Cases Of Meningitis Research Articles

Meningitis a Listeria monocytogenes in a young, immunocompetent male

Listeria Monocytogenes (LM) is a gram-positive intracellular pathogen usually transmitted to humans by ingesting contaminated food. It typically infects immunocompromised individuals, such as pregnant women, newborns, alcoholics, and the elderly. LM is a rare cause of meningitis in immunocompetent, healthy adults. However, its clinical presentation is similar to that of other viral or bacterial central nervous system infections and its course can be rapid and aggressive. Physicians should therefore always consider LM as a possible etiologic agent of meningitis, especially in cases that do not respond to first-line empiric antibiotic therapy. We report a case of Listeria Monocytogenes meningitis in a previously healthy 16-year-old.

A case of Candida meningitis in a patient with CARD9 deficiency: an autopsy report

Here we present the case of a 23-year-old female with a history of onychomycosis and oral thrush since childhood. She presented with a gradual onset of headache, and cerebrospinal fluid (CSF) analysis on admission revealed an elevated mononuclear cell count. Hydrocephalus was observed on brain MRI. Candida albicans (C. albicans) was detected in the CSF, and antifungal treatment was initiated to diagnose of Candida meningitis. Due to an insufficient therapeutic response, intraventricular administration of liposomal amphotericin B initiated; however, the lesions persisted. Subsequently, the patient experienced repeated occlusions of the ventriculoperitoneal shunt tube, ultimately dying from a bacterial shunt infection. Autopsy findings revealed diffuse fungal proliferation on the surface of the brainstem and ventricular walls. Genetic testing confirmed a diagnosis of CARD9 deficiency. Although CARD9 deficiency is a rare disease, genetic testing should be considered when primary immunodeficiency is suspected.

Spontaneous Gram-negative Bacterial Meningitis Following Steroid Therapy for Severe COVID-19

Abstract This case demonstrates an unusual case of spontaneous Gram-negative bacillary meningitis (GNBM) due to Serratia following COVID-19 and steroid exposure. A 52-year-old male presented with clinical features of acute meningitis following a prolonged hospitalization for severe COVID-19 pneumonia, during which he was administered corticosteroids. Neuroimaging was normal. Cerebrospinal fluid (CSF) analysis revealed high protein, hypoglycorrhachia, and neutrophilic pleocytosis. The Gram stain showed plenty of neutrophils but no bacteria. CSF culture demonstrated convex 1–2 mm colonies, slightly umbonate with entire margins, and opaque. On VITEK2, this was identified as Serratia marcescens and was susceptible to all tested antibiotics. Clinical improvement was noted after 48 h with the administration of meropenem (2 g q8 h) and levofloxacin (750 mg once daily). After a week of treatment, repeat CSF analysis showed a decrease in the CSF protein and total white blood cells, lymphocytic pleocytosis, and an increase in the CSF glucose. The patient made a complete recovery following 3 weeks of antibiotic therapy. This case report highlights that steroids should be used cautiously and judiciously in the COVID-19 setting. Serratia is a rare cause of spontaneous GNBM.

Cryptococcus neoformans and cryptococcosis: a contribution made by Prof. Dr. Mahendra Pal

Mycotic infections are reported to occur in both sexes, all age groups, in all seasons, and in urban and rural areas of the world. The people with weakened immune systems are more likely to get an infection due to fungi, which are widely prevalent in our environment. Cryptococcosis primarily caused by Cryptococcus neoformans is a life-threatening enigmatic mycosis of global importance. It is estimated that 1000000 cases of cryptococcal meningitis complicating HIV/AIDS are reported every year worldwide. Disease has been encountered in humans as well as in a variety of animals including cats and dogs. The source of infection is exogenous, as the fungus occurs as a saprophyte in nature. Currently, the pigeon excreta serve as the chief saprobic reservoir of C. neoformans. Human as well as animals may acquire the infection from the environment where the fungus grows luxuriantly. The respiratory tract is recognized as the principal mode of entry of the organism. The pathogen can also enter through the fungal contaminated objects via traumatized skin. Clinical spectrum of disease is varied, as manifested with several forms, such as pulmonary, meningeal, visceral, osseous, and cutaneous. The laboratory help is imperative to confirm an unequivocal diagnosis of cryptococcosis. The pathogen can be easily isolated from the clinical specimens of the patients on Pal sunflower seed medium. Modified Pal sunflower seed can be employed to undertake the sexual compatibility studies of Cr. neoformans. Several drugs including amphotericin B, fluconazole, and itraconazole have been recommended for the treatment of disease. The immediate attention to the skin injury and use of face mask when dealing with avian droppings can help in the prevention of infection.

