Biomedical subjects

L Kepa

Publications and source records attributed to L Kepa.

At least 19 recordsLinked to original sources

PubMed2005

Drug-induced aseptic meningitis in suspected central nervous system infections.

This study presents eight patients with drug-induced aseptic meningitis (DIAM) admitted to our centre with an initial suspicion of central nervous system (CNS) infection. In all patients clinical findings, cerebrospinal fluid (CSF) examination, a cause-effect relationship according to the Naranjo adverse drug reactions probability scale and other diagnostic criteria required for DIAM recognition, were fulfilled. Nonsteroidal anti-inflammatory drugs were the most frequent cause of DIAM. In two cases, there was previous antimicrobial use. The time between use of the causative drug and onset of the symptoms ranged from 2 to 7 days. Clinical symptoms and CSF findings in patients with DIAM are indistinguishable from the early stage of infections of the CNS. Detailed anamnesis is essential, particularly related to medication use immediately prior to the appearance of symptoms of CNS impairment. In conclusion, the differential diagnosis of CNS infections should include DIAM.

Adult↗

PubMed2001

[Tuberculous meningoencephalitis: a case report].

A case of tuberculous meningoencephalitis in 63-year old man is presented. Symptoms of the disease were found in the course of bone and pulmonary tuberculosis. Attention is paid to diagnostic data that may play an important role in diagnostics of the central nervous system tuberculosis. The therapy of tuberculous meningoencephalitis and the problem of potential Mycobacterium tuberculosis resistance to antituberculous drugs used up to the present are also discussed.

Antitubercular Agents↗

PubMed2001

[Cerebellitis in the course of varicella in a child: case report].

A case of cerebellitis as a complication of varicella in a 5-year old child was described. Special attention was paid to severe course of the disease and therapeutic problems. Actually available possibilities of active and passive prophylaxis of varicella-zoster virus infections were also discussed.

Cerebellar Diseases↗

PubMed2001

[Usefulness of plasma C-reactive protein (CRP) estimation in patients with bacterial sepsis].

Between 1997-2000 there were 30 patients with bacterial sepsis treated at Department of Infectious Diseases of Silesian Medical University School in Bytom. Neisseria meningitidis (23.33%), Streptococcus pneumoniae (20%) and Staphylococcus aureus (3.33%) were most frequent etiological factors of the disease. The etiology of sepsis was not revealed in 53.34% of cases. Clinical state of patients was assessed using SSS and SAPS II score. All subjects were divided into two groups: group I--patients with septic syndrome symptoms (11 cases), group II--patients without septic syndrome symptoms (19 cases). The aim of the study was usefulness of plasma C-reactive protein estimation in the course of bacterial sepsis monitoring. Plasma CRP concentration was assessed by immunoturbidometric method (using RANDOX, UK kits). Blood samples were taken on th 1., 4. and 10. day of therapy. Plasma CRP levels were statistically significantly higher in patients of the group I in samples of the first and the second assay. CRP serum concentration correlated with severity of a patient's clinical state. Type of sepsis's etiological factor did not exert influence on plasma CRP level. In fatal cases high plasma CRP concentration was recorded during the whole time of hospitalization, whereas in cases of recovery fast decrease of this protein level was noted. The obtained result indicate, that estimation of plasma CRP concentration in patients with bacterial sepsis may be helpful in evaluation of clinical state severity, monitoring of the disease course as well as therapy efficacy.

Adolescent↗

PubMed2001

Epidemiology of hepatitis C virus infections in children.

BACKGROUND: Epidemiological analysis of hepatitis C virus infections in children diagnosed and treated in the Hepatology Outpatient Clinic in Bytom between 1996 and 1999. MATERIAL AND METHODS: The study comprised 62 children with detected serum presence of anti-HCV antibodies (ELISA method) and/or HCV-RNA (RT-PCR method). Risk factors for the infection were thoroughly analysed on the base of questionnaires. RESULTS: It was established that in 55 (88.7%) children high probability of infection existed in connection with past hospitalization and applied diagnostic and therapeutic procedures, such as: transfusion of blood and its preparations (24.19%), surgical procedures (22.58%), hospital treatment without invasive procedures and blood transfusions (19.35%). Familial exposure was a risk factor in 4.84% of cases, while in 6.45% of cases there were no burdens in the history. CONCLUSIONS: 1. In the evaluated group of children HCV infection was iatrogenic in character in majority of cases. 2. Hospitalization, even without invasive procedures, may be an important risk factor for HCV infection. 3. Familial exposure seems to be of secondary importance in transmission of HCV infection.

