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Meningitis Selected abstracts: 1. Schaars CF, Meintjes GA, Morroni C, Post FA, Maartens G. Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole. BMC Infect Dis. 2006 Jul 18;6:118. Division of Infectious Diseases, University of Cape Town, Cape Town, South Africa. cfschaars@hotmail.com BACKGROUND: AIDS-associated cryptococcal meningitis has a high mortality. Fluconazole was the only systemic antifungal therapy available in our centre. From 1999-2001 we used low-dose fluconazole (200 mg daily initially), and did not offer therapy to patients perceived to have poor prognoses. In 2001 donated fluconazole became available, allowing us to use standard doses (400 mg daily initially). Antiretroviral therapy was not available during the study period. METHODS: Retrospective chart review of adult patients before and after the fluconazole donation. RESULTS: 205 patients fulfilled the inclusion criteria, 77 before and 128 after the donation. Following the donation fewer patients received no antifungal treatment (5% vs 19%, p = 0.002), and more patients received standard-dose fluconazole (90% vs 6%, p < 0.001). In-hospital mortality was 25%. Impaired consciousness, no antifungal treatment received and cerebrospinal fluid antigen titre > 1,000 were independent predictors of in-hospital mortality. Concomitant rifampicin did not affect in-hospital survival. Thirteen patients were referred to the tertiary referral hospital and received initial treatment with amphotericin B for a mean of 6 days - their in-hospital survival was not different from patients who received only fluconazole (p = 0.9). Kaplan-Meier analysis showed no differences in length of survival by initial treatment with standard or low doses of fluconazole (p = 0.27 log rank test); median survival was 76 and 82 days respectively. CONCLUSION: Outcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole. The early mortality is high. Initial therapy with amphotericin B and other measures may be needed to improve outcome. Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostic: 15102. Bera S, Shende N, Kumar S, Harinath BC. Detection of antigen and antibody in childhood tuberculous meningitis. Indian J Pediatr. 2006 Aug;73(8):675-9. 15103. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F; EFNS Task Force. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. Eur J Neurol. 2006 Sep;13(9):913-22. 15104. Dubos F, Moulin F, Gajdos V, De Suremain N, Biscardi S, Lebon P, Raymond J, Breart G, Gendrel D, Chalumeau M. Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis. J Pediatr. 2006 Jul;149(1):72-6. 15105. Mishra D, Sharma S, Gupta S, Das M, Chauhan D. Acute cysticercal meningitis--missed diagnosis. Indian J Pediatr. 2006 Sep;73(9):835-7. 15106. Mudaliar AV, Kashyap RS, Purohit HJ, Taori GM, Daginawala HF. Detection of 65 kD heat shock protein in cerebrospinal fluid of tuberculous meningitis patients. BMC Neurol. 2006 Sep 15;6:34. Pathogenesis: 15107. Pulickal AS, Mathew AM, Xavier D. Patterns and outcome of acute bacterial meningitis in a South Indian tertiary level hospital. Indian J publHlth 2005, 49(4), 254-6. 15108. Singh N, Husain S, Limaye AP, Pursell K, Klintmalm GB, Pruett TL, Somani J, Stosor V, del Busto R, Wagener MM, Steele C. Systemic and cerebrospinal fluid T-helper cytokine responses in organ transplant recipients with Cryptococcus neoformans infection. Transpl Immunol. 2006 Aug;16(2):69-72. Vaccine: 15109. Conterno LO, Silva Filho CR, Ruggeberg JU, Heath PT. Conjugate vaccines for preventing meningococcal C meningitis and septicaemia. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001834. Review. 15110. Giuliani MM, Adu-Bobie J, Comanducci M, Arico B, Savino S, Santini L, Brunelli B, Bambini S, Biolchi A, Capecchi B, Cartocci E, Ciucchi L, Di Marcello F, Ferlicca F, Galli B, Luzzi E, Masignani V, Serruto D, Veggi D, Contorni M, Morandi M, Bartalesi A, Cinotti V, Mannucci D, Titta F, Ovidi E, Welsch JA, Granoff D, Rappuoli R, Pizza M. A universal vaccine for serogroup B meningococcus. Proc Natl Acad Sci U S A. 2006 Jul 18;103(29):10834-9. 15111. Keyserling HL, Pollard AJ, DeTora LM, Gilmet GP. Experience with MCV-4, a meningococcal, diphtheria toxoid conjugate vaccine against serogroups A, C, Y and W-135. Expert Rev Vaccines. 2006 Aug;5(4):445-59. Review. 15112. Vu DM, Kelly D, Heath PT, McCarthy ND, Pollard AJ, Granoff DM. Effectiveness analyses may underestimate protection of infants after group C meningococcal immunization. J Infect Dis. 2006 Jul 15;194(2):231-7. Therapy: 15113. Goldstein F, Jonte J, Mandel F, Ben Ali A. Breakthrough pneumococcal meningitis in a patient treated with pristinamycin. Clin Microbiol Infect. 2006 Jul;12(7):696-7. 15114. Powderly WG. Antifungal treatment for cryptococcal meningitis. Intern Med J. 2006 Jul;36(7):404-5. 15115. Shalabi M, Whitley RJ. Recurrent benign lymphocytic meningitis. Clin Infect Dis. 2006 Nov 1;43(9):1194-7.
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