Presence of Enteric Fever with Unusual Clinical Scenarios: A Case Series

Salmonella species are associated with bacteraemia, diarrhoea, as well as focal infections. Salmonella Typhi is the most pathogenic species. Salmonella Paratyphi B commonly affects immunocompromised hosts. The present case series showcases six cases of infection caused by typhoidal Salmonellae with unusual clinical scenarios. The first case report explains a case of neonatal meningitis where the causative agent was S. Paratyphi B. A case of lumbar spondylodiscitis is also reported where the aetiology was found to be Salmonella Typhi. Case three reports S. Typhi infection in a patient with Pre-B cell Acute Lymphoblastic Leukemia (ALL). S. Paratyphi B was isolated from a blood culture of a patient on haemodialysis and also from ascitic fluid from a case of Chronic Liver Disease (CLD). S. Typhi was isolated from the pleural fluid of a patient with carcinoma of the prostate.

Clinical and Microbiological Characteristics of Bacteremia Caused by Carbapenemase-producing Enterobacterales in Minami Ibaraki Area, Japan.

Although recent propagation of carbapenemase-producing Enterobacterales (CPE) has become a problem worldwide, the picture of CPE infection in Japan has not fully been elucidated. In this study, we examined clinical and microbiological characteristics of invasive CPE infection occurring at 8 hospitals in Minami Ibaraki Area between July 2001 to June 2017. Of 7294 Enterobacterales strains isolated from independent cases of bacteremia and/or meningitis, 10 (0.14%) were CPE (8 Enterobacter cloacae-complex, 1 Escherichia coli, and 1 Edwardsiella tarda）, all of which had the blaIMP-1 gene and susceptible to gentamicin and trimethoprim/sulfamethoxazole. These strains were isolated from 7 adult and 2 infant bacteremia (1 infant patient developed CPE bacteremia twice) after 2007. The most common portal of entry was intravenous catheters. All of the adult patients were recovered, while the infant patients eventually died. Genomic analyses showed that the 8 E. cloacae-complex strains were classified into 5 groups, each of which was exclusively detected in specific facilities at intervals of up to 3 years, suggesting persistent colonization in the facilities. This study showed that invasive CPE infection in the area was rare, caused by IMP-1-type CPE having susceptibility to various antibiotics, and nonfatal among adult patients.

