Presence Of Meningitis Research Articles

Complete orbit and forehead reconstruction using a free latissimus dorsi flap and MEDPOR implants

Reconstruction of enormous composite defects of the face in the presence of meningitis is a difficult problem. We present a case of a 29-year-old man with a huge, posttraumatic bone and soft tissue defect of the upper half of the left side of the face (orbit-zygoma-frontal-partial temporal bones), frontal lobe of the brain, and enucleated eye with intact facial skin. An initial reconstruction using cement was complicated by multiple episodes of meningitis. In a multiple-stage procedure, we used a free latissimus dorsi muscle flap to re-construct the soft tissue defect and control the infection, a complete left orbit and frontal MEDPOR implant for the bone defect, and also an orbital sphere MEDPOR implant for the eyeball. In a 2-year follow-up, no infection was observed, and the cosmetic result is satisfactory. The combination of free flap and MEDPOR implants demonstrates an alternative method for reconstruction of complicated facial defects.

The clinical epidemiology of pulmonary cryptococcosis in non-AIDS patients at a tertiary care medical center.

Cryptococcus neoformans is a ubiquitous saprophytic fungus with worldwide distribution. It has been found in nature, primarily in association with bird droppings, but nonavian sources have been described as well (10). Although the lungs are thought to be the portal of entry for cryptococcus, pulmonary infection is uncommon. The organism is trophic to the central nervous system and the vast majority of recognized infections involve meningitis. Before the acquired immunodeficiency syndrome (AIDS) epidemic (1980), cryptococcosis was a rare infection, and pulmonary disease was described in 10%–45% of patients with cryptococcal meningitis (2). However, the true incidence of pulmonary cryptococcosis (PC) was not known, but was much lower than meningitis. Most PC cases were identified histologically and often at autopsy, with only about 20% diagnosed by culture (2, 3, 13). In recent years, many of the reports of cryptococcal infection have been in the human immunodeficiency virus (HIV)-positive population, and little is known of the disease in non-AIDS patients, particularly pulmonary involvement. At our institution, a tertiary care medical center with a large transplant program, sporadic cases of PC have occurred in solidorgan transplant recipients as well as in patients with a variety of different medical conditions. The purpose of our study was to investigate the epidemiology of PC in non-AIDS patients, and to determine predictors of outcome among these patients.

Empleo del score de NESI (Neisseria sepsis index) en meningococcemia aguda

Introduction: Meningococcal infection may present as meningitis or as fulminant septic shock. Different prognostic scoring systems have been developed in order to classify patients according to their expected outcome. The NESI score was designed using laboratory and clinical parameters. Objective: We measured the prognostical role of this index in paedriatric patients and compared it to the risk of death. Method: This was a prospective study, used in patients admitted to the PICU in the hospitals Sotero del Rio and Padre Hurtado with meningococcal infection between december 1995 and december 1999. NESI considers heart rate (HR), mean arterial blood pressure (MAP), base excess (BE) and progression of cutaneous lesions (CL). We noted some biochemical characteristics and the final outcome. Results: 121 consecutive cases of meningococcal infection were admitted. Neisseria meningitidis was cultured in 74 (61%). Patients were aged between 1 and 156 months (median 41), 58% were male. Eleven patients (9%) died owing to multiorgan failure. There were no statistical differences in mortality by age, sex or the presence of meningitis. Half of the patients had a NESI score of 2. Patients with a score of 3 or more had almost 4 times the risk of death (RR = 4.96, p < 0.01) as compared with those with a lesser score. Both sensitivity and negative predictive values were 100%. Conclusion: the fact that the NESI score considers few clinical parameters it might be used in any hospital for early recognition of a life threatening condition in patients with acute meningococcal infection.

Cytokine profiles of AIDS patients are similar to those of mice with disseminated Cryptococcus neoformans infection.

Cryptococcosis is an hematogenously disseminated meningoencephalitis during which the relationship between the disease severity and the immune response remains unclear. We thus analyzed, by enzyme-linked immunosorbent assay, proinflammatory (tumor necrosis factor alpha [TNF-alpha] and interleukin-6 [IL-6]) and anti-inflammatory (IL-10) cytokine levels in plasma at the time of diagnosis in 51 AIDS patients with culture-proven cryptococcosis. We used a murine model to determine the correlation between cytokine levels and fungal burden in blood and tissues and the kinetics of the immune response and of the formation of cerebral lesions. In AIDS patients, plasma TNF-alpha and IL-10, but not IL-6, levels were significantly higher in the case of fungemia or disseminated infection than in their absence, whereas the presence of meningitis had no influence on these levels. In mice, none of these cytokines were detected within the first day after inoculation. Later on, TNF-alpha and IL-10, but not IL-6, levels in plasma correlated significantly with the fungal burden in the blood and spleen but not the brain. In the brain, cytokine levels were low compared to those in other compartments, and tissue lesions and a degree of infection similar to those observed in humans were seen, further suggesting the relevance of this experimental model. Thus, AIDS patients with cryptococcosis produce an immune response that reflects the dissemination but not the meningeal involvement. This murine model of disseminated cryptococcosis can be used to investigate the pathophysiology of cryptococcosis and new therapeutic approaches.

