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PubMedDate not supplied

[The clinico-biological, etiological and therapeutic aspects of acute purulent meningitis in newborn and older infants].

Acute purulent meningitis of the newborn and infant still raise difficult diagnosis problems due to the often misleading onset, and require an energetic and early intervention, adapted, as much as possible, to the etiologic aspects. The study reports on 90 cases of acute purulent meningitis in the newborn and infant, admitted to the pediatric ward of the Bistriţa County Hospital, for 6 years (1983-1988). The clinical and biological aspects were various, sometimes blurred by the antibiotic administration. The study of CSF was the only valuable and compulsory parameter for supporting the diagnosis of meningeal infection and its etiology. In 63.3% cases, the meningeal infection was secondary to a primary infectious focus. Living gram-negative bacilli had the most frequent etiology, both in the newborn and in the infant. Meningitis with nonspecific etiology still hold 45.5%, and the most useful therapy in this situation seemed to be ampicillin + gentamicin + Biseptol and ampicillin + chloramphenicol. The age of the newborn and infant, the male sex, the biologic defects, the type and virulence of the etiologic agent were favouring factors in the appearance and severe evolution of the meningeal infection. Mortality was of 18.8% and the early found sequelae 8.8%. The evolution was favourable, when the diagnosis was precocious and the therapeutic intervention was energetic.

Acute Disease↗
PubMedDate not supplied

[Immunoenzymatic test for the detection of anti-Cysticercus cellulosae antibodies in cerebrospinal fluid of patients with meningitis of unknown etiology].

The enzyme-linked-immunosorbent assay using a new type of support consisting of discs of synthetic fabric-resin (ELISA-d) with antigenic components of Cysticercus cellulosae covalently bound, was employed with the purpose of investigating the presence of specific antibodies to the cysticerci (neurocysticercosis) in the cerebrospinal fluid (CSF) of patients with meningitis without etiological agent determined by the conventional methods. The test was performed in 277 CSF samples (128 children and 149 adults). The mean of optical density values (OD) obtained for 22 CSF normal patients (the diagnostic hyphotesis of meningitis was discarded) was of 0.03. The 44 CSF of patients with meningitis caused by other agents but C. cellulosae, showed OD of 0.05. The cut off determined with these two groups (control group) was 0.13 (OD + 3 SD). The group of 13 CSF of neurocysticercotic meningitis presented OD of 0.41 (0.10 to 0.91). Among the 198 CSF samples of indetermined meningitis, 23 (11.6%) presented OD above the cut off, which suggests the possibility that Cysticercus cellulosae was the etiological agent in this meningitis episode. The ELISA-d test has proved to be efficient for the immunodiagnosis of neurocysticercosis when conducted on CSF samples. The alterations observed in the 23 CSF reactive on ELISA-d were: increased number of lymphomononuclear cells in five, of polymorphonuclear cells in 13 and both cells in five samples.

Adolescent↗
PubMed1990

Cryptococcal meningitis in the acquired immunodeficiency syndrome.

Cryptococcosis is the most common, deep-seated fungal infection in AIDS patients, and cryptococcal meningitis is the most frequently observed syndrome. AIDS patients with cryptococcal meningitis usually have an indolent presentation and nonspecific findings on physical examination. Routine laboratory tests are of little assistance in diagnosing cryptococcal meningitis. Cerebrospinal fluid (CSF) white blood cell counts tend to be low, and glucose and protein levels are nonspecific. Serum cryptococcal antigen (CRAG) is a sensitive test for cryptococcal meningitis, and CSF CRAG is usually also positive. Definitive diagnosis is made by culture of the CSF. Therapy of cryptococcal meningitis is changing to antifungal agents that are easy to administer as outpatient therapy. Amphotericin B continues to be the primary antifungal used in initial treatment of cryptococcal meningitis; addition of flucytosine is of no benefit. Recent data suggest oral fluconazole is effective as primary therapy, and may be superior to amphotericin B as maintenance therapy. Maintenance therapy decreases the incidence of relapse and increases survival.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Prevention of meningeal leukemia. Review of 20 years of research and current recommendations.

