente de 28 años de sexo femenino, que presentó un cuadro clínico rápidamente progresivo de cambios en el comportamiento y deterioro del estado de conciencia. Ingresó con puntaje de Glasgow de 8/15 y requirió intubación traqueal. Tenía respuesta plantar extensora bilateral, pupila [...] izquierda midriática de 5 mm, sin respuesta a la luz, ptosis palpebral del mismo lado y nistagmo con componente rápido hacia la izquierda. El contenido de proteínas del líquido cefalorraquídeo fue de 0,86 g/l con pleocitosis moderada de predominio linfocitario. Tres semanas antes del ingreso, presentó parto vaginal eutócico; no tuvo control prenatal durante el embarazo. En el recién nacido se demostró serología reactiva para sífilis y FTA-ABS positivo. La paciente también fue hallada reactiva para serología de sífilis en el líquido cefalorraquídeo, con diagnóstico de meningitis sifilítica aguda. La prueba ELISA para VIH fue negativa. Abstract in english A 28 year-old woman presented with a rapidly progressive clinical picture of behavioral changes and altered level of consciousness. She was admitted with Glasgow Coma Score 8/15, 5 mm dilated non-reactive left pupil, right ptosis and nystagmus with left lateral gaze. Protein content at cerebrospinal [...] fluid was 0,86 g/L with pleocytosis. Three weeks earlier, the patient underwent vaginal delivery of a pregnancy without prenatal care, and the newborn was found to be reactive to syphilis serology and positive on FTA-ABS test. The patient was found positive as well for syphilis on serologic tests for syphilis, corresponding yhe picture to neurosyphilis.HIV testing was negative in the patient.

  14. Neuropsychiatric sequelae of viral meningitis in adults

    DEFF Research Database (Denmark)

    Damsgaard, Jesper; Hjerrild, Simon

    2011-01-01

    Viral meningitis is considered to be a benign illness with only mild symptoms. In contrast to viral encephalitis and bacterial meningitis, the prognosis is usually good. However, retrospective studies have demonstrated that patients suffering from viral meningitis may experience cognitive impairment following the acute course of infection. Larger controlled studies are needed to elucidate the potential neuropsychiatric adverse outcome of viral meningitis.

  15. Meningitis tras anestesia espinal / Meningitis after a spinal anesthesia

    Scientific Electronic Library Online (English)

    A. L., Vázquez-Martínez; F., Castro; G., Illodo; E., Freiré; M. A., Camba.

    2008-03-01

    Full Text Available La meningitis post-punción es una importante complicación de la anestesia espinal. Describimos el caso de un varón de cuarenta y seis años que ingresó para tratamiento quirúrgico de una hernia umbilical, la cirugía se realizó bajo anestesia intradural. Tras la intervención el paciente comenzó con un [...] cuadro clínico compatible con meningitis, que se confirmó tras examen del líquido cefalorraquídeo. Se trató con antibióticos a pesar de la no identificación de gérmenes, siendo la evolución favorable. El diagnóstico etiológico de una meningitis iatrogénica no siempre es posible, pero siempre debemos tener en cuenta esta posibilidad. En este artículo queremos revisar la situación actual del problema, especialmente la profilaxis y la actitud terapéutica. Abstract in english Post-dural puncture meningitis is a serious complication of spinal anesthesia. We describe the case of a forty six years old male who was admitted for surgical intervention of an umbilical hernia, performed under spinal anesthesia. After surgery the patient developed a clinical syndrome compatible w [...] ith meningitis, the diagnosis was confirmed by examination of the cerebrospinal fluid. Broad-spectrum antibiotics were started although spinal cultures were negatives, and the patient's clinical course was favourable. The meningitis differential diagnosis may be difficult, but we must think about this possibility. In this case report ,we want to check the present situation, specially the prevention and medical treatment.

  16. Meningitis tras anestesia espinal Meningitis after a spinal anesthesia

    Directory of Open Access Journals (Sweden)

    A. L. Vázquez-Martínez

    2008-03-01

    Full Text Available La meningitis post-punción es una importante complicación de la anestesia espinal. Describimos el caso de un varón de cuarenta y seis años que ingresó para tratamiento quirúrgico de una hernia umbilical, la cirugía se realizó bajo anestesia intradural. Tras la intervención el paciente comenzó con un cuadro clínico compatible con meningitis, que se confirmó tras examen del líquido cefalorraquídeo. Se trató con antibióticos a pesar de la no identificación de gérmenes, siendo la evolución favorable. El diagnóstico etiológico de una meningitis iatrogénica no siempre es posible, pero siempre debemos tener en cuenta esta posibilidad. En este artículo queremos revisar la situación actual del problema, especialmente la profilaxis y la actitud terapéutica.Post-dural puncture meningitis is a serious complication of spinal anesthesia. We describe the case of a forty six years old male who was admitted for surgical intervention of an umbilical hernia, performed under spinal anesthesia. After surgery the patient developed a clinical syndrome compatible with meningitis, the diagnosis was confirmed by examination of the cerebrospinal fluid. Broad-spectrum antibiotics were started although spinal cultures were negatives, and the patient's clinical course was favourable. The meningitis differential diagnosis may be difficult, but we must think about this possibility. In this case report ,we want to check the present situation, specially the prevention and medical treatment.

  17. Chronic hypothermia following tuberculous meningitis.

    OpenAIRE

    Dick, D J; Sanders, G L; Saunders, M; Rawlins, M.D.

    1981-01-01

    A patient who developed chronic hypothermia following tuberculous meningitis is described. A central defect of thermoregulation was discovered, probably due to a discrete vascular lesion in the anterior hypothalmus.

  18. Spinal perineurial and meningeal cysts

    Science.gov (United States)

    Tarlov, I. M.

    1970-01-01

    Perineurial cysts may be responsible for clinical symptoms and a cure effected by their removal. They do not fill on initial myelography but may fill with Pantopaque some time, days or weeks, after Pantopaque has been instilled into the subarachnoid space. Perineurial cysts arise at the site of the posterior root ganglion. The cyst wall is composed of neural tissue. When initial myelography fails to reveal an adequate cause for the patient's symptoms and signs referable to the caudal nerve roots, then about a millilitre of Pantopaque should be left in the canal for delayed myelography which may later reveal a sacral perineurial cyst or, occasionally, a meningeal cyst. Meningeal diverticula occur proximal to the posterior root ganglia and usually fill on initial myelography. They are in free communication with the subarachnoid space and are rarely in my experience responsible for clinical symptoms. Meningeal diverticula and meningeal cysts appear to represent a continuum. Pantopaque left in the subarachnoid space may convert a meningeal diverticulum into an expanding symptomatic meningeal cyst, as in the case described. Many cases described as perineurial cysts represent abnormally long arachnoidal prolongations over nerve roots or meningeal diverticula. In general, neither of the latter is of pathological significance. Perineurial, like meningeal cysts and diverticula, may be asymptomatic. They should be operated upon only if they produce progressive or disabling symptoms or signs clearly attributable to them. When myelography must be done, and this should be done only as a preliminary to a probable necessary operation, then patient effort should be made to remove the Pantopaque. Images PMID:5531903

  19. Experimental studies of pneumococcal meningitis.

    Science.gov (United States)

    Brandt, Christian T

    2010-01-01

    This thesis summarizes experimental meningitis research conducted at Statens Serum Institut in collaboration with the Copenhagen HIV programme and the Danish Research Centre for Magnetic Resonance between 2001 and 2007. Previous experimental studies had shown that the host inflammatory response in invasive infections contributed significantly to an extremely poor outcome despite initiation of efficient antimicrobial chemotherapy. Consequently, we aimed to investigate and clarify how the course of disease in pneumococcal meningitis was modulated by local meningeal inflammation and concomitant systemic infection and inflammation. Experimental studies were based on the development of a rat model of pneumococcal meningitis, refined and optimized to closely resemble the human disease, mimicking disease severity, outcome, focal- and global brain injury and brain pathophysiology. These endpoints were evaluated by the development of a clinical score system, definition of outcomes and measurement of hearing loss by otoacoustic emission. The investigation of in-vitro and in-vivo brain pathology with histology and MRI revealed an injury pattern similar to that found clinically. Additionally, MRI enabled the study of parameters closely related to the cerebral pathophysiology of meningitis (brain oedema, blood brain barrier (BBB) permeability, focal brain injury and hydrocephalus). Modulation of the inflammatory host response was achieved by initiation of treatment prior to infection: 1) G-CSF treatment increased the peripheral availability of leukocytes, 2) Selectin blocker fucoidin attenuated meningeal leukocyte accumulation and 3) A serotype specific Ab augmented systemic pneumococcal phagocytosis. The studies revealed a dual role of the inflammatory response in pneumococcal meningitis. Whilst focal brain injury appeared to result from local meningeal infectious processes, clinical disease severity and outcome appeared determined by systemic infection. Furthermore systemic disease contributed significantly to BBB permeability and brain ventricle expansion. Ventricle expansion was also associated with clinical appearance. An augmented systemic host response limited pneumococcal bacteraemia and protected from fatal outcome, but did not reduce occurrence of focal brain injury. Thus, our findings suggest that meningitis sequelae arise from local disease complications whereas fatal outcome is accelerated by systemic infection. Understanding of the relationship and interplay between septicaemia, intracranial pressure, ventricle expansion and brain edema could help optimize the treatment of these disease complications by, for example, improved systemic infection control. New therapeutic approaches to improve survival and neurological outcome from pneumococcal meningitis may be achieved through identification of the pathogen factors that initiate and prolong extensive systemic and local inflammation. Investigation of genomic differences and protein expression between pneumococcal serotypes or between identical serotypes with different virulence are considered crucial to this progress. Future progress may also be achieved by disease prevention with pneumococcal vaccines. Randomized trials of treatment strategies including bacteriostatic agents, antioxidants or more specific anti-inflammatory agents are realistic possibilities in the near future. PMID:20175949

  20. Dynamic CT of tuberculous meningeal reactions

    Energy Technology Data Exchange (ETDEWEB)

    Jinkins, J.R.

    1987-07-01

    The technique of intravenous dynamic cranial computed tomography has been applied to the patient population at this location in Saudi Arabia with meningeal tuberculosis. The various manifestations and sequelae including meningitis, arteritis, infarct, and true meningeal tuberculomata all have characteristic if not specific appearances. The dynamic study enhances an otherwise static examination and reveals a great deal about the pathophysiology of tuberculosis involving the cerebral meningeal surfaces.

  1. Meningitis postquirúrgica: Características diferenciales de la meningitis aséptica post-quirúrgica / Postsurgical meningitis: Differential characteristics of aseptic postsurgical meningitis

    Scientific Electronic Library Online (English)

    A., Ramos-Martínez; T. de las, Heras-Carballo; C., Fernández-Mateos; L. de, Reina; T., Álvarez de Espejo-Montiel; N., Escamilla-Fernández; I., Sánchez-Romero; I., Millán.

    2009-04-01

    Full Text Available Introducción. La meningitis postquirúrgica es una complicación infrecuente que se acompaña de un incremento de la estancia hospitalaria y de una elevada mortalidad. Algunos de estos casos no son debidos a una verdadera infección sino a una inflamación aséptica de las meninges denominada meningitis a [...] séptica post-quirúrgica (MAPQ). La adecuada identificación de estos casos permitiría una mejor utilización de los fármacos antimicrobianos. Material y métodos. Estudio retrospectivo de los pacientes con meningitis postquirúrgica en un hospital terciario durante 14 años comparando las características clínicas de los pacientes con meningitis bacteriana postquirúrgica (MBP) frente a las de pacientes con MAPQ Resultados. Durante el período analizado se identificaron 35 pacientes (71%) con MBP y 14 pacientes (29%) con MAPQ. La edad media de los pacientes con MBP fue similar a la de los pacientes con MAPQ. Hubo predominio de varones en el grupo de MBP (71%) en relación con los pacientes con MAPQ (36%, p=0,020). La proporción de pacientes con hemorragia intracraneal tendió a ser más frecuente en pacientes que posteriormente desarrollaron MAPQ (9 pacientes, 64 %) que en los pacientes con MBP (12 casos, 34%, p=0,055). Los pacientes sometidos a craneotomía posterior (p=0,092) y los que recibían tratamiento esteroideo (p=0,051) mostraron una mayor tendencia a padecer MAPQ. Siete pacientes MBP (20%) presentaron un recuento celular superior a 5000 células/mm³ en el LCR, cifra no encontrada en ningún caso de MAPQ. No se detectaron diferencias en la glucorraquia y proteinorraquia entre ambos grupos. La bacterias más frecuentemente aisladas fueron Staphylococcus coagulasa negativa y S. aureus. En 5 pacientes (14%) se aislaron bacilos gramnegativos no fermentadores (Pseudomonas aeruginosa y Acinetobacter spp). No hubo ningún fallecimiento atribuido a meningitis postquirúrgica. Conclusión. Los pacientes sometidos a neurocirugía que fueron ingresados por hemorragia cerebral, intervenidos de la fosa posterior o tratados con esteroides presentan una mayor tendencia a presentar MAPQ. Los recuentos celulares en LCR elevados (superiores a 5000 células /mm³) sugieren la existencia de MBP. Abstract in english Background. Postsurgical meningitis is a rare complication that is accompanied by an increase of hospital stay and high mortality. Some of these cases are not due to a true infection but due to an aseptic inflammation of the meninges denominated aseptic postsurgical meningitis (APSM). Proper identif [...] ication of these cases would allow better use of antimicrobial drugs. Methods. A retrospective study of patients with postsurgical meningitis in a universitary hospital for 14 years. We describe the clinical characteristics of patients with postsurgical bacterial meningitis (PBM) compared to those of patients with APSM. Results. During the studied period 35 patients (71%) with PBM and 14 patients (29%) with (APSM) were identified. The mean age of patients with PBM was similar to that of patients with APSM. There was a male predominance in the group of PBM (71%) compared with patients with APSM (36%, p = 0.020). Patients with intracranial hemorrhage tended to present more cases of APSM (64%) than of PBM (34%, p = 0.055). Patients undergoing posterior fossa craniotomy (p = 0.092) and those receiving steroids (p = 0.051) showed a greater tendency to suffer APSM. It was also noted a trend towards present PBM in patients who had suffered an infection in the previous month (p=0.072). There were seven patients with PBM (20%) with a cell count above 5000 cells/mm³ in CSF, values not found in any patients with APSM. No differences were detected in the glycorrachia and proteinorrachia between the two groups. The most common bacteria isolated were coagulase negative Staphylococcus and S. aureus. In 5 patients (14%) non fermenting gram-negative bacillus (Pseudomonas aeruginosa and Acinetobacter spp) were isolated. There were no deaths attributed to any type of postsurgical meningitis. Conclusion

  2. Meningeal metastasing of malignant melanomas

    International Nuclear Information System (INIS)

    Two woman patients with malignant melanoma of the skin known from their case history and with acutely emerging neurological symptoms were examined both by CT and by MR tomography (both plain and with intravenous contrast medium). The radiologically derived suspicion of meningioma could not be confirmed by intraoperatively performed histological examination. In both cases the patients had meningeal melanoma metastases with low melanin content and without noticeable bleeding into the metastases. MR diagnosis is rendered difficult by the absence of paramagnetic substances typical of melanoma metastases. Hence, if the case history is known, it should be considered whether there is meningeal metastasising with atypical histology. (orig.)

  3. Meningitis as cochlear implant complication

    Directory of Open Access Journals (Sweden)

    Kosanovi? Rade

    2009-01-01

    Full Text Available Over the last several decades, cochlear implantation has been fully proven as the treatment for profound hearing losses. The direct electrical stimulation of the spiral ganglion hair cells through the electrode inserted in the cochlear scala tympani is the essence of the cochlear implant (CI functioning. Modern technological development has introduced unexpected technical quality possibilities of the device itself, as well as coding strategies, which further enable improved patients' rehabilitation results. Nevertheless, in spite of cochlear implantation becoming a routine surgical procedure, which has been changing lives of thousands of profoundly deaf adults and children, it has possible complications. Though rare, these complications could lead to severe, even fatal consequences. Bacterial meningitis represents one of the most severe postoperative complications. In this article, our five-year experience with cochlear implantation is shown, compared to other, much bigger, experiences. Despite severity and a potentially fatal outcome of meningitis, it has rarely been seen, and the precise connection between surgical procedure and this complication is not yet clear. Do cochlear implants increase the risk of bacterial meningitis? Are deafness-associated factors predisposing the bacterial meningitis occurrence, independently from the implant? These are the questions that the Centers for Disease Control and Prevention (CDC, the Food and Drug Administration (FDA and the CI surgeons have been facing, as well as manufacturers and patients with their families.

  4. Streptococcus bovis Meningitis and Hemorrhoids ?

    OpenAIRE

    Smith, Adam Hewitt; Sra, Harminder K.; Bawa, Sandeep; Stevens, Richard

    2010-01-01

    We report a case of Streptococcus bovis (Streptococcus gallolyticus subsp. pasteurianus) meningitis, a rare cause of central nervous system (CNS) infection in an adult, and comment on the importance of investigation of the lower gastrointestinal tract to identify a portal of entry in cases of systemic Streptococcus bovis infection.

  5. Meningitis Due to Bacillus Anthracis

    OpenAIRE

    Gürcan, ?aban; Akata, Filiz; Kulo?lu, Figen; Erdo?an, Sevinç; Tu?rul, Murat

    2005-01-01

    The first case of haemorrhagic meningitis due to Bacillus anthracis in the European part of Turkey is reported here. B. anthracis, sensitive to penicillin, was isolated from the cerebrospinal fluid and blood cultures. Although appropriate therapy was administered, the patient died two days after hospitalization.

  6. Computed tomography in meningeal carcinomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Koizumi, H.; Ono, N.; Horikoshi, S.; Uki, J.; Takeda, F. (Saitama Cancer Center (Japan))

    1982-04-01

    CT findings of meningeal carcinomatosis were studied in 17 patients (seven with lung cancer, two with breast cancer, one with gastric cancer, one with malignant melanoma, five with leukemia, and one with malignant lymphoma). The diagnosis was confirmed by a cytological survey of the cerebrospinal fluid and/or autopsy. Signs and symptoms caused by meningeal carcinomatosis at the CT examination varied from individual to individual. Those most frequently observed were signs of increased intracranial pressure, often accompanied by cranial nerve palsies, paresthesia, motor weakness, cerebellar signs, and nuchal stiffness, CT scan revealed evidence of meningeal carcinomatosis in ten cases out of the seventeen. CT evidences were obtained in 16.7% of the cases with hematologic malignancy and in 81.8% of those with non-hematologic malignancies. The CT findings of meningeal carcinomatosis may be summarized as follows: I. 1) Obliteration and narrowing of the cisterns and sulci, with contrast enhancement along them. 2) Enhanced spots/areas beneath the brain surface, with contrast enhancement. 3) Diffuse, slightly high density of the brain surface, with contrast enhancement. 4) Enhancement of the ventricular wall. 5) Hydrocephalus. II. 1) No CT abnormalities.

  7. Increased anisotropy in neonatal meningitis: an indicator of meningeal inflammation

    Energy Technology Data Exchange (ETDEWEB)

    Trivedi, Richa; Gupta, Rakesh K.; Nath, Kavindra [Sanjay Gandhi Post Graduate Institute of Medical Sciences, Department of Radiodiagnosis, Lucknow, UP (India); Malik, Gyanendra K.; Gupta, Amit [King George' s Medical University, Department of Pediatrics, Lucknow (India); Prasad, Kashi N. [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Microbiology, Lucknow (India); Purwar, Ankur; Rathore, Divya; Rathore, Ram K.S. [Indian Institute of Technology, Department of Mathematics, Kanpur (India); Narayana, Ponnada A. [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Houston, TX (United States)

    2007-09-15

    Increased anisotropy in brain abscesses has been shown to be due to adhesion of inflammatory cells and is suggestive of an active inflammatory process. The objective of this study was to determine if similar changes occur in the pia-arachnoid on the surface of the cerebral cortex in patients with pyogenic meningitis, and if these changes regress following antibiotic therapy. Diffusion tensor imaging (DTI) was performed on 14 term neonates (mean age 13 days) with bacterial meningitis and 10 healthy age- and sex-matched controls. Regions of interest (ROIs) were placed on areas including the leptomeninges, the cerebral cortex and adjoining subcortical white matter for quantitation of mean fractional anisotropy (FA) and diffusivity (MD) values. Follow-up MRI was performed in five of the neonates in the patient group after 2 weeks of antibiotic treatment. FA and MD values were compared in patients before and after antibiotic treatment as well as with those in the healthy controls. Significantly higher FA values but no difference in MD values were observed in the patient group as compared to the healthy controls at both time points (before and after antibiotic treatment). Significantly decreased FA values in the frontal, occipital and temporal cortical regions were observed in patients following antibiotic treatment. DTI-derived FA may be of value in the noninvasive assessment of meningeal inflammatory activity and treatment response in neonates. (orig.)

  8. C-reactive protein and bacterial meningitis.

    Science.gov (United States)

    Cuevas, L E; Hart, C A; Molyneux, M; Mughogho, G H

    1988-12-01

    We have studied prospectively the C-reactive protein values in the cerebrospinal fluid of 54 patients with bacterial meningitis, tuberculous meningitis, and severe malarial infection and convulsions without infections of the central nervous system. CSF CRP above 1 mg/l was observed in 23 out of 28 patients with bacterial meningitis (sensitivity of 82%). The specificity was 73% at the 1 mg/l level. Five out of 19 patients with severe malarial infection had CSF CRP levels above 1 mg/l. Two patients with TB meningitis were also studied. Both of them had CSF CRP above 1 mg/l. Five patients with febrile convulsions or sepsis without meningitis had CSF CRP below 1 mg/l. It is concluded that CSF CRP would not be used as a useful discriminatory test in areas where malaria and TB meningitis are common. PMID:2467609

  9. Prevalence of Lyme meningitis in children with aseptic meningitis in a Lyme disease-endemic region.

    Science.gov (United States)

    Garro, Aris C; Rutman, Maia S; Simonsen, Kari; Jaeger, Jenifer L; Chapin, Kimberle; Lockhart, Gregory

    2011-11-01

    This study determined the prevalence of Lyme meningitis in children with undifferentiated aseptic meningitis from April to December in a Lyme disease-endemic region. Of the 60 children, 8 were seropositive (prevalence 13.3%; 95% confidence interval: 6.3-25.1%), with another probable case having high cerebrospinal fluid antibody titers. Clinicians in endemic regions should evaluate children with undifferentiated aseptic meningitis for Lyme meningitis in appropriate seasons. PMID:21909050

  10. Gallium-67 uptake in meningeal sarcoidosis

    International Nuclear Information System (INIS)

    A case of sarcoidosis limited to the central nervous system is described in which the diagnosis was suggested by high Ga-67 uptake in the cranial and spinal meninges. The diagnosis was confirmed by meningeal biopsy. Treatment with oral corticosteroids resulted in clinical improvement and marked reduction in Ga-67 uptake in the meninges. This is the first reported case of the central nervous system sarcoid diagnosed by Ga-67 imaging

  11. Tuberculous Meningitis in BCG-Vaccinated Children

    Directory of Open Access Journals (Sweden)

    M Movahhedi

    1998-05-01

    Full Text Available It is generally accepted that BCG vaccination is fully effective in preventing Tuberculous Meningitis and military Tuberculous, although it does not develop complete immunity for Tuberculous infection of lungs and other organs. A series of 3 children with Tuberculous Meningitis who had positive history of BCG vaccination as newborns and distinct BCG scar show that Tuberculous Meningitis may be caught despite successful BCG vaccination.

  12. Hyponatraemia associated with pneumonia or bacterial meningitis.

    OpenAIRE

    Shann, F.; Germer, S.

    1985-01-01

    Serum sodium concentrations were measured in 93 children with pneumonia or bacterial meningitis on their admission to hospital. Hyponatraemia (sodium value 134 mmol/l or less) was present in 33 (45%) of the 73 children with pneumonia, and in 10 (50%) of the 20 children with bacterial meningitis. Increased secretion of antidiuretic hormone is common in children with pneumonia, as well as in children with meningitis. The maintenance fluid requirement in these children is usually about 50 ml/kg/...

  13. Study of tuberculous meningitis by CT

    International Nuclear Information System (INIS)

    Computed tomography is a very valuable method by which the pathogenic evolution of tuberculous meningitis may be followed, thereby facilitating its differential diagnosis and controlling the efficiency of therapy. The initial miliary tuberculosis in the brain, very often unaccompanied by neurological symptoms, may offer very evident CT images. CT may also demonstrate the fibrogelatinous exudate which fills the basal cisterns and surrounds the arterial vessels which cross this region. Because of this, secondary arteritis is frequent and may be indirectly detected by CT in the form of foci of ischemic infarcts. Tuberculomas may be multiple, and are found equally in the cerebral and the cerebellar parenchyma. These tuberculomas present different images on CT, depending on the evolution of the disease at that moment. Hydrocephalus is a common complication of TM and is caused by a lack of reabsorption of the cerebrospinal fluid, or by an obstructive lesion in the ventricular drainage pathways due to a tuberculoma. This complication is usually easily identified by CT, which, moreover, permits the control of its evolution. (orig.)

  14. Study of tuberculous meningitis by CT

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, M.; Romero, F.; Torrent, O.; Ibarra, B.

    1980-04-01

    Computed tomography is a very valuable method by which the pathogenic evolution of tuberculous meningitis may be followed, thereby facilitating its differential diagnosis and controlling the efficiency of therapy. The initial miliary tuberculosis in the brain, very often unaccompanied by neurological symptoms, may offer very evident CT images. CT may also demonstrate the fibrogelatinous exudate which fills the basal cisterns and surrounds the arterial vessels which cross this region. Because of this, secondary arteritis is frequent and may be indirectly detected by CT in the form of foci of ischemic infarcts. Tuberculomas may be multiple, and are found equally in the cerebral and the cerebellar parenchyma. These tuberculomas present different images on CT, depending on the evolution of the disease at that moment. Hydrocephalus is a common complication of TM and is caused by a lack of reabsorption of the cerebrospinal fluid, or by an obstructive lesion in the ventricular drainage pathways due to a tuberculoma. This complication is usually easily identified by CT, which, moreover, permits the control of its evolution.

  15. Radiation in the treatment of meningeal leukemia

    International Nuclear Information System (INIS)

    At the present time, a successful regimen for the eradication of occult meningeal leukemia is the combination of cranial radiotherapy in a dose of 1800 rads in 10 fractions in 12 to 14 days with six doses of intrathecal methotrexate. This regimen, when given with prednisone and vincristine can be expected to give a relapse rate for isolated meningeal leukemia of approximately 5% during the first 2 years of follow-up. A modification of this regimen utilizing craniospinal radiation with prior and concurrent intrathecal methotrexate is given for the treatment of overt meningeal leukemia at diagnosis or for an isolated first relapse with meningeal leukemia. Radiation technique and morbidity are discussed

  16. Rapid diagnosis of meningitis using reagent strips

    Directory of Open Access Journals (Sweden)

    Parmar Ramesh

    2004-02-01

    Full Text Available OBJECTIVES: Identification of causative agent with estimation of cerebrospinal fluid (CSF glucose, protein, cells is necessary for accurate diagnosis of meningitis. Unfortunately, even these facilities are not available in many areas. Reagent strips that measure glucose and protein in blood and urine can serve this task but have been used with varying results in the past. This study was carried out to evaluate the utility and efficacy of Combur 10 strips in the diagnosis of meningitis. DESIGN, SETTINGS AND METHODS: A prospective clinical single blinded study of 63 children suspected to have meningitis undergoing CSF analysis. Each CSF sample was divided in to two and was utilised for reagent strip analysis in addition to standard laboratory evaluation and a correlation analysis were made. Statistical Method used: Results were analysed using standard statistical tests. Accuracy of the reagent strips as a screening tool was established using Godyn?s test. RESULTS: The sensitivity, specificity of the reagent strips for the diagnosis of meningitis was 97.14%, 96.42%. The sensitivity, specificity for tuberculous meningitis and bacterial meningitis were 100%, and 96.55%. That for the aseptic meningitis was 70% and 96.55%. Accuracy for the diagnosis of meningitis as a whole, bacterial meningitis, tuberculous meningitis, and aseptic meningitis were 96.78%, 98.2%, 98.27% and 83.0% respectively. CONCLUSION: Combur10 strips thus can be used for the rapid CSF analysis and screening with good accuracy. In situations where facilities of routine laboratory testing are not available this can be of an immense help.

  17. Kikuchi's disease: a rare cause of meningitis?

    Science.gov (United States)

    Noursadeghi, Mahdad; Aqel, Nayef; Pasvol, Geoffrey

    2005-10-15

    We present a case of Kikuchi's disease causing meningitis associated with fever and treated successfully with corticosteroids alone. This is considered to be rare but provides an instructive example of how the diagnosis may be confused with that of tuberculous meningitis and highlights the importance of histopathological analysis. PMID:16163623

  18. Focal parenchymal lesions in community-acquired bacterial meningitis in adults: a clinico-radiological study

    Energy Technology Data Exchange (ETDEWEB)

    Katchanov, Juri [Campus Charite Mitte, Charite, Department of Neurology, Berlin (Germany); University Hospital Charite, Campus Benjamin Franklin, Department of Neurology, Berlin (Germany); Siebert, Eberhard; Klingebiel, Randolf [Campus Charite Mitte, Charite, Department of Neuroradiology, Berlin (Germany); Endres, Matthias [Campus Charite Mitte, Charite, Department of Neurology, Berlin (Germany); Charite-Universitaetsmedizin Berlin, Center for Stroke Research Berlin, Berlin (Germany)

    2009-11-15

    Here, we analyzed the frequency, morphological pattern, and imaging characteristics of focal lesions as a consequence of community-acquired bacterial meningitis. We hypothesized that diffusion-weighted imaging combined with contrast-enhanced imaging, serial scanning, and multimodal vascular studies would provide further insight into the pathological basis of such parenchymal lesions in bacterial meningitis. We reviewed clinical and imaging data (i.e., magnetic resonance tomography, magnetic resonance angiography, computed tomography angiography, digital subtraction angiography) of 68 adult patients admitted to our neurological intensive care unit between March 1998 and February 2009 with the diagnosis of community-acquired bacterial meningitis. We identified seven patients with parenchymal lesions. These lesions could be attributed to four morphological patterns: (1) territorial cerebral ischemia, (2) perforating vessels ischemia, (3) ischemia of presumed cardiac origin, and (4) isolated cortical lesions. Whereas the patterns (1) and (2) were associated with vasculopathy of large- and medium-sized vessels (as shown by cerebral vascular imaging), vessel imaging in (3) and (4) did not show abnormal findings. Our study implies that parenchymal lesions in acute bacterial meningitis are mainly ischemic and due to involvement of large-, medium-, and small-sized arteries of the brain. Diffusion-weighted imaging combined with conventional, CT-, or MR-based cerebral angiography revealed the underlying pathophysiological mechanisms in the majority of patients. Furthermore, we detected two patients with isolated bilateral cortical involvement and normal vessel imaging. These lesions might represent ischemia due to the involvement of small pial and intracortical arteries. (orig.)

  19. Meningitis due to Xanthomonas maltophilia.

    Directory of Open Access Journals (Sweden)

    Girijaratnakumari T

    1993-07-01

    Full Text Available During 1st week of post-operative period, a 28 year old female patient operated for left cerebellopontine angle tumor, continued to get fever. Lumbar puncture did not reveal any organisms. She responded to ciprofloxacin. Two months later, she was readmitted with signs and symptoms of meningitis. The CSF tapped on lumbar puncture grew Xanthomonas maltophilia, Gram negative bacilli, sensitive to various antibiotics, ciprofloxacin being one of them. The patient was given ciprofloxacin for 3 weeks. On follow up, a year later she was found to be asymptomatic.

  20. Meningitis kan ligne subaraknoidal blødning

    DEFF Research Database (Denmark)

    Elghoura, Nour Foad Diab

    2012-01-01

    A 70 year-old man was admitted under the diagnosis of subarachnoid haemorrhage and presented with a history of ear pain, followed by acute onset of severe headache, nausea, vomiting, impaired consciousness, and fever. However, a computed tomography (CT) showed an acute mastoiditis and pneumocephalus, and a lumbar puncture confirmed the diagnosis meningitis. The increased middle ear pressure relative to the intracranial pressure had caused air and bacteria to penetrate intracerebrally. This case illustrates the importance of a rapid diagnostic workup in acute onset headache including a careful anamnesis, CT and lumbar puncture.

  1. CT finding of cryptococcal meningitis

    International Nuclear Information System (INIS)

    We have experienced 14 cases of cryptococcal meningitis in the last 6 years. Their neurological signs, CT findings, and prognoses were studied. They fall into three types: the brain-stem-encephalitis type, the cortical-encephalitis type, and the meningitis type, according to the clinical course. The first type (6 cases) revealed mainly cerebellar signs, eye-movement damage, and so forth. The second type (5 cases) demonstrated ''Personality'' changes, chiefly aphasia. The third type (5 cases) did not show any focal signs. Prognosis of the brain-stem-encephalitis type was very poor, with a 50% mortality rate. In the survivors, also, clinical signs did not disappear for a long time. Repeated CT was performed in 13 among the 14 cases; abnormal CT findings were revealed in 5 cases because of cryptococcal infection. Granuloma shadow and ventriculitis shadow were observed in 3 cases each. These abnormal findings disappeared upon treatment except in one case. The clinical signs are not completely related with the CT finding, but it is useful that the site which has been infiltrated by the cryptococcus can be observed. Abnormal CT findings were observed in the 4 cases of the brain-stem-encephalitis type among the 5 abnormal cases. It is very useful to know the severity of the condition. (author)

  2. Differential vasoactive effects of sildenafil and tadalafil on cerebral arteries

    DEFF Research Database (Denmark)

    Kruuse, Christina Rostrup; Gupta, Saurabh

    2012-01-01

    Phosphodiesterase 5 (PDE5) is associated with migraine pathophysiology, stroke recovery and vasospasm treatment. The potential vascular interplay of PDE5 inhibitors sildenafil, tadalafil and UK-114,542 was studied by intra- versus extra-luminal administration in rat middle cerebral arteries in vitro and on middle meningeal arteries in vivo. By Western blot PDE5 was detected in both cerebral and meningeal arteries, though with minor variations in band intensity between vascular beds. Rat middle cerebral artery diameter was investigated using pressurised arteriography, applying UK-114,542, sildenafil, and tadalafil intra- or extra-luminally. Effects on the dural middle meningeal artery were studied in the in vivo closed cranial window model. At high concentrations, abluminal sildenafil and UK-114,542, but not tadalafil, induced dilatation of the middle cerebral artery. Luminal application elicited a contraction of 4% (sildenafil, P=0.03) and 10% (tadalafil, P=0.02). In vivo, sildenafil, but not tadalafil, dose-dependently dilated middle meningeal artery concomitant to blood pressure reduction (1-3mg/kg);1mg/kg sildenafil inducing 60 ± 14% (P=0.04) and vehicle (DMSO) 13 ± 6% dilatation. In conclusion, PDE5 inhibitors applied luminally had minor contractile effect, whereas abluminal sildenafil induced middle cerebral artery dilatation above therapeutic levels. In vivo, sildenafil dilated middle meningeal artery concomitant with a reduction in blood pressure. Tadalafil had no dilatory effects. PDE5 inhibitors show differential vascular activity in cerebral arteries from healthy animals; arterial dilatation is seen primarily above therapeutic levels. Such findings support clinical studies showing no vasodilator effects of sildenafil on cerebral arteries in healthy subjects.

  3. Chronic meningitis and central nervous system vasculopathy related to Epstein Barr virus

    OpenAIRE

    Patil, Anil Kumar B.; Azad, Zeyaur Rahman; Mathew, Vivek; Alexander, Mathew

    2012-01-01

    Chronic active Epstein Barr virus (EBV) infection causes a wide spectrum of manifestation, due to meningeal, parenchymal and vascular involvement. An 11-year-old boy presented with chronic headache, fever and seizures of 18 months duration. His magnetic resonance imaging Brain showed fusiform aneurysmal dilatations of arteries of both the anterior and posterior cerebral circulation. Cerebrospinal fluid (CSF) showed persistent lymphocytic pleocytosis, raised proteins and low sugar with positiv...

  4. Epidemiología de la meningitis Venezuela 2010

    Scientific Electronic Library Online (English)

    Luis, Echezuría; Raiza, León; Eva, Rodríguez; Alejandro, Rísquez.

    2010-12-01

    Full Text Available Las meningitis en Venezuela constituyen un importante problema de salud pública, que afecta de manera especial a los niños menores de 5 años. Las vacunas antineumocócicas, antimeningocócicas, contra Haemophilus influenzae tipo b, así como la BCG, obligan a revisar la dinámica de la morbi-mortalidad [...] en nuestro país. La etiología más frecuente es viral, seguida de las meningitis bacterianas y las tuberculosas, mientras que se conoce poco de la micótica y otras causas. Los sistemas de vigilancia epidemiológica muestran cifras altas de la incidencia de las meningitis que ameritan acciones más enérgicas de salud pública para vigilar, prevenir y mejorar los Programas Nacionales de Inmunizaciones y sus coberturas, además de tratar médicamente las meningitis en cualquiera de sus causas infecciosas. Abstract in english Meningitis constitutes an important public health problem in Venezuela that affects children, specially under 5 years of age. Antimeningococcal, anti-pneumococcal, vaccines against Haemophilus influenzae type b and BCG induce pediatricians to review the dynamics of the morbidity and mortality of the [...] se diseases. The most common etiology is the viral followed by bacterial meningitis followed by tuberculosis, while little is known of the fungal or other causes. Epidemiological surveillance systems show high figures of the incidence which warrant a more intense public health action to monitor, prevent and improve national programs of immunization and their vaccine coverage, and to treat medically any infectious cause of meningitis.

  5. Meningitis de Mollaret: reporte de caso / Mollaret´s meningitis: A case report

    Scientific Electronic Library Online (English)

    Luz Clemencia, Zárate C; Juan Diego, Vélez L.

    2013-06-01

    Full Text Available La meningitis de Mollaret es una enfermedad rara caracterizada por episodios recurrentes y autolimitados de meningitis linfocítica. Se presenta un caso de meningitis de Mollaret asociado a la infección por herpes simple tipo 2 en una mujer de 27 años con confirmación por reacción en cadena de la pol [...] imerasa (PCR) del líquido cefalorraquídeo y se hace una revisión del tema. Abstract in english Mollaret´s meningitis is a rare disease characterized by recurrent and self-limited episodes of lymphocytic meningitis. We present a case of a 27-year-old woman with Mollaret´s meningitis related to viral infection with herpes simplex virus type 2 confirmed by cerebrospinal fluid polymerase chain re [...] action ( PCR ).

  6. Urinoma and arterial hypertension complicating neonatal renal candidiasis

    Energy Technology Data Exchange (ETDEWEB)

    Sirinelli, D.; Schmit, P.; Biriotti, V.; Bensman, A.; Lupold, M.

    1987-02-01

    During antibiotic treatment for E.coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abcess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.

  7. Urinoma and arterial hypertension complicating neonatal renal candidiasis

    International Nuclear Information System (INIS)

    During antibiotic treatment for E.coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abcess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal. (orig.)

  8. Carcinomatous meningitis mimicking Creutzfeldt-Jakob disease

    Directory of Open Access Journals (Sweden)

    Vas C

    2004-07-01

    Full Text Available We report a case of carcinomatous meningitis diagnosed at autopsy that was clinically diagnosed as a case of Creutzfeldt-Jakob disease (CJD because of rapidly evolving dementia. Pathological study revealed diffusely spreading carcinomatous meningitis, infiltrating into cortex along Virchow Robin space. Immunostaining for Prion protein was negative. Despite advances in clinical diagnosis, tissue diagnosis remains a pre-requisite for confirmation of CJD.

  9. Pneumocephalus associated with Bacteroides fragilis meningitis

    OpenAIRE

    Parmar Malvinder

    2004-01-01

    Gas within the intracranial cavity (pneumocephalus) commonly results from trauma or after surgery and rarely from infection by gas-forming organisms. The presence of pneumocephalus in the absence of injury or surgery should raise the suspicion of anaerobic infection of the central nervous system. I present a case of pneumocephalus associated with Bacteroides fragilis meningitis where the diagnosis was suspected after CT findings become available. Bacteroides fragilis meningitis is rare and of...

  10. Cryptococcus and lymphocytic meningitis in Botswana

    Scientific Electronic Library Online (English)

    Gregory P, Bisson; Ramishwari, Thakur; Rob Roy, MacGregor; John, Lukes; Isaac, Mtoni.

    2008-09-01

    Full Text Available We retrospectively reviewed microbiological data from a tertiary care hospital in Botswana, and found that Cryptococcus neoformans was cultured from 15% (193/1 307) of all cerebrospinal fluid (CSF) specimens submitted for analysis, making it the most common diagnosed cause of meningitis in this popu [...] lation. Moreover, almost 70% of CSF samples with significant lymphocytosis did not yield a pathogen, suggesting that many causes of lymphocytic meningitis go undiagnosed.

  11. Latex agglutination testing in bacterial meningitis.

    OpenAIRE

    Finlay, F. O.; Witherow, H.; Rudd, P. T.

    1995-01-01

    The value of the latex agglutination test in meningitis was assessed. This was positive in 60% cases of Streptococcus pneumoniae, 93% of Haemophilus influenzae type b, and 39% of Neisseria meningitidis infections. We cannot support the view that this test was more valuable than Gram staining in partially treated meningitis and cannot recommend its routine use. It may, however, be valuable if Gram staining does not identify an organism or if it suggests meningococcal infection.

  12. Cryptococcal meningitis among HIV infected patients

    OpenAIRE

    Manoharan G; Padmavathy B; Vasanthi S; Gopalte R

    2001-01-01

    Cryptococcal meningitis is an emerging opportunistic infection among HIV infected patients and an important cause of mortality among these patients. The incidence of cryptococcal meningitis varies from place to place. A total of 31 specimens of CSF out of 89 samples processed from known HIV positive cases yielded Cryptococcus neoformans during the period of 3 years. C.neoformans was the most common opportunistic pathogen isolated from CSF samples of these patients with an incidence of 34.8&#x...

  13. Cryptococcal meningitis among HIV infected patients

    Directory of Open Access Journals (Sweden)

    Manoharan G

    2001-01-01

    Full Text Available Cryptococcal meningitis is an emerging opportunistic infection among HIV infected patients and an important cause of mortality among these patients. The incidence of cryptococcal meningitis varies from place to place. A total of 31 specimens of CSF out of 89 samples processed from known HIV positive cases yielded Cryptococcus neoformans during the period of 3 years. C.neoformans was the most common opportunistic pathogen isolated from CSF samples of these patients with an incidence of 34.8%

  14. Síndrome de meningitis y retención urinaria / Meningitis-retention syndrome. Report of one case

    Scientific Electronic Library Online (English)

    Luis, Cartier R; Fernando, Hansen B.

    1607-16-01

    Full Text Available [...] Abstract in english The Meningitis-Retention Syndrome associates aseptic meningitis and neurogenic bladder, with a vesical dysfunction that outlasts meningitis widely. Urodynamic assessment shows a detrusor palsy with normal function of the external sphincter. We report a 24-year-old male admitted for headache, fever, [...] myalgias and acute urinary retention, which was diagnosed as a urinary tract infection. Worsening of symptoms and slight meningeal signs prompted for a lumbar puncture that yielded a cerebrospinal fluid with 94 lymphocytes, in which etiological evaluation was inconclusive. Meningeal syndrome and myalgia subsided by the fifth day, while urinary retention persisted. A magnetic resonance imaging of the brain and spinal cord done at the fifth day, showed high intensity signals in basal ganglia and central spinal cord, not altered by contrast. These images disappeared in the imaging control performed two months later. Bladder dysfunction lasted at least until the second month of follow up.

  15. Endolymphatic sac involvement in bacterial meningitis

    DEFF Research Database (Denmark)

    MØller, Martin Nue; Brandt, Christian

    2015-01-01

    The commonest sequelae of bacterial meningitis are related to the inner ear. Little is known about the inner ear immune defense. Evidence suggests that the endolymphatic sac provides some protection against infection. A potential involvement of the endolymphatic sac in bacterial meningitis is largely unaccounted for, and thus the object of the present study. A well-established adult rat model of Streptococcus pneumoniae meningitis was employed. Thirty adult rats were inoculated intrathecally with Streptococcus pneumoniae and received no additional treatment. Six rats were sham-inoculated. The rats were killed when reaching terminal illness or on day 7, followed by light microscopy preparation and PAS-Alcian blue staining. The endolymphatic sac was examined for bacterial invasion and leukocyte infiltration. Neither bacteria nor leukocytes infiltrated the endolymphatic sac during the first days. Bacteria invaded the inner ear through the cochlear aquaduct. On days 5-6, the bacteria invaded the endolymphatic sacthrough the endolymphatic duct subsequent to invasion of the vestibular endolymphatic compartment. No evidence of direct bacterial invasion of the sac through the meninges was found. Leukocyte infiltration of the sac occurred prior to bacterial invasion. During meningitis, bacteria do not invade the endolymphatic sac through the dura, but solely through the endolymphatic duct, following the invasion of the vestibular system. Leukocyte infiltration of the sac occurs prior to, as well as concurrent with bacterial invasion. The findings support the endolymphatic sac as part of an innate immune defense system protecting the inner ear from infection.

  16. TRANSETHMOIDAL MENINGOCELE AND RECURRENT MENINGITIS. CASE REPORT

    Directory of Open Access Journals (Sweden)

    A.I. Navazo Eguía

    2010-01-01

    Full Text Available Introduction: Transethmoidal meningoceles are rare. The diagnosis is usually delayed and often made by the presence of recurrent meningitis.Case report: A 10-year boy with history of recurrent pneumococcal meningitis. Nasal endoscopy: mass in the right nostril between middle turbinate and septum. CT: soft tissue density lesion with disruption of the cortex adjacent to the "crista gali". MRI: cystic component injury with pedicle in anterior cranial fossa. Right frontal craniotomy was performed, removing meningocele with exit point on the cribriform plate,posterior dural closure, bone itself and scalp. Pathologic Study: fibrovascular tissue as an aspect membranes and glial tissue. Discussion: Intranasal meningocele is a rare malformation characterized by herniation of the meninges into the nasal cavity through a defect in the cribriform plate, due to a congenital abnormality, but also secondary to trauma or chronic intracranial hypertension. More common in certain geographic areas, especially in Southeast Asia. Usually cause nasal obstruction with or without recurrent meningitis. Differential diagnosis must be made with dermoid cyst, hemangioma, glioma and nasal polyp. CT and MRI are essential in the diagnosis and should precede the biopsy. The treatment is surgical or endoscopic nasal intracranial approach. Conclusions: In the presence of recurrent acute meningitis, it is necessary to rule out occult malformations of the skull base.

  17. Risk of Bacterial Meningitis in Children with Cochlear Implants

    Science.gov (United States)

    ... in Latin America Information For... Media Policy Makers Risk of Bacterial Meningitis in Children with Cochlear Implants ... Facebook Tweet Share Compartir 2002 Study of the Risk of Bacterial Meningitis in Children with Cochlear Implants ...

  18. Meningitis tras anestesia y analgesia espinal / Meningitis after spinal anesthesia and analgesia

    Scientific Electronic Library Online (English)

    M., Robles Romero; M.A., Rojas Caracuel; C. del, Prado Álvarez.

    2013-08-01

    Full Text Available El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura [...] médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius), hay descritos casos con mala evolución de meningoencefalitis supurativa que han llevado a la muerte en pocas horas. Abstract in english The objective of this review is an update on etiology, diagnosis, prevention and treatment of meningitis after spinal anesthesia and analgesia. Although it is a major complication of this technique and its incidence is low, there are more and more frequent cases in the medical literature. According [...] to its etiology are classified in septic meningitis, viral and aseptic. The septic meningitis are the most common, and its etiology increasingly plays a more prominent role as Streptococcus salivarius agent involved. Aseptic meningitis are classified as those in which cerebrospinal fluid culture is negative, with a latency period of symptoms less than six hours, which may present with eosinophilia in the cerebrospinal fluid and levels close to normal in the CSF glucose. They usually have good response and evolution with antibiotic treatment with vancomycin and third-generation cephalosporins. Prophylaxis influence the aseptic precautions, especially the use of a face mask to perform the technique, as practical to reduce the incidence of bacteria whose origin is in the oral cavity and oropharynx. They could also reduce the incidence of aseptic meningitis measures such as hand washing, use of gloves and skin antisepsis. The differentiation between aseptic meningitis and septic will more securely when standardize techniques for detecting bacterial genome in the cerebrospinal fluid, now labeled as aseptic meningitis those in which cerebrospinal fluid culture is negative and whose negative Gram stain. Although the prognosis and evolution in general features of meningitis after spinal anesthesia and analgesia is good, compared with community-acquired meningitis, the low virulence of the bacteria involved (Streptococcus salivarius), cases have been described with poor outcome suppurative meningoencephalitis have led to death within hours.

  19. Adjuvant glycerol is not beneficial in experimental pneumococcal meningitis

    OpenAIRE

    Wittwer Matthias; Grandgirard Denis; Klein Matthias; Blaser Cornelia; Peltola Heikki; Weigand Michael; Koedel Uwe; Leib Stephen L

    2010-01-01

    Abstract Background Bacterial meningitis in children causes high rates of mortality and morbidity. In a recent clinical trial, oral glycerol significantly reduced severe neurological sequelae in paediatric meningitis caused by Haemophilus influenzae type b, and a tendency towards a benefit of adjunctive glycerol was seen in pneumococcal meningitis. Methods Here we examined the effects of glycerol in pneumococcal meningitis of infant rats and adult mice. All animals received ceftriaxone, and g...

  20. Leukemic meningitis involving the cauda equina: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Hyun; Kim, Ho Kyun; Lee, Young Hwan [School of Medicine, Catholic University of Daegu, Daegu (Korea, Republic of)

    2008-07-15

    The CNS involvement by leukemia may either be meningeal or parenchymal, although meningeal infiltration of leukemic cells, known as leukemic meningitis is more common. We report a case of leukemic meningitis involving the cauda equina in a patient with an acute lymphoblastic crisis which transformed from the chronic phase of chronic myeloid leukemia. An MR image revealed diffuse enlargement and peripheral ring enhancement of the nerve roots of the cauda equina.

  1. Venous hemodynamics of arteriovenous meningeal fistulas in the posterior cranial fossa

    Energy Technology Data Exchange (ETDEWEB)

    Brainin, M.; Samec, P.

    1983-06-01

    The etiology of arteriovenous meningeal fistulas (AVMFs) of the posterior fossa often remains unclear. Analyses of three personal cases, however, suggest a change in venous hemodynamics due to a primary lesion, the cases being of sinus thrombosis, intracerebral abcess with oedema and arteriovenous malformation. It is suggested that increase of venous pressure in the posterior fossa leads to increased drainage and, consequently, to dilatation of infratentorial veins and of meningeal branches of the external carotid and vertebral artery. Clinical findings and anatomical facts underlying AVMF lesions tend to confirm the view that the concept of a congenital malformation decompensating with age cannot be upheld for all AVMFs, especially when located in the posterior fossa and when clinical symptoms arise in middle age. It is proposed that a pressure activated mechanism of growth results in widening of normally insignificantly small dural vessels.

  2. Tuberculous meningitis in a 3 month old infanta case report

    Directory of Open Access Journals (Sweden)

    M.J. Saffar

    2006-01-01

    Full Text Available Tuberculosis especially tuberculous meningitis rarely accurs before 3 months of age. Though treatable, it may be fatal despite modern treatment. The diagnosis of congenital TB/TB meningitis should be considered in any neonate/infant with pneumonia –meningitis who fails to respond to conventional treatment, particularly in a child from ethnic or socioeconomic environment where tuberculosis is prevalent.

  3. Focal parenchymal lesions in community-acquired bacterial meningitis in adults: a clinico-radiological study

    International Nuclear Information System (INIS)

    Here, we analyzed the frequency, morphological pattern, and imaging characteristics of focal lesions as a consequence of community-acquired bacterial meningitis. We hypothesized that diffusion-weighted imaging combined with contrast-enhanced imaging, serial scanning, and multimodal vascular studies would provide further insight into the pathological basis of such parenchymal lesions in bacterial meningitis. We reviewed clinical and imaging data (i.e., magnetic resonance tomography, magnetic resonance angiography, computed tomography angiography, digital subtraction angiography) of 68 adult patients admitted to our neurological intensive care unit between March 1998 and February 2009 with the diagnosis of community-acquired bacterial meningitis. We identified seven patients with parenchymal lesions. These lesions could be attributed to four morphological patterns: (1) territorial cerebral ischemia, (2) perforating vessels ischemia, (3) ischemia of presumed cardiac origin, and (4) isolated cortical lesions. Whereas the patterns (1) and (2) were associated with vasculopathy of large- and medium-sized vessels (as shown by cerebral vascular imaging), vessel imaging in (3) and (4) did not show abnormal findings. Our study implies that parenchymal lesions in acute bacterial meningitis are mainly ischemic and due to involvement of large-, medium-, and small-sized arteries of the brain. Diffusion-weighted imaging combined with conventional, CT-, or MR-based cerebral angiographonal, CT-, or MR-based cerebral angiography revealed the underlying pathophysiological mechanisms in the majority of patients. Furthermore, we detected two patients with isolated bilateral cortical involvement and normal vessel imaging. These lesions might represent ischemia due to the involvement of small pial and intracortical arteries. (orig.)

  4. [A case of meningitis complicated by brainstem infarction].

    Science.gov (United States)

    Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Otani, Naoki; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Sugawara, Takashi; Aoyagi, Chikashi; Suzuki, Go

    2009-06-01

    A rare case of meningitis complicated by brainstem infarction is reported. A 64-year-old previously healthy female was admitted to our hospital because of a 1-week history of fever and headache. Cefdinir was orally administered for several days before admission. Analysis of cerebrospinal fluid (CSF) on admission showed a white blood cell (WBC) count of 9,013 cells/ micro/(97% polynuclear cells), a protein level of 212.8 mg/d/, and a glucose level of 3 mg/d/. CSF culture was negative for bacteria, including tubercle bacilli, and fungi. A brain computed tomography (CT) scan on admission showed acute hydrocephalus. Six hours after admission the patient developed tetraplegia. Diffusion-weighted magnetic resonance (MR) images on day 2 revealed elevated diffusion coefficients with high signal intensity in the pons and the medulla oblongata. MR angiography demonstrated a narrowing change of the cerebral arteries. Followup MR angiography two months after admission showed normalization of the cerebral arteries. The patient remained tetraplegic at eight months after admission. We speculated that brainstem infarction in our case might have been caused by vascultis or brain edema. PMID:19522288

  5. Anthrax Meningitis - Report Of An Autopsied Case

    Directory of Open Access Journals (Sweden)

    Mahadevan A

    1999-01-01

    Full Text Available Anthrax is a rare cause of hemorrhagic meningitis in man. This report illustrates the characteristic hemorrhagic manifestations in the brain of a patient dying of anthrax meningitis secondary to overwhelming bacteremia. Gross examination of the brain revealed a thick dense subarachnoid hemorrhage with numerous petechial hemorrhages in the cortex. Histologically, meningoencephalitis with vascular necrosis, edema, perivascular cortical hemorrhages and clumps of Gram positive bacilli in the vascular lumen and invading vessel wall were the salient features. The anthrax bacillus was isolated from CSF and brain tissue and further its pathogenecity was confirmed by animal inoculation.

  6. Tuberculosis meningitis presenting as isolated interhemispheric exudates

    International Nuclear Information System (INIS)

    Full text: The total number of tuberculosis cases in the world is increasing, and less common forms of tuberculous meningitis (TBM) with varying imaging manifestations are being encountered more often. We describe anterior interhemispheric variety of TBM, which has not been previously described to the best of our knowledge in the literature. Common imaging findings in these five patients include predominant involvement of the meninges in the anterior interhemispheric fissure with relatively little enhancement of the basal cisterns. Knowledge of uncommon radiological findings is vital in early diagnosis and treatment of this common disease.

  7. Meningeal chondroma in a young female

    Directory of Open Access Journals (Sweden)

    Kumari Niraj

    2010-01-01

    Full Text Available Meningeal chondroma is a rare intracranial neoplasm. It is usually diagnosed clinically as meningioma. Histologically it may have a differential diagnosis of chordoid meningioma, a malignant lesion, and needs radiotherapy. A chondroma is a benign lesion where surgical removal is the treatment. A 20-year-old female presented with symptoms of space occupying lesion which was clinically and radiologically considered meningioma. On histopathology, the lesion turned out to be a chondroma. Meningeal chondroma is a benign lesion for which surgical removal is the curative treatment. No further treatment in the form of radiation is required.

  8. Meningeal involvement in Behcet's disease: MRI

    International Nuclear Information System (INIS)

    Behcet's disease is a multisystem disease that involves the central nervous system up to half of cases. Presentation with neurologic symptoms occurs in 5 % of cases and cerebral venous thrombosis is one of its major manifestations. A feature not previously reported is progressive meningeal thickening with involvement of both optic nerves. We report a patient with cerebral venous thrombosis, meningeal thickening and contrast enhancement on MRI. This patient had two other unusual features: positive antineutrophil cytoplasmic antibodies and later development of central diabetes insipidus. (orig.)

  9. October 2012 Multistate Fungal Meningitis Outbreak

    Centers for Disease Control (CDC) Podcasts

    2012-10-17

    This podcast gives an overview of the October 2012 multistate fungal meningitis outbreak, including symptoms to watch for and a website for up-to-date information.  Created: 10/17/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 10/17/2012.

  10. Bilateral acute retinal necrosis after herpetic meningitis

    Directory of Open Access Journals (Sweden)

    Katsura T

    2012-04-01

    Full Text Available Keisho Hirota1,2, Masayuki Akimoto1,3, Toshiaki Katsura21Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, 2Internal Medicine, Kyoto Medical Center, 3Clinical Research Center, Kyoto Medical Center, Kyoto, JapanPurpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus

  11. Hearing assessment after meningitis and meningococcal disease.

    OpenAIRE

    Riordan, A.; Thomson, A; Hodgson, J.

    1995-01-01

    A method to increase audiology referral after meningitis or meningococcal disease was audited in 89 children. A standardised proforma increased referrals from 78% to 96% over a two year period. However, only 73% of children had a hearing test. The major reason for hearing not being tested changed from non-referral to non-attendance.

  12. Streptococcus equi subsp. zooepidemicus meningitis in Peru

    Science.gov (United States)

    Guevara, Jose M.; Tilley, Drake H.; Briceno, Jesus A.; Zunt, Joseph R.; Montano, Silvia M.

    2013-01-01

    A 59-year-old man with a history of fever, unsteadiness, hemiparesis, motor aphasia and consciousness disturbance was hospitalized for Streptococcus equi subsp. zooepidemicus meningitis. He denied contact with farm animals, but had a practice of consuming unpasteurized goats’ cheese from an uncertain source. PMID:23105024

  13. Characterization of a pneumococcal meningitis mouse model

    Directory of Open Access Journals (Sweden)

    Mook-Kanamori Barry

    2012-03-01

    Full Text Available Abstract Background S. pneumoniae is the most common causative agent of meningitis, and is associated with high morbidity and mortality. We aimed to develop an integrated and representative pneumococcal meningitis mouse model resembling the human situation. Methods Adult mice (C57BL/6 were inoculated in the cisterna magna with increasing doses of S. pneumoniae serotype 3 colony forming units (CFU; n = 24, 104, 105, 106 and 107 CFU and survival studies were performed. Cerebrospinal fluid (CSF, brain, blood, spleen, and lungs were collected. Subsequently, mice were inoculated with 104 CFU S. pneumoniae serotype 3 and sacrificed at 6 (n = 6 and 30 hours (n = 6. Outcome parameters were bacterial outgrowth, clinical score, and cytokine and chemokine levels (using Luminex® in CSF, blood and brain. Meningeal inflammation, neutrophil infiltration, parenchymal and subarachnoidal hemorrhages, microglial activation and hippocampal apoptosis were assessed in histopathological studies. Results Lower doses of bacteria delayed onset of illness and time of death (median survival CFU 104, 56 hrs; 105, 38 hrs, 106, 28 hrs. 107, 24 hrs. Bacterial titers in brain and CSF were similar in all mice at the end-stage of disease independent of inoculation dose, though bacterial outgrowth in the systemic compartment was less at lower inoculation doses. At 30 hours after inoculation with 104 CFU of S. pneumoniae, blood levels of KC, IL6, MIP-2 and IFN- ? were elevated, as were brain homogenate levels of KC, MIP-2, IL-6, IL-1? and RANTES. Brain histology uniformly showed meningeal inflammation at 6 hours, and, neutrophil infiltration, microglial activation, and hippocampal apoptosis at 30 hours. Parenchymal and subarachnoidal and cortical hemorrhages were seen in 5 of 6 and 3 of 6 mice at 6 and 30 hours, respectively. Conclusion We have developed and validated a murine model of pneumococcal meningitis.

  14. Diffusion-weighted magnetic resonance imaging of borderzone necrosis in paediatric tuberculous meningitis

    International Nuclear Information System (INIS)

    Tuberculous meningitis (TBM) is associated with borderzone necrosis (BZN) of the brain parenchyma in areas adjacent to meningeal inflammation. Diffusion-weighted MRI (DWI) allows for accurate detection of cytotoxic oedema associated with necrosis. Detection and characterisation of BZN using DWI to explain its pathogenesis in TBM have not been performed previously in children. Our objective was to identify the prevalence and characteristics of BZN using DWI in children with TBM and to correlate it with the presence, degree and distribution of basal meningeal enhancement (BE) in the absence of large-vessel thrombosis. A retrospective descriptive MRI DWI study of 34 children with TBM was conducted. The topography of BZN was compared with the presence and severity of BE on specific MRI sequences. BZN was identified on MRI DWI in 50% of patients of which 82% had involvement of the temporal lobes. The severity and extent of BE in either middle cerebral artery cistern correlated with the presence of BZN (P = 0.02). BZN did not correlate with radiologically detectable vascular occlusion BZN is common in TBM occurring in 50% of children. Detection and confirmation of cytotoxic oedema associated with BZN using DWI, and its clear relation to BE supports existing pathogenetic descriptions. The pathogenesis of BZN differs to that of topographical infarction on the basis of distribution as well as an absent statistical relationship between vascular occlusion and BZN.