Adolescent↗

PubMed2001

Influence of HBV or HCV associated chronic liver diseases on the course and outcome of purulent, bacterial meningoencephalitis.

BACKGROUND: Aim of the study was evaluation of HBV or HCV associated chronic liver diseases (HBV or HCV CHLD) influence on the course and outcome of purulent, bacterial meningoencephalitis (PBME), without symptoms of sepsis. MATERIAL AND METHODS: Between 1995-99 there were 8 patients with PBME, with chronic HBV (5 subjects) or HCV (3 subjects) infection, treated in our centre; mean age 43 years. Str. pneumoniae and N. meningitidis were etiologic factors of PBME in 25% and 12.5% of patients, respectively. In 62.5% of cases etiology of PBME remained unknown. In 2 patients HBV or HCV CHLD was diagnosed before PBME (1 case--chronic active hepatitis, 1 case--postinflammatory liver cirrhosis). During hospitalization due to PBME in 4 patients liver cirrhosis was diagnosed on the base of clinical picture and laboratory results, in 2 patients chronic hepatitis B or C was subject to further diagnostic procedures. RESULTS: In 7 subjects (87.5%) significant increase of AlAT and AspAT activity was recorded during acute phase of neuroinfection as compared to results preceding the hospitalization (to 300-400 U/l). Together with recovery from PBME decrease of aminotransferases activity was noted. In 1 fatal case high AlAT and AspAT activity was observed for the whole time of the disease. In 2 other patients with liver cirrhosis, classified into class A of Child-Turcott-Pugh classification at the beginning of PBME, after transient insignificant aminotransferases increase sudden decompensation of liver functions during recovery from PBME was observed. Both patients died due to haemorrhage from esophageal varices. In all patients with PBME and HBV or HCV CHLD inflammatory parameters of cerebrospinal fluid were increased for longer than average time. It was the reason of longer hospital stay. The influence of HBV or HCV CHLD on PBME outcome was not observed. CONCLUSIONS: 1. In patients with PBME concomitant HBV or HCV CHLD may exert negative influence on the course of neuroinfection and extend the period of hospitalization. 2. The increase of aminotransferases activity in these patients may suggest other hepatotropic virus superinfection and require further diagnostics. 3. In the case of HBV or HCV associated postinflammatory liver cirrhosis PBME may be connected with rapid liver disease progression and even the death of a patient.

Adult↗

PubMed1999

[Ischemic stroke during sepsis and bacterial meningoencephalitis: a case report].

A case of acute ischaemic stroke in a woman aged 49 years during sepsis and purulent, bacterial meningoencephalitis was described. Diagnosis was based on clinical examination and repeatedly CT scans. Attention is called to diagnostic difficulties in this complication of central nervous system bacterial infections.

Acute Disease↗

PubMed1999

[The HLA-I and HLA-II expression evaluation in liver biopsy specimens of patients with chronic viral hepatitis].

The main an etiological agents of chronic hepatitis are viral infections. The viral infection course and outcome depend mostly on the immunological response. Infected hepatocytes are damaged by appropriately viral antigen-specific cytolytic T lymphocytes. Those sensitised T cells react only with those hepatocytes which express viral antigen and antigen HLA on membrane surface. The aim of this study was to evaluate the expression of selected histocompatibility antigens HLA in liver biopsy specimens of patients with chronic viral hepatitis. Seventeen patients with chronic persistent hepatitis (inflammatory activity 1-4 points according to Scheuer scale modified by Gabriel) and 27 patients with chronic active hepatitis (5-10 points) were studied. In these groups of patients the intensity of HLA-I (A, B, C), HLA-II (DR) expression in liver biopsy specimens, alanine aminotransferase activity, markers of HBV and HCV in serum were examined. The monoclonal mouse anti-human antibodies and streptavidin-biotin with alkaline phosphatase method for estimation of HLA-I, HLA-II was used. Results were statistically analysed using Mann-Whitney's U test and Spearman's rank correlation test. Generally, the expression of HLA-I and HLA-II on hepatocyte membrane was shown. Significant differences in expression of HLA-II among studied groups were observed, moreover the highest degree of HLA-II intensity in the group of patients with greater inflammation activity was significantly more frequently observed. The expression of HLA-I, HLA-II was regardless of the viral a etiology and serological markers of HBV replication. The degree of studied parameters expression was positively correlated with biochemical activity of inflammation.