Lessons learned from a fatal case of Tuberculosis Meningitis: A case report

BACKGROUND In 2023, 10 million cases of Tuberculosis were reported by the WHO. Tuberculous meningitis (TBM) may be the sole manifestation of Tuberculosis (TB) and does not require prior pulmonary or extrapulmonary disease[1]. Approximately one-half of all TBM infections lead to severe neurological disability with a mortality rate of 30% with death in 6 months and 50% overall[2-4]. Despite being inarguably the most devastating clinical presentation of TB, frequent diagnostic delays are common due to low clinical suspicion or misdiagnosis as current diagnostic tests still have a limited yield[5]. The best way to reduce mortality and morbidity associated with TBM is by maintaining a high index of suspicion, timely diagnosis and initiation of treatment. This case report aims to highlight the clinical presentation, imaging findings, and diagnostic pitfalls in the diagnosis of TBM. CASE PRESENTATION A 36-year-old Indian man with no significant medical, social, or travel history initially sought treatment at a private hospital in Abu Dhabi for fever, intermittent headaches, and confusion. Investigations at the hospital included a negative QuantiFERON TB gold (QTF) test and a negative cerebrospinal fluid (CSF) culture, but the CSF analysis was not included in the provided reports. Consequently, he received acyclovir treatment for suspected viral encephalitis but was discharged without complete symptom resolution. Following discharge, he experienced worsening confusion over three days. Upon presentation to our Emergency Department (ED), he was febrile, disoriented, and difficult to rouse, with a GCS score of 11/15, displaying terminal neck stiffness. There were no signs of lateralization, cranial nerve deficits, or cerebellar abnormalities. A computerized tomography (CT) scan conducted in the ED revealed hydrocephalus with diffuse leptomeningeal enhancement. Laboratory results indicated significant hyponatremia at 121 mmol/L. He was started on broad-spectrum antibiotics and anti-tuberculosis medication empirically based on the clinical scenario and CT findings. During his Intensive Care Unit (ICU) stay, a CSF analysis suggested TB meningitis, and a positive Mycobacterium tuberculosis polymerase chain reaction (MTB-PCR) confirmed the diagnosis. An MRI of the brain showed meningoencephalitis with tuberculoma formation in the left cerebellar hemisphere. Unfortunately, despite treatment, his condition deteriorated, necessitating endotracheal intubation, multiple EVD revisions, and ventriculoperitoneal shunt placement. A follow-up MRI revealed worsening hydrocephalus and cerebral vessel thromboses, ultimately leading to his unfortunate demise in the ICU. CONCLUSION This case highlights that Tuberculous meningitis is a highly lethal, under-recognized disease with characteristic clinical and imaging features in which delay in diagnosis and subsequent treatment can lead to fatal consequences. Emergency Medicine physicians should maintain a high index of suspicion for TBM in patients with fever and vomiting and signs of altered mental status and keep in mind that a normal CXR, negative QuantiFERON test, and the absence of TB exposure history does not exclude TBM from the differential when clinical and Brain imaging findings raise concern. Prompt identification prevents delay in initiation of management and ultimately may lead to better long-term outcomes.

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil.

To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Training was provided to medical pathologists on MIA. A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance. A protocol was developed to perform minimally invasive autopsies (MIAs) in Death Verification Services (SVO), capable of expanding the system's capacity to identify a greater number of deaths suspected to be due to arboviruses. The experience suggests that in-service trained health professionals are able to perform MIA, and that use of this technique in SVOs has been shown to be capable of increasing the system's sensitivity in detecting deaths of interest to public health. Trained professionals will be able to collect biological material in hospitals, through MIA, in cases of interest for health surveillance and when family members do not allow a complete conventional autopsy to be performed.

Bacteremia and meningitis caused by penicillin-resistant Streptococcus pneumoniae serotype 35B successfully treated with ceftriaxone combined with vancomycin followed by linezolid: A case report.

We herein report a case of bacterial meningitis and bacteremia in a 3-month-old boy caused by Streptococcus pneumoniae serotype 35B multidrug resistance. Intravenous ampicillin was administered on admission. However, when pneumococcal meningitis was suspected, the antibiotic treatment was changed to ceftriaxone (CTRX) and vancomycin (VCM). However, owing to difficulties in achieving sufficient serum trough levels of VCM, this treatment was again switched to linezolid (LZD). The patient recovered without complications after 16 days of CTRX and LZD treatment. This case suggests that LZD is a viable treatment option for bacterial meningitis.

Менингит, ассоциированный с парвовирусом В 19 у ребенка

Damage to the nervous system is not typical for parvovirus infection, however, reports of such observations are becoming more and more widespread. We describe a case of meningitis associated with B19 parvovirus in an eight-month-old child without hematological diseases and immunodeficiency, which occurred simultaneously with staphylococcal enterocolitis. The diagnosis was made based on the detection of parvovirus B19 DNA in the cerebrospinal fluid and antibodies (Ig M) in the blood. Clinical symptoms were sparse, and the classic meningitis syndrome complex was not observed. There were also no typical manifestations of erythema infectiosum. Treatment included the administration of intravenous immunoglobulin and a short course of glucocorticosteroids. Recovery occurred 20 days after the disease onset. Observation for a month after discharge from the hospital did not show significant deviations in the child’s health.

