MENINGITIS
( SEVAMED 2001)
(Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics, Pathogenesis, Vaccines & Drugs)
1360. Balganesh
M. Lalitha MK. Nathaniel R. Rapid diagnosis of acute
pyogenic meningitis by a combined PCR dot-blot assay. Molecular & Cellular
Probes. 14(2):61-9, 2000 Apr.
Abstract
A multiplex PCR was employed to amplify
unique conserved sequences of DNA from the pathogens Haemophilus influenzae,
Neisseria meningitidis and Streptococcus pneumoniae from cerebrospinal
fluid samples of patients suffering from acute pyogenic meningitis. The accurate identification of the PCR amplified product was achieved by hybridizing
dot-blots of the PCR products to probes which were specific,
biotinylated internal sequences of the amplified target DNA. Detection of the
hybrids was done in a colour reaction using streptavidin-alkaline
phosphatase conjugate and BCIP/NBT substrates. The entire protocol took only 7
h for the correct identification of the pathogen present in
clinical samples of cerebrospinal fluid. The sensitivity and
specificity were >95%. Copyright 2000 Academic Press.
1361.
No Abstract
1362. Bisharda A.
Chowdhury R. Puliyel JM.
Evaluation of leukocyte esterase reagent strips for rapid diagnosis of pyogenic
meningitis [letter]. Indian Pediatrics. 36(9):955-6, 1999 Sep.
1363.
Buttery JP.
Moxon ER. Designing meningitis vaccines. [Review] [31 refs] Journal of the Royal College of Physicians of London. 34(2):163-8, 2000 Mar-Apr.
Abstract
Conjugate polysaccharide vaccines are a recent intervention to combat the relative inability of young children to mount an effective immune response against encapsulated bacteria, especially Haemophilus influenzae (Hib), Neisseria meningitidis (Nm) and Streptococcus pneumoniae (Sp). These organisms cause the majority of community acquired septicaemia and meningitis in UK children. Their capsular polysaccharides, important virulence factors in evading phagocytosis, are poorly immunogenic in young children compared to adults. Conjugation, by covalent linking, of the polysaccharide to an immunogenic protein, has been demonstrated for each of these organisms to produce good antibody response to the polysaccharide. Conjugate Hib vaccines have proven effective in reducing Hib meningitis and invasive disease in the countries thathave introduced them. Pneumococcal conjugate vaccines have proven effective in preventing invasive disease caused by serotypes contained in the vaccines. Efficacy studies are awaited for meningococcal conjugate vaccines. [References: 31]
1364. Chiu
CH. Tsai JR. Ou JT. Lin TY. Typhoid
fever in children: a fourteen-year experience [see comments]. T`aiwan Erh k`o i
Hs eh Hui Tsa Chih. 41(1):28-32, 2000 Jan-Feb.
Abstract
From 1982 to 1995, 71 children admitted in our medical center were diagnosed to have typhoid fever by culture or serology. Of the 71 children, most (83%) were aged 5-15 years. These children usually presented with fever and gastrointestinal symptoms, including abdominal pain, diarrhea, nausea or vomiting, and constipation. Hepatosplenomegaly was the most common physical sign observed and abdominal tenderness ranked the second. Thrombocytopenia occurring in 9 patients (13%) was the most common mode of complication. Other complications included intestinal perforation (3%), rectal bleeding (3%), ascites or pleural effusion (4%), and meningitis (1%). The incidence of complications tended to be higher among children 5 years of age or older (p = 0.31). Most patients responded well to appropriate antimicrobial therapies. There was no mortality. Relapse was observed in two children, although both had received 10 days of chloramphenicol therapy. The clinical isolates of Salmonella typhi were susceptible in vitro to all the antibiotics tested, including chloramphenicol, which, however, showed a higher MIC90 level than other drugs tested. In conclusion, there were age-specific differences of typhoid fever in children in terms of the incidence and morbidity and antibiotic resistance of S. typhi has not been a problem in this area at least up to 1995.
1365. Curry DJ. Frim DM. Delayed repair of open depressed skull fracture. Pediatric Neurosurgery. 31(6):294-7, 1999 Dec.
Abstract
INTRODUCTION: Elevation and repair of an
open depressed skull fracture is often thought of as an emergency procedure.
Common indications for emergent elevation of a depressed skull fracture have been dural
tear, seizure, gross contamination or mass effect
from bone or a sizable underlying intracerebral hematoma. As
treatment of head injury moves towards management of cerebral perfusion pressure
(CPP) rather than intracranial pressure (ICP), we sought a way
to maximize CPP in the initial treatment of head-injured patients
with depressed skull fractures that would eventually require surgery by
delaying surgery, when possible, until after the initial period of elevated
ICP. METHODS: Over a 12-month period, 7 patients (all male, ages 1-15
years) were admitted to our institution with the diagnosis of open
depressed skull fracture without significant mass effect requiring urgent decompression.
All had significant head trauma with altered mental
status and a Glasgow Coma Score of 3-12. Patients were treated with
antibiotic prophylaxis (nafcillin, ceftriaxone, metronidazole),
seizure prophylaxis (phenytoin) and underwent CPP management in an intensive
care unit setting as indicated by intracranial pressure
monitoring or clinical assessment. Length of medical management of CPP ranged
from 4 to 12 days. Upon stabilization of CPP, patients were operated
for repair of their dural, bone and scalp injuries. RESULTS: All 7
patients treated in the above manner suffered no ill effects from their
delayed surgery: there was no meningitis, no late seizures, and no
cerebrospinal fluid leak. Complications attributable to delay were not
present at follow-up ranging from 12 to 24 months. CONCLUSIONS: We have
delayed surgery for repair of open depressed skull fractures in order to
maximize medical management of CPP in the setting of acute trauma. Among
other considerations, the risk of intraoperative hypotension occurring at a
time of acutely raised ICP was avoided by this delay. We conclude that
there is a role, in this specifically defined subset of head trauma
patients, for delayed surgical repair of open depressed skull fractures.
Copyright 2000 S. Karger AG, Basel.
1366.
No Abstract
1367. Hortal M.
Camou T. Palacio R. Dibarboure H. Garcia A. Ten-year review of invasive pneumococcal diseases in
children and adults from Uruguay:
clinical spectrum, serotypes, and antimicrobial resistance. International
Journal of Infectious Diseases. 4(2):91-5, 2000.
Abstract
OBJECTIVES: Since 1987, the Reference
Laboratory of the Ministry of Health of Uruguay has been monitoring infections
due to Streptococcus pneumoniae in patients under 5 years
of age, in those between 5 to 14 years of age, and in adults. The purpose of the present
study was to retrospectively analyze a 10-year collection of invasive S.
pneumoniae isolates from children 5 to 14 years of age and adults. METHODS: The Reference
Children's Hospital, Pasteur Hospital, and
two private hospitals in Montevideo as well as four hospitals located
in other representative areas of the country participated in the
pneumococcal surveillance program. Based on the information available at the
Microbiology Department of the Central Public Health Laboratory
(demographic data, date and site of isolate, and clinical diagnosis), all patients with an invasive pneumococcal disease were recorded.
Pneumonia was clinically and radiologically diagnosed and etiology was
assessed by isolation of S. pneumoniae from blood or pleural fluid. All
specimens were collected at the Emergency Service. Capsular serotyping
and antimicrobial susceptibilities were determined for each isolate. RESULTS: During the 10-year period, 228 invasive S. pneumoniae
were identified and included in the study (blood, n = 129; cerebrospinal
fluid [CSF], n = 73; pleural fluid, n = 20; peritoneal fluid, n = 3;
synovial fluid, n = 1; pericardic fluid, n = 1; abscess, n = 1). The most
frequent clinical presentations were pneumonia (n = 71) and meningitis (n =
69). Thirty-five adults had an underlying condition including, four with
malignancies, four with lupus, two with human immunodeficiency virus
(HIV)-infected, and two patients in hemodialysis among others. Eighteen of the
228 patients died (7.9% fatality rate), but only four of these had
an underlying condition. Eleven fatal cases were attributable to meningitis
(2 children, 9 and 11 years old; 9 adults, mean age, 59 y). Four
patients with pneumonia and three with sepsis died, including a splenectomized
woman. Nine different capsular serotypes (1, 5, 7, 9, 12, 15, 19A,
20, and 23A) were identified among the 18 fatal cases. Resistance to
penicillin, generally combined with trimethoprim-sulfamethoxazole,
fluctuated annually, not surpassing 10%. CONCLUSIONS: The study results
indicated that 96% of the serotypes involved in severe pneumococcal diseases
were included in the 23-valent vaccine and that S. pneumoniae resistance to
penicillin was moderate.
1368. Jolles
S. Sewell WA. Leighton C. Drug-induced aseptic meningitis: diagnosis and
management. [Review] [162 refs] Drug Safety.
22(3):215-26, 2000 Mar.
Abstract
Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction with numerous agents. It is a diagnosis of exclusion, and clinical signs and CSF findings vary greatly. The body of evidence regarding DIAM is largely in the form of anecdotal case reports and must be interpreted carefully bearing this in mind. The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vaccines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particularly systemic lupus erythematosus, and ibuprofen. There are 2 major proposed mechanisms for DIAM. The first involves direct irritation of the meninges by intrathecal administration of the drug, and the second involves immunological hypersensitivity to the drug, most likely type III and type IV hypersensitivity. Recognition and diagnosis of DIAM is important, as it is treatable by withdrawal of the drug and recurrence is prevented. The outcome of DIAM is generally good, usually without long term sequelae. This article describes the case reports of DIAM in the current literature and discusses the diagnosis and management of this rare complication.
1369.
No Abstract
1370. Kamat DV.
Chakravorty BP. Comparative values of CSF-LDH isoenzymes in neurological
disorders. Indian Journal of Medical Sciences.
53(1):1-6, 1999 Jan.
Abstract
The present study was carried out to evaluate the usefulness of Cerebrospinal fluid (CSF) Lactate dehydrogenase (LDH) isoenzymes in the diagnosis in tuberculous meningitis (TBM), pyogenic meningitis (PM), viral encephalitis (VE) and hydrocephalus (HC). A characteristic dominance of isoenzymes in cerebrospinal fluid was observed: LDH4 in TBM while LDH3 in PM. However, in VE and HC, LDH2 and LDH1 were dominant respectively. The control subjects revealed the presence of isoenzymes LDH1 and LDH2 in very low concentrations. Pattern of LDH isoenzymes in CSF may serve as a diagnostic tool to differentiate these neurological disorders.
1371. Kanamalla US. Ibarra RA. Jinkins JR. Imaging of cranial meningitis and ventriculitis. [Review] [77 refs] Neuroimaging Clinics of North America. 10(2):309-31, 2000 May.
Abstract
A spectrum of infectious diseases may affect the cranial meninges. Contrast-enhanced MR imaging and fluid-attenuated inversion-recovery MR techniques are superior to contrast-enhanced computed tomography for detecting and characterizing most pathologic meningeal conditions. In patients with meningitis, a major role of medical imaging is to identify potential complications such as hydrocephalus, extra-axial mass-forming infectious collections, parenchymal infarcts related to arteritis, ventriculitis, and associated underlying parenchymal abscesses or granuloma formations. Early diagnosis of such complications may reduce the rate of morbidity and mortality in this group of patients.
1372. Kim KS. E. coli invasion of brain microvascular endothelial cells as a pathogenetic basis of meningitis. [Review] [14 refs] Sub-Cellular Biochemistry. 33:47-59, 2000.
Abstract
A major limitation to advances in prevention and therapy of bacterial meningitis is our incomplete understanding of the pathogenesis of this disease. Successful isolation and cultivation of BMEC, which constitute the blood brain barrier, and the development of experimental hematogenous meningitis animal model, which mimics closely the pathogenesis of human meningitis, enabled us to dissect the pathogenetic mechanisms of bacterial meningitis. We have shown for the first time using E. coli as a paradigm the mechanisms of bacterial crossing of the blood-brain barrier into the central nervous system. We have shown that invasion of BMEC is a requirement for E. coli K1 crossing of the blood-brain barrier in vivo (Prasadarao et al., 1996b; Huang et al., 1995). We have identified several novel E. coli proteins (i.e., Ibe10, Ibe7, and Ibe23) contributing to invasion of BMEC. We have also established a novel phenotype, i.e., invasion of BMEC, of a well known major E. coli protein, OmpA. In addition, we have shown that some of these E. coli proteins (i.e., OmpA, Ibe10) interact with novel endothelial receptors present on BMEC, not on systemic vascular endothelial cells. Further understanding and characterization of these E. coli-BMEC interactions should allow us to develop novel strategies to prevent this serious infection. In addition, the in vitro and in vivo models of the blood-brain barrier and the information derived from our study should be beneficial to investigating the pathogenesis of meningitis due to other organisms such as group B streptococci, Listeria monocytogenes, Streptococcus pneumoniae and Citrobacter.
1374. Kumar
S. Puri V. Mehndiratta MM. Gupta
S. Bhutani A. Sharma C. Paradoxical response to antitubercular drugs. Indian Journal of Pediatrics. 62(6):695-701, 1995 Nov-Dec.
Abstract
Seven patients with paradoxical response to antitubercular drugs are reported. In three cases of intracranial tuberculomas, newer lesions appeared and in two cases preexisting tuberculomas enlarged. In two cases of tubercular meningitis, multiple tuberculomas appeared. All these cases exhibited newer symptoms and CT/MBI revealed the paradoxical response to antitubercular drugs. All responded to continued conservative therapy, with addition of pyrazinamide.
1375. Leung WC. Tregoning D. Issues arising from two related cases of childhood tuberculous meningitis. Public Health. 114(1):57-9, 2000 Jan.
Abstract
Two cases of childhood meningitis occurred in the same school within two weeks. The cases were cousins. The first case died and the aetiology was confirmed as tuberculous following a gene probe of a culture from the meningeal tissues at postmortem. The second case, with similar life threatening clinical features compatible with tuberculous meningitis, recovered. Seventy-seven contacts of the two cases among the immediate and extended families were screened. The adult sources of the infection were found to be two aunts of the second case, who were nurses working in the same nursing home. A further 73 contacts of the adult cases were identified. A total of eight close contacts to the aunts were given chemoprophylaxis and three were treated for tuberculosis. Contact tracing was also undertaken in the nursing home but no further cases were identified. These two cases highlight the difficulties in making a rapid diagnosis in tuberculous meningitis, the difficulties in handling media and public concern with limited information, and deciding on the appropriate level of contact tracing in special circumstances.
1376. MacLennan JM. Shackley F. Heath
PT. Deeks JJ. Flamank C. Herbert M.
Griffiths H. Hatzmann
E. Goilav C. Moxon ER. Safety, immunogenicity, and induction of immunologic
memory by a serogroup C meningococcal conjugate vaccine in infants: A
randomized controlled trial [see comments]. JAMA.
283(21):2795-801, 2000 Jun 7.
Abstract
CONTEXT: Neisseria meningitidis is a common
cause of meningitis and septicemia in infants worldwide. Whether a
meningococcal C conjugate vaccine protects infants against the
serogroup C strain is unknown. OBJECTIVES: To determine whether a meningococcal C conjugate vaccine is
safe and immunogenic and induces immunologic
memory in infants. DESIGN:
Single-center, double-blind, randomized controlled trial in 1995 and 1996. SETTING: Community, Oxfordshire, England. PARTICIPANTS: One hundred eighty-two healthy infants. INTERVENTIONS: Participants were randomly assigned to receive vaccination with 0. 5-mL doses of 1 of 2 lots of meningococcal C conjugate vaccine (groups 1 and 2; n=60 in each group) or a hepatitis B control vaccine (group 3; n=62), administered with routine immunizations at 2, 3, and 4 months of age. Approximately half of each group received meningococcal C conjugate vaccine and half received plain meningococcal polysaccharide vaccine (MPS) at 12 months of age. MAIN OUTCOME MEASURES: Serum antibodies to meningococcal C polysaccharide, assayed by enzyme-linked immunosorbent assay, and serum bactericidal activity (SBA), at 2, 3, 4, 5, 12, and 13 months of age; local and systemic reactions, recorded for 6 days after each vaccination, compared by intervention group. RESULTS: Meningococcal C conjugate vaccine was well tolerated. After 3 doses, children in groups 1 and 2 achieved significantly higher meningococcal C IgG geometric mean concentrations (21 and 17 U/mL, respectively, vs 0.20 U/mL; P<.001) and SBA titers (629 and 420, respectively, vs 4.1; P<. 001) than controls. At 12 months, antibody concentrations had decreased in all groups but remained significantly higher in children vaccinated with meningococcal C conjugate vaccine (SBA, 24 and 16 in groups 1 and 2, respectively, vs 4.2 in group 3; P<.001). Following vaccination with MPS at 12 months of age, SBA in the meningococcal C conjugate vaccine group was significantly higher than in controls (SBA, 789 vs 4.5; P<.001). CONCLUSIONS: Our data indicate that meningococcal C conjugate vaccine is safe and immunogenic and results in immunologic memory when given with other routinely administered vaccines to infants at 2, 3, and 4 months of age. JAMA. 2000;283:2795-2801
1377.