  15. Analysis of Cerebrospinal Fluid in Viral Meningitis Patients

    Directory of Open Access Journals (Sweden)

    Afshan Zeeshan Wasti,

    2013-10-01

    Full Text Available Aim: Meningitis - an inflammation of the meninges, globally distributed as either sporadic or epidemic forms. Acute meningitis of infectious etiology involves viruses or bacteria making the differential diagnosis very difficult. Material and Methods: The present study was designed to evaluate the alterations in different biochemical parameters including glucose, protein, C-reactive proteins (CRP, electrolytes (sodium, potassium and chloride and enzymes (ALT, AST, ALP, CK and LDH in the CSF and serum samples of the viral meningitis patients (n=20 and compared with control subjects (n=20. Results: Our study revealed significant (p<0.0001 increase in CSF glucose and protein levels in viral meningitis patients as compared to their respective controls. The C-reactive protein was negative in all the cases of viral meningitis, as it is the diagnostic test to differentiate between viral and bacterial meningitis. Significant decrease (p<0.0001 was observed in the CSF electrolytes concentration particularly in case of sodium and potassium levels while insignificant decrease was observed in the concentration of chloride. We observed extremely significant (p<0.0001 high levels of all the enzymes (ALT, AST, ALP, CK and LDH in the CSF samples of viral meningitis as compared to their respective normal controls. Conclusion: The present study suggests that the combination of differential analysis of biochemical indices such as CRP, CSF protein, glucose, electrolytes and enzyme profiles is used to establish the more accurate strategy in order to diagnose viral meningitis and also in differentiating it with other types of meningitis.

  16. Bacteremia causes hippocampal neural apoptosis in experimental pneumococcal meningitis

    DEFF Research Database (Denmark)

    Ostergaard, Christian; Leib, Stephen L

    2010-01-01

    ABSTRACT: BACKGROUND: Bacteremia and systemic complications both play important roles in brain pathophysiological alterations and the outcome of pneumococcal meningitis. Their individual contributions to the development of brain damage, however, still remain to be defined. METHODS: Using an adult rat pneumococcal meningitis model, the impact of bacteremia accompanying meningitis on the development of hippocampal injury was studied. The study comprised of the three groups: I. Meningitis (n=11), II. meningitis with attenuated bacteremia resulting from iv injection of serotype-specific pneumococcal antibodies (n=14), and III. uninfected controls (n=6). RESULTS: Pneumococcal meningitis resulted in a significantly higher apoptosis score 0.22 (0.18-0.35) compared to uninfected controls (0.02 (0.00-0.02), Mann Whitney test, P=0.0003). Also, meningitis with an attenuation of bacteremia by antibody treatment resulted in significantly reduced apoptosis (0.08 (0.02-0.20), P=0.01) as compared to meningitis. CONCLUSIONS: Our results demonstrate that bacteremia accompanying meningitis plays an important role in the development of hippocampal injury in pneumococcal meningitis.

  17. Sacral meningeal cysts: evaluation with MR imaging.

    Science.gov (United States)

    Davis, S W; Levy, L M; LeBihan, D J; Rajan, S; Schellinger, D

    1993-05-01

    It is often difficult for the radiologist to determine if a given sacral meningeal cyst is causing symptoms. Radiographic criteria for identifying cysts likely to be symptomatic are needed. Using conventional magnetic resonance (MR) imaging along with a specifically designed flow-sensitive sequence, the authors characterized 24 cysts (19 patients) with respect to diameter and communication with the subarachnoid space. They found no significant difference in size between symptomatic and asymptomatic cysts (P > .05) but did observe a clear-cut disparity in the context of communication: Five of five asymptomatic cysts were shown to communicate on MR flow studies, while seven of seven symptomatic cysts were not shown to communicate. The authors propose that flow-sensitive MR imaging is useful in differentiating communicating from noncommunicating sacral meningeal cysts and that this information may be of value in classifying these lesions as more or less likely to be symptomatic. PMID:8475288

  18. Treatment for meningeal carcinomatosis in breast cancer

    International Nuclear Information System (INIS)

    Forty breast cancer patients with meningeal carcinomatosis were treated with a combined program of whole brain irradiation therapy with intrathecal and intraventricular methotrexate and citrovorum factor rescue. Responses were seen in 26 patients (65%); 13 patients (35%) failed to respond. The median survival time for the responding patients was six months, and for the nonresponders, one month. Factors affecting response and survival included pretreatment spinal fluid glucose, protein, and duration of CNS-related symptomatology prior to onset of therapy. In contrast, pretreatment CSF tumor cell count, CEA and initial CNS functional status did not appear to have prognostic significance. The authors conclude that following intensive therapy there can be much improvement in the quality of life and disease-free survival in breast cancer patients with meningeal carcinomatosis

  19. Aseptic meningitis epidemic during a West Nile virus avian epizootic.

    Science.gov (United States)

    Julian, Kathleen G; Mullins, James A; Olin, Annette; Peters, Heather; Nix, W Allan; Oberste, M Steven; Lovchik, Judith C; Bergmann, Amy; Brechner, Ross J; Myers, Robert A; Marfin, Anthony A; Campbell, Grant L

    2003-09-01

    While enteroviruses have been the most commonly identified cause of aseptic meningitis in the United States, the role of the emerging, neurotropic West Nile virus (WNV) is not clear. In summer 2001, an aseptic meningitis epidemic occurring in an area of a WNV epizootic in Baltimore, Maryland, was investigated to determine the relative contributions of WNV and enteroviruses. A total of 113 aseptic meningitis cases with onsets from June 1 to September 30, 2001, were identified at six hospitals. WNV immunoglobulin M tests were negative for 69 patients with available specimens; however, 43 (61%) of 70 patients tested enterovirus-positive by viral culture or polymerase chain reaction. Most (76%) of the serotyped enteroviruses were echoviruses 13 and 18. Enteroviruses, including previously rarely detected echoviruses, likely caused most aseptic meningitis cases in this epidemic. No WNV meningitis cases were identified. Even in areas of WNV epizootics, enteroviruses continue to be important causative agents of aseptic meningitis. PMID:14519244

  20. Pseudotumour cerebri syndrome due to cryptococcal meningitis.

    OpenAIRE

    Cremer, P. D.; Johnston, I. H.; Halmagyi, G. M.

    1997-01-01

    Three cases are reported of the pseudotumour cerebri syndrome-that is, intracranial hypertension without mass lesion or enlarged ventricles, due to cryptococcal meningitis. In these patients the papilloedema was successfully treated with optic nerve sheath decompression, and the intracranial hypertension with lumboperitoneal CSF shunting. These cases support the concept that pseudotumour cerebri is a syndrome of intracranial hypertension that can be due to any disorder producing obstruction o...

  1. [Pneumococcal meningitis in a pregnant woman].

    Science.gov (United States)

    Scharek, Petra; Jekkel, Csilla; Budai, József; Szilasi, Zsuzsanna; Helferich, Frigyes; Arva, Ilona; Váradi, András; Létay, Erzsébet; Katona, Katalin; Rókusz, László

    2014-01-30

    Bacterial meningitis is a life-threatening disease. The incidence of meningitis is about 2.6-6 cases per 100.000 adults per year in developed countries. The most common causative microorganisms are Sreptococcus pneumoniae and Neisseria meningitidis. A 33-year-old multigravida, at 24 week of gestation was admitted to the hospital because of ear pain, haedache, fever and confusion. Lumbal puncture was performed and cerebrospinal fluid analysis showed signs of bacterial meningitis. Latex agglutination test was positive for S. pneumoniae, Gram-positive diplococci have seen under microscope and later cultivation verified S. pneumoniae as the causative agent. After ceftriaxon, dexamethasone administration and treatment in intensive care unit, left side mastoidectomy was performed since cranial computed tomography showed acut exacerbation of chronic mastoiditis on the left side. After extubation, mobilisation and 14 days antibiotic treatment the patient, who had residual hearing loss on the left side, was discharged from the hospital. During the treatment the foetal parameters were normal. The patient at 39 week of gestation gave birth to a healthy infant. Forty-eight case reports have been published in this topic around the world until April, 2012. The most common causative agents were S. pneumoniae and Listeria monocytogenes. Because of the little amount of data, it is hard to appreciate the actual incidence and prognosis of this life-threatening illness both for mother and infant. As far as we know this is the first published case report of meningitis during pregnancy in Hungary. By this article we would like to draw attention to the importance of teamwork, of prevention of brain abscess formation and of the removal of the infection's focus. PMID:24654448

  2. Listeria monocytogenes meningitis in previously healthy adults.

    OpenAIRE

    Hearmon, C. J.; Ghosh, S K

    1989-01-01

    A retrospective study of four sporadic cases of Listeria monocytogenes meningitis is reported. Contrary to the conventional epidemiology these patients were adults who were not immuno-compromised. Although all four cases produced positive cerebrospinal fluid cultures, in three, listeria was not microscopically identified. Protein and glucose contents of cerebrospinal fluids were variable and all samples showed lymphocytic pleocytosis. All four had neutrophil leucocytosis in peripheral blood. ...

  3. Meningeal chondroma in a young female

    OpenAIRE

    Kumari Niraj; Sahu Rabi; Krishnani Narendra

    2010-01-01

    Meningeal chondroma is a rare intracranial neoplasm. It is usually diagnosed clinically as meningioma. Histologically it may have a differential diagnosis of chordoid meningioma, a malignant lesion, and needs radiotherapy. A chondroma is a benign lesion where surgical removal is the treatment. A 20-year-old female presented with symptoms of space occupying lesion which was clinically and radiologically considered meningioma. On histopathology, the lesion turned out to be a chondroma. Meningea...

  4. Cutaneous manifestations in acute meningococcal meningitis

    Directory of Open Access Journals (Sweden)

    Chakrabarty N

    1991-01-01

    Full Text Available Twenty three army recruits with acute meningococcal meningitis were admitted to a military hospital during February-March 1986. Of the 23 patients 11 developed cutaneous lesions, 3 had associated herpes simplex, 6 had arthritis/artharalgia and 3 got conjunctivitis. Maculopapular lesions were the commonest cutaneous manifestation although pinkish macules, purpura and cutaneous vasculitis were also seen. All the patients were treated with intravenous pencillin and other supportive measures.

  5. Daptomycin in experimental murine pneumococcal meningitis

    Directory of Open Access Journals (Sweden)

    Steckelberg James M

    2009-04-01

    Full Text Available Abstract Background Daptomycin, a lipopeptide antibiotic, could be an alternative to vancomycin for treatment of pneumococcal meningitis. We determined the activity of daptomycin versus vancomycin, with dexamethasone as an adjuvant, in a murine model of pneumococcal meningitis. Methods Ninety-six 25–30 gram mice were inoculated intracisternally with serotype 3 Streptococcus pneumoniae modified by the integration of a luminescent lux operon. All mice were treated with either dexamethasone 1 mg/kg intraperitoneally every 6 hours alone or in combination with either vancomycin or daptomycin, also administered intraperitoneally. Serum antimicrobial concentrations were selected to approximate those achieved in humans. Following treatment, bioluminescence and cerebrospinal fluid (CSF bacterial concentrations were determined. Caspase-3 staining was used to assess apoptosis on brain histopathology. Results Sixteen hours post intracisternal inoculation, bacterial titers in CSF were 6.8 log10 cfu/ml. Amongst the animals given no antibiotic, vancomycin 50 mg/kg at 16 and 20 hours or daptomycin 25 mg/kg at 16 hours, CSF titers were 7.6, 3.4, and 3.9 log10 cfu/ml, respectively, at 24 hours post infection (p-value, Conclusion Daptomycin or vancomycin, when given in combination with dexamethasone, is active in the treatment of experimental pneumococcal meningitis.

  6. Bacteriological Profile of Pyogenic Meningitis in Tertiary Care Hospital, Ahmedabad

    OpenAIRE

    Modi, Gaurav B.; Patel, Komal D.; Soni, Sumeeta T.; Patel, Kanu J.; Mangukiya, Jayasukh D.; Jain, Pooja S.

    2012-01-01

    Aims: Bacterial meningitis remains a major cause of mortality and long term neurological sequelae worldwide. The purpose of present study was to identify the pathogen in pyogenic meningitis and to determine its antibiotic susceptibility pattern. Material and Methods: Present study was undertaken from July 2010 to December 2011 included 1470 CSF samples of clinically suspected pyogenic meningitis cases in all age groups. The samples were subjected to macroscopic examination, microscopic examin...

  7. Molecular studies of BKCa channels in intracranial arteries: presence and localization

    DEFF Research Database (Denmark)

    Johansson, Helle Wulf; Hay-Schmidt, Anders

    2008-01-01

    Large conductance calcium-activated potassium channels (BK(ca)) are crucial for the regulation of cerebral vascular basal tone and might be involved in cerebral vasodilation relevant to migraine and stroke. We studied the differential gene expression of mRNA transcript levels and protein expression of the BK(Ca) channel in rat basilar, middle cerebral, and middle meningeal arteries by reverse transcription polymerase chain reaction (RT-PCR), quantitative real-time PCR, and Western blotting. Distribution patterns were investigated using in situ hybridization and immunofluorescence studies. RT-PCR and quantitative real-time PCR detected the expression of the BK(Ca) channel mRNA transcript in rat basilar, middle cerebral, and middle meningeal arteries, with the transcript being expressed more abundantly in rat basilar arteries than in middle cerebral and middle meningeal arteries. Western blotting detected the BK(Ca) channel protein in rat basilar and middle cerebral arteries. In situ hybridization and immunofluorescence studies confirmed that the BK(Ca) channel mRNA and protein expression was localized to smooth muscle cells in all three intracranial arteries. The data thus suggest the presence and localization of both mRNA and protein expression of the BK(Ca) channel in the smooth muscle cell layer in rat basilar, middle cerebral, and middle meningeal arteries.

  8. Molecular studies of BKCa channels in intracranial arteries : presence and localization

    DEFF Research Database (Denmark)

    Wulf, Helle; Hay-Schmidt, Anders

    2008-01-01

      Large conductance calcium-activated potassium channels (BK(ca)) are crucial for the regulation of cerebral vascular basal tone and might be involved in cerebral vasodilation relevant to migraine and stroke. We studied the differential gene expression of mRNA transcript levels and protein expression of the BK(Ca) channel in rat basilar, middle cerebral, and middle meningeal arteries by reverse transcription polymerase chain reaction (RT-PCR), quantitative real-time PCR, and Western blotting. Distribution patterns were investigated using in situ hybridization and immunofluorescence studies. RT-PCR and quantitative real-time PCR detected the expression of the BK(Ca) channel mRNA transcript in rat basilar, middle cerebral, and middle meningeal arteries, with the transcript being expressed more abundantly in rat basilar arteries than in middle cerebral and middle meningeal arteries. Western blotting detected the BK(Ca) channel protein in rat basilar and middle cerebral arteries. In situ hybridization and immunofluorescence studies confirmed that the BK(Ca) channel mRNA and protein expression was localized to smooth muscle cells in all three intracranial arteries. The data thus suggest the presence and localization of both mRNA and protein expression of the BK(Ca) channel in the smooth muscle cell layer in rat basilar, middle cerebral, and middle meningeal arteries.

  9. Meningitis Agudas en Córdoba,Colombia 2002 - 2004 / Acute meningitis in Córdoba, Colombia (2002-2004)

    Scientific Electronic Library Online (English)

    Vaneza, Tique; Nelson, Alvis; Renata, Parodi; Alvaro, Bustos; Salim, Mattar.

    2006-05-01

    Full Text Available Objetivo Establecer las características epidemiológicas y microbiológicas de las meningitis agudas del departamento de Córdoba. Métodos Se realizó un estudio descriptivo de vigilancia epidemiológica en el Hospital San Jerónimo de Montería. Se tomaron todos los casos de meningitis, presentados (junio [...] 2002 - junio 2004), las pruebas de laboratorio incluyeron: citoquímico, prueba de látex, tinción de Gram y cultivo. Resultados Se analizaron 503 muestras de liquido cefalorraquídeo, confirmados por cultivo 57 (11,3 %) casos y 85 (16,8 %) casos probables. Se presentaron 63 aislamientos distribuidos así: 17 bacilos Gram negativos no fermentadores (26,9 %), 16 Streptococcus pneumoniae (25,4 %), 7 Enterobacterias (1 %), 5 Criptococcus neoformans (8 %), 4 Neisseria meningitidis serotipo B (6,3 %), 3 S. viridans (4,8 %), 2 Streptococcus grupo B (3,2 %), 2 Haemophilus influenzae tipo B (3,2 %), 2 S. aureus (3,2 %), 2 Staphylococcus coagulasa negativos (3,2 %), 2 Enterococcus (3,2 %) y 1 Candida albicans (1,6 %). Los serotipos de S. Pneumoniae fueron: 5 (n=4), 23F (n=3), 14 (n=2), 18C (n=2), 18A (n=1), 17F (n=1), 1 (n=1). Conclusión El estudio permitió determinar los aspectos epidemiológicos y microbiológicos hasta ahora desconocidos de las meningitis agudas en el departamento de Córdoba. Streptococcus pneumoniae (25,4%) fue el principal agente causal de meningitis, los aspectos epidemiológicos establecidos confirman la necesidad de fortalecer e implantar medidas para el control y vigilancia de las meningitis en Córdoba. Abstract in english OBJECTIVE: Establishing characteristic epidemiologic and microbiologic features of acute meningitis in the Córdoba department. Methodology A descriptive epidemiological study was carried out between June 2002 and June 2004 at the Hospital San Jerónimo in Montería. All suspicious cases of meningitis [...] were included; laboratory tests included cytological smear, biochemistry, latex, Gram stain and culture. Results 57 (11,3 %) and 85 (16,8 %) of the 503 samples of cerebrum spinal fluid (CSF) were confirmed by culture as being probable cases. There were 6 cases of polymicrobial infection, making a total of 63 isolates: 17 non-fermenting Gram-negative bacilli (26,9 %), 16 Streptococcus pneumoniae (25,4 %), 7 Enterobacteriaceae (11 %), 5 Criptococcus neoformans (8 %) 4 Neisseria meningitidis serotype B (6,3 %), 3 S. viridans (4,8 %), 2 Streptococcus group B (3,2 %), 2 Haemophilus influenzae type B (3,2 %), 2 Staphylococcus negative coagulase (3,2 %), 2 S. aureus (3,2 %), 2 Enterococcus (3,2 %) and 1 Candida albicans (1,6 %). The S. Pneumoniae serotypes found were: 5 (n=4), 23F (n=3), 14 (n=2), 18C (n=2), 18A (n=1), 17F (n=1), 1 (n=1). Conclusions The study led to determining epidemiological and microbiological aspects of acute meningitis in the Córdoba department which had been unknown up to now. Streptococcus pneumoniae (25,4 %) was the main aetiological agent of meningitis; the epidemiologic aspects so established confirmed the need for strengthening and implementing measures for controlling meningitis in Córdoba and its surveillance there.

  10. Meningitis Agudas en Córdoba,Colombia 2002 - 2004 Acute meningitis in Córdoba, Colombia (2002-2004

    Directory of Open Access Journals (Sweden)

    Vaneza Tique

    2006-05-01

    Full Text Available Objetivo Establecer las características epidemiológicas y microbiológicas de las meningitis agudas del departamento de Córdoba. Métodos Se realizó un estudio descriptivo de vigilancia epidemiológica en el Hospital San Jerónimo de Montería. Se tomaron todos los casos de meningitis, presentados (junio 2002 - junio 2004, las pruebas de laboratorio incluyeron: citoquímico, prueba de látex, tinción de Gram y cultivo. Resultados Se analizaron 503 muestras de liquido cefalorraquídeo, confirmados por cultivo 57 (11,3 % casos y 85 (16,8 % casos probables. Se presentaron 63 aislamientos distribuidos así: 17 bacilos Gram negativos no fermentadores (26,9 %, 16 Streptococcus pneumoniae (25,4 %, 7 Enterobacterias (1 %, 5 Criptococcus neoformans (8 %, 4 Neisseria meningitidis serotipo B (6,3 %, 3 S. viridans (4,8 %, 2 Streptococcus grupo B (3,2 %, 2 Haemophilus influenzae tipo B (3,2 %, 2 S. aureus (3,2 %, 2 Staphylococcus coagulasa negativos (3,2 %, 2 Enterococcus (3,2 % y 1 Candida albicans (1,6 %. Los serotipos de S. Pneumoniae fueron: 5 (n=4, 23F (n=3, 14 (n=2, 18C (n=2, 18A (n=1, 17F (n=1, 1 (n=1. Conclusión El estudio permitió determinar los aspectos epidemiológicos y microbiológicos hasta ahora desconocidos de las meningitis agudas en el departamento de Córdoba. Streptococcus pneumoniae (25,4% fue el principal agente causal de meningitis, los aspectos epidemiológicos establecidos confirman la necesidad de fortalecer e implantar medidas para el control y vigilancia de las meningitis en Córdoba.meningitis in the Córdoba department. Methodology A descriptive epidemiological study was carried out between June 2002 and June 2004 at the Hospital San Jerónimo in Montería. All suspicious cases of meningitis were included; laboratory tests included cytological smear, biochemistry, latex, Gram stain and culture. Results 57 (11,3 % and 85 (16,8 % of the 503 samples of cerebrum spinal fluid (CSF were confirmed by culture as being probable cases. There were 6 cases of polymicrobial infection, making a total of 63 isolates: 17 non-fermenting Gram-negative bacilli (26,9 %, 16 Streptococcus pneumoniae (25,4 %, 7 Enterobacteriaceae (11 %, 5 Criptococcus neoformans (8 % 4 Neisseria meningitidis serotype B (6,3 %, 3 S. viridans (4,8 %, 2 Streptococcus group B (3,2 %, 2 Haemophilus influenzae type B (3,2 %, 2 Staphylococcus negative coagulase (3,2 %, 2 S. aureus (3,2 %, 2 Enterococcus (3,2 % and 1 Candida albicans (1,6 %. The S. Pneumoniae serotypes found were: 5 (n=4, 23F (n=3, 14 (n=2, 18C (n=2, 18A (n=1, 17F (n=1, 1 (n=1. Conclusions The study led to determining epidemiological and microbiological aspects of acute meningitis in the Córdoba department which had been unknown up to now. Streptococcus pneumoniae (25,4 % was the main aetiological agent of meningitis; the epidemiologic aspects so established confirmed the need for strengthening and implementing measures for controlling meningitis in Córdoba and its surveillance there.

  11. Tuberculous meningitis in Denmark: a review of 50 cases

    DEFF Research Database (Denmark)

    Christensen, Anne-Sophie H; Andersen, Åse Bengård

    2011-01-01

    Tuberculous meningitis is the most severe manifestation of extrapulmonary tuberculosis with a high mortality rate and a high rate of sequelae among survivors. The aim of this study is to assess the current epidemiology, clinical features, diagnostic procedures, treatment and outcome in patients with tuberculous meningitis in Denmark, a country with a low tuberculosis incidence.

  12. Unusual presentation of primary klebsiella meningitis: successful treatment with cefotaxime.

    OpenAIRE

    Sandyk, R.; Brennan, M. J.

    1983-01-01

    A man who presented with lumbar backache subsequently developed signs of meningitis. The causative organism was proved to be Klebsiella pneumoniae. Despite treatment with chloramphenicol and amikacin, the condition progressed until cefotaxime was added to the treatment regimen. The patient made a good recovery. This is the first report of the use of cefotaxime in klebsiella meningitis.

  13. Method for inducing experimental pneumococcal meningitis in outbred mice

    Directory of Open Access Journals (Sweden)

    Cintorino Marcella

    2004-09-01

    Full Text Available Abstract Background Streptococcus pneumoniae is the leading cause of bacterial meningitis. Pneumococcal meningitis is associated with the highest mortality among bacterial meningitis and it may also lead to neurological sequelae despite the use of antibiotic therapy. Experimental animal models of pneumococcal meningitis are important to study the pathogenesis of meningitis, the host immune response induced after infection, and the efficacy of novel drugs and vaccines. Results In the present work, we describe in detail a simple, reproducible and efficient method to induce pneumococcal meningitis in outbred mice by using the intracranial subarachnoidal route of infection. Bacteria were injected into the subarachnoid space through a soft point located 3.5 mm rostral from the bregma. The model was tested with several doses of pneumococci of three capsular serotypes (2, 3 and 4, and mice survival was recorded. Lethal doses killing 50 % of animals infected with type 2, 3 and 4 S. pneumoniae were 3.2 × 10, 2.9 × 10 and 1.9 × 102 colony forming units, respectively. Characterisation of the disease caused by the type 4 strain showed that in moribund mice systemic dissemination of pneumococci to blood and spleen occurred. Histological analysis of the brain of animals infected with type 4 S. pneumoniae proved the induction of meningitis closely resembling the disease in humans. Conclusions The proposed method for inducing pneumococcal meningitis in outbred mice is easy-to-perform, fast, cost-effective, and reproducible, irrespective of the serotype of pneumococci used.

  14. Purulent meningitis with unusual diffusion-weighted MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Abe, M.; Takayama, Y. E-mail: y-taka@fki.fitweb.or.jp; Yamashita, H.; Noguchi, M.; Sagoh, T

    2002-10-01

    We describe unusual findings obtained by diffusion-weighted magnetic resonance imaging (MRI) in a patient with acute purulent meningitis caused by penicillin-resistant Streptococcus pneumoniae. Along cerebral convexities and the Sylvian fissure, multiple small intense lesions showed high signal intensity in these sequences. This may be the first report of diffusion-weighted in purulent meningitis.

  15. First epidemic of echovirus 16 meningitis in Cuba.

    OpenAIRE

    Sarmiento, L; Mas, P; Goyenechea, A.; Palomera, R.; Morier, L.; Capó, V.; Quintana, I.; Santin, M.

    2001-01-01

    From April to September 2000, an epidemic of aseptic meningitis spread throughout Cuba, with 16,943 reported cases. Virologic studies identified echovirus 16 as the cause of this epidemic. This is the first reported isolate of echovirus 16 from patients with viral meningitis in Cuba.

  16. Quantitative proteomics for identifying biomarkers for tuberculous meningitis

    Directory of Open Access Journals (Sweden)

    Kumar Ghantasala S Sameer

    2012-11-01

    Full Text Available Abstract Introduction Tuberculous meningitis is a frequent extrapulmonary disease caused by Mycobacterium tuberculosis and is associated with high mortality rates and severe neurological sequelae. In an earlier study employing DNA microarrays, we had identified genes that were differentially expressed at the transcript level in human brain tissue from cases of tuberculous meningitis. In the current study, we used a quantitative proteomics approach to discover protein biomarkers for tuberculous meningitis. Methods To compare brain tissues from confirmed cased of tuberculous meningitis with uninfected brain tissue, we carried out quantitative protein expression profiling using iTRAQ labeling and LC-MS/MS analysis of SCX fractionated peptides on Agilent’s accurate mass QTOF mass spectrometer. Results and conclusions Through this approach, we identified both known and novel differentially regulated molecules. Those described previously included signal-regulatory protein alpha (SIRPA and protein disulfide isomerase family A, member 6 (PDIA6, which have been shown to be overexpressed at the mRNA level in tuberculous meningitis. The novel overexpressed proteins identified in our study included amphiphysin (AMPH and neurofascin (NFASC while ferritin light chain (FTL was found to be downregulated in TBM. We validated amphiphysin, neurofascin and ferritin light chain using immunohistochemistry which confirmed their differential expression in tuberculous meningitis. Overall, our data provides insights into the host response in tuberculous meningitis at the molecular level in addition to providing candidate diagnostic biomarkers for tuberculous meningitis.

  17. Meningitis de etiología poco habitual en niños

    Scientific Electronic Library Online (English)

    Antonio, Ávila; Daniela, Lezerovich; Verónica, Sabio Paz; Miriam, Lenz; Cecilia, Chede; Juan, Varón; Elizabet, Bogdanowicz; Adrián, Saporiti.

    2004-06-01

    Full Text Available La meningitis por Listeria monocytogenes es una enfermedad infrecuente en la población pediátrica y más aún en pacientes inmunocompetentes. Presentamos un niño de cuatro años, previamente sano, que se internó con diagnóstico de síndrome meníngeo con líquido cefalorraquídeo patológico. Inicialmente s [...] e trató con cefotaxima y dexametasona, pero al persistir la fiebre, a las 48 horas se agregó vancomicina y aciclovir al tratamiento anterior. A las 72 horas se recibió el informe del líquido cefalorraquídeo (LCR) que mostró bacilos grampositivos, el cultivo informó Listeria monocytogenes, por lo cual se inició tratamiento con ampicilina y se suspendieron los antibióticos indicados previamente. Como complicaciones presentó estado epiléptico por hiponatremia con osmolaridad plasmática normal, a los 20 días evolucionó a una hidrocefalia aguda que requirió colocación de un sistema de derivación ventriculoperitoneal. Ponemos énfasis en la importancia de la tinción de Gram del LCR para orientar el tratamiento empírico inicial y en la observación del equilibrio hidroelectrolítico para disminuir la morbimortalidad en esta enfermedad grave. Abstract in english Meningitis caused by Listeria monocytogenes is an uncommon disease in children and even more uncommon in immuno-competent patients. We report a previously healthy 4-years old patient, who was admitted with a diagnosis of meningeal syndrome with an abnormal spinal fluid. He was initially treated with [...] cefotaxime and dexametasone, but, as fever persisted after 48 hours, vancomycin and acyclovir were added to the previous therapy. After 72 hours, the report of the spinal fluid was received showing gram-positive rods. The culture grew Listeria monocytogenes, and therapy with ampicillin was initiated; previously prescribed antibiotic agents were withdrawn. Complications included an epileptic status caused by hyponatremia with normal plasma osmolarity; after 20 days the patient suffered an acute hydrocephalia which required a ventriculo-peritoneal shunt. We emphasize in the importance of spinal fluid Gram stain in order to orientate the empirical initial therapy, and the hydroelectrolytical balance in order to decrease the morbidity and mortality of this severe disease.

  18. Salmonella enterica Serotype Arizonae Meningitis in a Neonate.

    Science.gov (United States)

    Lakew, Wubishet; Girma, Abayneh; Triche, Elizabeth

    2013-01-01

    Typhoidal and nontyphoidal salmonella infections are common causes of gastroenteritis in the community. However, salmonella only rarely causes invasive infections like meningitis. We report a 13-day-old female neonate with signs and symptoms of meningitis whose cerebrospinal fluid (CSF) culture showed Salmonella enterica serotype Arizonae that was sensitive to ceftriaxone. She presented with fever and failure to feed for 2 days. Despite prompt treatment with ampicillin, gentamicin, and ceftriaxone, she developed communicating hydrocephalus, frequent seizures, and coma that progressed to death after 2 weeks of hospitalization. Salmonella enterica serotype Arizonae is a rare cause of human infection known to leading to meningitis symptoms similar to those caused by other salmonella species. This is the first report of it as a cause of meningitis in a child under one month of age. Therefore, it should be included in the differential diagnosis of Gram-negative bacillary meningitis in immunocompromised children, neonates, and those with contacts with reptiles. PMID:24187642

  19. Malignant middle-cerebral artery territory infarction in tuberculous vasculitis

    Directory of Open Access Journals (Sweden)

    Salvadeeswaran Meenakshi-Sundaram

    2014-09-01

    Full Text Available Intracranial large vessel involvement is an unusual complication of tuberculous meningitis. The authors report a 39-year-old female presenting with an episode of seizure, followed by rapid decline in sensorium without prominent systemic features. An initial cranial magnetic resonance imaging revealed tuberculomata and patchy infarcts. Despite antituberculous therapy, she progressively worsened. A cranial computed tomography scan done following the worsening revealed a massive middle-cerebral artery (MCA infarct. Unfortunately, the patient died in spite of decompressive craniotomy. Malignant MCA territory infarct is a rare and potentially fatal complication of tuberculous meningitis.

  20. Experimental bacterial meningitis in rabbit; evaluation with CT and MRI

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the usefulness of computed tomography(CT) and magnetic resonance imaging(MRI) in experimental bacterial meningitis. CT and MR images of experimental bacterial meningitis were obtained after inoculation of 1ml suspension of 10-6/ml Staphylococcus aureus directly into the supratentorial arachnoid space of 18 New Zealand white rabbits. Each animal was studied with both pre-enhanced and post-enhanced CT and MRI at 12, 24, 48 hours and 1 week. Cerebrospinal fluid of all of 18 rabbits were sampled and cultured for bacterial growth. All of 18 rabbits had the clinical symptoms such as neck stiffness and anorexia within 24 hours after the inoculation. Cerebrospinal fluid cultures were positive for Staphylococcus aureus growth. Gd-enhanced MRI exhibited diffuse enhancement along the thickened supratentorial meninges earlier than CT. In Gd-enhanced MRI, the mean contrast enhancement along the thickened supratentorial meninges earlier than CT. In Gd-enhanced MRI, the mean contrast enhancement ratio(CER) at supratentorial meninges increased to 1.93 at 12 hours and 2.99 at 24 hours from 1.06 at 0 hour. Histologic evaluation demonstrated inflammatory cell infiltration into the meninges. MRI also identified the complications of meningitis such as ependymitis and hydrocephalus more effectively than CT. These results indicated that Fd-enhanced MRI detectred earlier the abnormal findingfs of bacterial meningitis and evaluated more effectively thningitis and evaluated more effectively the complications of meningitis compared with CT. MRI was more useful than CT in evaluation of the bacterial meningitis

  1. In-depth characterization of CGRP receptors in human intracranial arteries

    DEFF Research Database (Denmark)

    Jansen-Olesen, Inger; JØrgensen, Linda

    2003-01-01

    The purpose of the present study was to characterize the effects of human (h) alpha- and beta-calcitonin gene-related peptide (CGRP) on intracranial arteries from man and to investigate the presence of mRNA for the calcitonin receptor like receptor (CRLR) and the receptor activity modifying proteins (RAMPs) 1, 2 and 3, in cerebral and middle meningeal arteries with and without endothelium, in microvessels and in the endothelial cells isolated from the human basilar artery. Reverse transcriptase-polymerase chain reaction (RT-PCR) revealed the presence of CRLR, RAMP 1, RAMP 2 and RAMP 3 in cerebral and middle meningeal arteries with and without endothelium as well as in microvessels and in the endothelial cells. Human and rat alpha- and beta-CGRP, amylin, adrenomedullin and [acetamidomethyl-Cys(2,7)]human CGRP induced strong concentration-dependent relaxation of human cerebral and middle meningeal arteries. Removal of the endothelium neither changed the maximum relaxant response nor the pIC(50) values for alpha- and beta-CGRP as compared to the responses in arteries with an intact endothelium. Human alpha-CGRP-(8-37) caused a shift of h alpha- and h beta-CGRP-induced relaxations in cerebral and middle meningeal arteries. Calculation of pK(B) values revealed that h alpha-CGRP-(8-37) could not significantly discriminate between relaxations induced by h alpha-CGRP (pK(B) around 6.8) and h beta-CGRP (pK(B) around 5.4). There was no significant difference in pK(B) value of h alpha-CGRP-(8-37) on h beta-CGRP-induced relaxation of human cerebral and middle meningeal arteries with and without endothelium. In conclusion, our molecular and pharmacological data support the existence of a single type of CGRP(1) receptors in the human intracranial circulation.

  2. Stages of tuberculous meningitis: a clinicoradiologic analysis

    International Nuclear Information System (INIS)

    Objective: To determine the frequencies and percentages of various clinicoradiologic variables of tuberculosis meningitis (TBM) with reference to British Medical Research Council (BMRC) staging of the disease. Study Design: A case series. Place and Duration of Study: Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, from October 2010 to September 2011. Methodology: The study included 93 adult patients with the diagnosis of tuberculous meningitis (TBM) at the study place. Patients were divided in three groups according to British Medical Research Council (BMRC) staging of TBM. Different clinical and radiological findings were analyzed at different stages of the disease. Data was analyzed using SPSS (Statistical Package of Social Sciences) version 11.0. Results: A majority of patients were found to be in stage-II disease at the time of admission. History of illness at the time of admission was more than 2 weeks in 50% of stage-I patients but around 80% in stage-II and stage-III patients. Neck stiffness was the most commonly reported finding in all stages. Cranial nerve palsies were higher in stage-III (75%) than in stage-II (43%) and in stage-I (24%) patients. Hydrocephalus and basal enhancement was the most frequently reported radiographic abnormalities. Conclusion: Duration of illness and cranial nerve palsies are important variables in the diagnosis of TBM stages and if TBM is suspected, empiric treatment should be started immediately without bacteriologic proof to prevent morbidity and mortality. (author)

  3. Communicating hydrocephalus subsequent to purulent meningitis

    International Nuclear Information System (INIS)

    Based on CT findings one year after shunting, ventricular dialtion was classified into five degrees for examining prognosis of communicating hydrocephalus subsequent to purulent meningitis. Factors causing and aggravating hydrocephalus were also examined. Patients with hydrocephalus tended to have spasms frequently as the first symptom within one month after birth when there were few characteristic findings. Spasm and disturbance of consciousness occurred frequently during the first week of the occurrence of disease. Large numbers of cells in the spinal fluid and high volume of spinal cord protein were persistent in patients aged one month or less. Chloride transport decreased in patients aged two months or more. The occurrence of syndrome of the pyramidal tract, eye symptoms, movement of head to the left and right, and involuntary movement suggested serious conditions of the disease. Disturbance of movement could be relieved by giving adequate antibiotics as soon as meningitis was discovered within one month after birth and by giving chloramphenicol when symptoms suggesting the development of serious conditions occurred. However, mental retardation and epilepsy could not be prevented. (Namekawa, K.)

  4. [A case of aseptic meningitis caused by relapsing polychondritis].

    Science.gov (United States)

    Nagashima, Takahide; Tanaka, Hideaki; Ito, Masafumi; Hirata, Koichi; Katayama, Soichi; Watanabe, Kazuo

    2006-01-01

    We report a patient of relapsing polychondritis (RP) with antecedent aseptic meningitis. A 65-year-old man has developed headache and fever. Neurological examination showed meningeal signs, and cerebrospinal fluid (CSF) examination revealed meningeal inflammation which contained 450 polymorphonuclear cells/microl, 302 mononuclear cells/microl, and 0 red cells/microl, with 79 mg protein/dl. Serologic testing for autoimmune disease as well as the culture and cytology of CSF were negative. He admitted our hospital as having aseptic meningitis and experienced antibiotic therapy. However, his pyrexia continued and he developed repeating visual and hearing impairment reacting to steroid. Three months later, he became behaviorally deaf, and bilateral auricular chondritis occurred with nonerosive seronegative inflammatory polyarthritis. The result of condral biopsy was consistent with the diagnosis of RP showing cartilage surrounded by an intense inflammatory cell response with a decreased number of chondrocytes. A clinical diagnosis was made and prednisolone 60 mg/day was begun with the result of resolution of the auricular chondritis, and slight improvement of his deafness. Aseptic meningitis is a rare complication of RP. Only one report detailed RP patient who had preceding meningitis. RP is a potentially lethal disease resulting from suffocation by airway collapse, the complications of a cardiac large vessel, and so on. For improvement of a life prognosis, an early diagnosis and treatment are indispensable. Although RP is a rare discovery, it is necessary that RP should be taken into consideration and be differentiated as a cause of relapsing aseptic meningitis. PMID:16541793

  5. Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period

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    Syriopoulou Vassiliki P

    2007-08-01

    Full Text Available Abstract Background Bacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases. Methods In the early 1970s a Meningitis Registry (MR was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974–1984, B (1985–1994 and C (1995–2005. Results Of the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3% were classified as "probable" and 1,331 (53.7% as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for Neisseria meningitidis, 1.3/100,000 for Streptococcus pneumoniae, 2.5/100,000 for Haemophilus influenzae type b (Hib before vaccination and 0.4/100,000 for Hib after vaccination. Neisseria meningitis constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to Streptococcus pneumoniae was stable. The long-term epidemiological pattern of Neisseria meningitidis appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR from all causes was 3.8%, while higher CFR were estimated for Streptococcus pneumoniae (7.5%, RR=2.1, 95% CI 1.2–3.7 and Neisseria meningitidis (4.8%, RR=1.7, 95% CI 1.1–2.5 compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015, and was estimated to be higher in period C. Conclusion By using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.

  6. Environmental enrichment restores cognitive deficits induced by experimental childhood meningitis

    Scientific Electronic Library Online (English)

    Tatiana, Barichello; Glauco D., Fagundes; Jaqueline S., Generoso; Caroline S., Dagostin; Lutiana R., Simões; Márcia C., Vilela; Clarissa M., Comim; Fabricia, Petronilho; João, Quevedo; Antonio L., Teixeira.

    2014-12-01

    Full Text Available Objective: To evaluate the influence of environmental enrichment (EE) on memory, cytokines, and brain-derived neurotrophic factor (BDNF) in the brain of adult rats subjected to experimental pneumococcal meningitis during infancy. Methods: On postnatal day 11, the animals received either artificia [...] l cerebrospinal fluid (CSF) or Streptococcus pneumoniae suspension intracisternally at 1 × 106 CFU/mL and remained with their mothers until age 21 days. Animals were divided into the following groups: control, control + EE, meningitis, and meningitis + EE. EE began at 21 days and continued until 60 days of age (adulthood). EE consisted of a large cage with three floors, ramps, running wheels, and objects of different shapes and textures. At 60 days, animals were randomized and subjected to habituation to the open-field task and the step-down inhibitory avoidance task. After the tasks, the hippocampus and CSF were isolated for analysis. Results: The meningitis group showed no difference in performance between training and test sessions of the open-field task, suggesting habituation memory impairment; in the meningitis + EE group, performance was significantly different, showing preservation of habituation memory. In the step-down inhibitory avoidance task, there were no differences in behavior between training and test sessions in the meningitis group, showing aversive memory impairment; conversely, differences were observed in the meningitis + EE group, demonstrating aversive memory preservation. In the two meningitis groups, IL-4, IL-10, and BDNF levels were increased in the hippocampus, and BDNF levels in the CSF. Conclusions: The data presented suggest that EE, a non-invasive therapy, enables recovery from memory deficits caused by neonatal meningitis.

  7. Meningitis Agudas en Córdoba,Colombia 2002 - 2004 / Acute meningitis in Córdoba, Colombia (2002-2004)

    Scientific Electronic Library Online (English)

    Vaneza, Tique; Nelson, Alvis; Renata, Parodi; Alvaro, Bustos; Salim, Mattar.

    2006-05-01

    Full Text Available Objetivo Establecer las características epidemiológicas y microbiológicas de las meningitis agudas del departamento de Córdoba. Métodos Se realizó un estudio descriptivo de vigilancia epidemiológica en el Hospital San Jerónimo de Montería. Se tomaron todos los casos de meningitis, presentados (junio [...] 2002 - junio 2004), las pruebas de laboratorio incluyeron: citoquímico, prueba de látex, tinción de Gram y cultivo. Resultados Se analizaron 503 muestras de liquido cefalorraquídeo, confirmados por cultivo 57 (11,3 %) casos y 85 (16,8 %) casos probables. Se presentaron 63 aislamientos distribuidos así: 17 bacilos Gram negativos no fermentadores (26,9 %), 16 Streptococcus pneumoniae (25,4 %), 7 Enterobacterias (1 %), 5 Criptococcus neoformans (8 %), 4 Neisseria meningitidis serotipo B (6,3 %), 3 S. viridans (4,8 %), 2 Streptococcus grupo B (3,2 %), 2 Haemophilus influenzae tipo B (3,2 %), 2 S. aureus (3,2 %), 2 Staphylococcus coagulasa negativos (3,2 %), 2 Enterococcus (3,2 %) y 1 Candida albicans (1,6 %). Los serotipos de S. Pneumoniae fueron: 5 (n=4), 23F (n=3), 14 (n=2), 18C (n=2), 18A (n=1), 17F (n=1), 1 (n=1). Conclusión El estudio permitió determinar los aspectos epidemiológicos y microbiológicos hasta ahora desconocidos de las meningitis agudas en el departamento de Córdoba. Streptococcus pneumoniae (25,4%) fue el principal agente causal de meningitis, los aspectos epidemiológicos establecidos confirman la necesidad de fortalecer e implantar medidas para el control y vigilancia de las meningitis en Córdoba. Abstract in english [...] s were included; laboratory tests included cytological smear, biochemistry, latex, Gram stain and culture. Results 57 (11,3 %) and 85 (16,8 %) of the 503 samples of cerebrum spinal fluid (CSF) were confirmed by culture as being probable cases. There were 6 cases of polymicrobial infection, making a total of 63 isolates: 17 non-fermenting Gram-negative bacilli (26,9 %), 16 Streptococcus pneumoniae (25,4 %), 7 Enterobacteriaceae (11 %), 5 Criptococcus neoformans (8 %) 4 Neisseria meningitidis serotype B (6,3 %), 3 S. viridans (4,8 %), 2 Streptococcus group B (3,2 %), 2 Haemophilus influenzae type B (3,2 %), 2 Staphylococcus negative coagulase (3,2 %), 2 S. aureus (3,2 %), 2 Enterococcus (3,2 %) and 1 Candida albicans (1,6 %). The S. Pneumoniae serotypes found were: 5 (n=4), 23F (n=3), 14 (n=2), 18C (n=2), 18A (n=1), 17F (n=1), 1 (n=1). Conclusions The study led to determining epidemiological and microbiological aspects of acute meningitis in the Córdoba department which had been unknown up to now. Streptococcus pneumoniae (25,4 %) was the main aetiological agent of meningitis; the epidemiologic aspects so established confirmed the need for strengthening and implementing measures for controlling meningitis in Córdoba and its surveillance there.

  8. Meningitis por Streptococcus suis en un paciente inmunocompetente Streptococcus suis meningitis in an immunocompetent patient

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    A. Nagel

    2008-09-01

    Full Text Available Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C, vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2 y de líquido cefalorraquídeo fueron positivos. La identificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias.A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.

  9. Meningitis por Streptococcus suis en un paciente inmunocompetente / Streptococcus suis meningitis in an immunocompetent patient

    Scientific Electronic Library Online (English)

    A., Nagel; V., Manias; N., Busquets; S., Sniadowsky; J., Anzardi; E. De Los A., Méndez.

    2008-09-01

    Full Text Available Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C), vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2) y de líquido cefalorraquídeo fueron positivos. La iden [...] tificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias. Abstract in english A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles) were positive. The isolate was preliminary identi [...] fied by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.

  10. [Sandfly virus meningitis in a Danish traveller returning from Tuscany].

    Science.gov (United States)

    Nissen, Nanna Bang; Jespersen, Sanne; Vinner, Lasse; Fomsgaard, Anders; Laursen, Alex

    2011-10-01

    We report the first case of Sandfly virus meningitis in a Danish traveller returning from Tuscany. A 52 year-old man was admitted with headache, fever and photophobia. Spinal fluid showed evidence of aseptic meningitis. Indirect immuno-fluorescence assays showed presence of immunoglobulin (Ig)M and IgG antibodies reactive against Toscana virus, and Phlebovirus RNA was detected in blood by real-time polymerase chain reaction. The patient recovered spontaneously. Since Sandfly virus is a very common cause of meningitis in the Mediterranean countries, it is important to be aware of this disease in travellers returning from these areas. PMID:21975188

  11. Meningococcal carriage in the African meningitis belt

    Science.gov (United States)

    2013-01-01

    A meningococcal serogroup A polysaccharide/tetanus toxoid conjugate vaccine (PsA-TT) (MenAfriVac#x2122;) is being deployed in countries of the African meningitis belt. Experience with other polysaccharide/protein conjugate vaccines has shown that an important part of their success has been their ability to prevent the acquisition of pharyngeal carriage and hence to stop transmission and induce herd immunity. If PsA-TT is to achieve the goal of preventing epidemics, it must be able to prevent the acquisition of pharyngeal carriage as well as invasive meningococcal disease and whether PsA-TT can prevent pharyngeal carriage needs to be determined. To address this issue, a consortium (the African Meningococcal Carriage (MenAfriCar) consortium) was established in 2009 to investigate the pattern of meningococcal carriage in countries of the African meningitis belt prior to and after the introduction of PsA-TT. This article describes how the consortium was established, its objectives and the standardised field and laboratory methods that were used to achieve these objectives. The experience of the MenAfriCar consortium will help in planning future studies on the epidemiology of meningococcal carriage in countries of the African meningitis belt and elsewhere. Un vaccin conjugué contenant un polysaccharide du sérogroupe A méningococcique et une anatoxine du tétanos (PsA-TT) (MenAfriVac™) est en cours de déploiement dans les pays de la ceinture africaine de la méningite. L’ expérience avec d’ autres vaccins conjugués polysaccharide/protéine a montré qu’ une partie importante de leur succès a été leur capacité à empêcher l’ acquisition du portage pharyngé et donc à arrêter la transmission et à induire une immunité de group. Si PsA-TT doit d’ atteindre l’ objectif de prévenir les épidémies, il devrait être en mesure d’ empêcher l’ acquisition du portage pharyngé ainsi que la méningococcie invasive et le fait que PsA-TT puisse empêcher le portage pharyngé devrait être déterminé. Pour résoudre ce problème, le consortium MenAfriCar (Consortium Africain du Portage Méningococcique) a été établi en 2009 pour étudier le mode de portage du méningocoque dans les pays de la ceinture africaine de la méningite avant et après l’ introduction de PsA-TT. Cet article décrit comment le consortium a été établi, ses objectifs et les méthodes de laboratoire et de terrain standardisées qui ont été utilisées pour atteindre ces objectifs. L’ expérience du consortium MenAfriCar aidera à planifier les futures études sur l’ épidémiologie du portage du méningocoque dans les pays de la ceinture africaine de la méningite et d’ ailleurs. Se está utilizando una vacuna meningocócica conjugada (MenAfriVac™) de polisacárido del serogrupo A / tétano toxoide (PsA-TT) en países del cinturón Africano de meningitis. Las experiencias obtenidas con otras vacunas conjugadas polisacárido/proteína han demostrado que una parte importante de su éxito se debe a su habilidad para prevenir la colonización faríngea de los portadores, acabando por lo tanto con la transmisión, y a la de inducir la protección de rebaño. Si PsA-TT ha de cumplir el objetivo de prevenir epidemias, debe ser capaz de prevenir el estado de portador faríngeo, al igual que la enfermedad invasiva por meningococo, y para ello es necesario determinar si la PsA-TT puede prevenir la colonización faríngea. Con el fin de abordar esta cuestión se estableció un consorcio africano en el 2009 - el MenAfriCar (African Meningococcal Carriage Consortium) – para investigar los patrones del estado de portador de meningococo en paí

  12. Mycobacterium bovis meningitis in young Nigerian-born male

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Daniel; Lillebaek, Troels

    2014-01-01

    In Denmark, tuberculous meningitis is rare. Central nervous system (CNS) involvement with Mycobacterium bovis is even rarer and has only been seen three times since 1992. We present a case of M. bovis meningitis in a previously healthy young Nigerian-born male, who had been exposed to unpasteurized dairy products in Nigeria but had no known contact with larger mammals. Before the development of meningitis, the patient had several contacts with the health system due to fever and non-specific symptoms. Finally, upon hospital admission, the patient was diagnosed with M. tuberculosis complex meningitis and treated empirically. After 13 days he was discharged without neurological sequelae. Later, the culture revealed M. bovis and treatment was adjusted accordingly.

  13. The Association of Meningitis with Postoperative Cerebrospinal Fluid Fistula

    OpenAIRE

    Allen, Kyle P.; Isaacson, Brandon; Kutz, J. Walter; Purcell, Patricia L.; Roland, Peter S.

    2012-01-01

    Objective?To determine the risk factors for and the clinical course of postoperative meningitis following lateral skull base surgery and to determine its relationship to cerebrospinal fluid (CSF) fistula.

  14. Five cases of recurrent meningitis associated with chronic strongyloidiasis.

    Science.gov (United States)

    Shimasaki, Teppei; Chung, Heath; Shiiki, Soichi

    2015-03-01

    Although meningitis secondary to chronic strongyloidiasis is a rare complication, it is associated with a high mortality rate. Recurrent meningitis can occur if the underlying parasitic infection is left untreated. We report five cases of recurrent meningitis related to chronic strongyloidiasis that were associated with human T-lymphotropic virus type 1 (HTLV-1) infection. Common causative organisms are Escherichia coli, Streptococcus bovis, and Klebsiella pneumonia. One patient died during the second episode of meningitis. Three patients showed significant gastrointestinal and respiratory symptoms before developing headache and fever. In four cases, patients developed multiple recurrences even with the treatment of thiabendazol. Ivermectin seems to be a better agent compared with thiabendazol to achieve eradication of strongyloidiasis. PMID:25548379

  15. The use of magnetic resonance and MR angiography in the detection of cerebral infarction: A complication of pediatric bacterial meningitis

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    Stoši?-Opin?al Tatjana

    2005-01-01

    Full Text Available Bacground. Association of both cerebral infarction and acute bacterial meningitis is more common in younger patients than in the elderly. The rate of mortality and the frequency of sequel are very high inspite of the use of modern antibiotic therapy. In more than 30% of the cases of childhood bacterial meningitis, both arterial and venous infarctions can occur. The aim of this study was to present the role of the use of magnetic resonance (MRI, and MR angiography (MRA in the detection of bacterial meningitis in children complicated with cerebral infarctions. Method. In the Centre for MR, the Clinical Centre of Serbia, 25 patients with the diagnosis of bacterial meningitis, of which 9 children with cerebral infarction whose clinical conditon deteriorated acutely, despite the antibiotic therapy, underwent MRI and MR angiography examination on a 1T scanner. Examination included the conventional spin-echo techniques with T1-weighted saggital and coronal, and T2- weighted axial and coronal images. Coronal fluid attenuated inversion recovery (FLAIR and the postcontrast T1-weighted images in three orthogonal planes were also used. The use MR angiography was accomplished by the three-dimensional time-of-flight (3D TOF technique. Results. The findings included: multiple hemorrhagic infarction in 4 patients, multiple infarctions in 3 patients, focal infarction in 1 patient and diffuse infarction (1 patient. Common sites of involvement were: the frontal lobes, temporal lobes and basal ganglia. The majority of infarctions were bilateral. In 3 of the patients empyema was found, and in 1 patient bitemporal abscess was detected. In 8 of the patients MR angiography confirmed inflammatory vasculitis. Conclusion. Infarction is the most common sequel of severe meningitis in children. Since the complication of cerebral infarction influences the prognosis of meningitis, repetitive MRI examinations are very significant for the evaluation of the time course of vascular involvement. The use of MRI, especially FLAIR imaging, confirmed its value in the detection and determination of the site and the extent of cerebral infarction. Non-invasive technique of examination, 3D TOF MR angiography clearly should show the presence of inflammatory vasculitis.

  16. Fatal Cryptococcal Meningitis in a Patient With Chronic Lymphocytic Leukemia

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    Oguzhan S?tk? Dizdar

    2012-01-01

    Full Text Available

    Patients with chronic lymphocytic leukemia (CLL are susceptible to infections, especially opportunistic infections. We have described a patient with CLL who had cryptococcal meningitis. Despite lack of previous immunosuppressive treatment history, the patient experienced serious and fatal fungal infection. Physicians should be alert for a diagnosis of cryptococcal meningitis in patient with CLL who developed fever and headache.

  17. Meningitis as a primary presentation of Dengue infection

    Directory of Open Access Journals (Sweden)

    Ramesh Y Bhat

    2013-03-01

    Full Text Available Dengue fever is the most prevalent arboviral infection in the world that is transmitted by mosquitoes. It is an acuteillness of sudden onset that usually follows a benign course with symptoms such as headache, fever and rash. Centralnervous system manifestations of dengue infection are usually rare. Here, a Dengue case with meningitis as primarymanifestation has been presented. J Microbiol Infect Dis 2013; 3(1: 39-40Key words: Meningitis, presentation, Dengue

  18. Streptococcus suis Meningitis with Bilateral Sensorineural Hearing Loss

    OpenAIRE

    Huh, Hee Jae; Park, Kyoung-jin; Jang, Ja-hyun; Lee, Mina; Lee, Jang Ho; Ahn, Yoon Hee; Kang, Cheol-in; Ki, Chang-seok; Lee, Nam Yong

    2011-01-01

    Streptococcus suis infection is an emerging zoonosis in Asia. The most common disease manifestation is meningitis, which is often associated with hearing loss and cochleovestibular signs. S. suis infection in humans mainly occurs among risk groups that have frequent exposure to pigs or raw pork. Here, we report a case of S. suis meningitis in a 67-yr-old pig carcass handler, who presented with dizziness and sensorineural hearing loss followed by headaches. Gram-positive diplococci were isolat...

  19. Salmonella enterica Serotype Arizonae Meningitis in a Neonate

    OpenAIRE

    Wubishet Lakew; Abayneh Girma; Elizabeth Triche

    2013-01-01

    Typhoidal and nontyphoidal salmonella infections are common causes of gastroenteritis in the community. However, salmonella only rarely causes invasive infections like meningitis. We report a 13-day-old female neonate with signs and symptoms of meningitis whose cerebrospinal fluid (CSF) culture showed Salmonella enterica serotype Arizonae that was sensitive to ceftriaxone. She presented with fever and failure to feed for 2 days. Despite prompt treatment with ampicillin, gentamicin, and ceftri...

  20. Epidemiology of infectious meningitis in the State of Amazonas, Brazil

    Scientific Electronic Library Online (English)

    Maria das Graças Gomes, Saraiva; Eyde Cristianne Saraiva, Santos; Valéria, Saraceni; Lívia Laura dos Santos, Rocha; Rossicléia Lins, Monte; Bernardino Cláudio de, Albuquerque; Michele de Souza, Bastos; Marcelo Cordeiro dos, Santos; Wuelton Marcelo, Monteiro; Maria Paula Gomes, Mourão; Marcus Vinitius de Farias, Guerra; Marcus Vinícius Guimarães de, Lacerda.

    2015-06-01

    Full Text Available INTRODUCTION: In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present s [...] tudy reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. METHODS: Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. RESULTS: The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. CONCLUSIONS: Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

  1. Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants.

    LENUS (Irish Health Repository)

    O'brien, Deirdre

    2010-12-15

    A 58-year old male presented with meningitis associated with subgaleal and subdural collections 6 weeks following a temporal craniotomy for resection of recurrent glioblastoma multiforme and Gliadel wafer implantation. Candida parapsilosis was cultured from cerebrospinal fluid (CSF) and Gliadel wafers removed during surgical debridement. He was successfully treated with liposomal amphotericin B. To our knowledge, this is the first reported case of Candida parapsilosis meningitis secondary to Gliadel wafer placement.

  2. Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre

    2012-02-01

    A 58-year old male presented with meningitis associated with subgaleal and subdural collections 6 weeks following a temporal craniotomy for resection of recurrent glioblastoma multiforme and Gliadel wafer implantation. Candida parapsilosis was cultured from cerebrospinal fluid (CSF) and Gliadel wafers removed during surgical debridement. He was successfully treated with liposomal amphotericin B. To our knowledge, this is the first reported case of Candida parapsilosis meningitis secondary to Gliadel wafer placement.

  3. Fatal group a streptococcal meningitis in an adult

    Directory of Open Access Journals (Sweden)

    Mani R

    2007-01-01

    Full Text Available Despite the recent resurgence in reports of invasive Group A Streptococcal (GAS infections worldwide, it remains a rare cause of pyogenic meningitis both in children and adults. We report a case of fatal GAS meningitis in a healthy adult emphasizing the need for clinicians to be aware of its fulminant course, prompting early diagnosis and treatment. There is also a need to consider postexposure chemoprophylaxis in close contacts of such cases.

  4. Neonatal Escherichia coli meningitis: spinal adhesions as a late complication.

    Science.gov (United States)

    Steinlin, M; Knecht, B; Könü, D; Martin, E; Boltshauser, E

    1999-12-01

    We describe two boys who had severe spinal complications in adolescence after a favorable initial recovery from neonatal Escherichia coli meningitis. Due to spinal granulomatous adhesions, one boy died after an attempted scoliosis operation (high cord lesion). The other showed severe progressive neurological deterioration with spinal and cerebellar symptoms. Conclusion The severe complication of chronic arachnoiditis with spinal adhesion may occur many years after neonatal acute bacterial meningitis. PMID:10592071

  5. Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department

    OpenAIRE

    Cooney, Derek R.; Cooney, Norma L.

    2011-01-01

    A 70-year-old female presented to the emergency department with a 3-day history of intermittent dysphasia and right facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were obtained, and the patient was found to have meningeal carcinomatosis, also known as leptomeningeal metastases. Meningeal carcinomatosis is a rare metastatic complication of some solid tumors and hematopoietic neoplasms, and has a median survival rate of 2.4 months. The role of the emergency physicia...

  6. Ambulant neuropsykologisk opfølgning af patienter indlagt med aseptisk meningitis

    DEFF Research Database (Denmark)

    Damsgaard Gunst, Jesper; Klostergaard, Kirsten Rose

    2014-01-01

    Aseptic meningitis is considered to be a benign illness with mild symptoms, and the prognosis is usually good. However, retrospective studies have demonstrated that these patients may experience cognitive sequelae. A neuropsychologist was affiliated to the Department of Infectious Diseases, and neuropsychological findings in patients with aseptic meningitis were assessed. In conclusion, at twelve months of follow-up cognitive dysfunction persist among the majority of patients; 75% had mental fatigue and 45% had changed their work status.

  7. Diagnostic Approach to Recurrent Bacterial Meningitis in Children

    Directory of Open Access Journals (Sweden)

    Song-Chei Huang

    2005-07-01

    Full Text Available Recurrence of bacterial meningitis in children is not onlypotentially life-threatening, but also involves or induces psychologicaltrauma to the patients through repeated hospitalizationand multiple invasive investigations if the underlyingcause remains undetected. Bacteria migration, along congenitalor acquired pathways from the skull or spinal dural defects,gains entrance into the central nervous system (CNS andshould be taken into consideration when children face recurrentbacterial meningitis, however, symptoms and signs ofcerebrospinal fluid (CSF rhinorrhea or otorrhea are rare insuch patients. Without evidence of CSF leakage, a cranialsymptom/sign or coccygeal cutaneous stigmata may suggestthe approximate lesion site, diagnosis and detection remainsdifficult. To detect an occult dural lesion along the craniospinalaxis, such as basal encephalocele, dermal sinus tract, orneurenteric cyst, a detailed clinical evaluation and the use of the modern diagnostic imagingmethods is necessary. Because of the possibility of concomitant occurrence of more than onemalformation, both the frontal and the lateral skull base should be carefully evaluated.Precise localization of the dural lesion is a prerequisite for successful surgical repair. Inaddition, the bacteria specificity could leave significant clues: Pneumoccocus or Hemophilussuggests cranial dural defects, E. coli or other gram negative bacilli suggests spinal duraldefects, and meningococci suggest immunologic deficiency. Asplenia or immunodeficiencysuch as complement or immunoglobulin deficiency rarely causes recurrent meningitis withouta history of frequent infection of non-CNS areas. Salmonella meningitis or brain abscessshould not be treated incompletely or inadequately and could lead to recrudescence, relapseor recurrence of bacterial meningitis. Antibiotic (penicillin or trimethoprim-sulfamethoxazoleinduced meningitis may repetitively occur on occasion.

