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At least 1,207 records · Page 67Linked to original sources
PubMed1995

[Acute encephalitis and bacterial meningitis in children in Aichi Prefecture (1984-1993)].

A survey was performed of acute encephalitis and bacterial meningitis in infancy and childhood from 1984 to 1993 using a questionnaire directed to departments of pediatrics in large hospitals in Aichi prefecture. The case records for 391 patients with acute encephalitis including related diseases and 328 patients with bacterial meningitis were obtained from 63 hospitals. Of 391 patients with acute encephalitis, 224 were male and 167 were female. Of 328 patients with bacterial meningitis, 200 were male and 128 were female. Sex ratio were 1.3, 1.6 respectively. Of the patients, 52.4% of encephalitis and 84.8% of meningitis were under 4 years of age and 0 year olds made up 53.7% of the latter. The causes of these diseases were confirmed in 38.7% and 82.9% of the encephalitis and meningitis patients, respectively, etiologically. In encephalitis, rubella virus was the most frequent with 29 cases, followed by measles virus (27 cases), herpes simplex virus (24) and varicella-zostervirus (19). In meningitis H. influenzae (95 cases), S. pneumoniae (56), Group B streptococcus (41) and E. coli (27) were frequently diagnosed. These diseases showed respective patterns of age distribution and clinical course, and moreover, the increases in their onset were clearly related to the prevalence of causal infections. Therefore, the results of this study should be utilized in the development of administrative measures for prevention of these diseases.

Acute Disease↗
PubMed1995

[Absence of meningitis caused by Haemophilus influenzae type b in The Netherlands following twofold vaccination].

OBJECTIVE: To determine the two-year results of nationwide vaccination with Haemophilus influenzae type b (Hib) vaccine on the occurrence of Hib meningitis in the Netherlands. DESIGN: Retrospective controlled study. SETTING: The Netherlands. METHOD: Children born since April 1, 1993 are vaccinated at the age of 3, 4, 5 and 11 months to protect them from infections with Hib. The number of Hib meningitis patients in the period 1 April, 1993 to 1 April, 1995, among infants born in this period who were offered the Hib vaccine (study group), was compared with the number of Hib meningitis patients in the period 1 April, 1991 to 1 April, 1993 among children born in last-mentioned period (control group). RESULTS: Twenty-one cases of meningitis by Hib were observed in the study group. Twelve children who, as a consequence of their age, had only been vaccinated once or not at all; 7 children were not vaccinated for several reasons. In addition one patient was infected by H. influenzae type f strain and one by a non-typable strain. In the control group 185 cases of Hib meningitis occurred. CONCLUSION: Hib meningitis was not observed among infants who had been vaccinated at least twice.

Haemophilus Vaccines↗
PubMed1995

Acute bacterial meningitis in Enugu, Nigeria. 1 April 1989 to 31 March 1993.

A total of 84 cases of meningitis confirmed by isolation of the organisms at the University of Nigeria Hospital (UNTH) Enugu, Nigeria between 1 April 1989 and 31 March 1993 are presented. The cases are analysed by diagnosis, seasonal distribution, age and sex distribution and age specific case fatality rate. The most common type of meningitis was pneumococcal meningitis 32 cases, followed by coliform meningitis 31 cases and meningococcal meningitis, six cases. Other bacterial causes of meningitis accounted for 15 cases. The majority of cases occurred in infants, followed by children, with all cases occurring sporadically. Mortality was high with Streptococcus pneumoniae having the highest case fatality rate of 28.13 pc followed by coliforms, 25.78 pc. Fifty pc of the patients had pre-medication before presentation at the hospital, and many of the patients could not receive appropriate therapy because they were unable to afford the cost of the drugs. This probably contributed to the high mortality.

Acute Disease↗
PubMed1994

[An adult case of basal encephalomeningocele with recurrent meningitis].