Mahadevan S.
Advances in diagnosis of tuberculosis. [Review] [19 refs] Indian Journal of
Pediatrics. 63(2):153-7, 1996 Mar-Apr.
Abstract
The diagnosis of childhood tuberculosis is acknowledged to be an imprecise process since bacteriological confirmation is available in only 30-40% of cases. Newer developments in diagnosis of tuberculosis include use of fluorescent stains for smears, newer systems for radiometric detection of mycobacteria, rapid sensitivity testing using firefly bioluminescence, liquid chromatographic analysis of mycolic acids, immunodiagnostics for M. tuberculosis specific antigens and the impact of molecular diagnostics with amplification methods. The search for simple, reliable test for early stages of the disease (in particular TB meningitis) still continues.
1378.No
Abstract
1379. Maltezou
HC. Spyridis P. Kafetzis DA. Tuberculosis during
infancy. International Journal of
Tuberculosis & Lung Disease.
4(5):414-9, 2000 May.
Abstract
SETTING: A worldwide re-emergence of tuberculosis has been observed during the last decade. However, few studies of infants with tuberculosis appear in the literature. OBJECTIVE: To describe tuberculosis during infancy. DESIGN: The records of all infants diagnosed with tuberculosis at a tertiary care hospital from 1982 to 1998 were reviewed. RESULTS: Thirty-nine infants with a median age of 10 months were identified, 59% of whom presented during the second half of the study period. Diagnoses included endothoracic tuberculosis (33 patients), meningitis (3), miliary tuberculosis (2) and cervical lymphadenitis (1). Reasons for medical evaluation were the onset of symptoms (25 patients), contact investigation (12) and tuberculin skin test screening (2). Common signs and symptoms included fever (22 patients), cough (7), appetite loss (4) and wheezing/rales (4). Chest X-ray revealed hilar adenopathy (22 patients), infiltrates (16), atelectases (3) and miliary pattern (2). Cultures were attempted in nine patients and were positive in seven. All patients responded promptly to treatment. No complications or deaths occurred. CONCLUSION: Tuberculosis in infants has been diagnosed increasingly during the last decade. Endothoracic tuberculosis predominates. One third of the patients were diagnosed due to contact investigation. As early diagnosis and treatment appears to prevent complications and reduce mortality, pediatricians should be alert for tuberculosis in an infant with an atypical picture suggestive of infection.
1380. O'Farrell R. Thornton J. Brennan P. Brett F. Cunningham AJ. Spinal cord infarction and tetraplegia--rare complications of meningococcal meningitis. British Journal of Anaesthesia. 84(4):514-7, 2000 Apr.
Abstract
A previously healthy 25-yr-old female developed flaccid areflexic tetraplegia, with intact cranial nerve function, 36 h after the diagnosis of bacterial meningitis. Polymerase chain reaction studies of cerebrospinal fluid and blood were positive for Neisseria meningitidis, serogroup B. Magnetic resonance of the cervicothoracic spine revealed increased signal intensity and expansion in the lower medulla, upper cervical cord and cerebellar tonsils. Neurosurgical consultation recommended hyperventilation, dexamethasone and regular mannitol therapy rather than decompressive intervention. The clinical course over the following 12 days was complicated by the development of progressive central nervous and multisystem organ failure with disseminated intravascular coagulopathy. Autopsy revealed cerebral oedema with cystic infarction extending from the medulla to the upper cervical cord and cerebellar tonsils. Flaccid areflexic tetraplegia with spinal cord infarction has not been reported following bacterial infection in an adult. The clinical implications would suggest complete central nervous system evaluation of patients recovering from meningococcal meningitis, since spinal cord lesions, although uncommon, do occur. In those very rare situations where a patient develops significant peripheral neurological deficits, urgent magnetic resonance imaging is warranted, to rule out an infective focus or an underlying anatomical anomaly.
1381. Ozates
M. Ozkan U. Kemaloglu S. Hosoglu
S. Sari I. Spinal subdural tuberculous abscess. Spinal Cord. 38(1):56-8, 2000 Jan.
Abstract
OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. Dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained.
CONCLUSION: Tuberculosis may cause a spinal
subdural abscess and although it is a rare disorder, when encountered MRI
is very useful in the diagnosis.
1382. Peltola H. Worldwide Haemophilus influenzae
type b disease at the beginning of the
21st century: global analysis of the disease burden 25 years after the
use of the polysaccharide vaccine and a
decade after the advent of conjugates.
[Review] [191 refs] Clinical Microbiology Reviews. 13(2):302-17, 2000 Apr.
Abstract
Vaccination against Haemophilus influenzae
type b (Hib) diseases began a quarter of a century ago with a
polysaccharide vaccine; this vaccine was followed by four different conjugates 10
years later. In this review, the burden of global Hib disease is quantified
following this 25-year period of vaccine availability to determine the potential impact of conjugate
vaccines. This task was accomplished by
analysis of data available in 10 languages in 75 geographical regions of over
50 countries. All severe Hib diseases, not only meningitis, were
characterized, and special attention was paid to the most vulnerable age group,
i.e., children aged 0 to 4 years. Prior to vaccination, the weighted worldwide
incidence of meningitis in patients younger than 5 years
was 57/100,000, and for all Hib diseases except nonbacteremic pneumonia,
it was 71/100,000, indicating 357,000 and 445,000 cases per year,
respectively. At least 108,500 of these children died. For all age groups
combined, there were 486,000 cases of Hib disease, excluding pneumonia, with
114,200 deaths and probably an equal number of sequelae per annum. If the
figures for nonbacteremic pneumonia are included, a conservative estimate
is that over 2.2 million cases of infection and 520,000 deaths from
Hib disease occurred worldwide, but the true numbers might have been
greater. Despite these large numbers and availability of safe and efficacious
vaccines, only 38,000 cases annually are prevented-a meager 8% or less
than a 2% reduction in cases, depending on whether nonbacteremic pneumonia
is included in the calculations. Although vaccination has had
great success in some affluent countries, the current level of activity has
had a very small impact globally. The use of conjugates, preferably
with a reduced number of doses and in combination with other vaccines or perhaps in fractional doses,
should be extended to less privileged
countries, where most Hib disease occurs.
1383. Pemde
HK. Harish K. Thawrani YP. Shrivastava
S. Belapurkar KM. C-reactive protein in
childhood meningitides. Indian Journal of Pediatrics. 63(1):73-7, 1996 Jan-Feb.
Abstract
Utility of C-reactive protein (CRP) latex agglutination test in meningitis was evaluated. Serum CRP test was positive in 100% cases of meningitic groups and 53% cases of "no meningitis (NM)" group. Cerebrospinal fluid (CSF) CRP test was positive in 100% cases of pyogenic meningitis, whereas it was negative in 95% cases of tuberculous meningitis and 100% cases of NM group. CSF CRP test showed 100% sensitivity and negative predictive values, 95-100% specificity and 94-100% positive predictive values for various inter-group differentiations. This study concluded that CSF CRP positive cases should be considered as pyogenic meningitis unless proved otherwise. Routine use of this simple, reliable and inexpensive test is recommended for rapid diagnosis and differential diagnosis f meningitis.
1384.
Reddy TS. Smith D.
Roy TM. Primary meningococcal pneumonia in elderly patients. American
Journal of the Medical Sciences.
319(4):255-7, 2000 Apr.
Abstract
Neisseria meningitidis infection in humans
usually manifests as meningitis and septicemia with skin manifestations.
Infections of the respiratory tract with N meningitidis have been
documented in the past, but often this organism is not routinely considered in the
differential diagnosis of pneumonia. The pathogenic role of N meningitidis
in lower respiratory tract infections may be underestimated
because its isolation is difficult, particularly when oropharyngeal flora are
present. We profile 2 elderly patients with primary meningococcal
pneumonia to show the importance of Gram stain and culture in early diagnosis.
These modalities helped guide treatment and prophylactic measures.
1385. Satishchandra P. Nalini A. Gourie-Devi M. Khanna N. Santosh V. Ravi V. Desai A. Chandramuki A. Jayakumar PN. Shankar SK. Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96). Indian Journal of Medical Research. 111:14-23, 2000 Jan.
Abstract
One hundred patients (95 males, 5 females,
mean age at presentation 31.6 +/- 9.4 yr) with various neurological
disorders associated with HIV infection during 1989-1996 were evaluated at
NIMHANS, Bangalore. Eighty patients belonged to group I associated with
opportunistic neuroinfections and 20 to group II--non infectious
neurological disorders. Cryptococcal meningitis either alone (n = 31) or
associated with tuberculous meningitis (n = 6) was the most common (46.3%) followed
by neurotuberculosis either alone (n = 24) or with cerebral
toxoplasmosis (n = 4) accounting for 35 per cent. Other opportunistic
neuroinfections included cerebral toxoplasmosis, herpes zoster, fulminant
pyogenic meningitis and neurosyphilis. Clinical characteristics,
diagnostic clues, their laboratory and radiological profiles and
problems encountered in diagnosis and management of these opportunistic
infections are highlighted. In group II (19 males and one female; mean age of
32.6 +/- 9.4 yr), two patients had cortical dementia, three acute brain
stem involvement, two epilepsy and one had features suggestive of
progressive multifocal leukoencephalopathy. Two patients of group I
during follow up developed cortical dementia. Six had peripheral nervous system involvement similar
to Guillain-Barre syndrome. Sixty six
patients (63 of group I and 3 of group II) progressed to AIDS, 33 patients
from group I and one patient from group II succumbed to the disease. With
the rapid increase in the incidence of HIV/AIDS and an increase in the
neurological manifestations of HIV/AIDS it is important to recognise the
magnitude of the problem for health planning in India.
1386.
Scott TF. Cerebral
herniation after lumbar puncture in sarcoid meningitis. Clinical Neurology & Neurosurgery. 102(1):26-8, 2000 Mar.
Abstract
A patient with chronic meningitis due to
neurosarcoidosis became comatose within minutes of a lumbar puncture and died
24 h later. The diagnosis of neurosarcoidosis was made post mortem.
Development of cerebral herniation may have been exacerbated by lumbar
puncture. It was proposed that arachnoid villi dysfunction may have
contributed to very high intracranial pressures in this patient, since post mortem
examination revealed communication between the ventricles and
outlet foramina of the fourth ventricle, and that herniation was in part
due to an acute pressure differential caused by lumbar puncture.
1387. Seward RJ.
Towner KJ. Evaluation of a PCR-immunoassay technique for detection of
Neisseria meningitidis in cerebrospinal
fluid and peripheral blood. Journal of Medical Microbiology. 49(5):451-6, 2000 May.
Abstract
A multiplex PCR-immunoassay for the rapid diagnosis of bacterial meningitis from cerebrospinal fluid (CSF) or peripheral blood was compared with conventional microbiological techniques used in the routine diagnostic laboratory. The multiplex PCR was designed to detect simultaneously a universal conserved sequence coding for bacterial 16S rRNA and the Neisseria meningitidis porA gene. The PCR-immunoassay had a detection limit of (3-5) x 10(2) cfu/ml (equivalent to 1-3 cfu/PCR) with spiked CSF or blood samples, compared with (3-5) x 10(3) cfu/ml for PCR followed by conventional agarose gel electrophoresis for detection of PCR products. Of 294 CSF samples from patients suspected on clinical grounds of suffering from meningitis, the PCR-immunoassay detected bacterial DNA in 29 CSF samples, 15 of which were also positive for N. meningitidis DNA. The 29 positive CSF samples comprised 25 samples that were also reported positive and four that were reported negative by conventional methodology; the latter four were all positive for N. meningitidis by the PCR-immunoassay. Of 173 peripheral blood samples examined, the PCR-immunoassay detected bacterial DNA in 18 samples, 14 of which were also positive for N. meningitidis DNA. In comparison, only 10 samples were reported positive for N. meningitidis by conventional methodology. All negative PCR-immunoassay results correlated with those obtained by conventional methodology for both CSF and blood samples. The sensitivity and speed of the PCR-immunoassay system indicated that it could be used as a routine diagnostic test for meningococcal meningitis, enabling a diagnosis to be made within 4 h of receipt of the specimen.
1388. Stockhammer G. Poewe W. Burgstaller
S. Deisenhammer F. Muigg A. Kiechl S. Schmutzhard E. Maier
H. Felber S. Schumacher P.
Gunsilius E. Gastl G. Vascular endothelial growth factor
in CSF: a biological marker for carcinomatous
meningitis. Neurology. 54(8):1670-6,
2000 Apr 25.
Abstract
OBJECTIVE: To determine the value of vascular endothelial growth factor (VEGF) in CSF as a marker for carcinomatous meningitis (CM). METHODS: The concentration of VEGF was measured by ELISA in matched samples of CSF and serum collected from 162 patients. These included patients with solid tumors with CM (n = 11) or brain metastases without concomitant CM (n = 12), paraneoplastic neurologic syndromes (n = 4), viral (n = 15) and bacterial (n = 20) meningitis, and a variety of non-neoplastic and noninfectious neurologic diseases (n = 100). Using CSF/serum albumin ratios, the VEGF index was calculated to estimate the proportion of intrathecally produced VEGF. Immunohistochemical staining for VEGF was performed in a brain metastasis from a mammary carcinoma associated with CM. RESULTS: High VEGF levels (median 6,794.8 pg/mL) were found in CSF of all patients with CM, whereas VEGF levels in matched sera were comparable to other disease groups. In patients with CM, the concentration of VEGF in CSF decreased significantly following antineoplastic treatment. In CSF samples from patients with brain metastases without concomitant CM, VEGF was not detectable. Median VEGF concentration in CSF from patients with acute bacterial meningitis was 38.6 pg/mL, with only 9 of these 17 patients showing detectable VEGF levels in CSF. The VEGF indices in patients with bacterial meningitis were significantly lower than in tumor patients with CM (<22.8 versus >62.3), suggesting that the proportion of intrathecally produced VEGF is much higher in patients with CM as compared with patients with bacterial meningitis. Patients without neoplastic or infectious neurologic disorders consistently showed VEGF levels in CSF below the assay detection limit of 25 pg/mL. Immunohistochemistry revealed strong cytoplasmic staining for VEGF in a metastatic lesion from breast cancer infiltrating the meninges. CONCLUSION: In patients with carcinomatous meningitis, significant amounts of VEGF are released into CSF. This study yields preliminary evidence that VEGF in CSF may be a useful biologic marker for both the diagnosis and evaluation of treatment response in carcinomatous meningitis.
1389. Terletskaia-Ladwig E. Metzger C. Schalasta G. Enders G. Evaluation of enterovirus serological tests IgM-EIA and complement fixation in patients with meningitis, confirmed by detection of enteroviral RNA by RT-PCR in cerebrospinal fluid. Journal of Medical Virology. 61(2):221-7, 2000 Jun.
