Full Text Available ... If symptoms occur, you should see a health care provider immediately. The health care provider suspects a diagnosis of meningitis after obtaining ... tests on the CSF can help the health care provider decide whether meningitis is present and whether ...
In comparative and evolutionary aspects in humans, the middle meningeal artery enters the cranium through the foramen spinosum, whereas in great apes the middle meningeal artery can enter the cranium through foramen spinosum, through foramen ovale or through petrosphenoid fissure. Generally, in nonhuman primates the anterior meningeal system is associated with the ophthalmic branch of the internal carotid artery. The vessels joining the two systems pass through the additional channels: the superior orbital fissure or through the cranio-orbital foramen. In anatomically modern humans, the absence of foramen spinosum involves abnormal development and course of the middle meningeal artery and it is usually accompanied with replacement of the conventional middle meningeal artery with such, arising from the ophthalmic artery system. In these cases the middle meningeal artery most often enters the middle cranial fossa through the superior orbital fissure and rarely through the meningo-orbital foramen. All skulls, investigated in the present study, belonged to adult individuals of both sexes, conditionally grouped into three cranial series--contemporary male, medieval male, and medieval female series. The absence of foramen spinosum was established only among the medieval male and female series--in 1 (0.70%) male and in 1 (0.72%) female skull on the right side and in 3 (2.13%) female skulls on the left side. In 1 (0.72%) female skull, a small atypically located foramen spinosum was established on the right side. In all of the described cases, the intracranial meningeal grooves started from the lateral edge of the superior orbital fissure and probably reflect the ophthalmic origin of the middle meningeal artery. PMID:22928356
Nikolova, Silviya Y; Toneva, Diana H; Yordanov, Yordan A; Lazarov, Nikolai E
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).
Amin, Faisal Mohammad; Asghar, Mohammad Sohail
A 72-year-old male presented with a primary hemangioblastoma of the posterior fossa with unusual dural attachment and meningeal arterial blood supply from the external carotid artery and marginal tentorial artery. Preoperative embolization facilitated complete resection of the tumor with no resultant neurological deficit. Hemangioblastoma must be included in the differential diagnosis of tumors with dural involvement. Preoperative embolization is very useful in such tumors. PMID:10093461
Tsugu, H; Fukushima, T; Ikeda, K; Utsunomiya, H; Tomonaga, M
Topical administration of 5-carboxamidotryptamine (5-CT; 0.01–1000 ?M) to the exposed dura mater encephali of anesthetized rats produced decreases in blood pressure and dilatation in the middle meningeal artery. Pretreatment with the 5-HT1B/1D receptor antagonist, N-[4-methoxy-3-(4-methyl-1-piperazinyl) phenyl]-2?-methyl-4?-(5-methyl-1,2,4-oxadiazol-3-yl) [1,1-biphenyl]-4-carboxamide hydrochloride monohydrate (GR-127935; 1 mg/kg, i.v.), unmasked meningeal dilator responses to lower con...
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.)
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.
Burguet, J.L.; Dietemann, J.L.; Wackenheim, A.; Kehr, P.; Buchheit, F.
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
Mirta López G
Because of the recent development of high-performance 3-dimensional computed tomography (3D-CTA), magnetic resonance angiography (MRA) and the consideration of the risk of digital subtraction angiography (DSA), DSA is not always necessary in performing surgery for cerebral aneurysms. However, DSA was necessary in patients in whom the ophthalmic artery from the internal carotid artery (IC) was not visualized on 3D-CTA or MRA, in order to predict the risk of blindness after front-temporal craniotomy. In this study, we investigated the preoperative evaluation and the surgical procedure for 330 cases of front-temporal craniotomy for surgery of aneurysm over the past 4.5 years. There were 5 cases without ophthalmic artery from IC in DSA or 3D-CTA, 4 cases with an anomalous ophthalmic artery arising from the middle meningeal artery and 1 case with an anomalous ophthalmic artery arising from unknown origin. Microsurgical procedure is needed to preserve the middle meningeal artery in front-temporal craniotomy in these cases with an anomalous ophthalmic artery arising from the middle meningeal artery, because this anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed in front-temporal craniotomy. Front-temporal craniotomy is difficult in cases with an anomalous ophthalmic artery arising from an unknown origin. (author)
Rasmussen encephalitis is a rare cause of intractable epilepsy in children. Between 2008 and 2010, 4 patients had second cortical resections performed after a primary corticectomy for Rasmussen encephalitis. In each case, we observed some degree of vessel wall change in leptomeningeal arteries, consisting of moderate to moderately severe intimal hyperplasia. The intervals between original resection and second operation ranged from 8 months to 10 years. Ages of the patients ranged from 9 to 12 years at their first resection and from 10 to 19 years at the time of revision. Four other Rasmussen encephalitis cases operated upon in the years 2006 to 2010 and 2 surgical revisions for severe cortical dysplasia, 1 for mild cortical dysplasia and 1 for recurrent dysembryoplastic neuroepithelial tumor, did not show significant vascular abnormalities (with surgical intervals of 10 months to 16 years). Leptomeningeal intimal hyperplasia appears to develop in the interval between repeated cortical resections for Rasmussen encephalitis, an inflammatory disorder. The pathogenesis of this vascular change may be related to meningeal inflammation in Rasmussen encephalitis. This finding in children undergoing surgical resection for Rasmussen encephalitis may itself lead to "secondary" ischemic change that contributes to worsening of epilepsy. PMID:22401768
Wagner, Aaron S; Yin, Nicole S; Tung, Spencer; Mathern, Gary W; Vinters, Harry V
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
Ko, Jung Ho; Kim, Young-Joon
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 una 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.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 is different viral agents. Also in certai
Ana Teresa Alvarado Guevara
... if untreated. Several different bacteria can cause meningitis. Neisseria meningitidis is the one with the potential to cause ... but can range between two and 10 days. Neisseria meningitidis only infects humans; there is no animal reservoir. ...
... and vomiting Sensitivity to light ( photophobia ) Severe headache Stiff neck Other symptoms that can occur with this disease: ... show: Fast heart rate Fever Mental status changes Stiff neck If the health care provider thinks meningitis is ...
... and vomiting Sensitivity to light ( photophobia ) Severe headache Stiff neck Other symptoms that can occur with this disease: ... show: Fast heart rate Fever Mental status changes Stiff neck If the doctor thinks meningitis is possible, a ...
... first signs of meningitis include fever, fatigue, a stiff neck, headache, nausea and vomiting, confusion, blurred vision or ... health care provider if you have headaches, a stiff neck, vision problems, confusion, nausea, or vomiting. If you ...
... spots ( petechiae ) Sensitivity to light ( photophobia ) Severe headache Stiff neck (meningismus) Other symptoms that can occur with this ... Fast heart rate Fever Mental status changes Rash Stiff neck If the health care provider thinks meningitis is ...
Cryptococcosis is a systemic fungal disease and meningitis is the most serious complication. The purpose of this study is to define problems related to its diagnosis and treatment. This is a retrospective analysis of 25 patients admitted from January 1978 to December 1981. All patients had cryptococcal neoformans meningitis proven by culture of cerebrospinal fluid. One patient had a predisposing illness, being on immunosuppressant therapy after a renal transplant 2 years ago. A progressively ...
Tjia, T. L.; Yeow, Y. K.; Tan, C. B.
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
Ploug, K.B.; Boni, L.J.
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
Boni, L.J.; Ploug, Kenneth Beri
Rickettsial infections are common in southern Europe and the most frequent and lethal type is Mediterranean spotted fever, caused by Rickettsia conorii. The disease is usually characterised by the classical triad of fever, eschar and rash, and is generally a mild disease in children. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in an 18-year-old man, presenting during summer with fever and persistent headache. The cerebrospinal fluid analysis revealed increased cellularity (107 cells/?L), hypoglycorrhachia (50% of glycaemia) and hyperproteinorrhachia (284 mg/dL). Rickettsial infection was confirmed by serology and the patient was treated with doxycycline, with a favourable outcome. The patient's pet squirrel and/or associated vectors might be involved in the transmission of Rickettsia spp. This case underlines the importance of a high clinical suspicion and the benefits of early empirical treatment when facing compatible epidemiological contexts. PMID:24614778
Salva, Inês; de Sousa, Rita; Gouveia, Catarina
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.
Thirty-eight cases of meningitis caused by Staphylococcus aureus, occurring from 1966 to 1981 at six hospitals associated with the University of Toronto Faculty of medicine, were reviewed. Thirteen patients were children and 25 were adults. Patients were categorised into three groups: Group A (16)--meningitis related to neurosurgery, trauma or cerebrospinal defects; Group B (7)--meningitis occurring with indwelling ventricular shunts; and Group C (15)--spontaneously occurring meningitis. Bacterial endocarditis was associated with one-third of the spontaneously occurring meningitis cases and this group in general ran a more fulminant course. Meningitis related to a ventricular shunt exhibited a more insidious onset with a lower case-fatality rate, similar to the experience with Gram-negative bacillary meningitis. Gram stain of the cerebrospinal fluid was positive in only one-third of cases. Treatment with cloxacillin, administered parenterally, achieved results similar to those with methicillin, while chloramphenicol was associated with a high failure rate. PMID:6463201
Fong, I W; Ranalli, P
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
Kalita, Jayantee; Prasad, Sreeram; Maurya, Pradeep K.; Misra, Usha K. (Dept. of Neurology, Sanjay Gandhi Post Graduate Inst. of Medical Sciences, Lucknow (India)), Email: email@example.com; Kumar, Sunil (Dept. of Radiodiagnosis, Sanjay Gandhi Post Graduate Inst. of Medical Sciences, Lucknow (India))
Primary malignant tumours arising from the meninges are distinctly uncommon, and when they occur, they are usually sarcomas. In contrast, metastatic meningeal involvement is increasingly seen as advances in cancer therapy have changed the natural history of malignant disease and prolonged the life span of cancer patients. The meninges can either be infiltrated by contiguous extension of primary tumours of the central nervous system, paranasal sinuses and skull base origin or can be diffusely ...
Mahendru, G.; Chong, V.
Retrospective study of 14 cases of Staphylococcus aureus meningitis and of data from the literature shows that this as yet infrequent disease which carries a high mortality rate (40%) is always related to neurosurgery, primary or iatrogenic septicemia, or local infection, usually in the lumbar area (spinal, abscess, spondylitis). The major clinical problem is the search for the meningeal lead point of Staphylococcus aureus penetration, whose eradication is more essential than in usual bacterial meningitis. Prognosis is mainly dependent upon the eventual existence of associated severe septicemia. Antibiotics active on Peni-M resistant Staphylococcus aureus and meningeal infection are reviewed. PMID:6318357
Lucht, F; Peyramond, D; Fayard, C; Bertrand, J L; Bertoye, A
We analyzed MRI findings for 17 children with bacterial meningitis. Contrast-enhanced T1-weighted images revealed meningeal enhancement at the basal cistern and/or the convex surface of the brain in 15 cases. Cerebral infarcts were found in the distribution of perforating and/or medullary arteries in four cases. In one neonatal case, venous infarction with hemorrhagic transformation was evident. Communicating hydrocephalus was noted in three cases, subdural effusion in two, subdural empyema in one, and encephalitis in one. In one neonatal case ventriculitis was found. We conclude that MRI is useful for the evaluation of the active inflammatory process of the meninges and the identification of the focal lesions in central nervous system complications. (author)
Kinoshita, Toshibumi; Ishii, Kiyoshi; Nakagawa, Hiroshi; Onuma, Takehide [Sendai City Hospital (Japan)
We present three cases with syringomyelia after tuberculous meningitis. The MR findings suggested the syrinx was formed by blockage of the CSF flow at the outlets of the fourth ventricle. We consider this complication is not a rare condition following tuberculous meningitis. (author)
Pasteurella multocida appears to be a very rare cause of meningitis. The bacterium has morphological similarities with other causative organisms, particularly Haemophilus influenzae, and its apparent rarity may be due partly to misidentification. This case, only the fourth reported from the United Kingdom, could not be distinuished clinically from the meningitis, owing to other pyogenic bacteria.
Smith, F. R.
A case of Serratia marcescens meningitis in a 66-year-old man is reported. The infection occurred 4 weeks after apparently successful otic surgery, and a nidus of infection in the middle ear was established at autopsy. This is the second case of S. marcescens meningitis following ear surgery reported in the English-language literature.
Theccanat, G.; Hirschfield, L.; Isenberg, H.
Aseptic meningitis is characterized by noninfective serous inflammation of the meninges. It can occur in a recurrent fashion when associated with dermoid and epidermoid cysts due to rupture of cyst contents into subarachnoid space resulting in aseptic chemical meningitis. Bacterial meningitis in association with these tumors is commonly related to a coexisting dermal sinus tract and the most common organism is Staphylococcus aureus.
Cherian, Ajith; Baheti, Neeraj N.; Easwar, H. V.; Nair, Divya S.; Iype, Thomas
Bacteroides fragilis is an obligate anaerobic bacillus residing in the normal intestinal flora of the colon. Anaerobic bacterial meningitis due to this pathogen is rarely diagnosed and if present, a predisposing source of infection should be actively sought for. Anaerobic cultures of cerebrospinal fluids should be done for patients with meningitis, especially those with concomitant pathologies that predispose to anaerobic infections. Two cases of anaerobic meningitis due to Bacteroides fragilis, one associated with cholesteotoma and the other with nasopharyngeal carcinoma, are reported. Both were successfully treated with metronidazole. PMID:7997905
Ngan, C C; Tan, A L
An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection. PMID:23102429
Jouhadi, Z; Sadiki, H; Lehlimi, M; Honsali, Z; Najib, J; Zerouali, K; Belabess, H; Mdaghri, N
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.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.
Marcela Castro R
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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.
Marcela, Castro R; Jaime, Cordero T.
Full Text Available Early recognition and prompt treatment of Kawasaki disease(KD are essential to ensure a succesful outcome of the coronary artery involvement. However, some patients lack sufficient clinical signs to fulfill the diagnostic criteria, and this may lead to problems in diagnosing children presenting with atypical symptoms. Central nervous system involvement, including aseptic meningitis, can be a presenting feature of KD itself. In this article, we describe a 9-year-old boy who presented with an unusual onset of disease, characterized by fever, erythematous maculopapular rash, vomiting and abdominal pain. He was diagnosed as aseptic meningitis with an unusual onset of Kawasaki Disease (KD clinical pattern together with the echocardiographic coronary arteries anomalies. Since the cardiovascular sequelaes of the disease could be prevented by early diagnosis and effective drug therapy, KD should be considered in the differential diagnosis in children with fever, erythematous maculopapular rash and vomiting that may be associated with clinical features of aseptic meningitis.
Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.
Eduardo Genaro, Mutarelli; Tarso, Adoni.
Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis. PMID:24166036
Kim, Dong-Min; Chung, Jong-Hoon; Yun, Na-Ra; Kim, Seok Won; Lee, Jun-Young; Han, Mi Ah; Lee, Yong-Bok
Full Text Available A case of leptomeningeal carcinomatosis due to a poorly differentiated malignancy is presented. Immunohistochemistry was used to characterize it as a squamous cell carcinoma. Squamous cell carcinomas rarely invade the meninges. There are few well-founded guidelines for managing patients with this condition. Prognosis is generally poor. A literature review of this entity is provided.
MacArthur Drake Jr.
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
Hernández, Marta I; Sandoval, Carmen C; Tapia, Jose L; Mesa, Tomas; Escobar, Raul; Huete, Isidro; Wei, Xing-Chang; Kirton, Adam
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.
Ishwar Chand Premsagar
Tuberculous meningitis (TBM) is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to re...
Murthy J. M. K.
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...
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 aséptica post-quirúrgica (MAPQ). La adecuada identificación de estos casos permitiría una mejor utilización de los fármacos antimicrobianos. Material y métodos. Estudio retrospectivo d...
Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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.
Efraín, Riveros; Fred, Manrique-Abril; Manuel, Bustamante.
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.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.
Full Text Available Tuberculous meningitis (TBM is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce the mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies.
Murthy J. M. K.
A 68-year-old man presented with right cervical carotid artery stenosis manifesting as ipsilateral amaurosis fugax. Angiography showed non-bifurcating cervical carotid artery with atherosclerotic stenosis near the branching of the superior thyroid artery. Carotid artery stenting (CAS) was carried out using two balloons for embolic protection of the internal carotid artery and middle meningeal artery because the ophthalmic artery was supplied by the middle meningeal artery. No procedure-related complications or restenosis occurred after stenting. Non-bifurcating cervical carotid artery is a very rare anomaly, in which the branches of the external carotid artery directly arise from the common trunk of the carotid artery without forming a bifurcation. The present patient was successfully treated with CAS for atherosclerotic stenosis associated with non-bifurcating cervical carotid artery. PMID:23615413
Sasaki, Tetsuo; Nagashima, Hisashi; Oya, Fusakazu; Satoh, Daisuke; Kobayashi, Shigeaki
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.
Dick, D. J.; Sanders, G. L.; Saunders, M.; Rawlins, M. D.
Otogenic meningitis can be defined as an acute bacterial meningitis that develop secondary to acute, chronic otitis media, chronic mastoiditis and related disorders. Many factors like bacterial virulence, release of cytokines (IL-1,IL-6, TNF alpha), change in blood brain barrier permeability and neuronal toxicity, contribute to the pathophysiology of the disease. Streptococcus pneumoniae is the predominant mocroorganism. Haemophylus influenzae dan P. aeruginosa being the second most important...
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
Tarlov, I. M.
We report a patient with primary leptomeningeal melanocytosis presenting as chronic meningitis. A previously healthy 27-year-old man presented with 2 months of severe headaches and photophobia. A lumbar puncture was notable for a highly elevated cerebrospinal fluid (CSF) protein level without pleocytosis. Imaging at the time of admission suggested only meningitis without the presence of parenchymal lesions. On the basis of the CSF findings, early meningeal biopsy was performed, leading to the diagnosis of a meningeal melanocytic neoplasm. Early meningeal biopsy should be considered in patients with meningitis when the CSF profile suggests the possibility of a central nervous system neoplasm. PMID:24355206
Honigberg, Michael C; Papavassiliou, Efstathios; Cohen, Yehuda Z
Full Text Available Las infecciones por Pasteurella multocida en seres humanos habitualmente están relacionadas con mordeduras o arañazos de perros y gatos. Muchas de ellas se acompañan de otros microorganismos de la orofaringe de estos animales. Se presenta un caso de meningitis bacteriémica por P. multocida en una mujer de 86 años que convivía con siete gatos. Si bien no se documentó una infección de piel o de partes blandas, es posible que ésta haya pasado inadvertida inicialmente y que fuera la causa de la bacteriemia con impacto en meninges, o bien que la meningitis se haya producido luego de la colonización nasofaríngea (no demostrada. Los aislamientos de hemocultivos y de líquido cefalorraquídeo fueron identificados como P. multocida por medio de API 20NE, API 20E y Vitek 1. La cepa aislada presentó sensibilidad a penicilina, cefotaxima, levofloxacina y tetraciclinas, en coincidencia con lo descrito en la literatura.Human infections by Pasteurella multocida are usually associated with bites or scratches from dogs and cats. Many of them are accompanied by other oropharyngeal microorganisms of these animals. We herein present a case of bacteremic meningitis by P. multocida in an 86-year-old woman who was living with seven cats. Even though no skin or soft tissue infection was recorded, it is possible that a mild infection had gone undetected and a subsequent bacteremia had impacted on the meninges, or that meningitis could have occurred after nasopharyngeal colonization (not demonstrated. The isolates obtained from blood cultures and cerebrospinal fluid were identified as P. multocida by API 20NE, API 20E, and Vitek 1. In agreement with findings in the literature, this strain was susceptible to penicillin, cefotaxime, levofloxacin and tetracyclines.
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.
Tabatabai, P.; Kheyrandish, N.; Movahhedi, M.
Full Text Available Streptococcus suis is a coccus Gram positive, anaerobic optional. Human infection by this microorganism is a zoonoticdisease that usually presents as purulent meningitis. Mortality is low but is common sequelae. A case of meningitis byS. suis secondary to contact with pigs is presented here. A 35-year-old male patient was admitted to the hospital complainingof high fever, malaise, vomiting and headache. A physical examination revealed decreased level of consciousness,with adequate response to painful stimulus and his eyes with deconjugated gaze. S. suis was isolated in bloodculture. He was treated with cefotaxime, vancomycin and acyclovir in the intensive care unit. He experienced progressiveimprovement. He was discharged with severe deafness and a minimally unstable gait as sequellae. J Microbiol Infect Dis2012; 2(4: 160-162Key words: Streptococcus suis, meningitis, deafness.
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.)
Full Text Available Mycobacterium bovis is a zoonotic bacteria infecting human. Early diagnosis and initiation of therapy is important for prognosis. Here,we present a three-year-old boy treated for bacterial meningitis. Because of inadequate clinical improvement, advanced diagnostic techniques were used and M. bovis was isolated from the cerebrospinal fluid. The patient survived with minimal sequela after 18 months therapy. In children without immune deficiency M. bovis meningitis is rare. In order to diagnose this disease, the clinician should suspect and use advanced diagnostic techniques like DNA Fingerprinting Spoligotyping. This rare case is presented to draw attention to M. bovis infections for public health.
Nihan Uygur Külcü
Full Text Available Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.
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.
Full Text Available 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.
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.
Koizumi, H.; Ono, N.; Horikoshi, S.; Uki, J.; Takeda, F. (Saitama Cancer Center (Japan))
Full Text Available Background: In children with meningitis, there is a difficulty to verify the etiology as viral or bacterial. Therefore, intensive research has been carried out to find new and rapid diagnostic methods for differentiating bacterial from viral meningitis. Objectives: The aim of this work was to study the behavior of procalcitonin (PCT and whether it can be used to differentiate children with bacterial from those with viral meningitis. We also compared PCT to C-reactive protein (CRP and white blood cell count. Patients and Methods: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. Results: PCT levels were significantly higher in patients with bacterial meningitis (mean, 24.8 ng/ml compared to patients with viral meningitis (mean, 0.3 ng/ml (P<0.001. PCT levels in bacterial meningitis group decreased after 3 days of starting treatment, but remained higher than viral meningitis group (mean, 10.5 ng/ml. All CSF parameters, blood leukocytes, and CRP showed overlapping values between the two groups. Serum PCT with cut off value >2 ng/ml showed sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66%, 68%, and 100%, respectively, for the diagnosis of bacterial meningitis. Conclusion: Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis. It is also a good indicator of the efficacy of treatment of bacterial meningitis.
In this paper, we aimed to evaluate the efficacy of flucloxacillin treatment of meningitis caused by methicillin-sensitive Staphylococcus aureus. We identified 33 patients with meningitis due to S. aureus; eight had community-acquired meningitis and 25 had neurosurgical meningitis. Six of the eight patients with community-acquired meningitis were cured. Eighteen of the 22 patients treated with flucloxacillin were cured without relapse (86%, 95%CI 65-97%) and their cerebrospinal fluid (CSF) cultures were sterile after a median of 3 days of treatment. The cure rate for 12 patients who also received an additional antibiotic at the outset of treatment was 75% (95%CI 43-95%). This was not different to the cure rate for the ten patients who received flucloxacillin alone 90% (95%CI 56-100%). We conclude that flucloxacillin is an effective treatment for meningitis caused by S. aureus. PMID:17554568
Ritchie, S R; Rupali, P; Roberts, S A; Thomas, M G
Full Text Available One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M. meningitis during the period from January 1986 to April 1989 and were processed for gram?s staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF. Totally 41.5% of turbid and hazy spinal fluid were positive for N. meningitidis by smear examination. Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests. All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.
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 week...
Full Text Available Mollaret’s meningitis is mostly described in the setting of recurrent attacks of fever along with signs and symptoms of meningitis. It resolves spontaneously without any treatment and in most of the cases no causative organism is identified. Here we present an atypical case of mollaret’s meningitis in which the patient presented with headache and meningismus in the absence of fever.
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.
Two cases of vertebral osteomyelitis presenting with secondary Staphylococcus aureus meningitis are described. In staphylococcal meningitis a search for a primary source should include the lower vertebral spine.
Markus, H. S.; Allison, S. P.
Infected cerebrospinal fluid from rabbits with Escherichia coli meningitis failed to opsonize the infecting organism. Cerebrospinal fluid from rabbits with Staphylococcus aureus meningitis did opsinize E. coli.
Bernhardt, L. L.; Simberkoff, M. S.; Rahal, J. J.
A 45-year-old woman developed signs of meningeal irritation after myelography with iohexol. Her condition improved very quickly (after antibiotic treatment). Rapid improvement, absence of pathogenic organisms in the pre-treatment CSF culture, the level of CSF pleocytosis and protein were in favor of chemical meningitis. (orig.).
Alexiou, J.; Deloffre, D.; Vandresse, J.H.; Sintzoff, S. (Clinique du Parc Leopold, Brussels (Belgium). Dept. de Radiologie); Boucquey, J.P. (Clinique du Parc Leopold, Brussels (Belgium). Dept. de Neurologie)
We studied the effects of cyclosporine on experimental cryptococcal meningitis. Like cortisone, cyclosporine depressed the highly effective defense mechanisms of normal rabbits against inoculated Cryptococcus neoformans, causing them to develop progressive, fatal cryptococcal meningitis. Unlike cortisone, which causes a striking reduction in leukocytes in cerebrospinal fluid, cyclosporine depressed mononuclear cell function rather than numbers. Interleukin 2, a primary target for the immunode...
Perfect, J. R.; Durack, D. T.
Since the discovery of human herpesvirus-6 (HHV-6) the illnesses associated with it have increased steadily. Two infants with meningitis are reported: both suffered a mild meningitis and serological studies confirmed an acute HHV-6 infection. This report supports a role of HHV-6 in nervous system disease.
Full Text Available Introduction: bacterial meningitis is an infectious disease considered a medicalemergency. The timely management has an important impact on the evolution of thedisease. Streptococcus agalactiae, a major causative agent of severe infections innewborns can colonize different tissues, including the central nervous system.Case report: Male patient 47 years old from rural areas, with work activity as amilker of cattle, referred to tertiary care, with disorientation, neck stiffness, and grandmal seizure. CSF study indicates neuroinfection. ICU care with steroids, antibiotics andmechanical ventilation. Cerebrospinal fluid culture reports growth of Streptococcus agalactiae. In coexistencewith the central nervous system involvement appeared otomastoidea infection.Conclusion: Bacterial meningitis can be caused by Streptococcus agalactiae,germ infrequently involved in this pathology. Work activities in non-tech agribusiness,had to be considered risk.RESUMEN:Introducción: la meningitis bacteriana (MB es una enfermedad infecciosa consideradauna emergencia médica. El manejo oportuno tiene importante impacto en la evoluciónde la entidad. El Streptococcus agalactiae, significativo agente causal de infeccionesseveras en recién nacidos, puede colonizar diferentes tejidos, entre ellos el sistemanervioso central.Caso clínico: paciente masculino de 47 años de edad, procedente de zona rural,con actividad laboral ordeñador de reses bovinas, remitido a tercer nivel de atención,con desorientación, rigidez de nuca y convulsión tónico-clónica. Estudio de líquidocefalorraquídeo indica neuroinfección. Manejo en UCI con esteroides, antibióticosy ventilación mecánica. Cultivo de líquido cefalorraquídeo, informa crecimiento deStreptococcus agalactiae. En coexistencia con el compromiso del sistema nerviosocentral se presentaba infección otomastoidea.Conclusión: la MB puede ser causada por el Streptococcus agalactiae, germeninfrecuentemente involucrado en este tipo de patología. Actividades laborales en laagroindustria no tecnificada, debiesen ser consideradas situaciones de riesgo.