By use of prophylactic CNS therapy, the incidence of meningeal relapse has been dramatically reduced and the length of the initial bone marrow remission has been greatly prolonged in children with acute lymphoblastic leukemia. Pinkel performed a controlled study in which 94 patients were randomized to one of two regimens of presymptomatic CNS therapy, or received no prophylactic CNS therapy. This crucial study showed that prophylactic CNS therapy was very useful both in preventing meningeal relapse and in prolonging the duration of complete remission. Then, many additional regimens for prophylactic CNS therapy were tried on thousands of children worldwide in an effort to improve upon these results. Among the many CNS therapy regimens that were tried, none gave results better than the original St. Jude regimen. Our knowledge of CNS leukemia in general has greatly increased, but the last 20 years have brought us no further significant progress as to improved results in preventing meningeal leukemia. The many novel and innovative CNS therapy regimens that have been tried have yielded essentially the same results as to prevention of meningeal leukemia and as to duration of disease-free survival. Five to ten percent, or fewer in patients at low risk, still show meningeal relapse, and nearly one half of children with ALL still have hematologic relapse within the first 5 years following initiation of therapy. The goal now is to reduce neurotoxicity. Thus, progress has been stymied and we now await some new addition to therapy that will dramatically improve our results. Nonetheless, there are still many promising avenues of research yet to be explored. Meningeal leukemia remains a fascinating and satisfying field of clinical research.

Child↗
PubMed1990

[Pneumococcal meningitis. A 40-year case load].

Eighty-four cases of pneumococcal meningitis were admitted to the medical-epidemic department C, Odense Hospital, during the period from 1940 to 1980. 39% of the patients were under 10 years, 17% under one year, whereas 23% were over 50 years. The proportion males to females in all groups was approximately 3:2. Pneumococcal meningitis, like other types of meningitis, responds dramatically to antibiotic treatment, but must still be considered a serious disease. Following treatment with a combination of penicillin, streptomycin, sulphonamides and chloramphenicol the mortality during the period 1952 to 1980 decreased to 12.7%. The fatal cases after 1952 all occurred during the years 1975-77. Patients with meningitis are very sensitive to overhydration. It was therefore decided to restrict intravenous administration in these patients. Following the introduction of this regimen the mortality decreased again. The prevailing cause of death from meningitis during the antibiotic era was brain edema, which may occur even if the inflammation of the meninges has vanished. Therefore it is considered important to avoid overhydration in these patients.

Adolescent↗
PubMed1990

CT and MRI in spinal meningeal cyst. Report of a case.

A case of meningeal cyst of the spinal canal in the lumbosacral region is described. A CT scan showed a soft tissue mass associated with bone erosion. Myelography and computerised tomographic myelography revealed a cyst filling with contrast and thus CSF containing. The diagnosis of meningeal cyst was confirmed in a non-invasive way by MRI showing a mass with the same signal intensities as CSF on both T1 and T2 weighted images. Final characterisation of meningeal cysts in one of the three categories comprising spinal extradural meningeal cyst without spinal nerve root fibers (type I), spinal extradural meningeal cyst with spinal nerve root fibers (type II) and intradural meningeal cyst (type III) is impossible without operative inspection and histological examination.

Aged↗
PubMed1989

Approaches to prevent acute bacterial meningitis in developing countries.

Endemic acute bacterial meningitis of childhood appears to be neglected as a cause of morbidity and mortality in developing countries, probably because it has been overshadowed by the dramatic epidemics of meningococcal disease in sub-Saharan Africa. The available data based on reviews of hospitalized patients suggest that endemic meningitis is mostly a disease of young infants, Streptococcus pneumoniae and Haemophilus influenzae type b being the most important etiologic agents. The epidemiological pattern appears to be different in developing countries, compared with northern Europe or the USA, and closely resembles the early age of onset and high incidence of meningitis observed among the native American populations in Alaska. The mortality from meningitis appears to be much higher in developing countries than in industrialized countries. The availability of vaccines against the pneumococcus and haemophilus, particularly those in which the bacterial polysaccharide is conjugated to a protein, promises protection against systemic bacterial infection from these organisms. The assessment of the efficacy of such vaccines will have to include a close examination of meningitis as an outcome. It is suggested that before such vaccines become available careful clinical and epidemiological studies of meningitis will help both to define the impact of this disease and how to design an intervention strategy.

Adolescent↗
PubMed1989

[The value of granulocyte elastase in the early diagnosis of infantile meningitis].