Abstract
An enzyme immunoassay (EIA) for detection of anti-enterovirus IgM antibodies was compared with complement fixation test in 43 patients with confirmed enterovirus meningitis by RT-PCR of cerebrospinal fluids (CSF). In 34% of patients with enterovirus meningitis, IgM antibodies could be found, whereas complement fixation tests were positive in only 20%. The specificity was determined with sera of 105 patients with non-enterovirus meningitis. Specificity of IgM EIA and of complement fixation was 94% and 85%, respectively. In four patients with meningitis but without enterovirus detection in CSF, RT-PCR and virus isolation from stools were positive. In three of these patients, IgM antibodies were detected, giving a strong indication of an enterovirus-associated disease. Because of the high specificity of IgM EIA, diagnosis of enterovirus-associated diseases can be carried out in a single serum sample, whereas by complement fixation tests, only fourfold increases in antibody titres in paired sera indicate an acute infection. The application of IgM EIA is especially important in cases of meningitis when CSF samples are not available and for diagnosis of enterovirus diseases with other clinical symptoms such as fever, enteritis, and hand-foot-and-mouth disease. Copyright 2000 Wiley-Liss, Inc.
1390.
Thomas RE. Preparing patients to travel
abroad safely. Part 2: Updating vaccinations. Canadian Family Physician. 46:646-52, 655-6, 2000 Mar.
Abstract
OBJECTIVE: To provide, for family physicians without access to a travel clinic, evidence-based recommendations on vaccinating infants and children, adults, pregnant women, and immunocompromised patients traveling to non-Western countries. QUALITY OF EVIDENCE: Searches were undertaken of MEDLINE from 1990 to November 1998 (372 articles); the Cochrane Collaboration Library; publications of the National Action Committee on Immunization and the Committee to Advise on Tropical Medicine and Travel in Canada Communicable Disease Reports; the Canadian Immunization Guide; and Laboratory Centre for Disease Control, United States Centres for Disease Control, and World Health Organization websites. Evidence-based statements, randomized controlled trials, systematic reviews, and meta-analyses were selected. Vaccination recommendations are based on this evidence. MAIN MESSAGE: Physicians should complete vaccination schedules for children whose primary series is incomplete and vaccinate unvaccinated adults. Hepatitis A is widespread, and travelers to areas where it is endemic should be vaccinated. The elderly should be vaccinated against influenza and pneumococcal disease. Pregnant women should receive vaccines appropriate to their trimester. Immunocompromised patients should be vaccinated, but BCG and live vaccines are contraindicated. Travelers to areas where meningitis, typhoid, cholera, Japanese encephalitis, and rabies are endemic should be vaccinated if they are likely to be exposed. Those traveling to areas where tuberculosis is endemic should take precautions and should have skin tests before traveling and 2 to 4 months after return. CONCLUSIONS: Family physicians can administer all necessary vaccinations. They can advise pregnant women and immunocompromised people about the balance of risk of disease and benefits of vaccination.
1391. White AC Jr. Neurocysticercosis: updates on epidemiology, pathogenesis, diagnosis, and management. [Review] [90 refs] Annual Review of Medicine. 51:187-206, 2000.
Abstract
Neurocysticercosis is now recognized as a common cause of neurologic disease in developing countries and the United States. The pathogenesis and clinical manifestations vary with the site of infection and accompanying host response. Inactive infection should be treated symptomatically. Active parenchymal infection results from an inflammatory reaction to the degenerating cysticercus and will also respond to symptomatic treatment. Controlled trials have not demonstrated a clinical benefit for antiparasitic drugs. Ventricular neurocysticercosis often causes obstructive hydrocephalus. Surgical intervention, especially cerebrospinal fluid diversion, is the key to management of hydrocephalus. Shunt failure may be less frequent when patients are treated with prednisone and/or antiparasitic drugs. Subarachnoid cysticercosis is associated with arachnoiditis. The arachnoiditis may result in meningitis, vasculitis with stroke, or hydrocephalus. Patients should be treated with corticosteroids, antiparasitic drugs, and shunting if hydrocephalus is present.
1392. Wu
HS. Kolonoski P. Chang YY.
Bermudez LE. Invasion of the brain and chronic central nervous system
infection after systemic Mycobacterium avium complex infection in mice.
Infection & Immunity.
68(5):2979-84, 2000 May.
Abstract
Central nervous system (CNS) infections
caused by nontuberculous mycobacteria have been described previously,
especially in patients with AIDS. To investigate specific aspects of the
pathogenesis of this entity, C57BL bg(+)/bg(-) mice were infected intravenously with Mycobacterium
avium, and cultures of blood and brain as
well as histopathology examination of brain tissue were carried out
at several time points up to 6 months after infection. Low-grade
inflammatory changes with small aggregates of lymphocytes and macrophages as
well as perivascular cuffing were seen early in the infection. A small
number of bacteria could be observed in the parenchyma of the choroid
plexus. Six months after infection, numerous bacteria were present
within the foamy macrophage of the granulomatous lesions along the
ventricle and meninges. None of the mice developed clinical signs of meningitis
or encephalitis or even died spontaneously during the period of
observation. Use of CD18(-/-) knockout mice indicated that transport of the
bacterium within neutrophils or monocytes into the brain is unlikely. Mild
chronic CNS infection developed in the mice during sustained systemic M.
avium infection, similar to what has been reported in most human cases.
1798. Andersen O. Myelitis. Current Opinion in Neurology. 13(3):311-6, 2000 Jun.
Abstract
Acute transverse myelitis (ATM) with
moderate symptomatology and smaller multiple magnetic resonance imaging lesions
is often caused by multiple sclerosis. Severe ATM with extensive
magnetic resonance imaging lesions with or without associated meningitis often
has a viral cause, particularly in the younger age groups,
whereas vascular disorders may prevail among older patients. Previously,
one had to rely on indirect evidence such as viral serology or viral
identification in throat washings to confirm a diagnosis of myelitis. Thus,
mycoplasma myelitis may occur coincident with a mycoplasma pneumonia.
Viral myelitis is now often diagnosed by specific polymerase chain
reaction of the cerebrospinal fluid, for echovirus, Coxsackie virus, mumps
virus, herpes simplex virus or varicella-zoster virus, but an autoimmune
component may still be important. An anterior horn syndrome may be
produced by the tick-borne encephalomyelitis virus. Severe ATM may also
be a postinfectious or postvaccinal disorder [i.e. a partial acute
disseminated encephalomyelitis (ADEM)]. Neuromyelitis optica, a combination
of severe myelitis and optic neuritis, is often a manifestation of ADEM
or systemic lupus erythematosus. Many of these disorders are potentially treatable with
specific antiviral agents or
immunosuppression. 'Idiopathic' ATM is probably a consequence of inadequate
examination and follow up. The differential diagnoses-viral myelitis,
multiple sclerosis, ADEM, neuromyelitis optica, spinal arteriovenous
malformation and arteritis-should be considered and are usually identified by a rapid
diagnostic work-up, leaving few ATM cases
undiagnosed.
1799. Atobe JH. Hirata MH. Hoshino-Shimizu S. Schmal MR. Mamizuka EM. One-step heminested PCR for amplification of Neisseria meningitidis DNA in cerebrospinal fluid. Journal of Clinical Laboratory Analysis. 14(4):193-9, 2000.
Abstract
A one-step polymerase chain reaction (Heminested-PCR) was designed to target the 16S rRNA fragment simultaneously using a set of primers for the universal bacterial group and a Neisseria meningitidis species-specific sequence for diagnostic purposes. The diagnostic features of the Heminested-PCR were evaluated in the study of 168 cerebrospinal fluid (CSF) specimens from 84 patients with a N. meningitidis infection, meningitis caused by unrelated bacteria and other etiologies (57 patients), or suspicious cases (27 patients) with clinical symptoms of bacterial meningitis but with negative results from bacteriological procedures. About 90% of patients with bacterial meningitis, including those suspicious cases, had prior antibiotic therapy. The sensitivity, specificity, positive, and negative predictive values found in relation to culture and/or microscopy were 91.7, 100, 100, 100, and 90.5%, respectively. In patients suspected of having bacterial meningitis, the Heminested-PCR revealed 51.9% (14 patients) positive for N. meningitidis infection and 40.7% (11 patients) positive for unrelated bacterial infections. The agreement of the Heminested-PCR with culture and/or microscopy was high and ranked as almost perfect (kappa indices > 0.856), in contrast to its agreement with other techniques. These findings speak in favor of the molecular diagnosis of meningococcal meningitis in patients who are culture- and/or microscopy-negative, due to their prior antibiotic treatment. Copyright 2000 Wiley-Liss, Inc.
1800. Auer M.
Pfister LA. Leppert D. Tauber MG.
Leib SL. Effects of clinically used antioxidants in
experimental pneumococcal meningitis. Journal of Infectious Diseases. 182(1):347-50, 2000 Jul.
Abstract
Reactive oxygen intermediates mediate brain injury
in bacterial meningitis. Several antioxidant drugs are
clinically available, including N-acetylcysteine (NAC), deferoxamine (DFO),
and trylizad-mesylate (TLM). The present study evaluated whether these
antioxidants are beneficial in a model of pneumococcal meningitis. Eleven-day-old rats were infected
intracisternally with Streptococcus
pneumoniae and randomized to intraperitoneal treatment every 8 h with NAC
(200 mg/kg), DFO (100 mg/kg), TLM (10 mg/kg), or saline (250 microL).
TLM-treated animals showed a significantly reduced mortality compared
with controls (P<.03). Meningitis led to extensive cortical injury at 22+/-2.2
h after infection (median, 14. 6% of cortex; range, 0-61.1%). Injury
was significantly (P<.01) reduced to 1.1% (range, 0-34.6%) by NAC, to
2.3% (range, 0-19.6%) by DFO, and to 0.2% (range, 0-36.9%) by TLM (the difference was not significant
among the 3 groups). None of the drugs
reduced hippocampal injury. Thus, several clinically used antioxidants reduced
cortical injury in experimental pneumococcal meningitis.
1801. Carrol ED.
Thomson AP. Shears P. Gray SJ.
Kaczmarski EB. Hart CA.
Performance characteristics of the
polymerase chain reaction assay to confirm clinical meningococcal disease. Archives of Disease in Childhood. 83(3):271-3, 2000 Sep.
Abstract
BACKGROUND: Confirmation of clinical
meningococcal disease (MCD) is essential for management of patients,
contacts, and outbreaks. Blood and CSF cultures, the traditional gold standard
diagnostic tests, have been adversely affected by preadmission
parenteral penicillin and fewer lumbar punctures. Rapid, reliable serogroup
determination without the need to grow isolates could improve laboratory confirmation of MCD. AIMS: To
determine performance characteristics of the
currently available meningococcal polymerase chain reaction
(PCR) assays in a clinical setting. METHODS: Prospective study of 319
children presenting with a suspected diagnosis of MCD (fever and a
rash, or suspected bacterial meningitis) over a 16 month period. RESULTS:
A total of 166 (52% of all) children had clinical MCD: diagnosis was confirmed microbiologically in
119 (72%) of these. Performance
characteristics (sensitivity, specificity, negative predictive value, positive
predictive value) in confirmation of clinical MCD were respectively (95%
confidence interval): blood culture 31% (24-38%), 100%, 57% (49-65%), 100%;
blood PCR 47% (39-55%), 100%, 65% (58-73%), 100%; any test positive 72%
(65-79%), 100%, 77% (70-84%), 100%. CONCLUSIONS: Meningococcal DNA detection in
blood or CSF by PCR is a useful method of diagnosis of MCD. PCR of
peripheral blood performs better than blood culture. In a child with clinically suspected MCD, PCR assays,
bacterial antigen tests, and oropharyngeal swabbing for meningococcal
carriage should be performed in addition to
blood or CSF culture, to improve case confirmation.
1802.
DeRiemer K.
Soares EC. Dias SM. Cavalcante SC. Title HIV testing among tuberculosis patients in
the era of antiretroviral therapy: a population-based study in Brazil. International Journal of Tuberculosis &
Lung Disease. 4(6):519-27, 2000 Jun.
Abstract
SETTING: Rio de Janeiro, Brazil, a city with 29862 cases of tuberculosis (TB) reported between January 1995 and June 1998. OBJECTIVES: To evaluate the counseling and testing practices for human immunodeficiency virus (HIV) infection among TB patients, and to identify the patient characteristics associated with HIV screening as antiretroviral therapy was introduced. DESIGN: Cross-sectional study of patients with TB who were reported to the health department and who initiated anti-TB treatment. The main outcome measure was screened versus not screened for HIV. RESULTS: The proportion of TB patients who received HIV screening increased from January 1995 through June 1998 (P < 0.001). Among young adults aged 20-49 years with TB, the independent predictors of HIV screening were a diagnosis of both pulmonary and extrapulmonary TB (odds ratio [OR] = 2.4, 95% confidence interval [CI] 2.1-2.8); TB meningitis (OR = 13.5, 95%CI 6.5-31.5); disseminated TB (OR = 8.2, 95%CI 5.3-12.9); lymphatic TB (OR = 5.6, 95%CI 4.7-6.6); and male sex (OR = 1.4, 95%CI 1.3-1.6). Patients with newly diagnosed TB who were women, lived in a low income neighborhood (OR = 0.7, 95%CI, 0.6-0.7), and sought TB treatment in their own residential neighborhood (OR = 0.3, 95%CI 0.3-0.4) were less likely to receive HIV counseling and testing. CONCLUSION: Health care providers in Rio de Janeiro selectively offered HIV counseling and testing to persons they perceived to be at risk for HIV and those with advanced stages of TB. HIV counseling and testing should be expanded and offered to all TB patients.
1803. Drake R. Dravitski J. Voss L. Hearing in children after meningococcal meningitis. Journal of Paediatrics & Child Health. 36(3):240-3, 2000 Jun.
Abstract
OBJECTIVE: To review the outcome of sensorineural hearing loss in children who have had confirmed meningococcal meningitis. METHODS: A retrospective audit of children admitted to the Starship Children's Hospital with a confirmed diagnosis of meningococcal meningitis during a 4-year period. RESULTS: Sixty-five children had confirmed meningococcal meningitis. Dexamethasone was administered according to recommended guidelines in 46 children (72%) while 12 children (19%) did not receive steroids at any stage. All children were appropriately referred for hearing assessment. Forty-nine children (75%) had their hearing tested and reliable sensorineural evaluation was obtained in all but one case. Thirty-four children (70%) were seen up to 6 weeks from discharge, 86% by 12 weeks. Sixteen cases (25%) did not attend for audiological assessment. Sensorineural hearing impairment was found in two children (4.2%). CONCLUSIONS: Children with meningococcal meningitis were reliably referred for audiological assessment but 39% either failed to attend for an outpatient hearing evaluation (25%) or had an unacceptable delay between discharge and testing (14%). Of those reliably tested, two children (4.2%) had significant sensorineural hearing loss.
1804.
Eintracht S. Silber E. Sonnenberg
P. Koornhof HJ. Saffer D. Analysis of adenosine deaminase isoenzyme-2
(ADA(2)) in cerebrospinal fluid in the diagnosis of tuberculosis
meningitis [letter]. Journal of Neurology, Neurosurgery &
Psychiatry. 69(1):137-8, 2000 Jul.
1805. Farinha NJ.
Razali KA. Holzel H. Morgan G.
Novelli VM. Tuberculosis of the central nervous system
in children: a 20-year survey. Journal of Infection. 1(1):61-8, 2000 Jul.