Villarreal-Velásquez Tatiana Paola
Full Text Available We present a 43-year-old immunocompetent man who developed meningitis caused byPseudallescheria boydii. The patient had no history of near drowning, trauma, steroidadministration, operations or any other underlying systemic disease. He presented withintermittent fever associated with headache, bilateral eye pain, and vomiting. Progressivehydrocephalus was noted during the course of the disease. Cerebrospinal fluid (CSF fromthe ventricular system allowed culture of the organism. Although the disease was diagnosedantemortemly, the patient died after antifungal treatment. This case is reported because ofthe unusual pathogen, unresponsiveness to amphotericin B combined with 5-fluocytocin,and immunocompetence of the patient without any predisposing factors.
Patient groups play a critical part in the fight against meningitis in all its forms. The UK has the world's three largest meningitis patient groups, which over the past 3 decades have worked tirelessly in the fight against meningitis. Within the UK, where the patient groups work to prevent or alleviate the suffering caused by meningitis and septicaemia, their work is in three areas: continued research; demonstrating burden; and awareness-raising and advocacy. The research relates to developing and improving vaccines, and to improving outcomes for forms of meningitis that are not vaccine preventable. Demonstrating burden - showing the real impact of meningitis from a human perspective - highlights the need for vaccines to prevent the disease. Lives are saved by raising awareness of signs and symptoms and of the need for fast action, whilst advocacy can bring about change to improve the quality of life of those affected by meningitis. Awareness raising and advocacy also have the wider benefit of creating a climate in which people recognise the need for vaccines to prevent this dreadful disease. In addition, the patient groups seek to influence the early introduction and uptake of vaccines as they are licensed and approved by the expert bodies, the UK body being the Joint Committee for Vaccination and Immunisation (JCVI). Each area of activity is explored, and examples given from each of the patient groups of work they have done or are doing in that area. PMID:22607905
Davie, Sue; Glennie, Linda; Rowland, Kate
A retrospective analysis of 10 adult patients with community-acquired Staphylococcus aureus meningitis was performed in order to elucidate the characteristics and treatment of this lethal disease. In all patients, a focus of infection outside the central nervous system was apparent at presentation. A poor prognosis was associated with severe underlying disease, greater degree of hyponatremia at presentation, development of seizures, failure of nuchal rigidity to develop, persistent or recurrent bacteremia, and the presence of concurrent S. aureus bronchopneumonia. Degree of deterioration in mental status and cerebrospinal fluid pleocytosis, protein levels, and glucose levels did not appear to have any prognostic significance. Therapy with rifampin and a semisynthetic penicillin effected a cure in all six patients treated with this regimen. In contrast, three of four patients treated with other antibiotic combinations died. On the basis of this experience, it is concluded that further trials with rifampin in combination with another anti-staphylococcal antibiotic for the treatment of S. aureus meningitis are warranted. PMID:4014271
Gordon, J J; Harter, D H; Phair, J P
The University Corporation for Atmospheric Research (UCAR), in conjunction with a team of health and weather organizations, has launched a project to provide weather forecasts to medical officials in Africa to help reduce outbreaks of meningitis. The forecasts will enable local health care providers to target vaccination programs more effectively. In 2009, meteorologists with the National Center for Atmospheric Research, which is managed by UCAR, will begin issuing 14-day forecasts of atmospheric conditions in Ghana. Later, UCAR plans to work closely with health experts from several African countries to design and test a decision support system to provide health officials with useful meteorological information. ``By targeting forecasts in regions where meningitis is a threat, we may be able to help vulnerable populations. Ultimately, we hope to build on this project and provide information to public health programs battling weather-related diseases in other parts of the world,'' said Rajul Pandya, director of UCAR's Community Building Program. Funding for the project comes from a $900,000 grant from Google.org, the philanthropic arm of the Internet search company.
Staphylococcus aureus is a relatively uncommon cause of meningitis associated with high mortality in neonates and neurosurgical patients. The infrequency of this infection has made its study difficult and has complicated the issues of treatment and prognosis. We reviewed 28 cases of S. aureus meningitis occurring over a 10-year period at three hospitals. Eight cases in children and 20 in adults were identified. Seventy-five percent of the children and 35% of the adults had central nervous system trauma or surgery; 45% of adults had comorbid disease that might have predisposed them to infection. Clinical presentation did not distinguish this form of meningitis from other bacterial meningitides. Findings in cerebrospinal fluid were characteristic of acute bacterial meningitis. Blood cultures were positive in 65% of cases. Overall mortality was 37%; 50% of adults but no children died of meningitis. No patients with S. aureus meningitis complicating cerebrospinal fluid shunts died; however, nine of 11 patients with identifiable foci of infection outside the central nervous system died. Only one patient receiving initial treatment with a penicillinase-resistant penicillin died of meningitis, whereas six of 12 patients not so treated died. PMID:2682944
Kim, J H; van der Horst, C; Mulrow, C D; Corey, G R
Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish 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.
Echezuría, Luis; León, Raiza; Rodríguez, Eva; Rísquez, Alejandro.
Cerebrospinal meningitis (CSM) is one of the infectious diseases likely to be affected by climate change. Although there are a few studies on the climate change-CSM nexus, none has considered perceptions of community members. However, understanding public perception in relation to a phenomenon is very significant for the design of effective communication and mitigation strategies as well as coping and adaptation strategies. This paper uses focus group discussions (FGDs) to fill this knowledge lacuna. Results show that although a few elderly participants ascribed fatal causes (disobedience to gods, ancestors, and evil spirits) to CSM infections during FGDs, majority of participants rightly linked CSM infections to dry, very hot and dusty conditions experienced during the dry season. Finally, community members use a suite of adaptation options to curb future CSM epidemics. PMID:25003550
Codjoe, Samuel Nii Ardey; Nabie, Vivian Adams
Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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 ).
Luz Clemencia, Zárate C; Juan Diego, Vélez L.
Full Text Available ... to assure follow-up of close contacts and protect against outbreaks. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. ...
These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs Homer A. Boushey, Associate Professor of Medicine, and David G. Warnock, Associate Professor of Medicine, under the direction of Dr Lloyd H. Smith, Jr, Professor of Medicine and Chairman of the Department of Medicine. Requests for reprints should be sent to the Department of Medicine, University of Californ...
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 Â± 14% (P=0.04) and vehicle (DMSO) 13 Â± 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.
Kruuse, Christina Rostrup; Gupta, Saurabh
Full Text Available A male infant admitted with pyogenic meningitis with protein energy malnutrition developed fatal infection due to Salmonella enteritidis. The same organism was isolated from CSF and blood cultures.
Serial serum and cerebrospinal fluid nafcillin concentrations were determined in a patient successfully treated with nafcillin (200 mg/kg per day) for Staphylococcus aureus bacteremia and meningitis. Nafcillin and methicillin cerebrospinal fluid concentrations were compared. PMID:1259413
Ruiz, D E; Warner, J F
Trimethoprim-Sulfamethoxazole has been used successfully in the treatment of a nocardial brain abscess and was recently found to be also effective in the treatment of bacterial brain abscess. During the past year five patients with bacterial meningitis we...
Z. Farid N. I. Girgis W. Yassin D. C. Edman W. F. Miner
To evaluate the occurrence of the meningeal sign in meningiomas and metastases. We studied 20 patients with meningiomas and 17 patients with cerebral metastases adjacent to the dura. MRI studies (Siemens, Magnetom 1,5) included axial T1-weighted and T2-weighted unenhanced as well as gadolinium-DTPA enhanced T1-weighted (axial, coronal, sagittal) SE imaging. In all patients the tumours were resected with the attached dura mater. Histopathological examinations were done, which corresponded to the area of marked enhancement by gadolinium-DTPA. There was no correlation between the occurrence of the meningeal sign and the histopathological examinations. In 20 patients with meningiomas adjacent to the dura we found the meningeal sign in 11 cases. Histologically we observed an increase of collagen fibres and fibrocytes. In 5 to 17 cases with superficial cerebral as dura infiltrations and microbleedings. The meningeal sign is not specific for meningiomas and can be observed in a wide variety of pathological entities. (orig.)
Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. Among the human immunodeficiency virus (HIV)-seropositive subjects, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection. Current trends are changing due to the marked improvement of quality and length of life produced by highly active antiretroviral therapy (HAART). The introduction of generic HAART in India has resulted in an increase in the...
Satishchandra P; Mathew T; Gadre G; Nagarathna S; Chandramukhi A; Mahadevan A; Shankar S
We report the case of a meningeal inflammatory pseudotumour occurring in a 23-year-old male presenting with focal seizures and headaches. Brain imaging techniques showed a 3.5 cm left parietal meningeal tumour. Histology of the surgical specimen showed a dense lymphoid infiltrate permeating the dura mater and leptomeninges, consisting of a predominant polyclonal B cell population as confirmed by immunophenotyping and genotyping. Cultures of serum, CSF, and surgical specimen were negative and ...
Non-enteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with classic meningitis signs and symptoms of > 72 h duration. The objective of this work is to describe a rare case of salmonella meningitis in an immunocompetent adult and, in the context of previously published case reports, describe the frequently atypical clinical course of salmonella meningitis along with the potential pitfalls encountered during its evaluation and treatment. An otherwise healthy 45-year-old man presented to our Emergency Department with frontal headache, fever, and stiff neck of 7 days duration. He was alert and oriented in triage, where he was noted to be afebrile, mildly tachycardic, with a normal blood pressure and respiratory rate; shortly after triage he developed a high fever, severe tachycardia, hypotension, and a change in mental status. He was resuscitated according to our severe sepsis protocol and treated empirically for bacterial meningitis. Blood and cerebrospinal fluid cultures grew group D Salmonella berta. An evaluation for underlying immunodeficiency was unrevealing. The patient was discharged home on hospital day 7 in good condition. Salmonella meningitis can present with an indolent course and can mimic, in many misleading ways, the less serious diagnosis of aseptic meningitis. This case highlights the need for an unbiased clinical assessment, aggressive management of critical illness, and point-for-point correspondence between clinical data and assigned diagnosis. PMID:18534805
Carr, Brendan G; Weisbein, Jessica L; Gaieski, David F
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.
Sirinelli, D.; Schmit, P.; Biriotti, V.; Bensman, A.; Lupold, M.
Infected cerebrospinal fluid from rabbits with Escherichia coli meningitis failed to opsonize the infecting organism. Cerebrospinal fluid from rabbits with Staphylococcus aureus meningitis did opsinize E. coli. PMID:7012035
Bernhardt, L L; Simberkoff, M S; Rahal, J J
Two cases of vertebral osteomyelitis presenting with secondary Staphylococcus aureus meningitis are described. In staphylococcal meningitis a search for a primary source should include the lower vertebral spine. PMID:2616438
Markus, H S; Allison, S P
Meningitis is a disease feared by parents and health professionals alike. The rapid onset and progression of the disease and potentially lethal outcome makes it vital to diagnose the disease early, but this can be difficult. This is particularly the case during the current swine flu pandemic, where concerns have been raised that cases of meningitis may be missed due to a misdiagnosis of swine flu. Early symptoms of meningitis and septicaemia often resemble viral illnesses such as influenza, making the condition difficult to diagnose. Classic symptoms (the ones that many health professionals and lay people most commonly associate with meningitis), such as a nonblanching rash and a stiff neck, are often late symptoms of the disease and neck stiffness is rarer in infants and young children. The presence of ear or upper respiratory tract infections does not necessarily exclude a diagnosis of meningitis. The emphasis should therefore be on regular, close monitoring of an ill child and assessment of the vital signs. Awareness of the recognised "red flag" symptoms of septicaemia--cold hands and feet, limb pain and pale or mottled skin--could also aid earlier diagnosis and hence potentially improve prognosis. PMID:20397549
Knight, Claire; Glennie, Linda
Gd-DPTA-enhanced MR images in 94 patients who had undergone craniotomy were studied, with particular attention paid to the meningeal enhancement. Such enhancement was noted in 26 of the 94 (27.6%) in the portion surrounding the craniotomy site. Meningeal enhancement, presumably of the subdural neomembrane, was apparent as a third line of a high signal intensity on T1-weighted MR images. The outer two high-intensity lines were derived from fat in the subcutaneous tissues of the scalp and fat in the bone marrow of the calvaria. We designated this characteristic enhancement as a 'triple white line'. Of the 26 patients with meningeal enhancement, 22 cases (23.4%) showed such a 'triple white line', 11 cases (11.7%) showed falx enhancement, and 12 cases (12.8%) showed tentorial enhancement. The intervals between surgery and the appearance of the meningeal enhancement ranged from 4 days to 88 weeks. A small amount of bleeding into the dura-arachnoid interface induced by surgery might result in the subdural neomembrane, as has previously been reported. This neomembrane might be enhanced by the leakage of Gd-DTPA through the proliferating capillaries. As meningeal enhancement occurs in approximately a third of the cases following craniotomy, much care should be taken in the differential diagnosis of the infection, inflammation, and metastasis or dissemination of malignant brain tumors. (author)
Full Text Available Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. Among the human immunodeficiency virus (HIV-seropositive subjects, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection. Current trends are changing due to the marked improvement of quality and length of life produced by highly active antiretroviral therapy (HAART. The introduction of generic HAART in India has resulted in an increase in the number of individuals getting treatment for HIV infection, as the cost of highly active antiretroviral therapy (HAART has decreased 20- fold. Cryptococcal meningitis occurs in non-HIV patients who are immunodeficient due to diabetes, cancer, solid organ transplants, chemotherapeutic drugs, hematological malignancies etc and rarely in healthy individuals with no obvious predisposing factors. Diagnosis of cryptococcal meningitis is fairly straightforward once the diagnosis is considered in the differential diagnosis of chronic meningitis. Treatment of a patient with cryptococcal infection is a challenge for both the physician and the patient, but rewarding, as many would recover with timely and adequate antifungal therapy.
It is well known that a Bernasconi-Cassinari artery is an important finding at diagnosis of the abnormality in tentorium. Since Bernasconi and Cassinari reported the artery in 1956, many reports have been presented and showed that the artery arose from the intracavernous portion of the internal carotid artery. We presented a 54-year-old female with tentorial meningioma. In selective external carotid angiography, the artery feeding the tumor was revealed arising from the accessory meningeal artery, which came off the internal maxillary artery and passed into the carnium through the foramen ovale, and took the same course of "Bernasconi-Cassinari artery". This angiographic finding suggests that it is possible for marginal tentorial artery to arise from an external carotid arterial system. It is said in the anatomical studies, when the trunk of primitive maxillary artery which is one of maxillo-carotid anastomotic arteries in fetus regresses, "marginal tentorial artery" usually remains linked to the internal carotid artery. But, if this transition of "the artery" from the external to the internal carotid artery failed, it is easily conceived the artery results in the origin of accessory meningeal artery, a branch of the external carotid artery. PMID:557749
Kakita, K; Fukuma, S; Taketomo, S; Sasaki, R; Omachi, J
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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.
Robles Romero, M.; Rojas Caracuel, M.A.; Prado Álvarez, C. del.
Three cases of Proteus mirabilis meningitis in neonates are reported, in 2 of which abscess formation was proved neuroradiologically. All neonates with P. mirabilis meningitis warrant a CAT scan, as does any newborn infant with meningitis who has a continuing pleocytosis after adequate treatment with antibiotics.
Smith, M. L.; Mellor, D.
Fahr's disease refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcifications. The basal ganglia and dentate nucleus are the most common site of involvement and most cases present extrapyramidal symptoms. This disease is mostly associated with a phosphocalcic metabolism disorder, especially to hypoparathyroidism. The authors report a case of Fahr syndrome (FS) discovered when a young patient with hypocalcemia and bacterial meningitis had a cerebral CT scan disclosing intracerebral calcifications. She fully recovered after both meningitis and hypocalcemia were treated. PMID:18329142
Sbai, H; Smail, L; Hamdani, S; Essatara, Y; Harrandou, M; Khatouf, M; Kanjaa, N
A woman with Staphylococcus aureus meningitis following postpartum endometritis presented with lumbar backache and fever of several weeks' duration. Thick, green exudate was aspirated at lumbar puncture hours before death. Histologic examination demonstrated subacute inflammation of the meninges and chronic inflammation of the endometrium. Although rare, postpartum endometritis followed by low back pain and fever should alter the physician to the possibility of serious infection involving the central nervous system. Diagnosis and treatment at this early stage would be expected to decrease mortality. PMID:847493
Ali, M A; Kabins, S A
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.)
The pressure of cerebrospinal fluid taken at lumbar puncture was recorded objectively by strain gauge pressure measurement in 35 infants and children with pyogenic meningitis. Raised pressures were found in 33 children. The median pressure was 15 mm Hg (range 4-70 mm Hg) in all age groups. The pressure level varied throughout the infection, but a higher median pressure (19 mm Hg) was found when this was measured on the day of admission. The clinical features of the meningitis in these patient...
Minns, R. A.; Engleman, H. M.; Stirling, H.
Full Text Available Invasive fungal infection is an uncommon, but increasing cause of morbidity and mortality in neonates and infants. Majority of the cases of central nervous system (CNS candidiasis are associated with disseminated or invasive candidiasis. CNS candida infections may be caused by meningitis, microabscesses of the brain, vasculitis from fungal invasion of the vessel wall with thrombosis and secondary infarction and mycotic aneurysms with hemorrhage. In this article thirty one day old patient with candida meningitis complicated with subarachnoid hemorrhage and cerebral infarction, a very rare manifestation, is reported.
The MR appearance of normal and pathological meninges was studied in 23 patients. Amongst twelve normals, T/sub 1/-weighted images demonstrated the meninges as slightly hyperintense density structures (compared with CSF) which increased in signal intensity somewhat after the administration of gadolinium-DTPA. On T/sub 2/-weighted images, the subarachnoid space and meninges were isointense. In eleven patients with inflammatory disease or tumourous infiltration of the meninges, abnormal findings were evident in the unenhanced images as well as after administration of gadolinium-DTPA. Compared with CT, MR proved greatly superior in the diagnosis of meningeal abnormalities.
Schoerner, W.; Henkes, H.; Sander, B.; Felix, R.
Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated seizures. The safety and efficacy of meropenem, a new carbapenem, were compared to those of cefotaxime in a prospective randomized trial of 190...
Klugman, K. P.; Dagan, R.
A patient with acquired immunodeficiency syndrome (AIDS) developed crytpococcal meningitis, complicated by papilledema and severe progressive visual loss despite medical therapy. Bilateral optic sheath fenestration resulted in significant improvement in vision and resolution of papilledema. Histopathologic evaluation of the optic nerve sheath demonstrated numerous cryptococci. Optic nerve sheath fenestration may be an effective treatment method when high intracranial pressure is contributing ...
Milman, Tatyana; Mirani, Neena; Turbin, Roger E.
We present a case of chronic meningitis due to the mold Aureobasidium proteae. Clinical features, the disease course, as well as the diagnostic methods and optimal treatment options are discussed. This case confirms the neuroinvasiveness of A. proteae and introduces it as a new human pathogen. PMID:22504065
Kutleša, Marko; Mlinari?-Missoni, Emilija; Hatvani, Lóránt; Voncina, Darko; Simon, Silvio; Lepur, Dragan; Barši?, Bruno
We present 9 patients with community acquired Staphylococcus aureus meningitis. Foci of infection outside the central nervous system were present in 8 (89%) patients, mostly endocarditis and pneumonia. Cardiorespiratory complications occurred frequently and 6 patients died (67%). Identification and treatment of the primary focus of infection should be a priority in these patients. PMID:19177261
Brouwer, Matthijs C; Keizerweerd, Gabriella D; De Gans, Jan; Spanjaard, Lodewijk; Van De Beek, Diederik
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
Full Text Available Zona Zoster, is a mostly benign disease in immunocompetent children. Those of in immunocompromised children, there is a risk of dissemination. Zona zoster, scarcely causes some neurological complications such as myelitis, aseptic meningitis, encephalitis and ventriculitis in both immunocompetent and immunocompromised children. A 17-year-old girl who had bone marrow transplantation for thalasemia major was admitted to our hospital with fever, itchy rash on the right chest and axillary region and diagnosed as zona zoster. She had severe headache and vomiting on follow-up. We performed lumbar puncture because of the neck stiffness and meningeal irritation signs, pleocytosis and protein elevation were detected in the cerebrospinal fluid (CSF. The diagnosis of aseptic meningitis due to zona zoster was confirmed by VZV-PCR in the CSF. She cured without sequele after the administration of acyclovir treatment for 10 days. If symptoms such as headache and vomiting develop in immunocompromised children with zona zoster, neurological complications like aseptic meningitis should be remembered. (Turk Arch Ped 2012; 47: 143-6
A case of intrasacral meningeal cyst is reported in which radiculography and computed tomography were not conclusive in diagnosing the lesion. Sacral epidurography delineated the cyst very clearly and is proposed as a complementary imaging technique in lesions of the sacral canal.
Roosen, N.; Vyve, M. van; Moor, J. de
A case of intrasacral meningeal cyst is reported in which radiculography and computed tomography were not conclusive in diagnosing the lesion. Sacral epidurography delineated the cyst very clearly and is proposed as a complementary imaging technique in lesions of the sacral canal. (orig.)
We report a rare case of urinary retention secondary to Listeria meningitis. A 90-year-old woman presented with high fever, nausea, diarrhea, and incontinence of urination and feces. Lumbar puncture was performed. The total cell number of the cerebrospinal fluid (CSF) was elevated indicating that the glucose level was decreased. A CSF culture and a blood culture revealed Listeria monocytogenes (L. monocytogenes). We treated this bacterial meningitis with antibiotic medicine. One month after onset, stiff neck and laboratory data greatly improved and only urinary retention continued. Lumbar magnetic resonance imaging (MRI) showed no responsible lesions for the urinary retention. She received urological examination for urinary retention and was diagnosed with a neurogenic bladder. Two months later, she was able to walk after rehabilitation. However, the urinary retention continued despite urological therapy. We are not aware of descriptions on urinary retention resulting from bacterial meningitis in the recent literature. This is a rare case of prolonged urinary retention caused by bacterial meningitis. PMID:18552472
Fujita, Kohei; Tanaka, Tomotaka; Kono, Syoichiro; Narai, Hisashi; Omori, Nobuhiko; Manabe, Yasuhiro; Abe, Koji
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.
We developed a guinea pig model of cryptococcal meningitis to evaluate antifungal agents. Immunosuppressed animals challenged intracranially with Cryptococcus neoformans responded to fluconazole and voriconazole. Disease was monitored by serial cerebrospinal fluid (CSF) cultures and quantitative organ cultures. Our model produces disseminating central nervous system disease and responds to antifungal therapy.
Kirkpatrick, William R.; Najvar, Laura K.; Bocanegra, Rosie; Patterson, Thomas F.; Graybill, John R.
An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism. On admission, blood tests showed a mild lymphopenia, with a normal C reactive protein and white cell count. Chest X-ray and CT of the head were normal. Cerebrospinal fluid (CSF) microscopy was normal. CSF protein and glucose were in the normal range. MRI of the head and cerebral angiography were also normal. Subsequent molecular testing of CSF detected enterovirus RNA by reverse transcriptase PCR. The patient's clinical syndrome correlated with her virological diagnosis and no other cause of her symptoms was found. Her symptoms were self-limiting and improved with supportive management. This case illustrates an important example of viral central nervous system infection presenting clinically as meningitis but with normal CSF microscopy. PMID:25035443
Dawood, Naghum; Desjobert, Edouard; Lumley, Janine; Webster, Daniel; Jacobs, Michael
Angiostrongylus cantonensis is one of the causative agents of eosinophilic meningitis. Humans get infected when they ingest raw or partially cooked snails or monitor lizards (Varanus bengalensis). There is a popular belief that the tongue and the liver of the monitor lizard has aphrodisiac properties. A 20-year-old man was admitted to our hospital with a history of fever, headache and vomiting. His cerebrospinal fluid revealed eosinophilia. He gave a history of the ingestion of a monitor lizard, ten days prior to the onset of the symptoms. So, a diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis was made. He was treated with oral albendazole and prednisolone. His symptoms improved gradually within two weeks from his admission.
Pai, Shivanand; Madi, Deepak; Achappa, Basavaprabhu; Mahalingam, Soundarya; Kendambadi, Rakshith
Full Text Available Derek J Sloan, Victoria Parris Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK Abstract: Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine, which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important. Keywords: cryptococcosis, HIV, immunosuppression, antifungal therapy, immune reconstitution inflammatory syndrome, antiretroviral therapy
Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine), which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important. PMID:24872723
Sloan, Derek J; Parris, Victoria
Tatyana Milman1, Neena Mirani1,2, Roger E Turbin11Ophthalmology Department, Institute of Ophthalmology and Visual Science, 2Pathology Department, University Hospital, New Jersey Medical School, Newark, NJ, USAAbstract: A patient with acquired immunodeficiency syndrome (AIDS) developed crytpococcal meningitis, complicated by papilledema and severe progressive visual loss despite medical therapy. Bilateral optic sheath fenestration resulted in significant improvement in vision and resolution of...
Tatyana Milman; Neena Mirani; Turbin, Roger E.
This report summarises a case history in which a 75-year-old man was admitted with bacterial meningitis caused by Streptococcus bovis. A subsequent abdominal investigation in the light of the known association between invasive S bovis infection and colonic cancer confirmed the suspicion of a cancer located to the rectum. The patient died from Clostridium difficile enterocolitis with sepsis and multi-organ failure. This is a highly relevant and interesting case presentation, which besides prov...
Shipway, Toby Edward; Nelatur, Varun
Angiostrongylus cantonensis is one of the causative agents of eosinophilic meningitis. Humans get infected when they ingest raw or partially cooked snails or monitor lizards (Varanus bengalensis). There is a popular belief that the tongue and the liver of the monitor lizard has aphrodisiac properties. A 20-year-old man was admitted to our hospital with a history of fever, headache and vomiting. His cerebrospinal fluid revealed eosinophilia. He gave a history of the ingestion of a monitor liza...
Pai, Shivanand; Madi, Deepak; Achappa, Basavaprabhu; Mahalingam, Soundarya; Kendambadi, Rakshith
BACKGROUND Combination antifungal therapy (amphotericin B deoxycholate and flucytosine) is the recommended treatment for cryptococcal meningitis but has not been shown to reduce mortality, as compared with amphotericin B alone. We performed a randomized, controlled trial to determine whether combining flucytosine or high-dose fluconazole with high-dose amphotericin B improved survival at 14 and 70 days. METHODS We conducted a randomized, three-group, open-label trial of induction therapy for ...
Day, Jeremy N.; Chau, Tran T. H.; Wolbers, Marcel; Mai, Pham P.; Dung, Nguyen T.; Mai, Nguyen H.; Phu, Nguyen H.; Nghia, Ho D.; Phong, Nguyen D.; Thai, Cao Q.; Thai, Le H.; Chuong, Ly V.; Sinh, Dinh X.; Duong, A.; Hoang, Thu N.