Frequency of myocarditis in cases of fatal meningococcal infection in children: observations on 31 cases studied at autopsy.

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 Glória in Vitória, 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.

Streptococcus &lt;italic&gt;suis&lt;/italic&gt; infection in Hong Kong

Twenty-five patients were admitted to two hospitals in Hong Kong for Streptococcus suis infection between 1984 and 1993. Among them, 15 (60%) had an occupational exposure to pigs or pork, and four had a clear history of skin injury up to 16 days before admission. Examination of the cerebrospinal fluid of 21 patients confirmed the presence of meningitis in every case; the remaining four patients who did not have lumbar punctures had each presented with arthritis, bronchopneumonia, endocarditis and pyrexia without neck stiffness. The only fatality was a patient admitted in septicaemic shock with evidence of meningitis and disseminated intravascular coagulation. Of the 24 survivors, 16 (67%) acquired varying degrees of hearing loss as a result of meningitic involvement. All the isolates of S. suis were sensitive to penicillin or ampicillin, which was used alone or in combination with other antibiotics for every patient. Two patients had a relapse of symptoms when penicillin was stopped, but were successfully treated after the antibiotic was resumed for a total of 6 weeks. Over 100 cases of S. suis infection have been described previously, with a geographic distribution heavily biased towards Northern Europe and Southeast Asia. Lack of awareness of this unique zoonosis may be a reason why it is not diagnosed more readily elsewhere.

Association of clinical presentation, laboratory findings, and virus serotypes with the presence of meningitis in hospitalized infants with enterovirus infection.

One hundred eight hospitalized infants with enteroviral infections were studied to determine the association of clinical presentation, laboratory findings, and virus serotypes with the presence of meningitis. Of 108 infants, 55 (51%) had meningitis. Clinical manifestations on admission did not distinguish between infants with and those without meningitis. Echoviruses 30 and 11 and coxsackie virus B were frequently associated with meningitis (34/38; 90%) whereas echoviruses 18, 24, and 25 were not (5/35; 4%). The virus isolation rate was directly proportional to the number of leukocytes in cerebrospinal fluid: 5 of 58 (9%) when up to 9 cells/mm3 were found, 10 of 21 (48%) when 10 to 99/mm3 cells were found, and 25 of 29 (86%) when greater than equal to 100 cells/mm3 were found. Meningitis is often unsuspected in children hospitalized with enterovirus infection. The frequency of meningitis among hospitalized infants is serotype dependent and is most frequently, but not exclusively, found with pleocytosis of the cerebrospinal fluid.

Interpretation of traumatic lumbar puncture in the presence of meningitis

Interpretation of traumatic lumbar puncture in the presence of meningitis

THE CONCENTRATIONS OF PENICILLINS IN THE CEREBROSPINAL FLUID AND BRAIN OF RABBITS WITH EXPERIMENTAL MENINGITIS

The selection of an antibiotic to treat purulent meningitis is based upon the minimal inhibitory concentration of the drug for the infecting organism and the concentration of the antibiotic in the blood and cerebrospinal fluid following systemic administration. Few antibiotics reach the cerebrospinal fluid of normal animals in appreciable concentrations. All reach higher levels in the presence of meningitis. Several semisynthetic penicillins possess novel properties suggesting that the drugs should be useful in the treatment of meningitis. The distribution of these drugs in the cerebrospinal fluid in meningitis is not known. Experiments were carried out in which the concentrations of nine semisynthetic penicillins were assayed in the blood, cerebrospinal fluid, and brain of rabbits with purulent meningitis. Appreciable concentrations of all penicillins were found in the cerebrospinal fluid. A correlation was shown between the levels reached in the cerebrospinal fluid and the amount of penicillin bound by plasma protein. Cerebrospinal fluid levels did not accurately reflect brain tissue concentrations.

Chronic meningococcemia.