  8. Nontuberculous mycobacterial meningitis: report of two cases and review.

    Science.gov (United States)

    Flor, A; Capdevila, J A; Martin, N; Gavaldà, J; Pahissa, A

    1996-12-01

    Nontuberculous mycobacterial meningitis (NTMM) is still a rare disease despite the increase in the number of cases of disseminated mycobacterial infection related to the AIDS epidemic. Moreover, there are doubts as to the clinical relevance of the isolation of mycobacteria other than Mycobacterium tuberculosis from cerebrospinal fluid. After analyzing the clinical and pathological data, we classified the cases of NTMM into three groups: definitive (28 cases), probable (19), and doubtful (5). We found that Mycobacterium avium is the most commonly isolated species (60% of cases). M. avium meningitis presents as a disseminated disease, is usually related to serious underlying conditions (mainly immunosuppression), and is associated with a death rate that approaches 70%. Mycobacterium fortuitum meningitis is associated with previous neurosurgery or back trauma; the prognosis for this infection is better when the concomitant abscesses are drained. The clinical characteristics of Mycobacterium kansasii meningitis are similar to those of M. tuberculosis meningitis, but the mortality related to M. kansasii meningitis is high despite appropriate antibiotic treatment. Herein, we present two cases of NTMM that occurred at our center, and we review 50 additional cases reported in the English-language literature. PMID:8953070

  9. Persistent stapedial arteries in human: from phylogeny to surgical consequences.

    Science.gov (United States)

    Hitier, Martin; Zhang, M; Labrousse, M; Barbier, C; Patron, V; Moreau, S

    2013-12-01

    The stapedial artery is an embryonic artery which disappears during the tenth week in utero, in human species. During its short life, this artery shapes the stapes and transforms the middle meningeal artery from the internal carotid artery to a branch of the external carotid system. Nevertheless, a persistent stapedial artery is seen in 0.2-4.8 per thousand of human adults. This persistence is usually asymptomatic but can sometimes cause pulsatile tinnitus or conductive hearing loss. Despite the risk of facial palsy, hearing loss and even hemiplegia argued by several authors, some surgeons have succeeded in coagulation without side effects. Reviewing the literature, we seek to enlighten the actual knowledge about the persistent stapedial artery to evaluate the risk to coagulate it. Embryologic studies explain the four types of persistent stapedial arteries: the hyoido-stapedial artery, the pharyngo-stapedial artery, the pharyngo-hyo-stapedial artery and aberrant internal carotid with persistent stapedial artery. Phylogenetic studies show that the stapedial artery persists in adulthood in many vertebrates. Its disappearance is therefore either a random effect or an adaptative convergence. This adaptation could be partially linked to the negative allometry of the stapes. Practically, the risk to coagulate a stapedial artery seems limited thanks to anastomoses, for example with the stylomastoid artery. The risk of hemiplegia reported is in fact an extrapolation of variation in rats' embryos. A persistent stapedial artery can therefore reasonably be coagulated, with special attention to the facial nerve, because the facial canal is always dehiscent where the artery penetrates. PMID:23640742

  10. Meningitis bacteriana por Streptococcus pyogenes: revisión de la literatura / Bacterial meningitis due to Streptococcus pyogenes: literature review

    Scientific Electronic Library Online (English)

    E., Ballesteros Moya; L., Herrera Castillo; L., Escosa García; M.P., Romero González; F., Lázaro Perona; M.I. de, José Gómez.

    2013-12-01

    Full Text Available Introducción: el Streptococcus pyogenes (S. pyogenes) es una etiología poco habitual de meningitis bacteriana a pesar de ser un germen que frecuentemente produce infecciones en otras localizaciones en la edad pediátrica. Material y métodos: se revisaron los casos de bacteriemia por S. pyogenes y los [...] factores de riesgo asociados en la base de datos del Servicio de Microbiología del Hospital Universitario La Paz desde junio de 2002 a junio de 2012. Resultados: únicamente se encontró un caso de bacteremia por S. pyogenes asociado a meningitis, que se describe en este artículo. Conclusiones: a pesar de su baja incidencia, se debe tener en cuenta el S. pyogenes en el diagnóstico diferencial de meningitis bacterianas, especialmente en pacientes con factores de riesgo asociados Abstract in english Introduction: Streptococcus pyogenes (S. pyogenes) is a rare cause of meningitis despite being a common source of pediatric infections in other sites. Material and methods: A search was performed of the pediatric patients with S. pyogenes bacteremia in the microbiology database of the Hospital Infan [...] til La Paz from June 2002 until June 2012. Results: A single case of S. pyogenes meningitis was found and is reported in this article. Conclusions: Despite its low incidence, S. pyogenes should be considered in the differential diagnosis of meningitis, particularly in patients with associated risk factors.

  11. Meningitis granulomatosa, glomerulonefritis rápidamente progresiva y vasculitis / Granulomatous meningitis, crescentic glomerulonephritis and vasculitis

    Scientific Electronic Library Online (English)

    Ana, Ludueña; Enrique, Dorado; Judith, Sarano; Guillermo, Semeniuk.

    2011-08-01

    Full Text Available El compromiso meníngeo es una manifestación infrecuente de la granulomatosis de Wegener. Puede manifestarse como cefalea con hiperproteinorraquia y engrosamiento de la duramadre con aspecto granulomatoso, que se observa en la resonancia magnética. Presentamos un varón de 57 años con granulomatosis d [...] e Wegener que debutó con compromiso de vías aéreas superiores, oídos, órbitas y meningitis granulomatosa asintomática y que posteriormente evolucionó con mononeuritis múltiple y glomerulonefritis crescéntica ANCA positiva. La presencia de ANCA y el compromiso sistémico (vías aéreas superiores, oído, órbitas, nervios periféricos, duramadre y glomerulonefritis rápidamente progresiva) permitieron en este caso llegar a un diagnóstico de certeza e iniciar el tratamiento inmunosupresor combinado (corticoides y ciclofosfamida). Evolucionó con remisión clínica y serológica (negativización de ANCA), pero persistiendo leve deterioro secuelar auditivo y de la función renal, sin recidiva de la enfermedad de base. Abstract in english Meningeal involvement is an infrequent manifestation of Wegener's granulomatosis. Clinical manifestations can be headache with high protein level in the cerebrospinal fluid and an enhanced MRI signal of granulomatous thickening of the duramater in the brain. We report a 57 year-old male with Wegener [...] granulomatosis with onset manifestations of asymptomatic granulomatous meningitis, upper respiratory tract, ears and orbits involvement. He progressively developed ANCA positive multiple mononeuritis and crescentic glomerulonephritis. The diagnostic confirmation of Wegener's granulomatosis based on a positive ANCA test and on the evidence of systemic disease (crescentic glomerulonephritis and involvement of the upper respiratory tract, ears, orbits, peripheral nerves and duramater) allowed a prompt initiation of aggressive immunosuppressive treatment with systemic cyclophosphamide and high - dosis corticosteroids. The patient entered into a sustained clinical remission with mild residual neurosensorial hearing loss and renal failure.

  12. Otobasal liquor fistula causing recurrent bacterial meningitis; Otobasale Liquorfistel als Ursache einer rezidivierenden bakteriellen Meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Doege, H. [Abteilung fuer Nuklearmedizin, Leipzig Univ. (Germany); Klinghammer, A.; Elix, H. [Klinik fuer Kinder- und Jugendmedizin, Leipzig Univ. (Germany); Pilz, D. [Institut fuer Bildgebende Diagnostik der Klinikum Chemnitz gGmbH (Germany); Bootz, F. [Klinik und Poliklinik fuer Hals-Nasen-Ohren-Heilkunde/ Plastische Operationen, Leipzig Univ. (Germany)

    2000-07-01

    Cerebral subarachnoid space scintigraphy today still is the modality of choice for detection of a liquorrea or a liquor fistula, especially in the case of a recurrent menengitis of unclear origin. This diagnostic method yielded the results required in the case reported for efficient and successful surgical treatment. (orig./CB) [German] Die zerebrale Liquorraumszintigraphie ist aufgrund der hohen Empfindlichkeit auch heute noch die Methode der Wahl zum Nachweis einer Liquorrhoe beziehungsweise einer Liquorfistel, insbesondere bei einer rezidivierenden Meningitis unklarer Genese. Sie ermoeglichte bei unserer Patientin eine gezielte definitive operative Behandlung. (orig.)

  13. Acute arterial occlusion - kidney

    Science.gov (United States)

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  14. Carcinomatose das meninges: dados clínico-patológicos de 3 casos / Carcinomatosis of the meninges: a report of three cases

    Scientific Electronic Library Online (English)

    Aristides Cheto de, Queiroz; Carlos Renato, Melo.

    1974-12-01

    Full Text Available Foram estudados 3 casos de carcinomatose das meninges, autopsiados no serviço de Anatomia Patológica do Hospital Prof. Edgard Santos. O quadro neurológico apresentado era proeminente e representado por sinto- matologia decorrente do envolvimento meníngeo e encefálico, razão pela qual foram considera [...] dos como portadores de meningite tuberculosa e encefalomielite. O aspecto de maior interesse neste estudo foi a discrepância entre o quadro clínico e os dados anátomo-patológicos do exame do encéfalo. A sintomatologia clínica foi proeminente, enquanto as lesões anatômicas foram apenas discretas ou moderadas e representadas por espessamento e granulosidade das meninges, com infiltração difusa do espaço subaracnoideano pela neoplasia. Nos casos 1 e 3 a neoplasia estava representada por adenocarcinoma, cujos focos primitivos foram localizados no pulmão e vesícula biliar, respectivamente. O caso 2 era um carcinoma indiferenciado do estômago, com envolvimento difuso do espaço subaracnoideano e subdural, havendo neste último extensa hemorragia recente. Os critérios diagnósticos e a maneira de disseminação desta condição são discutidos. Abstract in english A diffuse involvement of the meninges by carcinoma is described in three cases characterizing the so called "meningeal carcinomatosis". The neurologic symptoms were those of the chronic meningitis or encephalomyelitis, with changes in the spinal fluid. The morphologic features were identical in the [...] three cases and represented by slight to moderate thickening of the meninges by diffuse infiltration of tumor cells and few foci of inflamatory reaction. The cases 1 and 3 were represented by well differentiated adenocarcinoma with primary site in the lung and gallbladder, respectively. In case 2 the tumor was a poorly differentiated carcinoma of stomach with diffuse involvement of the arachnoid and dura mater associated with recent hemorrhage. An interesting point was the lack of correlation between clinical and pathological findings. The clinical symptoms were very prominent and the gross findings only slight to moderate. The criteria for diagnosis of this entity as well as the mechanism of dissemination of the carcinoma to the meninges are reviewed and discussed.

  15. MRI features of meningeal metastasis from lung cancer

    International Nuclear Information System (INIS)

    Objective: To investigate the pathway and MRI findings of meningeal metastasis original from lung cancer. Methods: 44 cases with cerebro-spinal meningeal metastasis original from lung cancer proven by clinical and pathology were retrospectively reviewed. All cases undergone plain MRI scan and Gd-DTPA enhanced MRI scan on brain and/or spine. Results: MRI plain scan indicated 28 cases with brain metastases, 3 cases with meningeal nodosity or irregularly patchy abnormal signal, 1 case with nodule in left cavernous sinus, 10 cases with abnormal signal in spine, 2 cases with abnormal signal in spinal dura mater. 34 cases with cerebro meningeal metastases were found in MRI enhancement scan. Among them, 11 cases displayed cerebral dura mater-arachnoid enhancement, 17 cases revealed cerebral pia mater-arachnoid enhancement and 6 cases with mixed typed enhancement. Osteoclasia in skull was found in 4 cases, spinal metastasis was revealed in 17 cases, and patchy abnormal enhancement in spinal dura mater was showed in 12 cases. Conclusion: Hematogenous metastasis is a main route of meningeal metastasis caused by lung cancer and enhanced MRI scan is of important diagnostic value. (authors)

  16. Should corticosteroids be used in bacterial meningitis in children?

    Science.gov (United States)

    Esposito, Susanna; Semino, Margherita; Picciolli, Irene; Principi, Nicola

    2013-01-01

    Bacterial meningitis is one of the most serious infections in infants and children, with considerable morbidity and mortality. Despite the spreading of conjugated vaccines against Haemophilus influenzae type b (Hib), the most important pneumococcal serotypes and serogroup C meningococcus has reduced the incidence of this infection in developed countries, it still remains a global public health problem and an important cause of mortality and disability. Whether corticosteroids should be used as a complementary therapy to antibacterials is still not clear because of the disparate findings from clinical trials and clinical evidence. The aim of this review is to analyze the available evidence on the impact of corticosteroid therapy in infants and children with bacterial meningitis in developed countries in order to define whether they should be added routinely in the empiric therapy of such disease. Our analysis concluded that in high-income countries dexamethasone has shown good results to prevent hearing loss in Hib meningitis if administered before or at the same time as the first dose of antibiotics. Dexamethasone should be evaluated in pneumococcal meningitis: it may be less beneficial in children with delayed presentation to medical attention and may be unfavourable in case of cephalosporin-resistant pneumococci. On the contrary, there is no evidence to recommend the use of corticosteroids in meningococcal meningitis. Further studies that take into account the epidemiologic changes of recent years, consider enrolment based on the onset of symptoms and evaluate outcomes such as hearing loss and neurologic sequelae with advanced techniques are urgently needed. PMID:22789668

  17. Use of Vaccines to Prevent Meningitis in Persons with Cochlear Implants

    Science.gov (United States)

    ... Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis (2010) National Center on Birth Defects ... surgical site infections and prevention and treatment of acute otitis media and meningitis . Pediatrics . 2010; 126:381. Thigpen MC, ...

  18. Childhood meningitis in the conjugate vaccine era: a prospective cohort study.

    Science.gov (United States)

    Sadarangani, Manish; Willis, Louise; Kadambari, Seilesh; Gormley, Stuart; Young, Zoe; Beckley, Rebecca; Gantlett, Katherine; Orf, Katharine; Blakey, Sarah; Martin, Natalie G; Kelly, Dominic F; Heath, Paul T; Nadel, Simon; Pollard, Andrew J

    2015-03-01

    Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16?years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis-13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3?months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3?months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay. PMID:25256088

  19. Clinical and microbiological features of cryptococcal meningitis

    Scientific Electronic Library Online (English)

    Lucia Kioko Hasimoto e, Souza; Carolina Rodrigues, Costa; Orionalda de Fatima Lisboa, Fernandes; Fernando Yano, Abrao; Thaisa Cristina, Silva; Carolina Martins, Tremea; Maria do Rosario Rodrigues, Silva.

    2013-06-01

    Full Text Available Introduction In this study, the clinical features, underlying diseases and clinical outcomes of patients with cryptococcosis were investigated. In addition, a molecular analysis of the Cryptococcus neoformans species complex isolated from these patients was performed. Methods A prospective study [...] of 62 cases of patients with cryptococcal infection was conducted at the Hospital de Doenças Tropicais de Goiás Dr. Anuar Auad from 2009-2010. Cryptococcal meningitis cases were diagnosed by direct examination and cerebrospinal fluid (CSF) sample culture. The profiling of these patients was assessed. The CSF samples were submitted to India ink preparation and cultured on Sabouraud dextrose agar, and C. neoformans was identified by the production of urease, a positive phenoloxidase test and assimilation of carbohydrates. C. neoformans and C. gattii isolates were distinguished by growth on L-canavanine-glycine-bromothymol blue medium, and molecular analysis was conducted via PCR fingerprinting reactions using M13 and (GACA)4 primers. Results From the 62 patients with cryptococcosis, 71 isolates of CSF were obtained; 67 (94.4%) isolates were identified as C. neoformans var. grubii/VNI, and 4 (5.6%) were identified as C. gattii/VGII. Of these patients, 53 had an HIV diagnosis. The incidence of cryptococcosis was higher among patients 20-40 years of age, with 74.2% of the cases reported in males. Cryptococcus-related mortality was noted in 48.4% of the patients, and the symptoms were altered sensorium, headache, fever and stiff neck. Conclusions The high morbidity and mortality observed among patients with cryptococcosis demonstrate the importance of obtaining information regarding the epidemiological profile and clinical course of the disease in the State of Goiás, Brazil.

  20. Progress towards meningitis prevention in the conjugate vaccines era

    Directory of Open Access Journals (Sweden)

    Cristina Aparecida Borges Laval

    2003-10-01

    Full Text Available Acute bacterial meningitis is an important cause of morbidity and mortality among children less than five years old. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis are the most important agents of bacterial meningitis in developing countries. The development of the conjugate vaccines in the beginning of the 90's, especially type b H. influenzae (Hib, and more recently the heptavalent pneumococcal and the serogroup C meningococcal vaccines, have contributed directly to changes in the epidemiological profile of these invasive diseases (direct effect and of their carriage status (indirect effect. We review the impact of the Hib conjugate vaccine in Latin American countries, where this vaccine has been implemented, and the potential of pneumococcal and meningococcal conjugate vaccines for the reduction of meningitis worldwide. We also address constraints for the development and delivery of these vaccines and review new candidate state-of-the-art vaccines. The greatest challenge, undoubtedly, is to implement these vaccines worldwide, especially in the developing regions.

  1. Cat scratch disease complicated with aseptic meningitis and neuroretinitis

    Scientific Electronic Library Online (English)

    Vitor Laerte, Pinto Jr.; André Land, Curi; Adriana da Silva, Pinto; Estevão Portela, Nunes; Maria de Lourdes Benamor, Teixeira; Tatiana, Rozental; Alexsandra Rodrigues, Favacho; Elba Regina Sampaio de, Lemos; Márcio Neves, Bóia.

    2008-04-01

    Full Text Available Cat scratch disease (CSD) is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. [...] We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI) assays for B. henselae were positive and the cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.

  2. Cat scratch disease complicated with aseptic meningitis and neuroretinitis

    Directory of Open Access Journals (Sweden)

    Vitor Laerte Pinto Jr.

    2008-04-01

    Full Text Available Cat scratch disease (CSD is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI assays for B. henselae were positive and the cerebrospinal fluid (CSF analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.

  3. Vaccine preventable meningitis in Malaysia: epidemiology and management.

    Science.gov (United States)

    McNeil, Hannah C; Jefferies, Johanna Mc; Clarke, Stuart C

    2015-06-01

    Worldwide bacterial meningitis accounts for more than one million cases and 135,000 deaths annually. Profound, lasting neurological complications occur in 9-25% of cases. This review confirms the greatest risk from bacterial meningitis is in early life in Malaysia. Much of the disease burden can be avoided by immunization, particularly against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Despite inclusion of the Hib vaccine in the National Immunisation Programme and the licensure of pneumococcal vaccines, these two species are the main contributors to bacterial meningitis in Malaysia, with Neisseria meningitidis and Mycobacterium tuberculosis, causing a smaller proportion of disease. The high Hib prevalence may partly be due to dated, small-scale studies limiting the understanding of the current epidemiological situation. This highlights the need for larger, better quality surveillance from Malaysia to evaluate the success of Hib immunization and to help guide immunization policy for vaccines against S. pneumoniae and N. meningitidis. PMID:25962101

  4. Probable acute disseminated encephalomyelitis due to Haemophilus influenzae meningitis.

    Science.gov (United States)

    Beleza, Pedro; Ribeiro, Manuel; Pereira, João; Ferreira, Carla; Jordão, Maria José; Almeida, Fátima

    2008-05-01

    We report the case of a 17-year-old male on long-term steroid therapy for minimal lesion glomerulopathy who, after an upper respiratory infection, presented with Haemophilus influenzae type b meningitis. Twenty-four hours later he developed depression of consciousness which progressed to coma and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple lesions (hyperintense on T2 and slightly hypointense on Tl) involving mainly white matter suggestive of inflammation. MRI features were compatible with acute disseminated encephalomyelitis (ADEM), although a differential diagnosis included cerebritis or vasculitis, secondary to bacterial meningitis. The patient was treated with high-dose steroids which resulted in a gradual improvement followed by complete clinical recovery. We propose a diagnosis of ADEM was the best diagnosis because of the radiological features and response to steroids. The occurrence of ADEM associated with acute meningitis, however rare, represents an important diagnostic challenge for the clinician. PMID:18355336

  5. Bacteremic meningitis caused by Parvimonas micra in an immunocompetent host.

    Science.gov (United States)

    Ko, Jae-Hoon; Baek, Jin Yang; Kang, Cheol-In; Lee, Woo Joo; Lee, Ji Yong; Cho, Sun Young; Ha, Young Eun; Kim, So Hyun; Chung, Doo Ryeon; Peck, Kyong Ran; Lee, Nam Yong; Song, Jae-Hoon

    2015-08-01

    A 61-year-old man with chronic hepatitis B and dyslipidemia visited the emergency department with a fever and severe headache. He was diagnosed with bacterial meningitis after a lumbar puncture, and blood culture revealed Parvimonas micra bacteremia. Although he had a history of extraction of a molar two weeks before symptom onset, there was no evidence of abscess formation on physical examination or imaging studies. He was successfully treated with oral metronidazole for 12 days after 9 days of treatment with IV ceftriaxone and vancomcycin. This is the first report of primary bacterial meningitis caused by this organism, which indicates that this organism is capable of being a bacterial meningitis pathogen. PMID:25977161

  6. Meningitis associated with Vancomycin resistant Enterococcus casseliflavus: First report

    Directory of Open Access Journals (Sweden)

    Nilay Sefa Uçar

    2011-12-01

    Full Text Available Enterococci are present in the gastrointestinal system as normal floral components. In the past two decades membersof the genus Enterococcus have emerged as important nosocomial pathogens worldwide. Enterococci may cause arange of different disorders such as urinary tract, intraabdominal, and wound infections, as well as endocarditis, meningitisand bacteraemia. Nosocomial enterococcal meningitis is most commonly observed following ventriculoperitonealshunt operations. Vancomycin resistant enterococcus (VRE represents 30% of all enterococci infections.This report presents a vancomycin-resistant Enterococcus casseliflavus meningitis case in a 66-year-old patient withventriculoperitoneal shunt, which has not been reported in the literature before. Successful outcomes were obtainedwith daptomycin plus linezolid combined treatment in VRE meningitis. Treatment recommendations in VRE meningitisare also discussed in this article. J Microbiol Infect Dis 2011;1 (3:138-140

  7. Hearing loss diagnosis followed by meningitis in Danish children, 1995-2004

    DEFF Research Database (Denmark)

    Parner, Erik T; Reefhuis, Jennita

    2007-01-01

    A higher risk of meningitis associated with cochlear implants may be explained in part by a generally higher risk of meningitis in children with severe to profound hearing loss. We investigated whether children with hearing loss have an increased risk of meningitis.

  8. The relationship between cerebrospinal fluid C-reactive protein and neonatal meningitis

    Directory of Open Access Journals (Sweden)

    Nastaran Khosravi

    2014-02-01

    Conclusion: In the present study, newborns with septic meningitis had higher cerebrospinal fluid CRP level than newborns with aseptic meningitis, and CSF-CRP can be used in rapid diagnosis of septic and aseptic meningitis. Although this result has been seen in many studies, but more research is needed.

  9. Bacillus cereus meningitis and bacteremia associated with an Ommaya reservoir in a patient with lymphoma.

    Science.gov (United States)

    Garcia, I; Fainstein, V; McLaughlin, P

    1984-07-01

    After placement of an Ommaya reservoir, meningitis and bacteremia due to Bacillus cereus occurred in a patient with stage IV lymphoblastic lymphoma and meningeal involvement. Bacillus species have been implicated as meningeal pathogens after lumbar punctures. These organisms have become an important cause of severe infection, especially in immunologically compromised patients. PMID:6429866

  10. Bacterial meningitis as a first presentation of pituitary macroprolactinoma

    Science.gov (United States)

    Margari, Niki

    2014-01-01

    Summary A 56-year-old man was brought to the Emergency Department after being found collapsed at his office with a reduced level of consciousness. From clinical examination and initial investigations, he was diagnosed as having bacterial meningitis and was promptly commenced on empirical i.v. antibiotics. Computed tomography of the brain revealed a parenchymal mass at the base of the skull and subsequent magnetic resonance imaging of the head 4 days later confirmed a large soft tissue mass, which extended through to the cavernous sinus. Examination of the cerebrospinal fluid (CSF) following lumbar puncture confirmed pneumococcal meningitis and antibiotics were continued for 2 weeks in total. During the admission, hormone profiling revealed a grossly elevated prolactin. When coupled with the initial results of the brain imaging, this result helped to confirm a macroprolactinoma that was invading the postnasal space. A final diagnosis of pneumococcal meningitis secondary to invading prolactinoma was made. The patient was started on cabergoline and was followed up in the outpatient clinic upon discharge. He made a full recovery from the meningitis. Over the next few months, prolactin levels returned to be normal and the prolactinoma shrank significantly in size. The patient remains on cabergoline that will most likely be continued indefinitely. Learning points Bacterial meningitis is a rare first presentation of pituitary macroprolactinoma.Patients with invasive macroprolactinoma do not always present with CSF leakage.Prompt treatment with antibiotics and a dopamine agonist is of great importance for a favourable outcome.Close monitoring of the patient for signs of raised intracranial pressure is essential in the management of macroprolactinoma.Note the risk of CSF leakage after initiation of dopamine agonist therapy irrespective of concomitant meningitis in macroprolactinoma. PMID:24963397

  11. Haemophilus influenzae type f meningitis in a previously healthy boy

    DEFF Research Database (Denmark)

    Ronit, Andreas; Berg, Ronan M G

    2013-01-01

    Non-serotype b strains of Haemophilus influenzae are extremely rare causes of acute bacterial meningitis in immunocompetent individuals. We report a case of acute bacterial meningitis in a 14-year-old boy, who was previously healthy and had been immunised against H influenzae serotype b (Hib). The causative pathogen was identified as H influenzae serotype f (Hif), and was successfully treated with ceftriaxone. An immunological evaluation revealed transient low levels of immunoglobulins but no apparent immunodeficiency was found 2 years after the clinical insult.

  12. Prevalence and antimicrobial resistance pattern of bacterial meningitis in Egypt

    Directory of Open Access Journals (Sweden)

    Shaban Lamyaa

    2009-09-01

    Full Text Available Abstract Infectious diseases are the leading cause of morbidity and mortality in the developing world. In Egypt bacterial diseases constitute a great burden, with several particular bacteria sustaining the leading role of multiple serious infections. This article addresses profound bacterial agents causing a wide array of infections including but not limited to pneumonia and meningitis. The epidemiology of such infectious diseases and the prevalence of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae are reviewed in the context of bacterial meningitis. We address prevalent serotypes in Egypt, antimicrobial resistance patterns and efficacy of vaccines to emphasize the importance of periodic surveillance for appropriate preventive and treatment strategies.

  13. Meningitis due to Rhodotorula glutinis in an HIV infected patient

    Directory of Open Access Journals (Sweden)

    Shinde R

    2008-01-01

    Full Text Available Rhodotorula spp, though considered a common saprophyte, recently has been reported as causative agent of opportunistic mycoses. We present a case of meningitis in an immunocompromised human immunodeficiency virus infected patient who presented with longstanding fever. He was diagnosed as a case of chronic meningitis. Diagnosis was confirmed by cell cytology, India ink preparation, Gram staining and culture of cerebrospinal fluid (CSF sample. CSF culture grew Rhodotorula glutinis . Therapy with amphotericin B was successful in eliminating the yeast from CSF and the patient was discharged after recovery.

  14. Meningeal involvement in Behcet`s disease: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Guma, A. [Department of Radiology, Hospital Duran i Reynals, Llobregat (Spain); Aguilera, C.; Pons, L. [Institut de Diagnostic per la Imatge, Centre de Bellvitge, Llobregat (Spain); Acebes, J. [Department of Neurosurgery, Universitaria de Bellvitge, Llobregat (Spain); Arruga, J. [Department of Ophthalmology, Universitaria de Bellvitge, Llobregat (Spain)

    1998-08-01

    Behcet`s disease is a multisystem disease that involves the central nervous system up to half of cases. Presentation with neurologic symptoms occurs in 5 % of cases and cerebral venous thrombosis is one of its major manifestations. A feature not previously reported is progressive meningeal thickening with involvement of both optic nerves. We report a patient with cerebral venous thrombosis, meningeal thickening and contrast enhancement on MRI. This patient had two other unusual features: positive antineutrophil cytoplasmic antibodies and later development of central diabetes insipidus. (orig.) With 4 figs., 11 refs.

  15. Hyperglycemia in bacterial meningitis: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Spanjaard Lodewijk

    2009-05-01

    Full Text Available Abstract Background Hyperglycemia has been associated with unfavorable outcome in several disorders, but few data are available in bacterial meningitis. We assessed the incidence and significance of hyperglycemia in adults with bacterial meningitis. Methods We collected data prospectively between October 1998 and April 2002, on 696 episodes of community-acquired bacterial meningitis, confirmed by culture of CSF in patients >16 years. Patients were dichotomized according to blood glucose level on admission. A cutoff random non-fasting blood glucose level of 7.8 mmol/L (140 mg/dL was used to define hyperglycemia, and a cutoff random non-fasting blood glucose level of 11.1 mmol/L (200 mg/dL was used to define severe hyperglycemia. Unfavorable outcome was defined on the Glasgow outcome scale as a score Results 69% of patients were hyperglycemic and 25% severely hyperglycemic on admission. Compared with non-hyperglycemic patients, hyperglycemia was related with advanced age (median, 55 yrs vs. 44 yrs, P vs. 3%, P = 0.005, and distant focus of infection (37% vs. 28%, P = 0.02. They were more often admitted in coma (16% vs. 8%; P = 0.004 and with pneumococcal meningitis (55% vs. 42%, P = 0.007. These differences remained significant after exclusion of patients with known diabetes. Hyperglycemia was related with unfavorable outcome in a univariate analysis but this relation did not remain robust in a multivariate analysis. Factors predictive for neurologic compromise were related with higher blood glucose levels, whereas factors predictive for systemic compromise were related with lower blood glucose levels. Only a minority of severely hyperglycemic patients were known diabetics (19%. The vast majority of these known diabetic patients had meningitis due to Streptococcus pneumoniae (67% or Listeria monocytogenes (13% and they were at high risk for unfavorable outcome (52%. Conclusion The majority of patients with bacterial meningitis have hyperglycemic blood glucose levels on admission. Hyperglycemia can be explained by a physical stress reaction, the central nervous system insult leading to disturbed blood-glucose regulation mechanisms, and preponderance of diabetics for pneumococcal meningitis. Patients with diabetes and bacterial meningitis are at high risk for unfavorable outcome.

  16. A Case of Tuberculous Meningitis Presented with Rapidly Progressive Hydrocephalus

    Directory of Open Access Journals (Sweden)

    ?eyda Eren

    2008-12-01

    Full Text Available Tuberculosis of the central nervous system is the most serious complication of tuberculosis and is fatal without prompt and appropriate treatment. The clinical progression of tuberculous meningitis may be rapid or gradual. Rapid progression occurs less frequently and causes symptoms for only several days before the onset of acute hydrocephalus. More commonly, the signs and symptoms progress slowly over several weeks. Here we present a 6-month-old boy with tuberculous meningitis, whose main complaint was vomiting for several days before the onset of acute hydrocephalus.

  17. Meningitis bacteriana por Lactococcus lactis cremoris Bacterial meningitis caused by Lactococcus lactis cremoris

    Directory of Open Access Journals (Sweden)

    Danais Vidal Rosell

    2008-12-01

    Full Text Available INTRODUCCIÓN: Lactococcus lactis cremoris es una bacteria perteneciente a la familia Streptococcaceae que normalmente puede aislarse como parte de la microbiota transitoria o residente del tracto gastrointestinal en el ser humano. Se considera esencial en la industria alimenticia donde se emplea en la fermentación de la leche para la obtención de productos derivados como el queso, yogur, mantequilla, entre otros. OBJETIVOS: este caso constituye el primer reporte de un paciente adulto sin evidencias anteriores de inmunodepresión con una meningitis bacteriana por L. lactis. MÉTODOS: se estudió la evolución del caso de una paciente de 73 años de edad, que llegó al cuerpo de guardia del hospital con un cuadro clínico sobreagudo dado por trastornos de la conducta como irritabilidad con inmediata evolución a estado de obnubilación y desorientación. Se realizó el diagnóstico microbiológico utilizando las técnicas convencionales de identificación y los estudios de sensibilidad antimicrobiana. RESULTADOS: se diagnosticó una meningitis bacteriana por L. lactis, bacteria asociada a procesos infecciosos fundamentalmente en pacientes pediátricos e inmunodeprimidos. CONCLUSIONES: el modo de transmisión de la infección es indirecto por vía oral. No se determinó el foco primario de infección a partir del cual se produjo la diseminación dentro del organismo, la cual se considera fue por vía hematógena según la localización anatómica de los sitios donde se encontraron signos de sepsis. En los datos referidos en la historia clínica de la paciente no se encontró ningún antecedente de compromiso de su inmunidad antes del cuadro clínico que motivó el ingreso.BACKGROUND: Lactococcus lactis cremoris is a bacteria from Streptococcaceae family that may usually be isolated as part of transient or residing microbiota in the human gastrointestinal tract. It is considered essential element in the food industry where it is used as milk fermenter to obtain byproducts such as cheese, yoghurt, butter and others. OBJECTIVES: this is the first report of an adult patient with bacterial meningitis by L. lactis, without a previous history of immunosuppresion. METHODS: the evolution of a 73 years-old female patient, who came to the Emergency Department with a very acute clinical picture of behavioural disorders like irritability, immediately evolving into obnulation condition and lack of proper orientation. The conventional identification techniques together with the antimicrobial sensitivity studies allowed making the microbiological diagnosis. RESULTS: bacterial meningitis caused by L. lactis was diagnosed. This bacterium is linked to infectious processes mainly in pediatric and inmmunosuppresed patients. CONCLUSIONS: the mode of transmission is indirect and orally. The primary focus of infection from which the virus disseminated inside the body was not found. It was considered then that it occurred according to the anatomical location of the sites where sepsis signs were found. According to the data provided by the patient´s medical history, not a single antecedent of compromised immunity was found before appearing the above-mentioned clinical picture.

  18. Meningitis bacteriana por Lactococcus lactis cremoris / Bacterial meningitis caused by Lactococcus lactis cremoris

    Scientific Electronic Library Online (English)

    Danais, Vidal Rosell; María de los Ángeles, Fernández Ferrer; Carlos, Alfonso Sabatier.

    2008-12-01

    Full Text Available INTRODUCCIÓN: Lactococcus lactis cremoris es una bacteria perteneciente a la familia Streptococcaceae que normalmente puede aislarse como parte de la microbiota transitoria o residente del tracto gastrointestinal en el ser humano. Se considera esencial en la industria alimenticia donde se emplea en [...] la fermentación de la leche para la obtención de productos derivados como el queso, yogur, mantequilla, entre otros. OBJETIVOS: este caso constituye el primer reporte de un paciente adulto sin evidencias anteriores de inmunodepresión con una meningitis bacteriana por L. lactis. MÉTODOS: se estudió la evolución del caso de una paciente de 73 años de edad, que llegó al cuerpo de guardia del hospital con un cuadro clínico sobreagudo dado por trastornos de la conducta como irritabilidad con inmediata evolución a estado de obnubilación y desorientación. Se realizó el diagnóstico microbiológico utilizando las técnicas convencionales de identificación y los estudios de sensibilidad antimicrobiana. RESULTADOS: se diagnosticó una meningitis bacteriana por L. lactis, bacteria asociada a procesos infecciosos fundamentalmente en pacientes pediátricos e inmunodeprimidos. CONCLUSIONES: el modo de transmisión de la infección es indirecto por vía oral. No se determinó el foco primario de infección a partir del cual se produjo la diseminación dentro del organismo, la cual se considera fue por vía hematógena según la localización anatómica de los sitios donde se encontraron signos de sepsis. En los datos referidos en la historia clínica de la paciente no se encontró ningún antecedente de compromiso de su inmunidad antes del cuadro clínico que motivó el ingreso. Abstract in english BACKGROUND: Lactococcus lactis cremoris is a bacteria from Streptococcaceae family that may usually be isolated as part of transient or residing microbiota in the human gastrointestinal tract. It is considered essential element in the food industry where it is used as milk fermenter to obtain byprod [...] ucts such as cheese, yoghurt, butter and others. OBJECTIVES: this is the first report of an adult patient with bacterial meningitis by L. lactis, without a previous history of immunosuppresion. METHODS: the evolution of a 73 years-old female patient, who came to the Emergency Department with a very acute clinical picture of behavioural disorders like irritability, immediately evolving into obnulation condition and lack of proper orientation. The conventional identification techniques together with the antimicrobial sensitivity studies allowed making the microbiological diagnosis. RESULTS: bacterial meningitis caused by L. lactis was diagnosed. This bacterium is linked to infectious processes mainly in pediatric and inmmunosuppresed patients. CONCLUSIONS: the mode of transmission is indirect and orally. The primary focus of infection from which the virus disseminated inside the body was not found. It was considered then that it occurred according to the anatomical location of the sites where sepsis signs were found. According to the data provided by the patient´s medical history, not a single antecedent of compromised immunity was found before appearing the above-mentioned clinical picture.

  19. Carga de enfermedad por meningitis bacteriana, Cuba 2006 / Burden of disease due to bacterial meningitis, Cuba 2006

    Scientific Electronic Library Online (English)

    Antonio E, Pérez Rodríguez; Lorenzo, de la Fuente Ricardo; Armando, Seuc Jo.

    2011-12-01

    Full Text Available Introducción: la meningitis bacteriana constituye una preocupación para los médicos y los sistemas de salud en general de cualquier país, así como para los organismos internacionales. Objetivo: estimar las cargas por morbilidad y mortalidad por meningitis bacteriana en Cuba para 2006. Métodos: se ut [...] ilizaron los datos de mortalidad y de incidencia de la encuesta epidemiológica de la Vigilancia Nacional de Meningitis Bacteriana del Instituto de Medicina Tropical "Pedro Kourí". Los procedimientos de estimación se basaron en las recomendaciones de la Organización Mundial de la Salud con el uso del DISMOD y las hojas de cálculos establecidas al efecto. Resultados: la carga global de meningitis bacteriana se estimó en 3527,26 años de vida ajustados por discapacidad (AVAD), lo que representó la pérdida de 31,3 años por cada 100 000 habitantes. La carga por morbilidad y mortalidad de meningitis bacteriana sin ponderar la secuela resultó 2056,25 años de vida ajustados por discapacidad, 55,9 % correspondió sin agente etiológico identificado, seguida de las originadas por Streptococcus pneumoniae (30,9 %), Neisseria meningitidis (9,5 %) y por Haemophilus influenzae tipo b (3,6 %). La carga por mortalidad fue aproximadamente 2 039 años de vida perdidos (AVP) por muerte prematura, o sea 57,8 %. Los menores de 5 años aportaron la mayor carga global de años de vida ajustados por discapacidad y dentro de ellos S. pneumoniae el que generó la mayor carga. Conclusión: la carga por meningitis bacteriana resultó elevada y corroboró su alta utilidad para evaluar los problemas de salud. Abstract in english Introduction: bacterial meningitis is a real concern for physicians and general health systems of any country as well as the international bodies. Objective: to estimate burdens of disease from morbidity and mortality caused by bacterial meningitis in Cuba during 2006. Methods: the mortality and the [...] incidence data of the epidemiological survey from the National Surveillance of Bacterial Meningitis of "Pedro Kourí" Institute of Tropical Medicine were used. The estimation methods were based on the WHO recommendations by using the DISMOD and the required Excel spreadsheets. Results: the global burden of bacterial meningitis was estimated at a total of 3527.26 Disability Adjusted Lost Years (DALYs), which accounted for 31.3 years lost per 100 000 inhabitants. Morbidity and mortality burden of bacterial meningitis without sequel weighing was 2056.25 disability adjusted lost years, being the 55.9 % caused by unidentified agent, followed by S. pneumoniae (30.9 %), N. meningitidis (9.5 %) and H influenza type b (3.6 %). The mortality burden was 2 039 years of life lost from premature death, that is, 57.8 % of the global burden. Children under five years of age contributed the biggest global burden of disability adjusted lost years, and S. penumoniae generated the biggest burden. Conclusion: the burden of bacterial meningitis was high. Burden of disease is an important measure to assess health problems.

  20. Using Relative Humidity Forecasts to Manage Meningitis in the Sahel

    Science.gov (United States)

    Pandya, R. E.; Adams-Forgor, A.; Akweogno, P.; Awine, T.; Dalaba, M.; Dukic, V.; Dumont, A.; Hayden, M.; Hodgson, A.; Hopson, T. M.; Hugonnet, S.; Yoksas, T. C.

    2012-12-01

    Meningitis epidemics in the Sahel occur quasi-regularly and with devastating impact. In 2008, for example, eighty-eight thousand people contracted meningitis and over five thousand died. Until very recently, the protection provided by the only available vaccine was so limited and short-lived that the only practical strategy for vaccination was reactive: waiting until an epidemic occurred in the region and then vaccinating in that region to prevent the epidemic's further growth. Even with that strategy, there were still times when demand outpaced available vaccine. While a new vaccine has recently been developed that is effective and inexpensive enough to be used more broadly and proactively, it is only effective against the strain of bacteria that causes the most common kind of bacterial meningitis. As a result, there will likely be continued need for reactive vaccination strategies. It is widely known that meningitis epidemics in the Sahel occur only in the dry season. Our project investigated this relationship, and several independent lines of evidence demonstrate a robust relationship between the onset of the rainy season, as marked by weekly average relative humidity above 40%, and the end of meningitis epidemics. These lines of evidence include statistical analysis of two years of weekly meningitis and weather data across the Sahel, cross-correlation of ten years of meningitis and weather data in the Upper East region of northern Ghana, and high-resolution weather simulations of past meningitis seasons to interpolate available weather data. We also adapted two techniques that have been successfully used in public health studies: generalized additive models, which have been used to relate air quality and health, and a linearized version of the compartmental epidemics model that has been used to understand MRSA. Based on these multiple lines of evidence, average weekly relative humidity forecast two weeks in advance appears consistently and strongly related to the number cases of meningitis in the Sahel. Using currently available forecast models contributed through the WMO Thorpex-Tigge project, and applying quantile regression to enhance their accuracy, we can forecast the average weekly relative humidity to two weeks in advance which allows us to anticipate the end of an epidemic in a region of the Sahel up to four weeks in advance. This would allow public health officials to deploy vaccines to areas in which the epidemics are likely to persist due to continued dryness and avoid vaccinating in areas where the epidemics will end with higher humidity. Our presentation will conclude by introducing the relative humidity decision-information tool developed for use by public-health officials. We will also summarize the results of a weekly meningitis forecast exercise held during the 2011-2012 dry season with public health decision makers from several African countries and the World Health Organization. Finally, we highlight some results of concurrent socio-economic research that suggests other interventions for managing meningitis and helps quantify the economic impact of the disease in Ghana. Overall, while our research has demonstrated an actionable relationship between weather and disease, this relationship is only one factor in a complex and coupled human-natural system which merits continued investigation.

  1. Long-term neuropsychiatric consequences of aseptic meningitis in adult patients

    DEFF Research Database (Denmark)

    Damsgaard Gunst, Jesper; Hjerrild, Simon

    2015-01-01

    Aseptic meningitis is considered a benign and self-limiting clinical condition. In contrast to viral encephalitis and bacterial meningitis, the prognosis is usually good. The existing literature is scarce on the potential long-term neuropsychiatric consequences of aseptic meningitis. Previous studies have primarily been retrospective and differences in methodologies make it difficult to draw conclusions regarding the prevalence and nature of neuropsychiatric manifestations. However, studies have reported decreased psychomotor speed and impaired executive and visuo-constructive functions following aseptic meningitis. Larger controlled prospective studies are urgently needed to elucidate the neuropsychiatric complications of aseptic meningitis.

  2. Características clínicas y epidemiológicas de la meningitis aséptica en recién nacidos / Clinical and epidemiological features of aseptic meningitis in newborns

    Scientific Electronic Library Online (English)

    Manuel, Díaz Álvarez; Teresa, Medina González; Adilén, Sánchez Jiménez; Libertad, Rivera Alés; Orlando, Rodríguez Castillo.

    2012-03-01

    Full Text Available Objetivo: exponer las características clínicas y epidemiológicas de la meningitis aséptica, probablemente enteroviral, en recién nacidos atendidos en nuestro servicio de neonatología. Métodos: estudio retrospectivo de 291 pacientes recién nacidos ingresados en el servicio de neonatología del Hospita [...] l Pediátrico Universitario "Juan M. Márquez", entre los años 1992-2009, con el diagnóstico de meningitis aséptica. La información se obtuvo de una base de datos creada para una investigación sobre meningitis neonatal. Se analizaron diversas variables clínicas y epidemiológicas de presentación de esta enfermedad. Resultados: ocurrieron picos de incremento de la incidencia de la meningitis aséptica, con una tendencia estadísticamente significativa a disminuir en el transcurso de los 18 años (p= 0,00027). La frecuencia de presentación mostró una agrupación de casos hacia los meses de junio a noviembre. La fiebre estuvo presente en todos los pacientes, seguida por la irritabilidad y la presencia de diversas manifestaciones del aparato respiratorio. La apariencia de niño enfermo y las convulsiones fueron manifestaciones poco frecuentes. Exceptuando la pleocitosis, los indicadores convencionales en el líquido cefalorraquídeo y la relación glucosa líquido cefalorraquídeo/sangre tuvieron una mediana dentro de los límites normales para el período neonatal, sin embargo, los rangos fueron amplios. Hubo pacientes con pleocitosis importante, otros con predominio de los polimorfonucleares en una proporción mayor del 50 % y también con relación glucosa líquido cefalorraquídeo/sangre baja. La evolución clínica de todos los pacientes fue favorable sin secuelas neurológicas inmediatas aparentes. Conclusiones: los episodios de meningitis aséptica ocurridos siguen un patrón característico de las infecciones enterovirales con agrupación de casos estacional y picos epidémicos periódicos. La expresión clínica de la infección y los resultados en los exámenes de biometría hemática y del examen citoquímico del líquido cefalorraquídeo, aunque característicos de una infección de esta índole, tienen amplia variabilidad, pues puede haber pacientes que presenten hallazgos que se asemejan a los observados en pacientes con meningitis bacteriana, lo cual puede crear incertidumbre clínica al médico que evalúa el paciente. Abstract in english Objective: to show the clinical and epidemiological features of the aseptic meningitis, potentially by enterovirus in newborns seen in our service of Neonatology. Methods: a retrospective study was conducted in 291 neonatal patients admitted in the Neonatology service of the "Juan Manuel Márquez" Ch [...] ildren Hospital from 1992 to 2009, diagnosed with aseptic meningitis. Information was collected from a database created for a research on neonatal meningitis. Different clinical and epidemiological variables of presentation of this disease were analyzed. Results: there were peaks of increase in the incidence of the aseptic meningitis with a statistically significant trend to decrease within the 18 years old (p= 0.00027). The frequency of presentation showed a grouping of cases towards June to November. The fever was present in all patients, followed by irritability and presence of different manifestations of respiratory tract. The appearance of the sick child and the convulsions were no more frequent manifestations. Excepting for the pleocytosis, the conventional indicators in the cerebrospinal fluid/blood had a mean within the normal limits for the neonatal period, however, the ranks were wide. There were patients presenting with a significant pleocytosis, other with predominance of polimorphonuclear ones in a ratio higher than 50 % and also a low relation of glucose-cerebrospinal fluid/blood. The natural history of all patients was favorable without neurological immediate obvious sequelae. Conclusions: the episodes of aseptic meningitis occurred have a pattern characteristic of the enterovirus infections with seasonal grouping of ca

  3. Tuberkuløs meningitis med svær hyponatriæmi på grund af cerebralt salttab

    DEFF Research Database (Denmark)

    Tinggaard, Jeanette; Schmidt, Ida Maria

    2011-01-01

    We describe two children, who were admitted with severe hyponatraemia and dehydration. In both children the hyponatraemia was due to cerebral salt wasting caused by tubercular meningitis. Differential diagnosis and pathophysiology is discussed. It is important to discriminate between cerebral salt wasting and inappropriate secretion of antidiuretic hormone since the therapy required is completely different in the two conditions.

  4. Diffusion-weighted imaging in acute bacterial meningitis in infancy

    International Nuclear Information System (INIS)

    Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2-5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas. (orig.)

  5. Diffusion-weighted imaging in acute bacterial meningitis in infancy

    Energy Technology Data Exchange (ETDEWEB)

    Jan, W.; Zimmerman, R.A.; Bilaniuk, L.T.; Hunter, J.V.; Simon, E.M.; Haselgrove, J. [Department of Radiology, Children' s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, PA 19104, Philadelphia (United States)

    2003-09-01

    Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2-5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas. (orig.)

  6. Prognostic indicators in bacterial meningitis: a case-control study

    Scientific Electronic Library Online (English)

    Maria de Fátima Magalhães Acioly, Mendizabal; Phelipe Cunha, Bezerra; Diego Lins, Guedes; Diogo Buarque Cordeiro, Cabral; Demócrito de Barros, Miranda-Filho.

    2013-10-01

    Full Text Available This was a case-control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, [...] laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p = 0.006), evidence of shock (p = 0.051), evidence of altered mental state (p = 0.000), absence of headache (p = 0.008), absence of vomiting (p = 0.052), and age >40 years old (p = 0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p = 0.073) and thrombocytopenia (p = 0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.

  7. Meningitis due to aeromonas hydrophila

    OpenAIRE

    Seetha K; Jose B; Jasthi A

    2004-01-01

    A 3-month-old male child with the history of fever, of not sucking the breast and exhibitingsymptoms of meningitis was brought to the hospital for medical advice and was investigated. Aeromonas hydrophila was isolated thrice from CSF, blood samples as well as the water source.

  8. Culture- and antigen-negative meningitis in Guatemalan children / Meningitis negativa a pruebas antigénicas y de cultivo en niños guatemaltecos

    Scientific Electronic Library Online (English)

    Erica L., Dueger; Edwin J., Asturias; Neal A., Halsey.

    2008-10-01

    Full Text Available OBJETIVO: Comparar los casos infantiles de meningitis bacteriana confirmada (MBC) y meningitis negativa a pruebas de látex y de cultivo (MNLC). MÉTODOS: Se evaluaron los niños de 1 a 59 meses de edad ingresados en tres grandes hospitales de referencia de la Ciudad de Guatemala entre el 1 de octubre [...] de 1996 y el 31 de diciembre de 2005 con signos clínicos de infección bacteriana. Se realizaron cultivos bacterianos y pruebas de aglutinación antigénica con látex en muestras de líquido cefalorraquídeo (LCR). RESULTADOS: La tasa de letalidad fue significativamente mayor en los 493 niños con MBC que en los 528 niños con MNLC (27,6% y 14,9%, respectivamente; P Abstract in english OBJECTIVE: To compare children with confirmed bacterial meningitis (CBM) and those with culture- and latex-negative meningitis (CLN). METHODS: Children 1 to 59 months of age admitted to three major referral hospitals in Guatemala City with clinical signs compatible with bacterial infections were eva [...] luated prospectively between 1 October 1996 and 31 December 2005. Bacterial cultures and latex agglutination antigen testing were performed on samples of cerebrospinal fluid (CSF). RESULTS: The case-fatality rate was significantly higher in the 493 children with CBM than in the 528 children with CLN (27.6% and 14.9%, respectively; P

  9. Recurrent meningitis in the adult: a diagnostic and therapeutic challenge Meningitis recurrente en el adulto: un reto diagnóstico y terapéutico

    Directory of Open Access Journals (Sweden)

    Mónica Zuluaga Quintero

    2010-02-01

    Full Text Available

    Recurrent meningitis is an uncommon condition with the capability of causing important midand long-term sequelae. Its clinical presentation depends on the etiologic agent, although most patients exhibit at least one of the classical symptoms of acute meningitis (intense headache, fever and neck stiffness. Due to the clinical variability of the disease, a high level of suspicion and an adequate use of laboratory tests are required in order to establish a timely diagnosis. This article contains a literature review regarding epidemiology, etiology, clinical presentation, diagnosis and management of recurrent meningitis.

    La meningitis recurrente no es una entidad común pero tiene el potencial de generar secuelas importantes a mediano y largo plazo. Su cuadro clínico depende del agente causal aunque en la mayoría de los pacientes se conserva al menos uno de los síntomas clásicos de la meningitis aguda (cefalea intensa, fiebre y rigidez de nuca. Debido a su variabilidad clínica se requieren un alto nivel de sospecha y usar bien las pruebas de laboratorio para llegar oportunamente al diagnóstico. El presente artículo contiene una revisión de la literatura sobre la epidemiología, la etiología, el cuadro clínico, el diagnóstico y el tratamiento de esta enfermedad.

  10. Arterial embolism

    Science.gov (United States)

    ... There may be signs of tissue death or gangrene. Tests to diagnose arterial embolism or reveal the ... or permanent kidney failure Tissue death ( necrosis ) and gangrene Transient ischemic attack (TIA)

  11. Sequelae due to bacterial meningitis among African children: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Moïsi Jennifer C

    2009-09-01

    Full Text Available Abstract Background African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent. Methods We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures and mortality, by pathogen. Results A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequelae (median = 18%, interquartile range (IQR = 13% to 27%. About a quarter of children surviving pneumococcal meningitis and Haemophilus influenzae type b (Hib meningitis had neuropsychological sequelae by the time of hospital discharge, a risk higher than in meningococcal meningitis cases (median = 7%. The highest in-hospital case fatality ratios observed were for pneumococcal meningitis (median = 35% and Hib meningitis (median = 25% compared to meningococcal meningitis (median = 4%. The 10 post-discharge studies of children surviving bacterial meningitis were of varying quality. In these studies, 10% of children followed-up post discharge died (range = 0% to 18% and a quarter of survivors had neuropsychological sequelae (range = 3% to 47% during an average follow-up period of 3 to 60 months. Conclusion Bacterial meningitis in Africa is associated with high mortality and risk of neuropsychological sequelae. Pneumococcal and Hib meningitis kill approximately one third of affected children and cause clinically evident sequelae in a quarter of survivors prior to hospital discharge. The three leading causes of bacterial meningitis are vaccine preventable, and routine use of conjugate vaccines could provide substantial health and economic benefits through the prevention of childhood meningitis cases, deaths and disability.

  12. Tuberculoma and Meningitis in a Young Girl: A Case Report

    Directory of Open Access Journals (Sweden)

    Behroz Ahssan

    2012-01-01

    Full Text Available Problem statement: Because of difficulty in early diagnosis and severe consequences of delay in diagnosis and treatment, tuberculosis meningitis is a serious problem for clinicians. Therefore recognizing rare cases of tuberculosis can improve clinician practice and save the patient's life in countries with a high burden of disease. An 18-year-old girl suffered from fever, headache, illness, arthralgia, myalgia, constipation and weight loss for several weeks. On clinical exam, lethargy, Strabismus, neck stiffness, papilledema, bilateral cranial nerve VI palsy and left facial nerve palsy were observed. Pleocytosis in CSF and multiple small nodular enhancements was detected within the cerebellum. The anti-tuberculosis plus corticosteroid were prescribed. Conclusion/Recommendations: In TB high burden regions such as Iran and Middle East, clinical diagnosis is an important tool for making decisions about such cases. Though using corticosteroids in tuberculosis meningitis are still controversial, we recommend it strongly.

  13. Meningite neofatal: aspectos associados / Neonatal meningitis: related features

    Scientific Electronic Library Online (English)

    Diogo C., Haussen; Lívia N., Brandalise; Fabiane A., Praetzel; André S., Malysz; Renate, Mohrdieck; Marco A.F., Reichelt; Célia B., Magalhães; Sérgio P., Grossi; Ana, Guardiola.

    2005-09-01

    Full Text Available INTRODUÇÃO: O objetivo deste estudo foi identificar e analisar fatores relacionados à meningite neonatal. MÉTODO: Em estudo de caso-controle, foram examinados neonatos com meningite no período de agosto/2002 a dezembro/2003 na Unidade de Tratamento Intensivo Neonatal (UTIN) e alocados recém-nascidos [...] hígidos como grupo controle (GC). Foram relatados dados referentes à gestação, ao parto e ao neonato. Os resultados foram considerados significativos quando p (alfa) Abstract in english OBJECTIVE: The goal of this study was to identify and to analyze the features related to the occurrence of neonatal meningitis. METHOD: In a case-control study we examined all newborns presenting meningitis between August/2002 and December/2003 in the neonatal Intensive Care Unit. Healthy newborns w [...] ere enrolled as a Control Group (CG). Data related to pregnancy, labor and the neonate itself were collected. The results with p

  14. Pasteurella multocida bacterial meningitis caused by contact with pigs

    Scientific Electronic Library Online (English)

    C., López; P., Sanchez-Rubio; A., Betrán; R., Terré.

    Full Text Available Pasteurella multocida belongs to the normal flora of the respiratory and digestive tract of many animals. Animal exposure is a considerable risk factor for Pasteurella infection. P. multocida is the most common cause of local infection after an animal bite but is an unusual cause of meningitis. We p [...] resent a case of bacterial meningitis by P. multocida in a 37-year-old man who worked in a pig farm and was bitten by a pig. The patient had a defect located in the lamina cribosa and this lesion could be the gateway of the infection, although in this case the infection could also be acquired through the pig bite. The bacteria was identified as P. multocida with the biochemical test API 20E (bioMérieux). In agreement with findings in the literature, the strain was susceptible in vitro to penicillin, ampicillin, cefotaxime, ceftriaxone ciprofloxacin, levofloxacin, imipenem and tetracycline.

  15. An unusual case of neonatal meningococcal meningitis complicated by subdural empyema and hydrocephalus

    Scientific Electronic Library Online (English)

    Y, Ramsamy; P, Mahabeer; M, Archary; R A, Bobat; Y M, Coovadia.

    2013-01-01

    Full Text Available Neisseria meningitidis is a leading cause of pyogenic meningitis worldwide, as well as causing large epidemics in parts of Africa. With the dramatic decline in cases of Haemophilus influenzae B, N. meningitidis has emerged as one of the most common causes of acute bacterial meningitis in children an [...] d adults in South Africa. However, it remains an uncommon cause of meningitis in the neonatal period. Subdural empyema together with hydrocephalus has been infrequently described as a complication of meningococcal meningitis. We report a rare case of neonatal meningococcal meningitis, complicated by subdural empyema and hydrocephalus. To the best of our knowledge only a few cases of neonatal meningococcal meningitis have been reported from South Africa, with none of these cases having the complication of subdural empyema.

  16. Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC study of aseptic meningitis

    Directory of Open Access Journals (Sweden)

    Robinson Joan L

    2006-04-01

    Full Text Available Abstract Background The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition. Methods A retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period. Results There were 233 cases of proven enteroviral (EV meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children ? 5 years of age, while rash, diarrhea and cough were more common in children Conclusion The clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants

  17. Meningeal hemangiopericytoma treated with surgery and radiation therapy -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong [College of Medicine, Chosun University, Gwangju (Korea, Republic of)

    2006-06-15

    Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2 x 2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis.

  18. Successful treatment of multidrug resistant Acinetobacter baumannii meningitis

    OpenAIRE

    Acinetobacter Baumannii, Post-surgical Meningitis

    2007-01-01

    Background: Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly.Cases: We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy.Conclusions: Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the tre...

  19. Meningeal hemangiopericytoma treated with surgery and radiation therapy -case report-

    International Nuclear Information System (INIS)

    Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2 x 2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractionnce with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis

  20. Acinetobacter meningitis: acquired infection in a neonatal intensive care unit.

    OpenAIRE

    Morgan, M. E.; Hart, C. A.

    1982-01-01

    A cluster of 4 cases of meningitis due to Acinetobacter calcoaceticus var anitratus occurred during a 5-day period in a neonatal intensive care unit. Three of the infants were preterm and all had a history of other medical problems. Initiation of intravenous therapy with carbenicillin was accompanied by clinical recovery and a bacteriological cure. Intensive bacteriological investigation failed to show a common source for the infections.

  1. Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma

    International Nuclear Information System (INIS)

    Hemangiopericytoma is a rare tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved. (orig.)

  2. Molecular Detection of Common Bacterial Pathogens Causing Meningitis

    Directory of Open Access Journals (Sweden)

    H Sadighian

    2009-03-01

    Full Text Available "nBackground: The clinical diagnosis of meningitis is crucial, particularly in children. The early diagnosis and empiric an­tibi­otic treatments have led to a reduction in morbidity and mortality rates. PCR and the enzymatic digestion of 16SrDNA frag­ment which is produced by universal primers led up fast and sensitive determination. The purpose of this study was to investi­gate a rapid method for detection of common bacterial pathogens causing meningitis."nMethods: According to the gene encoding 16SrDNA found in all bacteria, a pair of primers was designed. Then the univer­sal PCR was performed for bacterial agents of meningitis (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influ­enzae, etc. by employing broad- range DNA extraction method. The ob­tained uni­versal PCR products were digested with restriction enzymes (HaeIII, AluI and MnlI to identify bacterial species. "nResults: By the enzymatic digestion of the universal products of each standard strain of the above bacteria, specific patterns were achieved. These specific patterns may be used for comparison in CSF examination. The analytical sensitivity of the as­say was approximately 1.5´102 CFU/ml of CSF even in samples with high amount of proteins. Conclusion: The universal PCR coupled with enzymatic digestion can be used to detect and identify bacterial pathogens in clini­cal specimens rapidly and accurately. Molecular diagnostic of bacterial meningitis, though expensive and labor-inten­sive, but is valuable and critical in patient management.

  3. Bacterial meningitis as a first presentation of pituitary macroprolactinoma

    OpenAIRE

    Margari, Niki; Page, Simon

    2014-01-01

    A 56-year-old man was brought to the Emergency Department after being found collapsed at his office with a reduced level of consciousness. From clinical examination and initial investigations, he was diagnosed as having bacterial meningitis and was promptly commenced on empirical i.v. antibiotics. Computed tomography of the brain revealed a parenchymal mass at the base of the skull and subsequent magnetic resonance imaging of the head 4 days later confirmed a large soft tissue mass, which ext...

  4. Probable acute disseminated encephalomyelitis due to Haemophilus influenzae meningitis

    OpenAIRE

    Beleza, P; Ribeiro, M.; Pereira, J; Jordão, MJ; F. Almeida

    2008-01-01

    We report the case of a 17-year-old male on long-term steroid therapy for minimal lesion glomerulopathy who, after an upper respiratory infection, presented with Haemophilus influenzae type b meningitis. Twenty-four hours later he developed depression of consciousness which progressed to coma and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple lesions (hyperintense on T2 and slightly hypointense on Tl) involving mainly white matter suggestive of inflammation. MRI fe...