The therapeutic efficacy and attainable cerebrospinal fluid (CSF) concentrations of moxalactam, administered by intravenous drip in a dose of 2 g every 4 to 8 h, were evaluated in seven adult patients with bacterial meningitis. Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus var. anitratus, each caused infection in four patients, whereas Escherichia coli was the cause of infection in the other three patients. The mean moxalactam concent...
Uwaydah, Marwan; Tannir, Nizar; Kantarjian, Hagop; Osseiran, Maher; Bal A, Farid
Sixty children who survived meningitis during the outbreak of meningococcal group B infection in Bolton 1971-74 were assessed between 5 and 9 years later. Each case, together with a matched control, has been examined clinically and subjected to a number of psychological tests and to routine audiology. The results, unlike those from other series, did not demonstrate any incoordination, ataxia, or other physical abnormality, nor was there any statistically significant impairment on psychologica...
Moss, P. D.
Full Text Available Cryptococcus neoformans causes meningitis in AIDS patients. In the São José Hospital, reference center for patients with AIDS in Fortaleza - Ceará State - Brazil, 54 samples of the cerebrospinal fluid were analyzed from January 1st through December 31st 2000. Direct examination with India ink and culture in Sabouraud's agar at 37degreesC were done. Of the specimens studied 5(9.25% were positive.
Menezes Everardo Albuquerque
Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF) findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples...
Marx, Grace E.; Chan, Edward D.
The records of all patients with Staphylococcus aureus meningitis admitted to Vancouver General Hospital between 1956 and 1981 were reviewed. All the patients had clinical and laboratory features of meningitis, and in all cases S. aureus was isolated from the cerebrospinal fluid. S. aureus was responsible for 21 (3%) of the 710 cases of acute bacterial meningitis. Therapy with cloxacillin or methicillin, or both, with or without other agents, was successful in 14 of the 21 patients. Three of ...
Roberts, F. J.; Smith, J. A.; Wagner, K. R.
Rathke's cleft cysts (RCC) are usually benign, sellar and/or suprasellar lesions originating from the remnants of Rathke's pouch. Rarely, RCC can present with chemical meningitis, sellar abscess, lymphocytic hypophysitis, or intracystic hemorrhage. We describe an unusual presentation of RCC in which the patient presented with a clinical picture of chemical meningitis consisting of meningeal irritation, inflammatory cerebrospinal fluid profile, and enhancing pituitary and hypothalamic lesions, in addition to involvement of the optic tracts and optic nerve. PMID:24100110
Mrelashvili, Anna; Braksick, Sherri A; Murphy, Lauren L; Morparia, Neha P; Natt, Neena; Kumar, Neeraj
Salmonella meningitis is an unusual complication of Salmonella sepsis and occurs mainly in children. A rare case of Salmonella typhimurium meningitis occurring in an adult HIV positive man who presented with a history of fever and diarrhoea is reported. On examination he was dehydrated, and had oral thrush, weakness of lower limbs and neck stiffness. A septic diagnostic screen was performed and he was commenced on empiric intravenous cefotaxime therapy for meningitis. S typhimurium was cultur...
Coinfection of the nervous system by two distinct nonviral organisms is uncommon and often undiagnosed. Medical teaching emphasizes that a single pathologic process should be sought; however, in the presence of severe immunocompromise this approach may not hold true. We describe seven HIV-1 seropositive patients with cryptococcal meningitis, three of whom had a proven nervous system infection with a second organism: concurrent tuberculous meningitis, a tuberculoma, and the first documented case of cryptococcal meningitis and neurosyphilis. PMID:9781566
Silber, E; Sonnenberg, P; Koornhof, H J; Morris, L; Saffer, D
Full Text Available Tuberculous radiculomyelitis (TBRM is known to be a complication of tuberculous meningitis (TBM and has been reported rarely in the literature. Subacute radiculomyelopathy progressing over 3 months due to spinal cord compression was the presenting symptom of tuberculous meningitis in our patient with no radiological evidence of spinal tuberculosis. The obstructive myelopathy was the result of proliferative granulomatous meningitis. Early suspicion and antituberculosis treatment with steroids may prevent irreversible neurological deficit in this unusual presentation of central nervous system tuberculosis.
Meningitis, when caused by the fungal mycoses Cryptococcus neoformans, is normally seen in immunocompromised hosts. However, immunocompetent patients are also susceptible to cryptococcal meningitis (CM). In patients with an intact immune system, CM usually presents with the typical signs and symptoms of meningitis: fever, stiff neck, and headache. Major implications for the primary and advanced practice nursing plans of carefor CM patients include a thorough history and physical exam, early d...
Thompson, Hilaire I.
INTRODUCTION—Data on single photon emission computed tomography (SPECT) in tuberculous meningitis are lacking and prompted this study. SPECT findings in tuberculous meningitis are reported and correlated with clinical and radiological findings.?PATIENTS AND METHODS—Seventeen patients with tuberculous meningitis that was diagnosed on clinical, radiological, and laboratory criteria have been included. Their age ranged between 5 and 62 years and four of them were female. Computed tom...
Misra, U.; Kalita, J.; Das, B.
Incidence, morbidity and mortality of bacterial meningitis in developing countries are manifold greater than those in the industrialized world. We reviewed retrospectively children with meningitis treated in the paediatric hospital of Luanda in 2004. Among the 555 children, median age 11.0 months, the leading agents were Haemophilus influenzae type b (Hib), pneumococcus, and meningococcus in 60%, 24%, and 10%, respectively. The median length of illness before admission was 7 d. 65% had convulsed. Altered level of consciousness was observed in 61% and blood haemoglobin lower than 8 g/dl in 36% of cases. Case fatality was 35% and, of survivors, 24% were left with severe neurological sequelae. Blood transfusion appeared beneficial since fatality of children with and without transfusion was 23% versus 39% (p=0.003). While awaiting large-scale vaccinations, tools to improve the prognosis of meningitis in Angola comprise generating better awareness to reduce the delay, better fluid treatment and monitoring and active use of blood transfusions. PMID:18622806
Pelkonen, Tuula; Roine, Irmeli; Monteiro, Lurdes; Joao Simoes, Maria; Anjos, Elizabete; Pelerito, Ana; Pitkaranta, Anne; Bernardino, Luis; Peltola, Heikki
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.
Steckelberg James M
Rosai-Dorfman disease of the central nervous system is extremely rare and difficult to diagnose also for pathologists. We describe three unusual cases of meningeal Rosai-Dorfman disease and illustrate the difficulties of preoperative and pathological diagnosis. We retrospectively analyzed three patients who underwent surgery for a suspected meningioma for whom the final diagnosis was Rosai-Dorfman disease of the central nervous system. Pathological initial diagnosis was schwannoma, lymphoplasmacyte-rich meningioma, or inflammatory tumor, but final diagnosis in all cases was Rosai-Dorfman disease. These cases underline the preoperative and pathological difficulties of such diagnosis. Pathologists and physicians should be aware of the occurrence of such rare localization of this disease and should think about this differential diagnosis in lymphocyte-rich meningeal tumors mimicking, clinically and radiologically, a meningioma. Communication of significant previous medical history to pathologists and careful examination of slides with appropriate medical history and the use of S100 antibody in the diagnosis of meningeal tumors mimicking Rosai-Dorfman disease could lower the rate of misdiagnosis. PMID:24366336
Forest, Fabien; N'guyen, Anh Tuan; Fesselet, Jacques; Metellus, Philippe; Bouvier, Corinne; de Paula, André Maues; Roche, Pierre-Hughes; Figarella-Branger, Dominique
Meningitis due to Staphylococcus aureus is well described but uncommon. Most cases arise as a complication of neurosurgical interventions or head trauma, although some arise spontaneously. To our knowledge, no case of S. aureus meningitis has been previously reported in a person with the acquired immunodeficiency syndrome (AIDS). Herein we describe a case of S. aureus meningitis in a person with AIDS who had no history of a neurosurgical procedure, head trauma, or overwhelming bacteremia. Treatment of this infection was successful. S. aureus should be added to the list of potential pathogens that can cause spontaneous meningitis in people with AIDS. PMID:9818045
Miller, L G; Mathisen, G E; Chang, S
Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years. Cerebrospinal fluid polymerase chain reaction testing for herpes simplex virus type 2 was positive, and further testing excluded other common viral, bacterial, and inflammatory causes of meningeal irritation. The patient's family history was significant for a brother who also had multiple episodes of aseptic meningitis during a period of several years. This represents the first published report of a possible familial association involving Mollaret meningitis. It is likely that Mollaret meningitis is underrecognized among emergency physicians, and improved recognition of this entity may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission. PMID:20825883
Jones, Christopher W; Snyder, Graham E
A 44-year-old woman with a history of transient right hemiparesis presented with personality change. One year later, she was admitted with ophthalmoparesis, dysarthria and regression phenomenon. MRI indicated acute infarction of the paramedian region of the midbrain and a nodular lesion in the interpeduncular fossa with contrast enhancement. Two years later, the patient was admitted with sudden onset of right hemiplegia. MRI showed acute infarction in the left side of the pons, diffuse brain atrophy, and abnormal contrast enhancement in the nodular lesion of interpeduncular fossa and leptomeninges of the ventral pons. MR angiography revealed that cerebral main tracts were intact, and cerebrospinal fluid analysis revealed mild pleocytosis and slightly elevated protein levels. Cervical lymph node biopsy demonstrated caseating granuloma with acid-fast bacilli. The patient was diagnosed with chronic tuberculous meningitis, even though tuberculous bacilli were not detected on polymerase chain reaction (PCR) or in culture. Antituberculous medication resulted in radiological resolution and neurological improvement. Although the patient had mild headache and pyrexia at the first admission, no signs of meningeal irritation were confirmed throughout the clinical course. We suspect that a paucity of tuberculous bacilli released from the tuberculous foci in the meninges to the subarachnoid space caused prolonged clinical course and lack of meningeal irritation signs. PMID:24705835
Omoto, Shusaku; Yoshioka, Masayuki; Sakimoto, Yoshihiro; Yoshikawa, Koji; Hashimoto, Masaya; Suzuki, Masahiko
The present study was designed to determine whether cerebrovascular autoregulation is intact in experimental meningitis and to examine the relationship between fluctuations in cerebral blood flow (CBF) and increased intracranial pressure (ICP). Measurements of CBF were determined by the radionuclide microsphere technique in rabbits with experimental Streptococcus pneumoniae meningitis with simultaneous ICP monitoring via an implanted epidural catheter. CBF and ICP measurements were determined...
Tureen, J. H.; Dworkin, R. J.; Kennedy, S. L.; Sachdeva, M.; Sande, M. A.
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
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.
Abe, M.; Takayama, Y. E-mail: firstname.lastname@example.org; Yamashita, H.; Noguchi, M.; Sagoh, T
The authors describe a case of aseptic meningitis in a college student that was ultimately attributed to infection with lymphocytic choriomeningitis virus (LCMV). The authors also provide a review of LCMV infection, epidemiology, and public health implications. Providers should be aware of LCMV as a cause of meningitis in college students,…
Sosa, Lynn E.; Gupta, Shaili; Juthani-Mehta, Manisha; Hadler, James L.
We describe a case of lymphocytic choriomeningitis virus (LCMV) meningitis in a New York, NY, resident who had no apparent risk factors. Clues leading to the diagnosis included aseptic meningitis during winter and the finding of hypoglycorrachia and lymphocytosis in the cerebrospinal fluid. LCMV continues to be an underdiagnosed zoonotic disease.
Asnis, Deborah S.; Muana, Owen; Kim, Do Gyun; Garcia, Minerva; Rollin, Pierre E.; Slavinski, Sally
Lymphocytic choriomeningitis virus (LCMV) was detected in 2 patients with acute meningitis in southern Spain within a 3-year period. Although the prevalence of LCMV infection was low (2 [1.3%] of 159 meningitis patients), it represents 2.9% of all pathogens detected. LCMV is a noteworthy agent of neurologic illness in immunocompetent persons.
Pe?rez-ruiz, Mercedes; Navarro-mari?, Jose?-mari?a; Sa?nchez-seco, Mari?a-paz; Gegu?ndez, Mari?a-isabel; Palacios, Gustavo; Savji, Nazir; Lipkin, W. Ian; Fedele, Giovanni; Ory-mancho?n, Fernando
A young man who presented with a 3 week history of fever and severe headache accompanied by mild leukocytosis, was found to have lymphocytic meningitis due to Coxiella burnetti. Thus, Q fever can present as lymphocytic (aseptic) meningitis responsive to tetracycline with no evidence of pulmonary involvement.
Schattner, A.; Kushnir, M.; Zhornicky, T.; Fenakel, G.
Bacterial meningitis is an acute and serious illness associated with significant morbidity and mortality. Although methods to make the diagnosis are relatively simple and effective antimicrobial agents are available, bacterial meningitis accounts for more than 2000 reported deaths per year in the United States. The majority of cases and deaths occur in otherwise healthy individuals. PMID:3990432
Bolan, G; Barza, M
Enterovirus-specific genetic sequences were isolated from two Amblyomma americanum tick pools. Identical genetic sequences were later obtained from cerebrospinal fluid of a patient with aseptic meningitis and a recent history of tick attachment. These observations suggest the possibility of an emerging tick-borne human enterovirus associated with aseptic meningitis.
Freundt, Eric C.; Beatty, Douglas C.; Stegall-faulk, Teresa; Wright, Stephen M.
Full Text Available A fiftyfive year old gentleman with HIV infection was investigated for meningitis.Cryptococcus neoformans was isolated.Second case was a lady of 42 years, with HIV infection, was also investigated for meningitis. Cryptococcus neoformans was isolated. Antigen was detected in CSF as well as serum in both the cases.
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.
Oguzhan S?tk? Dizdar; Faruk Karakeçili; Belk?s Nihan Coskun; Beyza Ener; R?dvan Ali; Re?it M?st?k
A 12-year-old child developed meningitis 6 days after a third ventriculostomy by endoscopy. A coagulase-negative Staphylococcus sp. was isolated in pure culture from the cerebrospinal fluid and was definitely identified as Staphylococcus lugdunensis after the 16S ribosomal DNA gene and rpoB gene were sequenced. This report describes the first case of S. lugdunensis meningitis.
Kaabia, N.; Scauarda, D.; Lena, G.; Drancourt, M.
Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish 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.
Vaneza, Tique; Nelson, Alvis; Renata, Parodi; Alvaro, Bustos; Salim, Mattar.
Disseminated Cryptococcus disease occurs in patients with defective T-cell immunity. Cryptococcal meningitis following autologous stem cell transplant (SCT) has been described previously in only 1 patient, 4 months post SCT and while off antifungal prophylaxis. We present a unique case of Cryptococcus meningitis pre-engraftment after autologous SCT, while the patient was receiving fluconazole prophylaxis. A 41-year-old man with non-Hodgkin's lymphoma underwent autologous SCT. Post-transplant prophylaxis consisted of fluconazole 400 mg daily, levofloxacin 500 mg daily, and acyclovir 800 mg twice daily. On day 9 post transplant, he developed fever and headache. Peripheral white blood cell count (WBC) was 700/?L. Magnetic resonance imaging of the brain showed lesions consistent with meningoencephalitis. Cerebrospinal fluid (CSF) analysis revealed a WBC of 39 with 77% lymphocytes, protein 63, glucose 38, CSF pressure 20.5 cmH2 O, and a positive cryptococcal antigen. CSF culture confirmed Cryptococcus neoformans. The patient was treated with liposomal amphotericin B 5 mg/kg intravenously daily, and flucytosine 37.5 mg/kg orally every 6 h. He was switched to fluconazole 400 mg daily after 3 weeks of amphotericin therapy, with sterilization of the CSF with negative CSFCryptococcus antigen and negative CSF culture. Review of the literature revealed 9 cases of cryptococcal disease in recipients of SCT. Median time of onset was 64 days post transplant. Only 3 meningitis cases were described; 2 of them after allogeneic SCT. Fungal prophylaxis with fluconazole post autologous SCT is recommended at least through engraftment, and for up to 100 days in high-risk patients. A high index of suspicion is needed to diagnose and treat opportunistic infections, especially in the face of immunosuppression and despite adequate prophylaxis. Infection is usually fatal without treatment, thus prompt diagnosis and therapy might be life saving. PMID:24750320
Chaaban, S; Wheat, L J; Assi, M
Full Text Available 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 glycerol or placebo. Brain damage, hearing loss, and inflammatory parameters were assessed. Results Clinically and by histopathology, animals treated with glycerol or placebo did not differ. While both groups showed equally high levels of matrix metalloproteinase-9 at 24 h after infection, a significant difference in favour of glycerol was observed at 40 h after infection. However, this difference in matrix metalloproteinase-9 in late disease did not result in an improvement of histopathologic parameters. Conclusion No benefit of adjunctive glycerol was found in these models of pneumococcal meningitis.
Background Cryptococcus spp. are saprophytic and opportunistic fungal pathogens that are known to cause severe disease in immunocompromised animals. In goats there are reports of clinical cryptococcal pneumonia and mastitis but not of meningitis. Case presentation The following report describes a case of a five year old buck showing severe neurological signs, including paraplegia and strong pain reaction to touch of the hindquarters region. Treatment with antibiotics was unsuccessful and the animal was euthanized for humanitarian reasons. Postmortem examination revealed lumbar meningitis, lung nodules and caseous lymphadenitis lesions. Encapsulated Cryptococcus neoformans were identified from the lungs and meninges, showing that cryptococcal meningitis should be included in the differential diagnosis of goats showing paresis and hyperesthesia. The possibility of concurrent immunosuppression due to Corynebacterium pseudotuberculosis infection is raised. Conclusions Cryptoccocal meningitis should be included in the differential diagnosis list of goat diseases with ataxia and hyperesthesia.
Cerebral tuberculosis is the most severe type of extrapulmonary disease that is in developing countries highly predominant in children. Meningeal tuberculosis is the most common form and usually begins with respiratory infection followed by early haematogenous dissemination to extrapulmonary sites involving the brain. In comparison with the lung, Mycobacterium tuberculosis induces a very different immune response when infect the central nervous system. Herein, we review several aspects of the pathogenesis and immune response in pulmonary and cerebral tuberculosis in humans and experimental models and discuss the implications of this response in the cerebral infection outcome.
ISABEl, Bini Estela; ROGELIO, Hernandez Pando
In order to describe the clinical features and outcome of Staphylococcus aureus meningitis, the charts of 44 cases seen at one teaching hospital during a 20-year period were retrospectively reviewed. Staphylococcus aureus was the fifth most common cause of bacterial meningitis (10.2% of cases). There were 28 (63%) cases of postoperative meningitis and 16 (37%) of spontaneous meningitis. Patients with postoperative meningitis were younger than patients with spontaneous meningitis (mean age, 40.3 vs. 59.3 years; P=0.04) and had a lower frequency of community-acquired infection (32.1% vs. 93.8%; P<0.01), severe underlying diseases (28% vs. 87%; P<0.01) and associated staphylococcal infection (35% vs. 75%; P=0.01). The clinical presentation was similar in both groups, but patients with postoperative meningitis had a lower frequency of altered mental status (39% vs. 75%; P=0.02), meningeal signs (28% vs. 62%; P=0.02), petechial rash (0% vs. 18%; P=0.04), bacteremia (7% vs. 75%; P<0.01), and septic shock (0% vs. 44%; P<0.01). Most patients were treated with cloxacillin or vancomycin, with or without rifampicin, for a mean period of 22.5 days (range, 1-100 days). Overall mortality was 27%, and the mortality rate was higher for cases of spontaneous than postoperative meningitis (50% vs. 14%; P=0.01). Mortality correlated significantly with advanced age, spontaneous meningitis, altered mental status, and the presence of severe underlying diseases, bacteremia, and septic shock. PMID:12525921
Pintado, V; Meseguer, M A; Fortún, J; Cobo, J; Navas, E; Quereda, C; Corral, I; Moreno, S
We reformulated a multiplex PCR algorithm for serotyping of pneumococcal meningitis directly on cerebrospinal fluid (CSF). Compared to established methods on isolates, CSF-based PCR had at least 80% sensitivity and 100% specificity. In regional meningitis surveillance, CSF-based PCR increased the serotype information yield from 40% of cases (isolate testing) to 90%.
Objective: To explore the features of MRI in the patients with cryptococcus neoformans meningitis (CNM). Methods: All 10 cases with CNM in this group were examined with India-ink capsule staining of CSF. 9 cases were performed with contrast enhanced MRI head scan, 1 case performed with chest CT scan. Results: MRI features of CNM included: (1) There were no abnormalities on MRI plain scan in 2 cases, however with linear-like enhancement in cisterns and meninges after contrast. The leptomeninges and basal cisterns were often involved. (2) Multiple patch or flake-like longer T1 and T2 signals in bilateral basal ganglions, frontal, temporal and parietal lobes were displayed on MRI plain scan in 5 cases. And the lesions were enhanced like flake or no enhancement on contrast enhanced MRI. Basal and pre-pontine cisterns showed linear-like enhancement in 1 case. (3) Multiple round or oval shape longer T1 and T2 signals were occurred in the bilateral cerebral hemispheres, with nodular enhancement in 3 cases. (4) Hydrocephalus was found in 3 cases. Conclusion: CNM has high rate of misdiagnose, and the final diagnosis depend on pathology. Although MRI features of CNM lack specificity, MRI is of very important in the diagnosis and differential diagnosis of CNM. (authors)
Selective angiography of the external cartoid artery and superselective angiography of single branches can be used for demonstration of blood supply of dural tumors, tumors of the skull, skull base and of facial parts o the skull. Especially malformations of vessels and their blood supply can be shown. Improvements in X-ray technique and apparatus enable movement angiography, which can be very helpful for the diagnosis of special changes. In special kinds of headache influences from outside to the external carotid artery, to the maxillary artery, to the ascending pharyngeal artery, to the posterior auricular artery, to the occipital artery and the meningeal branches can be of higher importance than was assumed before. Selective angiographies of the external carotid artery and radiographic investigations of the anatomical situation are giving the basis for planning of embolisations. For diagnosis of intra- and extracranial changes the neuroradiologist is the connecting person between all specialists for skull and brain. (orig.)
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We reviewed the 20 cases of neonatal septicemia diagnosed at HospItal Infantil, Medellin, Colombia, between 1981 and 1986. Eleven were premature babies; in 12 septicemia had an early onset. In 5 the Infective agent was Klebsiella spp. and in another 5 It was a gram negative bacillus different from either Klebsiella or. Escherichia coli. Seven patients died, of whom 6 had been infected with gram negative bacilli. In 5 septicemia was complicated with meningitis, 4 of which occurred In cases with early onset. Relative Risk for death due to septicemia was greater among patients undergoing surgical procedures to correct congenital malformations and In those suffering from perinatal hypoxia. The risk for development of meningitis was greater among patients with early onset septicemia. We conclude that a change is taking place In the etiology of neonatal sepsis In than gram negative bacilli, different from Escherichia coli are now predominant.
Se hizo una revisión de los casos de septicemia y meningitis neo natales diagnosticados en el Hospital Infantil de Medellín entre 1981 y 1986; se detectaron 20 casos de septicemia; once niños fueron prematuros; en 12 la enfermedad fue de comienzo precoz; en 5 el agente infectante fue Klebsíella spp. y en otros 5 un bacilo gram negativo diferente de ésta y de Escheríchía colí. Cinco niños sufrieron, además, meningitis; cuatro de los 5 casos de meningitis ocurrieron en niños con septicemia de comienzo precoz; fallecieron 7 pacientes, de los cuales 6 hablan estado Infectados con bacilos gram negativos. El Riesgo Relativo de sufrir meningitis fue mayor entre los casos de septicemia de comienzo precoz y el de fallecer '0 fue entre los Intervenidos para corregir malformaciones congénitas y los que hablan presentado hipos la perinatal. Se llama la atención hacia el cambio en la etiología de las septicemias neonatales atendidas en esta institución en el sentido del predominio de bacilos gram negativos diferentes de la Escheríchía colf.
Rafael J. Manotas Cabarcas
The Hospital Universitari de Bellvitge (Barcelona, Spain) records all cases of bacterial meningitis in a 120-variable database. The characteristics of bacterial meningitis in cirrhotic patients are not well-known, and all cases of community-acquired bacterial meningitis occurring in cirrhotic patients were therefore identified. During 1977-2002, there were 602 episodes of community-acquired bacterial meningitis in adults, of which 29 (4.8%) occurred in cirrhotic patients. Compared to non-cirrhotic patients, there were significant differences in: duration of disease for >4 days at the time of diagnosis; absence of nuchal rigidity; certain aetiologies, e.g., Escherichia coli and Listeria monocytogenes; renal and liver function impairment; relapse of fever; and incidence of relapse and mortality. Overall, bacterial meningitis in cirrhotic patients was associated with a high mortality rate and a large number of complications. A high index of suspicion is necessary because of the frequent absence of meningeal signs. In addition to the classic meningeal pathogens, other aetiologies, including E. coli and L. monocytogenes, should be considered when prescribing empirical therapy. PMID:18005179
Cabellos, C; Viladrich, P F; Ariza, J; Maiques, J-M; Verdaguer, R; Gudiol, F
Aseptic meningitis refers to a clinical syndrome of meningeal inflammation in which bacteria cannot be identified in the cerebrospinal fluid (CSF). The viral etiology and the epidemiological, clinical, and laboratory characteristics of aseptic meningitis among children aged 2 months to 15 years in Shiraz, southern Iran were determined. From May 2007 to April 2008, 65 patients were admitted to the hospital with aseptic meningitis. Seven viruses, non-polio human enteroviruses, mumps virus, herpes simplex virus (HSV), varicella-zoster virus (VZV), human cytomegalovirus (HCMV), human herpes virus type 6 (HHV-6), and Epstein-Barr virus (EBV) were investigated by polymerase chain reaction (PCR) method. Viruses were detected in 30 (46.2%) patients in whom non-polio human enterovirus and mumps virus were detected in 13 (43.3%) and 11 (36.7%), respectively. The remaining 6 (20%) of the cases were caused by HSV, VZV, HCMV, and HHV-6. Haemophilus influenzae and non-polio human enterovirus were detected in one patient simultaneously. Viral meningitis was found to be more frequent during spring and summer. The majority (66.6%) of the patients were treated in the hospital for 10 days and had received antibiotics in the case of bacterial meningitis. Rapid diagnosis of viral meningitis using PCR testing of CSF can help shorten hospitalization, and avoid the unnecessary use of antibiotics. PMID:21412795
Hosseininasab, Ali; Alborzi, Abdolvahab; Ziyaeyan, Mazyar; Jamalidoust, Marzieh; Moeini, Mahsa; Pouladfar, Gholamreza; Abbasian, Amin; Kadivar, Mohamad Rahim
Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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.
Vaneza, Tique; Nelson, Alvis; Renata, Parodi; Alvaro, Bustos; Salim, Mattar.