Abstract
OBJECTIVE: To review our experience of central nervous system (CNS) tuberculosis at a major British paediatric tertiary referral centre, following the introduction of CT Scan facilities. METHODS: This was a retrospective case survey (prospective in nine patients) of patients admitted to Great Ormond Street over a 20-year period (1977-1997), who fulfilled criteria for a diagnosis of CNS tuberculosis. Data were collected with regard to the clinical, laboratory and demographic characteristics of patients, as well as results of radiological investigations and data on clinical outcome. RESULTS: We identified 38 children with CNS tuberculosis: 23 with tuberculous meningitis (TBM), 10 with tuberculous meningitis and associated tuberculomas and five with tuberculomas alone. The mean age of this group was 3.7 years, ranging from 8 months to 16 years. Only 14 (37%) were of Caucasian origin. A contact source was identified in 18 patients (47%). Previous BCG had only been given to six (16%). The main clinical symptoms and signs present on admission were alteration in consciousness in 30 patients (79%), focal neurological signs in 25 (66%) and fever in 25 (66%). Seizures were observed in 20 patients (53%) and meningism in 18 (47%). Mycobacterium tuberculosis was either cultured or identified by acid-fast stain from CSF or brain tissue from 24 patients (63%). The Mantoux reaction was positive in 17/33 (51%); abnormalities of the chest X-ray were found in 15 (40%). Cranial CT scans of the patients presenting with TBM showed hydrocephalus in 31 patients (94%), and basilar enhancement in 27 (93%) out of the 29 patients who received intravenous contrast. Anti-tuberculous therapy administered varied according to current recommendations of the period; concurrent steroids were given to 31 patients (82%). Neurosurgical procedures were required in the majority of patients with TBM, 25 (76%). In five patients with TBM, new tuberculoma developed during treatment. The overall mortality for our group of patients was 13%, whilst permanent neurological sequelae were seen in 47% of the patients. None of the patients who received BCG either died or had severe sequelae. Mortality and morbidity rates were higher in the first 10 years of the study and amongst those patients admitted in Stage III disease. CONCLUSIONS: CNS tuberculosis continues to be a condition which carries significant morbidity and mortality. Early diagnosis and prompt initiation of treatment are essential to improve the poor outcome. Copyright 2000
1806.
Garcia NS.
Castelo JS. Ramos V. Rezende GS.
Pereira FE. Frequency of myocarditis in cases of fatal
meningococcal infection in children: observations on 31 cases studied at
autopsy. Revista Da Sociedade Brasileira de Medicina
Tropical. 32(5):517-22, 1999 Sep-Oct.
Abstract
The frequency of myocarditis associated with
meningococcal disease in children was reported only in two autopsied
series (United States and South Africa). Here we report the frequency
of associated myocarditis in 31 children who died of meningococcal infection at Hospital Infantile
N.S. da Gloria in Vitoria, Espirito Santo State, Brazil. The diagnosis was
confirmed by isolation of Neisseria
meningitidis. At least three sections of fragments of both atria and ventricles
were studied using the Dallas Criteria for the morphologic diagnosis of
myocarditis. The mean age was 47.6 +/- 39.8 months and the mean survival
time after the onset of symptoms was 46.1 +/- 26.5 h (12-112 h).
Myocarditis was present in 13 (41.9%) patients, being of minimal severity in 11 cases and of moderate
severity in 2 cases. There were no cases
with severe diffuse myocarditis. The frequency of myocarditis was not
influenced by sex, presence of meningitis, survival time after the onset of
symptoms or use of vasoactive drugs. The frequency of myocarditis reported
here was intermediate between the values reported in the only two case
series published in the literature (57% in the United States and 27%
in South Africa). Although our data confirm the high frequency of myocarditis in meningococcal
disease, further investigations are
necessary to elucidate the contribution of myocarditis to myocardial
dysfunction observed in cases of meningococcal infection in children.
1807. Hernandez Abanto SM. Hirata MH. Hirata RD. Mamizuka EM. Schmal M.oshino-Shimizu S. Evaluation of Henes-PCR assay for Mycobacterium detection in different clinical specimens from patients with or without tuberculosis-associated HIV infection. Journal of Clinical Laboratory Analysis. 14(5):238-45, 2000.
Abstract
The need for early diagnosis of tuberculosis, particularly in HIV-infected patients, requires the development of diagnosis methods that have a high sensitivity and specificity, as does the nucleic acid-based technology. With the purpose of improving the detection of mycobacterium in different clinical samples, we proposed and evaluated an assay based on nucleic acid-amplification: heminested-PCR (Henes-PCR). The procedure was designed to identify Mycobacterium spp., M. tuberculosis complex (MTC), and M. avium complex (MAC), although it has the potential to include more primers for the identification of other species. Analytical and clinical evaluation of Henes-PCR was performed by analysis of reference strains and 356 clinical specimens from 246 patients with pulmonary and meningitis tuberculosis and unrelated infections, including 142 HIV-infected individuals. Ninety-three percent (199) positive and 100% (143) negative results were obtained in specimens from patients with tuberculosis and non-tuberculosis infection, respectively. The overall sensitivity of Henes-PCR was 93.4%, specificity was 100%, positive and negative predictive values were 100 and 91.1%, respectively. Sensitivity and negative predictive value of Henes-PCR were significantly higher than culture procedure for microscopy-negative specimens. Even though frequency of HIV infection was higher in patients with tuberculosis, diagnostic parameters of Henes-PCR were similar between HIV-positive and HIV-negative patients. MTB was identified in 194 (98%) specimens while MAC was detected in 5 (2%) specimens. These findings suggest that Henes-PCR is a useful test for rapid detection of mycobacterium in clinically suspected cases of tuberculosis with smear-negative results. Copyright 2000 Wiley-Liss, Inc.
1808.Hernandez-Albujar S. Arribas JR. Royo A. Gonzalez-Garcia JJ. Pena JM. Vazquez JJ. Tuberculous radiculomyelitis complicating tuberculous meningitis: case report and review. Clinical Infectious Diseases. 30(6):915-21, 2000 Jun.
Abstract
Tuberculous radiculomyelitis (TBRM) is a
complication of tuberculous meningitis (TBM), which has been reported
rarely in the modern medical literature. We describe a case of TBRM that
developed in an human immunodeficiency virus (HIV)-infected
patient, despite prompt antituberculous treatment. To our knowledge,
this is the second case of TBRM reported in an HIV-infected patient. We
also review 74 previously reported cases of TBRM. TBRM develops at
various periods after TBM, even in adequately treated patients after
sterilization of the cerebrospinal fluid (CSF). The most common symptoms are
subacute paraparesis, radicular pain, bladder disturbance, and subsequent paralysis. CSF evaluation
usually shows an active inflammatory
response with a very high protein level. MRI and CT scan are critical for
diagnosis, revealing loculation and obliteration of the subarachnoid space
along with linear intradural enhancement. As in other forms of
paradoxical reactions to antituberculous treatment, there is evidence that steroid
treatment might have a beneficial effect.
1809.
Kao HT.
Huang YC. Lin TY. Influenza A virus infection in infants.
Journal of Microbiology, Immunology & Infection. 33(2):105-8, 2000 Jun.
Abstract
Influenza A virus causes a variety of respiratory and nonrespiratory illness in children. The symptomatology varies with different age groups. The purpose of this retrospective study was to define the clinical characteristics of influenza A infection in Taiwanese infants. During the period from December 1997 to February 1998, 37 febrile patients younger than 1 year of age, including five newborns, were admitted to our hospital due to suspicion of sepsis or meningitis. The medical records of these patients were retrospectively evaluated. Influenza A virus was isolated from the specimens of the throat swabs in all patients, whereas no bacterial pathogen was detected. The most common clinical manifestations of these infants were lower respiratory tract infections, including pneumonia, bronchiolitis, and croup. There was no significant difference between the clinical characteristics of infants younger than 3 months and those aged from 3 months to 1 year. The mean duration of fever, peak of body temperature, and duration of hospitalization were 3.41 (+/-1.86) versus 4.4 (+/-2.02) days, 39.0 (+/-0.57) versus 39.9 (+/-0.63) oC, 4.9(+/-1.49) versus 6.3 (+/-3.7) days in infants younger than 3 months and infants aged from 3 months to 1 year, respectively. The older infants aged from 3 months to 1 year had a significantly higher peak body temperature than the infants younger than 3 months (p < 0.05). Two patients with croup had a more severe clinical course, however, the outcomes were good in all patients. During an influenza A virus outbreak, influenza A infection should be included in the differential diagnosis of infants with lower respiratory tract infection.
1810.
Kochar DK.
Kumawat BL. Agarwal N. Shubharakaran. Aseri S. Sharma BV.
Rastogi A. Meningoencephalitis in brucellosis. Neurology India. 48(2):170-3, 2000 Jun. Abstract
Human brucellosis, more specifically neurobrucellosis, is a less commonly reported disease in India; although, animal brucellosis and seroprevalence in specific areas is well reported. We are reporting 4 cases of neurobrucellosis presenting as meningoencephalitis. Diagnosis was confirmed by serological test and agglutination titre was > 1:320 in all the patients. All these patients had close contact with animals and history of raw milk ingestion was present in 3 cases. The aim of presenting these cases is to create awareness among physicians while treating meningitis in persons, engaged in occupations related to brucellosis or having a history of ingestion of raw milk or milk product.
1811. Kozar MP. Krahmer MT. Fox A. Gray BM. Failure To detect muramic acid in normal rat tissues but detection in cerebrospinal fluids from patients with Pneumococcal meningitis. Infection & Immunity. 68(8):4688-98, 2000 Aug.
Abstract
Muramic acid serves as a marker for the
presence of bacterial cell wall debris in mammalian tissues. There have been
a number of controversial and sometimes conflicting results on assessing
the levels of muramic acid in health and disease. The present report is
the first to use the state-of-the art technique, gas
chromatography-tandem mass spectrometry, to identify and quantify the levels of
muramic acid in tissues. Muramic acid was not found in normal rat brain or
spleen. However, when tissues were spiked with muramic acid, it was
readily identified. The detection limit was <1 ng of muramic acid/100 mg
(wet weight) of tissue. The levels of muramic acid reported in diseased human
spleen and spleen of arthritic rats, previously injected with bacterial cell walls, were 100- to
1,000-fold higher. In the present study,
muramic acid was also readily detected in the cerebrospinal fluid of
patients with pneumococcal meningitis (6.8 to 3,900 ng of muramic
acid/ml of cerebrospinal fluid). In summary, there can be an enormous difference
in the levels of muramic acid found in different mammalian tissues and
body fluids in health and disease. This report could have great impact
in future studies assessing the role of bacterial cell wall remnants in
the pathogenesis of certain human inflammatory diseases.
1813. Najioullah F. Bosshard S. Thouvenot D. Boibieux A. Menager B. Biron F. Aymard M. Lina B. Diagnosis and surveillance of herpes simplex virus infection of the central nervous system. Journal of Medical Virology. 61(4):468-73, 2000 Aug.
Abstract
Herpes simplex viruses (HSV) are responsible
for neurological disorders that require rapid diagnostic methods and
specific antiviral therapy. During 1997, 1431 cerebrospinal fluid
samples (CSF) collected from 1339 patients with neurological disorder presentations
were processed for HSV detection. Eleven patients were positive for
HSV, seven presenting with encephalitis (6/7 due to HSV1) and 4 with
aseptic meningitis (4/4 due to HSV2). The incidence of HSV encephalitis was
2.33 cases / 10(6) inhabitants/year. Among encephalitis (HSV
encephalitis) cases, 1 patient died due to the late implementation of
antiviral therapy, and sequelae were observed in 4 cases. No sequelae were
observed in aseptic meningitis cases. Four HSV encephalitis cases were
monitored by PCR detection in CSF. Despite acyclovir therapy, PCR remained positive in CSF up to 20 days in 2
cases. This result suggest that the
antiviral treatment for HSV encephalitis should be monitored by PCR
detection of HSV in CSF. Copyright 2000 Wiley-Liss, Inc.
1814. Nigrovic LE. Chiang VW. Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis [see comments]. Archives of Pediatrics & Adolescent Medicine. 154(8):817-21, 2000 Aug.
Abstract
BACKGROUND: Infants with fever and cerebrospinal fluid (CSF) pleocytosis are routinely admitted to the hospital for parenteral antibiotic therapy for potential bacterial meningitis pending results of CSF culture. Published estimates suggest that 90% of all episodes of meningitis are caused by enterovirus. Enteroviral polymerase chain reaction (ePCR) has a sensitivity of 92% to 100% and a specificity of 97% to 100% in CSF.
OBJECTIVE: To compare a management strategy
using ePCR with current practice to determine potential savings by
allowing earlier discharge. METHODS: Decision analysis comparing 2
strategies for the care of a retrospective cohort of infants with fever and CSF pleocytosis: standard
practice vs ePCR testing of all CSF samples.
Model assumptions include the following: (1) standard practice patients
continue parenteral antibiotic therapy until CSF cultures are negative at
48 hours, (2) patients with positive ePCR results would be discharged
after 24 hours, (3) patients with positive ePCR results have a negative
CSF culture, and (4) costs are calculated from actual patient charges with
a cost-to-charge ratio of 0.65. SUBJECTS: All infants aged 28 days to
12 months admitted to an urban teaching hospital with fever, CSF
pleocytosis, and a negative CSF Gram stain from January 1996 through December
1997. OUTCOME MEASURE: Total cost of hospitalization. RESULTS: A total of 126
infants were identified. One hundred twelve (89%) were discharged with a
diagnosis of aseptic meningitis; 72% of these cases occurred
during the peak enterovirus season (June to October). Three of 3 patients with
positive CSF cultures had bacterial growth within 24 hours of
admission. Mean length of stay for patients with aseptic meningitis was 2.3
days (SD, +/-1.4 days). Total cost of hospital care for all 126 infants
was $381,145. In our patient population, total patient costs would be
reduced by the ePCR strategy if enterovirus accounts for more than 5. 9% of
all meningitis cases. Varying the sensitivity of the ePCR assay from 100%
to 90% changes the "break-even" prevalence from 5.8%
to 6.5%. Total cost savings of 10%, 20%, and 30% would occur at an enteroviral
meningitis prevalence of 36.3%, 66.7%, and 97.1%, respectively. CONCLUSIONS:
Enteroviral PCR analysis of CSF for infants admitted to the hospital
with meningitis can result in cost savings when the prevalence of
enteroviral meningitis exceeds 5.9%. Limiting use of ePCR to the enterovirus
season would increase cost savings. A prospective study is needed to
validate these results. Arch Pediatr Adolesc Med. 2000;154:817-821
1815. Portegies P. Corssmit N. Epstein-Barr virus and the nervous system. Current Opinion in Neurology. 13(3):301-4, 2000 Jun.
Abstract
The neurological complications of Epstein-Barr virus infection include viral meningitis, encephalitis and neuromuscular complications. The introduction of cerebrospinal fluid polymerase chain reaction for Epstein-Barr virus DNA has improved diagnosis of these conditions and of primary central nervous system lymphoma in acquired immune deficiency syndrome, and has enabled cerebrospinal fluid monitoring of therapy. Prognosis remains good for most Epstein-Barr virus-related neurological complications; for primary central nervous system lymphoma in acquired immune deficiency syndrome the prognosis is still poor.
1816. Rajnik M.
Ottolini MG. Serious infections of the central nervous
system: encephalitis, meningitis, and brain abscess. Adolescent Medicine. 11(2):401-25, 2000 Jun.
Abstract
Central nervous system infections in
adolescents range from the diffuse cerebritis of encephalitis to the regional
inflammation of meningitis, and very focal disease of brain abscess.
Clinical presentations reflect this wide spectrum, with encephalitis primarily
characterized by altered mental status, meningitis by fever, headache, and neck stiffness, and brain
abscess manifesting localizing findings.
Encephalitis and viral meningitis are frequently caused by the seasonal
enteroviruses and arboviruses, while most adolescent bacterial meningitis is due
to Neisseria meningitidis and Streptococcus
pneumoniae. The microbiology
of brain abscess reflects underlying host risk factors. Gram-positive
cocci are seen in patients with congenital heart disease, while
respiratory flora including anaerobes are associated with sinus or otic disease. Lumbar puncture to characterize
and culture the CSF remains the optimal test
for the diagnosis and management of encephalitis and meningitis,
while CT-guided needle biopsy may be both diagnostic and therapeutic for
brain abscesses. New diagnostic tests include the use of PCR. A variety of
safe and effective treatment regimens exists for most bacterial
infections as well as for some herpesvirus infections. New vaccines are under study to further control
bacterial meningitis.
1817. Sanchez-Portocarrero J. Perez-Cecilia E. Corral O. Romero-Vivas J. Picazo JJ. The central nervous system and infection by Candida species. Diagnostic Microbiology & Infectious Disease. 37(3):169-79, 2000 Jul.
Abstract
In this paper we have reviewed the main
clinico-pathologic disease groups of neurocandidiasis: the microabscesses, the
macroabscesses, and the meningitis. Special attention has been paid
to the predisposing conditions for the appearance of neurocandidiasis, the
neuroimaging techniques, and the study of the cerebrospinal fluid, needed
for diagnosis. We have also discussed the differential diagnosis with other illnesses. Treatment
should be given with amphotericin-B and
5-fluorocytosine. The use of other antifungal drugs for neurocandidiasis is
also discussed.