A 35-year-old man developed meningitis for the first time at the age of 23. Thereafter, he repeatedly suffered from meningitis for six times before he was admitted to our clinic. Each meningitis was preceded by upper respiratory infection. Chronic infection in the head and neck, fracture of the skull base, liquorrhea, Mollaret meningitis, and acquired immunodeficiency were all ruled out. Nasal fiberscope examination revealed a palpating white tumor in the left olfactory cleavage. Coronal CT scanning demonstrated encephalomeningocele at the left ethmoidal cavity. The encephalomeningocele was surgically repaired and the patient has been free from further meningitis. The causal relationship between the encephalomeningocele and recurrent meningitis was discussed.

Adult↗
PubMed1994

[The characteristics of the present-day clinical course of tuberculous meningitis].

Clinical patterns of tuberculous meningitis have been analyzed for 32 admissions to the bacterial meningitis department of the 2nd Moscow Infection Hospital in 1983-1991. Early diagnosis of tuberculous meningitis caused great difficulties because of rare cases of tuberculous history, atypical symptoms (an acute onset, in particular), an obscure meningeal syndrome, rare neurological symptoms, atypical liquor characteristics (frequent neutrophil pleocytosis, a small protein rise, normal glucose). Secondary bacterial meningitides presented most serious difficulties for differential diagnosis. So did cerebral abscesses and viral meningitis. Antituberculous therapy should be started at first sings of tuberculous nature of meningitis as the disease outcomes are determined to a large extent by early administration of proper treatment.

Adolescent↗
PubMed1993

Factor XIIIa immunoreactivity in primary and secondary tumours of the meninges.

Occasionally variants of meningeal hemangiopericytomas (HPC) may be confused with primary and secondary tumours of the meninges by virtue of their features and patterns of growth. Until now, a specific immunohistochemical marker for HPC could not be identified. HPC are reported to express factor XIIIa (F XIIIa) in the cytoplasm of the tumour cells. In an effort to assess the diagnostic value of F XIIIa for meningeal HPC, we investigated 38 primary meningeal tumours (6 HPC, 28 meningiomas of various subtypes, 4 meningeal sarcomas) and 23 secondary meningeal tumors (8 metastatic carcinomas, 6 gliosarcomas, 9 anaplastic gliomas) with anti-F XIIIa antibody. All HPC revealed 5%-20% of F-XIIIa-positive neoplastic cells. Malignant fibrous histiocytomas and gliosarcomas with MFH-like structures also exhibited multiple F-XIIIa-positive cells. Most of the F-XIIIa-positive cells in meningiomas were identified as macrophages. Furthermore, there was a population of small dark cells of uncertain histogenesis. Cells with positive immunoreactivity for F-XIIIa in metastatic carcinomas and gliomas apparently were of macrophage lineage. Though, in some cases, it would have been difficult to distinguish reactive from neoplastic cells without simultaneous immunohistochemical investigation with antibodies for macrophages, cytokeratin, EMA and GFAP. Because of these uncertainties, wo believe that the potential of F XIIIa-antibody in obtaining precise differential diagnostic information is limited.

Carcinoma↗
PubMed1994

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. I].

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. The control group consisted of 100 healthy people. In purulent meningitis patients in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease, concentrations of the following acute phase proteins were measured in serum: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Usefulness of establishing alpha 2-haptoglobin, alpha 1-antitripsin, alpha 2-ceruloplasmin and particularly C-reactive protein concentrations for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of C-reactive protein and alpha 1-antitripsin concentration kinetics proved to be fully useful for monitoring of seriousness of the course of purulent meningitis, and together with evaluation of the clinical condition of the patient it can constitute a valuable marker of effectiveness of the disease treatment.

Adult↗
PubMed1994

[Acute viral meningitis].