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
Nissen, Nanna Bang; Jespersen, Sanne; Vinner, Lasse; Fomsgaard, Anders; Laursen, Alex
Meningitis, when caused by the fungal mycoses Cryptococcus neoformans, is normally seen in immuno-compromised hosts. However, immunocompetent patients are also susceptible to cryptococcal meningitis (CM). In patients with an intact immune system, CM usually presents with the typical signs and symptoms of meningitis: fever, stiff neck, and headache. Major implications for the primary and advanced practice nursing plans of care for CM patients include a thorough history and physical exam, early diagnosis and treatment, and an individualized plan of care focused on minimizing sequelae and side effects of treatment and maximizing functional recovery. PMID:16001819
Thompson, Hilaire J
Introduction. Central nervous system infections are among the most serious conditions in of medical practice. C-reactive Protein has recently been evaluated in terms of its ability to diffeccentiate bacterial from nonbacterial central nervous system inflammations.
Methods. We studied the frequency of positive CRP in 61 patients who had signs of meningitis. All the specimens referred to...
AR EMAMI NAEINI
Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish 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.
Nagel, A.; Manias, V.; Busquets, N.; Sniadowsky, S.; Anzardi, J.; Méndez, E. De Los A..
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.
Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish 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.
Antonio, Ávila; Daniela, Lezerovich; Verónica, Sabio Paz; Miriam, Lenz; Cecilia, Chede; Juan, Varón; Elizabet, Bogdanowicz; Adrián, Saporiti.
Full Text Available Se presentó un paciente de 54 años de edad con cuadro clínico de meningitis, que en el estudio del líquido cefalorraquídeo se aisló Pseudomonas aeruginosa. La meningitis por bacilos gramnegativos ha ido incrementándose desde la década de los años 70, con una mayor incidencia en niños pequeños. Dentro de este grupo de infecciones, la causada por Pseudomonas sp. por su poca frecuencia, resulta una rareza. La meningitis por Pseudomonas aeruginosa debe tenerse en cuenta por la severidad del cuadro clínico y el incremento de las cepas resistentes.Meningitis caused by gram-negative bacilli increased since the 1970, with a higher incidence in small children. Within this group of infections, the meningitis caused by Pseudomonas sp is rare. The case of a 54-year-old patient with a clinical picture of meningitis is reported. Pseudomonas aeruginosa was isolated from the cerebrospinal fluid. The meningitis caused by Pseudomonas aeruginosa should be taken into consideration because of the severity of the clinical picture and the high mortality and increasing strain resistance.
María del Carmen Batlle Almodóvar
Full Text Available Tuberculous meningitis (TBM and acute bacterial meningitis (ABM cause substantial mortality and morbidity in both children and adults. Identification of poor prognostic factors at patient’s admission could prepare physicians for more aggressive monitoring of patients with meningitis. The objective of this study was to determine the predictive value of neurological features to differentiate ABM and TBM. A retrospective study was conducted between patients affected with ABM or TBM admitted to three teaching hospitals during the last 14 years in Zahedan the central city of Sistan and Balouchestan province (Iran. The neurological features include seizure, level of consciousness, stroke, focal neurologic deficit and cranial nerve palsy at the time of admission. Mean age for patients with TBM and ABM were 41 ± 22.4 and 24 ± 18.5 years respectively. In univariate analysis, all measured variables revealed significant difference between ABM and TBM patients except for seizure episodes. Multivariate logistic regression analysis showed positive predictive effect of cranial nerve palsy (AOR=1.980, CI 95%: 1.161-3.376 on the diagnosis of TBM. In our study cranial nerve palsies was the most important neurological predictor factor to differentiate TBM from ABM
Tuberculous meningitis (TBM) and acute bacterial meningitis (ABM) cause substantial mortality and morbidity in both children and adults. Identification of poor prognostic factors at patient's admission could prepare physicians for more aggressive monitoring of patients with meningitis. The objective of this study was to determine the predictive value of neurological features to differentiate ABM and TBM. A retrospective study was conducted between patients affected with ABM or TBM admitted to three teaching hospitals during the last 14 years in Zahedan the central city of Sistan and Balouchestan province (Iran). The neurological features include seizure, level of consciousness, stroke, focal neurologic deficit and cranial nerve palsy at the time of admission. Mean age for patients with TBM and ABM were 41 ± 22.4 and 24 ± 18.5 years respectively. In univariate analysis, all measured variables revealed significant difference between ABM and TBM patients except for seizure episodes. Multivariate logistic regression analysis showed positive predictive effect of cranial nerve palsy (AOR=1.980, CI 95%: 1.161-3.376) on the diagnosis of TBM. In our study cranial nerve palsies was the most important neurological predictor factor to differentiate TBM from ABM. PMID:23585318
Moghtaderi, Ali; Alavi-Naini, Roya; Rashki, Saideh
Background The development of optimal vaccination strategies for pneumococcal conjugate vaccines requires serotype-specific data on disease incidence and carriage prevalence. This information is lacking for the African meningitis belt. Methods We conducted hospital-based surveillance of acute bacterial meningitis in an urban and rural population of Burkina Faso during 2007–09. Cerebrospinal fluid was evaluated by polymerase chain reaction for species and serotype. In 2008, nasopharyngeal swabs were obtained from a representative population sample (1 month to 39 years; N?=?519) and additional oropharyngeal swabs from 145 participants. Swabs were evaluated by culture. Results Annual pneumococcal meningitis incidence rates were highest among <6-month-old (58/100,000) and 15- to 19-year-old persons (15/100,000). Annual serotype 1 incidence was around 5/100,000 in all age groups. Pneumococcal carriage prevalence in nasopharyngeal swabs was 63% among <5-year-old children and 22% among ?5-year-old persons, but adding oropharyngeal to nasopharyngeal swabs increased the estimated carriage prevalence by 60%. Serotype 1 showed high propensity for invasive disease, particularly among persons aged ?5 years. Conclusions Serotype 1 causes the majority of cases with a relatively constant age-specific incidence. Pneumococcal carriage is common in all age groups including adults. Vaccination programs in this region may need to include older target age groups for optimal impact on disease burden.
Mueller, Judith E.; Yaro, Seydou; Ouedraogo, Macaire S.; Levina, Natalia; Njanpop-Lafourcade, Berthe-Marie; Tall, Haoua; Idohou, Regina S.; Sanou, Oumarou; Kroman, Sita S.; Drabo, Aly; Nacro, Boubacar; Millogo, Athanase; van der Linden, Mark; Gessner, Bradford D.
Phaeohyphomycosis of the central nervous system is rare but typically associated with high mortality. Treatment has not been standardized, but the combination of antifungal chemotherapy with surgical debridement is recommended. We report a 73-year-old, retired, male timber merchant with acute meningitis caused by Cladosporium sphaerospermum. The patient, who had well-controlled type 2 diabetes mellitus, presented with fever and weakness of the lower limbs. No brain abscess was apparent by cranial computed tomography. C. sphaerospermum was isolated from the cerebral spinal fluid and identified based on both morphology and DNA sequencing. He was treated with combination antifungal chemotherapy with amphotericin B and voriconazole for 28 days, followed by voriconazole monotherapy for 46 days. To date, the patient has recovered without significant sequelae. This patient represents the first reported case of cerebral phaeohyphomycosis caused by C. sphaerospermum. Moreover, the therapy was successful for totally less than 3 months of treatment duration. PMID:24263083
Chen, Chi-Yu; Lu, Po-Liang; Lee, Kun-Mu; Chang, Tsung Chain; Lai, Chung-Chih; Chang, Ko; Lin, Wei-Ru; Lin, Chun-Yu; Chen, Yen-Hsu
This review focusses on paradoxical reactions occurring during the treatment of tuberculous meningitis (TBM) in human immunodeficiency virus-negative cases. A paradoxical reaction is defined as the worsening of a pre-existing lesion or the appearance of new lesion in a patient whose clinical symptoms initially improved with anti-tuberculosis treatment. A number of different paradoxical reactions have been reported in patients with TBM including expansion of existing cerebral tuberculomas, and appearance of new tuberculomas, hydrocephalus, and optochiasmatic and spinal arachnoiditis. While the exact mechanism of paradoxical reactions is uncertain, an exaggerated immune reaction against Mycobacterium tuberculosis-associated antigens is currently the most accepted theory for tuberculous paradoxical reaction. Corticosteroids are considered to have a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumor necrosis factor-? antagonists, thalidomide and interferon-? have been used in isolated cases with more severe forms of paradoxical reactions. PMID:24680563
Garg, Ravindra Kumar; Malhotra, Hardeep Singh; Kumar, Neeraj
Tuberculous meningitis (TBM) is not the most common but the most serious clinical form of extrapulmonary tuberculosis. Serious complications resulting from difficulties in diagnosis and treatment of the disease makes it an important health problem. In our study, 82 patients with TBM, followed up in our clinic between January 1998-December 2002, are evaluated with their clinical and laboratory properties. 52% of our patients were females, 48% were males and their ages ranged from 15 to 70 with a mean of 32 years. The diagnosis was based on patients' history, clinical and laboratory properties, cerebrospinal fluid (CSF) findings and radiographic findings. 59% of our patients were grade II clinically, 29% were grade I, and 23% were grade III. Mostly observed complaints were headache (87%) and nausea-vomiting (63%) and fever (45%) and mostly seen physical findings were stiff neck (70%), alterations in consciousness (57%). Pleocytosis in CSF was detected in 94%, low CSF glucose level in 87%, and elevated CSF protein level in 82% of the patients. From CSF samples of 40 patients, out of total 82, Mycobacterium tuberculosis was isolated on Loewenstein-Jensen medium (49%). Nineteen patients had tuberculomas, 13 had basal meningitis, and 11 had hydrocephalus on cranial radiographic studies. 28% had miliary pattern and 26% had active infiltration and cavities on chest roentgenogram. A four-drug antituberculous regimen was administered for 88% of the patients and dexamethasone treatment was administered for 75%; 56 (68.3%) patients recovered from the illness, 14 (17%) patients had slight and 4 (4.9%) patients had serious neurological sequeales and 8 (9.8%) patients died in spite of tuberculous therapy. As a conclusion, TBM is an infectious disease with high morbidity and mortality rates. Various prognosis patterns may be observed according to the clinical grade of the patient on application. When suspected, an early diagnosis and early treatment of the disease are the most important factors which effect complication and mortality rates. PMID:15765287
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 pat...
Vitor Laerte Laerte Pinto Junior; Maria Cristina Rebelo; Rachel Novaes Gomes; Edson Fernandes de Assis; Castro-faria-neto, Hugo C.; Marcio Neves Bóia
Meningitis due to Gemella haemolysans developed in a 73 year old woman after thermolysis of the Gasserian ganglion for trigeminal neuralgia. The taxonomy of this organism is discussed, and previous cases of infection are reviewed.
Mitchell, R. G.; Teddy, P. J.
We present a unique case of a patient with deafness and blindness secondary to carcinomatous meningitis from colorectal adenocarcinoma with accompanying radiologic and pathologic images and a brief review of the relevant literature.
Bruce, Beau B.; Tehrani, Mahtab; Newman, Nancy J.; Biousse, Vale?rie
CT scans of 34 patients with severe tuberculous meningitis were reviewed. These patients were subsequently followed for a minimum period of nine months. Several diagnostic and prognostic features on CT scanning are discussed.
Bullock, Mrr; Welchman, Jm
Two patients presented with ampulla cardiomyopathy induced by meningitis. A 71-year-old man with meningitis was admitted to our neurosurgery division. Emergent coronary angiography was performed, because of sudden blood pressure fall and ST elevation in the precordial leads. Left ventriculography and coronary angiography revealed apical ballooning without coronary stenosis. A 73-year-old woman with meningitis was admitted to another hospital. She felt chest pain. Electrocardiography showed ST elevation in the precordial leads. She was transferred to our division. Echocardiography revealed apical ballooning and hyperkinesis of the base. Creatine kinase level showed no elevation on admission or 8 hr later. Ampulla cardiomyopathy with cerebrovascular disease is common, but rare with meningitis, which needs intensive care because of the risk of respiratory arrest. PMID:17136823
Kyuma, Michifumi; Noda, Ryosuke; Hagiwara, Makoto; Torii, Takaaki; Fukuoka, Masatada; Hikita, Nobuichi; Shoji, Tetsuro
Bacterial meningitis in adults is fatal in 20% of patients and leads to sequels in 30%. The clinical presentation includes two of the following four symptoms and signs: fever, headache, stiff neck, altered mental status. The essential ancillary test is the analysis of the cerebrospinal fluid. Sometimes, the lumbar puncture is not feasible or deferred (brain computer tomography), requiring antibiotics and corticosteroids early. 80% of bacterial meningitis are secondary to pneumococcus or meningococcus. Empirical antibiotics must be given as soon as possible and provide coverage for these both bacteria. Corticosteroids are also recommended for some meningitis. A score can predict the evolution. Preventive measure must be taken for close contacts of a patient with a meningococcal meningitis. PMID:19908635
Zender, H O; Olivier, P; Genné, D
The authors report the case of 5-year-old girl who presented with 4 episodes of recurrent meningitis. Her initial workup revealed a lumbosacral dermoid sinus associated with diastematomyelia and a tethered cord. Therefore, a surgical repair to correct the anomaly was performed. However, another episode of meningitis occurred after surgery, and a subsequent temporal bone scan revealed the presence of left Mondini dysplasia. To the authors' knowledge, this is the first report of Mondini dysplasia in association with diastematomyelia. PMID:21421905
Masri, Amira; Bakri, Faris G; Birkenhäger, Ralf; Alassaf, Abeer; Musharbash, Awni F; Haroun, Azmy; Zak, Imad
Toscana virus infection is endemic in Italy, but has also been documented in other Mediterranean countries. Our aim was to investigate the occurrence of Toscana virus (TOSV) meningitis in children and young adults in a metropolitan area in the north of Portugal. Cerebrospinal fluid samples from 308 patients with the diagnosis of meningitis and with negative bacterial culture were tested for enteroviruses and herpesviruseses by reverse transcription PCR. Those samples that proved negative for ...
Eosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the tropics is infection with the rat lungworm Angiostrongylus cantonensis. In this report, we describe a case of eosinophilic meningitis due to infection with this nematode in a traveller who presented with slight headache, diarrhoea, general malaise and thoracic radicular pain after a trip through Latin America and the Fiji Islands. She responded less than optimally to repeated steroid and albendazol...
Ali, A. B.; Den Enden, E.; Gompel, A.; Esbroeck, M.
Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis in humans. It is usually caused by ingestion of raw or inadequately cooked intermediate hosts or food contaminated with infective third-stage larvae. We describe a case of eosinophilic meningitis caused by A. cantonensis in a male Chinese patient. The patient had a history of eating raw fish and snail. We describe the clinical features of the patient, the diagnostic process and treatments. We also provide a brief ...
Liu, Jingyao; Gao, Jiguo; Zhou, Chunkui
Bacterial meningitis is rarely complicated by spinal cord involvement in adults. We report a case of Staphylococcus aureus septicemia complicated by meningitis and extensive spinal cord injury, leading to ascending brain stem necrosis and death. This complication was investigated by magnetic resonance imaging which demonstrated intramedullary hyperintensity on T2-weighted images and by multimodality evoked potentials. Postmortem microscopic examination confirmed that the extensive spinal cord...
Schryver, Nicolas; Cosnard, Guy; Pesch, Vincent; Godfraind, Catherine; Hantson, Philippe
Bacterial meningitis is rarely complicated by spinal cord involvement in adults. We report a case of Staphylococcus aureus septicemia complicated by meningitis and extensive spinal cord injury, leading to ascending brain stem necrosis and death. This complication was investigated by magnetic resonance imaging which demonstrated intramedullary hyperintensity on T2-weighted images and by multimodality evoked potentials. Postmortem microscopic examination confirmed that the extensive spinal cord...
Schryver, Nicolas; Cosnard, Guy; Pesch, Vincent; Godfraind, Catherine; Hantson, Philippe
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.
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.
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)...
Diedrich, Sabine; Schreier, Eckart
In developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/...
Kilpatrick, M. E.; Girgis, N. I.; Yassin, M. W.; Abu El Ella, A. A.
Though Elizabethkingia meningosepticum typically causes meningitis in neonates, its occurrence in adult is rare, with sixteen cases described worldwide. We report a case of E. meningosepticum meningitis in an immunocompetent adult. Bacterial identification was made a day earlier than conventional method by using matrix assisted laser desorption ionization time-of-flight (MALDI-TOF) Vitek mass spectrometry RUO (VMS), which resulted in successful treatment with rifampin, trimethoprim-sulfametho...
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.
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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.
Oguzhan S?tk? Dizdar
Neonatal meningitis is a serious disease with signi?cant mortality and morbidity. Its signs and symptoms are subtle, non-specific, atypical or absent. Cephalohaematoma is frequent in newborns and complications are uncommon, including local infection after haematogenous spread in the setting of bacteraemia or meningitis with a possibility of osteomyelitis, epidural abscess and subdural empyema. We report the case of a late preterm newborn, with an unremarkable pregnancy, born by vacuum-assis...
Vale, B.; Morais, S.; Resende, C.; Taborda, A.
Candidal meningitis is a rare infectious disease that usually leads to substantial morbidity and mortality. We present a case of candidal meningitis refractory to systemic antifungal therapy (amphotericin B and fluconazole). A 63-year-old female with lymphoblastic lymphoma and myelodysplasia with leukemia transformation developed prolonged fever and headache on the seventh day following intrathecal prophylactic chemotherapy. A lumbar puncture showed neutrophilic pleocytosis, and a cerebrospin...
Liu, Kung-hung; Wu, Chi-jung; Chou, Chen-hsi; Lee, Hsin-chun; Lee, Nan-yao; Hung, Shao-tsung; Ko, Wen-chien
Pasteurella multocida is known to form part of the normal flora in the nasopharynx or gastrointestinal tract in many domestic and wild animals. Most human P multocida infections are soft tissue infections caused by dog or cat bites. Less commonly this bacterium is associated with infections affecting other organ systems of man. A case of fatal P multocida meningitis discovered at the necropsy of a 52 year old man is described. P multocida is an unusual causative agent of meningitis which tend...
Armstrong, G.; Sen, R; Wilkinson, J.
Chryseobacterium indologenes is a rare cause of infection in infants. The majority of case reports belong to hospitalized infants with indwelling devices. We are presenting a rare case of Chryseobacterium indologenes meningitis in a healthy newborn with no neonatal intensive care unit admissions or indwelling devices. The pathogen is resistant to many antibiotics and the patient was successfully treated with cefepime. This is the first case of C. indolegenes meningitis presented in a newborn ...
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.
Cerebrovascular complications of bacterial meningitis may include vasculitis, vasospasm or vasoconstriction, delayed cerebral infarction, venous and arterial thrombosis, intracranial aneurysm formation. The role of invasive endovascular therapies has not been well studied for infectious vasospasm, which can lead to dire neurologic consequences. We present 2 patients who were diagnosed with bacterial meningitis. Brain MRI showed areas of acute ischemia. Neurologic worsening was seen in both patients despite aggressive medical management. Follow-up imaging demonstrated significant narrowing of the intracranial vessels with associated new scattered infarcts. Both patients underwent targeted intra-arterial vasodilator infusion with angiographically improved vessel caliber and distal flow. The neurological exam subsequently stabilized in both cases. Follow-up radiographic images demonstrated no further ischemia in one of the 2 patients. Vasculopathy and vasospasm causing delayed ischemic neurologic deficit is a rare, but severe complication of acute meningitis. It can be a significant predictor of poor prognosis, and the disease may progress despite aggressive medical therapy. Although frequently used in subarachnoid hemorrhage-related vasospasm, to our knowledge, this is the first report of endovascular vasodilator treatment as adjunctive intervention in patients with meningitis associated vasculopathy. PMID:24655738
Taqui, Ather; Koffman, Lauren; Hui, Ferdinand; Gomes, Joao; Hussain, M Shazam; Bain, Mark; Toth, Gabor
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O tumor fibroso solitário (TFS) é neoplasia mesenquimal rara, originalmente descrita na pleura e sendo mais recentemente também observada em vários outros sítios. Sua extensão para estruturas adjacentes não é incomum. O acometimento da meninge pelo TFS é raro, havendo relato de apenas vinte e seis c [...] asos na literatura. Apresentamos o caso de uma paciente de 25 anos, sexo feminino, com crises convulsivas tônico-clônicas generalizadas desde há seis anos. Durante a investigação, foi diagnosticado tumor em região occipital esquerda. A paciente foi submetida à craniotomia occipital, com exérese completa do tumor. O diagnóstico histopatológico e imuno-histoquímico foi de tumor fibroso solitário da meninge. Após seguimento pós-operatório por três anos, a paciente mantém o exame neurológico sem alterações e não apresenta evidência de recidiva nos controles tomográficos. É apresentada também uma breve revisão da literatura. Abstract in english The solitary fibrous tumor (SFT) is a rare mesenquimal neoplasm, found originally in association with the pleura. Recently, SFT was reported in others sites. The extension into adjacent structures is not uncommon. The meningeal involvement by SFT is rare and there has only twenty-six cases been repo [...] rted previously in the literature. We report a case of a 25 years-old female patient with generalized tonic clonic seizures in the last six years. During the neurologic investigation, a tumor in the left occipital region of the brain was found. The patient underwent an occipital craniotomy with total resection of the tumor. The histopatological and immunohistochemical diagnosis was STF. After three years of follow-up, the patient remains stable, with a normal neurological exam. There is no sign of tumor recidive in the postoperative cranial tomography. We will briefly review the literature about STF.
Centeno, Ricardo Silva; Pedroso, Alessandra Augusta Gorgulho; Pereira, Emilio Marcelo; Rassi Neto, Aziz.
Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish 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.
Ana, Ludueña; Enrique, Dorado; Judith, Sarano; Guillermo, Semeniuk.
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 de 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.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.
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 (alfaOBJECTIVE: 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 were enrolled as a Control Group (CG. Data related to pregnancy, labor and the neonate itself were collected. The results with p<0,05 were considered significant. RESULTS: 42 newborns with meningitis were compared to 42 controls. The meningitis group (MG presented a lower number of medical visits during the prenatal care. The most common abnormalities detected in both groups were: drug addiction, congenital infections, preeclampsia, eclampsia, gestational diabetes mellitus and urinary tract infections. Fetal respiratory distress and the use of respiratory support were related to the occurrence of meningitis. The average weight and the APGAR scores were lower in the MG. The prevalence of premature and small for the gestational age infants was significantly higher in the MG. The neurological examination detected abnormalities in 35.7% of the meningitis cases. CONCLUSION: The association of risk factors related to pregnancy, labor and the newborn itself to the neonatal meningitis outcome in our setting is similar to the described in the literature.
Diogo C. Haussen
The "Bacterial Meningitis Score" (BMS) has been designed to identify children at low (BMS = 0) or high (BMS > or = 2) risk of bacterial meningitis (M). Its calculation is simple; it is based on 5 different items: Gram stain, seizure at or before presentation, peripheral white blood cell count (WBC), cerebrospinal fluid (CSF) WBC and CSF protein concentration. As of today, it has been validated in one single study in the United States. The purpose of this study is to evaluate the BMS performance in children hospitalized for M over a 5 years period. The medical records of 277 patients diagnosed with M, aged 29 days to 15 years and hospitalized in the Department of Pediatrics of the CHR Citadelle Hospital in Liège between 1999 and 2003 were analysed. Among the 277 hospitalised cases, there were 29 bacterial (10,5%) and 248 viral (89,5%) M. For patients whose BMS or = 2, 59,3% had a bacterial M and 40,7% had a viral M. 23% of the children with BMS easily applicable method that could allow reduce the unnecessary use of antibiotics. PMID:17020231
Piérart, J; Lepage, P
Full Text Available Abstract Background Tuberculous meningitis (TBM is a major global health problem, and it is sometimes difficult to perform a differential diagnosis of this disease from other diseases, particularly partially-treated pyogenic meningitis (PTPM. In an earlier study, we demonstrated the presence of a 30-kD protein antigen in cerebrospinal fluid (CSF of TBM patients. We have also shown that lymphocytes from CSF of TBM patients respond differently to this antigen than do those from PTPM patients. The purpose of this study was to develop an assay that can discriminate between TBM and PTPM. Methods We developed a cell enzyme-linked immunosorbant assay (Cell ELISA to quantitatively measure production of antibodies against the 30-kD protein in B cells from CSF of TBM and PTPM patients. Results The cell ELISA yielded 92% (11/12 sensitivity and 92% (11/12 specificity for the differential diagnosis of TBM from PTPM. Conclusion When induced with the 30-kD protein antigen, B cells derived from CSF of TBM patients respond to IgG production within 24 h while those derived from PTPM patients do not respond.
Purohit Hemant J
... of Vaccines to Prevent Meningitis in Persons with Cochlear Implants FACT SHEET On this Page What You Should ... Information References What You Should Know Children with cochlear implants are more likely to get bacterial meningitis than ...
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 ...
Owusu Michael; Nguah Samuel; Boaitey Yaw; Badu-Boateng Ernest; Abubakr Abdul-Raman; Lartey Robert; Adu-Sarkodie Yaw
Meningitis is one of the hazardous and life threatening infections and is associated with mortality and morbidity. The aim of this study was to determine etiological agents of childhood bacterial meningitis. The culture, Gram staining, agglutination and PCR assays were used to examine CSF specimens from 277 patients with presumed bacterial meningitis for the occurrence of 4 most common infectious agents consist of N. meningitis, H. influnsae, S. pneumoniae and S. agalactiae between 2008 and 2...
Reza Ghotaslou; Safar Farajnia; Fatemeh Yeganeh; Shahram Abdoli-Oskouei; Mohammad Ahangarzadeh Rezaee; Mohammad Barzegar
True aneurysms of the superficial temporal artery (STA) are quite uncommon. Only 14 such cases are described in the literature. Ultrasound scan (USS) is an appropriate and easily accessible non-invasive diagnostic modality, as it can show both the anatomical and flow characteristics of the aneurysmal vessel. Other conditions to be included in the differential diagnosis are haematoma, angiofibroma, eroding middle meningeal artery aneurysm, abscess or a parotid mass. Operative intervention is i...