Case Reports1 July 1956CHRONIC MENINGOCOCCEMIAMAURICE GORE, M.D.MAURICE GORE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-45-1-142 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptChronic meningococcemia without the presence of meningitis is an uncommon clinical entity, particularly when this occurs in an isolated instance. During local outbreaks or in endemic areas, meningococcemia occurs frequently and can be easily diagnosed. According to Feddersen,1the first description of chronic meningococcemia was published by Solomon.2Feddersen reported that there were over 100 cases in the European literature3-6up to 1945, and stated that there were fewer cases in the American literature7-11because full investigations were not the usual procedure. With the advent of sulfonamide therapy, treatment was often started before adequate diagnostic studies were made. Since meningococcemia...Bibliography1. Feddersen AS: Meningeal septicemia, M. J. Australia 2: 47-48 (July 14) 1945. CrossrefGoogle Scholar2. Solomon H: Ueber Meningokokkenseptikämie, Berl. klin. Wchnschr. 39: 1045 (Nov. 10) 1902. Google Scholar3. Denison SB: Chronic meningococcic septicemia treated with 2-(p-aminobenzene-sulfonamide) pyridine, Lancet 2: 424 (Aug. 20) 1938. Google Scholar4. StottCopeman AWWS: Chronic meningococcic septicemia associated with an outbreak of cerebro-spinal fever, Lancet 1: 617 (June 22) 1940. Google Scholar5. Lane J: Chronic meningococcemia, M. J. Australia 2: 617 (Dec. 9) 1944. CrossrefGoogle Scholar6. DicksonMcKinnonMaguerMcGillwray RCNEDNB: Meningococcal infection, Lancet 2: 631 (Nov. 22) 1941. CrossrefGoogle Scholar7. SchwentkerGelmanLong FFSPJ: The treatment of meningococcic meningitis with sulfonamides, J. A. M. A. 58: 1407 (Apr. 24) 1937. CrossrefGoogle Scholar8. ZendelGreenberg JFD: Meningococcemia: treatment with sulfanilamide and Prontosil. Report of two cases, New York State J. Med. 37: 1744 (Oct. 15) 1937. Google Scholar9. Norman JK: Chronic meningococcemia, Mil. Surgeon 97: 455-457 (Dec.) 1945. MedlineGoogle Scholar10. CarconellCampbell AE: Prolonged meningococcemia, Arch. Int. Med. 61: 646 (Apr.) 1938. CrossrefGoogle Scholar11. Appelbaum E: Chronic meningococcus septicemia, Am. J. M. Sc. 193: 96-108 (Jan.) 1937. CrossrefGoogle Scholar12. Bruton OC: Agammaglobulinemia, Pediatrics 9: 722-728 (June) 1952. CrossrefMedlineGoogle Scholar13. BrutonAptJaneway OCLC: Absence of serum gamma globulins, Am. J. Dis. Child. 84: 632-636 (Nov.) 1952. Google Scholar14. WallSaslaw RLS: Adult agammaglobulinemia, Arch. Int. Med. 95: 33-36 (Jan.) 1955. CrossrefGoogle Scholar15. YoungWolfson IIQ: The agammaglobulinemia syndrome in adult men; its differentiation into familial lymphopenic agammaglobulinemia and familial non-lymphopenic dysglobulinemia, Clin. Res. Proc. 2: 101 (Apr.) 1954. Google Scholar16. SanfordFavourTribeman JPCBMS: Absence of serum gamma globulin in an adult, New England J. Med. 250: 1027-1029 (June) 1954. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, Illinois*Received for publication April 29, 1955.Requests for reprints should be addressed to Maurice Gore, M.D., 104 South Michigan Avenue, Chicago-3, Illinois. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDurch Gram-negative Bakterien bedingte Hauterscheinungen bei septischen KrankheitenMeningococcal arthritisChronic meningococcemiaChronic Meningococcemia 1 July 1956Volume 45, Issue 1Page: 142-145KeywordsArthritisErythemaMeningitisMeningococcemiaSulfonamide ePublished: 1 December 2008 Issue Published: 1 July 1956 PDF downloadLoading ...

UNILATERAL SYMPTOMS IN MENINGITIS

The classic signs of meningitis, such as the Brudzinski, Kernig and Babinski, are usually bilateral. When unilateral symptoms occur, one is often inclined to rule out the presence of meningitis and to think of brain abscess, brain tumor, encephalitis or poliomyelitis. I have encountered cases that manifested unilateral Brudzinski, Kernig and Babinski signs, in which the character of the cerebrospinal fluid, and, in some instances, the necropsy, proved the presence of a meningitis, either tuberculous, pneumococcic or meningococcic. This shows that, although the classic signs of meningitis are usually bilateral, unilateral manifestations of meningeal irritation do not exclude the diagnosis of meningitis. This knowledge is particularly important in the diagnosis of meningococcic meningitis, in which reliance on unilateral symptoms to exclude meningitis may lead to delay in the removal of cerebrospinal fluid and the administration of serum with consequent disastrous results. Unilateral manifestations during the course of meningitis may be