Viral meningitis are the most frequent cause of clear cerebrospinal fluid (CSF) meningitis and are usually benign. The viral nature is suggested by clinical arguments (context, associated manifestations) and particularly the analysis of CSF, typically lymphocytic. However, problems of CSF interpretation may occur during the polymorphonuclear reaction at the beginning of such meningitis and after elevated protein or low glucose concentration. The main differential diagnosis are: partially treated bacterial meningitis, the beginning of meningococcal meningitis, listeriosis or tuberculous meningitis which need and urgent and specific treatment. The most common agents are the enteroviruses. The etiology can only be detected through careful virological investigations. These studies may be useful in outbreaks or in epidemiological studies.

Acute Disease↗
PubMedDate not supplied

[Hemophilus aphrophilus meningitis: report of one case].

Hemophilus aphrophilus, a gram negative, capnophilic slow growing bacillus, is a rarely recognized pathogen in meningitis and is most frequently seen in patients with either endocarditis or brain abscess. This article reported one case with Hemophilus aphrophilus meningitis. A 10-year-old boy presented at the emergency room with chief complaint of fever for 2 days and sudden onset of loss of consciousness. Hemophilus aphrophilus was isolated from the blood and cerebrospinal fluid. Aqueous penicillin and chloramphenicol were given for three weeks. The patient discharged without any sequelae. Three months later, fever and consciousness disturbance were noted again. No pathogen was isolated from the cerebrospinal fluid and blood culture this time, but CSF finding was consistent with bacterial meningitis. Aqueous penicillin and chloramphenicol were readministered for 30 days. The patient recovered smoothly. Because the patient had no history of CSF rhinorrhea or hypogammaglobulinemia, recurrence of the bacterial meningitis could be due to incomplete treatment during the first admission. Brain computed tomography (CT) done during the two admissions showed focal cortical enhancement in the fronto-temporo-parietal region. This is presumed to indicate infarction over these regions. The findings of brain CT are in accordance with the development of hemiplegia in the patient. It is still unknown, however, whether Hemophilus aphrophilus meningitis also causes a higher incidence of brain infarction, which was frequently noted in patients with Hemophilus influenzae meningitis.

Child↗
PubMed1993

Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors.

OBJECTIVES: The mortality due to pneumococcal meningitis remains high, ranging from 15 to 60%. The purpose of this study was to analyze the prognosis of pneumococcal meningitis using a multivariate approach. The objectives were to select the most accurate initial mortality risk factors in pneumococcal meningitis and to determine an individual probability of death according to these prognostic factors. METHODS: The records of 105 consecutive cases of proven pneumococcal meningitis were retrospectively reviewed. The following parameters, recorded at presentation were considered for prognostic analysis: age, sex, duration of symptoms and antimicrobial chemotherapy before admission, underlying debilitating conditions, occurrence of seizures, pneumococcal bacteraemia or pneumonia, Glasgow coma scale score, Simplified Acute Physiological Score (SAPS), Cerebral Spinal Fluid (CSF) leucocyte count, CSF protein level, CSF glucose level and CSF/blood glucose ratio. Those parameters having a prognostic value after univariate logistic regression analysis were then entered into a multivariate stepwise logistic regression model. RESULTS: In multivariate analysis, a fatal outcome was best predicted by 4 variables. In descending order, these were the Glasgow coma scale score, age, CSF glucose level and concomitant pneumonia. The risk of dying was ten times higher in patients with Glasgow coma scale score < 7, seven times higher in patients older than 45 or having a CSF glucose level lower than 0.6 mmol/L and 4 times higher in patients with pneumonia. The logistic model provided an equation for the probability of dying that proved to have predictive values greater than 80% in determining the individual prognostic of pneumococcal meningitis. CONCLUSIONS: Our results are in agreement with most of previously published findings. We further demonstrated that the individual prognosis of pneumococcal meningitis could be accurately predicted with only 4 variables and highlighted the preeminent prognostic value of Glasgow coma scale score.

Adolescent↗
PubMed1993

[Meningeal carcinomatosis in patients with small cell lung cancer].