1818.
Scott TF.
Brillman J. Shunt-responsive dementia in sarcoid
meningitis: role of magnetic resonance imaging and cisternography. Journal of Neuroimaging. 10(3):185-6, 2000 Jul.
Abstract
The authors report a patient with
progressive cognitive and gait decline in association with sarcoid meningitis. The
patient had evidence of active inflammation as determined by cerebrospinal
fluid examination and was steroid dependent. Magnetic resonance
imaging and radionucleotide cisternography were complementary in establishing the diagnosis of
communicating hydrocephalus, and suggested
that the patient would be shunt responsive.
1819. Smith MB.
Boyars MC. Veasey S. Woods GL. Generalized tuberculosis in the acquired
immune deficiency syndrome. Archives of Pathology & Laboratory
Medicine. 124(9):1267-74, 2000 Sep.
Abstract
OBJECTIVE: Generalized, or hematogenously
disseminated, tuberculosis (TB) in patients with the acquired immune
deficiency syndrome (AIDS) has been associated with a high incidence of cases
remaining undiagnosed until postmortem. To better characterize
generalized TB in the setting of AIDS, this report describes the clinical,
laboratory, radiologic, and pathologic features of 20 fatal cases. DESIGN: The
medical records, autopsy protocols, and histologic material from
patients with AIDS and concomitant TB were reviewed. All patients were
autopsied at a tertiary care medical center during the years 1985-1997. RESULTS:
In 50% of our 20 cases, diagnosis was not made until postmortem.
Signs and symptoms were few, including the absence of fever (temperature
> or = 38 degrees C) in 55% of patients. Consistent laboratory
abnormalities of a nonspecific nature were limited to hyponatremia (sodium <135
mmol/L) in 60%. Both peripheral and deep (thoracic and abdominal)
lymphadenopathy, unusual in adults with TB, occurred in 45% and 95% of cases,
respectively. In contrast to previous reports, all of the 6 cases of tuberculous
meningitis presented as acute meningitis with a predominance of
neutrophils in cerebrospinal fluid. Necrotizing encephalitis with extension of
the acute inflammation into the superficial cortex was seen in all cases and
tuberculous brain abscesses occurred in 50% of cases, a higher frequency
than previously reported. Despite lung involvement in 90% of the
cases, 33% of chest radiographs were interpreted as normal and disseminated
mycobacterial disease was not suggested in the radiograph report in any of
the other cases. Soft tissue abscesses in uncharacteristic locations such
as the neck, mediastinum, and perirectal area occurred in these patients.
Histologically, 95% of organs sampled showed inflammatory foci
characterized by extensive necrosis with numerous neutrophils and/or karyorrhectic
debris, numerous acid-fast bacilli, few or no epithelioid histiocytes,
and no Langhans giant cells. CONCLUSION: Clinically and pathologically,
generalized TB in the setting of AIDS is characterized by either unusual
features or a lack of the typical features described for generalized
TB in patients who do not have AIDS. This absence of classic features
contributes to the high incidence of cases that remain undiagnosed until
postmortem examination.
1820. Tambussi G. Gori A. Capiluppi B. Balotta C. Papagno L. Morandini B. Di Pietro M. Ciuffreda D. Saracco A. Lazzarin A. Neurological symptoms during primary human immunodeficiency virus (HIV) infection correlate with high levels of HIV RNA in cerebrospinal fluid. Clinical Infectious Diseases. 30(6):962-5, 2000 Jun.
Abstract
This analysis involves 22 patients with
diagnosed symptomatic human immunodeficiency virus (HIV) infection.
Neurologic symptoms were present in 11 patients, ranging from severe and
persistent headache to clinical signs suggestive of meningitis. A strong correlation between neurological
symptoms and cerebrospinal fluid (CSF) viral
load was found. The mean CSF HIV ribonucleic acid (RNA) level was 4. 12
log for patients with neurological symptoms and 2.58 log for
patients without neurological symptoms (P<.00001). Plasma viral load
alone does not correlate or predict central nervous system (CNS) involvement. In
our sample of patients, HIV RNA levels could be detected in most
patients regardless of the presence of neurological symptoms. Moreover, early treatment including drugs with
high levels of penetration in the CNS must
be considered for patients with primary HIV infection.
1821. Tzeng YL.
Stephens DS. Epidemiology and pathogenesis of Neisseria
meningitidis. Microbes & Infection. 2(6):687-700, 2000 May.
Abstract
Neisseria meningitidis, an exclusive
pathogen of humans, remains the leading worldwide cause of meningitis and
fatal sepsis, usually in otherwise healthy individuals. In recent
years, significant advances have improved our understanding of the
epidemiology and genetic basis of meningococcal disease and led to progress in
the development of the next generation of meningococcal vaccines. This
review summarizes current knowledge of the human susceptibility to and
the epidemiology and molecular pathogenesis of meningococcal
disease.
1822.
Yeat SW.
Mukari SZ. Said H. Motilal R. Post meningitic sensori-neural hearing loss
in children--alterations in hearing level. Medical Journal of Malaysia. 52(3):285-90, 1997 Sep.
Abstract
Post meningitic sensori-neural hearing loss
was studied in forty new cases of bacterial meningitis and ten cases of
viral meningitis treated at the Pediatric Institute, Kuala Lumpur Hospital
from April 1991 to March 1992. Hearing assessment at 2 weeks, 3 months and
6 months following the diagnosis of meningitis using Brain Stem Evoked Response Audiometry showed
that hearing loss was prevalent only in
patients with bacterial meningitis. Hearing loss was detected in
32.5% of these patients during the acute phase of the disease, 22.8% after
3 months and 24.2% after 6 months. In 63.6% of the affected cases,
hearing loss was bilateral. In 61.5% of the patients who had hearing loss
during the acute phase of the disease, it was permanent, 16.7% had either
partial or complete recovery and, 15.4% had deterioration in hearing
level. In 2 cases the subsequent hearing level was unknown. The risk of
developing sensori neural hearing loss was found to be significantly higher in
patients who developed other neurological sequelae. The study highlights
the importance of performing repeated hearing assessment in children with
bacterial meningitis and the difficulty in appropriate selection of
hearing aids in the early stages.
1823.
Yoshida M.
Igarashi A. Suwendra P. Inada K.
Maha MS. Kari K. Suda H. Antonio MT.
Arhana BNP. Takikawa Y. Maesawa S.
Yoshida H. Chiba M. The first report on human cases
serologically diagnosed as Japanese encephalitis in Indonesia. Southeast Asian Journal of
Tropical Medicine & Public Health. 30(4):698-706, 1999 Dec.
Abstract
Although Japanese encephalitis (JE) virus
was isolated from mosquitos in 1974, human JE cases have never been
reported in Indonesia in spite of the prevalence of anti-JE antibodies among human
and pig populations as well as abundant JE vector mosquitos. In this
report, we describe serological diagnosis of JE cases in Bali. Indonesia.
using IgM-capture ELISA both on serum and cerebrospinal fluid (CSF) of the
patients. In the first series of our investigation (Series 1), we examined
serum specimens from 12 patients with clinical diagnosis of viral
encephalitis, meningitis or dengue hemorrhagic fever (DHF), and found 2
possible JE cases. In the next series (Series 2), we examined both serum
and CSF from encephalitis patients and gave laboratory diagnosis of
JE. One of them was suspected to have concomitant or recent infection with
dengue virus, probably type 3. These results strongly indicated that JE has
been prevalent in Bali, Indonesia.
2320. Anonymous. Meningococcal disease, African meningitis belt. Weekly Epidemiological Record. 76(8):57, 2001 Feb 23.
2321. Aponso D. Bullen C.Presenting features of meningococcal disease, public health messages and media publicity: are they consistent?. New Zealand Medical Journal. 114(1127):83-5, 2001 Mar 9.
Abstract
AIMS: To investigate whether the presenting features of meningococcal disease as promoted in public health awareness material and in the print media accurately reflect the clinical features in patients admitted to Auckland hospitals with meningococcal disease January 1998 to June 1999. METHODS: Hospital record, public health message and newspaper article review, with analysis by presenting feature, age group and disease complex. RESULTS: The most common presenting features were fever (95%), rash (65%), vomiting and nausea (64%), lethargy (62%), headache (44%), refusing food and drink (35%), irritability (33%), muscle ache and joint pains (27%) and stiff neck (26%). Public health messages gave appropriate emphasis to the key features, whereas newspaper articles under-emphasised these. The term 'meningitis' was used more frequently in newspapers (65%) than in public health messages (30%), despite meningitis alone presenting less frequently (38% of cases) than meningococcal septicaemia, and having a less serious prognosis. CONCLUSIONS: Presenting features currently noted in the Ministry of Health's health education resource material are appropriate. Public health specialists dealing with the media should ensure that appropriate messages are incorporated into media reports. A greater use of the term 'meningococcal disease' by both public health agencies and media would convey to the public the message that this disease has a spectrum of presenting features, with those of septicaemia more common, but also indicating an even greater need for urgency of action than with 'classical' meningitic features.
2322. Aronin SI. Quagliarello VJ. New perspectives on pneumococcal meningitis. [Review] [11 refs] Hospital Practice (Office Edition). 36(2):43-6, 49-50, 51, 2001 Feb 15.
2323. Awasthi M. Patankar T. Shah P. Castillo M. Cerebral cryptococcosis: atypical appearances on CT. British Journal of Radiology. 74(877):83-5, 2001 Jan.
Abstract
Cryptococcal infection is common in immunocompromised patients, often presenting with meningitis or meningoencephalitis. We report an unusual presentation of cryptococcal infection in an immunocompetent patient presenting with headache and hemiplegia. CT demonstrated a large ring-enhancing lesion in the parietal region with intralesional calcification.
2327. Chang DZ. Correia NG. Khurana P. Tuthill RJ. Taege AJ. A 35-year-old man with recurrent aseptic meningitis. Cleveland Clinic Journal of Medicine. 68(3):199-201, 205-6, 2001 Mar.
2328. Chin-Hong PV. Sutton DA. Roemer M. Jacobson MA. Aberg JA.Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS. Journal of Clinical Microbiology. 39(2):804-7, 2001 Feb.
Abstract
We report the first described case of Arthrographis kalrae pansinusitis and meningitis in a patient with AIDS. The patient was initially diagnosed with Arthrographis kalrae pansinusitis by endoscopic biopsy and culture. The patient was treated with itraconazole for approximately 5 months and then died secondary to Pneumocytis carinii pneumonia. Postmortem examination revealed invasive fungal sinusitis that involved the sphenoid sinus and that extended through the cribiform plate into the inferior surfaces of the bilateral frontal lobes. There was also an associated fungal meningitis and vasculitis with fungal thrombosis and multiple recent infarcts that involved the frontal lobes, right caudate nucleus, and putamen. Post mortem cultures were positive for A. kalrae.
2329. Cullington HE. Light eye colour linked to deafness after meningitis. BMJ. 322(7286):587, 2001 Mar 10.
2331. Fobelo MJ. Corzo Delgado JE. Romero Alonso A. Gomez-Bellver MJ. Aseptic meningitis related to valacyclovir. Annals of Pharmacotherapy. 35(1):128-9, 2001 Jan.
2332. Forgacs P. Geyer CA. Freidberg SR. Characterization of chemical meningitis after neurological surgery. Clinical Infectious Diseases. 32(2):179-85, 2001 Jan 15.
Abstract
We reviewed the records of 70 consecutive adult patients with meningitis after a neurosurgical procedure, to determine the characteristics that might help to distinguish a sterile postoperative chemical meningitis from bacterial infection. The spinal fluid profiles in bacterial and chemical meningitis are similar. The exceptions are that a spinal fluid white blood cell count > 7500/microL (7500 x 10(6)/L) and a glucose level of < 10 mg/dL were not found in any case of chemical meningitis. The clinical setting and clinical manifestations were distinct enough that no antibiotic was administered after lumbar puncture to 30 (43%) of the 70 patients with postoperative meningitis. Chemical meningitis was infrequent after surgery involving the spine and sinuses. Patients with chemical meningitis did not have purulent wound drainage or significant wound erythema or tenderness, coma, new focal neurological findings, or onset of a new seizure disorder. They rarely had temperatures > 39.4 degrees C or cerebrospinal fluid rhinorrhea or otorrhea.
2334. Gnanalingham MG. Clarke MA. Primary Staphylococcus aureus meningitis in an infant. Journal of the Royal Society of Medicine. 94(2):86-8, 2001 Feb.
2336. Grossman SA. Celano P. Images in clinical medicine. Neoplastic meningitis. New England Journal of Medicine. 344(7):494, 2001 Feb 15.
2337. Haase KK. Lapointe M. Haines SJ. Aseptic meningitis after intraventricular administration of gentamicin. Pharmacotherapy. 21(1):103-7, 2001 Jan.
2338. Holt DE. Halket S. de Louvois J. Harvey D. Neonatal meningitis in England and Wales: 10 years on. Archives of Disease in Childhood Fetal & Neonatal Edition. 84(2):F85-9,
2001 Mar.
Abstract
OBJECTIVES: To determine the incidence of neonatal meningitis in England and Wales. DESIGN: A national postal survey using the British Paediatric Surveillance Unit (BPSU) card scheme supplemented by information from other sources. SETTING: England and Wales 1996-1997. SUBJECTS: A total of 274 babies less than 28 days of age who were treated for meningitis. RESULTS: The incidence of neonatal meningitis in England and Wales has not changed since our previous study in 1985-1987. However, the acute phase mortality has fallen from 19.8% in 1985-1987 to 6.6% in this study. Group B streptococci (42%) and Escherichia coli (16%) remain the most common infecting microorganisms. Eight of 69 (12%) babies with group B streptococci and 4/26 (15%) with E coli died. Antibiotic regimens based on the third generation cephalosporins, notably cefotaxime, were most commonly used (84%). The BPSU scheme identified 72% of cases during the study period. Most cases of viral meningitis were not reported through the BPSU. Less than a third of samples from aseptic meningitis were examined for viruses; 56% of these were positive. CONCLUSIONS: Although the incidence of neonatal meningitis remains unchanged, mortality from this infection has fallen significantly. If this improvement is maintained as reflected in the level of sequelae at 5 years of age, then the fear surrounding meningitis during the neonatal period will have been dramatically reduced.
2339. Hoque SN. Graham J. Kaufmann ME. Tabaqchali S. Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. Journal of Hospital Infection. 47(3):188-92, 2001 Mar. Abstract
From September 1994 to May 1996, a strain of multi-resistant Chryseobacterium (Flavobacterium) meningosepticum was isolated from eight neonates on a neonatal intensive care unit. The strain was resistant to ampicillin, ceftazidime, imipenem, gentamicin, ciprofloxacin and trimethoprim-sulphamethoxazole, susceptible to piperacillin and amikacin, and had variable susceptibility to rifampicin and vancomycin. Two neonates were infected (one had pneumonia and one septicaemia and meningitis); the remaining six neonates were colonized in the respiratory secretions. Two cases occurred that could not be explained by cross-infection during the outbreak. Environmental screening recovered C. meningosepticum from sink taps. Pulsed-field gel electrophoresis of chromosomal macrorestriction digests of patient and environmental isolates showed them to be representatives of a single strain. The outbreak was controlled after staff were required to use an alcoholic handrub after washing hands, and toiletting of babies was done with sterile water instead of tap-water. Repair and chlorination of the water-tanks and changing the sink-taps resolves the outbreak. Copyright 2001 The Hospital Infection Society.
2340. Johnson JR. Delavari P. O'Bryan TT. Escherichia coli O18:K1:H7 isolates from patients with acute cystitis and neonatal meningitis exhibit common phylogenetic origins and virulence factor profiles. Journal of Infectious Diseases. 183(3):425-434, 2001 Feb 1.