  5. Gene expression in cortex and hippocampus during acute pneumococcal meningitis

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    Wittwer Matthias

    2006-06-01

    Full Text Available Abstract Background Pneumococcal meningitis is associated with high mortality (~30% and morbidity. Up to 50% of survivors are affected by neurological sequelae due to a wide spectrum of brain injury mainly affecting the cortex and hippocampus. Despite this significant disease burden, the genetic program that regulates the host response leading to brain damage as a consequence of bacterial meningitis is largely unknown. We used an infant rat model of pneumococcal meningitis to assess gene expression profiles in cortex and hippocampus at 22 and 44 hours after infection and in controls at 22 h after mock-infection with saline. To analyze the biological significance of the data generated by Affymetrix DNA microarrays, a bioinformatics pipeline was used combining (i a literature-profiling algorithm to cluster genes based on the vocabulary of abstracts indexed in MEDLINE (NCBI and (ii the self-organizing map (SOM, a clustering technique based on covariance in gene expression kinetics. Results Among 598 genes differentially regulated (change factor ? 1.5; p ? 0.05, 77% were automatically assigned to one of 11 functional groups with 94% accuracy. SOM disclosed six patterns of expression kinetics. Genes associated with growth control/neuroplasticity, signal transduction, cell death/survival, cytoskeleton, and immunity were generally upregulated. In contrast, genes related to neurotransmission and lipid metabolism were transiently downregulated on the whole. The majority of the genes associated with ionic homeostasis, neurotransmission, signal transduction and lipid metabolism were differentially regulated specifically in the hippocampus. Of the cell death/survival genes found to be continuously upregulated only in hippocampus, the majority are pro-apoptotic, while those continuously upregulated only in cortex are anti-apoptotic. Conclusion Temporal and spatial analysis of gene expression in experimental pneumococcal meningitis identified potential targets for therapy.

  6. Role of Oxidative Stress in the Pathophysiology of Pneumococcal Meningitis

    OpenAIRE

    Barichello, Tatiana; Generoso, Jaqueline S.; Simo?es, Lutiana R.; Elias, Samuel G.; Quevedo, Joa?o

    2013-01-01

    Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting the pia mater, the arachnoid, and the subarachnoid spaces. Streptococcus pneumoniae crosses the blood-brain barrier (BBB) by both transcellular traversal and disruption of the intraepithelial tight junctions to allow intercellular traversal. During multiplication, pneumococci release their bacterial products, which are highly immunogenic and may lead to an increased inflammatory respon...

  7. Priority during a meningitis epidemic: vaccination or treatment?

    OpenAIRE

    Veeken, H.; Ritmeijer, K.; Hausman, B.

    1998-01-01

    From November 1995 to May 1996, a meningitis epidemic occurred in northern Nigeria. More than 75,000 cases and 8440 deaths (case fatality rate (CFR), 11%) were recorded. Médecins sans Frontières, in cooperation with the Nigerian government, carried out an assistance programme (support to case management, surveillance and mass vaccination) in three states (Bauchi, Kano, Katsina) where 75% of cases occurred. Cost analysis of this assistance in Katsina State reveals that case management and ma...

  8. Progress towards meningitis prevention in the conjugate vaccines era

    Scientific Electronic Library Online (English)

    Cristina Aparecida Borges, Laval; Fabiana Cristina, Pimenta; João Guimarães de, Andrade; Soraya S., Andrade; Ana Lucia S. S. de, Andrade.

    2003-10-01

    Full Text Available Acute bacterial meningitis is an important cause of morbidity and mortality among children less than five years old. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis are the most important agents of bacterial meningitis in developing countries. The development of the conju [...] gate vaccines in the beginning of the 90's, especially type b H. influenzae (Hib), and more recently the heptavalent pneumococcal and the serogroup C meningococcal vaccines, have contributed directly to changes in the epidemiological profile of these invasive diseases (direct effect) and of their carriage status (indirect effect). We review the impact of the Hib conjugate vaccine in Latin American countries, where this vaccine has been implemented, and the potential of pneumococcal and meningococcal conjugate vaccines for the reduction of meningitis worldwide. We also address constraints for the development and delivery of these vaccines and review new candidate state-of-the-art vaccines. The greatest challenge, undoubtedly, is to implement these vaccines worldwide, especially in the developing regions.

  9. Antibiotic Therapy in Pyogenic Meningitis in Paediatric Patients

    International Nuclear Information System (INIS)

    Objective: To isolate and identify the causative pathogen, antibiotic sensitivity testing and success rate of empirical antibiotic therapy in pyogenic meningitis. Study Design: Analytical study. Place and Duration of Study: The Children's Hospital and Institute of Child Health, Lahore, Pakistan, from March to July 2012. Methodology: The study was performed on 72 culture positive meningitis cases in children less than 15 years of age. This therapy was evaluated by monitoring the patient's clinical picture for 14 - 21 days. The collected data was analyzed by Chi-square test. Results: Seventeen different bacteria were isolated. The most commonly occurring bacteria were coagulase negative Staphylococci (25%), E. coli (12.5%), Klebsiella pneumoniae (8.3%), Streptococcus pneumoniae (8.3%) and Pseudomonas aeruginosa (8.3%). All the bacteria were sensitive to vancomycin (96.7%), meropenem (76.7%), amikacin (75%), ciprofloxacin (65.3%), chloramphenicol (46.5%), ceftazidime (44.2%), cefepime (41.9%), co-amoxiclav (38.0%), oxacillin (34.8%), cefotaxime (21.4%), penicillin (20.7%), ceftriaxone (18.6%), cefuroxime (14%) and ampicillin (6.9%). The combination of sulbactam and cefoperazone showed antimicrobial sensitivity of 81.4%. The success rate of empirical antibiotic therapy was 91.7%. Conclusion: It was found that Gram negative bacteria were the major cause of pyogenic meningitis. Mostly there were resistant strains against all commonly used antibiotics except vancomycin. All empirical antibiotic therapies were found to be most successful. (author)

  10. Carcinomatous meningitis appearing as acoustic neuromas. Two cases

    Energy Technology Data Exchange (ETDEWEB)

    Astner, S.T.; Nieder, C.; Grosu, A.L. [Technical Univ. of Munich (Germany). Dept. of Radiation Oncology; Stock, K. [Technical Univ. of Munich (Germany). Dept. of Internal Medicine; Gaa, J. [Technical Univ. of Munich (Germany). Dept. of Radiology

    2007-05-15

    Background: For acoustic neuromas, stereotactic radiotherapy (radiosurgery or stereotactic fractionated radiotherapy) has been established as an important alternative to microsurgery. In most cases initial symptoms are slow progression of unilateral hearing loss, tinnitus or vertigo or acute hearing loss with vertigo. MRI scan shows a contrast-enhancing tumor within the inner auditory channel. If the patient undergoes primary radiotherapy, diagnosis is usually not verified histologically. Therefore, careful evaluation of the medical history is mandatory despite a typical appearance on the MRI scan. If medical history does not match with acoustic neuroma, further diagnostics are necessary to rule out infectious disease or carcinomatous meningitis. Case Report: Two patients with hearing loss, vertigo and the diagnosis of acoustic neuromas by MRI scan were referred for radiotherapy. In both cases the symptoms progressed very rapidly, not typical of acoustic neuromas, and in both patients repeated liquor puncture finally revealed carcinomatous meningitis. One patient died during therapy; in the second patient intrathecal chemotherapy and additional radiotherapy of the skull base led to partial remission continuing for several months. Conclusion: Before primary radiotherapy of small intrameatal lesions diagnosis must be reassessed carefully. This is especially true for bilateral lesions suspicious for acoustic neuromas and rapid progression and persistence of clinical symptoms where carcinomatous meningitis has to be taken into account. (orig.)

  11. Carcinomatous meningitis appearing as acoustic neuromas. Two cases

    International Nuclear Information System (INIS)

    Background: For acoustic neuromas, stereotactic radiotherapy (radiosurgery or stereotactic fractionated radiotherapy) has been established as an important alternative to microsurgery. In most cases initial symptoms are slow progression of unilateral hearing loss, tinnitus or vertigo or acute hearing loss with vertigo. MRI scan shows a contrast-enhancing tumor within the inner auditory channel. If the patient undergoes primary radiotherapy, diagnosis is usually not verified histologically. Therefore, careful evaluation of the medical history is mandatory despite a typical appearance on the MRI scan. If medical history does not match with acoustic neuroma, further diagnostics are necessary to rule out infectious disease or carcinomatous meningitis. Case Report: Two patients with hearing loss, vertigo and the diagnosis of acoustic neuromas by MRI scan were referred for radiotherapy. In both cases the symptoms progressed very rapidly, not typical of acoustic neuromas, and in both patients repeated liquor puncture finally revealed carcinomatous meningitis. One patient died during therapy; in the second patient intrathecal chemotherapy and additional radiotherapy of the skull base led to partial remission continuing for several months. Conclusion: Before primary radiotherapy of small intrameatal lesions diagnosis must be reassessed carefully. This is especially true for bilateral lesions suspicious for acoustic neuromas and rapid progression and persistence of clinical sympogression and persistence of clinical symptoms where carcinomatous meningitis has to be taken into account. (orig.)

  12. Laboratory surveillance of viral meningitis by examination of cerebrospinal fluid in Cape Town, 1981-9.

    OpenAIRE

    Mcintyre, J. P.; Keen, G. A.

    1993-01-01

    Nine years accumulated laboratory data derived from the culture of the cerebrospinal fluid of 11,360 aseptic meningitis cases were retrospectively reviewed to establish the epidemiology of viral meningitis in Cape Town. Virus was isolated from 3406 of the cases (91% enteroviruses and 9% mumps). Five major summer viral meningitis episodes were documented: two of echovirus 4 (706 and 445 cases), echovirus 9 (223), coxsackie A9 (104) and one of unidentified enterovirus (324 cases--probably echo ...

  13. Spontaneous gram-negative bacillary meningitis in adult patients : characteristics and outcome

    OpenAIRE

    Pomar, Virginia

    2013-01-01

    Background: Spontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens. Methods: Prospective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outc...

  14. Spinal meningeal melanocytoma with benign histology showing leptomeningeal spread: Case report

    International Nuclear Information System (INIS)

    Meningeal melanocytoma is a rare benign tumor with relatively good prognosis. However, local aggressive behavior of meningeal melanocytoma has been reported, especially in cases of incomplete surgical resection. Malignant transformation was raised as possible cause by prior reports to explain this phenomenon. We present an unusual case of meningeal melanocytoma associated with histologically benign leptomeningeal spread and its subsequent aggressive clinical course, and describe its radiological findings.

  15. Sequelae due to bacterial meningitis among African children: a systematic literature review

    OpenAIRE

    Moïsi Jennifer C; Steinhardt Laura C; Ulland Aaron J; Ramakrishnan Meenakshi; Were Fred; Levine Orin S

    2009-01-01

    Abstract Background African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent. Methods We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 ye...

  16. Bacterial meningitis following Pantopaque myelography. A case report and literature review.

    Science.gov (United States)

    Schelkun, S R; Wagner, K F; Blanks, J A; Reinert, C M

    1985-01-01

    A case of acute bacterial meningitis following Pantopaque myelography is reported, and the literature reviewed pertaining to this uncommon but potentially fatal complication. A positive Gram's stain is most helpful in differentiating bacterial from chemical meningitis. Treatment of the meningitis before and after determination of its cause is described. Preventive steps include removal of Pantopaque from the subarachnoid space immediately at the conclusion of fluoroscopy, and observance of strict sterile technique during myelography, including use of face masks. PMID:4094954

  17. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis.

    OpenAIRE

    Nhu, Nt; Heemskerk, D.; Thu, Dda; Chau, Tt; Mai, Nt; Nghia, Hd; Loc, Pp; Ha, Dt; Merson, L.; Thinh, Tt; Day, J.; Chau, N.; Wolbers, M.; Farrar, J; Caws, M.

    2014-01-01

    Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Microbiological confirmation is rare, and treatment is often delayed, increasing mortality and morbidity. The GeneXpert MTB/RIF test was evaluated in a large cohort of patients with suspected tuberculous meningitis. Three hundred seventy-nine patients presenting with suspected tuberculous meningitis to the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between 17 April 2011 and 31 December 2012 were included in ...

  18. Meningococcal Meningitis Control in Iran: Five Year Comparative Study 2000-2004

    OpenAIRE

    A Mehrabi Tavana; R A.Ataee

    2009-01-01

    The aim of this study was to compare the incidence and death rate of meningococcal meningitis among military and non military population in Iran from 2000 to 2004. All patients with clinical sign and symptoms of meningitis and para clinical findings were entered to the study from 21st March 2000 to 21st March 2004. Meningococcal meningitis was diagnosed on the basis isolation of the Neisseria meningitidis in culture. CSF samples were provided at admission before commencing antibiotic th...

  19. The contribution of MRI to the diagnosis of diffuse meningeal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Kreuzberg, B.; Kastner, J.; Ferda, J. [Department of Diagnostic Radiology, Faculty Hospital Pilsen, Alej Svobody 80, 30460, Pilsen (Czech Republic)

    2004-03-01

    We analysed MRI findings in patients in whom a diffuse abnormality of the meninges was revealed by MRI. We looked at T1 and T2-weighted spin-echo or fast spin-echo images and contrast-enhanced T1-weighted images. There were 15 patients with abnormalities on MRI, clinically suspected in ten. Four had meningoencephalitis, one meningeal and subcortical sarcoidosis nodules, four meningeal malignancies - one disseminated oligodendroglioma, one with meningeal infiltration around an adenocarcinoma, three meningeal infiltration by a haematological malignancy, and one a chronic subdural haematoma without a history of injury. We excluded patients with primary meningeal tumours and typical injury-related meningeal bleeding. The relatively small number of patients is due to both the infrequency of diffuse meningeal disease and to the low frequency of suspected meningeal pathology as an indication for MRI. The latter's diagnostic contribution is greatest in infectious disease and neoplastic infiltration, and less obvious in haematological malignancies. Contrast-enhanced T1-weighted images are most useful. (orig.)

  20. Pulmonary Arterial Hypertension (PAH)

    Science.gov (United States)

    ... the arteries of the lungs. Pulmonary arterial hypertension (PAH) is one form of pulmonary hypertension. Pulmonary arteries ... oxygen to be delivered throughout your body. In PAH, the pulmonary arteries constrict abnormally. This forces your ...

  1. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  2. Meningitis simultánea por candida y tuberculosis como debut de sida / Simultaneous meningitis caused by candida and tuberculosis as AIDS manifestation

    Scientific Electronic Library Online (English)

    M., Arias Gómez; I., Requena Caballero; C., Lema Devesa; J., Suárez Dono; J., Llovo Martínez; V., Martino.

    2001-09-01

    Full Text Available Las meningoencefalitis por gérmenes oportunistas ocupan un lugar importante dentro de la patología neurológica del sida. Treponema pallidum y Mycobacterium tuberculosis dentro de las baceterias, Crytptococcus neoformans dentro de los hongos, Toxoplasma gondii dentro de los protozoos y el Papovavirus [...] JC dentro de los virus, son los gérmenes más frecuentes dentro de cada grupo. Con cierta frecuencia las infecciones son mixtas, tal como ocurrió en el caso que se presenta de meningitis simultánea por Candida albicans y Mycobacterium tuberculosis, que cursó con pleocitosis neutrófila y normoglucorraquia, constituyendo la primera manifestación de un sida. El estudio secuencial del LCR es clave para el diagnóstico de estos casos, que, pese a su gravedad, pueden tener un tratamiento efectivo, tal como ocurrió en el que se describe. Es el primer caso descrito de meningitis simultánea candidiásica y tuberculosa en paciente portador de VIH. Abstract in english Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequentl [...] y implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.

  3. BURDEN OF BACTERIAL MENINGITIS: A RETROSPECTIVE REVIEW ON LABORATORY PARAMETERS AND FACTORS ASSOCIATED WITH DEATH IN MENINGITIS, KELANTAN MALAYSIA

    Science.gov (United States)

    BASRI, REHANA; ZUETER, ABDEL RAHMAN; MOHAMED, ZEEHAIDA; ALAM, MOHAMMAD KHURSHEED; NORSA’ADAH, BACHOK; HASAN, SITI ASMA; HASAN, HABSAH; AHMAD, FADZILAH

    2015-01-01

    ABSTRACT To describe the clinical characteristics and the risk factors associated with mortality in patients with meningitis. This is a retrospective review of patients diagnosed to have meningitis with positive culture of the cerebrospinal fluid (CSF) specimen. All cases aged 19 > years who were admitted to Hospital USM between January 2004 and December 2011 were included in the study. The CSF results database were obtained from the Department of Medical Microbiology and Parasitology, Hospital USM, Kelantan. A checklist was used to record the clinical characteristics. A total of 125 cases met the inclusion criteria. The age of patients ranged between newborn and 19 years old (Mean±SD, 74.5±80.6 months). The majority of them were males (65.6%). Fever was the most common presentation (73.6%) followed by poor oral intake (48.0%), seizure (36.0%) and headache (24.8%). The mortality rate was 31.2%. Coagulase negative staphylococcus was the most frequent pathogens isolated (21.6%), followed by Acinetobacter spp. (17.6%), Staphylococcus aureus (13.6%), Streptococcus spp. (11.2%) and Klebsiella pneumoniae (6.4%). There were significant association of in-hospital death with age (p=0.020) and conscious level (p=0.001). Infectious meningitis is a big health concern, especially among children. We found that coagulase negative staphylococcus, Acinetobacter species, S. aureus, Streptococcus spp and K. pneumoniae were prevalent in our hospital. These microorganisms were hospital associated pathogens. The 31% mortality linked to hospital acquired meningitis specifies the need for focused physician attention especially among younger aged patients. PMID:25797971

  4. Different ophthalmic artery origins: Embryology and clinical significance.

    Science.gov (United States)

    Louw, Louise

    2014-09-25

    This retrospective study gives a summary of ophthalmic artery (OA) variations to serve as guidelines for surgical interventionists and trainees. Pubmed and Medline searches were conducted. The OA usually arises intradurally (superomedial, anteromedial, or rarely superolateral) from the internal carotid artery (ICA). Rare extradural origin (primitive dorsal OA) (PDOA) remnant and extremely rare interdural origin (primitive ventral OA) (PVOA) remnant are of significance when sectioning the dural ring. Rarely, a persistent PDOA with ICA origin, or a PDOA remnant with inferolateral trunk origin, enters the orbit via the superior orbital fissure (SOF) for sole or partial orbital supply. Extremely rare, the PDOA and PVOA persist and form double OAs that arise from the ICA and run via the SOF and optic foramen. Occasionally, the OA arises from the middle meningeal artery (MMA), when both the PDOA and VDOA regress and enter the orbit via the SOF. Sole orbital supply via the external carotid artery (ECA), i.e. meningo-ophthalmic artery and/or MMA branches, or dual OAs (ECA and ICA origins) may occur. Other rare OA origins include anterior or posterior communicating artery; anterior or middle cerebral artery; basilar artery; posterior inferior cerebellar artery; and the carotid bifurcation. Primitive arteries (persistent or remnant), and/or abnormal anastomoses play pivotal roles in manifestations of OA variations. Of clinical importance are orbital collateral routes and dangerous extracranial-intracranial anastomoses. Awareness of OA origins and collateral routes is imperative for transarterial embolizations or infusion chemotherapy in the ECA territory to prevent visual complications. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc. PMID:25255996

  5. Meningitis due to Enterobacter aerogenes subsequent to resection of an acoustic neuroma and abdominal fat graft to the mastoid

    OpenAIRE

    Khan, Fida A.

    2004-01-01

    Meningitis is an uncommon complication of neurosurgical procedures, with an incidence of 1.1% to 2.5%. Although unusual, the frequency of nosocomial Gram-negative meningitis appears to be increasing. Gram-negative meningitis has been documented following disruption of the dura-arachnoid barrier secondary to trauma or surgery. The association of Gram-negative bacillary meningitis with neurosurgical procedures was first reported in the 1940's. Wolff et al. described the association between Ente...

  6. Sensitivity and specificity of enzyme-linked immunosorbent assay in the detection of antigen in tuberculous meningitis cerebrospinal fluids.

    OpenAIRE

    Kadival, G. V.; Mazarelo, T. B.; Chaparas, S. D.

    1986-01-01

    A sandwich enzyme-linked immunosorbent assay was developed for its potential utility in the detection of antigen in the cerebrospinal fluid of patients with tuberculous meningitis. Cerebrospinal fluids examined included those from untreated (group Ia) and treated (group Ib) Mycobacterium tuberculosis meningitis, nonseptic central nervous conditions (group II) such as epilepsy, viral meningitis, and tetany, and nonmycobacterial septic meningitis (group III). The average levels of antigens dete...

  7. Accessory splenic artery from left gastroepiploic artery

    Directory of Open Access Journals (Sweden)

    Padmalatha K

    2010-08-01

    Full Text Available Splenic artery is the largest branch of celiac axis and its course is among the most tortuous in the body. We describe a rare variation of accessory splenic artery originating from the left gastroepiploic artery. Knowledge of variations of splenic artery is essential to successfully accomplish surgical, oncologic or any interventional procedures.

  8. Increase in hippocampal water diffusion and volume during experimental pneumococcal meningitis is aggravated by bacteremia

    DEFF Research Database (Denmark)

    Holler, Jon G; Brandt, Christian T

    2014-01-01

    BACKGROUND: The hippocampus undergoes apoptosis in experimental pneumococcal meningitis leading to neurofunctional deficits in learning and memory function. The aim of the present study was 1) to investigate hippocampal apparent diffusion coefficient (ADC) and volume with MRI during the course of experimental pneumococcal meningitis, 2) to explore the influence of accompanying bacteremia on hippocampal water distribution and volume, 3) and to correlate these findings to the extent of apoptosis in the hippocampus. METHODS: Experimental meningitis in rats was induced by intracisternal injection of live pneumococci. The study comprised of four experimental groups. I. Uninfected controls (n?=?8); II. Meningitis (n?=?11); III. Meningitis with early onset bacteremia by additional i.v. injection of live pneumococci (n?=?10); IV. Meningitis with attenuated bacteremia by treatment with serotype-specific anti-pneumococcal antibodies (n?=?14). T2 and diffusion weighted MR images were used to analyze changes in hippocampus volume and water diffusion (ADC). The results were correlated to ADC of the cortex, to ventricular volume, and to the extent of hippocampal apoptosis. RESULTS: Both ADC and the volume of hippocampus were significantly increased in meningitis rats compared to uninfected controls (Kruskal-Wallis test, p?=?0.0001, Dunns Post Test, p??0.05). CONCLUSIONS: In experimental meningitis increase in volume and water diffusion of the hippocampus are significantly associated with accompanying bacteremia.

  9. Vaccine-induced waning of Haemophilus influenzae empyema and meningitis, Angola.

    Science.gov (United States)

    Peltola, Heikki; Pelkonen, Tuula; Bernardino, Luis; Monteiro, Lurdes; Silvestre, Silvia da Conceição; Anjos, Elizabete; Cruzeiro, Manuel Leite; Pitkäranta, Anne; Roine, Irmeli

    2014-11-01

    In Angola during 2003-2012, we detected Haemophilus influenzae in 18% of 2,634 and 26% of 2,996 bacteriologically positive pleural or cerebrospinal fluid samples, respectively, from children. After vaccination launch in 2006, H. influenzae empyema declined by 83% and meningitis by 86%. Severe H. influenzae pneumonia and meningitis are preventable by vaccination. PMID:25340259

  10. Vaccine-Induced Waning of Haemophilus influenzae Empyema and Meningitis, Angola

    OpenAIRE

    Peltola, Heikki; Pelkonen, Tuula; Bernardino, Luis; Monteiro, Lurdes; Silvestre, Silvia da Conceição; Anjos, Elizabete; Cruzeiro, Manuel Leite; Pitkäranta, Anne; Roine, Irmeli

    2014-01-01

    In Angola during 2003–2012, we detected Haemophilus influenzae in 18% of 2,634 and 26% of 2,996 bacteriologically positive pleural or cerebrospinal fluid samples, respectively, from children. After vaccination launch in 2006, H. influenzae empyema declined by 83% and meningitis by 86%. Severe H. influenzae pneumonia and meningitis are preventable by vaccination.

  11. A meningeal cyst of the thoracic spine presenting as prolonged paresis after ankle injury: case report.

    Science.gov (United States)

    Adelson, P D; Firlik, K S; Firlik, A D; Hamilton, R L

    1996-08-01

    A case of a thoracic meningeal cyst causing right lower extremity weakness in a fifteen-year-old girl is presented. The diagnosis was delayed due to a history of ankle injury which was initially used to explain her symptoms. The authors explain the difficulty in diagnosing intraspinal meningeal cysts and stress the importance of surgical excision before spinal cord injury progresses. PMID:8892372

  12. Cerebrospinal Fluid Stem Cell Factor Concentrations in the Children with Meningitis

    Directory of Open Access Journals (Sweden)

    Farhad Mashayekhi

    2007-01-01

    Full Text Available The aim of this study was to determine the level of Cere Brospinal Fluid (CSF Stem Cell Factor (SCF concentrations in the children with acute bacterial and viral meningitis. The presence of SCF in the CSF was confirmed by western blot using anti-SCF antibody as a probe. Using Enzyme Linked Immunosorbent Assay (ELISA, it was shown that the level of CSF SCF in the patients with acute bacterial meningitis is higher than in acute viral meningitis. We have also shown that the concentration of CSF SCF in the patients with acute viral and bacterial meningitis samples was higher than in normal CSF with the same age. It is concluded that CSF could be involved in the pathophysiology of meningitis. SCF may be important in neurogenesis and neural cell survival and provide a basis for future studies related to neuroprotective mechanisms exerted by SCF in meningitis. Moreover, CSF SCF levels can be used in the early diagnosis of meningitis. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and viral meningitis.

  13. Excacerbation of systemic lupus erythematodes, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography

    International Nuclear Information System (INIS)

    A clinical constellation of excacerbation of systemic lupus erythematodes (SLE), together with aseptic meningitis, and acutre mental symptoms occurred following lumbar myelography with metrizamide. Excacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new. (orig.)

  14. Contrast medium-enhanced MRI findings and changes over time in stage I tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Oztoprak, I. [Department of Radiology Cumhuriyet University Faculty of Medicine, 58140 Sivas (Turkey)], E-mail: oztoprak@cumhuriyet.edu.tr; Guemues, C.; Oztoprak, B. [Department of Radiology Cumhuriyet University Faculty of Medicine, 58140 Sivas (Turkey); Engin, A. [Department of Infectious Diseases, Cumhuriyet University Faculty of Medicine, Sivas (Turkey)

    2007-12-15

    Aim: To demonstrate the detailed imaging characteristics of early tuberculous meningitis (TBM) and changes over time on standard gadolinium-enhanced, T1-weighted magnetic resonance imaging (MRI) images. Materials and methods: Contrast-enhanced, T1-weighted, spin-echo MRI images of 26 patients with early TBM were evaluated retrospectively. Meningeal enhancement characteristics were categorized according to distribution and pattern as diffuse, focal, linear, nodular, and mixed. Results: We found that 35% of patients had diffuse meningeal enhancement and 65% of cases had focal meningeal enhancement. There was a predilection for focal meningeal enhancement in basal pial areas, the interpeduncular fossa being the most common. In six patients with diffuse meningeal enhancement admitted to hospital relatively early after the onset of symptoms, the type of meningeal enhancement later changed to the focal form. Conclusion: Reactive diffuse meningeal enhancement occurs in the early period of TBM on contrast medium-enhanced T1-weighted MR images, but later becomes limited to basal areas.

  15. Meningeal worm evokes a heterogeneous immune response in elk.

    Science.gov (United States)

    Bienek, D R; Neumann, N F; Samuel, W M; Belosevic, M

    1998-04-01

    Meningeal worm (Parelaphostrongylus tenuis) is a neurotropic nematode of ungulates in eastern North America. Lack of an effective diagnostic test increases the concern of translocating potentially infected ungulates into western North America, where P. tenuis does not occur naturally. In an attempt to identify serodiagnostic molecules, we determined (1) whether elk (Cervus elaphus) experimentally infected with P. tenuis produce antibodies against infective larvae or adult worms, and (2) if sera consistently recognize antigens that distinguish P. tenuis from a common nematode parasite of elk, the lungworm Dictyocaulus viviparus. Each of 10 elk were exposed to 15 or 300 infective P. tenuis larvae. Serum was collected (0, 41, and 83 days post-exposure and at necropsy) and monitored for antibodies using the enzyme-linked immunosorbent assay (ELISA) and immunoblot. When reactivity of sera with larval P. tenuis protein was compared (day 0 versus 83), ELISA values were significantly higher on day 83 for elk exposed to 15 or 300 parasites. Likewise, ELISA values using protein of adult P. tenuis were higher for elk exposed to 300 larvae. Immunoblots showed that sera from elk, with adult worms in the central nervous system, consistently recognized the 25-27, 28-30, and 34-36 kDa antigens of infective larvae after 83 days. However, many D. viviparus molecules were found to cross-react with antibodies formed against meningeal worm antigens. Use of adult worm proteins for serodiagnosis appears limited, because no protein was consistently recognized by sera collected from elk exposed to 15 larvae. We believe that development of a reliable diagnostic test for meningeal worm requires more research addressing cross-reactivity and detection of P. tenuis during the incubation stage. PMID:9577781

  16. IL-6 and IL-8 in cerebrospinal fluid from patients with aseptic meningitis and bacterial meningitis: their potential role as a marker for differential diagnosis

    Scientific Electronic Library Online (English)

    Vitor Laerte Laerte, Pinto Junior; Maria Cristina, Rebelo; Rachel Novaes, Gomes; Edson Fernandes de, Assis; Hugo C, Castro-Faria-Neto; Marcio Neves, Bóia.

    2011-04-01

    Full Text Available Cytokines are molecules that act as mediators of immune response; cerebral spinal fluid (CSF) IL-6 is found in all meningeal inflammatory diseases, but IL-8 is associated with acute bacterial meningitis (ABM). A case control study was done to ascertain the discriminatory power of these cytokines in [...] differentiating ABM from aseptic meningitis (AM); IL-6 and IL-8 CSF concentrations were tested through ELISA in samples collected from patients who underwent investigation for meningitis. Sixty patients, 18 with AM, nine with bacteriologic confirmed ABM and 33 controls, assisted in 2005 (MA and controls) and 2007 (ABM) were included. Differently from controls, IL-6 concentrations were increased both in MA and ABM patients (p

  17. Moxifloxacin in the Therapy of Experimental Pneumococcal Meningitis

    OpenAIRE

    Schmidt, H.; Dalhoff, A.; Stuertz, K.; Trostdorf, F.; Chen, V.; Schneider, O.; Kohlsdorfer, C.; Bru?ck, W.; Nau, R.

    1998-01-01

    The activity of moxifloxacin (BAY 12-8039) against a Streptococcus pneumoniae type 3 strain (MIC and minimum bactericidal concentration [MBC] of moxifloxacin, 0.06 and 0.25 ?g/ml, respectively; MIC and MBC of ceftriaxone, 0.03 and 0.06 ?g/ml, respectively) was determined in vitro and in a rabbit model of meningitis. Despite comparable bactericidal activity, 10 ?g of moxifloxacin per ml released lipoteichoic and teichoic acids less rapidly than 10 ?g of ceftriaxone per ml in vitro. Against...

  18. Radiation-induced rhabdomyosarcomatous transformation of a recurrent meningeal haemangiopericytoma

    International Nuclear Information System (INIS)

    A 53-year-old woman presented in 1979 with a posterior fossa meningeal haemangiopericytoma (HPC) for which she underwent surgical resection and post-operative radiotherapy. Repeated tumor recurrences occurred 18 years afterwards which were treated with resections and stereotactic radiotherapy. Surgery for tumor recurrence in 2005 revealed features of rhabdomyosarcomatous transformation. To our knowledge, this is the first reported case of rhabdomyosarcomatous transformation within a HPC which was likely to be radiation-induced, and was associated with relentless disease progression more than 20 years after the initial presentation. (author)

  19. Asymptomatic spinal arachnoiditis in patients with tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Srivastava, T. [Department of Neurology, CN Centre, All India Institute of Medical Sciences, New Delhi (India); Department of Medicine, S.P. Medical College, Bikaner, Rajasthan (India); Kochar, D.K. [Department of Medicine, S.P. Medical College, Bikaner, Rajasthan (India)

    2003-10-01

    Spinal arachnoiditis is one of the common and disabling complication of tuberculous meningitis (TBM). We focused on early diagnosis of spinal arachnoiditis by spinal MRI in asymptomatic patients in whom neurological examination was normal. We studied 16 patients with a diagnosis of probable or highly probable TBM with symptoms for less than 1 month; three had radiological evidence of spinal arachnoiditis. High cerebrospinal fluid protein appeared to be a risk factor for development of spinal arachnoiditis. MRI is sensitive to detect early spinal arachnoiditis. Earlier diagnosis may be helpful in management of spinal arachnoiditis in TBM. (orig.)

  20. Effect of contrast media and chymopapain on the spinal meninges

    International Nuclear Information System (INIS)

    Cases of paralysis following diskography and chemonucleolysis have been reported. The relationship between paralysis and the procedure has not been explained in previous experimental investigations. Therefore, we tested chymopapain and renografin in an experimental animal model used extensively for studying the toxic effect of drugs on the meninges. In four cynomolgus monkeys, renografin was injected into the epidural space, and in four other monkeys, chymopapain was used. The animals were killed 12 weeks later, and the dural sac was removed for histologic examination. The severity of arachnoid and dural fibrosis in the two groups was compared. Vascular thrombosis, foreign body reaction, and subarachnoid hemorrhage were assessed

  1. Streptococcus pneumoniae damages the ciliated ependyma of the brain during meningitis.

    Science.gov (United States)

    Hirst, Robert A; Gosai, Bejal; Rutman, Andrew; Andrew, Peter W; O'Callaghan, Christopher

    2003-10-01

    Streptococcus pneumoniae meningitis remains a disease with a poor outcome for the patient. A region of the brain that has been neglected in the study of meningitis is the ependyma, which has been identified as a location of adult pluripotent cells. In this study we have used a rat model of meningitis to examine whether the ependymal layer is affected by S. pneumoniae. The effects included localized loss of cilia, a decrease of the overall ependymal ciliary beat frequency, and damage to the ependymal ultrastructure during meningitis. In conclusion, loss of ependymal cells and ciliary function exposes the underlying neuronal milieu to host and bacterial cytotoxins and this is likely to contribute to the neuropathology commonly observed in pneumococcal meningitis. PMID:14500537

  2. Review of Pseudomonas aeruginosa meningitis with special emphasis on treatment with ceftazidime.

    Science.gov (United States)

    Fong, I W; Tomkins, K B

    1985-01-01

    Pseudomonas aeruginosa meningitis is a rare disease and the optimal antibiotic therapy for this condition is not well established. Results of therapy using various regimens reported since 1960 are reviewed. Ceftazidime, an investigational cephalosporin with potent antipseudomonal activity, has been used to treat P. aeruginosa meningitis in Europe and North America. The results in 24 patients are analyzed here. Most patients had failed to respond to other regimens before commencing therapy with ceftazidime. Nineteen (79.2%) of these patients were cured, and only three (12.5%) were considered therapeutic failures. Hence, ceftazidime is a useful agent in the treatment of gram-negative bacillary meningitis and may be superior to other cephalosporins on the market for the treatment of pseudomonas meningitis. Since development of resistance is a concern, however, it may be prudent to use a concomitant parenteral aminoglycoside with ceftazidime for the first week in the treatment of P. aeruginosa meningitis. PMID:3903939

  3. Tuberculous and syphilitic meningitis in a patient infected with the human immunodeficiency virus.

    Science.gov (United States)

    Makie, Toshio; Yamamoto, Yoshihiko; Uehira, Tomoko; Shirasaka, Takuma; Takeda, Masashi

    2007-01-01

    This report examines simultaneous tuberculous and syphilitic meningitis in a patient with human immunodeficiency virus (HIV). The 41-year-old homosexual patient presented with meningitis and hydrocephalus. His CD4+ and CD8+ T-lymphocyte counts per microliter were 60 and 71, respectively. His clinical presentation was of a rapid-onset cerebral attack incompatible with tuberculous meningitis. Imaging indicated fatal bilateral cerebral infarction at the basal nuclei, and basal meningitis. We believe that syphilitic meningitis in HIV exacerbated the central nervous system (CNS) damage caused by tuberculosis and syphilis. The combination of three pathogens, Mycobacterium tuberculosis, Treponema pallidum, and HIV, has a great potential to cause serious CNS damage. PMID:17409609

  4. Caso clínico de una meningitis por reactivación del virus varicela zóster en un paciente inmunocompetente / Case report of an inmunocompetent patient with reactivation of varicela zoster as meningitis

    Scientific Electronic Library Online (English)

    Felipe, Vial U; Sofía, González T-K; Mirta Javiera, López G.

    2013-09-01

    Full Text Available En este reporte presentamos el caso de un niño de 15 años sin antecedentes mórbidos, que consulta por un cuadro de cefalea febril, erupción cutánea de características herpéticas en tórax, en quien finalmente se confirma el diagnóstico de meningitis por varicela zóster. La literatura nos muestra que [...] la reactivación del virus varicela zóster en forma de meningitis es rara y en general afecta a la población inmunocomprometida, sin embargo, existen algunos reportes de casos similares al que se presenta, por lo que se debiese considerar como germen causal de meningitis, en la población inmunocompetente. Abstract in english This is a case report about a 15-year-old boy with no other previous medical history than chicken pox. His symptoms were headache, fever and a rash with vesicles in the dermatome that corresponds to T8. He was diagnosed with meningitis by the varicella-zoster virus. The information in the literature [...] is scarce and shows that reactivation of the varicella-zoster virus as meningitis is rare and generally affects immunodeficient patients; however, there are some case reports similar to this case in which the varicella-zoster virus is the agent involved, so it should also be considered in immunocompetent patients diagnosed with meningitis.

  5. Neuro-Behçet: differential diagnosis of recurrent meningitis / Presentación de enfermedad de Behçet como meningitis recurrente: Informe de un caso

    Scientific Electronic Library Online (English)

    Andreya, Fonseca Cardoso; Pedro Augusto, Rocha-Filho; Ana Rosa, Melo Correa-Lima.

    2013-01-01

    Full Text Available La enfermedad de Behçet is una perivasculitis sistémica inflamatoria caracterizada por episodios recurrentes de úlceras orales y genitales asociadas a lesiones cutáneas y oculares. El 5 a 10% de los casos tiene compromiso neurológico y el compromiso meníngeo aislado es muy poco común. Presentamos un [...] hombre de 21 años con enfermedad de Behçet y una historia de síndrome meníngeo en dos crisis previas y meningoencefalitis en tres otras. El paciente tenía una historia de conjuntivitis y úlceras orales y genitales. Al examen se encontraron lesiones aftosas, edema macular, compromiso de nervios craneanos, signos piramidales e irritación meníngea. El recuento celular del líquido cefalorraquídeo fue de 1.800 células/ml con predominancia polimorfonuclear. La resonancia magnética mostró lesiones en los ganglios basales y tronco encefálico. El paciente mejoró dramáticamente con el uso de corticoides endovenosos. Abstract in english Behçet disease is a systemic inflammatory perivasculitis characterized by recurrent episodes oforal and genital ulcers associated with skin and ocular lesions. Neurological involvement occurs in 5 to 10% of the cases, and isolated meningeal involvement is very uncommon. We report a 21 years old man [...] with a Behçet disease and a history of acute meningeal syndrome in two previous crises and meningoencephalitis in three others. He reported a history of conjunctivitis and oral and genital ulcers. On examination, he presented oral aphthoid lesions, macular edema, involvement of cranial nerves, pyramidal signs and meningeal irritation. The cell count in cerebrospinal fluid was 1800 cells/mm³, with polymorphonuclear predominance. Magnetic resonance imaging showed lesions in basal ganglia and the brainstem. The patient improved dramatically after intravenous steroid therapy.

  6. Neuro-Behçet: differential diagnosis of recurrent meningitis Presentación de enfermedad de Behçet como meningitis recurrente: Informe de un caso

    Directory of Open Access Journals (Sweden)

    Andreya Fonseca Cardoso

    2013-01-01

    Full Text Available Behçet disease is a systemic inflammatory perivasculitis characterized by recurrent episodes oforal and genital ulcers associated with skin and ocular lesions. Neurological involvement occurs in 5 to 10% of the cases, and isolated meningeal involvement is very uncommon. We report a 21 years old man with a Behçet disease and a history of acute meningeal syndrome in two previous crises and meningoencephalitis in three others. He reported a history of conjunctivitis and oral and genital ulcers. On examination, he presented oral aphthoid lesions, macular edema, involvement of cranial nerves, pyramidal signs and meningeal irritation. The cell count in cerebrospinal fluid was 1800 cells/mm³, with polymorphonuclear predominance. Magnetic resonance imaging showed lesions in basal ganglia and the brainstem. The patient improved dramatically after intravenous steroid therapy.La enfermedad de Behçet is una perivasculitis sistémica inflamatoria caracterizada por episodios recurrentes de úlceras orales y genitales asociadas a lesiones cutáneas y oculares. El 5 a 10% de los casos tiene compromiso neurológico y el compromiso meníngeo aislado es muy poco común. Presentamos un hombre de 21 años con enfermedad de Behçet y una historia de síndrome meníngeo en dos crisis previas y meningoencefalitis en tres otras. El paciente tenía una historia de conjuntivitis y úlceras orales y genitales. Al examen se encontraron lesiones aftosas, edema macular, compromiso de nervios craneanos, signos piramidales e irritación meníngea. El recuento celular del líquido cefalorraquídeo fue de 1.800 células/ml con predominancia polimorfonuclear. La resonancia magnética mostró lesiones en los ganglios basales y tronco encefálico. El paciente mejoró dramáticamente con el uso de corticoides endovenosos.

  7. Neuroimmunological findings of Angiostrongylus cantonensis meningitis in ecuadorian patients / Hallazgos neuroinmunologicos en meningitis por Angiostrongylus cantonesis en pacientes ecuatorianos

    Scientific Electronic Library Online (English)

    Alberto J., Dorta-Contreras; Barbara, Padilla-Docal; Juan M., Moreira; Luiggi Martini, Robles; Jenny Muzzio, Aroca; Fernando, Alarcón; Raisa, Bu-Coifiu- Fanego.

    2011-06-01

    Full Text Available La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en [...] suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26% en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país. Abstract in english Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quanti [...] fied and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

  8. The diagnosis and medical management of tuberculous meningitis in adults

    Scientific Electronic Library Online (English)

    S, Marais; R J, Wilkinson.

    2014-12-01

    Full Text Available Tuberculous meningitis (TBM) is a medical emergency for which tuberculosis (TB) treatment should be initiated as soon as possible after diagnosis. Owing to the low diagnostic yields of confirmatory tests, TBM is often diagnosed based on suggestive clinical and cerebrospinal fluid findings, evidence [...] for TB outside the central nervous system (CNS), typical brain imaging features and exclusion of other causes of meningitis. TB drug regimens used in TBM may be suboptimal as they are informed by studies of TB outside the CNS, rather than being based on randomised controlled trials in TBM. TBM has a high mortality and the management of HIV-co-infected patients is further complicated by neurological TB-immune reconstitution inflammatory syndrome (IRIS), which frequently occurs after starting antiretroviral therapy (ART) during TBM treatment and contributes to the poor outcome in HIV-associated TBM. HIV-infected TBM patients due to start ART should be counselled about the risk of developing neurological TB-IRIS, typical symptoms that could be expected and need to return to hospital should any of these develop. Currently, the only evidence-based treatment for TB-IRIS is with corticosteroids, which should be considered in all cases of neurological TB-IRIS.

  9. Unusual Tonsillar Herniation in Meningeal Melanocytoma: A Case Report

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    Kaveh Samimi

    2012-01-01

    Full Text Available Meningeal melanocytoma is a primary melanocytic neoplasm with certain MR and immunohistochemical characteristics worthy to note. In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study. Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal. Contrast-enhanced MRI revealed diffuse enhancement in the basal cisterns extending throughout the spinal canal. Immunohistochemical analysis on one of the intraspinal nodules proposed leptomeningeal melanocytoma. The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process. Moreover, there are unique immunohistochemical characteristics for this varied lesions.In appropriate clinical settings, certain radiologic findings, especially both T1 and T2 shortening in nodular CNS lesions should propose meningeal melanocytoma.

  10. A Case with Pituitary Abscess Presented with Acute Purulent Meningitis

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    ?lkay Çak?r

    2009-12-01

    Full Text Available Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI. We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient’s general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind in patients with acute meningitis whose clinical picture deteriorates despite the appropriate treatment. This case illustrates that the preoperative diagnosis is possible with careful evaluation, and with the treatment of this life-threatening condition, satisfactory results might be achieved. Turk Jem 2009; 13: 63-6

  11. Meningitis y artritis por Haemophilus influenzae en un adulto

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    Javier Molina

    1988-02-01

    Full Text Available Tradicionalmente el Haemophilus influenzae ha sido considerado un germen causante de infecciones en niños; en adultos se lo ha relacionado con Infecciones respiratorias, pero en los últimos tiempos se han descrito en ellos infecciones severas cuando hay algunos factores predisponentes. Se describe un paciente drogadicto de 30 años con cuadro de meningitis y artritis y prueba de látex y cultivo de LCR positivos para HaemophiIus influenzae, quien recibió tratamiento con ampicilina, 2 gramos Intravenosos cada 4 horas y evolucionó a la mejoría sin secuelas. Se plantea la necesidad de tener en cuenta al Haemophilus influenzae como patógeno del adulto y más en aquellas personas con factores predisponentes.

    Haemophilus influenzae has traditionally been considered as an infectious agent that predominantly affects children; instead, in adults It has been Linked either to respiratory infections or to gevere infections occurring when predisposing factors are present. We describe a 30 year-old drug adict patient that presented with meningitis and arthritis; both latex test and cerebrospinal fluid culture were positive for Haemophilus influenzae. He was treated with ampicilin 2 gm, I. V. every four hours and improved without sequelae. This microorganism must be considered among those affecting adult patients specially when predisposing factors for infection are present.

  12. Aseptic meningitis in Germany associated with echovirus type 13

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    Schreier Eckart

    2001-09-01

    Full Text Available Abstract Background Echoviruses are the commonest cause of aseptic meningitis. Echovirus type 13 which has not been isolated in Germany over a long period of time was the predominant enterovirus serotype associated with different local outbreaks of aseptic meningitis in Germany in 2000. Methods Virus isolation was performed from cerebrospinal fluid and stools. In order to study the genetic relationship of echovirus type 13 isolates, sequence analysis of a part of VP1 (~300 nt was carried out. Isolates from different geographic regions were compared to each other as well as to elder viruses (prototype strain from 1953, four isolates from 1965–1986. Results Overall, 55 isolates of echovirus type 13 were obtained from different parts of Germany. It was shown that the new isolated strains have a very high degree of homology on the nucleotide level (> 98% but differ significantly from the old strains (76–85%. Conclusions a Rare enterovirus serotypes can cause serious illness. b The molecular drift has also been shown for other enterovirus serotypes.

  13. Aetiological agents of cerebrospinal meningitis: a retrospective study from a teaching hospital in Ghana

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    Owusu Michael

    2012-10-01

    Full Text Available Abstracts Background Meningitis is an important cause of morbidity and mortality in low-resource settings. In sub-Saharan Africa, the meningitis belt has been characterized by particularly high and seasonal incidences of bacterial meningitis extending throughout life. Despite the progress being made in treating the condition, the mortality rates continue to be high, ranging between 2% and 30% globally. In Ghana, the mortality rate of meningitis has been estimated to range from 36% to 50%. However little information is available on the pathogens contributing to meningitis and their antimicrobial susceptibilities. Updated information is essential to adjust the recommendations for empirical treatment or prevention of meningitis which could have immense implications for local and global health. Methods We retrospectively reviewed laboratory records of all patients suspected of bacterial meningitis who underwent a lumbar puncture from January 1, 2008 to December 31, 2010. Data were retrieved from laboratory record books and double entered into a Microsoft® excel spreadsheet. Results Records of 4,955 cerebrospinal fluid samples were analysed. Of these, 163 (3.3%, 95%CI: 2.8% to 3.8% were confirmed meningitis and 106 (2.1%, 95%CI: 1.7% to 2.6% were probable meningitis cases. Confirmed meningitis cases were made up of 117 (71.8% culture positive bacteria, 19 (11.7% culture positive Cryptococcus neoformans and 27(16.6% Gram positive bacteria with negative culture. The most prevalent bacteria was Streptococcus pneumoniae 91 (77.7%, followed by E.coli 4 (3.4%, Salmonella species 4 (3.4%, Neisseria meningitidis 3 (2.5%, Pseudomonas species 3(2.5% and others. Pneumococcal isolates susceptibility to penicillin, chloramphenicol and ceftriaxone were 98.9% (95%CI: 94.0% to 100.0%, 83.0% (95%CI: 73.4% to 90.1% and 100.0% (95%CI: 95.8% to 100.0% respectively. Conclusion Streptococcus pneumoniae is an important cause of meningitis among all age groups and its susceptibility to penicillin and ceftriaxone still remains very high. Ghanaians of all ages and possibly other developing countries in the meningitis belt could benefit from the use of the pneumococcal vaccine. Other bacterial and fungal pathogens should also be considered in the management of patients presenting with meningitis.

  14. Carotid Artery Screening

    Science.gov (United States)

    Carotid Artery Screening What is carotid artery screening? Who should consider heart screening – and why? How are the procedures ... more information about heart screening? What is carotid artery screening? Screening examinations are tests performed to find ...

  15. Meningitis due to Enterobacter aerogenes subsequent to resection of an acoustic neuroma and abdominal fat graft to the mastoid

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    Fida A. Khan

    2004-10-01

    Full Text Available Meningitis is an uncommon complication of neurosurgical procedures, with an incidence of 1.1% to 2.5%. Although unusual, the frequency of nosocomial Gram-negative meningitis appears to be increasing. Gram-negative meningitis has been documented following disruption of the dura-arachnoid barrier secondary to trauma or surgery. The association of Gram-negative bacillary meningitis with neurosurgical procedures was first reported in the 1940's. Wolff et al. described the association between Enterobacter species and post-neurosurgical infection. More recently, risk factors for nosocomial Enterobacter meningitis have been characterized by Parodi et al. Adipose graft, as an independent risk factor has not yet been reported. A patient with acoustic neuroma resection, who developed bacterial meningitis from an abdominal fat pad graft to a mastoidectomy bed is described. A brief overview was made of post-neurosurgical Gram-negative meningitis.

  16. Meningitis due to Enterobacter aerogenes subsequent to resection of an acoustic neuroma and abdominal fat graft to the mastoid

    Scientific Electronic Library Online (English)

    Fida A., Khan.

    2004-10-01

    Full Text Available Meningitis is an uncommon complication of neurosurgical procedures, with an incidence of 1.1% to 2.5%. Although unusual, the frequency of nosocomial Gram-negative meningitis appears to be increasing. Gram-negative meningitis has been documented following disruption of the dura-arachnoid barrier seco [...] ndary to trauma or surgery. The association of Gram-negative bacillary meningitis with neurosurgical procedures was first reported in the 1940's. Wolff et al. described the association between Enterobacter species and post-neurosurgical infection. More recently, risk factors for nosocomial Enterobacter meningitis have been characterized by Parodi et al. Adipose graft, as an independent risk factor has not yet been reported. A patient with acoustic neuroma resection, who developed bacterial meningitis from an abdominal fat pad graft to a mastoidectomy bed is described. A brief overview was made of post-neurosurgical Gram-negative meningitis.

  17. Arthritis in adults with community-acquired bacterial meningitis: a prospective cohort study

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    de Gans Jan

    2006-03-01

    Full Text Available Abstract Background Although the coexistence of bacterial meningitis and arthritis has been noted in several studies, it remains unclear how often both conditions occur simultaneously. Methods We evaluated the presence of arthritis in a prospective nationwide cohort of 696 episodes of community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, which occurred in patients aged >16 years. The diagnosis of arthritis was based upon the judgment of the treating physician. To identify differences between groups Fisher exact statistics and the Mann-Whitney U test were used. Results Arthritis was recorded in 48 of 696 (7% episodes of community-acquired bacterial meningitis in adults. Joint-fluid aspirations were performed in 23 of 48 patients (48% and joint-fluid cultures yielded bacteria in 6 of 23 patients (26%. Arthritis occurred most frequently in patients with meningococcal meningitis (12%. Of the 48 patients with bacterial meningitis and coexisting arthritis, four died (8% and 10 (23% had residual joint symptoms. Conclusion Arthritis is a common manifestation in patients with community-acquired bacterial meningitis. Functional outcome of arthritis in bacterial meningitis is generally good because meningococcal arthritis is usually immune-mediated, and pneumococcal arthritis is generally less deforming than staphylococcal arthritis. Nevertheless, additional therapeutic measures should be considered if clinical course is complicated by arthritis. In patients with infectious arthritis prolonged antibiotic therapy is mandatory.

  18. Persistent Neutrophilic Meningitis in an Immunocompetent Patient after Basilar Skull Fracture: Case Report

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    Uslan Daniel Z

    2011-05-01

    Full Text Available Abstract Background Persistent neutrophilic meningitis is an unusual form of chronic meningitis that is defined as clinical meningitis with a neutrophilic pleocytosis that persists for greater than 7 days despite empiric antimicrobial therapy. Although numerous disease processes can cause this syndrome, the majority of cases are due to opportunistic pathogens infecting immunocompromised hosts. Case Presentation A 47 year-old female presented after basilar skull fracture with persistent neutrophilic meningitis unresponsive to empiric broad-spectrum antibiotics. After more than weeks of intensive therapy, 4 hospitalizations and 3 relapses, Nocardia cyriacigeorgica was identified from cerebral spinal fluid. Induction therapy was begun with Ceftriaxone and trimethoprim-sulfamethoxazole (TMP-SMX for 6 weeks followed by therapy with TMP-SMX and doxycycline for one year. The patient made a complete recovery without sequelae. Conclusions Due to the difficulty in obtaining a microbiologic diagnosis, appropriate treatment in cases of persistent neutrophilic meningitis is often delayed leading to morbidity, This case highlights a number of the unique features of Nocardia meningitis and the importance of considering Nocardia infection as a cause of persistent neutrophilic meningitis even in immunocompetent patients.

  19. KARIER MENINGITIS MENINGOKOK PADA JEMAAH HAJI INDONESIA TAHUN 1993-2003

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    Sarwo Handayani

    2012-10-01

    Full Text Available Research and routine survey of meningococcal meningitis on Indonesian hajj pilgrims have been conducted since 1993 until now. This paper consists of several research and routine survey of meningococcal meningitis during 1993 and 2003. The objectives of the test were determining the meningococcal meningitis carrier on hajj pilgrims, determining the serogroup of N. meningitidis and knowing sensitivity of bacteria to several antibiotics. The result showed increasing of meningococcal meningitis carrier in 1993 up to 1996, that was 1.3% - 9,4% respectively. This proportion of meningococcal meningitis carrier in the case groups decreased after given of rifampicin in 1994 and cyprofloxacin in 1997 as a chemoprophilactic. The result of the study in 1997 indiciated that the carrier rate of groups with cyprofloxacin (1.4% was lower than rifampicin group (1.4%. Most of the isolated bacteria of N. meningitidis in 1996 and 1997 were resistant to rifampicin (sensitivity test was 0-33%. Serogroup B of N. meningitidis were found dominantly between 1993 and 1999, it changed to be serogroup W135 from 2000 to 2003. The changes related  with the majority cases of meningococcal meningitis in another countries that caused by serogroup W135. Because  of  that  since 2002, immunization program has given a tetravalen (serogroup ACYW135 meningococcal vaccine to all of Indonesian hajj pilgrims. The carrier of meningococcal meningitis is still found in hajj pilgrims and their contact. More attention must be given, caused of meningococcal meningitis serogroup B vaccine is not available. The further researches are needed especially for subtype of N. meningitidis, effectivity of the drug choice and development of meningococcal meningitis vaccine serogroup B.

  20. Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children

    Scientific Electronic Library Online (English)

    Sofia, Águeda; Teresa, Campos; Ana, Maia.

    2013-08-01

    Full Text Available Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the [...] initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell > 7 µL-1) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0 ± 4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningi tidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839 cells/µL) compared to patients with aseptic meningitis (mean, 159 cells/µL, p

  1. YKL-40 is elevated in cerebrospinal fluid from patients with purulent meningitis

    DEFF Research Database (Denmark)

    Ostergaard, C; Johansen, JS

    2002-01-01

    YKL-40, a member of the family 18 glycosyl hydrolases, is secreted by activated neutrophils and macrophages. It is a growth factor for connective tissue cells and a potent migration factor for endothelial cells and may function in inflammation and tissue remodeling. YKL-40 was determined in 134 cerebrospinal fluid (CSF) samples taken on admission from patients suspected of having meningitis (48 with purulent meningitis, 49 with lymphocytic meningitis, 5 with encephalitis, and 32 without evidence of meningitis). YKL-40 levels in CSF were significantly higher in patients with purulent meningitis (median, 663 microg/liter [range, 20 to 8,960]) and encephalitis (5,430 microg/liter [620 to 11,600]) than in patients with lymphocytic meningitis (137 microg/liter [41 to 1,865]) or patients without meningitis (167 microg/liter [24 to 630]) (Kruskal-Wallis and Dunn multiple comparison tests, P < 0.001). CSF YKL-40 levels were also determined for 26 patients with purulent meningitis having a repuncture, and patients who died (n = 5) had significantly higher YKL-40 levels than patients who survived (n = 21) (2,100 microg/liter [1,160 to 7,050] versus 885 microg/liter [192 to 15,400], respectively; Mann-Whitney test, P = 0.018). YKL-40 was most likely locally produced, since patients with infections of the central nervous system had CSF YKL-40 levels that were at least 10-fold higher than the corresponding levels in serum (2,033 microg/liter [470 to 11,600] versus 80 microg/liter [19 to 195]). The CSF neopterin level was the biochemical parameter in CSF and blood that correlated best with CSF YKL-40 levels, indicating that YKL-40 may be produced by activated macrophages within the central nervous system. In conclusion, high levels of YKL-40 in CSF are found in patients with purulent meningitis.

  2. Cryptococcal meningitis in HIV infected: Experience from a North Indian tertiary center

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    Kumar Susheel

    2008-01-01

    Full Text Available Background: Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India. Aims: To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up. Settings and Design: A retrospective observational study undertaken in a large tertiary care center. Materials and Methods: Patient?s demographic data, presenting clinical symptomatology, physical findings, laboratory parameters, cerebrospinal fluid (CSF examination findings, side-effects of treatment, development of any complications and hospital outcome were analyzed. During follow-up any recurrence of cryptococcal meningitis, possible reasons of recurrence, type of treatment received, complications developed and outcome was recorded as well. Results: Forty patients diagnosed to have cryptococcal meningitis were analyzed. Twenty-two (55% patients had acute/ subacute presentation. Thirty-six (90% patients presented with headache and 18 (45% had altered sensorium. Twenty (50% patients had no cells in the CSF. Hypoglycorrhchia was seen in 30 (75% patients. Cryptococcal meningitis was the first acquired immune deficiency syndrome (AIDS-defining illness in 30 (75% patients. Thirty-five patients developed some adverse effects to amphotericin-B. Thirty-three patients improved with treatment while three patients died. Four patients had recurrence of cryptococcal meningitis within six months of first episode. Non-compliance of fluconazole therapy was the reason for recurrence in all of these patients. Conclusions: Cryptococcal meningitis is a common initial AIDS-defining illness. Acute and/or subacute presentation of cryptococcal meningitis is not uncommon in HIV-infected individuals. An early diagnosis of HIV infection might reduce the incidence of this infection.

  3. Streptococcus pneumoniae Damages the Ciliated Ependyma of the Brain during Meningitis

    OpenAIRE

    Hirst, Robert A; Gosai, Bejal; Rutman, Andrew; Andrew, Peter W; O'Callaghan, Christopher

    2003-01-01

    Streptococcus pneumoniae meningitis remains a disease with a poor outcome for the patient. A region of the brain that has been neglected in the study of meningitis is the ependyma, which has been identified as a location of adult pluripotent cells. In this study we have used a rat model of meningitis to examine whether the ependymal layer is affected by S. pneumoniae. The effects included localized loss of cilia, a decrease of the overall ependymal ciliary beat frequency, and damage to the ep...

  4. Cerebrospinal Fluid Stem Cell Factor Concentrations in the Children with Meningitis

    OpenAIRE

    Farhad Mashayekhi; Zivar Salehi

    2007-01-01

    The aim of this study was to determine the level of Cere Brospinal Fluid (CSF) Stem Cell Factor (SCF) concentrations in the children with acute bacterial and viral meningitis. The presence of SCF in the CSF was confirmed by western blot using anti-SCF antibody as a probe. Using Enzyme Linked Immunosorbent Assay (ELISA), it was shown that the level of CSF SCF in the patients with acute bacterial meningitis is higher than in acute viral meningitis. We have also shown that the concentration of C...

  5. Meningitis caused by Rhodotorula rubra in an human immunodeficiency virus infected patient

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    Thakur K

    2007-01-01

    Full Text Available Rhodotorula spp . are common saprophytes but may be responsible for systemic infections in immunocompromised patients. Meningitis caused by Rhodotorula spp. in human immunodeficiency virus (HIV infected patients has been reported only rarely. We present a case of meningitis caused by Rhodotorula rubra in HIV infected patient. The presumptive diagnosis of cryptococcal meningitis was made on the basis of India ink preparation, Gram staining and latex agglutination test (LAT for cryptococcal antigen. The final diagnosis was confirmed by isolation of Rhodotorula rubra from cerebrospinal fluid on culture. LAT was considered false positive. Amphotericin B and 5-fluorocytosine were administered but the patient succumbed to his illness.

  6. Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma

    Energy Technology Data Exchange (ETDEWEB)

    Sakata, K. [Tokyo Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology]|[Sapporo Medical Univ. (Japan). Dept. of Radiology; Aoki, Y.; Tago, M.; Karasawa, K.; Nakagawa, K.; Hasezawa, K.; Muta, N.; Terahara, A.; Onogi, Y.; Sasaki, Y. [Tokyo Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology; Hareyama, M. [Sapporo Medical Univ. (Japan). Dept. of Radiology

    1998-04-01

    Hemangiopericytoma is a rare tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved. (orig.) [Deutsch] Das Haemangioperizytom ist ein seltener Tumor, der seinen Ausgang von perikapillaeren Zellen oder Zimmermannschen Perizyten nimmt. Es kann ueberall dort entstehen, wo sich Kapillaren befinden. Wir berichten ueber einen Patienten mit meningealem Haemangioperizytom, der zunaechst radikal operiert wurde und 20 Jahre nach der Primaerbehandlung multiple Knochenmetastasen entwickelte. Der Patient wurde mit gutem palliativen Ergebnis mehrfach bestrahlt. (orig.)

  7. CT of the base of the skull in bacterial meningitis

    International Nuclear Information System (INIS)

    CT examinations of 42 cases of bacterial meningitis revealed in 38.1% of the cases relevant inflammatory processes at the base of the skull which were of significant importance for a transmitted infection. Such infections were: Sinusitis frontalis, ethmoidalis, maxillaris and sphenoidalis, mastoiditis or petrositis, suppurating mucocele, impression fracture, and an intracranially penetrated foreign body. Excepting the identification of fine fractures, conventional X-ray films were diagnostically superior. Hence, especially in the acute stages, special projections can be omitted, if CT is effected in the region of the osseous base of the skull. CT performed in inflammatory diseases of the brain must include the base of the skull, since this will yield reliable pointers to original focus of the inflammation requiring appropriate treatment and elimination. (orig.)