Gull, Sadaf; Badawy, Ayman; Chaudhuri, Arindam
We report a case of meningitis caused by Streptococcus salivarius in a 49-year-old woman with a previously undiagnosed cerebrospinal fluid fistula due to a sphenoid mucocele. We reviewed the literature concerning meningitis caused by this uncommon organism and to the best of our knowledge this is the first case of S. salivarius meningitis associated with sphenoid mucocele. PMID:15936084
Conte, Aristide; Chinello, Pierangelo; Civljak, Rok; Bellussi, Angelo; Noto, Pasquale; Petrosillo, Nicola
A case of meningitis caused by group G beta-hemolytic Streptococcus (dysgalactiae, subspecies equisimilis) is reported in an 83-year-old woman. Streptococci species other than Streptococcus pneumoniae are seldom found in patients with acute bacterial meningitis, therefore, our discussion is focused on this rare organism. The question of the diagnosis of meningitis in the elderly is also addressed. PMID:11728766
Luyx, C; Vanpee, D; Glupczynski, Y; Swine, C; Gillet, J B
Cryptococcosis, a significant opportunistic infection, has become a global concern since the advent of immunosuppressive chemotherapy or in immunodeficient patients. Host responses range from a harmless colonization to disseminated disease. An accurate or definitive diagnosis in patients with cryptococcal meningitis is often delayed because of the similar clinical presentation and biochemical or cerebrospinal fluid findings to those of a variety of infectious and non-infectious aetiologies, most of which are also especially prevalent in developing countries. Rarely, patients with cryptococcal meningitis can develop immune reconstitution inflammatory syndrome (IRIS) when initiated on combination antiretroviral therapy (cART) the diagnosis which is often missed and can be fatal. Due to the similar presentation of infection and IRIS, it is often confused with the relapse of cryptococcal meningitis. We report a case of paradoxical recurrent meningitis in response to the initiation of cART in a patient diagnosed with cryptococcal meningitis and propose that the recurrent symptoms resulted from a therapy-induced reconstitution of the immune response against residual Cryptococcus neoformans. PMID:24108453
Jhamb, Rajat; Kashyap, Bineeta; Das, Shukla; Berry, Neha; Garg, Arun
We describe the first case in the English language of Streptococcus bovis meningitis in a 45-y-old patient without any underlying disease or predisposing condition. S. bovis biotype II was isolated from his spinal fluid and blood. The illness was community-acquired and was clinically and biologically similar to disease caused by the classical meningeal pathogens. The patient was cured after 10 d of therapy with ceftriaxone and, 2.5 y later, is currently healthy. As a result of this case and a similar case published recently in the Spanish literature we conclude that S. bovis should be considered a microorganism capable of causing meningitis in the absence of any underlying condition or clear focus of infection. PMID:11874167
Vilarrasa, N; Prats, A; Pujol, M; Gason, A; Viladrich, P F
Fifty consecutive patients with meningococcal meningitis aged 7 to 75 years (mean, 29 years) were treated with intravenous penicillin G sodium (2 to 3 X 10(5) U/kg/d) for four days. Two of the patients (both teenagers) died of fulminant infection during the first 36 hours of therapy and one elderly woman developed aspiration pneumonia requiring penicillin therapy to be prolonged beyond four days. The remaining 47 patients recovered from the infection. On the fourth day, fever, mild meningeal signs, and moderate elevations of cerebrospinal fluid cell counts and protein contents persisted in some patients; nevertheless, all patients were cured without relapse. The results of our study suggest that meningococcal meningitis may be successfully treated with a four-day course of intravenous penicillin G. PMID:3778073
Viladrich, P F; Pallares, R; Ariza, J; Rufi, G; Gudiol, F
Full Text Available Abstract Background Fusobacterium necrophorum may cause a number of clinical syndromes, collectively known as necrobacillosis. Meningitis is a significant cause of mortality, rarely reported in the adult population. Case presentation We report a fatal case of meningitis, caused by Fusobacterium necrophorum, secondary to otitis media in an alcoholic male. Diagnosis was delayed due to the typical slow growth of the organism. The clinical course was complicated by encephalitis and by hydrocephalus. The patient failed to respond to metronidazole and penicillin. The patient died on day 12 from increased intracranial pressure and brain stem infarction. Conclusions This case emphasizes the need for a high index of clinical suspicion to make the diagnosis of Fusobacterium necrophorum meningitis. We recommend the use of appropriate anaerobic culture techniques and antimicrobial coverage for anaerobic organisms when the gram stain shows gram negative bacilli.
Meningeal carcinomatosis is defined as the malignant and widespread infiltration of the meninges due to the planting and growth of cancer cells within the leptomeningeal space. It occurs more frequently in patients with disseminated neoplastic disease, but it may occur after a disease free interval and may even be the first manifestation of cancer. The most common primary tumors in adults are breast (30-50%), lung (15-25%), melanoma (11%) and gastric cancer (0.16-0.69%); in marked contrast with pediatric cases in which lymphocytic leukemia is the most common. The following article describes an autopsy case of a patient with psychiatric symptoms, with no antecedents of importance, with progressive and fatal neurological impairment, whose pathological studies show meningeal carcinomatosis attributable to advanced gastric adenocarcinoma discovered de novo post mortem.
Infection with cryptococcal meningitis is uncommon in immunocompetent patients. The major virulence factor is the polysaccharide capsule, while nonencapsulated mutants are generally considered nonpathogenic. The authors present a case of hydrocephalus caused by meningitis from an indolent, nonencapsulated Cryptococcus sp. requiring placement and multiple revisions of a ventriculoperitoneal shunt (VPS). The patient presented with progressively worsening occipital headaches. Computed tomography and magnetic resonance imaging showed significant hydrocephalus with no apparent cause. Her symptoms initially resolved after placement of a VPS, but returned four months later. Cultures of the shunt tubing and cerebrospinal fluid (CSF) showed no bacterial infection. When the symptoms failed to resolve, CSF fungal culture revealed Cryptococcus-like yeast, although the organisms were nonencapsulated, and the cryptococcal antigen was negative. After antibiotic therapy, the symptoms resolved. The unusual clinical presentation delayed the diagnosis, highlighting the importance of understanding the detection, diagnosis, and treatment of meningeal infections caused by C. neoformans.
Garber, Sarah T.; Penar, Paul L.
Full Text Available Infection with cryptococcal meningitis is uncommon in immunocompetent patients. The major virulence factor is the polysaccharide capsule, while nonencapsulated mutants are generally considered nonpathogenic. The authors present a case of hydrocephalus caused by meningitis from an indolent, nonencapsulated Cryptococcus sp. requiring placement and multiple revisions of a ventriculoperitoneal shunt (VPS. The patient presented with progressively worsening occipital headaches. Computed tomography and magnetic resonance imaging showed significant hydrocephalus with no apparent cause. Her symptoms initially resolved after placement of a VPS, but returned four months later. Cultures of the shunt tubing and cerebrospinal fluid (CSF showed no bacterial infection. When the symptoms failed to resolve, CSF fungal culture revealed Cryptococcus-like yeast, although the organisms were nonencapsulated, and the cryptococcal antigen was negative. After antibiotic therapy, the symptoms resolved. The unusual clinical presentation delayed the diagnosis, highlighting the importance of understanding the detection, diagnosis, and treatment of meningeal infections caused by C. neoformans.
Paul L. Penar
Full Text Available Mattew Clarke,1 Hilary Enuh,1 Jessie Saverimuttu,2 Jay Nfonoyim31Department of Medicine, 2Division of Infectious Disease, 3Critical Care Unit, Richmond University Medical Center, Staten Island, NY, USAAbstract: Group C Streptococcus (GCS is a rare cause of bacteremia in humans. It is mostly associated with zoonological infections. Although GCS can be part of the normal oral, skin, and genitourinary flora, an infection with this pathogen can be highly virulent, causing rapid, disseminating disease. With a mortality of about 25%, the poor prognosis is linked to the severity of illness and the high level of virulence of the organism. Only a few cases of GCS meningitis have been reported. We present the first case of GCS meningitis with cavernous sinus thrombosis.Keyword: streptococcus group C, cavernous sinus thrombosis, meningitis
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.
Vitor Laerte Pinto Jr.
The records of all patients with Staphylococcus aureus meningitis admitted to Vancouver General Hospital between 1956 and 1981 were reviewed. All the patients had clinical and laboratory features of meningitis, and in all cases S. aureus was isolated from the cerebrospinal fluid. S. aureus was responsible for 21 (3%) of the 710 cases of acute bacterial meningitis. Therapy with cloxacillin or methicillin, or both, with or without other agents, was successful in 14 of the 21 patients. Three of the 14 patients without ventricular shunts died, 2 with fulminating septicemia and 1 with a postoperative brain abscess treated with cloxacillin. Following shunt removal and antibiotic therapy all seven patients with ventricular shunts survived the infection. Shunt removal may therefore be essential in appropriate cases. PMID:6850467
Roberts, F J; Smith, J A; Wagner, K R
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
Nilay Sefa Uçar
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
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.
Vascular endothelial growth factor (VEGF) is linked to brain edema and infarction, but there is paucity of studies correlating VEGF level with magnetic resonance imaging (MRI) changes in tuberculous meningitis (TBM). The aim of this study was to measure serum VEGF level in TBM and correlate it with clinical, laboratory, and MRI findings. Forty patients with TBM underwent cranial evaluation, cranial MRI, and MR angiography (MRA). Presence of exudates, hydrocephalous, infarction, tuberculoma, and MRA abnormalities was noted. Serum VEGF level was measured by enzyme-linked immunosorbent assay and compared in patients and controls. The VEGF level was also correlated with clinical, MRI, and MRA findings. The median age of the patients was 26.5 years. There was a trend towards higher serum VEGF level in TBM patients (100.7 ± 110.6 pg/ml) compared to the controls (60.6 ± 20.3 pg/ml). There was also a trend towards higher VEGF level in patients with shorter duration of illness (127.5 ± 152.4 pg/ml vs 76.5 ± 40.9 pg/ml), MRI evidence of infarction (131.4 ± 150.7 pg/ml vs. 73.0 ± 41.4 pg/ml), and paradoxical response (122.3 ± 157.6 pg/ml vs. 88.8 ± 50.8 pg/ml). Five patients died, and death was not related to VEGF level. It can be concluded that serum VEGF level in TBM patients is insignificantly higher in those with shorter duration of illness and infarction. PMID:23098361
Misra, Usha K; Kalita, Jayantee; Singh, Avadhesh P; Prasad, Sreeram
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish La meningitis tuberculosa (MTBC) es la forma más grave de tuberculosis extrapulmonar. El amplio espectro del cuadro clínico y su poca especificidad difícultan su diagnóstico precoz, relacionándose directamente con mayor letalidad. El objetivo de este estudio es analizar las características clínicas [...] de los pacientes con diagnóstico de MTBC en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova, de Santiago, Chile, entre 1995 y 2002. Se estudiaron 53 casos de MTBC en adultos, con una edad mediana de 39 años. Al ingreso 66% de los pacientes presentaba algún grado de compromiso de conciencia, pero sólo 30% la tríada sintomática clásica. El LCR mostró aumento de proteínas, glucosa baja y linfocitosis, en la mayoría de los casos. Treinta por ciento de los pacientes presentó co-infección con VIH; la letalidad en este grupo de pacientes fue mayor, 31 vs 17% del total de la muestra. La MTBC continúa siendo una enfermedad vigente. El diagnóstico de certeza precoz de esta patología no es posible con los métodos actuales, por lo que la sospecha clínica es importante Abstract in english Tuberculous Meningitis (TBM) is the most severe form of extrapulmonary tuberculosis. The clinical spectrum is broad and may be non-specific making early diagnosis difficult. This increases the incidence of mortality. We decribe the clinical characteristics of patients with TBM in the Dr. Lucio Córdo [...] va´s Infectious Disease Hospital in Santiago, Chile, between 1995 and 2002. We review 53 adult cases of TBM, with a median age of 39 years. At admission 66% of the patients had some mental status deterioration, and the classic triad of symptoms of meningeal irritation was present only in 30%. The cerebrospinal fluid (CSF) examination showed increased protein level, low glucose level and lymphocytic pleocytosis in most. Thirty percent of the patients were coinfected with HIV. The mortality in the later group was greater than in the TBM population as a whole (31 vs 17%). TBM is still a present diagnostic problem, in spite of the new diagnostic methods. A high index of suspicion is required in order to make an early diagnosis
Margarita, Enberg G; M. De la Luz, Quezada B; Carolina, de Toro V; Luzmaría, Fuenzalida L.
Full Text Available La meningitis tuberculosa (MTBC es la forma más grave de tuberculosis extrapulmonar. El amplio espectro del cuadro clínico y su poca especificidad difícultan su diagnóstico precoz, relacionándose directamente con mayor letalidad. El objetivo de este estudio es analizar las características clínicas de los pacientes con diagnóstico de MTBC en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova, de Santiago, Chile, entre 1995 y 2002. Se estudiaron 53 casos de MTBC en adultos, con una edad mediana de 39 años. Al ingreso 66% de los pacientes presentaba algún grado de compromiso de conciencia, pero sólo 30% la tríada sintomática clásica. El LCR mostró aumento de proteínas, glucosa baja y linfocitosis, en la mayoría de los casos. Treinta por ciento de los pacientes presentó co-infección con VIH; la letalidad en este grupo de pacientes fue mayor, 31 vs 17% del total de la muestra. La MTBC continúa siendo una enfermedad vigente. El diagnóstico de certeza precoz de esta patología no es posible con los métodos actuales, por lo que la sospecha clínica es importanteTuberculous Meningitis (TBM is the most severe form of extrapulmonary tuberculosis. The clinical spectrum is broad and may be non-specific making early diagnosis difficult. This increases the incidence of mortality. We decribe the clinical characteristics of patients with TBM in the Dr. Lucio Córdova´s Infectious Disease Hospital in Santiago, Chile, between 1995 and 2002. We review 53 adult cases of TBM, with a median age of 39 years. At admission 66% of the patients had some mental status deterioration, and the classic triad of symptoms of meningeal irritation was present only in 30%. The cerebrospinal fluid (CSF examination showed increased protein level, low glucose level and lymphocytic pleocytosis in most. Thirty percent of the patients were coinfected with HIV. The mortality in the later group was greater than in the TBM population as a whole (31 vs 17%. TBM is still a present diagnostic problem, in spite of the new diagnostic methods. A high index of suspicion is required in order to make an early diagnosis
Margarita Enberg G
Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization and multiple invasive investigations if the underlying cause remains undetected. Bacteria migration, along congenital or acquired pathways from the skull or spinal dural defects, gains entrance into the central nervous system (CNS) and should be taken into consideration when children face recurrent bacterial meningitis, however, symptoms and signs of cerebrospinal fluid (CSF) rhinorrhea or otorrhea are rare in such patients. Without evidence of CSF leakage, a cranial symptom/sign or coccygeal cutaneous stigmata may suggest the approximate lesion site, diagnosis and detection remains difficult. To detect an occult dural lesion along the craniospinal axis, such as basal encephalocele, dermal sinus tract, or neurenteric cyst, a detailed clinical evaluation and the use of the modern diagnostic imaging methods is necessary. Because of the possibility of concomitant occurrence of more than one malformation, 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. In addition, the bacteria specificity could leave significant clues: Pneumoccocus or Hemophilus suggests cranial dural defects, E. coli or other gram negative bacilli suggests spinal dural defects, and meningococci suggest immunologic deficiency. Asplenia or immunodeficiency such as complement or immunoglobulin deficiency rarely causes recurrent meningitis without a history of frequent infection of non-CNS areas. Salmonella meningitis or brain abscess should not be treated incompletely or inadequately and could lead to recrudescence, relapse or recurrence of bacterial meningitis. Antibiotic (penicillin or trimethoprim-sulfamethoxazole) induced meningitis may repetitively occur on occasion. PMID:16231527
Wang, Huei-Shyong; Kuo, Meng-Fai; Huang, Song-Chei
Sphingomonas paucimobilis is an aerobic gram-negative bacillus. The bacteria can cause infections, which can be devastating and, therefore, the patients need adequate and early antibiotic cover. We are presenting an interesting case of meningitis secondary to an unusual S. paucimobilis infection. This is the second case to our knowledge in the literature on meningitis due to S. paucimobilis. The 31-year-old previously healthy man presented with 2 months' history of weight loss and loss of appetite. He had fever and headache for 3 weeks. He was also speaking irrelevantly for 3 weeks. He had change of behaviour for 1 day. The patient was a farmer and worked in the soil. On examination, he was not responding to questions and was not obeying commands. Computed tomography (CT) brain with contrast revealed meningeal enhancement and cerebral oedema. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was more than 50 cm H2O. CSF analysis showed meningitis picture with raised white cell count of 210/?L (predominantly neutrophils), glucose 3.1 mmol/L, and raised protein 2.47 g/L. He was given intravenous ceftriaxone. The following day, his condition deteriorated. CSF culture grew S. paucimobilis sensitive to ceftriaxone. S. paucimobilis causes severe meningitis. This can lead to hydrocephalus, which results in a need for extraventricular drainage. A good occupational history is important with regard to finding the aetiology of serious meningitis (including rare bacteria) even before the culture result is known. Appropriate treatment can be given early and adequately to prevent mortality. PMID:24201101
Tai, Mei-Ling Sharon; Velayuthan, Rukumani Devi
The emergence of pneumococci resistant to penicillin and other agents prompted us to evaluate intravenous vancomycin for the therapy of pneumococcal meningitis, which has an overall mortality of 30%. Eleven consecutive adult patients with cerebrospinal fluid (CSF)-culture-proven pneumococcal meningitis and positive initial CSF Gram stain were given intravenous vancomycin (usual dosage, 7.5 mg/kg every 6 h for 10 days). The MBCs of vancomycin ranged from 0.25 to 0.5 micrograms/ml. Early adjunc...
Viladrich, P. F.; Gudiol, F.; Lin?ares, J.; Pallare?s, R.; Sabate?, I.; Rufi?, G.; Ariza, J.
Group C Streptococcus (GCS) is a rare cause of bacteremia in humans. It is mostly associated with zoonological infections. Although GCS can be part of the normal oral, skin, and genitourinary fora, an infection with this pathogen can be highly virulent, causing rapid, disseminating disease. With a mortality of about 25%, the poor prognosis is linked to the severity of illness and the high level of virulence of the organism. Only a few cases of GCS meningitis have been reported. We present the first case of GCS meningitis with cavernous sinus thrombosis.
Clarke, Mattew; Enuh, Hilary; Saverimuttu, Jessie; Nfonoyim, Jay
This article describes an outbreak of meningitis caused by Serratia marcescens in patients who had undergone spinal anaesthesia for caesarean section. Bacterial meningitis was diagnosed in 12 of the 46 patients who underwent a caesarean section under spinal anaesthesia in a 75-bed private hospital between 6(th) and 14(th) March 2011. S. marcescens was isolated from samples taken from four prefilled syringes and one bag containing 5% dextrose with norepinephrine, suggesting that medications used in spinal anaesthesia were contaminated extrinsically. Strategies for prevention of anaesthesia-associated infections in operating theatres are discussed. PMID:24814159
Ersoz, G; Uguz, M; Aslan, G; Horasan, E S; Kaya, A
A case of Staphylococcus aureus meningitis (SAM) secondary to endocarditis is presented. The presence of a petechial rash affecting the lower limbs led to an initial presumptive diagnosis of meningococcal meningitis. There were no stigmata of endocarditis at presentation, though these subsequently developed. Underlying endocarditis should be diligently sought in any patient presenting with spontaneous SAM, even if typical stigmata are initially absent. In view of the association with skin lesions and neurological complications, S. aureus endocarditis may mimic the classical presentation of meningococcal sepsis. PMID:10563077
Kelly, J; Barnass, S
Pasteurella multocida (P. multocida), a Gram-negative bacillus is a typical commensal in the oropharynx of animals such as dogs and cats. Human diseases caused by P. multocida are rare and include respiratory infections, sepsis and meningitis. P. multocida infections are described predominantly in patients with underlying chronic disorders, in elderly patients or in infants < or = 1 year. We describe the case of a 3-week-old boy with meningitis due to Pasteurella multocida. P. multocida was also identified in oral swab and stool cultures of the pet cat. A direct contact between baby and cat was negated by the parents. The patient recovered without any neurological sequelae. PMID:17206557
Haase, R; Stiefel, M; Merkel, N; Knopp, W; Sauer, H; Lieser, U
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.
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)
We reviewed the epidemiologic features and trends for 771 cases of meningitis in Oman from January 2000 to December 2005. We found 69% were bacterial in origin and 13% were viral. Leading bacterial pathogens included Haemophilus influenzae (15%), Streptococcus pneumoniae (14%) and Nesseria meningitidis (12%). For 56% of patients with suspected pyogenic meningitis, no specific bacterial pathogen could be identified. Peak occurrence was in children under 2 years old. The incidence of H. influenzae type b decreased by almost 100% after implementation of the national immunization programme in 2001, while the incidence of cases caused by S. pneumoniae and N. meningitidis remained steady. PMID:20218125
Dash, N; Al Khusaiby, S; Behlim, T; Mohammadi, A; Mohammadi, E; Al Awaidy, S
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.
A case of Ig D myeloma with meningeal myelomatosis is reported. A 64-year-old man, who complained of fatigue and loss of appetite, had nuchal rigidity, bilateral sixth nerve palsy, and choked disks. His cerebrospinal fluid contained plasma cells and a monoclonal protein band identical with that in the serum. CT scans showed, in the bilateral subdural spaces, brain edema and enhanced masses which disappeared after successful chemotherapy. Meningeal involvement in multiple myeloma is a rare occurrence. A cytologic examination of the cerebrospinal fluid and CT scans were valuable in this case. (author)
The diffusion of metioprim (MTP), tetroxoprim (TXP) and sulphadiazine (SDZ) in cerebrospinal fluid (CSF), following single intravenous doses and continuous infusions, was studied in dogs. The drugs penetrated well into the CSF of animals with and without experimental Staphylococcus aureus meningitis. In dogs with healthy meninges, the CSF bioavailability - expressed as the ratio of CSF/plasma area under the curve 0-5-hour values - following continuous infusion was determined to be 86.7% for MTP, 58.2% for TXP and 38.8% for SDZ. In infected animals, CSF availability following continuous infusion increases slightly to ratios of 96% (MTP), 70% (TXP) and 50% (SDZ). For all drugs, the concentrations reached in CSF were above the minimum inhibition concentrations for the majority of Enterobacteriaceae, indicating their potential value in treatment of gram-negative bacillary meningitis. PMID:6488935
Vergin, H; Bishop-Freudling, G B; Foing, N; Szelenyi, I; Armengaud, H; van Tho, T
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 utilizaron 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.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.
Antonio E Pérez Rodríguez
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.
Antonio E, Pérez Rodríguez; Lorenzo, de la Fuente Ricardo; Armando, Seuc Jo.
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.
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.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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
Díaz Álvarez, Manuel; Medina González, Teresa; Sánchez Jiménez, Adilén; Rivera Alés, Libertad; Rodríguez Castillo, Orlando.
To determine patient characteristics associated with isoniazid resistance in cases of tuberculous meningitis, we conducted a cross-sectional study by using data from the US National Tuberculosis Surveillance System during 1993–2005. Foreign-born patients were more likely to be infected with an isoniazid-resistant strain.
Vinnard, Christopher; Winston, Carla A.; Wileyto, E. Paul; Macgregor, Rob Roy; Bisson, Gregory P.
Rifampin was administered orally in one dose of 25 mg per kg of body weight to 6 patients with tuberculous meningitis who had received no previous antituberculous chemotherapy and to 7 control subjects. There was no sigificant difference in rifampin absor...
J. E. Sippel I. A. Mikhail N. I. Girgis H. H. Youssef
Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronic intractable pain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis.
Clouston, P. D.; Corbett, A. J.; Pryor, D. S.; Garrick, R.
Cryptococcosis is a systemic fungal infection associated with significant morbidity and mortality. It predominantly affects people with immunosuppresion and human immunodeficiency virus infection. Extrapulmonary dissemination is rare in immunocompetent hosts. We present here a case of disseminated cryptococcosis in an immunocompetent patient who presented with an unusually large pulmonary mass and meningitis and successfully managed with medical therapy.
Panigrahi, Manoj Kumar; Kumar, Narahari Narendra; Jaganathan, Venugopal; Kumar, Saka Vinod
Gastric adenocarcinoma is rarely observed in patients under the age of 40. Meningeal carcinomatosis as a first manifestation of disease is absolutely unique. If meningeal involvement occurs it is usually secondary event in previously diagnosed tumor. The prognosis is very unfavorable associated with short term survival. In the treatment of this disease there night be used either chemotherapy administered via lumbar injection or radiotherapy or combination of both. This case study is one of very few cases reported in literature when meningeal carcinomatosis was a first sign of advanced gastric adenocarcinoma. 39 years old woman was admitted to our hospital with severe headache, diplopia and vomiting. Meningeal carcinomatosis with gastric primary was diagnosed. She was treated with combination of cytosine arabinosid (Cytosar), methotrexate (Methotrexat), hydrocortisone (Hydrocortisone) administered via intrathecal lumbar injection and whole brain radiation. As a main complication she experienced disseminated intravascular coagulopathy. The improvement of patient's condition following the initial treatment had a very limited duration and the patient died of bilateral pneumonia and cerebral edema 44th day after the admission. PMID:11787214
Jank?, F; Dusková, J; Petruzelka, L; Krásná, L; Nováková, I
The meningitis belt is a region covering Sub-Saharan Africa from the Sahel of West Africa eastward to western Ethiopia. The region is prone to meningitis epidemics during the dry season extending from approximately January to May, depending on the region. Relative humidity has been found to be a critical environmental factor indicating the susceptibility of a region to meningitis epidemics. This study evaluates the variation of relative humidity across West Africa over 30 dry-seasons (1979 - 2009) using the NASA-MERRA dataset. The method of self-organizing maps is employed to characterize the changes in relative humidity patterns across the region within a given dry season as well as changes over the 30 years. A general pattern of changes in relative humidity is indicated as the rainbelt retreats to the south at the onset of the dry season and then returns to the region at the end of the dry season. Within each dry season there is a unique pattern. The climatological conditions of relative humidity at the onset of the dry season provide an indication of the moisture environment for the entire dry season. Year to year variation in the relative humidity patterns are found to be gradual. Future applications involve using the results from the SOM evaluation to be used for future decisions involving prevention of meningitis epidemics.
Seefeldt, M. W.; Hopson, T. M.
An early increase in activity of biotinidase in the cerebrospinal fluid (CSF) during the course of acute Staphylococcus aureus meningitis in a subject with subacute sclerosing panencephalitis (SSPE) is reported. A possible role of CSF biotinidase in the hydrolysis of specific opioid neuropeptides during acute inflammatory processes involving the CSF-central nervous system compartment is suggested. PMID:8048707
De Felice, C; Hayakawa, K; Nihei, K; Higuchi, S; Tanaka, T; Watanabe, T; Hibi, I
MR showed a neurenteric cyst posterior to the cervicomedullary junction in a man with chronic recurrent aseptic meningitis. On T1-weighted MR, the cyst was of high intensity in relation to the brain, and on T2-weighted MR it was of less intensity than cerebrospinal fluid. PMID:8938316
Weiss, M A; Gebarski, S S; McKeever, P E
Cryptococcosis is a systemic fungal infection associated with significant morbidity and mortality. It predominantly affects people with immunosuppresion and human immunodeficiency virus infection. Extrapulmonary dissemination is rare in immunocompetent hosts. We present here a case of disseminated cryptococcosis in an immunocompetent patient who presented with an unusually large pulmonary mass and meningitis and successfully managed with medical therapy. PMID:24778480
Panigrahi, Manoj Kumar; Kumar, Narahari Narendra; Jaganathan, Venugopal; Kumar, Saka Vinod
Citrobacter sedlakii was isolated from blood and cerebrospinal fluid cultures of a 5-day-old premature infant with sepsis, meningitis, and brain abscess. This newly described organism was difficult to identify due to discrepancies between the Vitek and API 20E identification systems. To our knowledge, this is the first report of the isolation of C. sedlakii from cerebrospinal fluid.
Dyer, J.; Hayani, K. C.; Janda, W. M.; Schreckenberger, P. C.