Abstract
Escherichia coli isolates of serotype O18:K1:H7, taken from women with acute cystitis, healthy control patients, and infants with neonatal bacterial meningitis (NBM), were analyzed and were compared with phylogenetically diverse control strains from the E. coli Reference collection. Clonal relationships were defined by amplification phylotyping, nicotinamide auxotrophy, and outer membrane protein patterns (OMPs). Virulence factor profiles were determined by multiplex polymerase chain reaction, probe hybridization, and hemagglutination testing. The O18:K1:H7 cystitis, fecal, and NBM isolates were clonally derived. The cystitis isolates and archetypal NBM isolates RS218 and C5 were from the OMP6 subclone of E. coli O18:K1:H7 and exhibited a consensus virulence genotype that included papG allele III (cystitis-associated P fimbrial adhesin), sfaS (S fimbrial adhesin), hlyA (hemolysin), cnf1 (cytotoxic necrotizing factor), iroN (putative siderophore), and ibeA (invasion of brain endothelium). The demonstrated commonality between O18:K1:H7 isolates from cystitis and NBM suggests common pathogenetic mechanisms and the possibility of new approaches to prevention.
2341. Kawashima M. Suzuki SO. Yamashima T. Fukui M. Iwaki T. Prostaglandin D synthase (beta-trace) in meningeal hemangiopericytoma. Modern Pathology. 14(3):197-201, 2001 Mar.
Abstract
The level of prostaglandin D synthase (PGDS), a major protein constituent of cerebrospinal fluid (CSF), is altered in various brain diseases, including meningitis. However, its role in the brain remains unclear. PGDS is mainly synthesized in the arachnoid cells, the choroid plexus and oligodendrocytes in the central nervous system. Among brain tumors, meningiomas showed intense immunoreactivity to PGDS in the perinuclear region. Thus, PGDS has been considered a specific cell marker of meningioma. In this study, we examined 25 meningeal hemangiopericytomas (HPCs) and found that 16 of the tumors (64%) showed immunoreactivity for PGDS in the perinuclear region. For comparison, 15 meningiomas, 14 soft-tissue HPCs, 1 mesenchymal chondrosarcoma, 3 choroid plexus papillomas, and 7 oligodendrogliomas were also examined. Meningiomas showed positive immunoreactivity for PGDS in 13 cases (80%). Except for one case located at the sacrum, none of the other soft-tissue HPCs showed immunostaining for PGDS. Mesenchymal chondrosarcoma arises in the bones of the skull, and its histological pattern resembles that of HPC; however, it showed no immunoreactivity for PGDS. Neither choroid plexus papillomas nor oligodendrogliomas were immunopositive for PGDS. These findings suggest that meningeal HPCs may have a unique molecular phenotype that is distinct from that of the soft-tissue HPCs. The origin of meningeal HPCs may be more closely related to the arachnoid cells.
2342. Kurup A. Tee WS. Loo LH. Lin R. Infection of central nervous system by motile Enterococcus: first case report. Journal of Clinical Microbiology. 39(2):820-2, 2001 Feb.
Abstract
A 66-year-old man with four indwelling ventriculoperitoneal shunts for multiloculated hydrocephalus from a complicated case of meningitis a year before developed shunt infection based on a syndrome of fever, drowsiness, and cerebrospinal fluid neutrophil pleocytosis in the background of repeated surgical manipulation to relieve successive shunt blockages. The cerebrospinal fluid culture, which yielded a motile Enterococcus species, was believed to originate from the gut. This isolate was lost in storage and could not be characterized further. The patient improved with vancomycin and high-dose ampicillin therapy. He relapsed a month later with Enterococcus gallinarum shunt infection, which responded to high-dose ampicillin and gentamicin therapy. This is probably the first case report of motile Enterococcus infection of the central nervous system.
2343. Lai KK. Enterobacter sakazakii infections among neonates, infants, children, and adults. Case reports and a review of the literature. [Review] [41 refs] Medicine. 80(2):113-22, 2001 Mar.
Abstract
Enterobacter sakazakii can cause serious infections especially among the very young and the elderly. It continues to be more common among neonates and infants than adults. Its tropism for the central nervous system in neonates and infants remains a mystery. Among neonates and infants, E. sakazakii has a propensity to cause meningitis resulting in ventriculitis, brain abscess or cyst formation, and development of hydrocephalus requiring ventricular-peritoneal shunt. Computed tomography of the head is therefore useful in following patients with E. sakazakii meningitis. Mortality and morbidity of E. sakazakii meningitis is high, and virtually all patients recovering from the central nervous system infection suffered mental and physical developmental delays. The case-fatality rate decreased among patients with meningitis treated with the third-generation cephalosporins. Most adults with E. sakazakii infection had serious underlying diseases and 50% of the adults with the infection had malignancies. However there has never been a known case of meningitis. Increasing antibiotic resistance among Enterobacter species should lead one to consider using the carbapenems or the newer cephalosporins in combination with a second agent such as an aminoglycoside. Limited data suggest that trimethoprim-sulfamethoxazole may be a useful agent in the treatment of infections caused by the Enterobacter species, especially in view of the production of extended-spectrum beta-lactamases capable of inactivating the cephalosporins and extended-spectrum penicillin.
2344. Liebeskind DS. Ostrzega N. Wasterlain CG. Buttner EA. Neurologic manifestations of disseminated infection with Mycobacterium abscessus. Neurology. 56(6):810-3, 2001 Mar 27.
Abstract
Mycobacterium abscessus is a ubiquitous, saprophytic organism with low pathogenic potential. The authors describe the previously unreported clinical features of meningitis and native valve endocarditis caused by this rapidly growing atypical mycobacterium. The fatal outcome of this unusual case coincides with the grim prognosis of this disseminated infection and the significant mortality rate associated with neurologic complications of infective endocarditis.
2345. Lortholary O. Dromer F. Mathoulin-Pelissier S. Fitting C. Improvisi L. Cavaillon JM. Dupont B. French Cryptococcosis Study Group. Immune mediators in cerebrospinal fluid during cryptococcosis are influenced by meningeal involvement and human immunodeficiency virus serostatus. Journal of Infectious Diseases. 183(2):294-302, 2001 Jan 15.
Abstract
Pro- and anti-inflammatory mediators (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, IL-8, IL-10, and soluble TNF receptor II [sTNFR] II) were measured in cerebrospinal fluid (CSF) before treatment (day 0), and after 2 weeks and 3 months of antifungal therapy in 51 human immunodeficiency virus (HIV)-positive and 7 HIV-negative patients with culture-confirmed cryptococcosis. On day 0, all mediator concentrations, except IL-10 in HIV-positive patients, were higher in patients with meningeal, rather than extrameningeal cryptococcosis or in control subjects (P<.05). For meningitis patients, all mediator levels, except sTNFR II, were higher in HIV-negative than HIV-positive patients (P<.05). Day 0 CSF IL-8 levels were higher in HIV-positive patients receiving antiretroviral therapy than in untreated persons (P<.02). Day 0 sTNFR II levels were higher in HIV-positive survivors at 3 months, and elevated levels were sustained in HIV-positive patients with meningitis. Overall, these data support the idea that inflammatory responses are crucial to the eradication of cryptococcal infections in the central nervous system.
2347. Manfredi R. Nanetti A. Valentini R. Chiodo F. Acinetobacter infections in patients with human immunodeficiency virus infection: microbiological and clinical epidemiology. Chemotherapy. 47(1):19-28, 2001 Jan-Feb.
Abstract
BACKGROUND: We evaluated the role of complications caused by Acinetobacter spp. in the setting of HIV infection. METHODS: Clinical records of 1,923 consecutive HIV-infected patients hospitalized in a 9-year period were retrospectively reviewed, in order to identify all cases of Acinetobacter spp. complications, and to assess their occurrence and outcome according to several epidemiological, clinical and laboratory parameters. RESULTS: Ten patients out of 1,923 (0.52%) developed Acinetobacter spp. infections: sepsis in four cases, urinary tract infection in three, pneumonia in two and septicaemic pneumonia in the remaining patient. All patients were severely immunocompromised, as shown by a mean CD4+ lymphocyte count of 122 cells/microl and a frequent prior diagnosis of AIDS. As opposed to other infections, septicaemia was associated with a significantly lower CD4+ cell count and a more frequent occurrence of neutropenia. Hospital-acquired Acinetobacter spp. infections were significantly more frequent than community-acquired ones, and prevailingly involved patients with AIDS and leucopenia, being responsible for frequent blood dissemination. Antimicrobial, corticosteroid and cotrimoxazole treatment were frequently carried out during the month preceding disease onset. Antibiotic susceptibility studies proved the complete resistance of microbial isolates to ampicillin and cephalothin and poor sensitivity to second-generation cephalosporins and gentamicin, while greater susceptibility was shown to ceftazidime, netilmicin and amikacin, followed by piperacillin, cotrimoxazole and quinolones. Appropriate antimicrobial treatment led to clinical and microbiological cure in all cases, with no related mortality or relapses. CONCLUSIONS: Since only 23 episodes of HIV-associated Acinetobacter spp. infections have been described to date in 11 different reports (nine cases of bacteraemia, eight of pneumonia, two of urinary tract involvement, one of intravenous access device infection, one of meningitis and two with unspecified localization), our series represents the largest one dealing with HIV-associated Acinetobacter spp. infections. According to our experience, Acinetobacter spp. may be responsible for appreciable morbidity among patients with HIV infection, above all when a low CD4+ cell count, neutropenia and hospitalization are present. Clinicians and microbiologists who work in the field of HIV infection should consider the potential pathogenic role of Acinetobacter spp. organisms even in the absence of some presumed risk factors, because of the relationship between these infections and immunodeficiency, hospitalization, other infectious complications, prior antibiotic and steroid treatment and extended antimicrobial resistance patterns. Copyright 1999 S. Karger AG, Basel
2348. McMinn P. Stratov I. Nagarajan L. Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clinical Infectious Diseases. 32(2):236-42, 2001 Jan 15.
Abstract
Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barre syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.
2349. Merkelbach S. Konig J. Rohn S. Muller M. The use of clinical scales in depicting cerebrovascular complications in bacterial meningitis. Journal of Neuroimaging. 11(1):25-9, 2001 Jan.
Abstract
To evaluate the utility of different scales for clinical assessment, over time, in acute bacterial meningitis, the authors investigated 53 consecutive patients (mean age 53 +/- 17 years). Clinical status on days 1, 3, 5, 8, and 14 after admission was determined by the Scandinavian Stroke Scale (SSS), Glasgow Coma Scale (GCS), and Hunt and Hess Scale (HH), and, on day 21, by the Glasgow Outcome Scale (GOS). Transcranial Doppler examinations were performed serially to assess for disease-related arterial narrowing. This was observed in 27 patients (51%) within 2 weeks of admission. All scales were observed to correlate with the 21-day GOS. Patients with cerebral arterial narrowing had significantly decreased SSS scores between days 1 and 8 and worse GCS and HH scores between days 3 and 5. Mean blood flow velocity in the middle cerebral artery on days 5 and 8 significantly correlated with GOS (r = 0.268, P < .008; r = -0.324, P < .003, respectively). The use of such clinical scales allows standardized assessment of patients with bacterial meningitis and provides prognostic information. Cerebral arterial narrowing was observed to correlate with neurologic impairment.
2350. Muller MP. Richardson DC. Walmsley SL. Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant patient. [Review] [20 refs] Clinical Nephrology. 55(1):80-4, 2001 Jan.
Abstract
A 45-year-old man underwent renal transplant for end-stage renal disease complicating systemic lupus erythematosis. Within 24 hours of initiating Pneumocystis carinii pneumonia (PCP) prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) he developed fever and confusion. Cerebrospinal fluid examination revealed a pleocytosis but cultures were negative. The patient improved within three days after cessation of the TMP-SMX but symptoms recurred rapidly upon drug rechallenge. Drug-induced aseptic meningitis is an uncommon but well described clinical entity. This is the first case described in a patient following renal transplantation. The literature is reviewed and the clinical features, diagnostic challenges and possible mechanisms of TMP-SMX-induced aseptic meningitis are discussed. This problem may be more common in the transplant population than is recognized given the difficulty of diagnosis combined with the widespread use of TMP-SMX as PCP prophylaxis.
2352. Panciera RJ. Ewing SA. Confer AW. Ocular histopathology of Ehrlichial infections in the dog. Veterinary Pathology. 38(1):43-6, 2001 Jan.
Abstract
Histologic examination of eyes and brains of 27 dogs experimentally infected with either Ehrlichia canis, E. ewingii, E. chaffeensis, or human granulocytic ehrlichia (HGE) was conducted in the course of several experiments, the primary objectives of which were to investigate the susceptibility of the domestic dog to infection with various ehrlichial species and to assess the ability of ixodid tick species to acquire and transmit those infections. Uveitis and meningitis occurred in each of the dogs infected with E. canis but was not observed in dogs infected with the other Ehrlichia species. The inflammatory infiltrate was predominantly lymphocytic, monocytic, and plasmacytic; granulocytes were notably few. Ocular inflammation was most common and most intense in the ciliary body, becoming less intense in the choroid, iris, and retina, respectively. Meningitis was often accompanied by mild neuroparenchymal vascular cuffing and gliosis. The meningeal inflammatory cell infiltrate included a prominent monocyte population. Ocular and meningeal lesions were present in all E. canis-infected dogs from 22 through 200 days postexposure. Neither ocular nor brain lesions were observed with any of the other ehrlichial infections.
2353. Ratka A. Erramouspe J. Intramuscular ceftriaxone in the treatment of childhood meningitis due to Haemophilus influenzae type F. Annals of Pharmacotherapy. 35(1):36-40, 2001 Jan.
Abstract
OBJECTIVE: To describe a case of meningitis caused by Haemophilus influenzae type f (Hif) in a child. CASE SUMMARY: A 2.5-year-old white girl (18 kg) was hospitalized because of acute ataxia. The cerebrospinal fluid culture grew H. influenzae, which was later identified as type f. Therapy was limited by the inability to gain intravenous access. Treatment was initiated with dexamethasone 8 mg (0.44 mg/kg) intramuscularly, one dose on the day prior to initiation of ceftriaxone therapy, and intramuscular ceftriaxone 2 g (111 mg/kg/dose) once a day. After the first day, dexamethasone was administered at 3 mg (0.17 mg/kg/d) orally four times per day for four days. Within two days, the patient became afebrile and improved significantly. The remaining treatments were given during daily hospital visits on an outpatient basis. No complications occurred during the follow-up visits. DISCUSSION: The clinical presentation and therapeutic management of Hif meningitis is similar to that of H. influenzae type b (Hib) meningitis. Factors that may predispose a child to infections caused by Hif include upper respiratory tract infections, day care attendance, Down syndrome, and immunodeficiency. Hif meningitis usually is treated with a third-generation cephalosporin (frequently ceftriaxone). Although most often administered intravenously, intramuscular ceftriaxone can provide a satisfactory clinical outcome in a child with adequate peripheral perfusion but limited intravenous access. The majority of reported cases of Hif meningitis resolve with appropriate antibiotic therapy; however, long-term neurologic sequelae occasionally occur. CONCLUSIONS: Hif occasionally causes pediatric meningitis. In a patient with good perfusion and difficult intravenous access, daily intramuscular administration of ceftriaxone can be an effective treatment option. In this case, Hif meningitis occurred abruptly and resolved within 48 hours of initiation of ceftriaxone and dexamethasone without long-term sequelae. The risks of giving dexamethasone appear to be minimal, although efficacy for preventing Hif complications remains to be proven.
2354. Ravenscroft A. Schoeman JF. Donald PR. Tuberculous granulomas in childhood tuberculous meningitis: radiological features and course. Journal of Tropical Pediatrics. 47(1):5-12, 2001 Feb.