A Case Report on Bacterial Meningitis and its Management

An elderly female patient was admitted to a critical care unit due to headache and vomiting. She was eventually found to have bacterial meningitis. An inflammation of the meninges around the brain and spinal cord is called bacterial meningitis. Covering the dura mater, arachnoid mater, and pia mater, the study underlines the criticality of diagnosing and treating bacterial meningitis as soon as possible because of its potentially lethal nature. A life-threatening inflammation of the meninges can result from various pathogens, with Streptococcus pneumoniae being a predominant cause. The first stages of management involve early detection, diagnostic testing, and prompt antibiotic treatment. Empirical therapy, such as a combination of ceftriaxone and vancomycin, is crucial. Corticosteroids, particularly dexamethasone, can be administered to reduce cerebral edema and intracranial pressure. The report emphasizes the importance of timely intervention in bacterial meningitis cases to improve outcomes and prevent complications.

Complete Intraventricular Migration of Ventriculoperitoneal Shunt: Once in a Blue Moon Phenomenon of Shunt Surgery

AbstractShunt surgery is a very common neurosurgical procedure for hydrocephalus. It is associated with numerous complications, and intraventricular shunt migration is one of rarest. Various mechanisms have been described to explain this rare entity. Hereby we present an index case of this rare complication of shunt surgery in which patient presented with tuberculous meningitis with hydrocephalus having intraventricular shunt migration and will discuss possible mechanisms responsible for it. A 1-year old male infant, previously diagnosed case of tuberculous meningitis with hydrocephalus with right-sided ventriculoperitoneal shunt in situ, presented to the emergency department with bulging fontanelles secondary to shunt malfunction. Left-sided ventriculoperitoneal shunt was inserted. After few months, patient turned up again with left-sided shunt malfunction and right-sided intraventricular migrated shunt. Endoscopy-assisted removal of intraventricular migrated shunt and simultaneous third ventriculostomy was done. Patient improved in postoperative period. Being an extremely uncommon complication, intraventricular migration of shunt described as “once in a blue moon” phenomenon. It can be avoided by proper surgical technique with adequate-sized burr hole. Removal of shunt is preferred for prevention of infection.

A case of tuberculous meningitis complicated by large cerebral infarcts

There is a substantial morbidity and fatality rate associated with tuberculosis meningitis (TBM). A severe consequence of tuberculosis meningitis is cerebral infarction (CI). It can be asymptomatic or symptomatic, causing stroke. In this case, large cerebral infarcts, an uncommon complication of TBM, is presented.

Herpesvirus infections and HIV (diagnosis and clinical features)