  8. CT of the base of the skull in bacterial meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Becker, H.; Schneider, E.

    1981-12-01

    CT examinations of 42 cases of bacterial meningitis revealed in 38.1% of the cases relevant inflammatory processes at the base of the skull which were of significant importance for a transmitted infection. Such infections were: Sinusitis frontalis, ethmoidalis, maxillaris and sphenoidalis, mastoiditis or petrositis, suppurating mucocele, impression fracture, and an intracranially penetrated foreign body. Excepting the identification of fine fractures, conventional X-ray films were diagnostically superior. Hence, especially in the acute stages, special projections can be omitted, if CT is effected in the region of the osseous base of the skull. CT performed in inflammatory diseases of the brain must include the base of the skull, since this will yield reliable pointers to original focus of the inflammation requiring appropriate treatment and elimination.

  9. Intracranial meningeal masson's hemangioma: CT and angiographic features

    International Nuclear Information System (INIS)

    Masson's hemangioma is a rare benign vascular condition with a papillary intravascular endothelial proliferation which may appear either as a primary form as a secondary form in a pre-existing vascular process. CT and angiographic features of 2 cases with Masson's hemangioma were presented. Both of them were located extra-axially in the posterior fossa. CT findings were not specific in both cases; One showed homogeneously enhancing mass, simulating meningioma. And the other demonstrated a multiocular rim enhancing mass. However, the angiographic features were rather characteristic; Both cases showed persistent vascular poolings of contrast media which were supplied form the meningeal vessels. Angiographic differential diagnosis of similar lesions in the posterior fossa is discussed

  10. Endotoxin as a cause of aseptic meningitis after radionuclide cisternography

    International Nuclear Information System (INIS)

    The role of pyrogens in aseptic meningitis after radionuclide cisternography was studied by means of the Limulus test, a sensitive detector of endotoxin. During a 15-month period, 39 reactions associated with cisternography were reported. Ten samples of specific lots of the radioactive drugs implicated in 20 of these reactions were tested and all reacted strongly positive to the Limulus test. The less sensitive rabbit pyrogen test was negative for these preparations when tested on a dose-per-weight basis. Our findings apparently provide clinical evidence for the observation made in animals that endotoxin is at least 1,000 times more toxic intrathecally than intravenously. The data implicate endotoxin contamination as a cause of adverse reactions to radionuclide cisternography. We conclude that the USP pyrogen test is insufficiently sensitive for intrathecal injectables and should be supplemented by the Limulus test. (auth)

  11. Recurrent pneumococcal meningitis in a splenectomised HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Quesne Gilles

    2003-11-01

    Full Text Available Abstract Background Streptococcus pneumoniae is a major cause of human disease, especially in pre-school children and elderly people, as well as in special risk groups such as asplenic, antibody deficient patients, or presenting disruption of natural barriers. The occurrence of pneumococcal disease has increased with the onset of the HIV epidemic and the emergence of drug-resistance. Case presentation We report the case of an HIV-1-infected patient who experienced three episodes of recurrent pneumococcal meningitis over a 4-year period, despite chemoprophylaxis and capsular vaccination. Conclusions Efficacy of anti-pneumococcal chemoprophylaxis and vaccination in HIV-infected patients are discussed in the light of this particular case.

  12. Carcinomatose meníngea / Carcinomatosis of the meninges: a case report

    Scientific Electronic Library Online (English)

    Milberto, Scaff; Daniele, Riva; Wilma S. O., Fernandes.

    1970-03-01

    Full Text Available Registro de um caso de carcinomatose meníngea. O diagnóstico foi estabelecido pela evolução e pelo encontro de células neoplásicas no líquido cefalorraqueano. A necropsia mostrou existir carcinoma papilífero do estômago, com metástases nas supra-renais, no espaço retroperitonial, no espaço sub-aracn [...] óideo comprometendo raízes nervosas, nas paredes e na luz de vasos linfáticos, na espessura da dura-mater e no tecido nervoso medular. Abstract in english A case of carcinoma of the meninges, diagnosed through the clinical picture and the finding of neoplastic cells in the cerebrospinal fluid is reported. The post-mortem examination showed a papillary carcinoma of the stomach with metastases in the retroperitoneal space, in the subarachnoideal space i [...] nfiltrating the spinal roots, in the lymphatic vessels of the nerve trunks, in the dura-mater and the spinal cord.

  13. Neonatal Meningitis: Clinical and Bacteriologic Findings in 120 Patients

    Directory of Open Access Journals (Sweden)

    SH Behjati

    2000-07-01

    Full Text Available In this retrospective study, clinical signs and bacteriological findings in 120 neonates (82 males, 38 female with meningitis have been evaluated. 60 were premature and 60 full term infants. Clinical signs consisted of weak neonatal reflexes in 86 neonates (70%, poor feeding 62 (41%, jaundice 41 (34%, fever 29 (24%, apnea 19 (16%, restlessness 18 (15%, respiratory distress 14 (11%, vomiting 10 (8% and abdominal distension 8 (7%. The signs of central nervous system involvement were observed as follows: Convulsions in 45 patients (37%, bulged fontanel 17 (14%, opisthotonous 5 (4% and coma 17 (14%. Blood culture was in only 28 cases positive. CSF culture was positive in 56 cases and the isolated microorganisms consisted of salmonella spp in 22 cases (39%, klebsiella 15 (27%, e coli 10 (18%, pneumococcus 2 (3.5%, staph aureus 2 (3.5%. 64 (53% neonates survived, of whom 31 (48% showed sequelae, hydrocephalus being the most frequently encountered one.

  14. Expression and regulation of antimicrobial peptide rCRAMP after bacterial infection in primary rat meningeal cells.

    Science.gov (United States)

    Brandenburg, Lars-Ove; Varoga, Deike; Nicolaeva, Nicoletta; Leib, Stephen L; Podschun, Rainer; Wruck, Christoph J; Wilms, Henrik; Lucius, Ralph; Pufe, Thomas

    2009-12-10

    Bacterial meningitis is characterized by an inflammation of the meninges and continues to be an important cause of mortality and morbidity. Meningeal cells cover the cerebral surface and are involved in the first interaction between pathogens and the brain. Little is known about the role of meningeal cells and the expression of antimicrobial peptides in the innate immune system. In this study we characterized the expression, secretion and bactericidal properties of rat cathelin-related antimicrobial peptide (rCRAMP), a homologue of the human LL-37, in rat meningeal cells after incubation with different bacterial supernatants and the bacterial cell wall components lipopolysaccharide (LPS) and peptidoglycan (PGN). Using an agar diffusion test, we observed that supernatants from meningeal cells incubated with bacterial supernatants, LPS and PGN showed signs of antimicrobial activity. The inhibition of rCRAMP expression using siRNA reduced the antimicrobial activity of the cell culture supernatants. The expression of rCRAMP in rat meningeal cells involved various signal transduction pathways and was induced by the inflammatory cytokines interleukin-1, -6 and tumor necrosis factor alpha. In an experimental model of meningitis, infant rats were intracisternally infected with Streptococcus pneumoniae and rCRAMP was localized in meningeal cells using immunohistochemistry. These results suggest that cathelicidins produced by meningeal cells play an important part in the innate immune response against pathogens in CNS bacterial infections. PMID:19879657

  15. Cochlear ossification in patients with profound hearing loss following bacterial meningitis

    DEFF Research Database (Denmark)

    Caye-Thomasen, Per; Dam, Mikkel Seidelin

    2012-01-01

    Cochlear ossification following bacterial meningitis is related to causative pathogen, but not age at disease or time point of evaluation. However, progression may occur over time, especially in case of primary signs of ossification.

  16. Spontaneous adult Gram-negative bacillary meningitis in Soweto, South Africa

    Directory of Open Access Journals (Sweden)

    Gloria Teckie

    2015-01-01

    Conclusions: A disproportionate burden of GNB meningitis fell on the HIV-infected, among whom absent or low CSF white cells was common. Management was complicated by high rates of resistance to third-generation cephalosporins.

  17. Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis

    Directory of Open Access Journals (Sweden)

    A. Denizmen Aygun

    1992-01-01

    Full Text Available Aims: To determine the level of serum procalcitonin and cerebrospinal fluid cytokines in children with bacterial or viral meningitis and to document the use of these parameters in differential diagnosis.

  18. Utility of the Xpert MTB/RIF assay for diagnosis of tuberculous meningitis.

    Science.gov (United States)

    Boulware, David R

    2013-10-01

    David Boulware discusses the challenges of diagnosing tuberculous meningitis and the implications of the study by Patel and colleagues using the Xpert MTB/RIF assay for diagnosis. Please see later in the article for the Editors' Summary. PMID:24167452

  19. Aseptic meningitis outbreak associated with echovirus 9 among recreational vehicle campers--Connecticut, 2003.

    Science.gov (United States)

    2004-08-13

    Aseptic meningitis is an inflammation of the tissues covering the brain and spinal cord and caused by a virus, most frequently an enterovirus. In August 2003, the Connecticut Department of Public Health (CDPH) received a report of three viral meningitis cases among recreational vehicle (RV) campers staying at a campground in northeastern Connecticut. CDPH, assisted by CDC, conducted an investigation, which 1) identified a total of 12 cases of aseptic meningitis and 24 cases of enterovirus-like illness among 201 campers interviewed, 2) demonstrated how transmission of enterovirus from persons with mild illness contributed to the aseptic meningitis outbreak, and 3) determined that crowded conditions inside RVs and in the campground swimming pool likely facilitated spread of enterovirus. Pool operators should check chlorine and pH levels frequently, particularly during peak pool occupancy; adults should take precautions against passing enterovirus to children, who are at greater risk for severe illness. PMID:15306755

  20. Prevention of meningeal relapses in acute lymphoblastic leukemia; Zapobieganie wznowom oponowym w ostrej bialaczce limfoblastycznej

    Energy Technology Data Exchange (ETDEWEB)

    Armata, J. [Polsko-Amerykanski Instytut Pediatrii, Collegium Medicum, Uniwersytet Jagiellonski, Cracow (Poland)

    1993-12-31

    The paper describes modern methods of preventing meningeal leukemia which, in view of the noxiousness of skull radiotherapy, increasingly restrict the use of this method in a growing number of children.(author) 25 refs, 3 tabs

  1. Detection of single bacteria – causative agents of meningitis using raman microscopy

    Science.gov (United States)

    Baikova, T. V.; Minaeva, S. A.; Sundukov, A. V.; Svistunova, T. S.; Bagratashvili, V. N.; Alushin, M. V.; Gonchukov, S. A.

    2015-03-01

    Early diagnostics of meningitis is a very topical problem as it is a fulminant disease with a high level of mortality. The progress of this disease is, as a rule, accompanied by the appearance of bacteria in the cerebrospinal fluid (CSF) composition. The examination of the CSF is well known to be the only reliable approach to the identification of meningitis. However, the traditional biochemical analyses are time consuming and not always reliable, simple, and inexpensive, whereas the optical methods are poorly developed. This work is devoted to the study of Raman spectra of several bacterial cultures which are mainly present during meningitis. Raman microscopy is a prompt and noninvasive technique capable of providing reliable information about molecular-level alterations of biological objects at their minimal quantity and size. It was shown that there are characteristic lines in Raman spectra which can be the reliable markers for determination of bacterial form of meningitis at a level of a single bacterium.

  2. Udvikling af bakteriaemi og meningitis med Streptococcus pneumoniae under pågående behandling med azithromycin.

    DEFF Research Database (Denmark)

    Lisby, Jan Gorm; Brasholt, Marie

    2002-01-01

    After absorption, azithromycin is concentrated intracellularly, with a correspondingly low serum concentration. A case of bacteriemia and meningitis caused by macrolide-sensitive Streptococcus pneumoniae during treatment with azithromycin is presented and discussed.

  3. MRI demonstration of unsuspected intraventricular rupture of pyogenic cerebral abscesses in patients being treated for meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Kamra, P.; Venkatesh, S.K.; Gupta, R.K. [Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Uttar Pradesh (India); Vatsal, D.K.; Husain, M. [Department of Neurosurgery, KG Medical College, Lucknow (India); Pradhan, S. [Department of Neurology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Uttar Pradesh (India)

    2002-02-01

    We report three patients with pyogenic meningitis who showed a partial response to medical treatment. MRI demonstrated an unsuspected brain abscess with intraventricular rupture, a possible cause of the partial response to treatment. (orig.)

  4. Long-term mortality in patients diagnosed with pneumococcal meningitis: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess

    2010-01-01

    The objective of the study was to determine the long-term mortality and the causes of death in patients diagnosed with pneumococcal meningitis. The authors performed a nationwide, population-based cohort study including all Danish patients diagnosed with pneumococcal meningitis from 1977 through 2006 and alive 1 year after diagnosis. Data were retrieved from medical databases in Denmark. The absolute and relative risks of all-cause and cause-specific death were analyzed by using Kaplan-Meier survival curves, Poisson regression analysis, Cox regression analysis, and cumulative incidence functions. The authors identified 2,131 pneumococcal meningitis patients and an age- and gender-matched, population-based cohort of 8,524 individuals. Compared with the background population, the pneumococcal meningitis patients had an increased long-term mortality varying from an 8-fold increased mortality in the age category 0-

  5. Infiltração do sistema nervoso central e das meninges nos linfomas com representação leucemica Meningeal and central nervous system infiltration in lymphomas with leukemic conversion: report of four cases

    Directory of Open Access Journals (Sweden)

    Marcos R. G. de Freitas

    1981-12-01

    Full Text Available Os autores fazem referência a 4 pacientes com representação leucêmica no decurso de linfomas malignos que apresentaram infiltração de células neoplasicas no sistema nervoso central e meninges. É feito o estudo anatomopatoló-gico, encontrando-se em 2 deles a formação de nódulos leucêmicos no parênquima nervoso. Nos outros dois, houve regressão total de sintomatologia neurológica com o uso do metotrexate por via intratecal.The cases of four patients with lymphoma with leucemic conversion, who exhibitted neoplasic infiltration of the central nervous system and of the meninges are reported. The anatomo-pathologic study showed the presence of small nodules of leucemic cells, in two patients. The other two patients had clinical improvement after the use of metotrexate by spinal route so that the anatomo-pathologic study of their CNS and meninges showed no abnomality.

  6. Bacterial Meningitis: A Density-Equalizing Mapping Analysis of the Global Research Architecture

    OpenAIRE

    Niklas Pleger; Beatrix Kloft; David Quarcoo; Simona Zitnik; Stefanie Mache; Doris Klingelhoefer; Groneberg, David A

    2014-01-01

    Bacterial meningitis is caused by a variety of pathogens and displays an important public health threat all over the world. Despite the necessity to develop customized public health-related research projects, a thorough study of global meningitis research is not present, so far. Therefore, the aim of this study was a combined density-equalizing and scientometric study. To evaluate the scientific efforts of bibliometric methods, density-equalizing algorithms and large-scale data analysis of t...

  7. Cystic solitary fibrous tumor arising from the left occipital meninges: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Bae Geun; Hwang, Yoon Joon; Cha, Soon Joo; Hur, Gham; Kim, Yong Hoon; Kim, Su Young; Seo, Jung Wook; Lee, Ji Young; Kim, Han Seung [Ilsan Paik Hospital, Inje University, School of Medicine, Goyang (Korea, Republic of)

    2007-02-15

    Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm of a spindle-cell origin, and it usually involves the pleura. It's occurrence in various organs of the body has recently been described. Meningeal SFT is very rare. Radiologically, it is a strongly enhancing solid mass and is undistinguishable from fibrous meningioma and hemangiopericytoma. Yet we report here on a case of SFT with massive cystic degeneration that arose from the meninges of the left occipital region.

  8. Diagnostic Value of Serum and Serum and Cerebrospinal Fluid Procalcitonin in Differentiation Bacterial from Aseptic Meningitis

    Directory of Open Access Journals (Sweden)

    Zhinous B. Makoo

    2010-01-01

    Full Text Available Problem statement: Acute bacterial meningitis is one of the most important causes of medical emergency diseases, which can cause high mortality and morbidity rates. Early antibiotic therapy is life saving in bacterial meningitis. One of the most common etiologies of acute meningitis is viral. Differentiation between bacterial and Aseptic meningitis is mandatory, which leads to avoid useless administration of antibiotics. Various diagnostic tests are available for diagnosis of acute bacterial meningitis; one of these tests is serum procalcitonin. Approach: This survey is a descriptive crosssectional study. During a 2 year period 50 patients over 13 years old who were admitted to Sina and Emam Reza hospitals of Tabriz University of Medical Sciences with presumptive diagnosis of acute meningitis were selected. Serum and Cerebrospinal Fluid (CSF procalcitonin of the patients were measured by semiquantative chromatographic PCT-Q Assay. Statistical data's of the patients were analyzed by SPSS 15. Results: 38% of the patients had acute bacterial and 62% aseptic meningitis, on the basis of positive clinical and lab tests. 0.5ng mL?1 of serum pricalcitonin was cut off point, which correlated to sensitivity of 100%, positive predictive value of 82.6%, specificity of 87.09% and negative predictive value of 100%. CSF procalcitonin cut off of 0.5ng mL?1 had sensitivity of 100% specificity of 84.21%, positive predictive value of 88.88% and negative predictive value of 90.62%. Conclusion: Serum procalcitonin cut off of 0.5 ng mL?1 has sensitivity and negative predictive value of 100%. This test can be a valuable measure in screening and differentiation of bacterial from aseptic meningitis.

  9. Risk Factors for Hearing Loss in Children following Bacterial Meningitis in a Tertiary Referral Hospital

    OpenAIRE

    Karanja, Benson Wahome; Oburra, Herbert Ouma; Masinde, Peter; WAMALWA, DALTON

    2013-01-01

    Objective. This study aimed to examine hearing function in children admitted with bacterial meningitis to determine the risk factors for sensorineural hearing loss. Setting. The study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital. Subjects and Methods. The study involved 83 children between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14. On discharge they underwent hearing tes...

  10. Temporal analysis of the incidence of meningitis in the Tehran metropolitan area, 1999-2005

    OpenAIRE

    Heidarnia Mohammadali; Asgari Freshteh; Esteghamati Abdolreza; Mosavi-Jarrahi Alireza; Mousavi-Jarrahi Yasamin; Goya Mohammadmehdi

    2009-01-01

    Abstract Objectives The aim of this study was to describe the temporal determinants of meningitis incidence in the population living in the Tehran metropolis. Methods All cases of meningitis reported to health districts throughout the Tehran metropolis from 1999 to 2005 were abstracted from patient files. Referral cases (patients who did not reside in the Tehran metropolis) were excluded. For each year, sex- and age-specific incidences were estimated. Temporality and its determinants were ana...

  11. VAKSIN HAEMOPHILUS INFLUENZAE type b (Hib UNTUK PENCEGAHAN MENINGITIS DAN PNEUMONIA

    Directory of Open Access Journals (Sweden)

    Muljati Prijanto

    2012-09-01

    Full Text Available Rendahnya insiden pada anak yang lebih tua umurnya dan orang dewasa disebabkan karena adanya antibodi bakterisidal terhadap capsul polisakarida Haemophilus influenzae tipe b dalam serumnya.Di negara maju maupun negara berkembang bakteri merupakan penyebab utama non epidemik meningitis pada kelompok umur tersebut. Beberapa bukti menunjukkan bahwa mortalitas meningitis pada kelompok bayi muda lebih tinggi di negara berkembang dari pada di negara industri. 

  12. Systemic steroid reduces long-term hearing loss in experimental pneumococcal meningitis

    DEFF Research Database (Denmark)

    WorsØe, Lise Lotte; Brandt, C.T.

    2010-01-01

    Sensorineural hearing loss is a common complication of pneumococcal meningitis. Treatment with corticosteroids reduces inflammatory response and may thereby reduce hearing loss. However, both experimental studies and clinical trials investigating the effect of corticosteroids on hearing loss have generated conflicting results. The objective of the present study was to determine whether systemic steroid treatment had an effect on hearing loss and cochlear damage in a rat model of pneumococcal meningitis.

  13. The diagnosis and management of acute bacterial meningitis in resource-poor settings.

    OpenAIRE

    Scarborough, M; Thwaites, GE

    2008-01-01

    Acute bacterial meningitis is more common in resource-poor than resource-rich settings. Survival is dependent on rapid diagnosis and early treatment, both of which are difficult to achieve when laboratory support and antibiotics are scarce. Diagnostic algorithms that use basic clinic and laboratory features to distinguish bacterial meningitis from other diseases can be useful. Analysis of the CSF is essential, and simple techniques can enhance the yield of diagnostic microbiology. Penicillin-...

  14. Validity of Electronic Medical Record-based Rules For the Early Detection of Meningitis and Encephalitis

    OpenAIRE

    Gundlapalli, Adi V; Tang, Hongying; Tonnierre, Claude; Stoddard, Greg; Rolfs, Robert T; Evans, R. Scott; Samore, Matthew H.

    2007-01-01

    Diseases of the central nervous system (CNS) such as meningitis or encephalitis may represent events of public health interest due to emerging infections and/or NIH/CDC Category B priority pathogens. Apart from influencing treatment and management of the index case, some diagnoses such as meningococcal meningitis warrant an immediate public health response. Others such as West Nile Virus may require public education and vector control. Thus early detection of CNS syndromes is of benefit to pa...

  15. Capnocytophaga canimorsus-meningitis diagnosticeret ved hjælp af 16S rRNA-analyse

    DEFF Research Database (Denmark)

    Risum, Malene; Ellekvist, Peter

    2012-01-01

    Capnocytophaga canimorsus is a gram-negative bacterial species hosted in the oral cavity of dogs. C. canimorsus can cause sepsis, meningitis and endocarditis. Penicillin is the drug of choice. However, the species is a slow-grower and sometimes missed in blood cultures. Patients with a history of alcoholism, splenectomy or immunodeficiency are at an increased risk of contracting serious infections with C. canimorsus following dog bites. We report a case story of C. canimorsus meningitis contracted after a dog bite.

  16. Bacillus cereus Bloodstream Infection in a Preterm Neonate Complicated by Late Meningitis

    OpenAIRE

    Toshinobu Horii; Kiyoko Tamai; Shigeyuki Notake; Hideji Yanagisawa

    2012-01-01

    Central nervous system infections caused by Bacillus cereus have rarely been reported in infants. In this paper, the case of a 2-month-old low-birth-weight female who developed meningitis 45 days after resolution of a bloodstream infection (BSI) is described. The pulsed-field gel electrophoresis results revealed that the patterns of both B. cereus isolates responsible for the acute meningitis and for the prior bacteraemic episode were closely related. Although the source of the infection from...

  17. Value of cerebrospinal fluid examination in the diagnosis of meningitis in the newborn.

    OpenAIRE

    Hristeva, L.; Bowler, I.; Booy, R.; King, A.; Wilkinson, A. R.

    1993-01-01

    Between 1 October 1988 and 30 September 1991 the results of all 896 cerebrospinal fluid examinations from 736 neonates were correlated with clinical diagnosis, treatment, and outcome. The prevalence of fungal or bacterial meningitis in babies requiring lumbar puncture was only 0.95%. Gram staining had a sensitivity of 68% and a positive predictive value of only 46% for the diagnosis of meningitis. Primary cultures directly onto agar plates had a sensitivity of 81% and positive predictive valu...

  18. Evaluation of a Rapid PCR Assay for Diagnosis of Meningococcal Meningitis

    OpenAIRE

    Richardson, David C.; Louie, Lisa; Louie, Marie; Simor, Andrew E.

    2003-01-01

    We compared the results of Gram staining and culture of cerebrospinal fluid to results obtained with a rapid PCR assay for the diagnosis of meningococcal meningitis in 281 cases of suspected bacterial meningitis. PCR had a sensitivity of 97% compared to a sensitivity of 55% for culture, and the PCR specificity was 99.6%. PCR results were available within 2 h of the start of the assay.

  19. Fulminant citrobacter meningitis with multiple periventricular abscesses in a three-month-old infant

    Directory of Open Access Journals (Sweden)

    P. Anoop

    2003-12-01

    Full Text Available Citrobacter, a Gram-negative enteric bacillus, is a rare cause of septicemia and meningitis, seldom reported beyond the neonatal period. It is characterized by a fulminant clinical course and a high incidence of complications, including brain abscesses. We studied a three-month-old infant with Citrobacter meningitis, who developed acute communicating hydrocephalus and multiple periventricular brain abscesses while on treatment. The patient died, despite intensive antibiotic treatment directed towards the causative organism, C. diversus.

  20. Pneumococcal Meningitis during Pregnancy: A Case Report and Review of Literature

    OpenAIRE

    Landrum, Lisa M.; Angela Hawkins; Jean Ricci Goodman

    2007-01-01

    Background. Bacterial meningitis is a medical emergency for which prompt diagnosis and treatment are imperative to reducing the rate of death and long-term neurologic compromise. Few cases of meningitis have been reported during pregnancy, many of which had devastating outcomes for mother, neonate, or both. Case. A 38-year-old multigravida at 35 weeks of gestation presented with mental status changes, fever, and preterm contractions. Lumbar puncture revealed gram positive cocci consistent ...

  1. Cystic solitary fibrous tumor arising from the left occipital meninges: a case report

    International Nuclear Information System (INIS)

    Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm of a spindle-cell origin, and it usually involves the pleura. It's occurrence in various organs of the body has recently been described. Meningeal SFT is very rare. Radiologically, it is a strongly enhancing solid mass and is undistinguishable from fibrous meningioma and hemangiopericytoma. Yet we report here on a case of SFT with massive cystic degeneration that arose from the meninges of the left occipital region

  2. Mobile laboratory to improve response to meningitis epidemics, Burkina Faso epidemic season 2004

    OpenAIRE

    Ouedraogo, R. T.; B.-M. Njanpop-Lafourcade; P. Jaillard; Traoré, Y; Mueller, J E; J.-F. Aguilera; M. Dabal; S. R. Tiendrébéogo; W. Goehde; da Silva, A.; Gessner, B D; P. Stoecke

    2009-01-01

    A Mobile Laboratory was developed for use primarily during the epidemic meningitis season in Burkina Faso. This report describes the Mobile Laboratory characteristics, its use to date, problems encountered and their resolution, and future directions. During 2004, the mobile laboratory intervention in three remote Burkina Faso districts experiencing meningitis epidemics led to more speci?c case management and led directly to vaccination of one district. However, in a second district, the inter...

  3. Nosocomial outbreak of neonatal Salmonella enterica serotype Enteritidis meningitis in a rural hospital in northern Tanzania

    Directory of Open Access Journals (Sweden)

    Krüger Carsten

    2004-09-01

    Full Text Available Abstract Background Clinicians at Haydom Lutheran Hospital, a rural hospital in northern Tanzania noted an unusually high case-fatality rate of pediatric meningitis and suspected an outbreak of an unknown agent or an organism resistant to the empirical therapy. Methods We established a provisional microbiology laboratory to investigate the suspected outbreak. Blood and spinal fluid specimens were taken from children below the age of seven years with suspected meningitis. The blood and spinal fluid specimens were inoculated in commercial blood culture bottles and locally prepared Thayer-Martin medium in slanted tubes, respectively. The bacterial isolates were sent to Norway for further investigation, including susceptibility testing and pulsed-field gel-electrophoresis (PFGE. Results Among 24 children with suspected meningitis and/or septicemia, five neonates had meningitis caused by Salmonella enterica serotype Enteritidis, all of whom died. Two children had S. Enteritidis septicemia without meningitis and both survived. Genotyping with PFGE suggested a clonal outbreak. The salmonella strain was resistant to ampicillin and sensitive to gentamicin, the two drugs commonly used to treat neonatal meningitis at the hospital. Conclusion The investigation reminds us that nontyphoidal salmonellae can cause meningitis associated with very high case-fatality rates. Resistance to multiple antimicrobial agents increases the risk of treatment failure and may have contributed to the fatal outcome in all of the five patients with salmonella meningitis. The investigation indicated that the outbreak was nosocomial and the outbreak subsided after hygienic measures were instituted. Establishing a provisional microbiological laboratory is a valuable and affordable tool to investigate and control outbreaks even in remote rural areas.

  4. Management of cryptococcal meningitis in HIV-infected patients: Experience from western India

    OpenAIRE

    Patel Atul; Patel Ketan; Ranjan Rajiv; Shah Shalin; Patel Jagdish

    2010-01-01

    Introduction: Cryptococcal meningitis is one of the acquired immunodeficiency syndrome defining infections with high mortality. Amphotericin B is the preferred drug for induction therapy. Despite advances in human immunodeficiency virus (HIV) treatment, Antiretroviral Treatment (ART) roll-out programs and availability of amphotericin B, cryptococcal meningitis remains an important cause of mortality in the African and other developing countries. Materials and Methods: We carried out a prospec...

  5. Persistent strongyloidiasis complicated by recurrent meningitis in an HTLV seropositive peruvian migrant resettled in Italy.

    Science.gov (United States)

    Zammarchi, Lorenzo; Montagnani, Francesca; Tordini, Giacinta; Gotuzzo, Eduardo; Bisoffi, Zeno; Bartoloni, Alessandro; De Luca, Andrea

    2015-06-01

    We describe a case of persistent strongyloidiasis complicated by recurrent meningitis, in a human T cell lymphotropic virus type 1 (HTLV-1) seropositive Peruvian migrant adult resettled in Italy. He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of Escherichia coli and Enterococcus faecium in two cases. He had been previously treated with several antihelmintic regimens not including ivermectin, without eradication of strongyloidiasis, and he had never been tested for HTLV before. During the described episode, the patient was treated for meningitis with broad-spectrum antibiotic therapy and 200 ?g/kg/dose oral ivermectin once daily on day 1, 2, 15 and 16 with full recovery and no further episodes of meningitis. The presented case underlines several critical points concerning the management of poorly known neglected diseases such as strongyloidiasis and HTLV infection in low-endemic areas. Despite several admissions for meningitis and strongyloidiasis, the parasitic infection was not adequately treated and the patient was not previously tested for HTLV. The supply of ivermectin and the choice of treatment scheme was challenging since ivermectin is not approved in Italy and there are no standardized guidelines for the treatment of severe strongyloidiasis in HTLV seropositive subjects. PMID:25846292

  6. Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries.

    Science.gov (United States)

    Loyse, Angela; Thangaraj, Harry; Easterbrook, Philippa; Ford, Nathan; Roy, Monika; Chiller, Tom; Govender, Nelesh; Harrison, Thomas S; Bicanic, Tihana

    2013-07-01

    Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks--eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis. PMID:23735626

  7. Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis

    International Nuclear Information System (INIS)

    Aim: To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. Materials and methods: The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. Results: The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). Conclusion: Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.ognosis in adult bacterial meningitis.

  8. Long-term mortality in patients diagnosed with Listeria monocytogenes meningitis: A Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess

    2012-01-01

    OBJECTIVES: To determine the long-term mortality, the causes of death and the incidence of cancer in listeria meningitis patients. METHODS: Nationwide, population-based cohort study including all adult patients diagnosed with listeria meningitis from 1977 to 2006 and alive 1 year after diagnosis, and an age-and gender-matched, population control cohort. Kaplan-Meier tables, Cox regression analysis and cumulative incidence function were used as outcome analyses. RESULTS: We identified 114 listeria meningitis patients and 1026 population controls. The adjusted mortality rate ratio (MRR) for listeria meningitis patients the first 5 years of follow-up was 2.35(95% confidence interval (CI) 1.60-3.45) thereafter the MRR was 0.93(95% CI: 0.56-1.55). Listeria meningitis patients had an increased risk of death due to cancer the first 5 years of follow-up, and in the same period patients above 50 years of age had a 2-fold increased risk of being diagnosed with cancer, thereafter the risks declined to that of the background population. CONCLUSIONS: The long-term mortality in adult patients diagnosed with listeria meningitis was increased the first 5 years of follow-up, mainly due to death from cancer, thereafter the mortality did not differ from the background population. To improve survival this patient population should be meticulously screened for predisposing conditions, mainly underlying malignant diseases.

  9. Myeloid-Related Protein 14 Promotes Inflammation and Injury in Meningitis

    DEFF Research Database (Denmark)

    Wache, Christina; Klein, Matthias

    2015-01-01

    BACKGROUND: ?Neutrophilic inflammation often persists for days despite effective antibiotic treatment and contributes to brain damage in bacterial meningitis. We propose here that myeloid-related protein 14 (MRP14), an abundant cytosolic protein in myeloid cells, acts as an endogenous danger signal, driving inflammation and aggravating tissue injury. METHODS: ?The release pattern of MRP14 was analyzed in human and murine cerebrospinal fluid (CSF), as well as in isolated neutrophils. Its functional role was assessed in a mouse meningitis model, using MRP14-deficient mice. RESULTS: ?We detected large quantities of MRP14 in CSF specimens from patients and mice with pneumococcal meningitis. Immunohistochemical analyses and a cell-depletion approach indicated neutrophils as the major source of MRP14. In a meningitis model, MRP14-deficient mice showed a better resolution of inflammation during antibiotic therapy, which was accompanied by reduced disease severity. Intrathecal administration of MRP14 before infection reverted the phenotype of MRP14-deficient mice back to wild type. Moreover, intrathecal injection of MRP14 alone was sufficient to induce meningitis in a Toll-like receptor 4 (TLR4)-CXCL2-dependent manner. Finally, treatment with the MRP14 antagonist paquinimod reduced inflammation and disease severity significantly, reaching levels comparable to those achieved after genetic depletion of MRP14. CONCLUSIONS: ?The present study implicates MRP14 as an essential propagator of inflammation and potential therapeutic target in pneumococcal meningitis.

  10. The changing epidemiology of pediatric aseptic meningitis in Daejeon, Korea from 1987 to 2003

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    Lee Mi-Hee

    2005-11-01

    Full Text Available Abstract Background Aseptic meningitis is a relatively frequent childhood disease and virologic data suggest that enteroviruses are the commonest etiologic agents. We evaluated the epidemiologic characteristics of aseptic meningitis in Daejeon, South Korea from 1987 to 2003. Methods 2201 medical records of children with aseptic meningitis admitted to The Catholic University of Korea, Daejeon St Mary's Hospital were retrospectively analyzed. Results Outbreaks of aseptic meningitis were observed in 1990, 1993, 1996, 1997, 2001 and 2002. The age distribution of cases was relatively uniform, with a higher incidence in those aged P = 0.001. Neurologic sequelae were observed in 0.7% of the patients. Conclusion Aseptic meningitis, rare before the 1980s in Korea, has since become a common clinical entity. Since 1990, outbreaks of aseptic meningitis have occurred every 1 to 3 years in Daejeon in keeping with Korea-wide epidemics. The frequency of disease affecting children less than one year of age may reflect herd immunity to the epidemic strain.

  11. Colagenopatía y meningitis aséptica recurrente en una paciente de 88 años Colagenopathy and recurrent aseptic meningitis in an 88 year old patient

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    Fernando J. VAzquez

    2004-02-01

    Full Text Available La meningitis aséptica recurrente (MAR en ancianos es rara y generalmente es secundaria a drogas. Su asociación a colagenopatías en ancianos ha sido raramente informada. El Síndrome de Sjögren (SS en ocasiones afecta el sistema nervioso central, pero la MAR asociada a SS es rara en este grupo etario. Se presenta una paciente de 88 años, autoválida, con antecedentes de xerostomía, xeroftalmos, Raynaud, disfagia y agrandamiento parotídeo recurrente autolimitado. En el año 2001 cursó una meningitis linfocítica y evolucionó con recuperación completa. Un año después volvió a presentar una meningitis linfocítica aséptica. Se descartaron causas infecciosas. Se demostró FAN 1/160 con patrón nucleolar moteado, Ac anti Ro y anti RNP positivos y anticoagulante lúpico positivo. Se confirmó sequedad ocular y la biopsia de labio fue compatible con SS. Evolucionó con resolución completa en 10 días sin tratamiento. Se interpretó como una enfermedad mixta del tejido conectivo (EMTC con síntomas predominantemente de SS, que cursó una MAR en su forma pura. La EMTC y el SS deberían ser considerados entre los diagnósticos diferenciales de la MAR, inclusive en ancianos.Recurrent aseptic meningitis (RAM infrequent in elderly patients and generally secondary to drugs. Its association with rheumatologic diseases is also seldom reported in the elderly. Sjögren Syndrome (SS sometimes affects the central nevous system, but the association between recurrent meningitis and SS is rare, specially in this age-group. We present an 88 year-old autovalid patient, with a history of xerostomia, xerophthalmia, Raynaud, dysphagia, and recurrent parotid enlargement. In 2001 she developed a lymphocytic meningitis with a complete remission. A year later, she developed again an aseptic lymphocytic meningitis. We ruled out infeccious causes. We found a FAN titer 1/160 with a nucleolar-mottled pattern, positive anti Ro and anti RNP antibodies and a positive lupus anticoagulant. We confirmed the ocular dryness and the lip biopsy was compatible with the diagnosis of SS. She had a good outcome with a complete remission without treatment in 10 days. We believe that this is a case of mixed connective tissue disease (MCTD with predominant symptoms of SS, that developed a recurrent meningitis in its pure form. MCTD and SS should be considered in the differential diagnoses of RAM, also in the elderly.

  12. Acelularidad del líquido cefalorraquídeo como factor pronóstico adverso en meningitis criptocóccica / Acellularity of cerebrospinal fluid as adverse prognostic factor in cryptococcal meningitis

    Scientific Electronic Library Online (English)

    Roberto Radamés, Larrea Fabra; Lizet, Sánchez Valdés.

    2013-12-01

    Full Text Available Introducción: las enfermedades oportunistas, y dentro de ellas la meningitis criptocóccica en pacientes inmunodeprimidos, constituyen causa mayor de letalidad en países en vías de desarrollo. Objetivo: identificar factores de mal pronóstico como la acelularidad del líquido cefalorraquídeo (LCR) para [...] individualizar medidas terapéuticas encaminadas al logro de una mayor supervivencia y calidad de vida de estos pacientes. Métodos: se estudió la celularidad de todos los LCR de los 170 casos de Bojanala, North West, ingresados en el Hospital Provincial de Rustenburg, South África por meningitis criptocóccica desde mayo de 2001 hasta abril de 2004. Se interrelacionó el número de células blancas del LCR con la letalidad intrahospitalaria, seropositividad al virus de inmunodeficiencia humana (VIH) y nivel de linfocitos T4. Resultados: se detectó una asociación altamente significativa entre acelularidad basal del LCR y riesgo a morir, y significativa con progresión lineal de mayor mortalidad en los casos con descenso evolutivo del número de células blancas en sucesivos LCR. Se constató un alto índice de letalidad (36,5 %) por meningitis criptocóccica. No hubo diferencias significativas entre acelularidad y letalidad en pruebas de comparación de grupos acorde al nivel de linfocitos T4 y a la confirmación o no de la seropositividad al VIH. Conclusiones: tanto la acelularidad basal como la progresión descendente evolutiva del número de células blancas del LCR constituyen herramientas útiles para la predicción del riesgo a morir por meningitis criptocóccica. Abstract in english Introduction: opportunistic diseases, and among them, cryptococcal meningitis in immune-compromised patients, are a major cause of lethality in developing countries Objective: to identify mal prognostic factors such as acellularity of cerebrospinal fluid (CSF) to identify therapeutic measures aimed [...] to achieve improved survival and quality of life of these patients. Methods: cellularity was studied in all CSF of the 170 cases in Bojanala, North West, who were admitted to the Rustenburg Provincial Hospital, South Africa for cryptococcal meningitis from May 2001 to April 2004. The number of CSF white cell with hospital mortality, seropositive human immunodeficiency virus (HIV) and level of T4 lymphocytes were interrelated. Results: a highly significant association was found between baseline CSF acellularity and risk of death, and significant linear progression of increased mortality in patients with developmental decline in the number of white cells in successive CSF. A high fatality rate (36.5 %) for cryptococcal meningitis was also found. No significant differences was found between acellularity and lethality tests comparing groups according to the level of T4 lymphocytes and the confirmation or otherwise of HIV seropositivity. Conclusions: both basal acellularity and evolutionary downward progression of the number of CSF white cells are useful tools for predicting the risk of death for cryptococcal meningitis.

  13. Characteristics of acute bacterial meningitis in Southeast Turkey

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    Celal Ayaz

    2004-08-01

    Full Text Available BACKGROUND: Acute bacterial meningitis (ABM remains a significant worldwide cause of death in adults. Even in the antibiotic era, the mortality rate in ABM remains significant and has been reported in the range of 8-40%. AIM: The aim of this study was to assess the characteristics of epidemiology, clinical manifestations, treatment modalities and outcome of patients with ABM in Southeast Turkey. SETTINGS AND DESIGN: This retrospective study included all cases of community-acquired ABM diagnosed and treated in Dicle University Hospital between June 1996 and December 2002. METHODS AND PATIENTS: The study group consisted of 186 adult patients (110 male, 76 female with ABM, those patients who are older than 14 years, followed up at Dicle University Hospital from June 1996 to December 2002. Patients? charts were retrospectively reviewed, clinical characteristics were recorded and final data were analyzed. STATISTICAL ANALYSIS: In statistical analyses, the Chi-square test was used for binary variables and Student?s t-test for continuous variables. RESULTS: The patients? mean age was 30.2 ± 15.3 years (range 14 to 90 years. On admission, typical symptoms of meningitis were found in most of the patients: headache in 92.5%, fever in 88.2%, and nuchal rigidity in 80.1%. The main predisposing factor for ABM was otitis media (40 patients, 21.5% and closed head trauma (12 patients, 6.5%. Streptococcus pneumonia was the most common identified pathogen. Twenty-nine patients (15.6% died during hospitalization period. In multivariate analyses, the significant mortality factor was found as initial level of consciousness, low cerebrospinal fluid/blood glucose ratio, high erythrocyte sedimentation rate and initial treatment by penicillin G. CONCLUSIONS: Although still remains as a serious infection, early diagnosis and effective treatment may reduce fatal outcome and improve the course of the disease in patients with ABM. Ceftriaxone should be considered as the drug of choice for initial empirical therapy, while waiting culture results and vancomycin must be withheld for patients having increased risk of penicillin resistant pneumococci strains.

  14. [Actual problem of meningitis and other intracranial complications in cases of otitis media and sinusitis in children].

    Science.gov (United States)

    Zieli?ski, Rafa?; Zakrzewska, Anna

    2012-01-01

    The most frequent primary infections causing purulent meningitis in older children are both acute and chronic otitis media and sinusitis or upper and lower airways infections. In these cases sometimes purulent meningitis is accompanied with other intracranial complications. Pharmacological treatment of intracranial complications without surgical intervention concerning primary source of infection increases risk of complications including death of a patient and also recurrences of bacterial meningitis. In the paper authors present two uncommon cases of children with purulent meningitis and other intracranial complications of otitis media and sinusitis diagnosed by pediatricians. PMID:22748686

  15. Recurrent meningitis and persistence of craniopharyngeal canal: case report / Meningitis de repetición y canal craneofaríngeo persistente: a propósito de un caso

    Scientific Electronic Library Online (English)

    D., Pinilla-Arias; J., Hinojosa; J., Esparza; A., Muñoz.

    2009-02-01

    Full Text Available Objetivos. El Canal Craneofaríngeo es una rara malformación del esfenoides que ha sido descrito hasta en el 0,42% de la población asintomática. Se le ha relacionado con la formación de la Bolsa de Rathke durante el desarrollo embrionario aunque existen autores que opinan que se trata de un vestigio [...] de un canal vascular primitivo. Métodos. Presentamos el caso de un niño de cuatro años y medio que desarrolló un cuadro de meningitis de repetición asociado a esta anomalía. Revisamos la literatura para discutir su formación, manifestaciones clínicas y opciones de tratamiento. Conclusión. Dada su baja incidencia y las dificultades diagnósticas es necesario un alto índice de sospecha durante el estudio de un caso de meningitis de repetición o fístula espontánea de líquido cefalorraquídeo. Existe una gran controversia en lo referente al abordaje quirúrgico idóneo. Abstract in english Objects. Craniopharyngeal Canal is a rare malformation of the sphenoid bone described in up to 0.42% of the asymptomatic population. It's been related to the development of the Rathke's pouch during embrionary period although some authors think it's a vestige of a former vascular channel. Methods. T [...] his report details a case of a four and a half years old child that developed recurrent meningitis associated with this anomaly. Its origin, clinical manifestations and treatment options are discussed. Conclusion. Due to its low incidence and diagnostic difficulties, a high suspicion index is required while studying a case of recurrent meningitis or CSF leakage. Surgical approach is still controversial.

  16. Estimating costs of care for meningitis infections in low- and middle-income countries.

    Science.gov (United States)

    Portnoy, Allison; Jit, Mark; Lauer, Jeremy; Blommaert, Adriaan; Ozawa, Sachiko; Stack, Meghan; Murray, Jillian; Hutubessy, Raymond

    2015-05-01

    Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines. PMID:25919168

  17. Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases

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    Meintjes Graeme

    2010-03-01

    Full Text Available Abstract Background The presentation and causes of adult meningitis in South Africa have changed substantially as a result of HIV. Knowledge of aetiology and laboratory findings in patients presenting with meningitis are important in guiding management. We performed a retrospective study to determine these findings in a setting of high HIV and TB prevalence in Cape Town. Methods Patients undergoing lumbar punctures between 1st January 2006 and 31st December 2008 at a public sector referral hospital were studied. Cases were classified by microbiological diagnosis, or in the absence of definitive microbiology as 1 normal CSF (neutrophils ? 1 × 106/L, lymphocytes ? 5 × 106/L, protein ? 0.5 g/dL, glucose ?1.5 mmol/L, 2 minor abnormalities (neutrophils 2-5, lymphocytes 6-20, protein 0.51-1.0, glucose 1.0-1.49 or 3 markedly abnormal (neutrophils>5, lymphocytes>20, protein>1.0, glucose Results 5578 LPs were performed on 4549 patients, representing 4961 clinical episodes. Of these, 2293 had normal CSF and 931 had minor abnormalities and no aetiology identified. Of the remaining 1737, microbiological diagnoses were obtained in 820 (47%. Cryptococcus accounted for 63% (514 of microbiological diagnoses, TB for 28% (227, bacterial meningitis for 8% (68. Of the remaining 917 who had marked abnormalities, the majority (59% had a sterile lymphocytic CSF. Of note 16% (81 patients with confirmed Cryptococcus, 5% (12 with TB and 4% (3 with bacterial meningitis had normal CSF cell-counts and biochemistry. Conclusions Cryptococcal and tuberculous meningitis are now the commonest causes of adult meningitis in this setting. TB meningitis is probably underdiagnosed by laboratory investigation, as evidence by the large numbers presenting with sterile lymphocytic markedly abnormal CSFs.

  18. Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

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    Weiss Débora PL

    2001-01-01

    Full Text Available OBJECTIVE: To document the incidence and the descriptive epidemiology of bacterial meningitis among individuals under age 20 in a geographically defined region in Brazil during the two-year period immediately preceding the introduction of Haemophilus influenzae type b (Hib vaccines into the national immunization program of Brazil. METHODS: Population-based epidemiological study of all cases of bacterial meningitis reported among residents of Campinas, Brazil, under age 20 (n=316,570 during the period of 1997-98, using comprehensive surveillance records compiled by the Campinas Health Department from cases reported among hospital inpatients, outpatients, emergency room visits, death certificates, and autopsy reports. RESULTS: The incidence of bacterial meningitis (n=274 was 334.9, 115 and 43.5 cases/10(5 person-years (pys for residents of Campinas under age 1, 5 and 20, respectively. All cases were hospitalized, with an average length of stay of 12 days. Documented prior antibiotic use was 4.0%. The case-fatality rate of bacterial meningitis in individuals under age 20 was 9% (24/274 with 75% of deaths occurring in children under the age of five. The incidence of Hib meningitis (n=26 was 62.8 and 17 cases/10(5 pys in children age <1 and <5, respectively. CONCLUSIONS: The incidence of Hib meningitis in children under the age of 5 in Campinas during 1997-98 was similar to that reported in the US, Western Europe, and Israel prior to widespread Hib vaccine use in those regions. This study provides a baseline for later studies to evaluate changes in the etiology and incidence of bacterial meningitis in children after introduction of routine Hib vaccination in Brazil.

  19. Patterns of complications of neonatal and infant meningitis on MRI by organism: A 10 year review

    International Nuclear Information System (INIS)

    Introduction: Imaging of meningitis in neonates and infants is not routine, but is frequent for complications. Aside from tuberculosis and herpesvirus, imaging findings related to most responsible pathogens are thought to be nonspecific, but few studies exist. We reviewed the imaging features of complicated meningitis in infants and neonates at our hospital in the past decade, hypothesizing that patterns of complications might be more specific than previously recognized. Methods: 10 yr retrospective review of magnetic resonance imaging (MRI) and microbiology data for all neonates (age <30 d) and infants (age <1 yr) imaged for possible complications of meningitis at a tertiary children's hospital. Results: We had 63 patients (25 neonates, 38 infants). The 3 most common pathogens were streptococcal species (n = 32, mean age 4.7 mo), E. coli (n = 9, mean 1.2 mo), and herpes simplex virus (n = 4). The most common findings were meningeal enhancement (78% of those given IV contrast), infarct (52%), subdural collection (35%), and ventriculomegaly (32%). E. coli presented much more frequently with ventriculomegaly (64% vs. 22%) than streptococcal species. Extensive infarcts were typical of streptococcal meningitis (13/32, 41%) and rarely seen with other organisms (2/31, 6%, p = 0.001). All 3 cases of Serratia meningitis had large parenchymal abscesses, and 2/4 cases of meningococcus had occipital cortical necrosis. Conclusion: Although overlap was present, each organism respoh overlap was present, each organism responsible for neonatal/infant meningitis produced an identifiable pattern of complications on MRI. Recognising these patterns can help the radiologist suggest possible diagnosis and influence early management.

  20. Clinical analysis of 26 cases with cryptococcal meningitis

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    Wei-wei HU

    2014-08-01

    Full Text Available Objective To study the clinical features of cryptococcal meningitis (CM and summarize its clinical manifestations, laboratory data, differential diagnosis and treatment, so as to discuss the treatment progress of CM.  Methods Clinical data of 26 cases with CM were retrospectively analyzed, and the treatment experiences were summarized.  Results All patients had headache and fever, and were positive for cerebrospinal fluid (CSF latex agglutination test. Twenty-one patients' CSF smear were found Cryptococcus neoformans. Almost 76.92% (20/26 of patients were cured or became better after receiving combined treatment of amphotericin B, flucytosine and fluconazole. The symptoms and signs of 4 patients who received combined treatment of amphotericin B and voriconazole were greatly improved.  Conclusions CM can prone to be misdiagnosed at early stage. CSF smear and fungi culture are beneficial to the diagnosis. Latex agglutination test is a quick and easy examination to reduce the misdiagnosis rate of CM. The combination of amphotericin B, flucytosine and fluconazole is effective for the treatment of CM. doi: 10.3969/j.issn.1672-6731.2014.08.009

  1. Bacillus cereus bacteremia and meningitis in immunocompromised children.

    Science.gov (United States)

    Gaur, A H; Patrick, C C; McCullers, J A; Flynn, P M; Pearson, T A; Razzouk, B I; Thompson, S J; Shenep, J L

    2001-05-15

    Two cases of Bacillus cereus meningitis in immunocompromised children at our hospital within a 2-month period prompted us to review B. cereus--related invasive disease. We identified 12 patients with B. cereus isolated in blood cultures from September 1988 through August 2000 at our institution. Three of these patients also had B. cereus isolated from CSF specimens; 1 additional patient had possible CNS involvement (33%, group A), whereas 8 patients had no evidence of CNS involvement (67%, group B). Patients in group A were more likely to have neutropenia at the onset of sepsis and were more likely to have an unfavorable outcome. They were also more likely to have received intrathecal chemotherapy in the week before the onset of their illness. Two patients from group A died. One survived with severe sequelae. The fourth patient had mild sequelae at follow-up. No sequelae or deaths occurred among patients in group B. In patients with unfavorable outcomes, the interval from the time of recognition of illness to irreversible damage or death was short, which demonstrates a need for increased awareness, early diagnosis, and more-effective therapy, particularly that which addresses B. cereus toxins. PMID:11317247

  2. Neisseria meningitis GNA1030 is a ubiquinone-8 binding protein.

    Science.gov (United States)

    Donnarumma, Danilo; Golfieri, Giacomo; Brier, Sébastien; Castagnini, Marta; Veggi, Daniele; Bottomley, Matthew James; Delany, Isabel; Norais, Nathalie

    2015-06-01

    Bexsero, a new vaccine against Neisseria meningitidis serogroup B (MenB), is composed of 3 main recombinant proteins and an outer membrane vesicle component. One of the main bactericidal antigens, neisseria heparin binding antigen (NHBA), is present as a fusion protein with the accessory protein genome-derived neisserial antigen (GNA) 1030 to further increase its immunogenicity. The gene encoding for GNA1030 is present and highly conserved in all Neisseria strains, and although orthologs are present in numerous species, its biologic function is unknown. Native mass spectrometry was used to demonstrate that GNA1030 forms a homodimer associated with 2 molecules of ubiquinone-8 (Ub8), a cofactor mainly involved in the electron transport chain and with antioxidant properties. Disc diffusion assays on the wild-type and knockout mutant of GNA1030, in the presence of various compounds, suggested that GNA1030 is not involved in oxidative stress or electron chain transport per se, although it contributes to constitutive refilling of the inner membrane with Ub8. These studies shed light on an accessory protein present in Bexsero and reveal functional insights into the family of related proteins. On the basis of our findings, we propose to name the protein neisseria ubiquinone binding protein (NUbp).-Donnarumma, D., Golfieri, G. , Brier, S., Castagnini, M., Veggi, D., Bottomley, M. J., Delany, I., Norais, N. Neisseria meningitis GNA1030 is a ubiquinone-8 binding protein. PMID:25713028

  3. Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis

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    Heda Melinda D. Nataprawira

    2014-10-01

    Full Text Available Perinatal tuberculosis (TB is rarely reported, because the clinical manifestations are not specific and there is a problem in its laboratory and radiology examination which caused undiagnosed. Perinatal TB is the preferred description that encompasses TB acquired either intra uterine, during or post delivery in early newborn period. A-3- month old baby was transferred to Pediatric Emergency Hasan Sadikin Hospital because of prolong fever and unable to breastfeed. There was no problem with delivery. Lethargic, fever, tachypnea, and hepatosphlenomegali were found on physical examination. Ziehl Neelsen smear of gastric lavage yielded positive acid fast bacilli. Tuberculine test was non reactive, chest x-ray showed a miliary pattern, and cerebral spinal fluid analysis gave tuberculous meningitis interpretation. By active finding, his father and grandfather were detected as a source of TB transmission. In additon to oral antituberculosis regimen, antibiotics and prednison were also given. Septic shock and disseminated intravascular coagulation were occurred during his illness and the baby died. Staphylococcus haemolyticus was identified from blood culture. In conclusion, although there were no problems during labor, active investigation of perinatal TB possibility is required on the family with a source of TB. Caution on TB in pregnant women is necessary at developing country with high rates of TB.

  4. Un modelo de predicción de meningitis bacteriana en recién nacidos con pleocitosis del líquido cefalorraquídeo / A bacterial meningitis predictive model for newborns with cerebrospinal fluid pleocytosis

    Scientific Electronic Library Online (English)

    Manuel, Díaz Álvarez.

    2013-09-01

    Full Text Available Introducción: se han desarrollado herramientas de predicción de meningitis bacteriana (MB) en pacientes pediátricos, pero ellas no incluyen el período neonatal. Objetivo: diseñar y validar un modelo de predicción de MB en pacientes neonatales quienes presentan pleocitosis del líquido cefalorraquídeo [...] (LCR) al ser evaluados por variables clínicas y de laboratorio. Pacientes y método: estudio retrospectivo y analítico, que incluyó 320 pacientes neonatales evaluados por probable infección, en quienes se hizo el diagnóstico de meningitis, 45 con MB y 275 con meningitis aséptica, e ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario "Juan M. Márquez", entre Febrero de 1992 y Diciembre del 2009. Se creó un Modelo Predictivo de Meningitis Bacteriana, sobre la base de un conjunto de variables identificadas mediante procedimientos de análisis uni y multivariado. El modelo se diseñó a partir de una población «de derivación», y se contrastó en otro grupo, este "de validación". Resultados: las variables seleccionadas para integrar el modelo predictivo fueron: 1) Apariencia de estado tóxico-infeccioso, 2) Convulsiones en el transcurso de la enfermedad, 3) Tinción de Gram del LCR positiva, 4) Proporción de leucocitos polimorfonucleares en el LCR >80%, y 5) Glucorraquia Abstract in english Introduction: there were developed a prediction tools for bacterial meningitis (BM) in pediatric patients, but those do not include the neonatal period. Objetive: to develop and validate a prediction model for BM in neonatal patients who present pleocytosis of the cerebrospinal fluid (CF) when they [...] were evaluated by clinical and laboratory variables. Patients and method: retrospective and analytic study, which included 320 neonatal patients evaluated for probable infection, with the diagnosis of meningitis, 45 with BM and 275 with aseptic meningitis, and who were admitted in the Neonatology Ward at the Universitary Pediatric Hospital «Juan M. Márquez», from february of 1992 up to december of 2009. There was developed a Predictive Model for BM, owing to some variables identified in uni and multivariate analysis. This model was developed from a «derivation group» and it was contrasted in the «validation group». Results: the variables selected to be included at the predictive model were: 1) Toxic appearance, 2) Seizures in the course of the illness, 3) positive CF Gram stain, 4) Polymorphonuclear leukocytes proportion in CF >80%, and 5) CF glucose concentration

  5. Meningitis aséptica concurrente con infección del tracto urinario en recién nacidos / Aseptic meningitis concomitant with urinary tract infection in newborns

    Scientific Electronic Library Online (English)

    Manuel, Díaz Álvarez; Luena, Cárdenas González.

    2011-06-01

    Full Text Available INTRODUCCIÓN. Trabajos publicados recientemente han destacado el hallazgo de meningitis aséptica (MA) en lactantes pequeños, concomitante con infección del tracto urinario (ITU). El objetivo de esta investigación fue determinar la frecuencia de tal presentación. MÉTODOS. Se realizó un estudio descri [...] ptivo, retrospectivo que incluyó a 626 recién nacidos con ITU, ingresados en el Hospital Pediátrico Universitario «Juan Manuel Márquez» entre febrero de 1992 y diciembre de 2008, y a quienes se les realizó una punción lumbar. Se comparó la frecuencia de MA e ITU con los informes documentados en la literatura médica. RESULTADOS. La frecuencia de MA concomitante con ITU fue del 7,0 % (IC 95 %: 4,9-9,1 %). Los resultados promedio del examen citoquímico del líquido cefalorraquídeo mostraron que la pleocitosis fue el indicador más notable entre los que comúnmente se miden. La frecuencia encontrada fue similar a la de los informes internacionales. CONCLUSIONES. Es llamativa la incidencia de MA concomitante con ITU en los recién nacidos y en concordancia con lo reportado internacionalmente. La concomitancia de MA e ITU puede ser multifactorial, y es posible que se presenten factores causales en algunos pacientes, o casuales en otros casos. Abstract in english INTRODUCTION. Papers recently published have emphasized the finding of the aseptic meningitis (AM) in small infants, concomitant with a urinary tract infection (UTI). The aim of present research was to determine the frequency of this type of presentation. METHODS. A retrospective and descriptive stu [...] dy was conducted including 626 newborns presenting with UTI, admitted in the "Juan Manuel Márquez" University Children Hospital between February, 1992 and December, 2008 who underwent a lumbar puncture. The AM and UTI frequency was compared with informed reports in medical literature. RESULTS. The frequency of AM concomitant with UTI was of 7.0% (95% CI. 4,9-9,1%). The mean results of cytochemical examination of cerebrospinal fluid (CSF) showed that pleocytosis was the more remarkable indicator among those usually measured. The frequency found was similar to that of international reports. CONCLUSIONS. It is interesting the incidence of AM concomitant with UTI in newborns and in concordance with that reported at international level. The AM and UTI concomitant feature may be multifactor, and it is possible the presence of causal factors in some patients or casual in other cases.

  6. Reacción paradojal en meningitis tuberculosa: presentación de un caso / Paradoxical reaction in tuberculous meningitis: a case report

    Scientific Electronic Library Online (English)

    Norma E, González; Silvia, Álvarez Ponte.

    2014-12-01

    Full Text Available La afectación del sistema nervioso central es una de las localizaciones extrapulmonares de la tuberculosis con peor pronóstico. El retraso en el diagnóstico y tratamiento es uno de los factores relacionados con mayor tasa de mortalidad y secuelas. Se describe la "reacción paradojal" como un deterior [...] o sintomático de grado variable, durante el tratamiento efectivo de la tuberculosis. El aumento de la resistencia del Mycobacterium tuberculosis a fármacos observado en los últimos años genera mayor preocupación ante la aparición de una reacción paradojal durante el tratamiento. Se presenta el caso de un niño con meningitis tuberculosa que, luego de un mes de tratamiento, presentó empeoramiento clínico y nuevas lesiones en la tomografía y resonancia magnética nuclear de cerebro. Se excluyeron patologías asociadas, se verificó que la toma de medicamentos haya sido supervisada, y la sensibilidad del bacilo a fármacos antituberculosos de primera línea fue confirmada. El paciente no requirió cambios en el esquema de tratamiento antituberculoso y se administraron esteroides para el alivio sintomático. La reacción paradojal durante el tratamiento antituberculoso es infrecuente y debida a una reacción de hipersensibilidad entre el huésped y el bacilo tuberculoso. Cuando aparece, se debe asegurar la efectividad y el cumplimiento del tratamiento administrado. Abstract in english The central nervous system is one of the locations of extrapulmonary tuberculosis with worse prognosis. The delay in diagnosis and treatment is one of the factors associated with higher mortality and sequelae. The "paradoxical reaction" is described as a variable degree of symptomatic deterioration [...] during the effective treatment of tuberculosis. The increased resistance of Mycobacterium tuberculosis to drugs observed in recent years generates greater concern about the emergence of a paradoxical reaction during treatment. The case of a child with tuberculous meningitis that after one month of treatment presented clinical worsening and new lesions in CT and MRI images of the brain is presented. Comorbidities were excluded, it was verified that taking drugs has been monitored, and the sensitivity of the bacillus to first-line antituberculosis drugs was confirmed. The patient required no change in the pattern of tuberculosis treatment and steroids were administered for symptomatic relief. The paradoxical reaction during antituberculosis treatment is rare and due to a hypersensitivity reaction between the host and the tuberculous bacillus. When it appears you must ensure the effectiveness and compliance of the treatment.