Abstract
The clinical course and serial cranial computerized tomographic (CT) findings of 202 children with tuberculous meningitis (TBM) admitted to Tygerberg Hospital between 1985 and 1994 were reviewed with regard to the incidence, CT appearance and clinical course of associated intracranial tuberculous granulomas. Thirty-four patients (16.85 per cent) had associated intracranial granulomas. Thirty-eight individual lesions were analysed and classified as meningeal, parenchymal or ependymal according to their central nervous system (CNS) location. Twenty-five patients had round to irregular, brain iso-, hypo- or hyperdense meningeal granulomas with variable degrees of enhancement and peri-lesional hypodensities. Four patients had diffusely enhancing, brain isodense, enplaque-like ependymal granulomas associated with the ventricular ependymal lining. Four patients with miliary tuberculosis and TBM showed multiple small diffusely enhancing, brain iso- or hyperdense parenchymal lesions and associated hypodensities on initial CT. Although granulomas in the meningeal and ependymal group had the propensity to paradoxically enlarge or appear on standard four-drug antituberculosis therapy, the majority resolved uneventfully. Rapid resolution of small parenchymal granulomas associated with miliary tuberculosis occurred in all cases. Most granulomas in this series were co-incidental, asymptomatic CT findings. In rare cases, the development or enlargement of a strategically located granuloma may result in complications.
2355. Rees JH. Balakas N. Agathonikou A. Hain SF. Giovanonni G. Panayiotopoulos CP. Luxsuwong M. Revesz T. Primary diffuse leptomeningeal gliomatosis simulating tuberculous meningitis.Journal of Neurology, Neurosurgery & Psychiatry. 70(1):120-2, 2001 Jan.
Abstract
Three patients are reported on who presented with communicating hydrocephalus due to presumed tuberculous meningitis. Subsequent clinical deterioration despite antituberculous chemotherapy prompted reassessment with FDG-PET scanning and meningeal biopsy in one case and repeat CSF cytology with special staining in the second. The third patient died and postmortem confirmed a diagnosis of primary diffuse leptomeningeal gliomatosis. In the first two patients, MRI of the entire neuraxis showed no evidence of a primary intraparenchymal tumour. These cases emphasise the need for repeated reassessment in patients with culture negative lymphocytic meningitis. In addition, this is the first report of FDG-PET scanning in leptomeningeal gliomatosis.
2356. Sacktor N. Lyles RH. Skolasky R. Kleeberger C. Selnes OA. Miller EN. Becker JT. Cohen B. McArthur JC. The Multicenter AIDS Cohort Study. HIV-associated neurologic disease incidence changes:: Multicenter AIDS Cohort Study, 1990-1998. Neurology. 56(2):257-60, 2001 Jan 23.
Abstract
This study examined the temporal trends in the incidence rates of HIV dementia, cryptococcal meningitis, toxoplasmosis, progressive multifocal leukoencephalopathy, and CNS lymphoma from January 1990 to December 1998 in the Multicenter AIDS Cohort Study. The incidence rates for HIV dementia, cryptococcal meningitis, and lymphoma decreased following the introduction of highly active antiretroviral therapy (HAART). The proportion of new cases of HIV dementia with a CD4 count in a higher range (i.e., 201 to 350) since 1996 may be increasing.
2357. Sakhuja V. Sud K. Kalra OP. D'Cruz S. Kohli HS. Jha V. Gupta K. Vasishta RK. Central nervous system complications in renal transplant recipients in a tropical environment. Journal of the Neurological Sciences. 183(1):89-93, 2001 Jan 15.
Abstract
Renal transplant recipients are at risk of developing various infectious and non-infectious complications affecting the central nervous system (CNS). There is paucity of data regarding the spectrum of CNS complications and the epidemiology of infective agents varies according to geographical location. We retrospectively studied the spectrum of CNS complications seen in 792 renal allograft recipients followed up at this tertiary care centre in north India over a 19-year period. Autopsy findings of 78 allograft recipients who died in the hospital were also reviewed and included. The brain was examined in 22 of these patients. Overall, 79 (10%) patients developed some form of CNS dysfunction with a mortality rate of 60.8%. CNS infections occurred in 31 renal allograft recipients (3.9% of total) and accounted for the largest group (39.2%). Fungi were the commonest etiological agents (21 patients) and were associated with a 70% mortality, with cryptococcal meningitis occurring in 12, mucormycosis in six, aspergillosis in one, and other unusual fungal infections in the remaining two patients. All patients with mucormycosis had a fatal outcome. The second largest group comprised of patients with non-uremic encephalopathies (23 patients, 29.1%) with metabolic encephalopathy occurring in 13, toxic encephalopathy in nine and hypertensive encephalopathy in one patient) and was associated with an overall mortality rate of 60.9%. Cerebrovascular accidents occurred in 12 patients (15.2%) and were associated with a mortality of 91.7%. Other CNS complications included treatment related complications in four (5.1%), primary CNS lymphomas in three (3.8%), and miscellaneous complications in six patients (7.6%). Patients with non-cryptococcal fungal infections of the CNS, hepatic and toxic encephalopathy and those with cerebrovascular accidents had the worst outcome. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. We conclude that complications involving the CNS occur in 10% of all renal transplant recipients and are associated a with high mortality, warranting early diagnosis and aggressive treatment.
2358. Socan M. Ravnik I. Bencina D. Dovc P. Zakotnik B. Jazbec J. Neurological symptoms in patients whose cerebrospinal fluid is culture- and/or polymerase chain reaction-positive for Mycoplasma pneumoniae. Clinical Infectious Diseases. 32(2):E31-5, 2001 Jan 15.
Abstract
We describe 13 patients with neurological signs and symptoms associated with Mycoplasma pneumoniae infection. M. pneumoniae was isolated from the cerebrospinal fluid (CSF) of 9 patients: 5 with meningoencephalitis, 2 with meningitis, and 1 with cerebrovascular infarction. One patient had headache and difficulties with concentration and thinking for 1 month after the acute infection. M. pneumoniae was detected, by means of PCR, in the CSF of 4 patients with negative culture results. Two had epileptic seizures, 1 had blurred vision as a consequence of edema of the optic disk, and 1 had peripheral nerve neuropathy.
2359. Tinsley C. Nassif X. Meningococcal pathogenesis: at the boundary between the pre- and post-genomic eras. [Review] [49 refs] Current Opinion in Microbiology. 4(1):47-52, 2001 Feb.
Abstract
Meningococcal disease remains an important public health burden worldwide and, indeed, cause of death, particularly in poorer countries. The rapidly progressive nature of infections means that antibiotic therapy often comes too late. Vaccines are of limited efficacy in infants, one of the most vulnerable age groups, and do not exist for bacteria of serogroup B. Hence, much remains to be achieved in terms of vaccine design and the understanding of the pathogenesis of meningococcal disease. The causative bacterium, Neisseria meningitidis, is usually a commensal of the nasopharynx. Factors that lead to the invasion of the bloodstream, often followed by the crossing of the blood-brain barrier and meningitis, may be partly host- and partly bacterium-dependent, but are ill-understood. It is hoped that, taken together with the fundamental knowledge gained from biochemical and genetic studies, the huge amount of new information made available with the recent publication of the genome sequences will help to unlock more of the secrets of the lifestyle and pathogenic potential of this still poorly understood pathogen. [References: 49]
2361. Wadia RS. Pujari SN. Kothari S. Udhar M. Kulkarni S. Bhagat S. Nanivadekar A. Neurological manifestations of HIV disease. Journal of the Association of Physicians of India. 49:343-8, 2001 Mar.
Abstract
We report the results of neurological evaluation of 1,527 HIV positive subjects. Neurological complications were seen in 457 patients (481 neurological events). The prevalence was 20.24% of patients attending the out-patient clinic and in 44.57% of in-patients. Involvement of all levels of neuraxes was documented. The commonest manifestations were neuropathies, including herpes zoster (28.27%), meningitis (17.88%) and mass lesions (16%). Cryptococcal meningitis was clearly commoner than tubercular meningitis (67.44% vs 18.60% of all cases of meningitis, respectivelv). Amongst mass lesions, 14/24 single lesions and 27/38 multiple lesions responded to anti-toxoplasma treatment and were diagnosed as CNS toxoplasmosis. In abscence of biopsy, it would be prudent to initiate empirical anti-toxoplasma treatment for all HIV patients with mass lesions and assess clinical and radiological response. To our knowledge this is the largest series of neurological manifestations of HIV disease documented in Indian literature.
2362. Wang CC. Siu LK. Chen MK. Yu YL. Lin FM. Ho M. Chu ML. Use of automated riboprinter and pulsed-field gel electrophoresis for epidemiological studies of invasive Haemophilus influenzae in Taiwan. Journal of Medical Microbiology. 50(3):277-83, 2001 Mar.
Abstract
A total of 87 invasive isolates of Haemophilus influenzae isolated throughout Taiwan from 1994 to 1998 was collected; 57 were from children <14 years old. In all, 60.9% of isolates were resistant to ampicillin and produced beta-lactamase. Ribotyping revealed six different profiles in 55 isolates of type b, nine profiles in 10 isolates of non-type b and 12 profiles in 22 isolates of non-typable H. influenzae. Among isolates from 35 cases of meningitis, 30 (86%) were in ribogroups 1, 2 and 3 with >90% genetic similarity. Compared with all the other ribogroups, ribogroups 1, 2 and 3, which encompassed all H. influenzae type b, were significantly more prevalent as a cause of meningitis in children <14 years old. Further subtyping of the predominant ribogroup by pulsed-field gel electrophoresis (PFGE) identified differences of 0-6 bands among these isolates of ribogroup 1, which indicated distant relatedness. Automated ribotyping was found to be a useful method and was less time-consuming for molecular epidemiology studies of H. influenzae. PFGE is suggested as an addition to ribotyping to improve discrimination if H. influenzae type b is involved. Differentiating ribogroups between type b and non-type b H. influenzae by genotyping may help to understand the molecular characteristics of outbreaks, endemicity and value of vaccination. According to the results of ribotyping and PFGE, it seems possible that spread of invasive H. influenzae type b had occurred and ribotyping confirmed that there was no clonal spread of non-type b H. influenzae in Taiwan.
2363. Wong M. Schlaggar BL. Landt M. Postictal cerebrospinal fluid abnormalities in children. Journal of Pediatrics. 138(3):373-7, 2001 Mar.
Abstract
OBJECTIVES: To determine the frequency and characteristics of seizure-induced cerebrospinal fluid (CSF) abnormalities in children and to identify potential alternative causes of these findings. METHODS: Consecutive patients (n = 80) who underwent lumbar puncture within 24 hours after a seizure were studied retrospectively. The presence of CSF abnormalities in total leukocytes, polymorphonuclear cells, and protein was determined by using age-specific reference values. Coexisting conditions that could affect CSF findings, such as traumatic lumbar puncture, concurrent neurologic disease, and undiagnosed meningitis, were identified. RESULTS: Eighteen of the 80 patients were excluded from the final study group because of the presence of another condition that could alter the CSF. More than 50% of the excluded patients had an abnormal CSF leukocyte count or protein level, including 2 patients with initially undiagnosed meningitis, which was subsequently detected by post-hoc polymerase chain reaction testing. In the remaining 62 patients, postictal pleocytosis was detected in only 3 (5%), and increased protein was detected in only 6 (10%). The maximal postictal pleocytosis and protein level were 8 x 10(6) leukocytes/L (8 leukocytes/mm(3)) and 0.52 g/L (52 mg/dL), respectively. CONCLUSIONS: Seizure-induced CSF abnormalities are rare in children, and alternative, often unidentified, disease processes may account for many observed postictal abnormalities. All patients with abnormal CSF after a seizure should be thoroughly evaluated for other causes of the abnormality.
2858.
Cellerini
M. Gabbrielli S. Maddali Bongi S. Cammelli D. MRI of cerebral rheumatoid pachymeningitis: report of
two cases with follow-up. Neuroradiology.
43(2):147-50, 2001 Feb.
Abstract
We report the clinical and neuroradiological
features of cerebral rheumatoid pachymeningitis with 1 year follow-up in two
patients. MRI of the head enabled noninvasive diagnosis of both the meningeal
abnormality and its complications, consisting of hypertensive hydrocephalus and
superior sagittal sinus thrombosis, respectively. Dural sinus thrombosis, very
uncommon in rheumatoid arthritis, was confirmed by phase-contrast MRA.
Worsening of the pachymeningitis at follow-up was observed in both patients
despite regression or stability of the clinical picture and long-term therapy.
2859.
Chaturvedi
P. Kishore M. Modified Glasgow Coma
Scale to predict mortality in febrile unconscious children. Indian Journal of
Pediatrics. 68(4):311-4, 2001 Apr.
Abstract
A prospective hospital based study was
conducted in the Department of Pediatrics of the Kasturba Hospital, Mahatma
Gandhi Institute of Medical Sciences, Sevagram, Wardha to predict the mortality
in children admitted with fever and unconsciousness using the Modified Glasgow
Coma Scale (MGCS) score. Forty eight children were admitted with fever and
unconsciousness; cases of febrile convulsions, epilepsy and cerebral palsy were
excluded. MGCS scores were assessed on admission and repeated at 12 hours, 24
hours, 48 hours and 72 hours after admission in each case. Diagnosis in each
case was confirmed by history, examinations and investigations. All the cases
were regularly followed up till death/discharge. The overall mortality was
29.1% (14/48) out of which 85% (12/14) died within the first 24 hours.
Mortality was highest in the toddler age group and in patients with pyogenic
meningitis. There was a significant association between death and MGCS scores
on admission with a post test probability for discharge being only 10% with a
score of less than 5 and 99% with a score of more than 10 respectively. MGCS
scores on admission can be used to predict mortality in patients hospitalized
with fever and unconsciousness. The scale is simple, easy, can be applied at
bed side and does not need any investigations. Its application in developing
countries with limited investigative and intensive care facilities can help the
treating physician decide regarding referral and counseling the parents
regarding the probable clinical outcome.
2860.
Henquell
C. Chambon M. Bailly JL. Alcaraz
S. De Champs C. Archimbaud C. Labbe A. Charbonne
F. Peigue-Lafeuille H. Prospective
analysis of 61 cases of enteroviral meningitis: interest of systematic genome
detection in cerebrospinal fluid irrespective of cytologic examination
results. Journal of Clinical
Virology. 21(1):29-35, 2001 Apr.
Abstract
BACKGROUND: Enteroviruses are the most
commonly identified cause of viral meningitis. Detection of the enterovirus
genome in cerebrospinal fluid (CSF) using reverse-transcription polymerase
chain reaction (PCR) has proved to be useful in diagnosis and is more rapid and
sensitive than viral cultures. In routine practice, cytologic examination
results of CSF are obtained swiftly and PCR indication is performed as a second
step. OBJECTIVES: The aim of this study was to determine, by analysis of
complete data from CSF results for 61 cases of proven enteroviral meningitis,
whether cytologic CSF findings can be used to establish viral etiology and to
indicate if PCR assay should be performed. STUDY DESIGN: From a prospective
study of children admitted during 1997 for suspected enterovirus meningitis in
which PCR and viral cultures of CSF were systematically performed, we selected
61 patients with proven enterovirus meningitis. We compared global white cell
count (WCC), relative percentage of lymphocytes/neutrophils, PCR and culture
for enterovirus, patient age, and clinical data. RESULTS: 92% of patients
(56/61) had positive PCR in CSF and in 48% (29/61) enterovirus was isolated in
CSF. Nine patients (14.75%) had WCC<10/mm(3); eight of them had positive PCR
and two had positive culture. There were comparable numbers of CSF with a
predominance of lymphocytes (n=25) and CSF with a predominance of neutrophils
(n=22), and of positive PCR and positive cultures of CSF in the two groups.
Results were not influenced by the age of the patients. CONCLUSION:
Irrespective of other CSF parameters, it seems difficult to dispense with PCR
assay for enterovirus genome detection. It should be introduced as a true rapid
routine test. Early reporting of a positive PCR result could result in a
considerable saving in health resources.
2861.
Kashyap
AS. Kashyap S. A 35 year man with acromegaly and neck
stiffness. Postgraduate Medical Journal.
77(906):269-70; discussion 279-80, 2001 Apr.
2862.
Kolb-Maurer
A. Pilgrim S. Kampgen E. McLellan
AD. Brocker EB. Goebel W.
Gentschev I. Antibodies against listerial protein 60 act as an opsonin
for phagocytosis of Listeria monocytogenes by human dendritic cells. Infection
& Immunity. 69(5):3100-9, 2001 May.