Elastase-alpha 1-proteinase inhibitor complex (E-alpha 1-PI) was evaluated in blood and cerebrospinal fluid in 176 patients between 1 month and 15 years old. They were divided in three groups: group 1 (n = 61) children without meningitis, group 2 (n = 69) non bacterial meningitis and group 3 (n = 46) bacterial meningitis. The CSF values of E-a 1-PI complex (P50: P2.5; P97.5) (micrograms/L) were (2.85: 0.1; 19.1) in group 1 (31.5: 0.88; 735) in group 2 and (247: 2.6; 10370) in group 3. Significant differences were found in it (p less than 0.001). We didn't find any differences between non bacterial meningitis group and bacterial meningitis group when the granulocytes count were below 100 X mm3. The blood values of E-a 1-PI complex (P50: P2.5; P97.5) (micrograms/L) were (1122: 337; 5005) in group 3, significantly greater (p less than 0.001) than in group 2 (346: 136; 1612). In CSF E-alpha 1-PI complex showed us a sensitivity of 89% and a specificity of 27.7% in the diagnosis of bacterial meningitis, while in blood stream, it was 85.3% and 85.4 respectively.

Adolescent↗
PubMed1989

Toxicity of intrathecally administered cytotoxic drugs and their antitumor activity against an intrathecal Walker 256 carcinosarcoma model for meningeal carcinomatosis in the rat.

Meningeal carcinomatosis in humans is refractory to most attempts at therapy and has a grave prognosis. As part of a search for new agents to treat meningeal carcinomatosis, the toxicity of a series of antitumor agents administered through an implanted catheter directly into the cerebrospinal fluid (CSF) of the lumbar spinal cord of 200-g rats has been examined. The highest non-toxic dose (HNTD) of the agents producing no signs of histological damage, motor dysfunction, or neurobehavioral changes was bleomycin (80 micrograms), cytarabine (640 micrograms), dacarbazine (1 microgram), doxorubicin (20 micrograms), 5-fluorouracil (150 micrograms), methotrexate (1000 micrograms), mitomycin C (10 micrograms), and triethylene phosphoramide (800 micrograms). No toxicity was observed at the highest dose that could be administered because of limited solubility of 1,3-bis(2-chloroethyl)-1-nitrosourea (100 micrograms), or diaziquone (70 micrograms). The rat model gave reasonable prediction of the toxicity of antitumor agents that have been administered intra-CSF to humans but with a tendency to underpredict toxicity. The antitumor activity of the agents administered intra-CSF at the HNTD against a Walker 256 carcinosarcoma model for meningeal carcinomatosis in the rat was examined. Diaziquone, doxorubicin, methotrexate, and mitomycin C gave a 25% or greater increase in lifespan and diaziquone and mitomycin C gave some long-term survivors. BCNU, bleomycin and 5-fluorouracil gave less than a 25% increase in lifespan. When mitomycin C was administered intra-CSF at the HNTD and diaziquone at the limit of solubility daily for 4 days there was no toxicity and an increase in survival of Walker 256 carcinosarcoma tumored animals compared to animals administered a single daily dose. Intrathecal diaziquone was more active against meningeal Walker 256 carcinosarcoma than i.v. diaziquone. Intravenous methotrexate had no activity against meningeal Walker 256 carcinosarcoma. We conclude that intra-CSF administration of some anticancer agents such as diaziquone and mitomycin C at doses that do not produce toxicity can significantly increase the survival of rats with experimental meningeal carcinomatosis.

Animals↗
PubMed1978

Meningitis due to Haemophilus influenzae other than type b: case report and review.

A 4-month-old female infant with meningitis caused by Haemophilus influenzae type f had a hospital course complicated by sterile subdural effusions and persistent neurologic abnormalities. One year later she was normal in all respects. The infant's mother had serum bactericidal antibodies to H. influenzae type b but not to type f. During recovery the patient had no bactericidal antibodies to type b, and the type f organism could not be maintained in her serum. Review of the literature identified 40 cases of meningitis reported as caused by H. influenzae other than type b. An evaluation of the ten cases described as due to encapsulated strains (a, e, and f) shows that the age distribution and clinical features are similar to those of meningitis caused by type b. Only five cases of meningitis caused by unencapsulated H. influenzae have been described. Four of the patients were older than the usual age range for type b meningitis and two had prior head trauma. A large clinical trial in Finland with a two-year observation period has demonstrated no untoward increase in non-b H. influenzae meningitis in recipients of a type b vaccine. Serious infections caused by other H. influenzae types will continue to occur sporadically and may increase in frequency when an effective vaccine against type b is widely used in infants.

Age Factors↗
PubMed1988

Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination.

A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. The overall annual incidence rate of H. influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000. For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000. A total of 85% and 100% of the cases of H. influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively. The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.

Age Factors↗
PubMed1987

A quantitative histological study of cell division and changes in cell number in the meningeal sheath of the embryonic human optic nerve.