Objective. Epidemiologic analysis of the incidence, prevalence, and structure of various forms of herpesvirus infections (HVI) in patients with and without HIV infection. Material and Methods. The study included 8729 adult patients with HIV-negative status, as well as 937 HIV-infected patients of both sexes aged over of 18 years, with established diagnoses of manifest HVI in 224 cases. The methods used were epidemiological, clinical, laboratory and statistical methods of data processing (Excel, Statistica 10). Results. Among the total number of adult patients, herpes zoster (HZ) was detected in 4446 patients without HIV infection. In 218 patients, a combined course of HVI and HIV infection was detected, of which 203 (22.02%) patients were hospitalized with clinically and laboratory confirmed HVI with moderate to severe course. The frequency of combination of HVI+HIV in relation to the entire group of HVI in hospitalized patients was 1.94%. Among all identified forms of HVI, the most common was HZ – 89.16%, while herpes simplex – 10.71%, Epstein-Barr virus (EBV) infection including infectious mononucleosis – 5.80%, and cytomegalovirus infection (CMVI) – 2.68%. In hospitalized patients with HVI and HIV, HZ was diagnosed in 89.16% of cases, herpes simplex in 6.90%, infectious mononucleosis in 2.46%, and CMVI in 1.48%. Among outpatients with HIV infection, the most common forms of HVI were herpes simplex in 47.61%, EBV infection, including infectious mononucleosis, in 38.09%, and CMVI in 14.29%. Among HIV-infected patients, the main reason for hospitalization was HZ (89.16%). HZ in the presence of HIV infection prevailed among young patients under 40 years of age, and patients over 55 years of age with HZ were significantly more common among patients without HIV infection. Among patients with HZ and HIV infection, severe and generalized forms, cases of meningitis and meningoencephalitis, and damage to 2 dermatomes were significantly more common. The incidence of postherpetic neuralgia and neuropathy among patients with HZ without HIV infection was 14.10% of cases, among patients with HZ and HIV infection in 10.49%. Cases of acute cerebral circulatory failure occurred only among patients of older age groups without HIV infection with the presence of HZ. The most common cause of death among all examined patients with HVI was HZ – 71.43% with complications (encephalitis, pneumonia).

Epidemiological Profile of Communicable Diseases in Childhood within the Babylon Governorate, Iraq from 2017 to 2021

Background: Notifiable communicable diseases are a significant public health issue in Iraq, particularly among children. Aims: This study aimed to comprehensively assess the epidemiological profile of childhood communicable diseases in Babylon Governorate, Iraq, over the period 2017–2021 Methods and Material: Data from 11,925 cases of notifiable communicable diseases were collected from the health department in AL-Hilla City, Iraq, between 2017 and 2021. The data were analysed according to the mode of transmission, type of infection, and age and sex patterns. Results: The majority of the reported communicable diseases (85.4%) were droplet and airborne infections, with pneumonia being the most frequently reported respiratory infection (76.8%). The reported cases of pertussis, viral meningitis, bacterial meningitis, chickenpox, and mumps showed a significant decrease during the study period, while the incidence of measles had two peaks in 2019 and 2020. Viral hepatitis A and typhoid fever were the most frequently reported foodborne infections. Kala-azar was the most common arthropod-borne infection, while brucellosis and rabies were the most common zoonotic infections. Pneumonia and meningitis affected infants and children aged 1-4 years more commonly than other age groups, while pertussis affected infants and children aged 1-4 years more frequently than other age groups, with a female predominance. Measles affected infants and children aged 1-4 years more commonly than older age groups, with a male predominance. Conclusions: This study provides a comprehensive overview of the occurrence and trends of notifiable communicable diseases among children in AL-Hilla City, Iraq, between 2017 and 2021. The findings highlight the need for improved surveillance and prevention measures.

Study of cerebrospinal fluid adenosine deaminase activity for differential diagnosis of tuberculous and non-tuberculous meningitis

Background: Diagnosing a case of tuberculous meningitis (TBM) has always been challenging. Numerous previous studies have demonstrated that cerebrospinal fluid-Adenosine deaminase (CSF-ADA) estimation is useful in the diagnosis of TBM and can differentiate TBM from other types of meningitis. Aims and Objectives: The current study aims to look for a simple, rapid, cost-effective, and specific test to differentiate tubercular etiology from other causes of meningitis. Materials and Methods: A total of 80 patients admitted to the hospital with signs and symptoms of meningitis were selected and divided into two groups: Group 1 (Cases): 40 patients of TBM, Group 2 (Control): 40 patients of pyogenic and viral meningitis. The CSF ADA was estimated by enzymatic method, CSF Protein by turbidimetric method, and CSF Glucose by Glucose oxidase (GOD) and Peroxidase (POD) method. Results: CSF ADA levels (mean ± SD) in the TBM and non-TBM groups were 10.874+7.72 IU/L and 2.44+1.757 IU/L, respectively (highly significant, P<0.001). With the CSF ADA cut off as >6 IU/L, the sensitivity of the test was 95%, and the specificity of 92.5%. On comparison of the values of CSF ADA in the two groups, the t value is −6.75, and the difference in these two values was found to be highly significant (P<0.01). Conclusion: ADA estimation in CSF is a simple, inexpensive, rapid, and specific method for making a diagnosis of tuberculous etiology in TBM. As a screening test, the determination of ADA activity in CSF can help the physician diagnose TBM early and reduce irreversible brain damage and neurologic sequelae by early administration of anti-tuberculous medications.