Adolescent↗

PubMed1998

[Complications and sequelae of the purulent, bacterial meningoencephalitis in the material from the 1st Clinic of Infectious Diseases of Silesian Medical Academy in Bytom in the years 1991-1997].

From 1991 to 1997 at the I Clinic of Infectious Diseases of Silesian Medical Academy in Bytom 123 patients with purulent, bacterial meningoencephalitis were treated. Mortality in the analysed group was 28.5% (35 cases). In the course of disease various complications were observed: seizures (43.1% cases), ischaemic stroke (2.4% cases), brain abscess (4.1%). Permanent consequences subsequent to the disease were found in 16.3% cases: deafness and partial deafness, psychic disorders, paresis and paralysis, epilepsy and cranial nerves paralysis. Bacterial infections of the central nervous system are still danger diseases producing high lethality, complications and subsequent neurological sequelae.

Abscess↗

PubMed1997

[Purulent meningoencephalitis treated in the Infectious Diseases Clinic of the Silesian Medical Academy in Bytom in 1994-1995: personal observations].

Among 267 patients with central nervous system infections, 43 patients (16.1%) suffered from purulent bacterial meningitis. An etiological agent was established in 15 cases (34.9%): Str. pneumoniae--9 cases, N. meningitidis--4 cases and Staph. aureus--2 cases. Most patients had severe course of the disease; lethality was 18.6%, the recovery with subsequent sequelae was noted in 11.6% cases, and 69.8% cases fully recovered. In two patients brain abscess and intracranial empyema, and persistent cerebral ischaemia were found, one of these patients died. Frequent use of antibiotics before hospitalization reduces the possibility of establishing the etiological agent. Bacterial infections of the central nervous system are still danger diseases producing high lethality and subsequent neurological sequelae.

Adolescent↗

PubMed1997

[Evaluation of tumor necrosis factor and C-reactive protein level determination in cerebrospinal fluid of meningitis and encephalitis].

The evaluation of TNF-alpha and CRP in cerebrospinal fluid (CSF) concentrations determining in the differential diagnosis of infectious meningitis was shown. The highest concentrations of these parameters were detected in the group of patients with bacterial meningitis. The findings correlated with the severity of clinical course of bacterial meningitis and with the routine determined laboratory data of CSF. Usefulness of examination CSF for TNF-alpha and CRP in differential diagnosis of meningitis was underlined, especially in cases, where routine parameters of CSF are not conclusive.

Adult↗

PubMed1997

[Current views on the pathophysiology of bacterial meningitis--new therapeutic possibilities?].

Despite the introduction of numerous antimicrobial therapeutic advances, the morbidity and mortality associated with bacterial meningitis remain high. New understanding of the pathogenesis and molecular pathophysiology of bacterial meningitis have led to the development of innovative, adjunctive treatment strategies in the hopes of improving outcome from this disorders. Studies in animal models have demonstrated, that the inflammatory response resulting from bacterial invasion of the subarachnoid space is due in large part to the activity of host-derived mediators (cytokines). This inflammatory response is responsible for the long-term neurological sequelae and death associated with bacterial meningitis. Experimental studies have demonstrated, that attenuation of the inflammatory response by anti-inflammatory agents may be useful in preventing many of the pathophysiologic consequences of bacterial meningitis. Numerous potential therapeutic agents, that may limit inflammation of the subarachnoid space have been and are being developed, and trials in animal models and in humans are under way. There are: corticosteroids (dexamethasone), non-steroidal anti-inflammatory agents, pentoxifylline, anti-leukocyte CD-18 receptor antibodies, specific cytokine antagonists, antagonists of Platelet-Activating Factor (PAF) and others. Safe and effective agents with demonstrated efficacy as adjuvants to bactericidal antimicrobial agents in the therapy for bacterial meningitis in humans may improve the prognosis of this disease.

Animals↗

PubMed1995

[Purulent neuroinfections in the course of septicemia in the years 1988-1992: personal experience].