Small cell carcinoma of the lung is extremely sensitive to chemotherapy and radiation therapy. We describe the case of a patient who had a complete response to such treatment but relapsed with meningeal carcinomatosis. We propose that prophylactic therapy to the spinal cord as well as the brain should be considered in the treatment of patients with small cell carcinoma of the lung
Full Text Available Meningeal metastasis is rare in the clinical course of ovarian carcinoma and its prognosis is extremely poor. We experienced a case of carcinomatous meningitis from metastatic ovarian small cell carcinoma. A 33-year-old woman with atypical genital bleeding, was diagnosed with a right ovarian tumor and referred to our department. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy. It was an optimal debulking surgery. She was diagnosed with ovarian carcinoma classified as Stage IIIc according to the Féderation Internationale de Gynécologie et d’Obstétrique classification system. Histological findings showed small cell carcinoma of the pulmonary type. The tumor was bilateral with paraaortic lymph node involvement. The patient was treated with irinotecan and cisplatin (CPT-P therapy. After 4 courses of CPTP therapy, multiple liver metastases and Virchow’s lymph node metastases were found. She was treated with amrubicin as a secondline chemotherapy, but the treatment was ineffective. Five months after surgery, the patient complained of severe headache and nausea. Lumbar puncture was performed and cytology was positive. Magnetic resonance brain imaging indicated meningeal thickening. The patient was diagnosed with meningeal metastasis and received 19-Gy whole cranial irradiation. In spite of these treatments, her disease progressed rapidly and she was often drowsy. She died of aspiration pneumonia 6 months after surgery.
Background: Meningeal melanocytoma is described as rare benign lesion with a high risk of recurrence. There are no well-substantiated treatment recommendations in the literature. Only case reports have been published by now. Patients and Methods: In 1997 a patient was irradiated for a recurrent spinal meningeal melanocytoma and 2 years later for brain metastases indicating malignant transformation. This case gave rise to a literature review for therapeutic options. All sufficiently documented cases published since 1972, when the term meningeal melanocytoma was established, were evaluated. Based on published and on original data recurrence and overall survival rates up to 5 years were calculated for three different therapeutic approaches, namely complete tumor resection, incomplete resection with subsequent radiotherapy, and incomplete resection alone. Statistical evaluation was performed using the ?2 test and Kaplan-Meier-analysis. Results: 53 patients (including our patient) met selection criteria. Complete tumor resection was superior to incomplete resection alone with lower recurrence (4-38% versus 50-92%) and better overall survival rates (86-95% versus 30-58%). After incomplete resection radiotherapy seemed to improve prognosis (recurrence 15-45%; overall survival 91-92%). Between complete resection and incomplete resection plus radiotherapy no significant differences were observed. Conclusions: For meningeal melanocytoma complete resection must be regarded as the best of the modalities compared. After incomplete resection radiotherapy should be considered, although a specific radiotherapeutic regimen cannot be recommended at present. However, for multiple cranial or spinal lesions total cranial irradiation or craniospinal irradiation is indicated. (orig.)
Full Text Available Abstract Background Tuberculous meningitis (TBM is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis syndrome, the following are associated with the diagnosis: new-onset seizures; focal neurologic deficit; pulmonary tuberculosis (PTB on chest X-ray; cerebrospinal fluid (CSF pleocytosis with lymphocytic predominance; decreased CSF glucose; increased CSF protein. Methods Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast bacilli (AFB smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast study. Logistic regression was done to determine which were associated with a diagnosis of TBM. Results 91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM. After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic predominance, decreased CSF glucose, and increased CSF protein was associated with the diagnosis of TBM. Conclusion In patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.
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.)
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)
Tuberculous meningitis (TBM) is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently.
Pasticci, Maria Bruna; Paciaroni, Maurizio; Floridi, Piero; Cecchini, Enisia; Baldelli, Franco
Background: Aims of the study were: (i) to characterise the clinical picture, immunological features and changes in brain morphology and function in patients with widespread unilateral pain and HSV-infections, and (ii) to analyse the prevalence, clinical symptoms and immunological predisposing factors of HSV-2 induced recurrent lymphocytic meningitis (RLM) in Southern Finland.
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
Mendizabal, Maria de Fátima Magalhães Acioly; Bezerra, Phelipe Cunha; Guedes, Diego Lins; Cabral, Diogo Buarque Cordeiro; Miranda-Filho, Demócrito de Barros.
Full Text Available
We report the case of young patient, whose cause of death was generalized syphilitic cerebrospinal meningitis. The results of autopsy and histological examination are presented. The possibility of using magnetic resonance imaging to verify the form of neurosyphilis is discussed.
Staphylococcus aureus meningitis is a challenging disease and little is known about its epidemiology. There are no established management guidelines. We retrospectively reviewed the clinical information, bacteriologic data, and outcomes of all 33 patients with cerebrospinal fluid (CSF) cultures positive for S aureus seen at a single urban teaching hospital from 1999 to 2008. Pulsed-field gel electrophoresis (PFGE) and polymerase chain reaction for staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator (agr) typing, and Panton-Valentine leukocidin (PVL) loci were done on methicillin-resistant S aureus (MRSA) CSF isolates starting in 2005. S aureus caused 12 (36%) cases of postoperative and 21 (64%) cases of hematogenous meningitis. MRSA isolates were found in 6 (50%) cases of postoperative and 10 (48%) cases of hematogenous meningitis. Twelve (75%) of the 16 MRSA infections occurred in the last 5 years of the study. Hematogenous meningitis was associated with older age (p = 0.04), injection drug use (p < 0.01), community-acquired infection (p < 0.01), underlying disease (p = 0.01), staphylococcal infection outside the central nervous system (p = 0.01), altered mental status (p = 0.02), fever (p = 0.01), septic shock (p = 0.03), and bacteremia (p < 0.01). The analysis of the 9 MRSA isolates showed 3 PFGE types: 3 USA100 (33%), 5 USA300 (56%), and 1 USAnot100-1100 (11%). For SCCmec typing, there were 2 (22%) type II and 7 (78%) type IV. All USA300 strains were SCCmec IVa. For agr typing, there were 5 (56%) type I and 4 (44%) type II. Three isolates (33%) were positive for the PVL gene and were USA300 strains. Most patients received nafcillin or vancomycin with or without rifampin or trimethoprim/sulfamethoxazole for a mean period of 17 days (range, 1-42 d). Overall mortality was 36%, and it was associated with community-acquired infection (p = 0.02). Postoperative and hematogenous S aureus meningitis are distinct clinical syndromes. S aureus hematogenous meningitis has devastating clinical consequences and elevated mortality rates, especially if it is acquired in the community. The incidence of MRSA meningitis increased over the last 5 years of the study. Treatment of choice is nafcillin for methicillin-sensitive strains and vancomycin for MRSA strains. The addition of trimethoprim/sulfamethoxazole or rifampin to vancomycin is recommended in severe cases and community-acquired MRSA infections. Linezolid is also a good option due to its good CSF penetration and favorable case reports. The mortality rate is higher in infections acquired in the community. PMID:20517182
Aguilar, Javier; Urday-Cornejo, Varinia; Donabedian, Susan; Perri, Mary; Tibbetts, Robert; Zervos, Marcus
The aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint. Ten patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied. The analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint. The direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint.
The aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint. Ten patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied. The analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint. The direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint.
Cuccia, Antonino Marco; Caradonna, Carola; Caradonna, Domenico [Dept. of Surgical and Oncological Disciplines, University of Palermo, Palermo (Italy); Anastasi, Giuseppe; Milardi, Demetrio; Favaloro, Angelo; Caradonna, Luigi; Cutroneo, Giuseppina [Biomorphology and Biotechnologies, University of Messina, Messina (Italy); De Pietro, Anita; Angileri, Tommaso Maurizio [Villa Santa Teresa, Diagnostica per Immagini, Palermo (Italy)
Human enteroviruses are the most common cause of viral meningitis. Viral-bacterial interaction may affect the clinical course and outcome of bacterial meningitis. In Africa, viruses might be responsible for 14-25% of all meningitis cases. However, only few studies from Africa have reported detection of viruses in the cerebrospinal fluid (CSF) or mixed viral-bacterial infections of the central nervous system (CNS). The aim of the present study was to investigate the presence of picornaviruses in the CSF of children suffering from meningitis in Luanda, Angola. The study included 142 consecutive children enrolled in a prospective study of bacterial meningitis in Luanda between 2005 and 2006, from whom a CSF sample was available. CSF samples were obtained at hospital admission, stored in a deep-freeze, and transported to Finland for testing by real-time PCR for picornaviruses. Enteroviruses were detected in 4 (3%) of 142 children with presumed bacterial meningitis. A 5-month-old girl with rhinovirus and Haemophilus influenzae meningitis recovered uneventfully. An 8-year-old girl with human enterovirus and pneumococcal meningitis developed no sequelae. A 2-month-old girl with human enterovirus and malaria recovered quickly. A 7-month-old girl with human enterovirus was treated for presumed tuberculous meningitis and survived with severe sequelae. Mixed infections of the CNS with picornaviruses and bacteria are rare. Detection of an enterovirus does not affect the clinical picture and outcome of bacterial meningitis. PMID:22585725
Pelkonen, Tuula; Roine, Irmeli; Anjos, Elizabete; Kaijalainen, Svetlana; Roivainen, Merja; Peltola, Heikki; Pitkäranta, Anne
The therapeutic options available for central nervous system (CNS) infections due to resistant Gram-positive cocci remain limited. We report an unusual case of community-acquired methicillin-resistant Staphylococcus aureus meningitis complicated by cerebral infarction in the middle cerebral artery territory in a previously healthy young male. After an initial vancomycin-based regimen, treatment was completed with a seven-week course of linezolid and levofloxacin. The potential role of such a combination and, particularly, linezolid as a first-line therapy in serious CNS infections is also discussed. PMID:20847500
Fernández-Ruiz, Mario; Cervera, Carlos; Pitart, Cristina; Pérez, Gloria; del Río, Ana; Miró, José M; Marco, Francesc; Moreno, Asunción
Full Text Available SciELO South Africa | Language: English Abstract in english 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.
Y, Ramsamy; P, Mahabeer; M, Archary; R A, Bobat; Y M, Coovadia.
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
Robinson Joan L
Full Text Available 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 evaluated 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 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 < 0,001. Los niños con MBC tuvieron menor probabilidad de recibir antibióticos y mayor de sufrir convulsiones, choques o entrar en coma al ser ingresados que los niños con MNLC. Se observó un mayor porcentaje de manifestaciones clínicas de secuelas al alta hospitalaria en los 182 niños sobrevivientes con MBC que en los 205 sobrevivientes con MNLC estudiados entre octubre de 2000 y diciembre de 2005 (78,6% y 46,8%, respectivamente; P < 0,0001. Los factores de riesgo de muerte en los niños con MBC fueron: glucosa en LCR < 10 mg/dL, neutrófilos periféricos < 2 000 células/mm³, coma o choque al ingreso, y sepsis o neumonía concurrentes; solo el coma y el choque al ingreso predijeron la muerte en niños con MNLC. CONCLUSIONES: Las altas tasas de letalidad y de secuelas indican que muchos niños con MNLC pueden haber tenido meningitis bacteriana. Las estadísticas basadas solamente en los casos confirmados de meningitis subestiman la verdadera carga de enfermedad prevenible mediante vacuna. Se deben emprender estudios adicionales para determinar las etiologías de la MNLC en esta población.
Erica L. Dueger
We report a rare case of spinal extradural abscess presenting as Staphylococcus aureus meningitis in a previously well child. After initial improvement with intravenous antibiotics the patient clinically deteriorated in a non-specific manner. Magnetic resonance imaging (MRI) scan of the spine revealed an occult spinal extradural abscess and urgent neurosurgical laminectomy led to full recovery. No evidence of an underlying spinal abnormality or immunodeficiency was demonstrated on investigation. A high index of suspicion is required in these cases due to the frequent absence in children of classic symptoms of spinal extradural abscess. Conclusion: we advise an urgent MRI of the head and spine in such unexplained cases of Staphylococcus aureus meningitis, to allow early diagnosis and management of occult underlying pathology. Such an approach will minimise the risk of potentially catastrophic neurological sequelae. PMID:17999081
Murray, Matthew J; Fawi, Nourelhuda M T; Barter, Dennis A C
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.
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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
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.
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
López, C.; Sanchez-Rubio, P.; Betrán, A.; Terré, R..
We evaluated diagnosis and treatment of four cases of meningeal carcinomatosis associated with primary lung cancer: case 1; small cell carcinoma (64 years old), case 2; small cell carcinoma (50 years old), case 3; adenocarcinoma (53 years old), and case 4; adenocarcinoma (55 years old). Determination of tumor markers in cerebrospinal fluid (CSF) together with the MRI findings that Gd-DTPA-enhanced T1-weighted image showing high intensity signal along the spinal cord was clinically useful in the diagnosis of meningeal carcinomatosis. Two of four patients received intrathecal chemotherapy and/or CSF drainage through Ommaya-Reservoir, resulting in dramatic improvement of various symptoms such as motor weakness and vesicorectal disorder. Intrathecal chemotherapy and placement of an Ommaya-Reservoir for CSF drainage should be considered to provide better Quality of Life (QOL) when patient can tolerate it. PMID:15801281
Yamamoto, Akihito; Takahashi, Kazuhisa; Morio, Yoshiteru; Gunji, Yoko; Iwakami, Naoko; Kajiyama, Yuichiro; Yoshioka, Masataka; Miura, Kayo; Suzuki, Tsutomu; Ohwada, Akihiko; Sato, Koichi; Fukuchi, Yoshinosuke
Neurologic complications occur in 5% of patients with sarcoidosis. Neurosarcoidosis ranges from mild neurologic deficits to a destructive, life-threatening disease, and at times is the only presenting symptom of sarcoidosis, thus posing a diagnostic challenge for the doctor neurologic symptoms include cranial nerve palsies, with the vestibulocochlear nerve rarely being involved. We present a patient with neurosarcoidosis manifesting as recurrent episodes of aseptic meningitis, vertigo, and acute hearing loss. PMID:22844729
Nitzan, Orna; Elias, Mazen; Saliba, Walid
The authors report a 36-year-old male who presented with headache and hypopituitarism, and MRI revealed a ring enhancing lesion with pituitary stalk thickening. During follow-up, he presented with recurrent pyogenic meningitis with persistence of the lesion, therefore a diagnosis of pituitary abscess was considered. He underwent trans-sphenoidal surgery (TSS) with evacuation of pus and received antibiotic treatment for the same. After this he remarkably improved and had no recurrence of sympt...
Walia, Rama; Bhansali, Anil; Dutta, Pinaki; Shanmugasundar, G.; Mukherjee, Kanchan Kumar; Upreti, Vimal; Das, Ashim
A model for chronic Cryptococcus neoformans meningitis in corticosteroid-treated rabbits was used to determine the influence of pre-formed agglutinating antibody to cryptococcal polysaccharide on the progress of this infection. Immunized rabbits developed serum agglutinating antibody with a geometric mean titre of 1:32, but none was detected in cerebrospinal fluid. Prior immunization did not enhance immunity to infection, had no effect on the number of viable cryptococci in cerebrospinal flui...
Perfect, J. R.; Lang, S. D.; Durack, D. T.
Ten patients with meningeal carcinomatosis associated with nonhaemoatological neoplasms were examined: Six with breast, two with gastrointestinal and one with lung cancer, plus one with a tumour of unknown origin. Cytology was positive in all but one. The patients were classified into four groups according to the gadolinium-enhanced MRI (Gd-MRI) appearances: Group 1 had pure leptomeningeal carcinomatosis, group 2 dural carcinomatosis, group 3 spinal leptomeningeal carcinomatosis, and group 4 had normal Gd-MRI except for hydrocephalus. In group 1, Gd-MRI showed diffuse enhancement of the subarachnoid space, including the cisterns around the midbrain, the sylvian fissures, or cerebellar and cerebral sulci. In group 2, Gd-MRI showed diffuse, thick, partially nodular enhancement of the dura mater. No leptomeningeal or subependymal enhancement was evident. In group 3, nodular masses were seen only in the spinal canal. In group 4, no definite evidence of meningeal carcinomatosis was demonstrated on contrast-enhanced CT (CE-CT) or Gd-MRI. The median survival time was 2.0 months in group 1, 1.0 month in group 3, and 4.5 months in group 4, but the two patients in group 2 were alive 10 and 15 months after a definite diagnosis of meningeal carcinomatosis was made. In all patients examined by both CE-CT and Gd-MRI, the latter was superior for identification of meningeal carcinomatosis. Hydrocephalus is an important indirect sign of leptomeningeal carcinomatosis, but was not seen in patients with dural carcinomatosis despite the presence of increased intracranial pressure. (orig.)
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 enhanc...
Samimi, Kaveh; Gharib, Mohammad Hadi; Rezaei-kalantari, Kiara; Jafari, Maryam
Lumbosacral radiculopathy is a rare complication of radiotherapy and may be challenging to differentiate from diagnosis of a tumor recurrence. We reviewed the records of three patients with a past history of cancer and radiotherapy who were referred for suspicion of carcinomatous meningitis on lumbar MRI, but whose final diagnosis was radiation-induced lumbosacral radiculopathy. The three patients developed a progressive lumbosacral radiculopathy at 20, 13, and 47 years after lumbar radiother...
Ducray, Franc?ois; Guillevin, Re?my; Psimaras, Dimitri; Sanson, Marc; Mokhtari, Karima; Delanian, Sylvie; Navarro, Soledad; Maisonobe, Thierry; Cornu, Philippe; Hoang-xuan, Khe?; Delattre, Jean-yves; Pradat, Pierre-franc?ois
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, letha...
Behroz Ahssan; Shahla Afrasiabian
The five year old, somnolent girl from Mozambique with no medical history was presented with fever, neckstiffness, headaches, an almost complete paraplegia and a septic picture. Malaria parasites and HIV testing was negative. The lumbal puncture revealed staphylococcus. Subsequently a MRI scan showed no sign of meningitis but an extensive posterior epidural collection from C3 to the level of S1. Moreover it showed a vertebral osteomyelitis at L1. Bacteria in CSF were seen as an artefact and t...
Recently reports on toxocariasis are increasing by serodiagnosis in Korea. A previously healthy 17-yr-old boy complained of headache, fever, dyspnea, and anorexia. He showed symptoms and signs of eosinophilic meningitis with involvement of the lungs and liver. Specific IgG antibody to Toxocara canis larval antigen was positive in serum and cerebrospinal fluid by ELISA. He took raw ostrich liver with his parents 4 weeks before the symptom onset. His parents were seropositive for T. canis antig...
Noh, Young; Hong, Sung-tae; Yun, Ji Young; Park, Hong-kyun; Oh, Jung-hwan; Kim, Young Eun; Jeon, Beom S.
Echovirus 13 (EV13), considered rare, was reported worldwide in 2000, mostly related to aseptic meningitis outbreaks. In Spain, 135 EV13 isolates were identified. The genetic relationships between 64 representative strains from Spain and other reported isolates from the United States, Germany, Italy, Japan, and Sweden were described by analyzing the partial sequence of the major capsid protein (VP1) gene. The strains from Spain were clearly identified as EV13 (79.5% similarity with the EV13 r...
Avello?n, Ana; Casas, Inmaculada; Trallero, Gloria; Pe?rez, Carmen; Tenorio, Antonio; Palacios, Gustavo
Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM) occurring in up to 85% of children with the disease. It is more severe in children than in adults. It could be either of the communicating type or the obstructive type with the former being more frequently seen. The Vellore grading system for clinical grading of patients with TBM and hydrocephalus with grade I being the best grade and grade IV being the worst grade has been validated by several authors....
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...
Veeken, H.; Ritmeijer, K.; Hausman, B.
Objective: Past decade has seen increase in cases of tuberculous meningitis (TBM) and multidrug resistance in such cases. The mortality rate for a mismanaged TBM is very high which increases manifold in presence of associated complicating factors. The present study was thus planned to evaluate the prevalence of MDR-TBM and look for associated complicating factors and carry out drug sensitivity pattern in all culture positive isolates. Methods: One hundred cerebro-spinal fluid (CSF) samples fr...
Chander Prakash Baveja; Vidyanidhi Gumma; Manisha Jain; Monica Chaudhary; Bibek Talukdar; Vinay Kumar Sharma
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...
Beleza, P.; Ribeiro, M.; Pereira, J.; Jorda?o, Mj; Almeida, F.
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 ...
Hristea, A.; Manciuc, C.; Zaharia-kezdi, E.; Dorobat, C.; Arbune, M.; Olaru, I.; Jipa, R.; Niculescu, I.; Streinu-cercel, A.
Full Text Available Abstract Background 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. Methods A nationwide retrospective study was conducted, comprising all patients notified with tuberculous meningitis (TBM in Denmark from 2000-2008. Medical records were reviewed using a standardised protocol. Results Fifty patients, including 12 paediatric patients, were identified. 78% of the patients were immigrants from countries of high tuberculosis endemicity. 64% of all patients had a pre-existing immunosuppressive condition; 10% were HIV positive, 48% were HIV seronegative and 42% had an unknown HIV status. Median symptom duration before admission was 14 days in the Danish patient population and 20 days in the immigrant group. Biochemical analysis of cerebrospinal fluid (CSF samples revealed pleocytosis in 90% with lymphocyte predominance in 66%. Protein levels were elevated in 86%. The most common findings on neuro-radiological imaging were basal meningeal enhancement, tuberculomas and hydrocephalus. Lumbar puncture was performed on 42 patients; 31 of these specimens (74% had a positive CSF culture for mycobacteria and 9.5% were smear positive for acid-fast bacilli. The overall mortality rate was 19% and 48% of the remaining patients had neurological sequelae of varying degree. Conclusion TBM is a rare but severe manifestation of extrapulmonary TB in Denmark. The clinician must be prepared to treat empirically if the suspicion of TBM has arisen to improve treatment outcome.
Andersen Peter H
A simple immunocytochemical method was standardized for the direct demonstration of mycobacterial antigen in cerebrospinal fluid (CSF) specimens of patients with tuberculous meningitis (TBM). CSF-cytospin smears were prepared from 22 patients with a clinical diagnosis of TBM and also from an equal number of patients with nontuberculous neurological diseases (disease control). Immunocytological demonstration of mycobacterial antigens in the cytoplasm of monocytoid cells was attempted, by using...
Sumi, M. G.; Mathai, A.; Reuben, S.; Sarada, C.; Radhakrishnan, V. V.
Background: A modified clinical presentation of tuberculous meningitis (TBM) in children vaccinated with BCG has been described in the literature. However, most reports are old and not based on actual comparisons and tests of significance. Also, neuroimaging features were not compared. With large scale BCG coverage, it becomes pertinent to describe the "modified" presentation and identify any significant differences between vaccinated and unvaccinated children with TBM.
Kumar, R.; Dwivedi, A.; Kumar, P.; Kohli, N.
Objective. This study aimed to evaluate epidemiological, clinical, laboratory, and neuroimaging features of 160 adult patients with tuberculous meningitis (TBM) according to “Thwaites' diagnostic index.” Methods. The subjects of this retrospective study are the patients with TBM who were followed up between years 1998 and 2009 in a tertiary referral hospital. Diagnosis of TBM was based on clinical, laboratory, and neuroimaging signs and Thwaites' diagnostic index. Results. Mycobacterium t...
Pehlivanoglu, Filiz; Kart Yasar, Kadriye; Sengoz, Gonul
Tuberculous meningitis (TBM) is the most lethal form of tuberculosis, and new treatments that improve outcomes are required. We randomly assigned adults with TBM to treatment with standard antituberculosis treatment alone or in combination with ciprofloxacin (750 mg/12 h), levofloxacin (500 mg/12 h), or gatifloxacin (400 mg/24 h) for the first 60 days of therapy. Fluoroquinolone concentrations were measured with plasma and cerebrospinal fluid (CSF) specimens taken at predetermined, randomly a...
Thwaites, Guy E.; Bhavnani, Sujata M.; Chau, Tran Thi Hong; Hammel, Jeffrey P.; To?ro?k, M. Este?e; Wart, Scott A.; Mai, Pham Phuong; Reynolds, Daniel K.; Caws, Maxine; Dung, Nguyen Thi; Hien, Tran Tinh; Kulawy, Robert; Farrar, Jeremy; Ambrose, Paul G.
Full Text Available 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 treatment of these infections.
Acinetobacter baumannii, Post-surgical meningitis, High dose meropenem
Cefmenoxime, a new semisynthetic cephalosporin structurally similar to cefotaxime, was evaluated for its activities in vitro and in vivo against a K1 Escherichia coli strain in comparison with activities of cefotaxime and ampicillin. In vitro the MICs and MBCs of both cefmenoxime and cefotaxime were the same, 1/16th and 1/32nd those of ampicillin, respectively. The efficacies of cefmenoxime and cefotaxime against experimentally induced E. coli bacteremia and meningitis in newborn rats were si...
Kim, K. S.
The clinical picture of herpes simplex virus type 2 (HSV-2) infection includes genital blisters and less frequently meningitis, and some individuals suffer from recurrent episodes of these manifestations. We hypothesized that adaptive and/or innate immune functional deficiencies may be a major contributing factor in susceptibility to recurrent HSV-2 meningitis. Ten patients with recurrent HSV-2 meningitis were studied during clinical remission. For comparison, 10 patients with recurrent genit...
Franzen-ro?hl, Elisabeth; Schepis, Danika; Lagrelius, Maria; Franck, Kristina; Jones, Petra; Liljeqvist, Jan-a?ke; Bergstro?m, Tomas; Aurelius, Elisabeth; Ka?rre, Klas; Berg, Louise; Gaines, Hans
Background: Mycobacterium tuberculosis is a common, devastating cause of meningitis in HIV-infected persons. Due to international rollout programs, access to antiretroviral therapy (ART) is increasing globally. Starting patients with HIV-associated tuberculous meningitis (TBM) on ART during tuberculosis (TB) treatment may increase survival in these patients. We undertook this study to describe causes of meningitis at a secondary-level hospital in a high HIV/TB co-infection setting and to dete...
Marais, Suzaan; Pepper, Dominique J.; Schutz, Charlotte; Wilkinson, Robert J.; Meintjes, Graeme
Meningitis caused by Staphylococcus aureus is an unusual illness that is often associated with bacteremia, contiguous infection and/or a post-neurosurgical state. Until recently, most cases were caused by methicillin-susceptible strains, but there are a few reports of methicillinresistant S aureus strains causing meningitis. A new case of meningitis caused by methicillin-resistant S aureus in a neonatal intensive care nurse who did not have bacteremia or neurosurgery is reported. The patient...
Dylewski, Joe; Martel, Guillaume
Abstract Background Aseptic meningitis is a serious adverse reaction to intravenous immunoglobulin (IVIG) therapy. We studied the clinical characteristics of patients with acute Kawasaki disease (KD) who developed IVIG-induced aseptic meningitis. Methods A retrospective analysis of the medical records of patients with KD who developed aseptic meningitis after IVIG treatment was performed. Results During the 10-year period from 2000 through 2009, am...
Kemmotsu Yasushi; Nakayama Tomotaka; Matsuura Hiroyuki; Saji Tsutomu
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...
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 childre...