Abstract
Human-monocyte-derived dendritic cells
(MoDC) are very efficient in the uptake of Listeria monocytogenes, a
gram-positive bacterium which is an important pathogen in humans and animals
causing systemic infections with symptoms such as septicemia and meningitis. In
this work, we analyzed the influence of blood plasma on the internalization of
L. monocytogenes into human MoDC and compared the uptake of L. monocytogenes
with that of Salmonella enterica serovar Typhimurium and Yersinia
enterocolitica. While human plasma did not significantly influence the uptake
of serovar Typhimurium and Y. enterocolitica by human MoDC, the efficiency of
the uptake of L. monocytogenes by these phagocytes was strongly enhanced by
human plasma. In plasma-free medium the internalization of L. monocytogenes was
very low, whereas the addition of pooled human immunoglobulins resulted in the
internalization of these bacteria to a degree comparable to the highly
efficient uptake observed with human plasma. All human plasma tested contained
antibodies against the 60-kDa extracellular protein of L. monocytogenes (p60),
and anti-p60 antibodies were also found in the commercially available pooled
immunoglobulins. Strikingly, in contrast to L. monocytogenes wild type, an iap
deletion mutant (totally deficient in p60) showed only a minor difference in
the uptake by human MoDC in the presence or the absence of human plasma. These
results support the assumption that antibodies against the listerial p60
protein may play an important role in Fc-receptor-mediated uptake of L.
monocytogenes by human MoDC via opsonization of the bacteria. This process may
have a major impact in preventing systemic infection in L. monocytogenes in
immunocompetent humans.
2863.
Lan
SH. Chang WN. Lu CH. Lui CC. Chang HW. Cerebral infarction in chronic
meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis.
QJM. 94(5):247-53, 2001 May.
Abstract
Twenty-eight patients with cerebral
infarction secondary to chronic meningitis were retrospectively identified at
our institution over a period of 5 years. They accounted for 47% (17/36) of
tuberculous meningitis (TBM) and 32% (11/34) of cryptococcal meningitis cases.
Single infarctions were found in 15 patients and multiple infarctions in 13.
The distribution of single infarctions was: basal ganglia 7; internal capsule
3; thalamus 1; cerebellum 1; and cortical infarct 3. Therapeutic outcomes at 3
months were determined using a modified Barthel INDEX: At follow-up of 3 months
or more, 10 had good outcomes while the other 18 had poor outcomes. The 18 with
poor outcomes included six who died, and 12 who had severe neurological
sequelae. TBM and cryptococcal meningitis shared similar clinical features,
both being frequently associated with other neurological complications,
including hydrocephalus, cranial nerve palsy, and seizures in our patients.
However, extracranial involvement, such as spinal and pulmonary involvement,
was more commonly found in TBM patients. Cerebral infarction can occur in both
the acute stage and later stages of treatment. Mortality and morbidity are
high, and early diagnosis and appropriate antimicrobial treatment are
essential. If hydrocephalus is demonstrated, early ventricular decompression is
needed to prevent further cerebral ischaemia.
2864.
Limcangco
MR. Armour CL. Salole EG.
Taylor SJ. Cost-benefit analysis of a Haemophilus influenzae type b
meningitis prevention programme in The Philippines. [Review] [49 refs]
Pharmacoeconomics. 19(4):391-400, 2001.
Abstract
BACKGROUND: Haemophilus influenzae type b
(Hib) meningitis is associated with high mortality and serious sequelae in
children under 5 years of age. Vaccines which can prevent this infection are
available. OBJECTIVE: To evaluate the costs and benefits of a 3-dose
immunisation schedule in Manila, Philippines. PERSPECTIVE: Government and
societal perspectives. DESIGN AND PARTICIPANTS: A cost-benefit analysis based
on a birth cohort of 100,000 children. The state of health of the cohort with
and without a Hib immunisation programme was modelled over a 5-year period. A
survey of medical records of patients with Hib in Manila provided data on the
extent and cost of sequelae following infection. INTERVENTION: A 3-dose Hib
vaccination programme given at ages 2, 3 and 4 months. RESULTS: The model
predicted that vaccinating children against Hib meningitis would prevent 553
cases per year in a birth cohort of 100,000, at a cost of 56,200 Philippine
pesos (PHP) [$US1,605; 1998 exchange rate] per case (base case assumptions of
90% vaccine efficacy rate, 95 per 100,000 Hib incidence rate, 85% vaccination
coverage). Results from the cost-benefit analyses indicated that the saving to
the government would be around PHP39 million ($US1.11 million), and the saving
to society would be PHP255 million ($US7.28 million). CONCLUSION: There would
be a positive economic benefit for the Philippine government and for the
Filipino society if a Hib vaccination programme was introduced in Manila.
[References: 49]
2865.
MacLean
LL. Vinogradov E. Crump EM.
Perry MB. Kay WW. The structure
of the lipopolysaccharide O-antigen produced by Flavobacterium psychrophilum
(259-93). European Journal of Biochemistry.
268(9):2710-6, 2001 May.
Abstract
Flavobacterium psychrophilum, a
Gram-negative bacterium, is the etiological agent of rainbow trout fry syndrome
and bacterial cold water disease, septicemic infections in reared salmonids. In
humans Flavobacterium spp. have been associated with neonatal meningitis and
septicemia, catheter-associated bacteremia, and pneumonia. Recently, several F.
psychrophilum surface molecules, including lipopolysaccharide (LPS), have been
implicated in its pathogenesis and identified as potential vaccine and
diagnostic candidate macromolecules. Studies on the LPS produced by the
bacterium are reported herein. The structure of the antigenic O-polysaccharide
contained in the LPS of F. psychrophilum was deduced by the application of
analytical NMR spectroscopy, mass spectrometry, glycose and methylation
analysis, and partial hydrolysis degradations, and was found to be an
unbranched polymer of trisaccharide repeating units composed of L-rhamnose
(L-Rhap), 2-acetamido-2-deoxy-L-fucose (L-FucpNAc) and 2-acetamido-4-((3S,5S)-3,5-dihydroxyhexanamido)-2,4-dideoxy-D-quinovose
(D-Quip2NAc4NR, 2-N-acetyl-4-N-((3S,5S)-3,5-dihydroxyhexanoyl)-D-bacillosamine)
(1 : 1 : 1) and having the structure:
-->4)-alpha-L-FucpNAc-(1-->3)-alpha-D-Quip2NAc4NR-(1-->2)- alpha-L-Rhap-(1-->
where R is (3S,5S)-CH3CH(OH)CH2CH(OH)CH2CO-.
2866.
Maclennan
J. Meningococcal group C conjugate
vaccines. Archives of Disease in Childhood.
84(5):383-6, 2001 May.
2867.
Marcos
MA. Martinez E. Almela M.
Mensa J. Jimenez de Anta MT. New
rapid antigen test for diagnosis of pneumococcal meningitis. Lancet. 357(9267):1499-500, 2001 May 12.
Abstract
Conventional diagnostic methods for
bacterial meningitis are frequently not rapid or sensitive enough to guide
initial antimicrobial therapy. Streptococcus pneumoniae is the most frequent
and severe cause of community-acquired bacterial meningitis and treatment is
complicated by the increasing prevalence of antimicrobial resistance to
third-generation cephalosporins. We used a new rapid antigen test in the cerebrospinal
fluid and urine of patients with suspected bacterial meningitis, and found it
to be highly sensitive and specific for the detection of pneumococci. This test
might help guide initial therapy for bacterial meningitis according to the
local rates of pneumococcal antimicrobial resistance.
2868.
Massung
RF. Davis LE. Slater K. McKechnie
DB. Puerzer M. Epidemic typhus
meningitis in the southwestern United States.
Clinical Infectious Diseases.
32(6):979-82, 2001 Mar 15.
Abstract
A patient residing in New Mexico had murine
typhus diagnosed. A novel molecular assay was performed at the Centers for
Disease Control and Prevention, and Rickettsia prowazekii, the agent of
epidemic typhus, was found, rather than R. typhi. To our knowledge, this is the
first reported case of epidemic typhus confirmed by means of polymerase chain
reaction--based testing of cerebrospinal fluid, and it introduces a novel assay
for the molecular diagnosis of both epidemic and murine typhus.
2869.
McIntire
SC. Green M. Fever and stiff neck.
Archives of Pediatrics & Adolescent Medicine. 155(5):603-6, 2001 May.
2870.
Narchi
H. Aseptic meningitis. Pediatrics.
107(2):451, 2001 Feb.
2871.
Nash
D. Mostashari F. Fine A.
Miller J. O'Leary D. Murray K.
Huang A. Rosenberg A. Greenberg A. Sherman M. Wong S. Layton M.
1999 West Nile Outbreak Response Working Group. The outbreak of West Nile virus infection in
the New York City area in 1999. [see comments]. New England Journal of
Medicine. 344(24):1807-14, 2001 Jun 14.
Abstract
BACKGROUND: In late August 1999, an unusual
cluster of cases of meningoencephalitis associated with muscle weakness was
reported to the New York City Department of Health. The initial epidemiologic
and environmental investigations suggested an arboviral cause. METHODS: Active
surveillance was implemented to identify patients hospitalized with viral
encephalitis and meningitis. Cerebrospinal fluid, serum, and tissue specimens
from patients with suspected cases underwent serologic and viral testing for
evidence of arboviral infection. RESULTS: Outbreak surveillance identified 59
patients who were hospitalized with West Nile virus infection in the New York
City area during August and September of 1999. The median age of these patients
was 71 years (range, 5 to 95). The overall attack rate of clinical West Nile
virus infection was at least 6.5 cases per million population, and it increased
sharply with age. Most of the patients (63 percent) had clinical signs of
encephalitis; seven patients died (12 percent). Muscle weakness was documented
in 27 percent of the patients and flaccid paralysis in 10 percent; in all of
the latter, nerve conduction studies indicated an axonal polyneuropathy in 14
percent. An age of 75 years or older was an independent risk factor for death
(relative risk adjusted for the presence or absence of diabetes mellitus, 8.5;
95 percent confidence interval, 1.2 to 59.1), as was the presence of diabetes
mellitus (age-adjusted relative risk, 5.1; 95 percent confidence interval, 1.5
to 17.3). CONCLUSIONS: This outbreak of West Nile meningoencephalitis in the
New York City metropolitan area represents the first time this virus has been
detected in the Western Hemisphere. Given the subsequent rapid spread of the
virus, physicians along the eastern seaboard of the United States should
consider West Nile virus infection in the differential diagnosis of
encephalitis and viral meningitis during the summer months, especially in older
patients and in those with muscle weakness.
2872.
Reiber
H. Peter JB. Cerebrospinal fluid analysis: disease-related data patterns and
evaluation programs. [Review] [75 refs] Journal of the Neurological
Sciences. 184(2):101-22, 2001 Mar 1.
Abstract
Cerebrospinal fluid (CSF) analysis is a
basic tool for diagnosis of neurological diseases. Knowledge regarding
blood-CSF barrier function (molecular flux/CSF flow theory) and neuroimmunology
is reviewed to aid understanding and evaluation of CSF data. Disease-related
immunoglobulin patterns (IgG, IgA, IgM with reference to albumin) are described
in CSF/serum quotient diagrams with the hyperbolic reference range for
blood-derived protein fractions in CSF. Clinical relevance of complementary
analyses (cytology, PCR, oligoclonal IgG, antibody detection and brain-derived
proteins) is briefly discussed. Integrated CSF data reports are shown with
numerical and graphical data representation, reference range-related
interpretation and diagnosis-related comments. The principles and rationale of
general CSF analysis reported in this review should enable the reader to
accurately interpret CSF data profiles, and to plan a proper evaluation of new
brain- or blood-derived analytes in CSF. [References: 75]
2873.
Salleras
L. Dominguez A. Prats G.
Parron I. Munoz P. Dramatic
decline of serogroup C meningococcal disease incidence in Catalonia (Spain) 24
months after a mass vaccination programme of children and young people. Journal of Epidemiology & Community
Health. 55(4):283-7, 2001 Apr.
Abstract
STUDY OBJECTIVES: The objective of this
study was to evaluate the effectiveness of a mass vaccination programme carried
out in Catalonia (Spain) in the last quarter of 1997 in response to an upsurge
of serogroup C meningococcal disease (SCMD). DESIGN: Vaccination coverage in
the 18 month to 19 years age group was investigated by means of a specific
vaccination register. Vaccination effectiveness was calculated using the
prospective cohort method. Cases of SCMD were identified on the basis of
compulsory reporting and microbiological notification by hospital laboratories.
Vaccination histories were investigated in all cases. Unadjusted and age
adjusted vaccination effectiveness referred to the time of vaccination and the
corresponding 95% confidence intervals (CI) were estimated at 6, 12, 18 and 24
months of follow up. SETTING: All population aged 18 months to 19 years of
Catalonia. MAIN RESULTS: A total of seven cases of SCMD were detected at six
months of follow up (one in the vaccinated cohort), 12 cases at 12 months (one
in the vaccinated cohort), 19 cases at 18 months (two in the vaccinated cohort)
and 24 at 24 months (two in the vaccinated cohort). The age adjusted
effectiveness was 84% (95%CI 30, 97) at six months, 92% (95%CI 63, 98) at 12
months, 92% (95% CI 71, 98) at 18 months and 94% (95%CI 78, 98) at 24 months.
In the target population, cases have been reduced by more than two thirds (68%)
two years after the vaccination programme. In the total population the
reduction was 43%. CONCLUSION: Vaccination effectiveness has been high in
Catalonia, with a dramatic reduction in disease incidence in the vaccinated
cohort accompanied by a relevant reduction in the overall population. Given
that vaccination coverage was only 54.6%, it may be supposed that this
vaccination effectiveness is attributable, in part, to the herd immunity
conferred by the vaccine.
2874.
Somali
MH. Anastasiou AL. Goulis DG.
Polyzoides C. Avramides A.
Pituitary abscess presenting with cranial nerve paresis. Case report and review
of literature. [Review] [45 refs]
Journal of Endocrinological Investigation. 24(1):45-50, 2001 Jan.
Abstract
Non-adenomatosus lesions of the pituitary
represent a small part of the intrasellar processes and they have heterogeneous
presentation. Making a precise diagnosis is of great importance, as it may lead
to more efficient management. A 65-year-old man was admitted to the hospital
because of headache and right cranial nerve III palsy. Basic laboratory work-up
was normal whereas endocrinological assessment revealed hypopituitarism without
diabetes insipidus. Plain radiography showed an enlarged sella and frontal and
paranasal sinusitis. Computed tomography (CT) and magnetic resonance imaging
(MRI) of the sella revealed an intrasellar lesion with extension to the
sphenoid and cavernous sinuses as well as the suprasellar region, exerting
pressure on the optic chiasm. On T1-weighted images the mass had a
low-intensity signal with a smooth enhancing rim with bright signal. Given the
presence of multiple sinusitis and imaging characteristics a pre-operative
diagnosis of pituitary abscess was made. The patient was operated via
transphenoidal route and purulent material was drained out. Cultures of the
material were positive for Staphylococcus aureus. Antibiotics as well as
cortisol replacement therapy were given. Three months later hypopituitarism
persisted but there was significant improvement in the neurological findings.
We report a case of an unusual presentation of a pituitary abscess. High index
of suspicion, the presence of associated conditions such as pituitary tumors,
meningitis or sinusitis, as well as diabetes insipidus and specific imaging
features are the main diagnostic clues. Pre-operative diagnosis, which will
lead to prompt antibiotic therapy and transphenoidal drainage, can decrease
high mortality and morbidity associated with this disease. [References: 45]
2875.
Tsui
EY. Loo KT. Mok CK. Yuen MK. Cheung YK. Primary multifocal leptomeningeal
gliomatosis. European Journal of
Radiology. 37(1):5-7, 2001 Jan.
Abstract
A 23-year-old female university student was
presented with recent onset of non-specific headache and dizziness. She had no
neurological deficit on neurological examination and magnetic resonance imaging
of the brain revealed diffuse enhancement in the basal cisterns and cerebral
sulci. She was treated as tuberculous meningitis but she did not improve and
developed respiratory arrest. Autopsy showed primary multifocal leptomeningeal
gliomatosis.