Mitotic cells are present in all layers of the meninges of the human optic nerve between 8 and 18 weeks post-conception. The number of meningeal cells per section remains constant between 8 and 12 weeks before rising rapidly from 234 at 12 weeks to 747 at 18 weeks. The mitotic index is only 0.17% at 8 weeks but rises to 1.02% at 10 weeks before falling gradually to 0.29% at 18 weeks. A comparison of the results of this study with a previous one on gliogenesis in the same nerves (Sturrock, 1975) leads to the tentative conclusion that mitotic activity in the layers of the meninges is probably sufficient to account for the increase in meningeal cell number between 8 and 18 weeks. The substantial increase in thickness of the meninges found between 14 and 15 weeks is due to a large increase in the amount of collagen in the developing dural layer rather than the modest increase in cell number. During mitosis meningeal cells do not retract their processes and cell division usually occurs tangentially.

Cell Count↗
PubMed1986

[Prospective evaluation of coagglutination and latex agglutination in the diagnosis of bacterial meningitis in childhood].

UNLABELLED: Two simple and low-priced kits to detect bacterial antigens in cerebrospinal fluid (CSF) specimens from patients with suspected meningitis have recently become available. Methods employed by these kits are staphylococcal coagglutination (COA) and latex agglutination (LA). The COA "Phadebact CSF-kit" (Pharmacia) detects Haemophilus influenzae type b (HIb), Neisseria meningitidis (NM) groups A, B, C, Y and W 135 and Streptococcus pneumoniae (SP), whereas the LA "Slidex Méningite-kit" (BioMérieux) includes HIb, NM A, NM C and SP. These two diagnostic tests were compared with the standard methods for analyzing CSF specimens from children with suspected meningitis. A total of 336 CSF specimens were tested. Forty-three were from children with bacterial meningitis due to HIb, NM or SP obtained before antimicrobial therapy. Thirty-four of them (79%) were correctly detected by COA, 23 (54%) by LA, and 42 (97%) by microscopic analysis of stained smears. There were 65 CSF samples of such meningitis cases obtained after initiation of antimicrobial therapy: COA detected 26 (40%), LA 17 (26%) and staining 26 (40%). With culture-positive CSF specimens from patients before therapy, the best sensitivities were obtained with LA for SP (100%) and COA for HIb (87%), whereas the results for NM antigen detection were only 43% with COA and 0% with LA (no reagent against NM B). Cross-reactions with other bacterial antigens were frequent with COA (26%) and rare with LA (2%), resulting in false-positive findings in 6 of the 66 positive tests with COA (9%) but in none of the 40 positive tests with LA (0%). One of the 48 specimens from aseptic meningitis cases was false-positive for HIb by COA, whereas all 172 normal specimens were negative with both methods. With 5 culture-negative CSF specimens from patients with unequivocal purulent meningitis COA detected bacterial antigen in 5 and LA in 2. CONCLUSIONS: The two kits evaluated cannot replace standard methods for analyzing CSF specimens, in view of insufficient sensitivity (mainly LA) or frequent cross-reactions and false-positive values (COA). However, due to their simplicity, rapidity, and possible identification of bacterial pathogens after initiation of antimicrobial therapy, these kits are recommended as an useful addition to standard methods.

Adolescent↗
PubMed1985

[Clinical value of the sequential study of the uric acid level in the CSF in patients with postoperative meningitis].

In this study we discuss the clinical value of the sequential measurement of the CSF uric acid and CSF cells in patients with postoperative acute meningitis. CSF was investigated for uric acid and cells in 10 cases with postoperative meningitis and 12 cases without it for the control group. The results were as follows; The CSF uric acid level was markedly increased in direct proportion to neutrophilia in the CSF in the acute stage of postoperative meningitis. Some cases with postoperative meningitis had biphasic increasing pattern of the CSF uric acid level. In 12 cases without postoperative meningitis the CSF uric acid level had been progressively reduced and then normalized until the fourth day after operation. The factors contributing to the increase of the uric acid in CSF under the condition of postoperative meningitis were thought to be 1) increased permeability of the blood-CSF barrier, 2) neutrophilia in the CSF and increase of the nucleic acid due to it, 3) increase of hypoxanthine, xanthine or xanthine oxidase activity in the central nervous system and 4) dysfunction of the CSF dynamics.

Adolescent↗
PubMed1984

[Clinical studies of meningeal gliomatosis].