Ramakrishnan Meenakshi; Ulland Aaron J; Steinhardt Laura C; Moïsi Jennifer C; Were Fred; Levine Orin S
Methicillin-resistant Staphylococcus epidermidis (MRSE) can cause nosocomial meningitis in the presence of prosthetic devices. Vancomycin is the treatment of choice, but its penetration into the cerebrospinal fluid is poor, especially in cases without severe meningeal inflammation. We successfully used linezolid to treat a case of posttraumatic MRSE meningitis with a low-level inflammatory response. Therapeutic effectiveness was documented microbiologically and by the simultaneous measurement...
Krueger, Wolfgang A.; Kottler, Bernd; Will, Bernd E.; Heininger, Alexandra; Guggenberger, Heinz; Unertl, Klaus E.
Important aspects of the management of meningitis in children include notification to local officers for control of communicable diseases; chemoprophylaxis for index cases and close contacts in cases of meningococcal or Haemophilus influenzae meningitis; and a formal hearing assessment for all survivors. A retrospective audit of these aspects of management was carried out for children admitted with meningitis in 12 months from 1 September 1990 to 31 August 1991 at the Royal Belfast Hospital f...
Bacterial meningitis remains a serious cause of morbidity and mortality in childhood, despite the availability of effective vaccines against Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae. The purpose of this study was to analyze data on bacterial meningitis cases in Korea from 1996 through 2005. The information of all hospitalized bacteria-proven meningitis cases was obtained from 17 university hospitals nationwide. A total of 402 cases were identified. Of these, 125 (29.9%)...
INTRODUCTION: Bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes the temporal evolution of bacterial meningitis in Salvador, Brazil, 1995-2009, and verifies the association between its spatial variation and the living conditions of the population....
Shirley Fonseca de Souza; Maria da Conceição Nascimento Costa; Jairnilson Silva Paim; Marcio Santos da Natividade; Susan Martins Pereira; Alcina Marta de Souza Andrade; Maria Glória Teixeira
Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults. We report 29 cases of streptococcal meningitis (1977-1997). The patients comprised 19 men and 10 women, with a mean age +/- standard deviation of 47 +/- 18 years. Nine cases were secondary to neurosurgical procedures, seven to brain abscess, five to cerebrospinal fluid pericranial fistula, and three to endocarditis. Causative microorganisms included the following: viridans group streptococci, 20 cases; anaerobic streptococci, 3; Streptococcus agalactiae, 3; Streptococcus bovis, 2; and Streptococcus pyogenes, 1. Four Streptococcus mitis strains showed decreased susceptibility to penicillin (MIC, 0.5-2 microg/mL). Five patients (17%) died. The infection is increasing in the hospital setting. Streptococci resistant to penicillin should be considered in the empirical treatment of nosocomial meningitis. In cases of community-acquired infection, anaerobic streptococci or streptococci of the Streptococcus milleri group should alert the clinician to the presence of an undiagnosed brain abscess, whereas oral streptococci of the viridans group suggest the diagnosis of bacterial endocarditis. PMID:10452643
Cabellos, C; Viladrich, P F; Corredoira, J; Verdaguer, R; Ariza, J; Gudiol, F
Fusobacterium necrophorum is an anaerobic, gram-negative highly virulent bacillus, isolated from the oropharingeal cavity, the gastrointestinal tract, and the female genital tract. It is responsible of several clinical syndromes, mainly in children or adolescents, ranging from localized abscess, usually in the upper respiratory sites, to severe septicemic diseases, including meningitis. We report the fatal case of an immunocompetent male with suppurative otitis media and meningitis. Initial empiric antibiotic treatment was not effective. After the recovery of anaerobic gram-negative bacilli from blood cultures, treatment with metronidazole was started, and a rapid improvement in laboratory parameters was observed. However, the patient's clinical course was incurable because of cerebral hypertensive complications. F. necrophorum was identified as the causative agent of this metastatic and fatal infection. This case has shown the severity of infection due to F. necrophorum and, at the same time, the underestimation of anaerobic bacteria in the spectrum of etiologic agents responsible for meningitis. Only a prompt diagnosis and an adequate treatment can improve the prognosis and avoid a fatal outcome. PMID:22766589
Angelino, Giulia; Cantarutti, Nicoletta; Chiurchiù, Sara; Amodio, Donato; De Luca, Maia; Lancella, Laura; Coltella, Luana; Russo, Cristina; Finocchi, Andrea
Full Text Available Abstract Background Enterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate. Enterococcus casseliflavus has been implicated in a wide variety of infections in humans, but never in meningitis. Case presentation A 77-year-old Italian female presented for evaluation of fever, stupor, diarrhea and vomiting of 3 days duration. There was no history of head injury nor of previous surgical procedures. She had been suffering from rheumatoid arthritis for 30 years, for which she was being treated with steroids and methotrexate. On admission, she was febrile, alert but not oriented to time and place. Her neck was stiff, and she had a positive Kernig's sign. The patient's cerebrospinal fluid was opalescent with a glucose concentration of 14 mg/dl, a protein level of 472 mg/dl, and a white cell count of 200/?L with 95% polymorphonuclear leukocytes and 5% lymphocytes. Gram staining of CSF revealed no organisms, culture yielded E. casseliflavus. The patient was successfully treated with meropenem and ampicillin-sulbactam. Conclusions E. casseliflavus can be inserted among the etiologic agents of meningitis. Awareness of infection of central nervous system with Enterococcus species that possess an intrinsic vancomycin resistance should be increased.
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
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.
Pneumorrhachis is the presence of air in the spinal canal; mostly, it has an iatrogenic origin. The association of this entity with spontaneous pneumomediastinum without any pneumothorax is rarely reported in the literature. The spontaneous resorption is the usual evolution. The association to acute transverse myelitis is discussed by the authors. The patient is a 21-year-old male with pneumorrhachis associated to a spontaneous pneumomediastinum was admitted at the emergency department for bacterial meningitis. The antibiotherapy has marked the clinical profile by disappearance of the meningeal signs in the 48 h after admission. In contrast, the neurological symptoms were of marked aggravation by appearance of a tetraparesis with a respiratory distress syndrome having required artificial ventilation. The computed tomography (CT) scan showed a typical hypodensity corresponding to paramedullary air extending to several thoracic segments. The spinal magnetic resonance imaging (MRI) showed a high cervical medullary edema without signs of compression. The patient died within 15 days with a profile of vasoparalysis resistant to vasoactive drugs. Pneumomediastinum associated to pneumorrhachis and transverse myelitis complicating purulent meningitis is a rare entity. Although the usual evolution is favorable, the occurrence of serious complications is possible. PMID:24672182
Amara, Bouchra; Boujraf, Saïd; Benzagmout, Mohammed; Labib, Smael; Harandou, Mustapha
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)
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
Laval, Cristina Aparecida Borges; Pimenta, Fabiana Cristina; Andrade, João Guimarães de; Andrade, Soraya S.; Andrade, Ana Lucia S. S. de.
Adenosine deaminase activity (ADA) was estimated in cerebrospinal fluid (CSF) of 30 patients of tuberculous meningitis (TBM) and 10 patients each of partially treated pyomeningitis (PTM), aseptic meningitis (AM) and pyogenic meningitis (PM). Mean ADA levels in CSF of TBM patients were higher (18.22 U/L) as compared to 6.28 U/L, 3.43 U/L and 7.98 U/L in PTM, AM and PM respectively. This difference of ADA values in CSF between TBM and other types of meningitis was statistically significant (p<0...
Rana, Satya Vati; Singhal, Raj Kumar; Singh, Kartar; Kumar, Lata
Cerebrospinal fluid (CSF) lactate assay has been a subject of research since 1925. A systematic review by Huy and colleagues in the previous issue of Critical Care summarizes data from 25 studies evaluating the role of CSF lactate in the differential diagnosis between acute bacterial and aseptic meningitis. The authors concluded that CSF lactate is a good single indicator and a better marker compared with conventional markers. But concerns remain because of poor quality of included studies, l...
Prasad, Kameshwar; Sahu, Jitendra Kumar
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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.
M., Arias Gómez; I., Requena Caballero; C., Lema Devesa; J., Suárez Dono; J., Llovo Martínez; V., Martino.
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 quantified 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: ...
Full Text Available Background Tuberculous meningitis (TBM is a common central nervous system (CNS infectious disease, and is a serious threat to people's health. Due to its diverse clinical manifestations, especially atypical in infants and young children, it is easy to be misdiagnosed and can lead to high disablility rate and mortality rate. At present, cerebrospinal fluid (CSF cytology still plays an important role in the etiological diagnosis of CNS infectious diseases. Based on the observation of CSF cytological changes of children with TBM, this study is to further understand the performance and evolution characteristics of this disease, so as to improve the ability of early diagnosis and judgment on the treatment effect. Methods Fresh CSF was collected to make smears by using cytological slide centrifugation, and apply May-Grunwald-Giemsa (MGG staining for morphological classification. Results CSF cytology of all patients were abnormal. The average leukocyte count of children with TBM was (310.19 ± 156.26× 106/L, and was significantly different from that of children with purulent meningitis (P = 0.000. Lymphocyte proportion of TBM group was (66.56 ± 14.08%, and there were significant differences among different groups ( P = 0.037, 0.000. Compared to children with purulent meningitis, higher proportion of monocytes ( P = 0.000, 0.020 and plasma cells ( P = 0.001, 0.004 were found in children with TBM and viral meningitis. The positive detection rate of plasma cells in children with TBM was higher than that in children with purulent meningitis ( P = 0.001. Conclusion The CSF cytology changing characteristics of children with TBM are revealed. In the beginning the lymphocyte proportion is dominant in CSF cytology, and then different extents of mixed cellular response appear as disease develops. For children with effective treatment, the proportion of neutrophils decreases rapidly and turns to lymphocyte reaction gradually, with monocytes and plasma cells, lasting for a long time. Long-term mixed cellular response will happen in children with ineffective treatment. All in all, the CSF cytology changing characteristics are significant in clinical diagnosis and differential diagnosis of TBM in children.
The passage of mezlocillin into the CSF was investigated in normal dogs and in dogs with experimentally induced Staphylococcus aureus meningitis. The areas under the curves (AUC) of mezlocillin concentrations in blood and CSF were compared. The antibiotic was administered by slow (1 hour) intravenous infusion in doses of 100, 200 and 400 mg/kg bodyweight. Samples of blood and CSF were collected simultaneously 30, 40, 60, 75, 90, 105, 120, 180 and 240 minutes after the infusion. The penetration of mezlocillin into the CSF of dogs with non-inflamed meninges was poor (peak less than or equal to 2 micrograms/ml, CSF/serum AUC ratio : 0.9 %), but it was very substantial in dogs with meningitis. After the 200 mg/kg dose, the mean CSF peak was 43 micrograms/ml (range : 33-60 micrograms/ml) and the CSF/serum AUC ratio was 26.6 %. Similar experiments were performed with other beta-lactam antibiotics. In dogs with healthy meninges the CSF/serum AUC ratios were 0.52 % with amoxycillin, 0.75 % with cefuroxime, 1.05 % with cefamandole, 1.18 % with cefoxitin and 3.6 % with cefotaxime. In dogs with meningitis, the corresponding ratios were 16.3 % with cefotaxime, 17.4 % with cefamandole, 18.5 % with cefoxitin, 18.6 % with amoxycillin and 18.7 % with cefuroxime. These results suggest that cefotaxime penetrates best across normal meninges and mezlocillin across inflamed meninges. PMID:6460978
Armengaud, M; Massip, P; Tran Van Tho, A; Chan Lai Wane, L
More and more clinical observations and trials support the concept of heterogeneity of atheroma according to the arterial bed. In a pilot study named "Étude Comparative des Lésions Athéromateuses" (ECLA), we have shown that carotid and femoral plaques possess different characteristics. Carotid arteries display increased lipid content compared to femoral arteries whereas femoral arteries are more prone to calcify and to develop osteoid metaplasia. These observations should lead the researcher and the clinician to look at the cellular and molecular mechanisms governing the heterogeneity of atheromas. At last, a better understanding of the characteristics of plaques should help us to determine plaque stability, to prevent cardiovascular events and to choose the best medical, endovascular or surgical option. PMID:23159822
Gouëffic, Y; Davaine, J-M; Merlini, T; Rimbert, A; Hérisson, F; Heymann, M-F; Heymann, D; Steenman, M; Lambert, G
We examined total and regional cerebral blood flow (CBF) by stable xenon computed tomography in 20 seriously ill children with acute bacterial meningitis to determine whether CBF was reduced and to examine the changes in CBF during hyperventilation. In 13 children, total CBF was normal (62 +/- 20 ml/min/100 gm) but marked local variability of flow was seen. In five other children, total CBF was significantly reduced (26 +/- 10 ml/min/100 gm; p less than 0.05), with flow reduced more in white matter (8 +/- 5 ml/min/100 gm) than in gray matter (30 +/- 15 ml/min/100 gm). Autoregulation of CBF appeared to be present in these 18 children within a range of mean arterial blood pressure from 56 to 102 mm Hg. In the remaining two infants, brain dead within the first 24 hours, total flow was uniformly absent, averaging 3 +/- 3 ml/min/100 gm. In seven children, CBF was determined at two carbon dioxide tension (PCO2) levels: 40 (+/- 3) mm Hg and 29 (+/- 3) mm Hg. In six children, total CBF decreased 33%, from 52 (+/- 25) to 35 (+/- 15) ml/min/100 gm; the mean percentage of change in CBF per millimeter of mercury of PCO2 was 3.0%. Regional variability of perfusion to changes in PCO2 was marked in all six children. The percentage of change in CBF per millimeter of mercury of PCO2 was similar in frontal gray matter (3.1%) but higher in white matter (4.5%). In the seventh patient a paradoxical response was observed; total and regional CBF increased 25% after hyperventilation. Our findings demonstrate that (1) CBF in children with bacterial meningitis may be substantially decreased globally, with even more variability noted regionally, (2) autoregulation of CBF is preserved, (3) CBF/CO2 responsitivity varies among patients and in different regions of the brain in the same patient, and (4) hyperventilation can reduce CBF below ischemic thresholds.
Ashwal, S.; Stringer, W.; Tomasi, L.; Schneider, S.; Thompson, J.; Perkin, R. (Loma Linda Univ. School of Medicine, CA (USA))
Eight patients with AIDS were treated orally with 800 mg of fluconazole daily for cryptococcal meningitis for a mean duration of 4.5 months. Previous antifungal treatment had failed for all of the patients. No major toxicity was observed. Three patients died from cryptococcal infection. High-dose fluconazole may be effective salvage therapy for cryptococcal meningitis.
Berry, A. J.; Rinaldi, M. G.; Graybill, J. R.
We present three cases with syringomyelia after tuberculous meningitis. The MR findings suggested the syrinx was formed by blockage of the CSF flow at the outlets of the fourth ventricle. We consider this complication is not a rare condition following tuberculous meningitis.
Tsuchiya, Kazuhiro; Takeshita, Koji; Makita, Kozo; Furui, Shigeru; Takenaka, Eiichi
Staphylococcus aureus meningitis is a rare but well recognized condition which had a high mortality and incidence of neurological sequelae. It is usually associated with chronic underlying conditions. A case is reported of S. aureus meningitis in a previously healthy young man. The epidemiology, microbiological findings and treatment of this condition are discussed. PMID:9279737
Parker, S L; Conn, K S; Ignotus, P I
The authors report 5 cases of leptospirosis with neurological symptoms. One case of polyradiculoneuritis, one case of meningoencephalitis, two of meningitis and a case a meningeal syndrome were observed. Three of these cases were contracted near Marseille, one in Singapour and one in Comores. The diagnosis was done by serology and the evolution was good. PMID:4085096
Soulayrol, L; Raoult, D; Harle, J R; Mailloux, M; Gallais, H; Casanova, P
Streptococcus pyogenes meningitis (SPM) occurs sporadically, even with the increase of invasive streptococcal disease observed in the past years. We reported two cases of SPM in infants to alert pediatricians for the possibility of this agent as a cause of meningitis in previously healthy children.
Arnoni, Mariana V.; Berezin, Eitan N.; Sa?fadi, Marco A. P.; Almeida, Fla?via J.; Lopes, Cla?udia R. C.
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.)
Full Text Available Meningitis is one of the hazardous and life threatening infections and is associated with mortality and morbidity. The aim of this study was to determine etiological agents of childhood bacterial meningitis. The culture, Gram staining, agglutination and PCR assays were used to examine CSF specimens from 277 patients with presumed bacterial meningitis for the occurrence of 4 most common infectious agents consist of N. meningitis, H. influnsae, S. pneumoniae and S. agalactiae between 2008 and 2009 at different wards of the Children Hospital of Tabriz. The mean age of patients was 35±2 (Mean±SEM month, (minimum 11 days maximum14 years, of all cases 59.6% male and 40.4% female. Overall the diagnosis was confirmed with a CSF culture in 11/277 (3.97%, by agglutination test in 14/277 (5.05%. The isolated bacteria included S. pneumoniae 5 cases, H. influnsae 2 cases, N. meningitis 3 cases and P. aeroginusae 1 case. A positive PCR assay allowed us to diagnose bacterial meningitis in 19 patients (6.8%. In the present study, we found PCR to be a useful and sensitive method for the detection of bacterial DNA in the CSF samples from suspected meningitis patients. Furthermore, to maximize management of meningitis cases, a combination of culture and PCR is necessary.
Mohammad Ahangarzadeh Rezaee
We report here two cases of patients complicated with aseptic meningitis after microvascular decompression (MVD). The first case, a 56-year-old female complained of headache with high fever 18 days after the MVD for right trigeminal neuralgia. The amount of cells in cerebrospinal fluid (CSF) had so much increased that bacterial meningitis was suspected. However, there was no improvement after antibiotics therapy, so immune globulin was injected and the meningitis gradually improved. Eosinophilia remained in peripheral blood and the symptoms improved rapidly after the steroid therapy. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. The second case, a 30-year-old male complained of headache with mild fever 15 days after MVD for left hemifacial spasm. The amount of cells in CSF increased, so bacterial meningitis was suspected. Eosinophilia remained in peripheral blood and the steroid therapy proved very effective for the meningitis. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. We suspected that the two patients suffered from aseptic meningitis caused by allergic reaction, and the antigen for this abnormal allergic reaction was the foreign materials used for MVD. The materials were Dacron for prostesis, Goatex or Lyodula for dural plasty, fibrin glue for preventing CSF leakage. We ascertained that the abnormal allergic reaction was caused by human fibrinogen in the second case. It is important to be aware of such allergic reaction to fibrin glue in the post-operative stage after MVD. PMID:12491585
Wakamoto, Hirooki; Miyazaki, Hiromichi; Orii, Maaya; Ishiyama, Naomi; Akiyama, Katsunori; Konohana, Izumi
Congenital malformations may present as meningitis caused by enteric organisms, but this is extremely rare and occurs almost exclusively in the paediatric population. We report an unusual case of a young man with chronic constipation presenting with spontaneous Gram-negative meningitis due to an underlying congenital spinal malformation known as the caudal regression syndrome.
Benson, S.; King, M.; Coulter, C.; Boyle, R. S.
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.
The emergence of pneumococci resistant to penicillin and other agents prompted us to evaluate intravenous vancomycin for the therapy of pneumococcal meningitis, which has an overall mortality of 30%. Eleven consecutive adult patients with cerebrospinal fluid (CSF)-culture-proven pneumococcal meningitis and positive initial CSF Gram stain were given intravenous vancomycin (usual dosage, 7.5 mg/kg every 6 h for 10 days). The MBCs of vancomycin ranged from 0.25 to 0.5 micrograms/ml. Early adjunctive therapy with intravenous dexamethasone, mannitol, and sodium phenytoin was also instituted. After 48 h of therapy, all 11 patients showed a satisfactory clinical response, although the CSF culture remained positive in one case; median trough CSF and serum vancomycin levels were 2 and 5.1 micrograms/ml, respectively, and trough CSF bactericidal titers ranged from less than 1:2 to 1:16. On day 3, one patient died of acute heart failure. Four patients had clinical failure at on days 4 (two patients), 7 (one), and 8 (one) of therapy; they all immediately responded to a change in antibiotic therapy. The remaining six patients were cured after 10 days of vancomycin therapy. At this point, median peak CSF and serum vancomycin levels were 1.9 and 18.5 micrograms/ml, respectively. A transient alteration of renal function occurred in two patients, and persistent slight hypoacusia occurred in three patients. In summary, 11 adults with pneumococcal meningitis were treated with vancomycin and early adjunctive therapy including dexamethasone. All patients initially improved, and 10 were ultimately cured of the infection. However, four patients experienced a therapeutic failure, which led to a change in vancomycin therapy. PMID:1810180
Viladrich, P F; Gudiol, F; Liñares, J; Pallarés, R; Sabaté, I; Rufí, G; Ariza, J
Full Text Available BACKGROUND AND AIMS: This study aims at evaluating the clinical and radiological outcome of tuberculous meningitis (TBM patients with pulmonary miliary tuberculosis. MATERIAL AND METHODS: Diagnosis of TBM was based on clinical, CT scan or MRI and CSF criteria, and that of miliary tuberculosis on chest radiograph. Detailed clinical evaluation was done in all. Severity of meningitis was graded into Grades I, II and III. Complete hemogram, serum chemistry and Montaux tests were performed. The recovery was defined on the basis of 6 months Barthel index score as poor, partial or complete. RESULTS: 20 out of 165 patients with TBM had pulmonary miliary tuberculosis. Their mean age was 30 years; there was one child and 13 patients were females. The mean duration of symptoms was 6.3 months. Montoux test was negative in 9 patients. Six patients were in stage I, 3 in stage II, and 11 in stage III meningitis. Hemoglobin was below 12 gm% in 13 and liver dysfunction and hypocalcaemia was present in 8 and 18 patients respectively. CT scan was abnormal in 16 patients and revealed hydrocephalus (10, granuloma (7, exudates (3 and infarction (1. MRI was abnormal in 7 out of 8 patients and 3 of these patients had normal CT scan. MRI revealed multiple granuloma in 7 patients and exudates in 2. At 6 months, 2 patients died, 10 had complete, 2 had partial and 4 had poor recovery. CONCLUSION: TBM with pulmonary miliary tuberculosis was commoner amongst females who were anemic and hypocalcaemic. MRI revealed multiple granuloma and the majority of the patients improved.
Quantifying the local burden of disease is an important step towards the introduction of new vaccines, such as Haemophilus influenzae type b (Hib) conjugate vaccine. We adapted a generic protocol developed by the World Health Organization for population-based surveillance of bacterial meningitis. All hospitals that admit paediatric patients with meningitis in the National District, Dominican Republic were included in the system and standard laboratory methods were used. The system identified 111 cases of confirmed bacterial meningitis. Hib was the leading cause of bacterial meningitis, followed by group B streptococcus, S. pneumoniae, and N. meningitidis. Unlike hospital-based case series, this population-based system was able to calculate incidence rates. The incidence of Hib meningitis was 13 cases per 100,000 children < 5 years old. The data from this study were used by the Ministry of Health to support the introduction of routine Hib vaccination and will be used to monitor its effectiveness.
Gomez, E.; Peguero, M.; Sanchez, J.; Castellanos, P. L.; Feris, J.; Pena, C.; Brudzinski-LaClaire, L.; Levine, O. S.
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
Three cases of meningitis due to criptococcus in children infected with HIV are reported. All patients had severe immunodeficiency. The first case occurred before antiretroviral therapy. The second case had poor adherence to treatment. The third case is a teenager with prolonged fever, who did not have a clear source of transmission of HIV and was immunodeficient at the time of diagnosis. Examination of cerebrospinal fluid with India ink dye was essential for making the diagnosis in all three cases. The disease course was adequate in all three patients despite flucytosine not being available. PMID:23282503
Quian, Jorge; Gutiérrez, Stella; González, Virginia; Sánchez, Mercedes; Abayian, Marina; Baccino, Fernando
Full Text Available Meningitis is rarely seen following oral injury. We describe a 3-year-old boy developingmeningitis and brain abscess following a penetrating oral wooden stick injury. Therewas no cerebrospinal fluid rhinorrhea noted. A cerebrospinal fluid culture yielded viridansstreptococcus. Brain magnetic resonance imaging and computed tomography revealed amultiloculated ring-enhancing mass. This patient underwent surgical drainage and completed8-week antibiotic therapy. The patient demonstrated a late and dismal complication of apenetrating oral injury. At 2-year follow-up the patient was in good condition. A penetratingoral wooden stick inury should be regarded as potentially serious.
Full Text Available A 58-year-old male patient presented to the emergency department with complaints of severe neck pain. He admitted to drug use but denied using intravenous (IV drugs. On exam, he had a fever of 100.7 F, positive Kernig’s sign, and normal neurologic exam. The patient was suspected to have bacterial meningitis and was started on IV antibiotics. The next day the patient developed decreased hand grip. Magnetic resonance imaging of the spine the next day showed a soft-tissue mass impinging on the spinal canal. The patient was subsequently taken to the operating room where the epidural abscess was drained.
Full Text Available Hemangiopericytoma is an uncommon vascular tumour. Complete surgical resection is treatment of choice. However, late local recurrences and distant extraneural metastases ranging from 12% to 57% are reported in literature after complete removal. Post operative radiotherapy is indicated in unresectable or incompletely excised tumour. We present a case of meningeal hemangiopericytoma in a 60 years old female patient treated with surgery and adjuvant radiotherapy. There is no evidence of disease at primary site and no sign or symptoms of metastatic disease in the patient after three years.
Recently reports on toxocariasis are increasing by serodiagnosis in Korea. A previously healthy 17-yr-old boy complained of headache, fever, dyspnea, and anorexia. He showed symptoms and signs of eosinophilic meningitis with involvement of the lungs and liver. Specific IgG antibody to Toxocara canis larval antigen was positive in serum and cerebrospinal fluid by ELISA. He took raw ostrich liver with his parents 4 weeks before the symptom onset. His parents were seropositive for T. canis antigen but had no symptoms or signs suggesting toxocariasis. This is the first report of toxocariasis in a family due to ingestion of raw ostrich liver in Korea. PMID:22969260
Noh, Young; Hong, Sung-Tae; Yun, Ji Young; Park, Hong-Kyun; Oh, Jung-Hwan; Kim, Young Eun; Jeon, Beom S
Full Text Available SciELO Chile | Language: English Abstract in spanish 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.
Fonseca Cardoso, Andreya; Rocha-Filho, Pedro Augusto; Melo Correa-Lima, Ana Rosa.
Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2–10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig’s and Brudzinski’s signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) ? 4.3 for proven/...
Laman, Moses; Manning, Laurens; Greenhill, Andrew R.; Mare, Trevor; Michael, Audrey; Shem, Silas; Vince, John; Lagani, William; Hwaiwhanje, Ilomo; Siba, Peter M.; Mueller, Ivo; Davis, Timothy M. E.
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.
In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3821485
Schlesinger, L S; Ross, S C; Schaberg, D R
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.
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
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.
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 mass vaccination were efficient: US$ 35 per case treated and US$ 0.64 per vaccination. There was, however, a remarkable difference in cost-effectiveness between the two strategies. The cost per death averted by improved case treatment was estimated to be US$ 396, while the cost per death averted by vaccination was estimated to be US$ 6000. In large part this difference is attributed to the late start of vaccination: more than 6 weeks after the epidemic threshold had been passed. During meningitis epidemics in countries where surveillance systems are inadequate, such as in most of sub-Saharan Africa, curative programmes should have priority. PMID:9648353
Veeken, H; Ritmeijer, K; Hausman, B
A 6-year-old boy is presented in whom plain CT failed to reveal specific findings suggesting inflammation, but enhanced CT revealed noticeably abnormal enhancement along the right middle cerebral artery and linear enhancement at the periphery of the artery. The cause of specific enhancement and its clinical value are discussed. (Namekawa, K.)