  7. Meningitis aséptica concurrente con infección del tracto urinario en recién nacidos Aseptic meningitis concomitant with urinary tract infection in newborns

    Directory of Open Access Journals (Sweden)

    Manuel Díaz Álvarez

    2011-06-01

    Full Text Available INTRODUCCIÓN. Trabajos publicados recientemente han destacado el hallazgo de meningitis aséptica (MA en lactantes pequeños, concomitante con infección del tracto urinario (ITU. El objetivo de esta investigación fue determinar la frecuencia de tal presentación. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo que incluyó a 626 recién nacidos con ITU, ingresados en el Hospital Pediátrico Universitario «Juan Manuel Márquez» entre febrero de 1992 y diciembre de 2008, y a quienes se les realizó una punción lumbar. Se comparó la frecuencia de MA e ITU con los informes documentados en la literatura médica. RESULTADOS. La frecuencia de MA concomitante con ITU fue del 7,0 % (IC 95 %: 4,9-9,1 %. Los resultados promedio del examen citoquímico del líquido cefalorraquídeo mostraron que la pleocitosis fue el indicador más notable entre los que comúnmente se miden. La frecuencia encontrada fue similar a la de los informes internacionales. CONCLUSIONES. Es llamativa la incidencia de MA concomitante con ITU en los recién nacidos y en concordancia con lo reportado internacionalmente. La concomitancia de MA e ITU puede ser multifactorial, y es posible que se presenten factores causales en algunos pacientes, o casuales en otros casos.INTRODUCTION. Papers recently published have emphasized the finding of the aseptic meningitis (AM in small infants, concomitant with a urinary tract infection (UTI. The aim of present research was to determine the frequency of this type of presentation. METHODS. A retrospective and descriptive study was conducted including 626 newborns presenting with UTI, admitted in the "Juan Manuel Márquez" University Children Hospital between February, 1992 and December, 2008 who underwent a lumbar puncture. The AM and UTI frequency was compared with informed reports in medical literature. RESULTS. The frequency of AM concomitant with UTI was of 7.0% (95% CI. 4,9-9,1%. The mean results of cytochemical examination of cerebrospinal fluid (CSF showed that pleocytosis was the more remarkable indicator among those usually measured. The frequency found was similar to that of international reports. CONCLUSIONS. It is interesting the incidence of AM concomitant with UTI in newborns and in concordance with that reported at international level. The AM and UTI concomitant feature may be multifactor, and it is possible the presence of causal factors in some patients or casual in other cases.

  8. Anomalous origin of right coronary artery from pulmonary artery

    OpenAIRE

    Gupta, Rajat; Marwah, Ashutosh; Shrivastva, Savitri

    2012-01-01

    Anomalous origin of coronary artery from the pulmonary artery is a rare anomaly that most frequently involves the left coronary artery and very rarely the right coronary artery. These lesions can be missed on echocardiography unless carefully looked for. We describe a case of isolated anomalous origin of right coronary artery from pulmonary artery diagnosed on echocardiography and confirmed by computed tomography (CT) angiography.

  9. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... During carotid endarterectomy: You receive general anesthesia . You are asleep and pain-free. Some hospitals use local anesthesia instead. Only ...

  10. Peripheral Artery Disease

    Science.gov (United States)

    ... In P.A.D., the arteries that carry oxygenated blood throughout the body become narrowed or even ... artery. Catheter-directed Thrombolysis : In this minimally invasive treatment, an interventional radiologist uses a catheter to reach ...

  11. Radial Artery Catheterization

    Science.gov (United States)

    ... by Shah, P. B. Related Content Load related Internet Resources information Social ... of Radial Artery Catheterization The Radial Artery Catheterization Procedure Risks of Radial Catheterization Deciding Between the Radial and ...

  12. Coronary Artery Disease

    Science.gov (United States)

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  13. Coronary Artery Bypass

    Science.gov (United States)

    ... procedures performed each year in the United States. Arteries can become clogged over time by the buildup ... bypass" around a section of clogged or diseased artery. The surgery involves using a section of blood ...

  14. Acute Arterial Emergencies

    OpenAIRE

    Dagnone, L. E.; Brown, P. M.

    1983-01-01

    The response of the primary care physician in the initial assessment and management of acute arterial injuries will often be the deciding factor in survival of life, limb or organ system. Most arterial emergencies occur as a result of trauma, disruption of vessel wall and/or occlusion of flow. The common clinical syndromes of acute arterial emergencies are injuries to and beyond the aorta, acute aortic dissection, ruptured aortic aneurysm, and thromboembolic occlusive arterial disease. The ro...

  15. Influence of ecologic factors on prevalence of meningeal worm (parelaphostrongylus tenuis) infection in South dakota, USA.

    Science.gov (United States)

    Jacques, Christopher N; Jenks, Jonathan A; Grovenburg, Troy W; Klaver, Robert W; Dubay, Shelli A

    2015-04-01

    The meningeal worm (Parelaphostrongylus tenuis) is a nematode parasite that commonly infects white-tailed deer (Odocoileus virginianus; WTD) throughout the deciduous forest biome and deciduous-coniferous ecotone of eastern and central North America; the species is not known to occur west of the grassland biome of central North America. We used county-specific prevalence data to evaluate potential effects of landscape and climatologic factors on the spatial distribution of meningeal worm infection in South Dakota, US. Probability of infection increased 4-fold between eastern and western South Dakota and 1.3-fold for each 1-cm increase in summer precipitation. Sixty-three percent of WTD had only a single worm in the cranium. Expansion of meningeal worm infection across western South Dakota may be inherently low due to the combined effects of arid climate and potential attributes of the Missouri River that limit regional movements by infected WTD. Use of landscape genetic analyses to identify potential relationships between landscape features and population genetic structure of infected deer and parasites may contribute to a greater understanding of regional heterogeneity in meningeal worm infection rates across South Dakota, particularly in counties adjacent to the Missouri River. Future research evaluating heterogeneity in prevalence and intensity of infection between fawn and yearling deer, and the potential role of yearling male deer as dispersal agents of meningeal worms across the Missouri River, also is warranted. PMID:25588013

  16. Contrast-enhanced FLAIR in the early diagnosis of infectious meningitis

    International Nuclear Information System (INIS)

    We investigated the accuracy of MRI in the early diagnosis of infectious meningitis with emphasis on the value of gadolinium-enhanced fluid-attenuated inversion recovery (FLAIR) sequence. Twenty-seven patients with clinical suspicion of infectious meningitis were included. MRI was performed within 3 h of clinical evaluation. For all patients, T1-weighted spin-echo, dual-echo T2-weighted fast-spin-echo and FLAIR sequences were performed, followed by gadolinium-enhanced T1-weighted spin-echo and FLAIR sequences. Final diagnosis was based on the clinical findings and the analysis of cerebrospinal fluid, obtained by lumbar puncture after the MRI. Infectious meningitis was confirmed in 12 patients. In all of these patients of the plain studies, FLAIR was positive in only four patients. MRI gadolinium-enhanced FLAIR showed abnormal meningeal enhancement in all 12 patients, while gadolinium-enhanced T1-weighted spin-echo was positive only in six cases. There were no false-positive or false-negative results. It is concluded that MRI could have an important role in the early screening for infectious meningitis, provided a gadolinium-enhanced FLAIR sequence is used. (orig.)

  17. Genomic pneumococcal load and CSF cytokines are not related to outcome in Malawian adults with meningitis

    Science.gov (United States)

    Wall, Emma C.; Gritzfeld, Jenna F.; Scarborough, Matthew; Ajdukiewicz, Katherine M.B.; Mukaka, Mavuto; Corless, Caroline; Lalloo, David G.; Gordon, Stephen B.

    2014-01-01

    Summary Objective Bacterial meningitis in sub-Saharan Africa is predominantly caused by Streptococcus pneumoniae, is often associated with HIV co-infection and mortality rates are double those seen in better resourced settings. Methods To investigate the cause of this excessive mortality we quantified the pneumococcal DNA load and six common pro-inflammatory cytokines in the cerebrospinal fluid (CSF) of Malawian adults with culture proven pneumococcal meningitis and correlated the results to clinical parameters and outcome. There are currently no published data relating bacterial load to outcome in adults with pneumococcal meningitis. Results The mean age of patients was 32 years, 82% were HIV infected and 49% had died by day 40. CSF bacterial loads were high (median 6.5 × 105 copies/ml CSF) and there was no significant variation in bacterial load between survivors and non-survivors. All pro-inflammatory CSF cytokines were elevated in the CSF, with no clinically important differences between survivors and non-survivors. HIV status did not affect the CSF bacterial load or cytokine response. Conclusion Mortality from pneumococcal meningitis in adults in sub-Saharan Africa is not related to pneumococcal bacterial load. More research is needed to understand the very high mortality from meningitis in this region. PMID:24975177

  18. Impact of bacteremia on the pathogenesis of experimental pneumococcal meningitis : Journal of Infectious Diseases

    DEFF Research Database (Denmark)

    Brandt, C.T.; Holm, D.

    2008-01-01

    Background. Bacteremia plays a major role in the outcome of pneumococcal meningitis. This experimental study investigated how bacteremia influences the pathophysiologic profile of the brain. Methods. Rats with Streptococcus pneumoniae meningitis were randomized to 1 of 3 groups of infected study rats: (1) rats with attenuated bacteremia resulting from intravenous injection of serotype-specific pneumococcal antibody, (2) rats with early-onset bacteremia resulting from concomitant intravenous infection, or (3) a meningitis control group. The blood-brain barrier (BBB) breakdown, ventricle size, brain water distribution, and brain pathologic findings were analyzed using magnetic resonance morphological and functional imaging. Laboratory data and clinical disease scores were obtained. Results. Attenuation of the bacteremic component of pneumococcal meningitis improved clinical disease symptoms and significantly reduced ventricle expansion and BBB breakdown (P <.05). Early-onset bacteremia did not further increase ventricle size or BBB leakage. Significantly increased brain edema developed among rats with both attenuated and early-onset bacteremia (P <.05). Focal brain pathologic findings were unaffected by bacteremia and were found to be associated with cerebrospinal fluid inflammation. Conclusion. Although brain lesions appear to result from local meningeal infection, systemic infection significantly contributes to clinical disease presentation and the pathophysiology of BBB breakdown and ventricle expansion. The different end points affected by the systemic and local infectious processes should be addressed in future studies. © 2008 by the Infectious Diseases Society of America. All rights reserved.

  19. Evidence that meningeal mast cells can worsen stroke pathology in mice.

    Science.gov (United States)

    Arac, Ahmet; Grimbaldeston, Michele A; Nepomuceno, Andrew R B; Olayiwola, Oluwatobi; Pereira, Marta P; Nishiyama, Yasuhiro; Tsykin, Anna; Goodall, Gregory J; Schlecht, Ulrich; Vogel, Hannes; Tsai, Mindy; Galli, Stephen J; Bliss, Tonya M; Steinberg, Gary K

    2014-09-01

    Stroke is the leading cause of adult disability and the fourth most common cause of death in the United States. Inflammation is thought to play an important role in stroke pathology, but the factors that promote inflammation in this setting remain to be fully defined. An understudied but important factor is the role of meningeal-located immune cells in modulating brain pathology. Although different immune cells traffic through meningeal vessels en route to the brain, mature mast cells do not circulate but are resident in the meninges. With the use of genetic and cell transfer approaches in mice, we identified evidence that meningeal mast cells can importantly contribute to the key features of stroke pathology, including infiltration of granulocytes and activated macrophages, brain swelling, and infarct size. We also obtained evidence that two mast cell-derived products, interleukin-6 and, to a lesser extent, chemokine (C-C motif) ligand 7, can contribute to stroke pathology. These findings indicate a novel role for mast cells in the meninges, the membranes that envelop the brain, as potential gatekeepers for modulating brain inflammation and pathology after stroke. PMID:25134760

  20. [Bacterial meningitis in adults: a retrospective multicentric study in Tuscany (Italy)].

    Science.gov (United States)

    Ricciardi, L; Meini, M; Luchi, S; Scasso, A; Corbisiero, R; Mencarelli, M; Cellesi, C; Aquilini, D; Carbonai, S; Paladini, A; Bresci, S; Panunzi, I; Leoncini, F; Trezzi, M; Nencioni, C; Toti, M; Maccanti, O; Pardelli, R; Sani, S; Pippi, L; Esperti, F; Messeri, D; Dionisio, D; Pippi, F; Ble, C; Pienotti, P; Mazzotta, F

    2006-06-01

    The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died. PMID:16891852

  1. Genome-wide identification of Streptococcus pneumoniae genes essential for bacterial replication during experimental meningitis

    DEFF Research Database (Denmark)

    Molzen, T E; Burghout, P

    2010-01-01

    Meningitis is the most serious of invasive infections caused by the Gram-positive bacterium Streptococcus pneumoniae. Vaccines protect only against a limited number of serotypes, and evolving bacterial resistance to antimicrobials impedes treatment. Further insight into the molecular pathogenesis of invasive pneumococcal disease is required in order to enable the development of new or adjunctive treatments and/or pneumococcal vaccines that are efficient across serotypes. We applied genomic array footprinting (GAF) in the search for S. pneumoniae genes that are essential during experimental meningitis. A total of 6,000 independent TIGR4 marinerT7 transposon mutants distributed over four libraries were injected intracisternally into rabbits, and cerebrospinal fluid (CSF) was collected after 3, 9, and 15 h. Microarray analysis of mutant-specific probes from CSF samples and inocula identified 82 and 11 genes mutants of which had become attenuated or enriched, respectively, during infection. The results point to essential roles for capsular polysaccharides, nutrient uptake, and amino acid biosynthesis in bacterial replication during experimental meningitis. The GAF phenotype of a subset of identified targets was followed up by detailed studies of directed mutants in competitive and noncompetitive infection models of experimental rat meningitis. It appeared that adenylosuccinate synthetase, flavodoxin, and LivJ, the substrate binding protein of a branched-chain amino acid ABC transporter, are relevant as targets for future therapy and prevention of pneumococcal meningitis, since their mutants were attenuated in both models of infection as well as in competitive growth in human cerebrospinal fluid in vitro.

  2. Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Kawaguchi, T., E-mail: madarafuebuki@yahoo.co.jp [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Sakurai, K.; Hara, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Muto, M. [Department of Radiology, Okazaki City Hospital, Okazaki, Aichi (Japan); Nakagawa, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Tohyama, J. [Department of Radiology, Toyota-kai Medical Corporation Kariya Toyota General Hospital, Kariya, Aichi (Japan); Oguri, T. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Mitake, S. [Department of Neurology, Tosei General Hospital, Seto-shi, Aichi (Japan); Maeda, M. [Department of Radiology, Mie University School of Medicine, Tsu, Mie (Japan); Matsukawa, N.; Ojika, K. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Shibamoto, Y. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan)

    2012-04-15

    Aim: To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. Materials and methods: The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. Results: The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). Conclusion: Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.

  3. Contrast-enhanced FLAIR in the early diagnosis of infectious meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Splendiani, Alesssandra; Puglielli, Edoardo; Amicis, Rosanna De; Masciocchi, Carlo; Gallucci, Massimo [University of L' Aquila, Department of Radiology, L' Aquila (Italy); Necozione, Stefano [University of L' Aquila, Department of Statistic, L' Aquila (Italy)

    2005-08-01

    We investigated the accuracy of MRI in the early diagnosis of infectious meningitis with emphasis on the value of gadolinium-enhanced fluid-attenuated inversion recovery (FLAIR) sequence. Twenty-seven patients with clinical suspicion of infectious meningitis were included. MRI was performed within 3 h of clinical evaluation. For all patients, T1-weighted spin-echo, dual-echo T2-weighted fast-spin-echo and FLAIR sequences were performed, followed by gadolinium-enhanced T1-weighted spin-echo and FLAIR sequences. Final diagnosis was based on the clinical findings and the analysis of cerebrospinal fluid, obtained by lumbar puncture after the MRI. Infectious meningitis was confirmed in 12 patients. In all of these patients of the plain studies, FLAIR was positive in only four patients. MRI gadolinium-enhanced FLAIR showed abnormal meningeal enhancement in all 12 patients, while gadolinium-enhanced T1-weighted spin-echo was positive only in six cases. There were no false-positive or false-negative results. It is concluded that MRI could have an important role in the early screening for infectious meningitis, provided a gadolinium-enhanced FLAIR sequence is used. (orig.)

  4. Expression of c-fos-like immunoreactivity in brainstem after meningeal irritation by blood in the subarachnoid space.

    Science.gov (United States)

    Nozaki, K; Boccalini, P; Moskowitz, M A

    1992-08-01

    The expression of c-fos protein was examined by immunohistochemistry in serial sections of brainstem following the instillation of either autologous arterial blood (0.3 ml) or mock cerebrospinal fluid (0.3 ml) through a catheter placed in the cisterna magna, or following catheter placement alone in pentobarbital-anesthetized Sprague-Dawley rats. After injection, blood was distributed within the subarachnoid space surrounding the brainstem and in the region of the circle of Willis. c-fos protein-like immunoreactivity was present at 1 h, peaked at 2 h and decreased by 8 h. At 2 h, immunoreactivity was strongly expressed within trigeminal nucleus caudalis (lamina I, IIo), as well as within nucleus of the solitary tract, area postrema, ependyma, pia mater and arachnoid in every animal. Moderate labeling was found in parabrachial nucleus, medullary lateral reticular nucleus and central gray. Sparse labeling was present in trigeminal nucleus caudalis (lamina III-V) and trigeminal nucleus interpolaris; few or no labeled cells were detected in other parts of the trigeminal nuclear complex, thalamus, cerebral cortex, cerebellar cortex or trigeminal ganglion. The number of positive cells was not related to the volume of injectate but was related to the amount of injected blood. The density of cell labeling evoked by injecting mock cerebrospinal fluid or after catheter placement was markedly lower than after blood in all brainstem areas. The number of labeled cells was greatly reduced within trigeminal nuclear complex, parabrachial nucleus and medullary lateral reticular nucleus, but not within the nucleus of the solitary tract, area postrema or ependyma when blood was injected into adult animals in which unmyelinated C-fibers were destroyed by neonatal capsaicin treatment. Similar results were obtained after blood was instilled into the cisterna magna of rats in which meningeal afferents were chronically sectioned at the ethmoidal foramen bilaterally. We conclude that blood in the subarachnoid space is an effective stimulus for activating c-fos expression within subpopulations of brainstem neurons. Activation within trigeminal nucleus caudalis is mediated in large part by excitation of small-caliber meningeal afferents (trigeminovascular fibers), whereas c-fos expression within nucleus of the solitary tract and area postrema may reflect direct stimulation of blood or blood products, or possibly the response to autonomic activation from noxious stimulation.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1501769

  5. Categorías de riesgo de meningitis bacteriana y tratamiento con antibióticos en neonatos con pleocitosis del líquido cefalorraquídeo / Categories of bacterial meningitis risk and antibiotic treatment for neonates with cerebrospinal fluid pleocytosis

    Scientific Electronic Library Online (English)

    Manuel, Díaz Álvarez.

    2014-06-01

    Full Text Available Introducción: recientemente se desarrolló y validó el Modelo de Predicción de Meningitis Bacteriana Neonatal, lo cual provee de una herramienta efectiva en la toma de decisiones médicas para la indicación de tratamiento antibiótico ante un neonato con pleocitosis del líquido cefalorraquídeo. Objetiv [...] o: conocer cómo se procedió retrospectivamente con la indicación de tratamiento antibiótico en neonatos con pleocitosis del líquido cefalorraquídeo, antes de desarrollar el modelo mencionado, y fortalecer y fundamentar una estrategia del tratamiento antibiótico, basados en nuestro Modelo de Predicción de Meningitis Bacteriana Neonatal, ante un neonato con pleocitosis del líquido cefalorraquídeo. Métodos: estudio retrospectivo y aplicado, que incluyó 290 neonatos evaluados por probable infección, 44 con meningitis bacteriana y 246 con meningitis aséptica, ingresados en el Servicio de Neonatología del Hospital Pediátrico "Juan Manuel Márquez", entre febrero/1992 y diciembre/2009. Se verificó la efectividad del Modelo de Predicción de Meningitis Bacteriana Neonatal, lo que permitió clasificar los pacientes en alto o bajo riesgo de meningitis bacteriana. Se determinó retrospectivamente la indicación y los motivos de tratamiento antibiótico ante un neonato con pleocitosis del líquido cefalorraquídeo, así como análisis de asociación para distintas circunstancias clínicas, entre ellas, la clasificación de riesgo de infección bacteriana severa. Resultados: se precisó que el Modelo de Predicción de Meningitis Bacteriana Neonatal tuvo una sensibilidad y valor predictivo negativo de 100 % para meningitis bacteriana. Hubo concordancia estadísticamente significativa entre la predicción por el modelo y la clasificación de riesgo de infección bacteriana severa. Se comprobó un uso racional del tratamiento antibiótico, pues se utilizó de inmediato al diagnóstico de meningitis bacteriana en 100 % de los casos, y solo en una cuarta parte de los neonatos con meningitis aséptica, identificando como causas principales de indicación en estos casos con meningitis aséptica, tener resultados del examen del líquido cefalorraquídeo sospechosos de meningitis bacteriana sin calificar como positivos por el modelo, y hallazgos positivos para alto riesgo por los criterios de riesgo de infección bacteriana severa. Conclusiones: la indicación de tratamiento antibiótico ha sido bastante racional, pero en algunos casos innecesario. El modelo propuesto facilita y fundamenta la indicación de tratamiento antibiótico solo cuando existe un alto riesgo de meningitis bacteriana, y también limitar con confianza su uso cuando la predicción es de bajo riesgo de meningitis bacteriana, aunque puede haber situaciones clínicas excepcionales que lo justifiquen de manera transitoria. Abstract in english Introduction: recently, the neonatal bacterial meningitis predicting model was developed and validated, which provides an effective tool in medical decision-making to prescribe antibiotic treatment to neonates with cerebrospinal fluid pleocytosis. Objective: to find out retrospectively the procedure [...] to indicate the antibiotic treatment for neonates with cerebrospinal fluid pleocytosis prior to the development of the stated model, and to strengthen and substantiate an antibiotic treatment strategy, based on our neonatal bacterial meningitis prediction model of a newborn with cerebrospinal fluid pleocytosis. Methods: retrospective and implemented study of 290 neonates with probable infection; 44 had bacterial meningitis and 246 aseptic meningitis. They were all admitted to the neonatology service of "Juan Manuel Marquez" pediatric hospital from February 1992 to December 2009. The effectiveness of the neonatal bacterial meningitis prediction model was verified, which allowed classifying the patients into high or low bacterial meningitis risk. The indication and the reasons for antibiotic treatment of a neonate with cerebrospinal fluid pleocytosis were retrospectively determined, as well a

  6. Characteristics of tuberculous meningitis in HIV-infected patients

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    A Hristea

    2012-11-01

    Full Text Available Background: Tuberculous meningitis (TBM has a substantial mortality even with anti-tuberculous treatment, in HIV-non-infected patients. Purpose of the study. The objectives were to describe clinical and laboratory differences of TBM in HIV-infected versus HIV non-infected patients and to assess risk factors of death in HIV-infected patients. Methods: We retrospectively analyzed patients admitted to four infectious diseases hospitals in Romania, between 2001 and 2011, with TBM. Patients were defined as having TBM according to a consensus definition published by Marais et al. [1] and further divided into three categories of TBM (definite, probable and possible. Results: We identified 162 patients with TBM of which 47 (29% tested positive for HIV infection. Sixty-six patients had definite, 53 probable and 43 possible TBM. Out of the 47 HIV-infected patients 25 had definite, 17 probable and 5 possible TBM. TBM in HIV-infected patients vs. HIV non-infected patients was significantly associated in multivariable analysis with younger age (p=0.01, in-hospital mortality (p<0.001, absence of meningean syndrome (p=0.021, and absence of cranial nerve palsy (p=0.036. HIV-infected patients who died had a median CD4 count of 61 cells/mm3 (IQR 21-132 vs. 135 cells/mm3 (IQR 61–255 in patients who survived (p=0.014. HIV infection was diagnosed before TBM episode in 35 (75% patients. Twenty-four (51% HIV-infected patients had concomitant extra-central nervous system tuberculosis. Conclusions: HIV infection is associated with increased mortality in patients with TBM. Most of our patients with TBM were late presenters. Death in HIV infected patients was associated with a lower median CD4 count.

  7. Importance of differentiating Mycobaterium bovis in tuberculous meningitis

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    Alejandra Gonzàlez-Duarte

    2011-08-01

    Full Text Available The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycoba - cterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortu nately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30% had a neurological infection. Positive cultures were found in 54 (84% cases, 18 (33% in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001 and the presence of M. bovis (P=0.020 were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032 when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis.

  8. Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study

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    Gouveia Edilane L

    2011-11-01

    Full Text Available Abstract Background Prior to the availability of generic third-generation cephalosporins, penicillins were widely used for treatment of pneumococcal meningitis in developing countries despite concerns about rising levels of penicillin resistance among pneumococcal isolates. We examined the impact of penicillin resistance on outcomes of pneumococcal meningitis over a ten year period in an infectious diseases hospital in Brazil. Methods Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 ?g/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes. Results During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17% were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43. Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76. Conclusions Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.

  9. The role of dexamethasone in the treatment of bacterial meningitis - a systematic review

    DEFF Research Database (Denmark)

    Borchorst, S; MØller, K

    2012-01-01

    Corticosteroids are used as an adjunct to antibiotics in the treatment of bacterial meningitis in an attempt to attenuate the intrathecal inflammatory response and thereby reduce mortality and morbidity. The purpose of the present paper is to provide a review of clinical studies of corticosteroids in the treatment of bacterial meningitis. Relevant literature was found in PubMed, the Cochrane databases, and references in studies. Forty-four publications of relevance were identified, comprising 29 publications of randomised studies, 10 publications reporting either non- or quasi-randomised studies, and five reporting retrospective studies, and nine meta-analyses. Taken together, dexamethasone treatment may be associated with a lower mortality in adults and fewer neurological and auditory sequelae in adults and children from high-income countries, in particular in adults suffering from pneumococcal meningitis. In contrast, studies conducted in developing countries have yielded less favourable results.

  10. Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review

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    Komagamine Tomoko

    2012-09-01

    Full Text Available Abstract Background Kikuchi Fujimoto disease (KFD, or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge. Case presentation We report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient’s headache and lymphadenopathy spontaneously resolved without any sequelae. Conclusions A diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.

  11. [Neonatal group A streptococcal meningitis and portal vein thrombosis: a casual association?].

    Science.gov (United States)

    Hmami, F; Oulmaati, A; Mahmoud, M; Boubou, M; Tizniti, S; Bouharrou, A

    2014-09-01

    Invasive group A streptococcal infections are potentially serious. The occurrence in the neonatal period and meningeal location are two unusual situations. The complications reported in the literature vary; we add the risk of thromboembolic events. We report the case of a newborn, admitted to our department at 22 days of life for late neonatal group A streptococcal meningitis and diffuse cerebral infarction lesions. Ultrasound and abdominal CT scan objectified the presence of portal vein thrombosis and cavernoma. Echocardiography, electrocardiogram, as well as coagulation and thrombophilia tests were normal. Progression was marked by the installation of cerebral atrophy and ventricular dilation without the appearance of signs of portal hypertension over 18 months. We therefore concluded in neonatal group A streptococcal meningitis complicated by multiple thrombosis that can be explained by the invasive properties and hypercoagulability characterizing group A beta-hemolytic streptococcus. However, the characteristics of the fetal circulation may explain the possibility of paradoxical cerebral embolism from portal thrombosis. PMID:25089040

  12. Incidence of tuberculous meningitis in the State of Santa Catarina, Brazil

    Scientific Electronic Library Online (English)

    Cíntia Helena, de Souza; Ayaka, Yamane; Jeison Cleiton, Pandini; Luciane Bisognin, Ceretta; Fabiane, Ferraz; Glauco Duarte, da Luz; Priscyla Waleska, Simões.

    2014-07-01

    Full Text Available Introduction The aim of this study was to estimate the incidence of tuberculous meningitis in the State of Santa Catarina (SC), Brazil, during the period from 2001 to 2010. Methods Ecological, temporal, and descriptive methods were employed using data obtained from the Information System on Diseas [...] e Notification (Sistema de Informação de Agravos de Notificação). Results One hundred sixteen reported cases of tuberculous meningitis occurred from 2001 to 2010, corresponding to 1.2% (0.2 cases/100,000 inhabitants) of all meningitis cases reported in SC. There was a predominance of new cases in males, corresponding to 56.9% of new cases (0.2 cases/100,000 inhabitants; males vs. females; p=0.374), in patients aged 20-39 years, corresponding to 52.6% of new cases (0.5 cases/100,000 inhabitants; 20-39 years versus others; p

  13. Laboratory surveillance of viral meningitis by examination of cerebrospinal fluid in Cape Town, 1981-9.

    Science.gov (United States)

    McIntyre, J P; Keen, G A

    1993-10-01

    Nine years accumulated laboratory data derived from the culture of the cerebrospinal fluid of 11,360 aseptic meningitis cases were retrospectively reviewed to establish the epidemiology of viral meningitis in Cape Town. Virus was isolated from 3406 of the cases (91% enteroviruses and 9% mumps). Five major summer viral meningitis episodes were documented: two of echovirus 4 (706 and 445 cases), echovirus 9 (223), coxsackie A9 (104) and one of unidentified enterovirus (324 cases--probably echo 9). Although coxsackie B was endemic, clusters of one or other type were dominant at any one time. Mumps was endemic. Sixty-two percent of all viral cases were dominated overall, particularly in mumps. PMID:8405162

  14. Detección precoz de afectación neurosensorial en niños convalecientes de meningitis bacteriana

    Scientific Electronic Library Online (English)

    Eric, Martínez Torres; Bárbara, Bertot Acosta; María Cecilia, Pérez Avalos; Maritza, Perera González; Martha, Moroño Guerrero.

    1995-04-01

    Full Text Available Se estudiaron 100 pacientes entre 2 meses y 2 años de edad que sufrieron meningitis bacteriana aguda. Se les realizó examen neuropediátrico, pruebas psicométricas y potenciales evocados auditivos de tallo cerebral. Treinta y siete niños tuvieron resultados anormales. Se encontró pérdida auditiva sen [...] sorineural en 15, conductiva en 11 y otra afectación neurológica (retardo psicomotor, espasticidad, paresias) en 11. La incidencia de exámenes anormales fue significativamente más allá en el grupo de convalecientes de meningitis, con respecto a otros egresados de terapia intensiva. La edad menor de 6 meses fue el factor (considerado en forma aislada) que se asoció con mayor frecuencia a afectación residual. El germen causal, el sexo y las complicaciones durante la meningitis no fueron significativas. La combinación de métodos clínicos con métodos de laboratorio de neurofisiología permitió identificar a un grupo de niños en riesgo de secuela neurosensorial, mucho mayor que el obtenido por cada uno por separado.

  15. Meningitis and stridor in advanced Human immunodeficiency virus/acquired immune deficiency syndrome

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    Naidoo P

    2013-09-01

    Full Text Available P Naidoo, D Pillay, S SamanDepartment of Internal Medicine, Port Shepstone Regional Hospital, University of KwaZulu-Natal, South AfricaAbstract: A 37-year-old female presented confused with a preceding history of severe headache. After clinical examination and investigations, she was diagnosed with disseminated tuberculosis (including central nervous system involvement, and Human immunodeficiency virus/acquired immune deficiency syndrome. Her hospital stay was complicated. She developed stridor and a cerebrovascular accident with left hemiplegia. She died approximately 2 weeks after admission. The potential causes of her stridor included a mediastinal mass or a central mechanism secondary to tuberculosis meningitis. Limited resources precluded definitive imaging of the chest to rule out a mediastinal mass. Further, an autopsy was not done. Despite these limitations, this case is unique because it reports the presence of both stridor and tuberculosis meningitis in an adult patient.Keywords: Human immunodeficiency virus, acquired immune deficiency syndrome, meningitis, stridor, tuberculosis

  16. Detección precoz de afectación neurosensorial en niños convalecientes de meningitis bacteriana

    Directory of Open Access Journals (Sweden)

    Eric Martínez Torres

    1995-04-01

    Full Text Available Se estudiaron 100 pacientes entre 2 meses y 2 años de edad que sufrieron meningitis bacteriana aguda. Se les realizó examen neuropediátrico, pruebas psicométricas y potenciales evocados auditivos de tallo cerebral. Treinta y siete niños tuvieron resultados anormales. Se encontró pérdida auditiva sensorineural en 15, conductiva en 11 y otra afectación neurológica (retardo psicomotor, espasticidad, paresias en 11. La incidencia de exámenes anormales fue significativamente más allá en el grupo de convalecientes de meningitis, con respecto a otros egresados de terapia intensiva. La edad menor de 6 meses fue el factor (considerado en forma aislada que se asoció con mayor frecuencia a afectación residual. El germen causal, el sexo y las complicaciones durante la meningitis no fueron significativas. La combinación de métodos clínicos con métodos de laboratorio de neurofisiología permitió identificar a un grupo de niños en riesgo de secuela neurosensorial, mucho mayor que el obtenido por cada uno por separado.

  17. Meningitis and bacteremia due to Bacillus cereus. A case report and a review of Bacillus infections.

    Science.gov (United States)

    Siegman-Igra, Y; Lavochkin, J; Schwartz, D; Konforti, N

    1983-06-01

    A patient with meningitis and bacteremia due to Bacillus cereus is described. The patient had transsphenoidal hypophysectomy for chromophobe adenoma, complicated by rhinorrhea, which was corrected by subarachnoid drainage. Three weeks after removal of the drain, the patient presented with meningitis and died the following day. The causative organism was identified as B. cereus. The literature on Bacillus infections is reviewed with special attention to severe infections. A modified classification is proposed, dividing infections into superficial, closed-space and systemic ones. Sixty-one previously reported cases of systemic Bacillus infections are reviewed according to type of infection (endocarditis, meningitis or pulmonary infection), and the underlying conditions, ways of acquiring the infection, clinical picture and mortality are discussed. PMID:6408023

  18. Which clinical parameters predict a CSF diagnosis of meningitis in a population with high HIV prevalence?

    Scientific Electronic Library Online (English)

    W, Loughborough; M, Abouyannis; L, Jones; S, Garach.

    2014-02-01

    Full Text Available BACKGROUND: The HIV epidemic has changed the aetiology of meningitis in sub-Saharan Africa, and frontline clinicians are faced with a variety of meningitic presentations. Doctors working in resource-limited settings have the challenge of appropriately selecting patients for lumbar puncture (LP), a p [...] otentially risky procedure that requires laboratory analysis. METHODS: In a rural South African hospital, the practice of performing LPs was audited against local guidelines. Data were collected retrospectively between February and June 2013. Symptoms and signs of meningitis, HIV status, investigations performed prior to LP and cerebrospinal fluid (CSF) results were recorded. With the aim of determining statistically significant clinical predictors of meningitis, parameters were explored using univariate and multivariate logistic regression analyses RESULTS: A total of 107 patients were included, of whom 43% had an abnormal CSF result. The majority (76%) of patients were HIV-positive (CD4+ cell count

  19. Treatment of eosinophilic meningitis with a combination of prednisolone and mebendazole.

    Science.gov (United States)

    Chotmongkol, Verajit; Sawadpanitch, Kookwan; Sawanyawisuth, Kittisak; Louhawilai, Sitichoke; Limpawattana, Panita

    2006-06-01

    To study the efficacy of the combination of prednisolone and mebendazole for the treatment of eosinophilic meningitis, we conducted a pilot study among Thai patients with eosinophilic meningitis. Patients were given a two-week course of prednisolone, 60 mg/day, and mebendazole, 10 mg/kg/day. The primary observation parameter was the number of patients who still had headaches after the two-week course of treatment. Forty-one patients were enrolled in the study. Four (10%) patients still had headaches after the two-week course of treatment and the median length of time until complete disappearance of headaches was three days. Serious side effects were not detected. Treatment for two weeks with the combination regimen of prednisolone and mebendazole is safe and beneficial in relieving headaches in patients with eosinophilic meningitis. PMID:16760531

  20. Jet pump assisted artery

    Science.gov (United States)

    1975-01-01

    A procedure for priming an arterial heat pump is reported; the procedure also has a means for maintaining the pump in a primed state. This concept utilizes a capillary driven jet pump to create the necessary suction to fill the artery. Basically, the jet pump consists of a venturi or nozzle-diffuser type constriction in the vapor passage. The throat of this venturi is connected to the artery. Thus vapor, gas, liquid, or a combination of the above is pumped continuously out of the artery. As a result, the artery is always filled with liquid and an adequate supply of working fluid is provided to the evaporator of the heat pipe.

  1. [Cerebellum abscess: first demonstration of undiagnosed infective endocarditis in an adult with corrected transposition arteries].

    Science.gov (United States)

    Oudghiri, N; Faroudy, M; Mosadik, A; Sbihi, S; Ababou, A; Lazreq, C; Sbihi, A

    2006-01-01

    Neurological complications occur in approximately 30% of all patients with infective endocarditis and represent a major factor associated with an increased mortality rate. Third of these complications is represented by cerebral embolism, followed by mycotic aneurysm, meningitis or meningoencephalitis. Brain abscesses are rare; their localization to the cerebellum is exceptional. A case of cerebellum abscess occurring in a 34-year-old patient with non-operated corrected transposition of the great arteries is reported. Occurrence of this abscess was the first demonstration of undiagnosed infective endocarditis. PMID:16271445

  2. Brain scanning in unilateral and bilateral occlusion of the posterior cerebral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Einsiedel-Lechtape, H.; Lechtape-Grueter, R.

    1977-05-01

    Nineteen patients with unequivocal angiographic evidence of unilateral or bilateral posterior cerebral artery occlusion were scanned during the acute phase of the stroke. In 12 of them an abnormal accumulation of radioactivity was apparent on the posterior view, but only 2 also exhibited abnormal uptake on the corresponding lateral view. The size, shape, and location of the uptake were rather constant and appeared to be almost independent of the site of occlusion and also of a collateral circulation by meningeal anastomoses. Pathological uptake was found with increasing frequency as occlusion occurred farther distally.

  3. Brain scanning in unilateral and bilateral occlusion of the posterior cerebral arteries

    International Nuclear Information System (INIS)

    Nineteen patients with unequivocal angiographic evidence of unilateral or bilateral posterior cerebral artery occlusion were scanned during the acute phase of the stroke. In 12 of them an abnormal accumulation of radioactivity was apparent on the posterior view, but only 2 also exhibited abnormal uptake on the corresponding lateral view. The size, shape, and location of the uptake were rather constant and appeared to be almost independent of the site of occlusion and also of a collateral circulation by meningeal anastomoses. Pathological uptake was found with increasing frequency as occlusion occurred farther distally

  4. Relative Frequency of Echovirus 30 in Patients Suffering From Enterovirus Meningitis in Ahvaz

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    Ali Samarbaf-Zadeh

    2013-04-01

    Full Text Available Background: Human enteroviruses are members of Picornaviridae family; they are non-enveloped, icosahedral viruses with positive RNA as genome. Echovirus 30 is an important member of enteroviruses that is recognized in outbreaks of enterovirus meningitis..Objectives: The aim of this study was to determine relative frequency of echovirus 30 as an important agent of aseptic meningitis among children referred to Aboozar hospital, Ahvaz, Iran..Patients and Methods: 34 cerebrospinal fluid samples from patients with enterovirus aseptic meningitis, negative bacterial culture, WBC (white blood cell count > 5x106/mm3, and aseptic meningitis symptoms were entered in the study. These samples were collected in a year between May 2010 and May 2011. RNA of enteroviruses were extracted and investigated for echovirus 30 infection with RT-PCR (reverse transcription polymerase chain reaction test. Samples also were cultured in RD (rhabdomyosarcoma cell and positive results were approved by RT-PCR test with enterovirus specific primers. To recognize PCR-product, 440 bp RT-PCR product was sequenced and phylogenic tree was drawn based on Neighbor Joining method with 1000 replication bootstrap..Results: Echovirus 30 infection was not detected in any case. Just one CSF sample grew in RD cell culture. This sample was approved by RT-PCR and sequencing. Positive sample was recognized as coxsackie virus B3. .Conclusions: There was no echovirus 30 in Ahvaz because of diverse nature of enteroviruses and several serotypes with various distribution patterns in different geographical regions, and the fact that echovirus 30 is mostly detected in outbreaks rather than endemism. Coxsackie virus B3 was responsible for aseptic meningitis of a child in this study. Based on another study conducted in Tehran, it seems that Coxsackie B viruses are among current agents causing enterovirus aseptic meningitis in Iran. Of course we need to conduct more studies in Ahvaz and other parts of the country to approve this hypothesis.

  5. Non-Polio Enteroviruses Aseptic Meningitis:Embaba Fever Hospital Admissions 2010-2011

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    Raafat A. Abdel-Twab¹, Kouka S. Abdel-Wahab2. Ahmed O. El-Kafrawi3, Moustafa A. Aly3, Laila A. EL-Bassiony4, May EL-Maamoun4, Caroline Fayez5

    2013-07-01

    Full Text Available Human enteroviruses (EV cause a wide spectrum of both common and uncommon illnesses among all age groups. Enterically transmitted. The objective of this study was to identify non-poliovirus EV as a cause of viral aseptic meningitis (VAM by two methods (cell culture and Real time PCR. From October 2010 to August 2011 cerebrospinal fluid (CSF samples were collected from 85 patients Embaba fever hospital admitted with symptoms of aseptic meningitis of any age and both sexes. The 85 CSF samples were inoculated into RD (human rhabdomyosarcoma cell line in three blind passages to amplify isolates producing EV-like CPE. A total of 14 (16.5% out of 85 CSF samples showed EV-like CPE. By Real time PCR 11 out of the 14 culture positive samples and 5 out of the 14 source of virus isolation original CSF were non polio EV positive. The frequency of non-polio EV meningitis hospital admissions was in the summer season (50%, spring (25%, late autumn (16.6% and least frequency in winter (8.4%. non-polio EV meningitis was detected in 6 out of 41 male patients (14.5% and in 6 out of 44 female patients (13.5%. Also non-polio EV meningitis was detected in all ages with marked increase of incidence in young children (41.6% and old age (50% and less in adult (8.4%. . In conclusionOur data showed that the non-polioviruses EV was associated with the majority of VAM during 2010 – 2011 at the Embaba fever hospital which serves Embaba, Shoubra Elkheema, Qualyba and neighbors localities in Egypt. Rapid detection of non-polio EV meningitis is essential for making decisions about patient management and treatment

  6. Evaluation of meningitis surveillance before introduction of serogroup a meningococcal conjugate vaccine - Burkina Faso and Mali.

    Science.gov (United States)

    2012-12-21

    Each year, 450 million persons in a region of sub-Saharan Africa known as the "meningitis belt" are at risk for death and disability from epidemic meningitis caused by serogroup A Neisseria meningitidis. In 2009, the first serogroup A meningococcal conjugate vaccine (PsA-TT) developed solely for Africa (MenAfriVac, Serum Institute of India, Ltd.), was licensed for persons aged 1-29 years. During 2010-2011, the vaccine was introduced in the hyperendemic countries of Burkina Faso, Mali, and Niger through mass campaigns. Strong meningitis surveillance is critical for evaluating the impact of PsA-TT because it was licensed based on safety and immunogenicity data without field effectiveness trials. Case-based surveillance, which includes the collection of epidemiologic and laboratory data on individual cases year-round, is recommended for countries that aim to evaluate the vaccine's impact. A key component of case-based surveillance is expansion of laboratory confirmation to include every case of bacterial meningitis because multiple meningococcal serogroups and different pathogens such as Haemophilus influenzae type b and Streptococcus pneumoniae cause meningitis that is clinically indistinguishable from that caused by serogroup A Neisseria meningitidis. Before the introduction of PsA-TT, evaluations of the existing meningitis surveillance in Burkina Faso and Mali were conducted to assess the capacity for case-based surveillance. This report describes the results of those evaluations, which found that surveillance infrastructures were strong but opportunities existed for improving data management, handling of specimens shipped to reference laboratories, and laboratory capacity for confirming cases. These findings underscore the need to evaluate surveillance before vaccine introduction so that activities to strengthen surveillance are tailored to a country's needs and capacities. PMID:23254257

  7. Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study

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    Reitsma Johannes B

    2006-10-01

    Full Text Available Abstract Background A low cerebrospinal fluid (CSF white-blood cell count (WBC has been identified as an independent risk factor for adverse outcome in adults with bacterial meningitis. Whereas a low CSF WBC indicates the presence of sepsis with early meningitis in patients with meningococcal infections, the relation between CSF WBC and outcome in patients with pneumococcal meningitis is not understood. Methods We examined the relation between CSF WBC, bacteraemia and sepsis in a prospective cohort study that included 352 episodes of pneumococcal meningitis, confirmed by CSF culture, occurring in patients aged >16 years. Results CSF WBC was recorded in 320 of 352 episodes (91%. Median CSF WBC was 2530 per mm3 (interquartile range 531–6983 per mm3 and 104 patients (33% had a CSF WBC 3. Patients with a CSF WBC 3 were more likely to have an unfavourable outcome (defined as a Glasgow Outcome Scale score of 1–4 than those with a higher WBC (74 of 104 [71%] vs. 87 of 216 [43%]; P 3 more often had a positive blood culture (72 of 84 [86%] vs. 138 of 196 [70%]; P = 0.01 and more often developed systemic complications (cardiorespiratory failure, sepsis than those with a higher WBC (53 of 104 [51%] vs. 69 of 216 [32%]; P = 0.001. In a multivariate analysis, advanced age (Odds ratio per 10-year increments 1.22, 95%CI 1.02–1.45, a positive blood culture (Odds ratio 2.46, 95%CI 1.17–5.14, and a low thrombocyte count on admission (Odds ratio per 100,000/mm3 increments 0.67, 95% CI 0.47–0.97 were associated with a CSF WBC 3. Conclusion A low CSF WBC in adults with pneumococcal meningitis is related to the presence of signs of sepsis and systemic complications. Invasive pneumococcal infections should possibly be regarded as a continuum from meningitis to sepsis.

  8. Dust and epidemic meningitis in the Sahel: A public health and operational research perspective

    International Nuclear Information System (INIS)

    Now that the health communities attention is increasingly focused on climate-health interactions, it has become essential for health decision makers to better understand the role that climate plays in driving disease burdens and health outcomes (both now and in the future) and the opportunity for integrating climate knowledge and information into health decision-making processes to mitigate the negative and strengthen the positive of climate-health interactions. Here we explore the potential climatic indicators and the climate information needs of relevance to the meningitis prevention and control community engaged in the African 'meningitis belt'.

  9. Repeat Lumbar Puncture: CSF Lactic Acid Levels are Predictive of Cure with Acute Bacterial Meningitis

    Directory of Open Access Journals (Sweden)

    Burke A. Cunha

    2013-12-01

    Full Text Available A common clinical problem concerns the utility of repeat lumbar puncture (LP in adults with acute bacterial meningitis (ABM, e.g., pneumococcal meningitis [1]. An LP is initially done for diagnostic purposes in patients with suspected ABM, i.e., diagnostic lumbar puncture (DLP. A repeat LP (RLP may be done 1–3 days after the initial DLP, if the patient shows no improvement. If a patient with ABM is not doing well after three days, adequacy of antimicrobial therapy is the main concern. Other reasons for RLP is to detect possible intracranial complications of ABM unrelated to adequacy of therapy [1–2].

  10. Chronic meningitis by histoplasmosis: report of a child with acute myeloid leukemia

    Scientific Electronic Library Online (English)

    G.H., Pereira; S.S., Pádua; M.V.F., Park; R.P., Muller; R.M.A., Passos; Y., Menezes.

    2008-12-01

    Full Text Available Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high [...] as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

  11. Dust and epidemic meningitis in the Sahel: A public health and operational research perspective

    Energy Technology Data Exchange (ETDEWEB)

    Thomson, M C [International Research Institute for Climate and Society, Palisades, NY (United States); Jeanne, I [CERMES/Reseau International des Instituts Pasteur, BP 10 887 Niamey (Niger); Djingarey, M [WHO-Multi-Disease Surveillance Centre, Ougadougou (Burkina Faso)], E-mail: mthomson@iri.columbia.edu

    2009-03-01

    Now that the health communities attention is increasingly focused on climate-health interactions, it has become essential for health decision makers to better understand the role that climate plays in driving disease burdens and health outcomes (both now and in the future) and the opportunity for integrating climate knowledge and information into health decision-making processes to mitigate the negative and strengthen the positive of climate-health interactions. Here we explore the potential climatic indicators and the climate information needs of relevance to the meningitis prevention and control community engaged in the African 'meningitis belt'.

  12. Bacterial meningitis Meningitis bacateriana aguda en niños: estudio clínico y bacteriológico en el Hospital Infantil de Medellín

    Directory of Open Access Journals (Sweden)

    Daniel Hoyos

    1988-02-01

    Full Text Available

     

    Between aprl13, 1984 and march 31,1986,95  children with acute bacterial meningitis (ABM were admitted to Hospital lnfantil, Medellín, Colombia. 68 (71.6% were under two years old. Haemophifus influenza  type B was the predominant microorganism (41%, followed by Streptococcus pneumoniae (27.4%, enterobacteriaceae (15.8%, Neisseria meningitidis (4.2%, Staphylococcus aureus (3.2% and betahemolytlc streptococci (2.1%. One case produced by Streptococcus agalactiae was the first one in our Hospital and another one due to Shigella was the first one in Colombia. Bacterial origin was confirmed in 93.7% of the cases, employing direct examination, cultures and counter immuno electrophoresis. The most frequent clinical manifestations were: fever, vomit, irritability, meningeai irritation and seizures; the younger the patient the most severe the clinical picture. Those with persistent focal seizures showed cerebral infarction, subdural effusion, ventricular dilatation or a combination of them. Mortality was 19%; sequelae were observed in 26% (seizure, motor deficit and deafness; Haemophilus influenzae resistance to ampicilin was observed for the first time in this institution. We suggest modifications in the initial therapeutic approach and recommend the suppression of the routine pre-discharge lumbar puncture.

    Entre abril 3 de 1984 y marzo 31 de 1986, se estudiaron 95 niños que ingresaron al Hospital Infantil de Medellín con el diagnóstico de meningitis bacteriana aguda (MBA; 68 de ellos fueron menores de 2 años (71.6%; el HaemophiIus influenzae tipo e fue el germen predominante (41.0%; le siguieron el Streptococcus pneumoniae (27.4%, las enterobacterias (15.8%, la Neisseriameningitidis (4.2%, el Staphylococcus aureus (3.2% y estreptococos beta hemoifticos (2.1%; uno de éstos fue Streptococcus agalactiae y correspondió al primer caso de MBA descrito en Medellín por tal microorganismo; igualmente, se halló el primer caso colombiano de MBA por Shigella La fiebre, el vómito, la irritabilidad, los signos de irritación meníngea y las convulsiones, fueron las manifestaciones más frecuentes; en general el cuadro clínico fue más severo y mayores las complicaciones mientras menor fuera el paciente; los pacientes con convulsiones persistentes de predominio focal tenían, por lo general, infarto cerebral, derrame subdural, dilatación ventricular o una combinación de los mismos. El origen bacteriano del padecimiento se pudo comprobar en 89 pacientes (93.7% mediante una combinación de exámenes directos, cultivos y contra inmunoelectroforesis. La mortalidad general fue de 19.0%; de otro lado el 26.0% de los pacientes quedó con secuelas tales como convulsiones, déficit motor y sordera. Por primera vez se comprobó en este Hospital resistencia del H. influenza a la ampicilina (3 de las 26 cepas estudiadas. Con base en éste y los demás hallazgos se recomiendan modificaciones al esquema terapéutico Inicial de la MBA y la supresión de la punción lumbar final rutinaria.

  13. Meningitis tuberculosa: claves para su diagnóstico y propuestas terapéuticas / Tuberculous meningitis: tips for diagnosis and proposals for treatment

    Scientific Electronic Library Online (English)

    Martín, Lasso B.

    2011-06-01

    Full Text Available El diagnóstico de la meningitis tuberculosa (MTBC) es siempre un desafío. Debemos dar importancia a las manifestaciones clínicas y su duración. El análisis citoquímico del LCR tiene características propias y debe ser controlado varias veces durante el tratamiento. La adenosin deami-nasa con punto de [...] corte > 15 UI/mL y la RPC para M. tuberculosis en LCR son las pruebas más relevantes. Las imágenes aportan elementos valiosos pero no establecen el diagnóstico por si solas. A futuro se puede estructurar un puntaje con todos estos elementos para apoyar al clínico en el proceso diagnóstico. El tratamiento de la MTBC, dada su alta morbilidad y mortalidad, necesariamente debe ser más intensivo y prolongado, y debemos seleccionar fármacos con buena penetración en el SNC. Se propone un esquema de 12 meses. La fase diaria debería durar tres meses e incluir isoniacida, rifampicina, pirazinamida y etambutol o moxifloxacina. Estreptomicina no debería ser incluida dada su mala penetración en el SNC y reconocida toxicidad. La fase de mantención debería ser trisemanal e incluir isoniacida, rifampicina y pirazinamida. Dexa-metasona debe administrarse durante las primeras seis semanas de tratamiento. En el caso de pacientes con infección por VIH que requieran iniciar TARV ésta debe ser aplazada para después de la fase diaria y no debería incluir inhibidores de proteasa e integrasa. Abstract in english Diagnosis of tuberculous meningitis (TBM) is always a challenge. We must give importance for duration of clinical manifestations. Cerebrospinal fluid (CSF) has own characteristic and it have to be control several times during the treatment. Adenosin deaminase with cut off more than 15 UI/mL and M. t [...] uberculosis polymerase chain reaction in CSF are the most relevant diagnostic tests. Radiologic test gives diagnostic clues but do not confirm the diagnosis. In the future we can structure a score with all these elements to support the clinician in the diagnostic process. The treatment of TBM because of its high morbidity and high mortality has to be necessarily more intensive and prolonged and we must select drugs with a good penetration into the central nervous system (SNC). A therapeutic scheme with duration of 12 months with two phases is proposed, the diary phase during the first three months of treatment includes isoniacid, rifampicin, pirazinamid and ethambutol or moxifloxacin. Streptomycin must not be included due to own erratic SNC penetration and its known toxicity. The second twice a week phase has to be changed by a three times per week phase during 9 months and it must include isoniacid, rifampicin and pirazinamide. Dexamethasone is added during the first 6 weeks of treatment. Patients with HIV infection than required treatment with antiretroviral drugs have to start ART treatment when diary phase has finished and must not include protease or integrase inhibitors.

  14. Meningitis tuberculosa: claves para su diagnóstico y propuestas terapéuticas Tuberculous meningitis: tips for diagnosis and proposals for treatment

    Directory of Open Access Journals (Sweden)

    Martín Lasso B

    2011-06-01

    Full Text Available El diagnóstico de la meningitis tuberculosa (MTBC es siempre un desafío. Debemos dar importancia a las manifestaciones clínicas y su duración. El análisis citoquímico del LCR tiene características propias y debe ser controlado varias veces durante el tratamiento. La adenosin deami-nasa con punto de corte > 15 UI/mL y la RPC para M. tuberculosis en LCR son las pruebas más relevantes. Las imágenes aportan elementos valiosos pero no establecen el diagnóstico por si solas. A futuro se puede estructurar un puntaje con todos estos elementos para apoyar al clínico en el proceso diagnóstico. El tratamiento de la MTBC, dada su alta morbilidad y mortalidad, necesariamente debe ser más intensivo y prolongado, y debemos seleccionar fármacos con buena penetración en el SNC. Se propone un esquema de 12 meses. La fase diaria debería durar tres meses e incluir isoniacida, rifampicina, pirazinamida y etambutol o moxifloxacina. Estreptomicina no debería ser incluida dada su mala penetración en el SNC y reconocida toxicidad. La fase de mantención debería ser trisemanal e incluir isoniacida, rifampicina y pirazinamida. Dexa-metasona debe administrarse durante las primeras seis semanas de tratamiento. En el caso de pacientes con infección por VIH que requieran iniciar TARV ésta debe ser aplazada para después de la fase diaria y no debería incluir inhibidores de proteasa e integrasa.Diagnosis of tuberculous meningitis (TBM is always a challenge. We must give importance for duration of clinical manifestations. Cerebrospinal fluid (CSF has own characteristic and it have to be control several times during the treatment. Adenosin deaminase with cut off more than 15 UI/mL and M. tuberculosis polymerase chain reaction in CSF are the most relevant diagnostic tests. Radiologic test gives diagnostic clues but do not confirm the diagnosis. In the future we can structure a score with all these elements to support the clinician in the diagnostic process. The treatment of TBM because of its high morbidity and high mortality has to be necessarily more intensive and prolonged and we must select drugs with a good penetration into the central nervous system (SNC. A therapeutic scheme with duration of 12 months with two phases is proposed, the diary phase during the first three months of treatment includes isoniacid, rifampicin, pirazinamid and ethambutol or moxifloxacin. Streptomycin must not be included due to own erratic SNC penetration and its known toxicity. The second twice a week phase has to be changed by a three times per week phase during 9 months and it must include isoniacid, rifampicin and pirazinamide. Dexamethasone is added during the first 6 weeks of treatment. Patients with HIV infection than required treatment with antiretroviral drugs have to start ART treatment when diary phase has finished and must not include protease or integrase inhibitors.

  15. The Comparison of Leukemia Inhibitory Factor (LIF Concentration in the Serum and Cerebrospinal Fluid of Children with Bacterial Meningitis

    Directory of Open Access Journals (Sweden)

    Mashayekhi, F

    2012-01-01

    Full Text Available AbstractBackground and objectives: Meningitis is one of the mostcommon infectious of the central nervous system (CNS, definedas an inflammation of the meninges. LIF is a potent proinflammatoryfactor. Cerebrospinal fluid (CSF contains thegrowth factors and cytokines whose concentrations have beenchanged in most neurological diseases. The aim of this study wasto determine the LIF concentration of serum and CSF in thechildren with bacterial meningitis.Material and Methods: In this study, the total proteinconcentration (TPC and LIF in the serum and CSF of normalsubjects and children with bacterial meningitis were measured byenzyme linked immunosorbent assay (ELISA.Results: the Values of serum TPC for children with meningitis(74.17±7.73 g/L and controls (73.50±7.28 g/L are not differentsignificantly (P=0.7, and the TPC in the CSF of childrensuffering from meningitis and controls are 35±0.03 and 0.34±0.05g/L, respectively (P=0.65. The concentration of serum LIF forchildren with meningitis( 253±19.14 ng/ml is higher than thatof controls (49.75±8.97 ng/ml, and also the concentration ofLIF in the CSF of the children with meningitis (116.25±8.60ng/ml is significantly higher than that of controls which is9.04±1.83ng/ml (P<0.001.Conclusion: The LIF concentration in the CSF and serum mayprovide additional information in the differential diagnosis ofmeningitis. It is also concluded that LIF could be significantlyinvolved in the pathophysiology of meningitis.Key words: Serum, Cerebrospinal fluid, Leukemia inhibitoryfactor, Children, Bacterial meningitis

  16. Impact of Haemophilus influenzae type b conjugate vaccine on bacterial meningitis in the Dominican Republic / Impacto de la vacuna conjugada contra Haemophilus influenzae tipo b sobre la meningitis bacteriana en la República Dominicana

    Scientific Electronic Library Online (English)

    Ellen H., Lee; Miriam, Corcino; Arelis, Moore; Zacarias, Garib; Chabela, Peña; Jacqueline, Sánchez; Josefina, Fernández; Jesús M., Feris-Iglesias; Brendan, Flannery.

    2008-09-01

    Full Text Available OBJETIVOS: El uso generalizado de la vacuna contra Haemophilus influenzae tipo b (Hib) ha permitido reducir radicalmente la carga de enfermedad por Hib en las Américas. Pocos estudios han evaluado el impacto de la vacunación contra Hib sobre los casos no confirmados mediante cultivo. En este estudio [...] se analizaron las tendencias en el número de casos probables de meningitis bacteriana antes y después de la introducción de la vacuna contra Hib en la República Dominicana y se estimó la eficacia de la vacuna contra la meningitis. MÉTODOS: Se identificaron los casos de meningitis en niños menores de 5 años a partir de los registros de ingreso del principal hospital pediátrico de Santo Domingo entre 1998 y 2004. Los casos de meningitis con probable etiología bacteriana se clasificaron según criterios de laboratorio; los casos confirmados contaban con cultivo bacteriano positivo o detección de antígenos específicos en el líquido cefalorraquídeo. Se calcularon las tasas de incidencia acumulada de casos confirmados y probables de meningitis en los niños que vivían en el Distrito Nacional. Los casos confirmados de meningitis por Hib se incorporaron a un estudio de casos y controles -pareados según la edad y el barrio de residencia- para calcular la eficacia de la vacuna. RESULTADOS: Antes de la introducción de la vacuna, la tasa anual de meningitis de posible etiología bacteriana era de 49 casos por 100 000 niños menores de 5 años; de los casos confirmados de origen bacteriano, 60% fue por Hib. En el período 2002-2004, después de la introducción de la vacuna, la tasa anual de meningitis de posible etiología bacteriana fue de 16 casos por 100 000, es decir 65% más baja, y 26% de los casos confirmados correspondieron a Hib. Las tasas de meningitis por Hib y de posible origen bacteriano de etiología desconocida se redujeron en 13 y 17 casos por 100 000, respectivamente. CONCLUSIONES: La introducción de la vacuna contra Hib redujo sustancialmente la incidencia de casos de meningitis confirmados y probables en la República Dominicana. El impacto estimado de la vacunación contra Hib fue dos veces mayor cuando se consideraron los casos no confirmados mediante cultivo. Abstract in english OBJECTIVES: Widespread use of Haemophilus influenzae type b (Hib) vaccines has dramatically reduced the burden of Hib disease throughout the Americas. Few studies have evaluated the impact of Hib vaccination on non-culture-confirmed disease. This study analyzed trends in probable bacterial meningiti [...] s before and after the introduction of Hib vaccine in the Dominican Republic and estimated vaccine effectiveness against Hib meningitis. METHODS: Meningitis cases among children

  17. Impact of Haemophilus influenzae type b conjugate vaccine on bacterial meningitis in the Dominican Republic Impacto de la vacuna conjugada contra Haemophilus influenzae tipo b sobre la meningitis bacteriana en la República Dominicana

    Directory of Open Access Journals (Sweden)

    Ellen H. Lee

    2008-09-01

    Full Text Available OBJECTIVES: Widespread use of Haemophilus influenzae type b (Hib vaccines has dramatically reduced the burden of Hib disease throughout the Americas. Few studies have evaluated the impact of Hib vaccination on non-culture-confirmed disease. This study analyzed trends in probable bacterial meningitis before and after the introduction of Hib vaccine in the Dominican Republic and estimated vaccine effectiveness against Hib meningitis. METHODS: Meningitis cases among children OBJETIVOS: El uso generalizado de la vacuna contra Haemophilus influenzae tipo b (Hib ha permitido reducir radicalmente la carga de enfermedad por Hib en las Américas. Pocos estudios han evaluado el impacto de la vacunación contra Hib sobre los casos no confirmados mediante cultivo. En este estudio se analizaron las tendencias en el número de casos probables de meningitis bacteriana antes y después de la introducción de la vacuna contra Hib en la República Dominicana y se estimó la eficacia de la vacuna contra la meningitis. MÉTODOS: Se identificaron los casos de meningitis en niños menores de 5 años a partir de los registros de ingreso del principal hospital pediátrico de Santo Domingo entre 1998 y 2004. Los casos de meningitis con probable etiología bacteriana se clasificaron según criterios de laboratorio; los casos confirmados contaban con cultivo bacteriano positivo o detección de antígenos específicos en el líquido cefalorraquídeo. Se calcularon las tasas de incidencia acumulada de casos confirmados y probables de meningitis en los niños que vivían en el Distrito Nacional. Los casos confirmados de meningitis por Hib se incorporaron a un estudio de casos y controles -pareados según la edad y el barrio de residencia- para calcular la eficacia de la vacuna. RESULTADOS: Antes de la introducción de la vacuna, la tasa anual de meningitis de posible etiología bacteriana era de 49 casos por 100 000 niños menores de 5 años; de los casos confirmados de origen bacteriano, 60% fue por Hib. En el período 2002-2004, después de la introducción de la vacuna, la tasa anual de meningitis de posible etiología bacteriana fue de 16 casos por 100 000, es decir 65% más baja, y 26% de los casos confirmados correspondieron a Hib. Las tasas de meningitis por Hib y de posible origen bacteriano de etiología desconocida se redujeron en 13 y 17 casos por 100 000, respectivamente. CONCLUSIONES: La introducción de la vacuna contra Hib redujo sustancialmente la incidencia de casos de meningitis confirmados y probables en la República Dominicana. El impacto estimado de la vacunación contra Hib fue dos veces mayor cuando se consideraron los casos no confirmados mediante cultivo.