Six patients (2.7%) developed meningeal carcinomatosis among 207 patients with small cell lung cancer (SCLC) receiving intensive combination chemotherapy. The cumulative probability of developing meningeal carcinomatosis was 2.7% at 3 years and 7.8% at 5 years after diagnosis of SCLC. Pain in legs, gait disturbance, headache, nausea and vomiting were the characteristic symptoms at the onset of meningeal carcinomatosis. Although cytological examination of cerebro-spinal fluid (CSF) was essential for the diagnosis of meningeal carcinomatosis, elevated protein, LDH, CEA and/or NSE concentration and decreased glucose concentration in CSF were also helpful for the diagnosis. For treatment of meningeal carcinomatosis, all patients received intrathecal administration of methotrexate, cytosine arabinoside and/or prednisolone. Additionally, 3 patients received spinal irradiation, and one received cerebro-spinal irradiation. However, only 2 patients responded, and survival was brief ranging from 2 to 38 weeks. Development of meningeal carcinomatosis seems to be a rare event; however, it may be an obstacle to the prolongation of patient survival in the treatment of SCLC.

Adolescent↗
PubMed1993

[Duration of the treatment of meningitis except in the neonatal period].

Optimal treatment of bacterial meningitis raises three questions: which antibiotic? which dosage? which duration? The overall duration of antibiotherapy has been shortened since the last decade. If a short-course treatment shows similar efficacy and rate of relapse, unnecessary prolonged course of treatment exposes to increased cost, duration of hospitalization and secondary effects. From 1979, Gold et al in Toronto treated all uncomplicated cases of meningitis for seven days and obtained satisfactory results. The first randomized trials evaluating optimal duration of treatment in meningitis were performed in 1985 by Lin et al: they showed no difference in terms of efficacy and complications between conventional and short-term treatment. Current rules in meningococcal meningitis consist of seven days or less on therapy, and 7-10 days for pneumococcal or Haemophilus meningitis. The sequential follow-up of C-reactive protein (CRP) levels seems a useful tool for the management of bacterial meningitis.

Anti-Bacterial Agents↗
PubMed1996

[Recurrent aseptic meningitis caused by rupture of a pineal cyst].

A 40-year-old woman experienced three attacks of aseptic meningitis in 19 months. Each attack was characterized by sudden onset of meningeal irritation followed by spontaneous remission in several days. The patient was free of neurological symptoms between the attacks. In the acute phase of each attack, her cerebrospinal fluid (CSF) showed mononuclear pleocytosis and increased protein concentration. Epithelial cell clusters in the CSF were evident during the third episode. No pathogenic microorganisms were identified in CSF or blood cultures. Brain imaging revealed a pineal cyst, 1 cm in diameter, and we suspected that the epithelial cell clusters represented the ruptured cystic wall and that the recurrent aseptic meningitis was triggered by spontaneous rupture of the cyst. Recently several new etiologies for the benign recurrent aseptic meningitis (Mollaret's meningitis) have been reported, but its existence as a clinical entity is still in dispute. Our case appears to support "spontaneous rupture of central nervous system epidermoid cysts" as one of the etiologies of recurrent aseptic meningitis.

Adult↗
PubMed1997

Bacterial meningitis in children at Kalafong Hospital, 1990-1995.