Efficacy and Safety Is Maintained in Adult Patients with Paroxysmal Nocturnal Hemoglobinuria Receiving Pegcetacoplan for up to 3 Years

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening disease characterized by complement-mediated hemolysis and thrombosis. Pegcetacoplan, the first complement component 3 (C3) inhibitor for PNH, increased hemoglobin (Hb) levels in complement component 5 inhibitor (C5i)-experienced and -naive adult patients with PNH in 2 phase 3 clinical trials (PEGASUS [NCT03500549] and PRINCE [NCT04085601], respectively). This integrated analysis of data from the pivotal phase 3 trials and the subsequent open-label extension (study 307; NCT03531255) evaluated the long-term efficacy and safety of pegcetacoplan for PNH treatment. Methods: For this integrated analysis, baseline was defined as the initiation of pegcetacoplan, regardless of when in the trials this occurred. Patients initially received pegcetacoplan 1080 mg subcutaneously twice weekly; dose escalations to once every 3 days or 3 times weekly were permitted. Efficacy was evaluated from baseline up to Weeks 132 (2.5 years, PRINCE) and 156 (3 years, PEGASUS) by Hb, lactate dehydrogenase (LDH; upper limit of normal [ULN] 226 IU/L), absolute reticulocyte count (ARC), and indirect bilirubin values; Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores; and transfusion avoidance rates (percentages of patients who did not require a transfusion during treatment). Safety was assessed by incidence of adverse events (AEs) and serious AEs (SAEs) during pegcetacoplan monotherapy for up to 3 years. Results: Of the 133 patients in the phase 3 trials (PEGASUS, 80; PRINCE, 53), 114 enrolled in the extension study (PEGASUS, 64; PRINCE, 50). At least 75% had received a transfusion in the year before enrolling in PEGASUS or PRINCE. Prior to pegcetacoplan initiation, mean (SD) Hb levels were 8.95 (1.09) g/dL in PEGASUS, 9.27 (1.44) g/dL in PRINCE, and 9.08 (1.24) g/dL in the total population; median (interquartile range) LDH levels were 217.0 (184.8, 276.5) IU/L in PEGASUS, 1964.0 (1409.0, 2503.3) IU/L in PRINCE; and mean (SD) FACIT-Fatigue scores were 31.6 (11.7) in PEGASUS, 36.6 (10.0) in PRINCE, and 33.6 (11.3) in the total population. After pegcetacoplan initiation, mean Hb levels markedly improved from baseline and remained stable through Weeks 132 (2.5 years, PRINCE) and 156 (3 years, PEGASUS) ( Figure). Median LDH rapidly decreased and stabilized below the ULN ( Figure). Improvements in ARC and indirect bilirubin were similarly maintained. Average FACIT-Fatigue scores increased (indicating less fatigue) rapidly and were maintained near the general population norm of 43.6. Annual transfusion avoidance ranged from 71%-79% in PEGASUS and 80%-86% in PRINCE, with 52% of patients from PEGASUS avoiding transfusion for up to 3 years of pegcetacoplan treatment and 67% of patients from PRINCE avoiding transfusion for up to 2.5 years. Overall, >92% patients had compliance rates of at least 95%. Over 3 years, most patients experienced an AE; SAEs were reported in 50.0% of patients, with 4.5% experiencing a SAE deemed related to pegcetacoplan. Overall, 17 patients discontinued pegcetacoplan due to an AE; of those, 9 discontinued due to a hemolytic disorder, 7 of which discontinued within 1 year of starting pegcetacoplan. Over 3 years, 4 (3.0%) deaths occurred, none were deemed related to pegcetacoplan; 3 (2.3%) patients experienced a thrombotic event (in the context of multiple associated comorbidities or discontinuation of pegcetacoplan) and no cases of meningitis were reported. Overall, no new or unexpected safety findings were identified. Conclusions: Rapid improvements in Hb, LDH, ARC, indirect bilirubin, and FACIT-Fatigue values were observed and maintained up to 3 years in C5i-experienced patients and up to 2.5 years in C5i-naive patients. The transfusion burden was significantly reduced. No new safety findings were identified. This analysis demonstrates sustained efficacy and continued safety of long-term pegcetacoplan for patients with PNH, regardless of prior C5i treatment.