Between 1988 and 1992 thirty patients with purulent infections of central nervous system in the course of bacterial septicaemia were treated in the Intensive Care Unit of the I Clinic of Infectious Diseases of Silesian School of Medicine in Bytom. These cases made about 32% of the total bacterial neuroinfections treated in the Clinic during that time. Imminent or existing acute respiratory insufficiency, increasing intracranial pressure, intensification of haemorrhagic diathesis and imminent septic shock were the indications to the hospitalization in the Intensive Care Unit. Neisseria meningitidis, Streptococcus pneumoniae and Escherichia coli were the most often found etiological factors in subsequently 53.33%, 33.33% and 3.34% of patients. In 10% of cases the etiological factors remained unknown. Intratracheal intubations and/or tracheotomies were carried out in over 60% of patients. About 40% of cases required assisted or controlled mechanical ventilation with the aid of ventilator (on the average 5 days). Mean time of hospitalization in the Intensive Care Unit closed in the period of 7 days. Mortality in the analyzed group was 23.33% (7 cases). Bacterial septicaemia with purulent infections of central nervous system often leads to the directly life threatening complications. Hospitalization in conditions of Intensive Care Unit affords possibilities for effective treatment and improvement of prognosis in patients suffering from these diseases.

Adult↗

PubMed1995

[Acid-base balance and electrolytes in cerebrospinal fluid of patients with bacterial and lymphocytic meningitis].

Acid-base balance and electrolytes concentration in cerebrospinal fluid (CSF) of patients with bacterial and lymphocytic meningitis were assessed. Inflammatory process causing the damage of blood-brain barrier and brains hypoxia leads to statistically significant changes of pH, pO2, bicarbonates and K+ concentrations in CSF of patients with bacterial meningitis, which in lymphocytic meningitis were not observed. Patients with fatal; outcome of bacterial meningitis showed higher CSF's acidosis and lover bicarbonates with higher K+ concentrations, which suggest deeper damage of brain hemostasis regulating mechanisms in those patients.

Acid-Base Imbalance↗

PubMed1995

[Hearing loss during the course of mumps].

Unilateral deafness as a permanent hearing injury in a patient aged 15 years with mumps is presented. Attention is paid to uncommon occurence of that complication in the course of the disease and to necessarity of taking into consideration mumps virus among other ototoxic infectious factors.

Adolescent↗

PubMed1994

[Posttraumatic meningoencephalitis in the material from the First Clinic of Infectious Diseases of Silesian Medical Academy in Bytom between 1986 and 1993].

Since 1986 to 1993 18 patients with bacterial, posttraumatic meningoencephalitis were hospitalized at the I Clinic of Infectious Diseases of Silesian Medical Academy in Bytom, and they made about 11.46% of the total purulent neuroinfections treated during that time. The group was composed of 16 men and one, 7-year-old girl, who was hospitalized twice. The course of the disease was very serious in 55.56% of cases and serious in the rest of patients. Permanent consequences subsequent to the disease like deafness, partial deafness and epilepsy were observed in 6 cases. Two patients died. After recovery gained by pharmacotherapy every patient was diagnosed with X-rays in order to find the spot of pathological connection between the cranium cavity and exterior environment, what afforded possibilities for neurosurgical or laryngological repair operation. The aim of the treatment was elimination of imminent recurrent infections of central nervous system. Accurate X-ray diagnostics and co-operation with surgical specializations enable us to improve prognosis and definitively restore patients to health after posttraumatic meningoencephalitis.

Adolescent↗

PubMed1993

[Tetanus --observations in the I Clinic of Infectious Diseases, Silesian Medical Academy in Bytom in the years 1988-1992].

Fifteen patients with tetanus were treated in the I Clinic of Infectious Diseases in Bytom in the period 1988-1992; the clinical and epidemiologic analysis was carried out of them. Severe tetanus occurred in 66% of patients and 46% of them needed mechanical ventilation. The percentage of mortality was high (46.7%). It was found that the information about tetanus was inadequate among health service personnel (physicians) and the population. Attention is called to inadequate knowledge of tetanus prophylaxis in the first line of patient's contact with the health service, which increases the risk of tetanus development. For reducing the incidence of tetanus and for improvement the efficacy of treatment this disease the authors suggest the need of adequate tetanus prophylaxis (passive and/or active immunization) in high risk injured patients.

Adult↗

PubMed1993

[Poisoning after eating sausage in observations from I Clinic of Infectious Diseases of the Slask Academy of Medicine in 1985-1992].

On the basis of our own material and the literature review the analysis of 10 cases of botulism is presented. A mild course of the disease was observed in 40%, a medium-severe course in 30% and a severe course also in 30% of patients. Fatal courses were not recorded. All patients were discharged from the Clinic in the good state of health. Etiopathogenesis, symptomatology and treatment of botulism is discussed. Attention is paid to new diagnostic method.

Adolescent↗