Background Cryptococcal meningitis has been described in immunocompromised patients as well as in those for whom no immune defect has been identified. GM-CSF regulates the function of phagocytes and pulmonary alveolar macrophages, critical elements in cryptococcal control. Methods We performed clinical histories, immunological evaluation, and anticytokine autoantibody screening in 4 current patients with cryptococcal meningitis, and identified and tested 103 archived plasma/CSF samples from patients with cryptococcal meningitis. We assessed the ability of anti-GM-CSF autoantibody containing plasmas to inhibit GM-CSF signaling. Results We recognized anti-GM-CSF autoantibodies in an otherwise healthy female with cryptococcal meningitis who later developed pulmonary alveolar proteinosis. Her diagnosis prompted screening of patients with cryptococcal meningitis for anticytokine autoantibodies. We identified 7 HIV uninfected patients with cryptococcal meningitis who tested positive for high-titer anti-GM-CSF autoantibodies. Two of the 7 later developed evidence of PAP. Plasma from all patients prevented GM-CSF-induced STAT-5 phosphorylation and MIP-1? production in normal PBMC. This effect was limited to their IgG fraction. Conclusions Anti-GM-CSF autoantibodies are associated with some cases of cryptococcal meningitis in otherwise immunocompetent patients. These cases need not have associated pulmonary alveolar proteinosis.
Rosen, Lindsey B.; Freeman, Alexandra F.; Yang, Lauren M.; Jutivorakool, Kamonwan; Olivier, Kenneth N.; Angkasekwinai, Nasikarn; Suputtamongkol, Yupin; Bennett, John E.; Pyrgos, Vasilios; Williamson, Peter R.; Ding, Li; Holland, Steven M.; Browne, Sarah K.
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 whodied (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.
Ostergaard, C; Johansen, JS
Full Text Available Purpose: To address the epidemiological characteristics and clinical indices that may predict the prognostic profile of meningitis among children. Methods: Children admitted to Alexandria fever hospital with clinical diagnosis of meningitis/meningoencephalitis during the period 2002-2003 were recruited for the study. They were subjected to clinical examination as well as CSF bacteriological and serological investigations Results: Three hundred and ten patients (195 males and 115 females were included. About 65.2% of them were infected with acute bacterial meningitis (ABM and 34.8% were infected with aseptic meningitis. In this study, ABM was caused by Haemophilus influenzae (21%, Streptococcus pneumoniae (13.9%, Neisseria meningitidis (14.2% and other undetermined bacteria (16.1%. ABM showed significant association with age group 1-9 years (66.3%, low socio-economic class (96%, working mother (83.2%, more than two smokers in the family (62.9% and cold seasons(fall 35.1% and winter 48.5%. Aseptic meningitis showed significant association with age group 3-15 months (100% and previous immunization(81.5%. The overall case fatality rate was 10.3%; 13.9% for ABM and 3.4% for aseptic meningitis. 7.1% of all survivors developed epileptic attacks. Predictors for death or epilepsy events were high WHO meningitis score (> 9, decreased CSF glucose level (Conclusion: This study highlights the importance of several predictors of the outcome of meningitis in children. It is concluded that quick and simple scoring scales, such as the WHO scale, are not only applicable but valuable prognostic tools for meningitis in children.
Clinical and microbiological profile of 9 neonates with meningitis by Elizabethkingia meningosepticum identified by 16S ribosomal gene sequencing was studied. All the clinical isolates were resistant to cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, ? -lactam combinations, carbapenems and only one isolate was susceptible to ciprofloxacin. All the isolates were susceptible to vancomycin. Six of nine neonates died even after using vancomycin, based on susceptibility results. E. meningosepticum meningitis in neonates results in high mortality rate. Though the organism is susceptible to vancomycin in vitro, its efficacy in vivo is questionable and it is difficult to determine the most appropriate antibiotic for treating E. meningosepticum meningitis in neonates. PMID:24678326
Shailaja, V V; Reddy, Ashok Kumar; Alimelu, M; Sadanand, L N R
Clinical and microbiological profile of 9 neonates with meningitis by Elizabethkingia meningosepticum identified by 16S ribosomal gene sequencing was studied. All the clinical isolates were resistant to cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, ?-lactam combinations, carbapenems and only one isolate was susceptible to ciprofloxacin. All the isolates were susceptible to vancomycin. Six of nine neonates died even after using vancomycin, based on susceptibility results. E. meningosepticum meningitis in neonates results in high mortality rate. Though the organism is susceptible to vancomycin in vitro, its efficacy in vivo is questionable and it is difficult to determine the most appropriate antibiotic for treating E. meningosepticum meningitis in neonates.
Shailaja, V. V.; Reddy, Ashok Kumar; Alimelu, M.; Sadanand, L. N. R.
Meningitis caused by Staphylococcus aureus is an unusual illness that is often associated with bacteremia, contiguous infection and/or a post-neurosurgical state. Until recently, most cases were caused by methicillin-susceptible strains, but there are a few reports of methicillinresistant S aureus strains causing meningitis. A new case of meningitis caused by methicillin-resistant S aureus in a neonatal intensive care nurse who did not have bacteremia or neurosurgery is reported. The patient made a full recovery after treatment with vancomycin and rifampin. PMID:18159511
Dylewski, Joe; Martel, Guillaume
Full Text Available Abstract Introduction Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses. Case presentation We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis. Conclusions Atypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.
Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish Introducción: La difícil interpretación de los hallazgos sugestivos de meningitis bacteriana y viral en el líquido cefalorraquídeo con frecuencia imposibilita su diferenciación. Por décadas, los investigadores han intentado crear escalas predictivas que permitan resolver tal disyuntiva. El objetivo [...] del presente trabajo es determinar la validez y seguridad de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en Pediatría. Métodos: Realizamos un estudio retrospectivo, transversal, de evaluación de una prueba diagnóstica en una muestra de pacientes con edades entre 29 días y 12 años, egresados con diagnóstico de meningitis entre enero de 1992 y diciembre de 2006, del Departamento de Pediatría del Hospital ?Dr. Jesús Yerena?, ubicado en Caracas, Venezuela. Aplicamos una escala clínica predictiva y calculamos su sensibilidad, especificidad, valores predictivos y razones de verosimilitud para el diagnóstico de meningitis bacteriana. Resultados: La muestra estuvo conformada por 41 pacientes. Predominó el sexo masculino (n=29; 70,73 %). El grupo etareo más afectado fue el de los lactantes menores (n=26; 63,41 %). Se identificaron 14 meningitis bacterianas y 27 asépticas. Mediante la escala clínica predictiva se clasificaron 31 meningitis como de alto riesgo de meningitis bacteriana y 10 como de bajo riesgo. La sensibilidad y valor predictivo negativo fueron de 100 %. Conclusiones: La escala clínica predictiva aplicada resultó ser válida y segura para descartar meningitis bacteriana. Abstract in english Introduction: The overlapping of findings suggestive of bacterial or viral meningitis in cerebrospinal fluid makes it difficult to differentiate one of another. For decades, investigators have attempted to create clinical prediction scores to resolve such disjunctive. The objective of this investiga [...] tion was to determine the validity and safety of a clinical prediction score for the diagnosis of bacterial meningitis in childhood. Methods: We performed a retrospective, transversal, diagnostic test evaluation study of a sample of patients between 29 days to 12 years of age, discharged from January 1992 to December 2006, with diagnosis of meningitis, from the Pediatrics Department of Dr. Jesús Yerena Hospital, in Caracas, Venezuela. The clinical prediction score was applied. We evaluated its validity and safety with the calculation of sensibility, specificity, predictive values and likelihood ratios for the diagnosis of bacterial meningitis. Results: A total of 41 patients were included. Male gender was more common (n= 29; 70,73 %). The infant age group was predominant (n=26 ; 63,41 %). We identified 14 bacterial meningitis and 27 aseptic meningitis. With the clinical prediction score, 31 meningitis were classified as high risk of bacterial meningitis and 10 as low risk. The sensibility and the negative predictive value were 100 %. Conclusions: The clinical prediction score applied resulted to be valid and safe for identifying patients without bacterial meningitis.
Ruiz, Karla; Soave, Yanina; Torres, Mary; Alcalá, Nelson.
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 < 0.05. CSF IL-8 levels were higher in ABM than in AM and controls (p < 0.05. Discriminatory power in ABM as assessed by the area under receiver operator (ROC curve was 0.951 for IL-8, using a cut-off of 1.685 ng/dL (100% of sensitivity and 94% of specificity. The CSF concentration of both IL-6 and IL-8 are increased in the presence of meningeal inflammation, IL-8 could be an important tool to differentiate ABM from AM.
Vitor Laerte Laerte Pinto Junior
In the United States, the annual number of central nervous system (CNS) infections that occur as a result of viral agents far exceeds that of infections caused by bacteria, yeast, molds, and protozoa combined. The recent incursion of West Nile virus (WNV) into North America has led to a dramatic change in the incidence and epidemiology of summer-associated viral CNS disease. As a result of increased testing for WNV, lesser known viral causes of CNS infection have been identified. Even the epidemiology of such traditional viral neuropathogens as rabies has changed in recent years. This review provides an overview of viruses traditionally associated with meningitis and encephalitis (enteroviruses, La Crosse virus, St. Louis encephalitis virus, eastern and western equine viruses, varicella-zoster virus), as well as several of the less common (Powassan virus, lymphocytic choriomeningitis virus, Colorado tick fever virus, rabies virus, influenza viruses, etc.) and emerging (West Nile virus) viral pathogens. PMID:12881794
Romero, José R; Newland, Jason G
To summarize the epidemiology, clinical features, treatment, and outcome of cryptococcal meningitis (CM) in autoimmune hemolytic anemia (AIHA) patients and to provide a reference for the prevention and control of AIHA complicated with CM, we evaluated five cases of CM in patients with AIHA treated in our hospital from 2003 to 2013 and eight related foreign cases. All of the clinical isolates were Cryptococcus neoformans var. grubii and grouped into the VNI genotype and serotype A. The clinical features exhibit significant features. Headache, nausea, and fever are common symptoms of AIHA complicated with CM. The early clinical manifestations lack specificity, which may lead to delayed diagnosis and treatment. Long-term use of prednisone (?15 mg day(-1)), poor control of anemia, and splenectomy are risk factors for AIHA complicated with cryptococcal infection. The combination of intravenous amphotericin B and oral 5-fluorocytosine remains the preferred treatment for AIHA complicated with CM. PMID:24952011
Yang, YaLi; Sang, Junjun; Pan, Weihua; Du, Lin; Liao, Wanqing; Chen, Jianghan; Zhu, Yuanjie
Full Text Available The five year old, somnolent girl from Mozambique with no medical history was presented with fever, neckstiffness, headaches, an almost complete paraplegia and a septic picture. Malaria parasites and HIV testing was negative. The lumbal puncture revealed staphylococcus. Subsequently a MRI scan showed no sign of meningitis but an extensive posterior epidural collection from C3 to the level of S1. Moreover it showed a vertebral osteomyelitis at L1. Bacteria in CSF were seen as an artefact and the child was treated by multilevel (purely epidural punctures with drainage, rinsing and instillation of ceftriaxon. The epidural puncture proved acid fast bacilli in the pus, so that an anti-tuberculotic therapy was given. The child recovered quickly from sepsis and was able to walk several steps without help after three months.
Paradoxical response to anti-tubercular drugs remains a diagnostic dilemma. In India where tuberculosis is quite prevalent, paradoxical response to anti-tubercular treatment (ATT) is either misdiagnosed or under-diagnosed. We report two cases of optochiasmatic arachnoiditis due to paradoxical response in children suffering from tuberculous meningitis. Visual acuity was recorded as no light perception in all eyes of both patients while they were taking 4-drug ATT (isoniazid, rifampicin, pyrazinamide and ethambutol). However their systemic conditions did not worsen. They were treated with intravenous methylprednisolone for five days followed by systemic corticosteroids on a tapering dose for four weeks along with ATT. This case report highlights the importance of early recognition of this sight-threatening complication and timely, effective treatment to prevent permanent blindness.
Nema, Nitin; Verma, Abha; Singh, Kuldeep; Mehar, Virendra
In this prospective study, a simple method was standardized for measuring circulating mycobacterial antigen in the cerebrospinal fluid (CSF) for the laboratory diagnosis of tuberculous meningitis (TBM). The heat-inactivated CSF specimens from tuberculous and non-tuberculous patients were subjected to sodium dodecyl sulfate (SDS) - polyacrylamide gel electrophoresis (PAGE) (SDS-PAGE) and they were subsequently transferred onto nitrocellulose membrane (NCM) Using a rabbit polyvalent antibody to M tuberculosis, a heat stable 82 kDa mycobacterial antigen was demonstrated in the CSFs of patients with TBM. This antigen was conspicuous by its absence in the CSFs of non-tuberculous subjects. Due to inactivation of CSF specimens, there is a minimal risk of handling of infectious material in the laboratory. Besides, this newer approach is simple, inexpensive and can be readily applied in any routine clinical laboratory and it is particularly suited to developing countries. PMID:11404064
Mathai, A; Radhakrishnan, V V; George, S M; Sarada, C
Full Text Available Neurocysticercosis (NCC is the most common parasitic disease of the nervous system and is the main cause of acquired epilepsy in developing countries. Clinical manifestations result from inflammatory response to cyst degeneration, mass effect, obstruction of CSF pathway or residual scarring but are related to the numbers, size and location of lesions and the severity of host's immune response. The subarachnoid/cisternal form of NCC and majority of the intraventricular NCC are of racemose type, and differ from more common cysticercus cellulose in that they are larger, appear as multiloculated cysts and lack scolex. Racemose NCC is uncommon in India. We are reporting a patient presenting as chronic meningitis due to racemose NCC.
A 39-year-old man with a high fever, headache, and stiff neck, and Kernig and Brudzinski signs admitted in June 2004 had a WBC of 10,680/microL and CRP of 10.5mg/dL. Streptococcus pneumoniae was detected in blood and spinal fluid culture, but brain CT was normal. Meningitis was diagnosed and antibiotics and corticosteroids begun. After four days of treatment, his blood test and spinal fluid data had improved, but his consciousness had deteriorated. ADEM was diagnosed by the clinical course and brain MRI (T2-weighted image) that showed high-intensity lesions in the white cerebral matter, and steroid pulse treatment was begun on day 4 after admission. His consciousness disturbance rapidly disappeared and brain MRI showed that the multiple high-intensity lesions had ameliorated. The patient was released after 40 days of treatment. PMID:17966640
Ohnishi, Hachiro; Sawayama, Yasunori; Ariyama, Iwao; Yamaji, Kouzaburou; Furusyo, Norihiro; Hayashi, Jun
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.
Becker, H.; Schneider, E.
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.)
Full Text Available In this study the clinical and laboratory findings of 48 children with purulent meningitis were examined, prospectively, to determine the prognostic factors in childhood meningitis in a developing country. Patients were examined for the following variables: history of antibiotic use; period between onset of symptoms and hospital admission; age at presentation; sex; fever; convulsion; level of consciousness; malnutrition; anemia; leukocyte and thrombocyte counts; erythrocyte sedimentation rate; serum C-reactive protein (CRP level; and cerebrospinal fluid (CSF including white blood cell count; glucose, protein, and CRP concentrations; antibiotic treatment; neurological sequelae; and fatality rate during the hospital stay. Most of these parameters were re-evaluated in all patients 36-48 h after admission. Patients were divided into 3 groups: surviving without sequelae, surviving with sequelae, and not surviving (deceased. A total of 48 children, 19 girls (39.5% and 29 boys (60.5%, aged 2 months to 13 years, were included in the study. Of the 48 patients, 29 (60.5 % survived without sequelae, 13 (27% survived with sequelae and 6 (12.5% died. In a comparison among groups, we found that absence of anemia, low (< 1,000 CSF white blood cell (WBC count, and high CRP level at admission were the indicative of poor prognosis. Thirty-six to 48 h after admission, the presence of fever, depressed level of consciousness, high (> 1,000 CSF WBC count, and low CRP level were also poor prognostic factors. In addition, we observed that mortality rate was lower in the penicillin G + chloramphenicol group than in the ampicillin-sulbactam + cefotaxime group (P < 0.05. The mean period between onset of symptoms and hospital admission was longer in the surviving with sequelae and in the not surviving groups than in the surviving without sequelae group (P < 0.05.
Though pial arteriovenous fistulae (PAVF) are an uncommon cerebrovascular disorder, their presentation with subarachnoid hemorrhage (SAH) is not rare. PAVF near the craniocervical junction are rare and may have a worse outcome. These fistulae are often fed from either the carotid and/or the vertebrobasilar systems, but are rarely fed by the anterior spinal artery. We report the case of a young man presenting with SAH. Cerebral angiography revealed 2 AVF, a symptomatic PAVF located at the craniocervical junction and fed from the anterior spinal artery and incidental dural AVF (DAVF) originate from the left occipital and middle meningeal arteries. These fistulae were treated with different endovascular techniques, including Onyx and platinum coil embolization into the feeding arteries of the DAVF and PAVF, respectively. PMID:21223434
Alshekhlee, Amer; Edgell, Randall C; Kale, Sushant P; Kitchener, Jacob; Vora, Nirav
We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. During ventriculoscopy, the cyst had all aspects of an arachnoid cyst. An endoscopic fenestration and partial removal of the cyst was performed, combined with a ventriculocisternostomy. The coincidental finding of viral meningitis and a third ventricle arachnoid cyst in a patient with acute hydrocephalus has, to our knowledge, not been described in literature before. If there is a relation between the enteroviral meningitis, the arachnoid cyst (possibly causing a pre-existing subclinical hydrocephalus) and the rapidly evolving neurological deterioration, remains speculative. Proposed mechanisms, by which the viral meningitis could accelerate the disease process, are slight brain swelling or increased CSF production. This rare combination of diagnoses could also be coincidental. PMID:24169867
Jeltema, Hanne-Rinck; Kuijlen, Jos M A; Hoving, Eelco W
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.
A. Denizmen Aygun
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.
Nocardia infection is a well recognized complication of the immunocompromised hosts. It is mostly a primary pulmonary infection, which may disseminate to other organs. The central nervous system (CNS) involvement of nocardiosis is usually manifested as brain abscesses. We report a 25-year-old male patient who presented with nocardial pneumonia and meningitis without brain abscess. He was diagnosed as immune thrombocytopenic purpura and methyl prednisolone was started 5 weeks previously. Nocardia spp. was obtained from his cerebrospinal fluid culture, but he died at the 7th day of intensive care. Nocardia meningitis is a rare manifestation of systemic disease. Nocardia meningitis should be considered in the differential diagnosis of meningitis with the coexisting nodular pulmonary lesions in the immunocompromised patient and medications other than co-trimoxazole may be required. PMID:19858711
Mete, Bilgül; Yemisen, Mücahit; Demirel, Aslihan Ertaban; Ozaras, Resat; Mert, Ali; Ozturk, Recep; Tabak, Fehmi
Full Text Available The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT, in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4% cases of bacterial meningitis. In contrast, Gram stain and culture showed 16.9 and 23.1% positivity, respectively. LPAT correlated well with Gram stain and culture and can be recommended as an adjunct laboratory test for rapid aetiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.
The pharmacokinetics of amoxycillin in the CSF following intravenous and oral administration at a 150 mg/kg per day or 250 mg/kg per day dosage in the treatment of purulent meningitis is described. A significant correlation between meningeal inflammation and CSF levels of amoxycillin were observed, including a correlation between the initial neurological state and the outcome of the illness. Despite the early introduction of oral therapy and the reduction in dosage following meningeal and pneumococcal meningitis, no treatment failures could be attributed to this therapeutic regime. Such a treatment schedule, moreover, reduces the risk of superinfection in hospital as well as the cost of treatment and aids the comfort to the patient. PMID:4007254
Tazi-Lakhassi, L; Benbachir, M; el Mdaghri, N; Zaghloul, J
Ophthalmologic complications are frequently encountered in patients with bacterial meningitis, and we have previously reported from Egypt on the fundus complications, ocular muscle affections, pupillary dysfunction and corneal and conjunctival lesions tha...
L. S. Hanna N. I. Girgis Z. Farid H. Yassin
The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT), in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4%) cases of bacterial meningitis. In contrast, Gram stain and culture showed 16.9 and 23.1% positivity, respectively. LPAT correlated well with Gram stain and culture and can be recommended as an adjunct laboratory test for rapid aetiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics. PMID:18087093
Surinder, K; Bineeta, K; Megha, M
Objective: To assess the effectiveness and safety of brachial artery access for percutaneous renal artery stenting. Methods: From January 2002 to January 2005, transbrachial artery renal angioplasty and stenting(RAS) was performed in 8 patients(7 males, 1 female)with severe renal artery stenosis. Imaging assessment of the target renal artery was performed before all procedures, which precluded the possibility of femoral approach. Either long guiding sheath or otherwise pigtail methods were selected according to patients' status for evaluation of the target renal artery during the procedure. Monitoring the blood pressure and renal function was followed up of 6 months after the procedure. Results: The technical success was 100% with no procedure-related complication and good outcome follow up to 6 months. Conclusion: Brachial artery access for renal artery stenting is a safe and technically feasible for renal artery stenosis, providing an alternative for unsuitable femoral approach. (authors)
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
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.
Marcos R. G. de Freitas
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 (RE...
Amaya-villar, Rosario; Garcia-cabrera, Emilio; Sulleiro-igual, Elena; Fernandez-viladrich, Pedro; Fontanals-aymerich, Dionisi; Catala?n-alonso, Pilar; Rodrigo-gonzalo Liria, Carlos; Coloma-conde, Ana; Grill-diaz, Fabio; Guerrero-espejo, Antonio; Pacho?n, Jero?nimo; Prats-pastor, Guillen
The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT), in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4...
Surinder K; Bineeta K; Megha M
Investigation of the aetiology of viral meningitis in Brazil is most often restricted to cases that occur in the Southern and Southeastern Regions; therefore, the purpose of this study is to describe the viral meningitis cases that occurred in state of Pará, Northern Brazil, from January 2005-December 2006. The detection of enterovirus (EV) in cerebrospinal fluid was performed using cell culture techniques, RT-PCR, nested PCR and nucleotide sequencing. The ages of the 91 patients ranged from...
Leptospirosis is a zoonotic disease caused by the pathogenic Leptospira spp. The clinical presentations are diverse, ranging from undifferentiated fever to fulminant disease including meningeal forms. The neurological leptospirosis forms are usually neglected. The aim of this study was to investigate leptospirosis as the cause of aseptic meningitis using different diagnostic techniques including the polymerase chain reaction (PCR). Thirty-nine cerebrospinal fluid (CSF) samples from patients p...
BACKGROUND: Brain stem herniation due to raised intracranial pressure (ICP) is a common cause of mortality in severe bacterial meningitis, but continuous measurements of ICP and the effects of ICP-reducing therapy in these patients have, to our knowledge, not been described. METHODS: During a four-year period, an ICP-monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20 mmHg was treated using...
A 45-year-old man with a cholesteatoma experienced purulent meningitis. Microbial analysis of cerebrospinal fluid yielded in pure culture a gram-negative bacillus. Phenotypic methods were suggestive of a Bacteroides distasonis or either a Bacteroides thetaiotaomicron or Bacteroides ovatus infection. The isolate was identified by 16S rRNA gene sequence analysis as B. thetaiotaomicron. This is the first case of B. thetaiotaomicron meningitis in pure culture.
Feuillet, Lionel; Carvajal, Joseph; Sudre, Isabelle; Pelletier, Jean; Thomassin, Jean Marc; Drancourt, Michel; Cherif, Andre? Ali
In the central nervous system of patients with multiple sclerosis, B cell aggregates populate the meninges, raising the central question as to whether these structures relate to the B cell infiltrates found in parenchymal lesions or instead, represent a separate central nervous system immune compartment. We characterized the repertoires derived from meningeal B cell aggregates and the corresponding parenchymal infiltrates from brain tissue derived primarily from patients with progressive mult...
Lovato, Laura; Willis, Simon N.; Rodig, Scott J.; Caron, Tyler; Almendinger, Stefany E.; Howell, Owain W.; Reynolds, Richard; O’connor, Kevin C.; Hafler, David A.
After an outbreak in 2000 of eosinophilic meningitis in tourists to Jamaica, we looked for Angiostrongylus cantonensis in rats and snails on the island. Overall, 22% (24/109) of rats harbored adult worms, and 8% (4/48) of snails harbored A. cantonensis larvae. This report is the first of enzootic A. cantonensis infection in Jamaica, providing evidence that this parasite is likely to cause human cases of eosinophilic meningitis.
Lindo, John F.; Waugh, Cecilia; Hall, John; Cunningham-myrie, Colette; Ashley, Deanna; Eberhard, Mark L.; Sullivan, James J.; Bishop, Henry S.; Robinson, David G.; Holtz, Timothy; Robinson, Ralph D.
We studied the pharmacokinetics and in vivo antifungal action of SCH39304, a new antifungal azole compound, in rabbits. It crossed the blood-cerebrospinal fluid barrier in the presence or absence of meningeal inflammation, reaching approximately 60% of the simultaneous concentrations in serum. In the treatment of experimental cryptococcal meningitis, SCH39304 was as effective as fluconazole in reducing yeast counts in the subarachnoid space. SCH39304 and fluconazole both were highly effective...
Moxifloxacin, an 8-methoxyquinolone with broad-spectrum activity in vitro, was studied in the rabbit model of Escherichia coli meningitis. The purposes of this study were to evaluate the bactericidal effectiveness and the pharmacodynamic profile of moxifloxacin in cerebrospinal fluid (CSF) and to compare the bactericidal activity with that of ceftriaxone and meropenem therapy. After induction of meningitis, animals were given single doses of 10, 20, and 40 mg/kg or divided-dose regimens of 5,...
Rodriguez-cerrato, Violeta; Mccoig, Cynthia C.; Michelow, Ian C.; Ghaffar, Faryal; Jafri, Hasan S.; Hardy, Robert D.; Patel, Chetan; Olsen, Kurt; Mccracken, George H.
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 ente...
On presentation of Staphylococcus aureus endocarditis, unusual manifestations may represent the main clinical features of the disease. Isolated bacterial meningitis as the first manifestation of endocarditis is considered to be an unusual neurological complication. Here, we describe a case S. aureus endocarditis presenting as isolated meningitis and mimicking meningococcal septicaemia. Because of the high mortality rate of the disease, the prompt recognition of this infectious syndrome is of ...
Ceccarelli, Giancarlo; D Ettorre, Gabriella; Vullo, Vincenzo
Acute bacterial meningitis has a low incidence (3/100,000 in the United States) and yet high fatality rate (approximately 14–16%) and classically presents as a triad of fever, neck stiffness, and altered mental status. However, less than half of patients with meningitis present with this classic triad. We present the clinical course of a patient who initially prese