Ten (23%) patients out of 43 with malignant glioma developed meningeal gliomatosis during the follow up period of at least one year. The duration between the first surgery and diagnosis of meningeal gliomatosis ranged from one to 78 weeks (median 45 weeks). In younger age group less than 20 years old, 5 (56%) out of 9 patients had meningeal gliomatosis, and on the contrary the incidence was lower in older age group above 20 years old (5 of 34, 15%). Seven (22%) out of 32 male and 3 (27%) out of 11 female patients developed meningeal gliomatosis. The primary tumor location were frontal lobe in 4 cases (including one bifrontal tumor), temporal in 2, parieto-occipital in 1, thalamus in 1, midbrain in 1, and cerebellar hemisphere in 1, respectively. Histologically, 7 tumors were anaplastic astrocytoma, and 3 were glioblastoma. The characteristic neurological findings observed during the course of meningeal gliomatosis were abnormal mental status (80%), cranial nerve palsies (50%), paraplegia (60%), stiff neck (80%), seizure (50%), and respiratory disturbance (80%), CSF cytology was positive in all 9 patients tested. CT scan demonstrated hydrocephalus (70%), and diffuse contrast enhancement of ventricular wall (60%) and basal cistern (10%). In 2 cases, block and irregular filling defect were seen by myelography. Six patients were treated by irradiation to the whole brain and/or spine, and 5, by intrathecal chemotherapy with methotrexate, cytosine arabinoside and bleomycin. However, all patients died of the tumor one to 46 weeks (median 18 weeks) after the diagnosis of meningeal gliomatosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Haemophilus influenzae b bacteremia and meningitis in infant rabbits after intranasal inoculation.

A suitable model of Haemophilus influenzae meningitis will facilitate better understanding of the pathophysiology, therapy, and prevention of the disease and its sequelae. Bacteremia and meningitis were induced in infant New Zealand white rabbits by intranasal inoculation of H. influenzae type b. Intranasal trypsin prior to challenge significantly increased (p = 0.002) the rate of bacteremia from 64% (7/11) to 100% (45/45). In the trypsin-treated group, H. influenzae b was isolated from the CSF of 89% (25/28) of 17- to 21-day-old rabbits and from 76% (13/17) of 23- to 30-day-old animals, p = 0.3; fatality rates were 88% and 31%, respectively, p = 0.001. Bacteremia developed within 24 hr of inoculation and meningitis within 96 hr. Death occurred 1 to 7 days after the development of meningitis. Histologic evidence of nasopharyngitis and meningitis was found at autopsy. The intranasal route of infection, the age-dependent outcome, the size of the animal, and its low cost and availability make the infant rabbit an appropriate model of H. influenzae b meningitis.

Animals↗
PubMed1984

[Lethality and danger of 14 types of purulent meningitis in the pre-ampicillin and in the ampicillin period. Synoptic overview of an epidemiologic study].

UNLABELLED: Based on epidemiological data in the western literature, the lethality of purulent meningitis over the last 32 years has been assessed. 14 types of meningitis (11 with frequent, 3 with rare etiologic agents) were investigated, and the results of the pre-ampicillin period (1948-1962) compared with the post-ampicillin period (1963-1979). RESULTS: during the ampicillin period lethality decreased significantly in patients aged below 60 years. For meningitis caused by salmonellae and certain strains of streptococci, the decrease was not statistically significant. In the population over 60, however, no significant decrease occurred, and the lethality of meningococcal meningitis even increased significantly. Presentation in graph form shows these findings very clearly, and comparison with the lethality of Hemophilus influenzae meningitis serves to express the potential danger of all these meningitis types numerically.

Adolescent↗
PubMed1980

Isotopic cisternography in tuberculous meningitis of childhood.

The changes in the CSF circulation and absorption are valuable in the diagnosis and management of tuberculous meningitis. We describe the isotopic cisternographic analysis of 45 children with tuberculous meningitis and 30 children with purulent meningitis. The cisternographic patterns of tuberculous meningitis consist of (1) obliteration of CSF space at the level of basal cisterns or cisterna Sylvii and (2) ventricular entry of radiopharmaceutical without clearing by 24 hours (communicating hydrocephalus). None of the patients with a definite diagnosis of tuberculous meningitis demonstrated a normal CSF flow pattern. Thirty patients with purulent meningitis underwent isotopic cisternography. Sixteen of 30 patients demonstrated a normal CSF flow pattern, 3 had mild hydrocephalus, 6 had obliteration of the subarachnoid space at the level of cisterna Sylvii at either side, 3 had delay of CSF flow, and 2 had abnormal CSF collection due to a posttraumatic dura defect.

Cerebral Ventricles↗