  18. Factores asociados con la mortalidad por meningitis neumocócica en hospitales de La Habana / Factors associated with mortality due to pneumococcal meningitis in Havana hospitals

    Scientific Electronic Library Online (English)

    Gabriel E, Lobo Ramírez; Félix O, Dickinson Meneses; Antonio E, Pérez Rodríguez; Beatriz, Vega Riverón; Misladys, Rodríguez Ortega.

    2013-09-01

    Full Text Available Introducción: la meningitis neumocócica constituye un serio problema de salud por su alta morbilidad, letalidad y graves secuelas. Objetivos: identificar algunos factores de riesgo asociados con la mortalidad por meningitis neumocócica. Métodos: se realizó un estudio de caso-control en 7 hospitales [...] de La Habana (enero de 2002-diciembre de 2011) de 45 pacientes (0-86 años de edad), con meningitis neumocócica confirmada: 15 fallecidos (casos) y 30 sobrevivientes (controles), a partir de la vigilancia nacional de síndromes neurológicos bacterianos, historias clínicas, movimientos hospitalarios, tarjetas de enfermedades de declaración obligatoria y registros de laboratorio. Se midió la asociación (análisis bivariado y multivariado) de algunos factores con la muerte a través de la oportunidad relativa y su intervalo de confianza a 95 %, considerando asociación cuando fue mayor o igual que 2. Resultados: la letalidad general resultó de 33,3 %. La media entre el inicio de los síntomas y la consulta médica fue de 2,4 días; entre la consulta y el ingreso 0,5 días; entre el ingreso y el diagnóstico 0,4 días, y entre el diagnóstico y el tratamiento 0,2 días. La estadía hospitalaria media fue de 12,2 días. El análisis bivariado y multivariado mostró asociación significativa de la inconsciencia al ingreso, con la muerte. Otras variables se asociaron con el desenlace fatal pero no fueron significativas. Conclusiones: estar inconsciente al momento del ingreso es un factor de riesgo para la muerte por meningitis neumocócica, en los pacientes con esta enfermedad de los hospitales investigados en La Habana. Abstract in english Introduction: pneumococcal meningitis is a critical public health problem with a high rate of morbidity and mortality and serious sequelae. Objectives: identify some risk factors associated with mortality due to pneumococcal meningitis. Methods: a case-control study was conducted of 45 patients aged [...] 0-86 with confirmed pneumococcal meningitis cared for in seven Havana hospitals from January 2002 to December 2011. Of the 45 patients studied, 15 had died (cases) and 30 had survived (controls). The study was based on national bacterial neurological syndrome surveillance data, medical records, hospital movements, notifiable disease cards and laboratory records. Association (bivariate and multivariate analysis) of some factors with death was measured through odds ratio with a confidence interval of 95 %, considering it an association if greater than or equal to 2. Results: overall case-fatality rate was 33.3 %. Mean time between the onset of symptoms and medical consultation was 2.4 days; between consultation and admission 0.5 day; between admission and diagnosis 0.4 day; and between diagnosis and treatment 0.2 day. Mean hospital stay was 12.2 days. Bivariate and multivariate analysis revealed a significant association between unconsciousness at admission and death. Other variables were associated with death as well, but they were not significant. Conclusions: being unconscious at admission is a risk factor for death due to pneumococcal meningitis in patients with this disease in the Havana hospitals studied.

  19. Primer caso de meningitis por Streptococcus equi subsp. zooepidemicus en Cuba / First case of meningitis from Streptococcus equi subsp. zooepidemicus in Cuba

    Scientific Electronic Library Online (English)

    Gilda, Toraño Peraza; Itciar, Arias Portales; Ariadna, Castillo Marshall; Gardenia, Brossard Alejo.

    2015-03-01

    Full Text Available La meningitis en humanos es posiblemente la entidad clínica más rara de infección por Streptococcus Grupo C. Esta bacteria se considera un patógeno de animales en particular de equinos. La intención de este trabajo es notificar un caso fatal de meningitis por Streptococcus equi subsp. zooepidemicus [...] (Streptococcus ß-hemolítico Grupo C) en Cuba. Se trata de un individuo masculino inmunocompetente de 50 años de edad, de piel negra, que aunque profesionalmente no estaba expuesto a animales, gustaba cabalgar frecuentemente en una propiedad familiar donde había otros animales. El paciente residía en Santiago de Cuba e ingresó en la Unidad de Cuidados Intensivos Emergentes del hospital regional en mayo de 2014. Al momento de la admisión presentaba rigidez de nuca, cefalea intensa, antecedente de fiebre sostenida de 39,5 °C durante cuatro días, lenguaje incoherente, dificultad para la marcha, obnubilación y vómitos. Este cuadro clínico y los resultados del estudio del líquido cefalorraquídeo, llevaron al diagnóstico de una meningitis bacteriana. Se administró tratamiento en correspondencia. El individuo evolucionó desfavorablemente hasta fallecer el mismo día de su admisión, apenas siete horas después. Se sugirió la transmisión de la infección a partir del contacto del paciente. Este trabajo constituye el primer registro de meningitis por Streptococcus equi subsp. zooepidemicus en Cuba. Su notificación contribuye a fundamentar la tesis de que se trata de una zoonosis emergente cuyo control se hace imprescindible en el país. Abstract in english Meningitis in human beings is possibly the rarest clinical illness caused by Group C Streptococcus infection. This bacterium is regarded as an animal pathogen, particularly echinus. The objective of this paper was to present a fatal meningitis case in Cuba caused by Streptoccus equi subsp. zooepidem [...] icus (Streptococcus ß-hemolytic C). It was a Black 50 years-old male immunocompetent patient, who did not work directly with animals but used to frequently ride horses in a family farm where there were other animals. The patient lived in Santiago de Cuba province and was admitted to the Intensive Care Unit of the regional hospital on May, 2014. At the time of hospitalization, he presented with stiff neck, headache, continuous fever of 39.5 oC for four days, incoherent speech, difficulties to walk, obnubilation and vomiting. This clinical picture and the results of the cerebrospinal fluid analysis yielded a diagnosis of bacterial meningitis. He received the corresponding treatment. However, the patient progressed into death just seven hours after his hospitalization. It was suggested that the patient was infected from some contact with any animal. This paper is the first record of meningitis from Streptococcus equi subsp. zooepidemicus in Cuba and contributes to support the thesis that this is an emerging zoonosis and it is necessary to have it under control nationwide.

  20. Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy? / Remissão espontânea da acromegalia: meningite simulando apoplexia ou meningite como causa da apoplexia?

    Scientific Electronic Library Online (English)

    Rocío, Villar-Taibo; María D., Ballesteros-Pomar; Alfonso, Vidal-Casariego; Rosa M., Álvarez-San Martín; Georgios, Kyriakos; Isidoro, Cano-Rodríguez.

    2014-02-01

    Full Text Available A apoplexia é uma síndrome clínica rara, mas potencialmente fatal, caracterizada por infarto isquêmico ou hemorragia em um tumor pituitário. O diagnóstico de apoplexia de tumor pituitário é frequentemente complicado pela natureza inespecífica dos seus sinais e sintomas, que podem simular diferentes [...] processos neurológicos, incluindo a meningite. Vários fatores estão associados com a apoplexia, como o uso de agonistas dopaminérgicos, radioterapia ou trauma da cabeça, mas a meningite foi raramente relatada. Descrevemos o caso de uma mulher de 51 anos de idade com acromegalia por um macroadenoma pituitário. Antes do tratamento cirúrgico, ela foi trazida ao pronto-socorro com febre, náusea, vômitos e meningismo. Os sintomas e análises laboratoriais sugeriram meningite bacteriana e o tratamento com antibióticos foi iniciado, com melhora rápida dos sintomas. Uma tomografia computadorizada (CT) na admissão ao hospital não revelou nenhuma alteração no adenoma pituitário, mas algumas semanas depois uma ressonância magnética (MRI) mostrou informações de apoplexia pituitária, com desaparecimento completo do adenoma. Atualmente, a acromegalia está curada, mas ela desenvolveu hipopituitarismo e diabetes insipidus depois da apoplexia. Questionamo-nos se a paciente realmente apresentou meningite que levou à apoplexia ou se a apoplexia foi mal interpretada como sendo meningite. A relação entre a meningite e a apoplexia pode ser bidirecional. A apoplexia pode simular a meningite viral ou bacteriana, mas a meningite também pode causar apoplexia. Esse fato enfatiza a importância do diagnóstico diferencial ao se avaliar pacientes com adenomas pituitários e sintomas neurológicos. Abstract in english Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic [...] different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms.

  1. Transposition of Anterior Choroidal Artery and Posterior Communicating Artery Origin

    OpenAIRE

    Choi, Chan Young; Lee, Chae Heuck

    2012-01-01

    The anterior choroidal artery has several kinds of variations. Among them, the transposition of anterior choroidal artery and posterior communicating artery origins has been extremely rare. We report a case with cerebral aneurysm arising from posterior communicating artery which origin was distal to the anterior choroidal artery and review the relevant literature.

  2. Meningitis y diseminación tuberculosa en paciente con el síndrome de inumodeficiencia adquirida (sida) / Meningitis and tuberculosis dissemination in acquired immunodeficiency syndrome (AIDS) patients

    Scientific Electronic Library Online (English)

    Lilian María, Mederos Cuervo; Juan Francisco, Bandera Tirado; Lidunka, Valdés Alonso; Virginia, Capó de Paz; Gilberto, Fleites González; María Rosarys, Martínez; Ernesto Hilario, Montoro Cardoso.

    2010-06-01

    Full Text Available Las meningoencefalitis por gérmenes oportunistas ocupan un lugar importante dentro de la patología neurológica del paciente sida, Treponema pallidum y Mycobacterium tuberculosis dentro de las bacterias, Cryptococcus neoformans dentro de los hongos, Toxoplasma gondii dentro de los protozoos y el Papo [...] virus JC dentro de los virus, son de los gérmenes mas frecuentes dentro de cada grupo. También en los pacientes inmunodeprimidos en general y en particular en el paciente sida, se han encontrado con cierta frecuencia infecciones mixtas, precisamente por el gran deterioro en su barrera inmunológica. La meningitis tuberculosa (MTB) es la forma mas grave en que se manifiesta la tuberculosis extrapulmonar, pues la inespecificidad de sus síntomas, la lentitud en el diagnóstico etiológico y las severas secuelas neurológicas que puede producir sobre todo en este tipo de paciente, hacen de esta enfermedad un importante problema de salud, tanto en países desarrollados como en los que están en vías de desarrollo. En este estudio se describe el ¨primer caso¨ meningitis e infección diseminada por Mycobacterium tuberculosis en paciente cubano infectado por el virus de inmunodeficiencia humana. Abstract in english Meningoencephalitis due to opportunistic germs has an important place among the neurological diseases in AIDS patient. Treponema pallidum and Mycobacterium tuberculosis (bacteria), Cryptococcus neoformans (fungi), Toxoplasma gondii (protozoa), and Papovirus JC (virus) are the most frequently germs f [...] ound in each group. Likewise, in immunodepressed patients in general and in HIV/AIDS patients in particular, mixed infections have been frequently found, basically as a consequence of the patient’s deteriorated immunological barrier. Tuberculosis meningitis (TBM) is the most severe form of presentation of the extrapulmonary tuberculosis. Its unspecific symptoms, the delay in the etiological diagnosis, and the severe neurological sequelae that can appear in this specific type of patient make of this disease an important health problem, in both developed and developing countries. This study describes the "first case" of meningitis and disseminated infection by Mycobacterium tuberculosis in a Cuban patient infected by the human immunodeficiency virus.

  3. The clinical and cerebrospinal fluid cytological features of tuberculous meningitis

    Directory of Open Access Journals (Sweden)

    YANG Xiao

    2012-04-01

    Full Text Available Objective To analyze the clinical and cerebrospinal fluid (CSF cytological features of patients with tuberculous meningitis (TBM, to improve early diagnostic accuracy and treatment of TBM. Methods Clinical presentations, etiology and biochemical and cytological features of CSF were analyzed retrospectively among 60 adult cases with TBM hospitalized at Neurology Department of General Hospital of Ningxia Medical University from January 2005 to May 2011. Results Most patients (58/60, 96.67% had fever and headache at onset. In some patients, disturbance of consciousness (9/60, 15.00%, seizure (5/60, 8.33% occurred in 1 week and focal neurological signs developed during the course. Forty?four patients (73.33% had pulmonary tuberculosis history. In CSF examination, acid?fast bacillus positive was found in 8 patients. Positive acid ? fast myobacterium tuberculous culture was detected in 5 patients and positive myobacterium tuberculosis DNA were seen in 5 patients. The main changes of CSF were intracranial hypertension, increase of protein, and decrease of glucose. CSF presented mixed cellular response with predominace in the increasing of leucocytes. During early stage the mean percentage of neutrophil in CSF was less than 40%. After short term (as long as 2 months of regular antituberculotic therapy no significant changes in total cell count and the proportion of neutrophils were seen. In 60 patients, 44 patients were ameliorated, 11 were not healed or were discharged or transferred to other hospital and 5 were dead. Prognosis of patients treated within 3 weeks after onsets was superiorly to those treated at more than 3 weeks after onset. Conclusion There are no specific clinical features in TBM and it is hard to perform early diagnosis for TBM, particularly, existing of low efficiency in pathogenic detection, but pulmonary tuberculosis is of accessary value to diagnose TBM. Whereas mixed cellular response may complementarily provide the diagnosis of TBM in early stage. Cytologic changes of CSF can be very slow even after therapy. Therefore persistent mixed cellular response in CSF cannot exclude TBM. The time of treatment will determine the therapeutic effectiveness in a great degree.

  4. Clinical analysis of carcinomatous meningitis in 63 cases

    International Nuclear Information System (INIS)

    Objective: To analyze the clinical characteristics and the prognostic factors of carcinomatous meningitis (CM). Methods: 63 patients with CM treated in Tianjin Medical University Cancer Institute and Hospital from 1998 to 2008 were reviewed retrospectively. The correlations between clinical characteristics, treatment modalities and the prognosis of CM were analyzed. The common primary site was lung cancer (65%) and breast cancer (13%). All the patients were underwent MRI scan and 29 of the patients received lumbar puncture. Fifty-one patients received whole brain radiotherapy, systemic and/or intrathecal chemotherapy. The other 12 patients only received supportive care. Kaplan-Meier method and Log-rank test were used for survival analysis. Results: All patients died by the end of follow-up. The follow-up rate was 95%. The number of patients who undergone 1-, 2 years follow-up were 59 and 56. The median survival time was 2.2 months (range: 0.1-24.4 months) for the entire group. The clinical stage and the control status of the primary disease were strongly correlated with survival (?2=6.68, P=0.036) and (?2=7.04, P=0.008). The median survival time was 3.0 months (range: 1.0-24.4 months) in patients who received ? 30 Gy whole brain irradiation, while only 1.8 months (range: 0.1-14.2 months) in those who did not receive radiotherapy (?2=5.54, P=0.019). The median survival time of radiotherapy ± chemotherapy group, chemotherapy only group and supportive treatment only group were 3.0 months (range: 0.5-24.4 months), 2.2 months (range: 0.3-14.2 months) and 1.2 months (range: 0.1- 4.5 months), respectively (?2=9.32, P=0.009). Conclusions: The prognosis of CM is very poor. The clinical stage before the diagnosis of CM and the control status of primary disease and were significantly correlated with survival. Sufficient whole brain irradiation dose may prolong survival and worth further study in a large sample study. (authors)

  5. Definitive neuroradiological diagnostic features of tuberculous meningitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Andronikou, Savvas; Smith, Bruce; Douis, Hassan [University of Cape Town, Department of Pediatric Radiology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Hatherhill, Mark [University of Cape Town, Department of Intensive Care, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Wilmshurst, Jo [University of Cape Town, Department of Neurology, Red Cross War Memorial Children' s Hospital School of Child and Adolescent Health, Cape Town (South Africa)

    2004-11-01

    Although CT scanning is used widely for making the diagnosis and detecting the complications of tuberculous meningitis (TBM) in children, the radiological features are considered non-specific. CT is particularly suggestive of the diagnosis when there is a combination of basal enhancement, hydrocephalus and infarction, and even then the diagnosis may be in doubt. In this paper we introduce a new CT feature for making the diagnosis of TBM, namely, hyperdensity in the basal cisterns on non-contrast scans, and we assess which of the recognized CT features is most sensitive and specific. To determine the sensitivity and specificity of the presence of high-density exudates in the basal cisterns (on non-contrast CT) and basal enhancement (on contrast-enhanced CT) for the diagnosis of TBM in children, and to correlate these with the complications of infarction and hydrocephalus. Retrospective review of CT scans with readers blinded to the diagnosis, which was based on a definitive culture of cerebrospinal fluid (CSF) for TBM or other bacteria. Computer-aided conversion of hard-copy film density to Hounsfield units was employed as well as a density threshold technique for determining abnormally high densities. The most specific feature for TBM is hyperdensity in the basal cisterns prior to IV contrast medium administration (100%). The most sensitive feature of TBM is basal enhancement (89%). A combination of features (hydrocephalus, infarction and basal enhancement) is as specific as pre-contrast hyperdensity, but has a lower sensitivity (41%). There were statistically significant differences in the presence of hydrocephalus (p=0.0016), infarcts (P=0.0014), basal enhancement (P<0.0001) and pre-contrast density (P<0.0001) between the negative and positive TBM patient groups. The presence of granulomas was not statistically significant between the two groups (P=0.44). The presence of high density within the basal cisterns on non-contrast CT scans is a very specific sign for TBM in children. This will enhance diagnostic confidence, allow early institution of therapy and could reduce expenditure on contrast medium, scan time and radiation exposure. With the use of threshold techniques we believe that the pre-contrast hyperdensity may be detectable by a computer program that will facilitate diagnosis, and may also be modified to detect abnormal enhancement. Basal enhancement is a sensitive sign for the diagnosis of TBM and should be sought after contrast medium administration when no hyperdensity is seen in the basal cisterns or when this finding needs to be confirmed. The CT scan feature of hyperdense exudates on pre-contrast scans should be added to the inclusion criteria for the diagnosis of TBM in children. (orig.)

  6. About Peripheral Artery Disease (PAD)

    Science.gov (United States)

    About Peripheral Artery Disease (PAD) Updated:Sep 15,2014 Peripheral artery disease (PAD) is a narrowing of the peripheral arteries to ... was last reviewed on 8/05/2014. Peripheral Artery Disease • Home • About Peripheral Artery Disease (PAD) • Why ...

  7. Bacterial Meningitis: A Density-Equalizing Mapping Analysis of the Global Research Architecture

    Directory of Open Access Journals (Sweden)

    Niklas Pleger

    2014-09-01

    Full Text Available Bacterial meningitis is caused by a variety of pathogens and displays an important public health threat all over the world. Despite the necessity to develop customized public health-related research projects, a thorough study of global meningitis research is not present, so far. Therefore, the aim of this study was a combined density-equalizing and scientometric study. To evaluate the scientific efforts of bibliometric methods, density-equalizing algorithms and large-scale data analysis of the Web of Science were applied in the period between 1900 and 2007. From this, 7998 publications on bacterial meningitis have been found. With a number of 2698, most publications have been written by U.S. authors, followed by the UK (912, Germany (749 and France (620. This dominance can also be shown in the international cooperation. The specific citation analyses reveal that the nation with the highest average citation rate (citations per publications was Norway (26.36, followed by Finland (24.16 and the U.S. (24.06. This study illustrates the architecture of global research on bacterial meningitis and points to the need for customized research programs with a focus on local public health issues in countries with a low development index, but high incidences, to target this global public health problem.

  8. Bacterial meningitis: a density-equalizing mapping analysis of the global research architecture.

    Science.gov (United States)

    Pleger, Niklas; Kloft, Beatrix; Quarcoo, David; Zitnik, Simona; Mache, Stefanie; Klingelhoefer, Doris; Groneberg, David A

    2014-01-01

    Bacterial meningitis is caused by a variety of pathogens and displays an important public health threat all over the world. Despite the necessity to develop customized public health-related research projects, a thorough study of global meningitis research is not present, so far. Therefore, the aim of this study was a combined density-equalizing and scientometric study. To evaluate the scientific efforts of bibliometric methods, density-equalizing algorithms and large-scale data analysis of the Web of Science were applied in the period between 1900 and 2007. From this, 7998 publications on bacterial meningitis have been found. With a number of 2698, most publications have been written by U.S. authors, followed by the UK (912), Germany (749) and France (620). This dominance can also be shown in the international cooperation. The specific citation analyses reveal that the nation with the highest average citation rate (citations per publications) was Norway (26.36), followed by Finland (24.16) and the U.S. (24.06). This study illustrates the architecture of global research on bacterial meningitis and points to the need for customized research programs with a focus on local public health issues in countries with a low development index, but high incidences, to target this global public health problem. PMID:25272079

  9. Candida dubliniensis Meningitis as Delayed Sequela of Treated C. dubliniensis Fungemia

    OpenAIRE

    van Hal, Sebastian J; Stark, Damien; Harkness, John; Marriott, Deborah

    2008-01-01

    We present a case of Candida dubliniensis meningitis that developed 2 months after apparently successful treatment of an episode of C. dubliniensis candidemia in a heart-lung transplant recipient in Australia. This case highlights the importance of follow-up in patients with candidemia or disseminated infection, especially in immunosuppressed patients.

  10. Evaluation of fusidic acid in therapy of experimental Staphylococcus aureus meningitis

    DEFF Research Database (Denmark)

    Østergaard, Christian; Yieng-Kow, Runa Vavia

    2003-01-01

    Combination therapy that includes fusidic acid, an antimicrobial agent highly active against staphylococci, has been recommended in the treatment of patients with Staphylococcus aureus meningitis. The aim of this study was to evaluate the pharmacokinetic, CSF bactericidal and anti-inflammatory properties of fusidic acid.

  11. Meningitis aguda por Streptococcus Constellatus: a propósito de un caso fatal

    Directory of Open Access Journals (Sweden)

    Maikel Vargas Sanabria

    2011-09-01

    Full Text Available Se presenta el caso de un paciente masculino de 14 años, con el único antecedente de sinusitis resuelta hacía un año, que desarrolló de nuevo una pansinusitis y una meningitis aguda que lo llevó en diez días a la muerte. Durante su estancia hospitalaria no fue posible determinar el agente etiológico, sin embargo los cultivos post mortem demostraron que el microorganismo presente era Streptococcus constellatus un comensal habitual de las mucosas del ser humano, del cual se han descrito muy pocos casos de meningitis en pacientes inmunocompetentes, lo cual hace de este caso un verdadero reto diagnóstico para los médicos tratantes y los anatomopatólogos.The present case is of a 14 year-old male with the only history of a sinusitis that solved one year before presentation.The patient developed a newly-onset pansinusitis followed by pyogenic meningitis that lead him to death ten days after. It was not possible to determine the etiologic agent during his hospitalization but postmortem culture tests taken from the leptomeninges and the etmoidal cells showed Streptococcus constellatus, a usual commensal in human mucous membranes. Very few cases of acute meningitis caused by S. constellatus have been described in immunocompetent patients, which makes this case a real diagnostic challenge for clinicians and pathologists.

  12. Meningitis aguda por Streptococcus Constellatus: a propósito de un caso fatal

    Scientific Electronic Library Online (English)

    Maikel, Vargas Sanabria; Rodolfo, Guzmán Cervantes.

    2011-09-01

    Full Text Available Se presenta el caso de un paciente masculino de 14 años, con el único antecedente de sinusitis resuelta hacía un año, que desarrolló de nuevo una pansinusitis y una meningitis aguda que lo llevó en diez días a la muerte. Durante su estancia hospitalaria no fue posible determinar el agente etiológico [...] , sin embargo los cultivos post mortem demostraron que el microorganismo presente era Streptococcus constellatus un comensal habitual de las mucosas del ser humano, del cual se han descrito muy pocos casos de meningitis en pacientes inmunocompetentes, lo cual hace de este caso un verdadero reto diagnóstico para los médicos tratantes y los anatomopatólogos. Abstract in english The present case is of a 14 year-old male with the only history of a sinusitis that solved one year before presentation.The patient developed a newly-onset pansinusitis followed by pyogenic meningitis that lead him to death ten days after. It was not possible to determine the etiologic agent during [...] his hospitalization but postmortem culture tests taken from the leptomeninges and the etmoidal cells showed Streptococcus constellatus, a usual commensal in human mucous membranes. Very few cases of acute meningitis caused by S. constellatus have been described in immunocompetent patients, which makes this case a real diagnostic challenge for clinicians and pathologists.

  13. Temporal analysis of the incidence of meningitis in the Tehran metropolitan area, 1999-2005

    Directory of Open Access Journals (Sweden)

    Heidarnia Mohammadali

    2009-12-01

    Full Text Available Abstract Objectives The aim of this study was to describe the temporal determinants of meningitis incidence in the population living in the Tehran metropolis. Methods All cases of meningitis reported to health districts throughout the Tehran metropolis from 1999 to 2005 were abstracted from patient files. Referral cases (patients who did not reside in the Tehran metropolis were excluded. For each year, sex- and age-specific incidences were estimated. Temporality and its determinants were analyzed using Poisson regression. Results Age-specific incidence is highest among males younger than 5 years of age at 10.2 cases per 100,000 population per year. The lowest incidence was among females aged 30 to 40 years at 0.72 cases per 100,000 population per year, with an overall male-to-female incidence ratio of 2.1. The temporal analysis showed seasonality, with a higher risk of meningitis in spring at a rate ratio of 1.31 with a 95% confidence interval (CI of 1.20 to 1.41 and in autumn (rate ratio = 1.16, 95% CI 1.06, 1.27. For periodicity, we found a peak of occurrence around the years 2000 and 2003. Conclusion The epidemiology of meningitis in Iran follows similar patterns of age, sex, and seasonality distribution as found in other countries and populations.

  14. The utility of the polymerase chain reaction assay for aetiologic definition of unspecified bacterial meningitis cases

    Scientific Electronic Library Online (English)

    Mari, Tuyama; Renata F, Boente; Maria C, Rebelo; Ricardo P, Igreja; David E, Barroso.

    2008-03-01

    Full Text Available Most patients with acute suppurative meningitis are otherwise healthy individuals with regard to immune mechanisms against invasive bacterial disease. This medical emergency is among the most dramatic and potentially ravaging diseases that affect humans, particularly young children. The illness ofte [...] n strikes suddenly, and can either result in death or leave the survivors with significant neurological dysfunctions. The demonstration of a bacterial aetiology is necessary for decisions regarding treatment and prophylaxis. Conventional bacteriological methods frequently fail to identify an agent, as a result of administration of antibiotics or delayed lumbar punctures. We investigated the major aetiologic sources of unspecified bacterial meningitis cases (G00.9, ISCD-10) by polymerase chain reaction (PCR)-based identification of Neisseria meningitidis (crgA), Streptococcus pneumoniae (ply) and Haemophilus influenzae (bexA) in cerebrospinal fluid samples. The multiplex PCR detected N. meningitidis in 92%, S. pneumoniae in 4% and H. influenzae in 1% of the 192 clinical samples assayed; 3% were negative for all three DNA targets. Bacterial DNA detection was found to be a valuable adjunct to enhance bacterial meningitis surveillance when the yield of specimens by culture is reduced. The implementation of PCR assays as a diagnostic procedure in Public Health Laboratories is perceived to be a significant advance in the investigation of bacterial meningitis.

  15. Two cases of meningeal carcinomatosis with interesting appearance in computed tomography

    International Nuclear Information System (INIS)

    Diffuse infiltration of meningeal carcinomatosis occasionally results in a diagnostic CT imaging. Two cases which showed folia-like high density areas along the surface of the cerebellum in the contrast enhancement. No reports concerning such appearance have yet been able to find in the refferences on the brain CT. Several causes are discussed. (author)

  16. V1-distributed Herpes Zoster and Meningitis in a Two-year Old.

    Science.gov (United States)

    Wang, Audrey S; Ann Nguyen, Tuyet; Krakowski, Andrew C

    2015-05-01

    Since the advent of the varicella vaccine, occurrence of herpes zoster in children has been rare. However, a subset of patients may develop herpes zoster after receiving the vaccine. Herein the authors report a case of a two-year-old boy who developed herpes zoster in the V1 distribution and meningitis following a single dose of varicella vaccine. PMID:26029337

  17. Systemic non-albicans infections presented as meningitis in chronic hepatitis B patient: a case report

    Directory of Open Access Journals (Sweden)

    Wen-Jing Lv

    2014-12-01

    Full Text Available Non-albicans candida meningitis is a relatively rare disease, with nonspecific clinical manifestation, which makes the misdiagnosis occur sometimes, especially in the early stage of the disease. Abuse of broad-spectrum antibiotics, corticosteroids, central vein cannulas, senility, big operation, malignancy, and total parenteral alimentation were all the susceptible factors of non-albicans candida infection. We present a case of this type of non-albicans infection in a 42-year-old woman who was early misdiagnosed as tuberculous meningitis and was treated with antibiotics and antituberculosis agents. The diagnosis of non-albicans infection was confirmed by fungus culture of the cerebrospinal fluid (CSF with a low detectable rate. This case reminds us that the non-albicans candida meningitis had a nonspecific clinical presentations and laboratory data, and was difficult to differentiate from tuberculosis meningitis. Hence, we should highly suspect this disease if central nervous system infections with uncertain pathogens. Test cell counts; protein and fungus culture of CSF should be used to confirm the diagnosis. Once the diagnosis was established, the patients should receive antifungal treatment based on drug sensitivity tests as early as possible.

  18. First Report of Sphingomonas koreensis as a human pathogen in a patient with meningitis

    DEFF Research Database (Denmark)

    Marbjerg, Lis H; Gaini, Shahin

    2015-01-01

    Sphingomonas koreensis is an aerobic Gram-negative rod originally described in 2001 following isolation from natural mineral water in Korea. Here we report a case study with Sphingomonas koreensis as the causative agent of meningitis. To our knowledge, this is the first documented case of Sphingomonas koreensis as a human pathogen.

  19. Soluble tumor necrosis factor (TNF) receptors conserve TNF bioactivity in meningitis patient spinal fluid

    DEFF Research Database (Denmark)

    Möller, B; Ellermann-Eriksen, S

    1996-01-01

    The content of tumor necrosis factor (TNF)-alpha antigen and the bioactivity of soluble TNF receptor type II (sTNF-RII) in cerebrospinal fluid (CSF) from 29 patients with meningeal symptoms and fever were examined. Immunoreactive TNF was demonstrated in CSF from 4 of 7 patients with bacterial meningitis. In 3 of 8 patients with aseptic meningitis, CSF also contained TNF, but TNF bioactivity was confined to samples from patients with bacterial meningitis. Bioactive TNF was exclusively in high-performance liquid chromatography fractions containing 30- to 60-kDa proteins. Lipopolysaccharide induced down-regulation, possibly after shedding of granulocyte surface membrane TNF-RII. Consistently, there was a statistically significant correlation between sTNF-RII and CSF leukocyte counts. Bioactive TNF was found only in CSF containing >1 ng of sTNF-RII/mL; samples without TNF bioactivity contained less sTNF-RII. Thus, a stabilizing effect of sTNF-RII on the oligomeric cytokine in vivo is plausible.

  20. Characteristic findings of computed tomography in metastatic brain tumors and meningeal carcinomatosis

    International Nuclear Information System (INIS)

    The purpose of the present paper is to evaluate the diagnostic value of computed tomography in cases of metastatic brain tumors and meningeal carcinomatosis. The computed tomograms were analyzed in 32 cases of metastatic neoplasm in the brain and 4 cases in the meninges. The characteristic findings of computed tomograms in metastic brain tumors and meningeal carcinomatosis can be summarized as follows: 1. Metastatic brain tumors are seen to be mainly isodense nodules (63%) on plain CT, but on enhanced CT they are increased in their density (97%). 2. Large nodules of a metastatic tumor (over 2cm in diameter) tend to contain a less dense central area, the so-called central cavitation. 3. The direction of the expansion and/or extension of the perifocal low density is largely determined by the location of the tumor. 4. The central cavitation, the high-density area on enhanced CT, and the perifocal low-density area are found to be related to necrosis, cancer tissue, and brain edema respectively on histological examination. 5. The diffuse periventricular and the ventricular high density on enhanced CT are characteristic findings in the cases of meningeal carcinomatosis. (author)

  1. Frequency, Severity, and Prediction of Tuberculous Meningitis Immune Reconstitution Inflammatory Syndrome

    OpenAIRE

    Marais, Suzaan; Meintjes, Graeme; Pepper, Dominique J.; Dodd, Lori E.; Schutz, Charlotte; Ismail, Zahiera; Wilkinson, Katalin A.; Wilkinson, Robert J.

    2012-01-01

    Tuberculous meningitis (TBM) immune reconstitution inflammatory syndrome is a severe complication of antiretroviral therapy in human immunodeficiency virus–associated TBM. We found that high cerebrospinal fluid neutrophil counts and Mycobacterium tuberculosis culture positivity at TBM presentation characterize, and cytokine concentrations predict, this syndrome.

  2. V1-distributed Herpes Zoster and Meningitis in a Two-year Old

    Science.gov (United States)

    Wang, Audrey S.; Ann Nguyen, Tuyet

    2015-01-01

    Since the advent of the varicella vaccine, occurrence of herpes zoster in children has been rare. However, a subset of patients may develop herpes zoster after receiving the vaccine. Herein the authors report a case of a two-year-old boy who developed herpes zoster in the V1 distribution and meningitis following a single dose of varicella vaccine. PMID:26029337

  3. Stroke in community-acquired bacterial meningitis : a Danish population-based study

    DEFF Research Database (Denmark)

    Bodilsen, Jacob; Dalager-Pedersen, Michael

    2014-01-01

    Stroke is a serious complication in community-acquired bacterial meningitis (CABM), but the incidence, predispositions, and outcome need further clarification; this pertains in particular to the impact of pre-existing atherosclerosis risk factors. Therefore, we aimed to assess these features in a retrospective population-based cohort study.

  4. Vogt-Koyanagi-Harada syndrome: A rare but important differential diagnosis of viral meningitis

    DEFF Research Database (Denmark)

    Smit, Jesper; Berman, Dalia Cecilia

    2012-01-01

    Abstract Vogt-Koyanagi-Harada syndrome (VKHS) is an inflammatory syndrome affecting melanocyte-containing organs. The clinical onset is often acute with neurological and ophthalmological symptoms and there is considerable risk of sequelae if the condition is not promptly diagnosed and treated. We present a case illustrating that VKHS is a rare but important differential diagnosis of viral meningitis.

  5. Three cases of Capnocytophaga canimorsus meningitis seen at a regional hospital in one year

    DEFF Research Database (Denmark)

    Monrad, Rikke Nygaard; Hansen, Dennis SchrØder

    2012-01-01

    Three cases of meningitis caused by the fastidious Gram-negative rod Capnocytophaga canimorsus have been observed at a regional hospital in 1 y. The difficulties connected with the correct diagnosis by classical culturing methods in contrast to molecular methods, as well as possible reasons for the accumulation of cases, are discussed.

  6. Frequency and clinical significance of CAT findings in purulent and lymphocytic meningitis

    International Nuclear Information System (INIS)

    From 1974-1980, computerized tomography was carried out on 34 patients with purulent and on 17 patients with lymphocytic meningitis. 25 out of the patients with purulent meningitis resp. meningoencephalitis could be examined in the acute stage. For all patients with already attenuated clinical symptoms normal results were obtained, while for the remainder findings were in part highly pathological consisting, e.g. in dilatations or narviowings of the ventricula system, failure to make the outer liquor cavities roentgenoparens, accumulation of pas in the subarachnoidal and subdur spaces including the interhemispheric clefs, cerebral medulla and periventricular edemas, abscesses and signs of ependymitis. Various findings could only be classified as pathological upon serial examination. Correlation statistics showed that all patients with marked pathological CT findings also suffered from distinct pertubations of consciousness. Out of 14 patients with pathological CT findings, 12 died. No connexions could be established between the level of liquor cell counts and CT alterations. Among 17 patients with a lymphocytic meningitis, CT findings were pathological with a mean dilatation of the ventricular system in only one case of chronic course and predominantly basal localization. The patient decreased. Phathological CT findings in purulent and lymphocytic meningitis point to an unfavourable prognosis. (orig.)

  7. Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis

    DEFF Research Database (Denmark)

    Rom Poulsen, Frantz; Schulz, Mette

    2015-01-01

    BACKGROUND: Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate that this technique may separate ischemia and non-ischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis. METHODS: Cerebral energy metabolism was monitored in 15 patients with severe community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio >30 with intracerebral pyruvate level 30 at a normal or increased interstitial concentration of pyruvate (?70 ?mol L(-1)). Patients with LP-ratios<30 were classified as no mitochondrial dysfunction. RESULTS: The biochemical pattern was in 8 patients (10 microdialysis catheters) classified as no mitochondrial dysfunction, in 5 patients classified as non-ischemic mitochondrial dysfunction, and in 2 patients (3 catheters) classified as ischemia. CONCLUSIONS: In patients with severe community-acquired meningitis, compromised cerebral energy metabolism occurs frequently and was diagnosed in 7 out of 15 cases. A biochemical pattern of non-ischemic mitochondrial dysfunction appears to be a more common underlying condition than cerebral ischemia.

  8. Melanomatose meningea: analise citomorfologica do liquido cefalorraqueano / Meningeal melanomatosis: cytomorphological analysis of cerebrospinal fluid

    Scientific Electronic Library Online (English)

    J. A., Livramento; L. R., Machado; H. A. M., Clemente; A., Tabares-Olives; A., Spina-França.

    1979-03-01

    Full Text Available [...] Abstract in english Six cases of meningeal melanomatosis are reported. The cytomorphological analysis of cerebrospinal fluid lead to diagnosis in all of them. Emphasis is given to morphological characteristics of the tumor cells and specially to the melanin dark brown pigment, observed in all cases here reported. [...

  9. Long-term mortality in patients with tuberculous meningitis: a danish nationwide cohort study

    DEFF Research Database (Denmark)

    Christensen, Anne-Sophie Halkjær; Roed-Petersen, Casper

    2011-01-01

    With high short-term mortality and substantial excess morbidity among survivors, tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis (TB). The objective of this study was to assess the long-term mortality and causes of death in a TBM patient population compared to the background population.

  10. Listeria monocytogenes meningitis in an atomic bomb survivor receiving corticosteroid therapy for aplastic anemia

    International Nuclear Information System (INIS)

    We report a case of successfully treated Listeria monocytogenes (Lm) meningitis in a atomic bomb survivor receiving steroid therapy for aplastic anemia. The patient was a 62-year-old woman and the past medical history included hypothyroidism due to radioiodide therapy for Basedow disease, breast cancer, aplastic anemia, steroid-induced diabetes mellitus, and pulmonary tuberculosis. At the time of onset, she was receiving corticosteroid, anabolic steroid, an H2-blocker (famotidine), and other medication. Since she developed symptoms of meningitis when she visited our hospital for regular medical check-up for aplastic anemia, she was hospitalized and given antibiotic therapy, including ABPC, without delay. With this effective antibiotic therapy and successful management of the co-existing medical conditions, she was cured except for being a little euphoric. Lm meningitis is known to occur in aged and immunocompromised patients. Since most of the atomic bomb survivors are now aged and the prevalence of malignancy, diabetes mellitus, and other diseases which cause immunodeficiency have been rising year by year, Lm meningitis is one of the emergency neurologic conditions whose diagnosis should not be delayed in this population. (author)

  11. Radionuclide cisternography in the diagnosis of hydrocephalus type in tuberculous meningitis in children

    International Nuclear Information System (INIS)

    The radionuclide cisternography permits an accurate diagnosis in hydrocephalus, this is an easy procedure, not traumatic nor expensive. Hydrocephalus is one of the most serious complications of tuberculous meningitis, that, without an opportune treatment, leads to severe sequel and death of the patient. The medical records of thirty patients with diagnosis of tuberculosis meningitis were reviewed, to whom the Neuro-Pediatric Service of the National Institute of Children Health solicited radionuclide cisternography to evaluate hydrocephalus and to determinate type, between january 1990 and october 1992. The hydrocephalus was demonstrated by radionuclide cisternography in 26/30 patients (86,7%) The most frequent age was in children under five years old 21/26 (80,7%) and pre-students in 65,38%. The most common finding was communicating hydrocephalus, pattern type IV in 20/30 patients (66,7%). It is concluded that the radionuclide cisternography is very useful for the diagnosis of hydrocephalus and its type patients with tuberculous meningitis. This exam is recommended for all patients with diagnosis of tuberculous meningitis, with no satisfactory evolution, in order to obtain an early diagnosis of hydrocephalus and its type, and get an opportune medical or surgical treatment. (author). 35 refs., 3 tab., 8 ills

  12. Hepatic Artery Infusion Chemotherapy

    OpenAIRE

    Tuchmann, A.; Schu?ller, J.; Kroiss, A.; Dinstl, K.

    1990-01-01

    Hepatic artery chemotherapy was given to 36 patients, using totally implantable devices consisting of a port and external pump. Twenty-seven patients had inoperable liver metastases of colorectal origin. The infusion system was inserted by laparotomy into the hepatic artery via the gastroduodenal artery. There was no operative mortality. Thirteen infusion systems could not be used for chemotherapy due to dislodgement, early death and lack of follow-up. FUdR was infused every two w...

  13. Celiac Artery Compression Syndrome

    OpenAIRE

    Mohammed Muqeetadnan; Syed Amer; Ambreen Rahman; Salman Nusrat; Syed Hassan

    2013-01-01

    Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  14. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  15. C-reactive protein and bacterial meningitis : a meta-analysis

    DEFF Research Database (Denmark)

    Gerdes, Lars Ulrik; JØrgensen, P E

    1998-01-01

    The aim of the study was to review published articles on the diagnostic accuracy of C-reactive protein (CRP) tests with cerebrospinal fluid and serum in diagnosing bacterial meningitis. The literature from 1980 and onwards was searched using the electronic databases of MEDLINE, and we used summary receiver operating characteristic curve analyses (SROCs) to describe central tendencies and examine possible sources of inter-study variability in the results. We included data from 35 studies of both children and adults: 21 in which CRP had been measured in cerebrospinal fluid, 10 in which CRP had been measured in serum, and 4 in which it had been measured in both cerebrospinal fluid and serum. The odds ratio for bacterial meningitis versus aseptic meningitis for a positive CRP test with cerebrospinal fluid was estimated at 241 (95% confidence interval [CI]: 59-980), and the central tendencies for the true-positive fraction (sensitivity) and the false-positive fraction (1-specificity) were estimated at 0.94 and 0.06, respectively. The corresponding figures for a CRP test with serum were 150 (95% CI: 44-509), 0.92 and 0.08, respectively. Regression analyses including variables coding for study design features, inclusion of neonatal patients, geographical region, or use of a quantitative biochemical method did not indicate statistically significant contributions to inter-study variances in the log odds ratios. For values of the true- and the false-positive fractions of 0.92-0.94 and 0.06-0.08, respectively, the post-test probability of not having bacterial meningitis given a negative test is very high (> or = 97%), in the range of a pre-test probability (prevalence of bacterial meningitis) from 10 to 30%, whereas the post-test probability of bacterial meningitis given a positive test is considerably lower. Hence, only a negative test is highly informative in a typical clinical setting. This, as well as the absence of analyses to show if CRP tests contribute independent diagnostic information, relatively to the information held in the traditionally used clinical and biochemical variables, makes it difficult to conclude on the clinical usefulness of CRP tests in the management of patients suspected of having bacterial meningitis.

  16. Epidemiology of meningitis due to Haemophilus influenzae type b in children in Bulgaria: a prospective, population-based surveillance study

    Directory of Open Access Journals (Sweden)

    Kojouharova Mira

    2002-01-01

    Full Text Available OBJECTIVE: To assess the incidence of meningitis caused by Haemophilus influenzae type b (Hib among children in Bulgaria and to provide evidence for an informed decision on the use of Hib vaccines in Bulgaria. METHODS: From 1 July 1997 to 31 December 1999, active surveillance for meningitis was conducted in six regions. For children with suspected meningitis, a cerebrospinal fluid (CSF specimen was sent for cytology, chemistry, latex agglutination testing, culture and sensitivity. FINDINGS: During the 2.5-year study period, surveillance was conducted among 138 249 children aged <5 years - a sample representing 40% of all Bulgarian children in this age group. Overall, 285 children with suspected meningitis were identified. In eight children, clinical symptoms of meningitis resolved rapidly before a CSF specimen could be obtained. Of the remaining 277 children, 121 (44% were classified as having probable bacterial meningitis on the basis of a CSF examination. An organism was identified for 88 (73% of the 121 cases with probable bacterial meningitis. There were 21 cases of Hib, giving a mean annual incidence of 6.1 Hib meningitis cases per 100 000 children <5 years; the case-fatality rate was 10%. Nearly 60% of Hib isolates were resistant to one or more antibiotics, but they were not resistant to third-generation cephalosporins. CONCLUSION: On the basis of these findings, Hib conjugate vaccines have been included in the list of vaccines recommended for children by the Bulgarian Ministry of Health. The recommended initial treatment for paediatric bacterial meningitis has been changed to third-generation cephalosporins.

  17. Meningitis por estreptococo ß-hemolítico del grupo B en lactantes Meningitis in breast-fed infants caused by Group B ß-hemolytic streptococcus

    Directory of Open Access Journals (Sweden)

    Félix Orlando Dickinson Meneses

    2013-03-01

    Full Text Available Introducción: el estreptococo ß-hemolítico del grupo B es causa frecuente de sepsis y muerte neonatal. Objetivo: caracterizar el comportamiento de la meningitis por estreptococo ß-hemolítico del grupo B en Cuba. Métodos: se realizó un estudio observacional (descriptivo y analítico de 57 casos de meningitis por ß-hemolítico del grupo B, con inicio de los síntomas entre el 1ro de enero de 1998 y 31 de diciembre de 2010. Se estimó el riesgo según el año de ocurrencia, la edad, el sexo, la provincia y el municipio, así como la letalidad y la asociación de la demora en la consulta médica y el ingreso hospitalario, con la muerte. Resultados: la incidencia de todo el período fue 0,03/1 000 nacidos vivos y la letalidad alcanzó 31,58 %. La proporción de casos en el sexo masculino (50,9 % fue muy similar al femenino (49,1 %. Los menores de 2 meses fueron más afectados por la enfermedad (38 casos y aportaron el 100 % de los fallecidos (18. Las provincias con mayor riesgo fueron Pinar del Río (0,09/1 000 nacidos vivos y Santiago de Cuba (0,08/1 000 nacidos vivos. El municipio con mayor riesgo fue San Luis, en Santiago de Cuba (0,31/1 000 nacidos vivos. La media de tiempo para la consulta médica fue alrededor de 17 horas, y para el ingreso fue aproximadamente 5 horas. No hubo asociación de la demora para la consulta (RR= 0,66 y el ingreso (RR= 1,22 con la muerte. Conclusiones: la meningitis por estreptococo ß-hemolítico del grupo B constituye una causa importante y prevenible de meningitis y muerte neonatal en Cuba.Introduction: group B ß-hemolytic streptococcus is a common cause of sepsis and neonatal death, Objective: to characterize the behavior of the Group B ß-hemolytic streptococcus meningitis in Cuba. Methods: an observational, descriptive and analytical study was performed on 57 patients suffering meningitis caused by Group B ß-hemolytic streptococcus, with the onset of symptoms ranging from January 1st 1998 to December 2010. The risk was estimated according to the year of occurrence, the age, the province and the municipality as well as the fatality rate and the association of delay in medical diagnosis and in admission to the hospital and death. Results: the incidence rate of the whole period was 0.03 per 1 000 livebirths and the fatality rate amounted to 31.58 %. The propo9rtion of cases between males and females was very similar (50.9 % and 49.1 % respectively. The infants aged younger than 3 months were more affected by the disease (38 cases and they accounted for 100 % of those children who died (18 cases. The most risky provinces were Pinar del Rio (9.09 per 1 000 livebirths and Santiago de Cuba (0.08 per 1 000 livebirths. The municipality with the highest risk index was San Luis in Santiago de Cuba (0.31 per 1 000 livebirhts. The average length of time for medical diagnosis was 17 hours and for admission to the hospital was 5 hours. No association was found between delay in medical diagnosis (RR= 0.66 and in admission to the hospital (RR= 1.22 and death occurrence. Conclusions: Group B ß-hemolytic streptococcus is a significant preventable cause of meningitis and neonatal death.

  18. Meningitis tuberculosa en menores de cinco años en la Argentina / Tuberculous meningitis in children under 5 years of age in Argentina

    Scientific Electronic Library Online (English)

    Raquel, Darnaud; Veronica, Prieto; María Delfina, Sequeira.

    2006-04-01

    Full Text Available La tuberculosis meníngea en menores de cinco años continúa siendo un serio problema de salud pública en Argentina, con una tasa de 0.39/100.000 habitantes en el bienio 2003-2004. Esta tasa refleja las infecciones recientes y es un indicador operacional de la búsqueda y tratamiento de casos adultos p [...] ulmonares y de la cobertura de la vacunación con BCG en el recién nacido. Este estudio se realizó con el objeto de describir las variables epidemiológicas y clínicas de los casos de meningitis tuberculosa en menores de cinco años en Argentina en el período 1999-2001 y para obtener mayor certeza sobre el número real de meningitis que se producen en el país. Se estudiaron con fichas epidemiológicas 15 casos de meningitis de los 32 notificados (46.8%). La mediana de la edad fue 14 meses, 6 niños tenían cicatriz de BCG, pero en sólo uno se pudo constatar que fue vacunado al nacer, 11/13 (92.3%) estaban en estadio 2 de la enfermedad, la investigación bacteriológica resultó positiva en 8/11 (72.7%), por lo menos 7 (46.8%) presentaron imágenes compatibles con tuberculosis pulmonar, la prueba tuberculínica resultó no reactiva en todos los casos en que fue aplicada. Este estudio puso en evidencia que los niños se diagnosticaron en estadios avanzados de la enfermedad, ninguno curó sin secuelas y hubo un muy alto porcentaje de letalidad (46%). Para contrarrestar esta situación epidemiológica es necesario incrementar la búsqueda y tratamiento supervisado de casos bacilíferos, el estudio de contactos y la cobertura de vacunación con BCG al nacimiento. Abstract in english Tuberculous (TB) meningitis in children under 5 years of age is a serious health problem in Argentina, with a rate of 0.39/100.000 inhabitants, for 2003-2004. This rate indicates recent infections. It is an operational indicator for case finding and treatment of pulmonary adult cases, and for BCG va [...] ccination of the newborn. The object of this study was to describe epidemic and clinical variables registered in cases of TB meningitis in children less than 5 years old in Argentina, from 1999 to 2001 and to determine the real number of TB meningitis cases in our country. Fifteen cases of TB meningitis out of 32 (46.8%) were studied through epidemic records. The average age was 14 months. Six children presented BCG scars but in only one child it was proved that he had been vaccinated at birth; 11/13 (92.3%) were at the second stage of illness, the bacteriological investigation was positive in 8/11 (72.7%) and in (46.8%) chest radiography revealed abnormal findings. The tuberculin reaction was negative in all tested cases. This study showed that the diagnosis was made at an advanced stage of disease. None of these patients was cured without sequels and a high death rate (46%) was observed. In order to control this epidemic situation, it is necessary to increase case finding and directly observed treatment of smear positive pulmonary TB cases, as well as BCG vaccination given at birth.

  19. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis.

    Science.gov (United States)

    Kourbeti, Irene S; Vakis, Antonis F; Ziakas, Panayiotis; Karabetsos, Dimitris; Potolidis, Evangelos; Christou, Silvana; Samonis, George

    2015-05-01

    OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilatorassociated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics. PMID:25343179

  20. Clinical characteristics of Haemophilus influenzae meningitis in Denmark in the post-vaccination era

    DEFF Research Database (Denmark)

    Pedersen, T.I.; Howitz, M.

    2010-01-01

    P>The introduction of Haemophilus influenzae type b (Hib) vaccine into the Danish childhood vaccination programme in 1993 may have influenced the epidemiology of H. influenzae meningitis (i.e. increasing frequency of other non-vaccine types; presentation in other age groups). Based on nationwide registration, clinical information and laboratory findings were collected from all 65 confirmed cases of H. influenzae meningitis during the period 1994-2005. Twenty-nine patients (45%) were 24 years old [median 62 years (range 25-96)]. Hib accounted for 31% (20/65) of the cases, and significantly more children were infected with Hib compared with adults [53% (16/29) vs. 11% (4/36), respectively, p 0.0003]. Overall, 38% of cases had an otogenic focus and this was thus the most frequent primary focus of infection. Among children infected with Hib, two cases (13%) were identified as true vaccine failures. Six patients (9%) died; one premature infant infected with serotype f and five adults (age 83-96 years) with non-typeable H. influenzae. Hearing loss was reported in 16% of the surviving children and in 10% of the surviving adults. The presence of a lung focus was an independent prognostic factor for an unfavourable outcome (p 0.03). In conclusion, meningitis caused by Hib has been infrequent in Denmark after introduction of the Hib vaccine in the childhood vaccination programme, and no increase in meningitis cases due to non-b type H. influenzae has been observed. Cases with H. influenzae meningitis frequently had an otogenic focus, with low risk of an unfavourable outcome

  1. Factors associated with the occurrence of hearing loss after pneumococcal meningitis

    DEFF Research Database (Denmark)

    WorsØe, Lise Lotte; Caye-Thomasen, P.

    2010-01-01

    Background. On the basis of a nationwide registration during a 5-year period (1999-2003), the frequency and severity of hearing loss was investigated retrospectively in 343 consecutive Danish patients who survived pneumococcal meningitis, to identify important risk factors (including the pneumococcal serotype) for development of hearing loss. Methods. Results of blood and cerebrospinal fluid (CSF) biochemistry, bacterial serotyping, follow-up audiological examinations, and medical records were collected, and disease-related risk factors for hearing loss were identified. The mean pure-tone hearing threshold levels were compared with normative data. Results. Of 240 patients examined by use of audiometry, 129 (54%) had a hearing deficit, and 50 (39%) of these 129 patients were not suspected of hearing loss at discharge from hospital. Of the 240 patients, 16 (7%) had profound unilateral hearing loss, and another 16 (7%) had bilateral profound hearing loss. Significant risk factors for hearing loss were advanced age, the presence of comorbidity, severity of meningitis, a low CSF glucose level, a high CSF protein level, and a certain pneumococcal serotype (P <.05). By applying multivariate logistic regression analysis, we found that advanced age, female sex, and a certain serotype were significant risk factors, because fewer patients with serotype 6B had hearing loss than did patients with serotype 12F (P = .03), which was the most commonly occurring serotype. Conclusion. Hearing loss is common after pneumococcal meningitis, and audiometry should be performed on all those who survive pneumococcal meningitis. Important risk factors for hearing loss are advanced age, female sex, severity of meningitis, and bacterial serotype

  2. Pre-infection physical exercise decreases mortality and stimulates neurogenesis in bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Liebetanz David

    2012-07-01

    Full Text Available Abstract Physical exercise has been shown to increase neurogenesis, to decrease neuronal injury and to improve memory in animal models of stroke and head trauma. Therefore, we investigated the effect of voluntary wheel running on survival, neuronal damage and cell proliferation in a mouse model of pneumococcal meningitis. Mice were housed in cages equipped with voluntary running wheels or in standard cages before induction of bacterial meningitis by a subarachnoid injection of a Streptococcus pneumoniae type 3 strain. 24 hours later antibiotic treatment was initiated with ceftriaxone (100?mg/kg twice daily. Experiments were terminated either 30 hours or 4?days (short-term or 7?weeks (long-term after infection, and the survival time, inflammatory cytokines and corticosterone levels, neurogenesis in the dentate gyrus of the hippocampal formation and the cognitive function were evaluated in surviving mice. Survival time was significantly increased in running mice compared to control animals (p?=?0.0087 in short-term and p?=?0.016 in long-term experiments, log-rank test. At the end of the long-term experiment, mortality was lower in trained than in sedentary animals (p?=?0.031, Fisher’s Exact test. Hippocampal neurogenesis – assessed by the density of doublecortin-, TUC-4- and BrdU?+?NeuN-colabeled cells - was significantly increased in running mice in comparison to the sedentary group after meningitis. However, Morris water maze performance of both groups 6?weeks after bacterial meningitis did not reveal differences in learning ability. In conclusion, physical exercise prior to infection increased survival in a mouse model of bacterial meningitis and stimulated neurogenesis in the dentate gyrus of the hippocampal formation.

  3. Neuroradiological features of intracranial and intraorbital meningeal haemangiopericytomas

    International Nuclear Information System (INIS)

    The neuroradiological features of six intracranial and one intraorbital haemangiopericytomas (HP) are reviewed. CT was performed before and after IV contrast medium in 5 patients. In 2 patients MRI was performed before and after contrast medium; in another, only unenhanced images were obtained. Five patients were studied by selective external and internal carotid artery angiography. Women constituted 5 of the 7 patients, and the mean age was 50.5 years, thus the sex and age distribution did not differ from that of typical meningiomas. Contrary to previous reports, calcification was present in two of the intracranial HP, and bone erosion was clearly seen in one intracranial HP and the orbital lesion. On MRI the tumours showed no differences from angioblastic meningiomas. All 6 intracranial HP were aggressive; all recurred following treatment and extracerebral metastasis occurred in one case. (orig.)

  4. Definitive neuroradiological diagnostic features of tuberculous meningitis in children

    International Nuclear Information System (INIS)

    Although CT scanning is used widely for making the diagnosis and detecting the complications of tuberculous meningitis (TBM) in children, the radiological features are considered non-specific. CT is particularly suggestive of the diagnosis when there is a combination of basal enhancement, hydrocephalus and infarction, and even then the diagnosis may be in doubt. In this paper we introduce a new CT feature for making the diagnosis of TBM, namely, hyperdensity in the basal cisterns on non-contrast scans, and we assess which of the recognized CT features is most sensitive and specific. To determine the sensitivity and specificity of the presence of high-density exudates in the basal cisterns (on non-contrast CT) and basal enhancement (on contrast-enhanced CT) for the diagnosis of TBM in children, and to correlate these with the complications of infarction and hydrocephalus. Retrospective review of CT scans with readers blinded to the diagnosis, which was based on a definitive culture of cerebrospinal fluid (CSF) for TBM or other bacteria. Computer-aided conversion of hard-copy film density to Hounsfield units was employed as well as a density threshold technique for determining abnormally high densities. The most specific feature for TBM is hyperdensity in the basal cisterns prior to IV contrast medium administration (100%). The most sensitive feature of TBM is basal enhancement (89%). A combination of features (hydrocephalus, infarction and basal enhancement) is as specfarction and basal enhancement) is as specific as pre-contrast hyperdensity, but has a lower sensitivity (41%). There were statistically significant differences in the presence of hydrocephalus (p=0.0016), infarcts (P=0.0014), basal enhancement (P<0.0001) and pre-contrast density (P<0.0001) between the negative and positive TBM patient groups. The presence of granulomas was not statistically significant between the two groups (P=0.44). The presence of high density within the basal cisterns on non-contrast CT scans is a very specific sign for TBM in children. This will enhance diagnostic confidence, allow early institution of therapy and could reduce expenditure on contrast medium, scan time and radiation exposure. With the use of threshold techniques we believe that the pre-contrast hyperdensity may be detectable by a computer program that will facilitate diagnosis, and may also be modified to detect abnormal enhancement. Basal enhancement is a sensitive sign for the diagnosis of TBM and should be sought after contrast medium administration when no hyperdensity is seen in the basal cisterns or when this finding needs to be confirmed. The CT scan feature of hyperdense exudates on pre-contrast scans should be added to the inclusion criteria for the diagnosis of TBM in children. (orig.)

  5. Doença meningocócica e meningite / Meningococcal disease and meningitis

    Scientific Electronic Library Online (English)

    Ricardo G., Branco; Carolina F., Amoretti; Robert C., Tasker.