Bilateral Facial Nerve Palsy Following Antibiotic Treatment for Listeria Monocytogenes Meningitis

Listeria monocytogenes (LM) is an intracellular, facultative, gram-positive bacillus transmitted mainly through contaminated food, particularly dairy products and cold deli meats. It typically affects immunocompromised patients, and a rarely neuroinvasive disease in immunocompetent healthy adults has been described in the literature. Despite the timely intervention, neurologic morbidity has been observed after extended periods of recommended antibiotic regimens. This case study highlights the challenges in diagnosing and managing LM meningitis, especially when atypical symptoms and complications arise. Herein, we describe the case of a 57-year-old healthy man admitted with symptoms of nausea, vomiting, headache, neck pain, and stiffness, who was eventually diagnosed with LM-related meningitis and treated with antibiotics. The patient’s hospital course was complicated by bilateral facial nerve palsy, while other symptoms improved with antibiotic treatment, raising suspicion for parainfectious immunological response, which improved with a short course of steroids. This case contributes to the medical literature by providing insights into the immunological response for treating LM meningitis and managing LM meningitis–associated complications. To our knowledge, this could potentially be the first case of LM meningitis causing the parainfectious immunological response of bilateral facial nerve palsy after antibiotic treatment.

HSV-2 Associated Meningitis Case: A Challenging Diagnosis in An Immunocompetent Woman

Herpes simplex virus type-2 (HSV-2) associated aseptic meningitis is rarely seen in healthy individuals. Herein, we report a rare case of meningitis, associated with HSV-2, without the presence of genital lesions. A healthy, 40-year-old female was presented to the emergency service with unremitting headache, vomiting and nausea. Her cerebrospinal fluid (CSF) revealed elevated protein level of 308,2 mg/dL, high leukocyte cell count of 1,118,000 cells/µL with 98% lymphocytes and 2% polymorphonuclear neutrophils (PMNs). The bacterial culture and gram staining of CSF were negative. Real-time quantitative polymerase chain reaction (RT-qPCR) CSF analysis indicated the presence of HSV-2. The cranial MRI revealed meningeal contrast enhancement. The patient was administered acyclovir for 10 days during her hospital stay and she was discharged without any neurological sequela. The patient has a history of herpes infection. This case report shows that HSV-2 meningitis can occur in immunocompetent individuals via re-activation and should always be considered by the clinicians even in the absence of genital lesions.

Scrub typhus Meningoencephalitis : Diagnostic dilemma

Background: Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. It is seldom considered in the differential diagnosis of meningitis in the Indian subcontinent. Case Presentation: We report a case of Scrub typhus meningitis in 13year old male child. The Cerebrospinal Fluid (CSF) revealed lymphocytic pleocytosis, raised proteins and a normal glucose level. Conclusion : Early diagnosis and prompt institution of doxycycline therapy may lead to early cure of scrub typhus even when features of meningitis supervene. However, Ceftriaxone which is commonly used to treat bacterial meningitis is suboptimal in the treatment of scrub typhus. Key words : Scrub typhus, Meningoencephalitis, CSF