    2007-05-01

    Full Text Available OBJETIVO: Revisar a literatura pertinente ao diagnóstico e tratamento de doença meningocócica (DM). FONTES DOS DADOS: Revisão não-sistemática da literatura médica através de busca na base de dados MEDLINE usando os seguintes termos: meningocócico, choque séptico, diagnóstico, e tratamento. Os artigo [...] s foram selecionados de acordo com sua relevância para o objetivo do trabalho e de acordo com a opinião dos autores. SÍNTESE DOS DADOS: A DM é uma das principais causas de morte em crianças, devido à infecção. Ela progride rapidamente e é preciso um alto grau de suspeita para se estabelecer o diagnóstico precocemente. Intervenção precoce com fluidoterapia agressiva e antibioticoterapia podem melhorar significativamente o desfecho. Na unidade de tratamento intensivo pediátrico, uma grande quantidade de volume pode ser necessário durante os primeiros dias e drogas vasoativas são geralmente usadas. Coagulopatia é freqüente, mas não tem tratamento específico. O uso de colóides e esteróides pode ser benéfico, mas outros tratamentos novos tais como insulina e proteína C ativada ainda precisam ser investigados em mais detalhe. O tratamento de resgate com circulação extracorpórea pode ser adequado em casos com complicações causadas pela síndrome do desconforto respiratório agudo grave, mas não no caso de choque refratário. A meningite geralmente não é diagnosticada na DM por causa da gravidade da doença e da incapacidade de realização de uma punção lombar com segurança em um paciente com coagulopatia, coma, ou instabilidade hemodinâmica. Quando presentes, edema cerebral e fluxo sangüíneo cerebral anormal são as principais preocupações. O uso de solução hiperosmolar pode ser necessário, mas a principal intervenção terapêutica é garantir pressão sangüínea adequada para que a perfusão cerebral seja adequada. Convulsões e hiponatremia devem ser tratadas agressivamente. Esteróides parecem não afetar o desfecho na meningite meningocócica. CONCLUSÕES: DM é uma infecção com risco de vida que necessita reconhecimento e tratamento precoces. Ressuscitação volumétrica e antibioticoterapia em tempo adequado são as terapias mais efetivas no tratamento da DM. Outras terapias, como uso de esteróides, podem ser úteis em seu tratamento mas ainda necessitam estudos confirmatórios. Abstract in english OBJECTIVE: To review the literature relevant to diagnosis and management of meningococcal disease (MD). SOURCES: Non-systematic review of medical literature through the MEDLINE database using the terms meningococcal, septic shock, diagnosis, and treatment. Articles were selected according to their r [...] elevance to the objective of the study and according to the authors’ opinion. SUMMARY OF THE FINDINGS: MD is a leading cause of death due to infection in children. It progresses rapidly and a high level of suspicion is necessary for early diagnosis. Early intervention with aggressive fluid resuscitation and antibiotic therapy can significantly improve outcome. In the pediatric intensive care unit, a large amount of fluids may be required during the first few days and vasoactive drug infusions are often needed. Coagulopathy is frequent, but it has no specific treatment. The use of colloids and steroids may be beneficial, but other new therapies such as insulin and activated protein C still need further assessment. Rescue therapy with extracorporeal membrane oxygenation may be appropriate in cases complicated by severe acute respiratory distress syndrome, but not for refractory shock. Meningitis is often not diagnosed in MD because of the severity of illness and the inability to perform a lumbar puncture safely in a patient with coagulopathy, coma, or hemodynamic instability. When present, cerebral edema and altered cerebral blood flow are the main concerns. The use of osmolar solution may be necessary, but the main therapeutic intervention is to ensure adequate blood pressure for adequate cerebral perfusion. Seizures and hyponatremia should be agg

  6. Doença meningocócica e meningite Meningococcal disease and meningitis

    Directory of Open Access Journals (Sweden)

    Ricardo G. Branco

    2007-05-01

    Full Text Available OBJETIVO: Revisar a literatura pertinente ao diagnóstico e tratamento de doença meningocócica (DM. FONTES DOS DADOS: Revisão não-sistemática da literatura médica através de busca na base de dados MEDLINE usando os seguintes termos: meningocócico, choque séptico, diagnóstico, e tratamento. Os artigos foram selecionados de acordo com sua relevância para o objetivo do trabalho e de acordo com a opinião dos autores. SÍNTESE DOS DADOS: A DM é uma das principais causas de morte em crianças, devido à infecção. Ela progride rapidamente e é preciso um alto grau de suspeita para se estabelecer o diagnóstico precocemente. Intervenção precoce com fluidoterapia agressiva e antibioticoterapia podem melhorar significativamente o desfecho. Na unidade de tratamento intensivo pediátrico, uma grande quantidade de volume pode ser necessário durante os primeiros dias e drogas vasoativas são geralmente usadas. Coagulopatia é freqüente, mas não tem tratamento específico. O uso de colóides e esteróides pode ser benéfico, mas outros tratamentos novos tais como insulina e proteína C ativada ainda precisam ser investigados em mais detalhe. O tratamento de resgate com circulação extracorpórea pode ser adequado em casos com complicações causadas pela síndrome do desconforto respiratório agudo grave, mas não no caso de choque refratário. A meningite geralmente não é diagnosticada na DM por causa da gravidade da doença e da incapacidade de realização de uma punção lombar com segurança em um paciente com coagulopatia, coma, ou instabilidade hemodinâmica. Quando presentes, edema cerebral e fluxo sangüíneo cerebral anormal são as principais preocupações. O uso de solução hiperosmolar pode ser necessário, mas a principal intervenção terapêutica é garantir pressão sangüínea adequada para que a perfusão cerebral seja adequada. Convulsões e hiponatremia devem ser tratadas agressivamente. Esteróides parecem não afetar o desfecho na meningite meningocócica. CONCLUSÕES: DM é uma infecção com risco de vida que necessita reconhecimento e tratamento precoces. Ressuscitação volumétrica e antibioticoterapia em tempo adequado são as terapias mais efetivas no tratamento da DM. Outras terapias, como uso de esteróides, podem ser úteis em seu tratamento mas ainda necessitam estudos confirmatórios.OBJECTIVE: To review the literature relevant to diagnosis and management of meningococcal disease (MD. SOURCES: Non-systematic review of medical literature through the MEDLINE database using the terms meningococcal, septic shock, diagnosis, and treatment. Articles were selected according to their relevance to the objective of the study and according to the authors’ opinion. SUMMARY OF THE FINDINGS: MD is a leading cause of death due to infection in children. It progresses rapidly and a high level of suspicion is necessary for early diagnosis. Early intervention with aggressive fluid resuscitation and antibiotic therapy can significantly improve outcome. In the pediatric intensive care unit, a large amount of fluids may be required during the first few days and vasoactive drug infusions are often needed. Coagulopathy is frequent, but it has no specific treatment. The use of colloids and steroids may be beneficial, but other new therapies such as insulin and activated protein C still need further assessment. Rescue therapy with extracorporeal membrane oxygenation may be appropriate in cases complicated by severe acute respiratory distress syndrome, but not for refractory shock. Meningitis is often not diagnosed in MD because of the severity of illness and the inability to perform a lumbar puncture safely in a patient with coagulopathy, coma, or hemodynamic instability. When present, cerebral edema and altered cerebral blood flow are the main concerns. The use of osmolar solution may be necessary, but the main therapeutic intervention is to ensure adequate blood pressure for adequate cerebral perfusion. Seizures and hyponatremia should be aggressively treated. Steroids do no

  7. Carotid Artery Disease

    Science.gov (United States)

    ... involves the placement of a small flexible tube (catheter) into an artery from the groin. The catheter is then directed to the neck to reach ... of atherosclerosis (build-up of plaque in the peripheral, coronary or carotid arteries) • Age (men have a ...

  8. Pulmonary Arterial Hypertension

    Science.gov (United States)

    ... Arterial Hypertension? With PAH, the arteries become too narrow to handle the amount of blood that must be pumped through the lungs. This causes several things to happen: a backup of blood in the veins returning blood to the heart; an increase in ...

  9. Use of magnetic resonance imaging to detect neoplastic meningitis: Limited use in leukemia and lymphoma but convincing results in solid tumors

    International Nuclear Information System (INIS)

    Background: An early diagnosis of meningitis is important to improve patients’ survival. Data about a direct comparison of cerebrospinal fluid cytology (CSF-cytology) and MRI are very limited. Therefore, the aim of this study was to compare these two diagnostic modalities in diagnosing meningitis in patients with hematopoietic and solid malignancies. Methods: In 68 patients suspicious for neoplastic meningitis, cytology and MRI (1.5 T) was performed. The meningeal, pial or intraparenchymal hyperintense signal or contrast enhancement was correlated to the final CNS diagnosis and to cytology. Results: 44 patients (64.7%) had neoplastic meningitis, 21 patients (30.9%) had non-neoplastic meningitis. The sensitivity to diagnose meningeal disease was 49.2% for MRI and 95.4% for cytology (p < 0.001). In patients with neoplastic meningitis, sensitivity was 45.5% for MRI and 93.2% for cytology (p < 0.001). In patients with infectious meningitis, sensitivity was 57.1% for MRI and 100% for cytology (p = 0.0013). In patients with solid tumors, the sensitivity was 84.6% for both diagnostic methods. The sensitivity for MRI was low in patients with leukemia (20.0%) and lymphoma (37.5%). The positive predictive value (PPV) for MRI to differentiate infectious from neoplastic meningitis was high in patients with infectious meningitis (75.0%), in patients with lymphoma (83.3%), and in patients with solid tumors (72.7%). Ppv was low in patients with leukemia (33.3%). Conclusion: Diagnoith leukemia (33.3%). Conclusion: Diagnostic value of MRI for diagnosing meningitis is especially limited in patients with hematopoietic malignancies. MRI better detected leptomeningeal involvement caused by solid tumors than by leukemia or lymphoma. The ppv to specify neoplastic meningitis depends on tumor subtype.

  10. A serogroup A meningococcal polysaccharide vaccine: studies in the Sudan to combat cerebrospinal meningitis caused by Neisseria meningitidis group A.

    Science.gov (United States)

    Erwa, H H; Haseeb, M A; Idris, A A; Lapeyssonnie, L; Sanborn, W R; Sippel, J E

    1973-01-01

    Vaccination against cerebrospinal meningitis (CSM) has regained interest with the use of capsular polysaccharides (or polyosides) of the meningococcus as specific immunizing agents. These compounds proved to be effective in the USA against meningitis caused by Neisseria meningitidis serotype C. This study considers whether the polysaccharides of the serotype A meningococcus, which is prevalent in the African CSM belt, could be protective in epidemic conditions. Taking advantage of the usual seasonal peak of CSM cases, controlled field trials were undertaken in the Sudan early in 1973. 21 640 persons were vaccinated, half of them with a meningococcal polyoside A vaccine and the other half with tetanus toxoid as a placebo. In the former group there were no cases of meningitis, whereas in the latter 10 cases were reported, of which 7 were confirmed by laboratory tests. These studies indicate that the meningococcal polyoside A vaccine is efficient in epidemic conditions and could be used to control outbreaks of meningococcal meningitis. PMID:4211056

  11. Listeria monocytogenes meningitis in an immunocompetent 18-year old patient as a possible diagnostic and therapeutical problem

    Directory of Open Access Journals (Sweden)

    Vrbi? Miodrag

    2013-01-01

    Full Text Available Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

  12. Three-year multicenter surveillance of community-acquired listeria monocytogenes meningitis in adults

    Directory of Open Access Journals (Sweden)

    Grill-Díaz Fabio

    2010-11-01

    Full Text Available Abstract Background Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series. Methods A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF culture or blood culture. The patients were followed up until death or discharge from hospital. Results Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042, immunosupression (OR 2.520; 95% CI 1.05-6.00; p = 0.037, and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002 were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49% patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68% patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79% of 43 patients, in 11 (32% of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024 and a higher mortality (67% vs 32%; p = 0.040.The mortality rate was 28% (12 of 43 patients and 5 of 31 (16.1% surviving patients developed adverse clinical outcome. Conclusions Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

  13. Neonatal Listeria-meningitis in San Luis, Argentina: a three-case report / Meningitis neonatal por Listeria monocytogenes en San Luis, Argentina: análisis de tres casos

    Scientific Electronic Library Online (English)

    Analía L., Laciar; María L., Vaca Ruiz; Alban, Le Monnier.

    2011-03-01

    Full Text Available En el presente estudio se describen tres casos de infección neonatal por Listeria monocytogenes, dos de inicio temprano y uno tardío, diagnosticados en San Luis, Argentina, entre noviembre de 1996 y diciembre de 2006. En uno de los pacientes afectados por listeriosis temprana, la meningitis condujo [...] a la hidrocefalia secundaria. En los otros recién nacidos, la evolución clínica fue favorable después de la administración de un rápido y adecuado tratamiento. Los aislamientos de L. monocytogenes de dos pacientes pertenecieron al grupo IVb (serovar 4b) y el del tercer paciente al grupo IIB (serovar 1/2b) según la técnica de PCR. La listeriosis es, por razones que se desconocen, una enfermedad rara en Argentina, especialmente la presentación materno-fetal. Los resultados presentados aquí podrán ser utilizados en un futuro con fines epidemiológicos. Abstract in english Between November 1996 and December 2006, two cases of early-onset and one case of late-onset neonatal listeriosis were reported in San Luis, Argentina. This article describes clinical and laboratory findings as well as treatment and outcome for newborns treated for Listeria monocytogenes meningitis [...] or septicaemia. In one of the newborns with early-onset listeriosis, meningitis led to important complications including hydrocephalus. The two other newborns showed complete recovery following adequate treatment. The L. monocytogenes isolates from two patients belonged to PCR group IVb (including serovar 4b strains) and to PCR group IIb (including serovar 1/2b strains) in the third patient. Listeriosis, especially the maternal-fetal presentation, is still rare in Argentina for unknown reasons. Our data can be used in the future as an epidemiological survey.

  14. Primer caso de meningitis por Streptococcus suis en el noroeste de Argentina / First case of meningitis by Streptococcus suis in the norwest area of Argentina

    Scientific Electronic Library Online (English)

    Juan M, Núñez; Mariana, Marcotullio; Andrea, Rojas; Luis, Acuña; Mariel, Cáceres; Silvana, Mochi.

    2013-10-01

    Full Text Available La infección por Streptococcus suis puede causar meningitis, bacteriemia, endocarditis, endoftalmitis, artritis y shock tóxico, tanto en el ser humano como en cerdos. La incidencia de esta zoonosis está aumentando en el mundo. Se presenta el caso de un varón de 54 años de edad, trabajador rural prov [...] eniente de la provincia de Tucumán, Argentina, que consultó por cefalea, vómitos y fotofobia de dos días de evolución, constatándose una sepsis de foco meníngeo. Tanto en el cultivo de líquido cefalorraquídeo como en el hemocultivo se aisló S. suis. Se trató con ceftriaxona con buena evolución y sin secuelas. Es el primer caso de S. suis en el noroeste argentino y el tercero en Latinoamérica. Se resalta la importancia del antecedente de exposición laboral a cerdos para la sospecha inicial de este microorganismo. Abstract in english Streptococcus suis causes meningitis, bacteremia, endocarditis, endophthalmitis, artrithis and toxic shock in both pigs and human beings. The incidence of this pathogen is increasing worldwide. A case of 54 years old men from a rural zone of Tucumán, Argentina with two days of headache, vomit and ph [...] otophobia was admitted septic, with purulent meningitis. Streptococcus suis was growth from the blood and cerebrospinal fluid culture. The patient was treated with ceftriaxona and had a good evolution without sequels. This is the first case of S. suis described in the northwest of Argentina and the third of Latin America, and it is emphasized that the occupational contact with pigs is an important background for the initial suspect of this pathogen.

  15. Pharmacokinetics and bacteriological efficacy of moxalactam (LY127935), netilmicin, and ampicillin in experimental gram-negative enteric bacillary meningitis.

    OpenAIRE

    U. B. Schaad; McCracken, G H; Loock, C A; Thomas, M. L.

    1980-01-01

    Moxalactam (LY127935) is a 1-oxa-beta-lactam which was active in vitro against the majority of 128 strains of gram-negative enteric bacilli isolated from meningitis in neonates. Pharmacokinetics and bacteriological efficacy of LY127935 were studied in a lapin meningitis model. The average penetration of this investigational oxa-cephalosporin into cerebrospinal fluid of infected rabbits was 23% compared with 25% for netilmicin and 11% for ampicillin. The cerebrospinal fluid concentrations of L...

  16. Meningitis Dipstick Rapid Test: Evaluating Diagnostic Performance during an Urban Neisseria meningitidis Serogroup A Outbreak, Burkina Faso, 2007

    OpenAIRE

    Rose, Am; Mueller, Je; Gerstl, S.; Njanpop-lafourcade, Bm; Page, Al; Nicolas, P.; Traore?, Ro; Caugant, Da; Guerin, Pj; Traore, Ro

    2010-01-01

    Meningococcal meningitis outbreaks occur every year during the dry season in the "meningitis belt" of sub-Saharan Africa. Identification of the causative strain is crucial before launching mass vaccination campaigns, to assure use of the correct vaccine. Rapid agglutination (latex) tests are most commonly available in district-level laboratories at the beginning of the epidemic season; limitations include a short shelf-life and the need for refrigeration and good technical skills. Recently, a...

  17. Optic Neuritis as Isolated Manifestation of Leptomeningeal Carcinomatosis: A Case Report and Systematic Review of Ocular Manifestations of Neoplastic Meningitis

    OpenAIRE

    Silvia Lanfranconi; Paola Basilico; Ilaria Trezzi; Linda Borellini; Giulia Franco; Vittorio Civelli; Francesco Pallotti; Nereo Bresolin; Pierluigi Baron

    2013-01-01

    Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique ma...

  18. Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines.

    OpenAIRE

    Robbins John B.; Schneerson Rachel; Gotschlich Emil C.; Mohammed Idris; Nasidi Abdulsalami; Chippaux Jean-Philippe; Bernardino Luis; Maiga Moussa A.

    2003-01-01

    Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub-Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal polysaccharide vaccine, which is protective at all ages when administered as directed. Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage. WHO's policy of epidemic containment prevents, at best, about 50% of cases and ignores ...

  19. Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis.

    OpenAIRE

    Klugman, K P; Friedland, I R; Bradley, J. S.

    1995-01-01

    There are reports of failure of extended-spectrum cephalosporin treatment in pneumococcal meningitis. On the basis of in vitro and animal experimental studies, the addition of vancomycin or rifampin to an extended-spectrum cephalosporin has been recommended for empiric treatment of these patients. Cerebrospinal fluid (CSF) was taken from 31 children with bacterial meningitis randomized to receive ceftriaxone alone (n = 11), ceftriaxone plus rifampin (n = 10), or ceftriaxone plus vancomycin (n...

  20. Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis

    OpenAIRE

    Erdem Ilknur; Hakan Tayfun; Ceran Nurgul; Metin Fatma; Akcay Seniha; Kucukercan Metin; Berkman M; Goktas Pasa

    2008-01-01

    Background: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. Aim: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. Setting and design: Tertiary care hospital and an observational study. Materials and Methods: The study subjects included 2265 patients who un...

  1. Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus / LCR ventricular normal: un factor de confusión en el diagnóstico de hidrocefalia por meningitis tuberculosa

    Scientific Electronic Library Online (English)

    S., Alfayate-Miguélez; L., Martínez-Lage-Azorín; L., Marín-Vives; S., García-Martínez; M.J., Almagro; J.F., Martínez-Lage.

    2011-04-01

    Full Text Available Antecedentes. El procedimiento habitual para el diagnóstico de infección del sistema nervioso central (CNS) consiste en el estudio del liquido cefalorraquídeo (LCR) mediante la realización de una punción lumbar. Sin embargo, en pacientes que debutan con un cuadro de hidrocefalia aguda que son tratad [...] os de urgencia mediante la inserción de un sistema de drenaje de LCR, el líquido es rutinariamente obtenido desde el sistema derivativo implantado. Pero, en ciertos casos, el LCR ventricular y lumbar analizados pueden mostrar diferencias significativas, tanto en condiciones fisiológicas como patológicas. Casos ilustrativos. Se describen los casos de dos niños que presentaron resultados dispares en los estudios iniciales del LCR ventricular y lumbar, en los que se demostró posteriormente que padecían una hidrocefalia por meningitis tuberculosa, lo que motivó un considerable retraso en su diagnóstico y tratamiento. Objetivo. Al describir estos dos casos, pretendemos alertar al médico responsable sobre la posibilidad de esta discrepancia, para evitar retrasos en el diagnóstico y tratamiento de estos pacientes. Discusión. Se comentan los posibles mecanismos patogénicos que pueden producir esta disociación en la composición del LCR ventricular y lumbar. Conclusiones. Un resultado normal del LCR, especialmente del líquido ventricular, no descarta siempre la presencia de una meningitis tuberculosa. Sugerimos la obtención de una muestra de LCR a partir del espacio subaracnoideo lumbar en casos dudosos o sospechosos de infección del SNC, incluso ante la presencia de un LCR ventricular normal. Abstract in english Background. The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the f [...] luid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions. Illustrative cases. We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment. Aim. By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients. Discussion. We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. Conclusions. Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF.

  2. Displasia de Mondini asociada a meningitis bacteriana recurrente, correlación clínico-imagenológica / Mondini dysplasia associated to recurrent bacterial meningitis-a clinical and imaging correlation

    Scientific Electronic Library Online (English)

    Julianis Loraine, Quintero Noa; María del Carmen, Hernández Cordero; Ileana, Álvarez Lam; Aiza, Martínez Romero; Antonio, Paz Cordovés; Daisy, Hevia Bernal.

    2014-06-01

    Full Text Available Se describe la displasia de Mondini asociada a pérdida auditiva y meningitis bacteriana recurrente. La malformación de Mondini representa el 30 % de las anomalías congénitas del oído interno, puede ser unilateral o bilateral, y su principal característica consiste en el desarrollo coclear incompleto [...] , causante de grados variables de hipoacusia neurosensorial. Se considera que la ocurrencia de esta malformación se produce por disrupción del desarrollo embrionario durante la séptima semana de gestación, en la cual se detiene el desarrollo coclear. Se presenta el caso de una niña de 12 años, atendida en los Servicios de Pediatría y Otorrinolaringología del Hospital Pediátrico Universitario "William Soler", por presentar 3 infecciones meningoencefálicas, en las cuales se aisló Streptococcus pneumoniae serotipo 19F, y se constató hipoacusia neurosensorial severa en el oído izquierdo. La tomografía axial computarizada de alta resolución del oído (cortes axiales y coronales), evidenció la malformación coclear y vestibular, con presencia de tejido en el oído medio que se comunicaba directamente con el oído interno del lado izquierdo a nivel de la ventana oval. Se destaca la importancia de la sospecha clínica de displasia de Mondini, y el impacto científico de la tomografía computarizada del hueso temporal, para el diagnóstico precoz de fístula congénita en el oído interno asociada a meningitis bacteriana recurrente. Abstract in english Mondini dysplasia associated to hearing loss and recurrent bacterial meningitis was described in this paper. Mondini malformation accounts for 30% of congenital anomalies in the inner ear, either unilateral or bilateral, and its main characteristic is the incomplete cochlear development causing vari [...] ous grades of neurosensory hypoacusis. It is considered that the occurrence of this malformation results from the disruption of the embryonal development on the 7th week of gestation when the cochlear development ceases. This is the case of 12 years-old girl who was attended to at the pediatric and otorhinolaryngology service of "William Soler" university pediatric hospital because she presented with three meningoencephalic infections from which Streptococcus pneumonia serotype 19F was isolated. It was also confirmed that she suffered severe neurosensory hypoacusis in her left ear. High-resolution computerized axial tomography of the ear (axial and coronal planes) evinced the cochlear and vestibular malformation, with tissue of the middle ear communicating directly with the inner ear of the left size at the oval window. This paper underlined the importance of the clinical suspicion of Mondini disease, and the scientific impact of the computerized axial tomography of the temporal bone in order to early diagnose the congenital fistula in the inner ear associated to recurrent bacterial meningitis.

  3. Incidencia de meningitis en lactantes con crisis febriles simples. Experiencia en un hospital de 3er nivel / Incidence of meningitis in infants with simple febrile seizures. Experience in a 3th level hospital

    Scientific Electronic Library Online (English)

    Luisa Fernanda, Rojas-Rosas; Iván Darío, Flórez; Javier Mauricio, Sierra; William, Cornejo-Ochoa.

    2013-10-01

    Full Text Available Introducción. Se denominan convulsiones febriles (CF) simples aquellas crisis generalizadas, autolimitadas, de menos de 15 minutos de duración, sin recurrencia en las primeras 24 horas y sin alteración neurológica postictal. Las CF constituyen el cuadro convulsivo más frecuente en niños menores de 5 [...] años y se caracterizan por ser eventos benignos y autolimitados. Aproximadamente 2-4% de los niños tienen al menos una CF en algún momento de la vida. Objetivo. Determinar la incidencia de meningitis en niños menores de 18 meses de edad con un primer episodio de convulsión febril simple. Material y Métodos. Revisión retrospectiva de historias clínicas de pacientes entre 3 y 18 meses que consultaron a urgencias del Hospital Universitario San Vicente Fundación (HUSVF), en Medellín, por un primer episodio de convulsión febril simple, entre 2006 y 2011. Resultados. Se revisaron 286 registros de pacientes con diagnóstico de convulsión febril, 79 (27%) correspondían a CF simple. 50 niños (63%) tenían menos de 12 meses, Se realizó punción lumbar en 45 (57%), y se identificaron 6 casos con pleocitosis, uno de los cuáles fue considerado meningitis bacteriana y tres como meningitis aséptica. Dos casos adicionales se consideraron meningitis parcialmente tratada. Los niños con meningitis o meningitis parcialmente tratada tenían sígnos clínicos sospechosos, habían recibido antibióticos o tenía vacunación incompleta. Conclusión. La meningitis en niños con CF simple es poco frecuente y los casos sospechosos pueden detectarse con los criterios de la Academia Americana de Pediatría; si se realiza punción lumbar a niños que han recibido antibióticos, con vacunas incompletas o con signos clínicos neurológicos. La punción lumbar no debe ser rutinaria en casos de CF. Debe estudiarse el perfil epidemiologico de las de las infecciones por neumococo en Colombia, luego de la inclusión de la vacuna de 10 serotipos, para determinar su efecto en el riesgo de meningitis. Abstract in english Introducction. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less than 15 minutes with no recurrence in 24 hours and without neurological inpairment in the post ictal period. FS are the most common cause for convulsions in patients less than 5 years old. These type of [...] crisis are benign and self-limited . FS Lifetime incidence has been calculated between 2-4% in pediatric population. Objective. To determine the inicidence of meningitis in children under 18 months with first simple febrile seizure (FS). Materials and Methods. A retrospective review of medical records of patients 3 to 18 months of age who visited the emergency room at the Hospital Universitario San Vicente Fundación (HUSVF) after first episode of simple febrile seizure (FS), between January 2005 and December 2010. Results. We analized 286 clinical records of patients between 3 and 18 months of age with febrile seizures, 79 (27%) were considered a single FS. Fifty-patients were under 12 months of age (63%). Lumbar puncture was performed in 45 children (57%) and there were 6 children with pleocytosis, one of them was considered as bacterial meningitis, and three as aseptic meningitis. Two cases had diagnosis of partially treated meningitis. Children with suspected meningitis had abnormal neurological signs, had previously received antibiotics or had incomplete vaccination. Conclusion. Meningitis in children with simple FS is not frequent and all cases could be detected according to the criteria of the American Academy of Pediatrics to perform lumbar puncture in children who previously received antibiotics, had incomplete vaccination or have positive neurological signs. Routine lumbar puncture in children with simple CF must be discouraged. The current state of pneumococcal infections in Colombia after implementation of immunization 10 serotypes vaccine must be assessed, in order to know the effect of vaccination status on the risk of meningitis in children with FS.

  4. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan

    Directory of Open Access Journals (Sweden)

    Lee Meng-Luen

    2011-01-01

    Full Text Available Abstract Background Salmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome. Methods The records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments. Results Of the twenty-four patients, seizures were noted in fifteen (63% before admission and thirteen (54% during hospitalization. Acute complications mainly included hydrocephalus (50%, subdural collection (42%, cerebral infarction (33%, ventriculitis (25%, empyema (13%, intracranial abscess (8%, and cranial nerve palsy (8%. Three patients (13% died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%, motor disability (48%, intelligence quotient Conclusion Salmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.

  5. Sodium Butyrate Prevents Memory Impairment by Re-establishing BDNF and GDNF Expression in Experimental Pneumococcal Meningitis.

    Science.gov (United States)

    Barichello, Tatiana; Generoso, Jaqueline S; Simões, Lutiana R; Faller, Cristiano Julio; Ceretta, Renan A; Petronilho, Fabricia; Lopes-Borges, Jéssica; Valvassori, Samira S; Quevedo, João

    2014-10-01

    Pneumococcal meningitis is a serious infection of the central nervous system (CNS) with high fatality rates that causes reduced psychomotor performance, slight mental slowness, impairments in attention executive functions and learning and memory deficiencies. Previously, we demonstrated a correlation between memory impairment and decreased levels of brain-derived neurotropic factor (BDNF) in the hippocampi of rats subjected to pneumococcal meningitis. Emerging evidence demonstrates that histone acetylation regulates neurotrophins; therefore, a potential molecular intervention against cognitive impairment in bacterial meningitis may be the histone deacetylase (HDAC) inhibitor, sodium butyrate, which stimulates the acetylation of histones and increases BDNF expression. In this study, animals received either artificial cerebrospinal fluid as a placebo or a Streptococcus pneumoniae suspension at a concentration of 5?×?10(9) colony-forming units (CFU/mL). The animals received antibiotic treatment as usual and received saline or sodium butyrate as an adjuvant treatment. Ten days after, meningitis was induced; the animals were subjected to open-field habituation and the step-down inhibitory avoidance task. Immediately after these behavioural tasks, the animals were killed, and their hippocampi were removed to evaluate the expression of BDNF, nerve growth factor (NGF) and glial cell line-derived neurotrophic factor (GDNF). In the meningitis group that received saline, the animals presented memory impairment in both behavioural tasks, and hippocampal BDNF and GDNF expression was decreased. Sodium butyrate was able to prevent memory impairment and re-establish hippocampal neurotrophin expression in experimental pneumococcal meningitis. PMID:25284351

  6. Vertebrobasilar Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Schoen, Jessica

    2011-05-01

    Full Text Available The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion. [West J Emerg Med. 2011;12(2:233-239.

  7. Coronary artery aneurysms

    International Nuclear Information System (INIS)

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment. (orig.)

  8. Meningite como complicação de endocardite infecciosa / Meningitis as a complication of infective endocarditis

    Scientific Electronic Library Online (English)

    Viviane Cordeiro, Veiga; Júlio César de, Carvalho; Luis Enrique Campodonico, Amaya; Marcos Sérgio, Martins; Salomón Soriano Ordinola, Rojas.

    2012-09-01

    Full Text Available As complicações neurológicas estão presentes em aproximadamente 30% dos pacientes com endocardite infecciosa; no entanto, a meningite apresenta-se como uma complicação rara. Apresenta-se aqui o caso de paciente do gênero feminino com quadro de meningite decorrente de endocardite em valva mitral, que [...] necessitou de procedimento cirúrgico em razão de quadro agudo de insuficiência cardíaca por ruptura de cordoalha valvar. Abstract in english Although approximately 30% of patients with endocarditis present with neurological complications, the development of meningitis in these patients is rare. This case report describes a female patient who developed meningitis as a complication of mitral valve endocarditis, and surgery was required for [...] this patient due to acute heart failure resulting from the rupture of the chordae tendineae.

  9. The cost of treatment for child pneumonias and meningitis in the Northern Areas of Pakistan.

    Science.gov (United States)

    Hussain, Hamidah; Waters, Hugh; Omer, Saad B; Khan, Aamir; Baig, Imam Yar; Mistry, Rozina; Halsey, Neal

    2006-01-01

    Pneumonia, meningitis, and sepsis place a significant economic burden on health care systems, particularly in developing countries. This study estimates treatment costs for these diseases in health facilities in the Northern Areas of Pakistan. Health facility resources are organized by categories--including salaries, capital costs, utilities, overhead, maintenance and supplies--and quantified using activity-based costing (ABC) techniques. The average cost of treatment for an outpatient case of child pneumonia is dollar 13.44. For hospitalized care, the health system spent an average of dollar 71 per episode for pneumonia, dollar 235 for severe pneumonia, and dollar 2,043 for meningitis. These costs provide important background information for the potential introduction of the conjugate Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in Pakistan. PMID:17044548

  10. Brillouin spectroscopy as a new method of screening for increased CSF total protein during bacterial meningitis.

    Science.gov (United States)

    Steelman, Zachary; Meng, Zhaokai; Traverso, Andrew J; Yakovlev, Vladislav V

    2015-05-01

    Bacterial meningitis is a disease of pronounced clinical significance, especially in the developing world. Immediate treatment with antibiotics is essential, and no single test can provide a conclusive diagnosis. It is well established that elevated total protein in cerebrospinal fluid (CSF) is associated with bacterial meningitis. Brillouin spectroscopy is a widely used optical technique for noninvasive determination of the elastic moduli of materials. We found that elevated protein levels in CSF alter the fluid elasticity sufficiently to be measurable by Brillouin spectroscopy, with model healthy and diseased fluids distinguishable to marked significance (P = 0.014), which increases with sample concentration by dialysis. Typical raw output of a 2-stage VIPA Brillouin spectrometer: inelastically scattered Brillouin peaks (arrows) and elastically scattered incident radiation (center cross). PMID:25044770

  11. Computed tomography in epidural abscess, subdural empyema, meningitis, and brain abscess

    International Nuclear Information System (INIS)

    Computerised tomography cannot be of great help in diagnosing meningitis. Examination of the cerebrospinal fluid remains essential. After the inflammation of the meninges has progressed to some stage of encephalitis, the formation of an abscess can be located via computed tomography. It is characterised by the ring-type abscess capsule. Computed tomography for diagnostic purposes is superior to cerebral scanning, which demonstrates enhanced activity, but does not show the formation of a membrane, so essential for differential diagnosis. Furthermore, computed tomography shows the adjacent anatomical structures and answers the questions of displacements and threatening invasion of the ventricle system. Epidural and subdural abscesses can also be located by computed tomography. Therapy can begin directly after computerised tomography, whereas in scintigraphy only a non-specific enhanced activity is present, which often does not allow differentiation between epidural and subdural location. (orig.)

  12. Meningitis caused by Alcaligenes xylosoxidans in a patient with HIV/AIDS

    Scientific Electronic Library Online (English)

    F., Espinoza-Gómez; O.A., Newton-Sánchez; V., Melnikov; O., Virgen-González; J., Unrau.

    2007-12-01

    Full Text Available The purpose of the present work was to inform about the first case of meningitis associated to the bacteria Alcaligenes xylosoxidans in a patient with HIV/AIDS. The patient was a 46-year-old male, with the antecedent of have been diagnosed for HIV/ AIDS, who attended in the Hospital Universitario de [...] Colima, Mexico, with fever, shock and meningismus. The study of the cerebrospinal fluid showed pleocytosis, elevated protein levels and hypoglycorrhachia. The culture yielded the presence of Alcaligenes xylosoxidans with sensitivity to ciprofloxacin. After 14 days of treatment with this antibiotic, the patient showed neurologic improvement and was able to continue with his outpatient antiretroviral treatment. The present case shows the importance of the inclusion of this bacterium in the differential diagnosis of the neurological infections in HIV/AIDS patients and emphasizes the importance of considering the bacterial meningitis in this population.

  13. Carcinomatous meningitis: Yet another cause for rapidly progressive dementia and triphasic waves in electroencephalograph!

    Science.gov (United States)

    Jadav, R; Sinha, S; Nagarathna, S; Bindu, Ps; Mahadevan, A; Bharath, Rs; Shankar, Sk; Taly, Ab

    2012-05-01

    We report a 65-year-old woman who manifested with progressive cognitive impairment, abnormal behavior, slurred speech, inability to carry out activities with right upper limb, gait disturbances, emotional liability, and double incontinence that evolved progressively over the last 8 months. A clinical syndrome of "rapidly progressive dementia" was considered. The MRI of brain was unremarkable except for small para third ventricular enhancing lesion was detected in the left thalamic region. There was bi/tri-phasic sharp waves in the routine scalp EEG occurring at periodically 1.5-2.0 Hz, mimicking Creutzfeldt-Jakob disease (CJD). She was later diagnosed to have carcinomatous meningitis based on cerebrospinal fluid (CSF) cytology. This case is being discussed for rarity and interesting EEG observations in patients with carcinomatous meningitis and to highlight the importance of CSF cytology in an appropriate clinical setting. One needs to be careful in concluding CJD as possible diagnosis in such scenario. PMID:22865984

  14. Measurement of cytokine levels in cerebrospinal fluid over time in neonatal Enterococcal meningitis.

    Science.gov (United States)

    Ikeda, Naho; Suganuma, Hiroki; Ohkawa, Natsuki; Nagata, Satoru; Shoji, Hiromichi; Shimizu, Toshiaki

    2014-08-01

    Enterococcus faecalis is rarely involved in neonatal meningitis. Several studies have indicated that the cytokines related to bacterial infection may induce nerve cell damage; therefore, the cytokine levels in cerebrospinal fluid (CSF) could represent a valuable hallmark for rapid recognition of the disease and evaluation of the degree of neurological involvement. We analyzed cytokine levels in the CSF of a neonate with E. faecalis meningitis over time. Tumor necrosis factor-? (TNF-?) tended to be elevated during the acute phase of infection, and then decreased during the convalescent stage after treatment. CSF inflammatory cytokine measurement may provide important clues for predicting the development of complications in the host because some of these cytokines, such as TNF-?, can injure neurons. PMID:25252071

  15. Eficacia de la cuantificación de interleucina- 6 en el líquido cefalorraquídeo para el diagnóstico de meningitis bacteriana neonatal / Effectiveness of the measurement of interleukin- 6 in cerebrospinal fluid for detection of neonatal bacterial meningitis

    Scientific Electronic Library Online (English)

    Federico Javier, Ortiz- Ibarra; Jesús, Reyna- Figueroa; Rodrigo Efrén, Aldana- Cuevas; Jacqueline, Lara- Sánchez.

    2005-08-01

    Full Text Available Introducción. Una gran variedad de citocinas se producen en el sistema nervioso central como respuesta a infección microbiana, elevándose de manera consistente para ser consideradas indicadores de infección, por lo que bien podría servir para el diagnóstico de meningitis neonatal. Objetivo: conocer [...] las concentraciones de interleucina- 6 (IL- 6) en líquido cefalorraquídeo (LCR) del recién nacido (RN) con meningitis bacteriana y determinar la eficacia de la prueba en el diagnóstico de meningitis. Material y métodos. Este estudio se realizó de manera prospectiva de diciembre de 2002 a julio de 2003, en el que se midieron las concentraciones de IL- 6 en el LCR de 58 RN con sospecha de sepsis a los que se les realizó punción lumbar para la obtención y análisis del LCR. Resultados. Catorce de los 58 RN cursaron con meningitis bacteriana. La media de la concentración de IL- 6 en el grupo de no expuestos fue de 15.4 pg/mL, mientras que en el grupo expuesto fue de 9 994 pg/mL (P Abstract in english Introduction. A great variety of cytokines are produced locally in the central nervous system in response to microbial infection, and their levels have been used as a diagnostic parameter of infection. Objectives: to determine the concentrations of interleukin- 6 (IL- 6) in cerebrospinal fluid (CSF) [...] of newborns with bacterial meningitis and the effectiveness of the determination as a diagnostic tool. Material and methods. This was a prospective study from December 2002 to July 2003, in the Instituto Nacional de Perinatologia (INPer), in which the concentrations of IL- 6 in the CSF were measurered in newborns with a clinical diagnosis of sepsis. Results. Fourteen out of 58 newborns attended during the study period had bacterial meningitis.The mean IL- 6 concentration in the meningitis group was 9 994 pg/mL vs 15.4 pg/mL in the control group (P 50 pg/mL in CSF are the cut- off level of neonatal bacterial meningitis. The concentrations of IL- 6 in the CSF were greater, demonstrating itself that concentrations of IL- 6 equal or greater to 50 pg/mL have a sensitivity of 92% and a specificity of 100%, for the diagnosis of bacterial meningitis. Conclusions. The determination of the concentration of IL- 6 in CSF could be a useful tool in the meningitis diagnosis; however CSF conventional analysis and culture are still the gold standard.

  16. Tuberculous meningitis: a uniform case definition for use in clinical research.

    OpenAIRE

    Marais, S.; Thwaites, G.; Schoeman, Jf; To?ro?k, Me; Misra, Uk; Prasad, K.; Donald, Pr; Wilkinson, Rj; Marais, Bj

    2010-01-01

    Tuberculous meningitis causes substantial mortality and morbidity in children and adults. More research is urgently needed to better understand the pathogenesis of disease and to improve its clinical management and outcome. A major stumbling block is the absence of standardised diagnostic criteria. The different case definitions used in various studies makes comparison of research findings difficult, prevents the best use of existing data, and limits the management of disease. To address this...

  17. Rat meningeal and brain microvasculature pericytes co-express the vesicular glutamate transporters 2 and 3

    OpenAIRE

    Mathur, Brian N.; Deutch, Ariel Y.

    2008-01-01

    Pericytes are small cells that are apposed to brain and meningeal microvasculature and control capillary contraction, thereby regulating local cerebral perfusion. Pericytes respond to exogenously applied glutamate in vitro and express metabotropic glutamate receptors. However, it is unclear if pericytes have the capacity to release glutamate. We therefore determined whether pericytes express vesicular glutamate transporters (VGLUTs), which are considered to be unambiguous markers of cells tha...

  18. Combination therapy with fluconazole and flucytosine in the murine model of cryptococcal meningitis.

    OpenAIRE

    Nguyen, M H; Najvar, L K; Yu, C.Y.; Graybill, J R

    1997-01-01

    This study elucidates the role of combined fluconazole and flucytosine as therapy for cryptococcosis in the murine model of meningitis. Three strains of Cryptococcus neoformans for which the range of fluconazole MICs was wide--2 microg/ml (susceptible strain), 8 microg/ml (moderately susceptible strain), and 32 microg/ml (resistant strain)--were used for infection. One day postinfection, the mice were randomized into eight treatment groups: placebo; flucytosine (40 mg/kg of body weight/day); ...

  19. Correlation of anti-fungal susceptibility with clinical outcomes in patients with cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Lee Chen-Hsiang

    2012-12-01

    Full Text Available Abstract Background This study aimed to investigate the correlation of minimum inhibiting concentrations (MICs, obtained by broth micro-dilution, and clinical response in patients with cryptococcal meningitis. Methods Using retrospective analyses covering the period 2001–2010, factors affecting clinical therapeutic cure in patients with cryptococcal meningitis 10 weeks after the start of anti-fungal therapy were identified. Specific emphasis was placed on the role of anti-fungal susceptibility. Results Of 46 patients with cryptococcal meningitis identified, 21 were cured after 10 weeks of treatment. Overall, 12 strains (26.1% were resistant to fluconazole (>8 ?g/ml and 8 (17.4% had an MIC >1 ?g/ml for amphotericin B. Twenty-three patients received combination amphotericin B and fluconazole as their initial antifungal therapy, 17 were given amphotericin B only, five received fluconazole only, and one received a combination of amphotericin B and flucytosine. After 2 weeks, all patients received fluconazole (400–600 mg daily for 8 weeks at least, then 200 mg daily thereafter. The presence of isolates resistant to fluconazole (MIC >8 ?g/ml; 4.8% vs. 44%, p?8 ?g/ml, was an independent predictor of therapeutic cure at 10-week evaluation (OR?=?15.7; 95% CI: 1.8-135.9; p?=?0.01, but higher MIC of amphotericin B (>1 ?g/ml was not. Conclusions The MICs of fluconazole, determined by the CLSI method, may be a potential predictor of therapeutic cure in patients with cryptococcal meningitis.

  20. Cryptococcal meningitis in a patient with chronic hepatitis C treated with pegylated-interferon and ribavirin

    OpenAIRE

    Lee, Tae-Hee; Lee, Kee-Ook; Kim, Yong-Seok; Kim, Sun-Moon; Huh, Kyu-Chan; Choi, Young-Woo; Kang, Young-Woo

    2014-01-01

    Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-? and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis C virus (HCV) infection. She had been treated for 7 months. Her headaches were refractory to analgesics, and she developed subtle nuchal rigidity. The cerebral spinal fluid (CSF) revealed a white ...

  1. The kynurenine pathway contributes to long-term neuropsychological changes in experimental pneumococcal meningitis.

    Science.gov (United States)

    Too, Lay Khoon; McQuillan, James A; Ball, Helen J; Kanai, Masaaki; Nakamura, Toshikazu; Funakoshi, Hiroshi; McGregor, Iain S; Hunt, Nicholas H

    2014-08-15

    Pneumococcal meningitis is a lethal form of bacterial infection in the central nervous system that often causes lifelong neurological sequelae, despite therapeutic advances. The contemporary view is that the inflammatory response to infection contributes to the functional disabilities among survivors of this disease. We previously have established a mouse model of neurobehavioural deficits, using an automated IntelliCage™ system that revealed long-term behavioural and cognitive deficits in C57BL/6J female mice cured of meningitis by ceftriaxone treatment. We now have investigated the roles of two kynurenine pathway enzymes, indoleamine dioxygenase-1 (IDO1) and tryptophan dioxygenase-2 (TDO2), in the pathomechanisms of pneumococcal meningitis. Since tryptophan metabolism has long been implicated in behavioural and cognitive modulation through the production of neuroactive compounds, we hypothesised that preventing the actions of these enzymes through gene knockout would be beneficial in mice subjected to pneumococcal infection. We found no significant effect of IDO1 or TDO2 on mortality. Post-meningitic wild-type mice showed long-term diurnal hypoactivity and nocturnal hyperactivity when they were exposed to an Intellicage adaptation test throughout both the light and dark phases. These changes were not apparent in IDO1(-/-) survivors, but were present in the TDO2(-/-) survivors. Both IDO1(-/-) and TDO2(-/-) survivors were not protected against developing long-term cognitive deficits as measured in IntelliCage-based patrolling or reversal tasks. Collectively, these observations suggest (i) involvement of the kynurenine pathway in causing some behavioural sequelae of pneumococcal meningitis and (ii) that this pathway might operate synergistically with, or independently of, other pathways to cause other aspects of neurological sequelae. PMID:24844751

  2. Response of Meningeal Carcinomatosis from Breast Cancer to Capecitabine Monotherapy: A Case Report

    OpenAIRE

    Tanaka, Yumi; Oura, Shoji; Yoshimasu, Tatsuya; Ohta, Fuminori; Naito, Koma; Nakamura, Rie; Hirai, Yoshimitsu; Ikeda, Masako; Okamura, Yoshitaka

    2013-01-01

    A 62-year-old woman with breast cancer received neoadjuvant chemotherapy followed by breast-conserving surgery and sentinel node biopsy. During adjuvant endocrine therapy with aromatase inhibitor, she developed multiple bone metastases. Thereafter, she received tamoxifen and zoledronate therapy. In May 2011, she developed a tongue deviation and was diagnosed as having meningeal carcinomatosis. The tongue deviation disappeared 3 weeks after taking capecitabine (2,400 mg/day). Magnetic resonanc...

  3. Caulobacter species as a cause of postneurosurgical bacterial meningitis in a pediatric patient

    OpenAIRE

    Bridger, Natalie; Walkty, Andrew; Crockett, Maryanne; Fanella, Sergio; Nichol, Kim; Karlowsky, James A.

    2012-01-01

    Caulobacter species have been rarely found to be a cause of human infection. A case of probable Caulobacter species meningitis occurring postneurosurgery in a pediatric patient is reported in the present article. Gram stain and colony morphology of the isolate were not consistent with the identification provided by commercial phenotypic identification systems. The present case illustrates the need to reconcile conflicting phenotypic test results using 16S ribosomal DNA sequencing.

  4. IMPROVEMENT OF BLOOD-BRAIN BARRIER AND ANTIOXIDANT ENZYME ACTIVITIES BY IMMUNOX V DRUG IN MENINGITIS

    OpenAIRE

    V.K. DWIVEDI*, ADNAN AHMAD, ANURAG PAYASI AND MANU CHAUDHARY,

    2010-01-01

    The aim of the present study was investigated the improvement of antioxidant enzymes activities and bloodbrain barrier by Immunox V drug in cerebral spinal fluid of meningitis induced rat model. Twenty four albinorats were selected and divided into three groups of eight; Control group (n=8), Infected group (n=8) andImmunox V treated group (n=8). Our results showed that there were significantly (p

  5. Expression of innate immune complement regulators on brain epithelial cells during human bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Gasque Philippe

    2006-09-01

    Full Text Available Abstract Background In meningitis, the cerebrospinal fluid contains high levels of innate immune molecules (e.g. complement which are essential to ward off the infectious challenge and to promote the infiltration of phagocytes (neutrophils, monocytes. However, epithelial cells of either the ependymal layer, one of the established niche for adult neural stem cells, or of the choroid plexus may be extremely vulnerable to bystander attack by cytotoxic and cytolytic complement components. Methods In this study, we assessed the capacity of brain epithelial cells to express membrane-bound complement regulators (ie, CD35, CD46, CD55 and CD59 in vitro and in situ by immunostaining of control and meningitis human brain tissue sections. Results Double immunofluorescence experiments for ependymal cell markers (GFAP, S100, ZO-1, E-cadherin and complement regulators indicated that the human ependymal cell line model was strongly positive for CD55, CD59 compared to weak stainings for CD46 and CD35. In tissues, we found that CD55 was weakly expressed in control choroid plexus and ependyma but was abundantly expressed in meningitis. Anti-CD59 stained both epithelia in apical location while increased CD59 staining was solely demonstrated in inflamed choroid plexus. CD46 and CD35 were not detected in control tissue sections. Conversely, in meningitis, the ependyma, subependyma and choroid plexus epithelia were strongly stained for CD46 and CD35. Conclusion This study delineates for the first time the capacity of brain ependymal and epithelial cells to respond to and possibly sustain the innate complement-mediated inflammatory insult.

  6. Management of cryptococcal meningitis in a district hospital in KwaZulu-Natal: A clinical audit

    OpenAIRE

    Adeyemi, Benjamin O.; Andrew Ross

    2014-01-01

    Background: Despite the development of context-specific guidelines, cryptococcal meningitis (CCM) remains a leading cause of death amongst HIV-infected patients. Results from clinical audits in routine practice have shown critical gaps in clinicians’ adherence to recommendations regarding the management of CCM. Aim: The aim of this study was to review the acute management of CCM at an urban district hospital in KwaZulu-Natal, South Africa with a view to making recommendations for improv...

  7. Neoplastic Meningitis: How MRI and CSF Cytology Are Influenced by CSF Cell Count and Tumor Type

    OpenAIRE

    P. Prömmel; Pilgram-Pastor, S.; Sitter, H.; J.-H. Buhk; Strik, H

    2013-01-01

    Background. Although CSF cytology and MRI are standard methods to diagnose neoplastic meningitis (NM), this complication of neoplastic disease remains difficult to detect. We therefore reevaluated the sensitivity of gadolinium (GD)-enhanced MRI and cerebrospinal-fluid (CSF)-cytology and the relevance of tumor type and CSF cell count. Methods. We retrospectively identified 111 cases of NM diagnosed in our CSF laboratory since 1990 with complete documentation of both MRI and CSF cytology. 37 ha...

  8. Treatment of murine cryptococcal meningitis with an SCH 39304-amphotericin B combination.

    OpenAIRE

    Albert, M. M.; Graybill, J. R.; Rinaldi, M. G.

    1991-01-01

    Cryptococcal meningitis was induced in BALB/c mice by intracerebral infection with Cryptococcus neoformans. Drug therapy was initiated 1 day later, with mice receiving amphotericin B (AMB), SCH 39304, combination therapy, or no drug therapy (controls). Most, but not all, combinations showed additive benefits, significantly prolonging survival and reducing organism counts in tissues compared with those in controls and groups which received the drugs independently. Optimum protection was obtain...

  9. Leukemic meningitis in a patient with hairy cell leukemia. A case report

    International Nuclear Information System (INIS)

    Central nervous system involvement has not previously been described in patients with hairy cell leukemia (HCL). A patient is reported who presented with meningeal involvement as his initial symptom of HCL. Diagnosis was established by morphologic and cytochemical studies of his cerebrospinal fluid (CSF) and bone marrow. Treatment with whole-brain irradiation and intrathecal chemotherapy was successful in clearing leukemic cells from the CSF with resolution of symptoms

  10. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

    OpenAIRE

    Gomez, Juliana B.; Yvan Maque; Moquillaza, Manuel A.; Anicama, William E.

    2013-01-01

    Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A we...

  11. Twist Buckling Behavior of Arteries

    OpenAIRE

    Garcia, Justin R.; Lamm, Shawn D.; Han, Hai-chao

    2012-01-01

    Arteries are often subjected to torsion due to body movement and surgical procedures. While it is essential that arteries remain stable and patent under twisting loads, the stability of arteries under torsion is poorly understood. The goal of this work was to experimentally investigate the buckling behavior of arteries under torsion and to determine the critical buckling torque, the critical buckling twist angle, and the buckling shape. Porcine common carotid arteries were slowly twisted in v...

  12. Decompressive craniectomy and early cranioplasty in a 15-year-old boy with N. meningitidis meningitis

    Science.gov (United States)

    Hoehne, Julius; Friedrich, Monika; Brawanski, Alexander; Melter, Michael; Schebesch, Karl-Michael

    2015-01-01

    Background: Intracranial hypertension is a well-known life-threatening complication of bacterial meningitis. Investigations on decompressive craniectomy after failure of conservative management are scarce, but this surgical treatment should be considered and performed expeditiously, as it lowers the intracranial pressure and improves brain tissue oxygenation. Early cranioplasty can further aid the rehabilitation. Case Description: A 15-year-old boy was admitted to our emergency department because of sudden onset of neurologic decline and consecutive loss of consciousness. Clinical examination and imaging showed elevated intracranial pressure, leading to the suspected diagnosis of meningitis. Intracranial pressure monitoring was installed, but the initiated conservative management failed. Finally, the patient underwent bilateral decompressive craniectomy. The microbiological test showed growth of Neisseria meningitidis. After full neurologic recovery, cranioplasty with two CAD/CAM titanium implants was conducted successfully. Conclusions: This unique report shows that decompressive craniotomy with duroplasty may be a crucial therapeutic approach in bacterial meningitis with refractory increased intracranial pressure and brainstem compression. Early cranioplasty with a patient-specific implant allowed the early and full reintegration of the patient. PMID:25883850

  13. Could Proteomic Research Deliver the Next Generation of Treatments for Pneumococcal Meningitis?

    Science.gov (United States)

    Goonetilleke, U. R.; Ward, S. A.; Gordon, S. B.

    2009-01-01

    Streptococcus pneumoniae is the most common bacterial cause of community-acquired meningitis worldwide. Despite optimal antibiotic therapy and supportive care, the mortality of this condition remains very high at 20–30% in the developed world and over 60% in under-resourced hospitals. In developed countries, approximately half of the survivors suffer intellectual impairment, hearing loss, or other neurological damage. There is an urgent need for more information about the mechanisms of brain damage and death in pneumococcal meningitis so that new treatments can be designed. Using proteomic techniques and bioinformatics, the protein content of cerebrospinal fluid can be examined in great detail. Animal models have added greatly to our knowledge of possible mechanisms and shown that hippocampal apoptosis and cortical necrosis are distinct mechanisms of neuronal death. The contribution of these pathways to human disease is unknown. Using proteomic techniques, neuronal death pathways could be described in CSF samples. This information could lead to the design of novel therapies to minimize brain damage and lower mortality. This minireview will summarize the known pathogenesis of meningitis, and current gaps in knowledge, that could be filled by proteomic analysis. PMID:19503804

  14. Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites.

    Science.gov (United States)

    Butler, T

    2015-07-01

    Newly named in 1989, Capnocytophaga canimorsus is a bacterial pathogen found in the saliva of healthy dogs and cats, and is transmitted to humans principally by dog bites. This review compiled all laboratory-confirmed cases, animal sources, and virulence attributes to describe its epidemiology, clinical features, and pathogenesis. An estimated 484 patients with a median age of 55 years were reported, two-thirds of which were male. The case-fatality rate was about 26 %. Its clinical presentations included severe sepsis and fatal septic shock, gangrene of the digits or extremities, high-grade bacteremia, meningitis, endocarditis, and eye infections. Predispositions were prior splenectomy in 59 patients and alcoholism in 58 patients. Dog bites before illness occurred in 60 %; additionally, in 27 %, there were scratches, licking, or other contact with dogs or cats. Patients with meningitis showed more advanced ages, higher male preponderance, lower mortality, and longer incubation periods after dog bites than patients with sepsis (p?sepsis, particularly post-splenectomy sepsis, and meningitis after dog bites. PMID:25828064

  15. Minocycline-induced hypersensitivity syndrome presenting with meningitis and brain edema: a case report

    Directory of Open Access Journals (Sweden)

    Lefebvre Nicolas

    2007-05-01

    Full Text Available Background Hypersentivity Syndrome (HS may be a life-threatening condition. It frequently presents with fever, rash, eosinophilia and systemic manifestations. Mortality can be as high as 10% and is primarily due to hepatic failure. We describe what we believe to be the first case of minocycline-induced HS with accompanying lymphocytic meningitis and cerebral edema reported in the literature. Case presentation A 31-year-old HIV-positive female of African origin presented with acute fever, lymphocytic meningitis, brain edema, rash, eosinophilia, and cytolytic hepatitis. She had been started on minocycline for inflammatory acne 21 days prior to the onset of symptoms. HS was diagnosed clinically and after exclusion of infectious causes. Minocycline was withdrawn and steroids were administered from the second day after presentation because of the severity of the symptoms. All signs resolved by the seventh day and steroids were tailed off over a period of 8 months. Conclusion Clinicians should maintain a high index of suspicion for serious adverse reactions to minocycline including lymphocytic meningitis and cerebral edema among HIV-positive patients, especially if they are of African origin. Safer alternatives should be considered for treatment of acne vulgaris. Early recognition of the symptoms and prompt withdrawal of the drug are important to improve the outcome.

  16. In vivo study of experimental pneumococcal meningitis using magnetic resonance imaging : BMC Medical Imaging

    DEFF Research Database (Denmark)

    Brandt, C.T.; Simonsen, H.

    2008-01-01

    Background: Magnetic Resonance Imaging (MRI) methods were evaluated as a tool for the study of experimental meningitis. The identification and characterisation of pathophysiological parameters that vary during the course of the disease could be used as markers for future studies of new treatment strategies. Methods: Rats infected intracisternally with S. pneumoniae (n = 29) or saline (n = 13) were randomized for imaging at 6, 12, 24, 30, 36, 42 or 48 hours after infection. T1W, T2W, quantitative diffusion, and post contrast T1W images were acquired at 4.7 T. Dynamic MRI (dMRI) was used to evaluate blood-brain-barrier (BBB) permeability and to obtain a measure of cerebral and muscle perfusion. Clinical- and motor scores, bacterial counts in CSF and blood, and WBC counts in CSF were measured. Results: MR images and dMRI revealed the development of a highly significant increase in BBB permeability (P 0.05). Areas of well-'perfused' muscle decreased with the progression of infection indicative of septicaemia (P = 0.05). Conclusion: The evolution of bacterial meningitis was successfully followed in-vivo with MRI. Increasing BBB-breakdown and ventricle size was observed in rats with meningitis whereas changes in brain water distribution were heterogeneous. MRI will be a valuable technique for future studies aiming at evaluating or optimizing adjunctive treatments. © 2008 Brandt et al; licensee BioMed Central Ltd.

  17. In vivo study of experimental pneumococcal meningitis using magnetic resonance imaging.

    DEFF Research Database (Denmark)

    Brandt, Christian T; Simonsen, Helle

    2008-01-01

    BACKGROUND: Magnetic Resonance Imaging (MRI) methods were evaluated as a tool for the study of experimental meningitis. The identification and characterisation of pathophysiological parameters that vary during the course of the disease could be used as markers for future studies of new treatment strategies. METHODS: Rats infected intracisternally with S. pneumoniae (n = 29) or saline (n = 13) were randomized for imaging at 6, 12, 24, 30, 36, 42 or 48 hours after infection. T1W, T2W, quantitative diffusion, and post contrast T1W images were acquired at 4.7 T. Dynamic MRI (dMRI) was used to evaluate blood-brain-barrier (BBB) permeability and to obtain a measure of cerebral and muscle perfusion. Clinical- and motor scores, bacterial counts in CSF and blood, and WBC counts in CSF were measured. RESULTS: MR images and dMRI revealed the development of a highly significant increase in BBB permeability (P 0.05). Areas of well-'perfused' muscle decreased with the progression of infection indicative of septicaemia (P = 0.05). CONCLUSION: The evolution of bacterial meningitis was successfully followed in-vivo with MRI. Increasing BBB-breakdown and ventricle size was observed in rats with meningitis whereas changes in brain water distribution were heterogeneous. MRI will be a valuable technique for future studies aiming at evaluating or optimizing adjunctive treatments.

  18. Biofilm characteristics of Staphylococcus epidermidis isolates associated with device-related meningitis.

    LENUS (Irish Health Repository)

    Stevens, Niall T

    2009-07-01

    Staphylococcus epidermidis biofilm causes device-related meningitis in neurosurgical patients. This study assessed the contribution of polysaccharide and protein to the development of a strong biofilm-positive phenotype in four S. epidermidis isolates associated with probable device-related meningitis, under varying environmental conditions. RT-PCR analysis of the intercellular adhesion operon (icaADBC) and assessment of polysaccharide intercellular adhesin (PIA) production indicated a correlation between increased icaA transcription and PIA production in ica(+) isolates grown in medium with 4 % ethanol and 4 % NaCl. Treatment of biofilm with sodium metaperiodate caused dispersion of adhered cells (P <0.0001), indicating involvement of PIA. Transcriptional levels of protein factors revealed that atlE transcription levels were similar in all isolates, whilst aap levels were variable, with induction being seen in two isolates following growth in the presence of alcohol or salt. Transcription of agr did not influence protein expression and RNAIII transcription varied among the strains. Although aap transcription was induced, the treatment of biofilm with proteinase K did not always disperse the biofilm. Our data suggest that, among the three ica(+) S. epidermidis isolates clinically associated with meningitis that were studied, PIA contributed to the strong biofilm-positive phenotype, whereas protein factors appeared to have a secondary role.

  19. Mesenteric Lymphadenopathy in Childhood Epidemic Aseptic Meningitis: Sonographic Features and Clinical Significance

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Sung Hee; Park, Young Chan; Lee, Young Hwan [Catholic University of Daegu, College of Medicine, Daegu (Korea, Republic of)

    2006-09-15

    To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. Thirty-three patients (25 male, 8 female: mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesenteric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the patient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients (17 cases, 52%). Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymptomatic patients. The number of enlarged nodes was most prevalent between 6-10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asymptomatic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically different between the two groups. Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus

  20. Pneumococcal Meningitis during Pregnancy: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Lisa M. Landrum

    2007-03-01

    Full Text Available Background. Bacterial meningitis is a medical emergency for which prompt diagnosis and treatment are imperative to reducing the rate of death and long-term neurologic compromise. Few cases of meningitis have been reported during pregnancy, many of which had devastating outcomes for mother, neonate, or both. Case. A 38-year-old multigravida at 35 weeks of gestation presented with mental status changes, fever, and preterm contractions. Lumbar puncture revealed gram positive cocci consistent with S. pneumoniae. Patient was intubated and admitted to ICU where she was given antibiotics and adjunctive therapy with dexamethasone. Continuous fetal monitoring was utilized throughout her course of her hospitalization. Patient was discharged home after ten days in the hospital and had an uncomplicated vaginal birth after caesarean section (VBAC at 38 weeks. Both she and the infant are doing well with no permanent neurologic sequelae. Conclusion. A review of literature indicates only isolated cases of pneumococcal meningitis being described during pregnancy. An extended period of time between onset of maternal illness and delivery appears to reduce the risk of neonatal transmission and improve both maternal and fetal outcomes.