OBJECTIVES: To determine the bacteriological profile, morbidity, mortality and factors which contributed to the outcome. DESIGN: Retrospective descriptive. SETTING: Kalafong Hospital, Pretoria. SUBJECTS: Children older than 1 month and younger than 13 years admitted between January 1990 and December 1995 with culture-proven bacterial meningitis. MAIN OUTCOME MEASURES: Causative bacteria, antibiotic sensitivity, age, clinical features and short-term morbidity and mortality. RESULTS: Sixty-one patients had culture-proven bacterial meningitis. In 57% Haemophilus influenzae, in 33% Streptococcus pneumoniae and in 1.6% (1 patient) Neisseria meningitidis were cultured (5 patients yielded other organisms). Some H. influenzae cultures showed resistance to cefotaxime and ampicillin and some S. pneumoniae cultures to penicillin. The mean age of all patients was 18 months. Twenty-three per cent of the patients had consulted between 1 and 5 health workers and were then self-referred. Fever, cough and vomiting were the most common complaints. On examination, fever and pneumonia were the most common findings apart from neurological system involvement. Twelve patients (20%) died and 46% were discharged with obvious neurological complications. Morbidity and mortality were the highest for S. pneumoniae meningitis. Bad prognostic features were delayed referral, S. pneumoniae meningitis, convulsions and abnormal neurological signs on admission. CONCLUSION: H. influenzae was the most common cause of childhood bacterial meningitis at Kalafong Hospital, with N. meningitidis meningitis being very rare. Morbidity and mortality were very high, compared with outcome in developed countries. Delayed referral seems to be an important factor in predicting an adverse outcome.

Age Factors↗
PubMed1997

Klebsiella pneumoniae meningitis: analysis on clinical features of thirty-two adult patients.

BACKGROUND: To assess the clinical features and therapeutic outcomes of adult Klebsiella pneumoniae (KP) meningitis. METHODS: Thirty-two adult patients with KP meningitis were included in this study. Their clinical features, the outcomes with the third generation cephalosporin (moxalactam, cefotaxime, ceftazidime) treatment and prognostic factors were analyzed. RESULTS: These patients' diseases were predominantly community-acquired. Males outnumbered females (3:1). Diabetes mellitus (DM) was the most common underlying disease, followed by other debilitating diseases such as liver cirrhosis, neoplasm and end-stage renal disease (ESRD). Patients with spontaneous meningitis had a more fulminant course with a higher prevalence of bacteremia, shock and death (66%). Metastatic septic abscess was frequent (19%). Among the 21 patients who received initial appropriate antimicrobial therapy (IAAT), 2 took cefotaxime and 1 died; 13 took moxalactam of whom 5 died; and 6 took ceftazidime of whom 3 died. All of the other 11 patients who did not receive IAAT died. CONCLUSIONS: The clinical features of KP meningitis are various and indistinguishable from other form of bacteria meningitis. Most of the patients with KP meningitis are associated with underlying medical problems, such as diabetes mellitus and liver cirrhosis. Many factors, including septic shock, bacteremia, high cerebrospinal fluid lactate concentration, and IAAT, might influence the prognosis. In spite of a high mortality rate, however, IAAT is mandatory to improve the overall survival rate.

Adult↗
PubMed1998

[Treatment of tuberculous meningitis: marker of cure].

A 49-year-old male with tuberculous meningitis was reported. When admitted to our hospital with mild right hemiparesis, he was alert but he developed disorientation 7 days later. A diagnosis of tuberculous meningitis was reached because of elevated levels of adenosine-deaminase at 19.6U/liter in the cerebrospinal fluid. MRI showed a marked enhancement in the basal cisterns and an enhanced intraparenchymal lesion in the brainstem. Chronological changes of MRI findings did not closely correlate with the clinical course. Slight meningeal enhancement on MRI seems to remain for a long time without active tuberculous meningitis, and absence of the meningeal enhancement on MRI is not necessarily appropriate as a marker of cure of tuberculous meningitis.

Adenosine Deaminase↗
PubMed1997

[Multicenter prospective study on severe bacterial meningitis in children].

UNLABELLED: We prospectively studied the epidemiologic, clinic signs and outcome of bacterial meningitis in 125 children who were admitted into a PICU (Pediatric Intensive Care Unit) of 11 hospitals of Spain and whose meningitis was diagnosed between May 1994 and April 1995. RESULTS: The median age of the children was 3.55 +/- 3.32 years (range 1 month to 16.5 yrs). Eighty-eight were bacterial meningitis, probably bacterial 30 and aseptic 7. The most frequently isolated organisms were N. meningitidis (52), H. influenza type b (17) and S. pneumoniae (8). Twenty-five percent of N. meningitidis had C serotype. Incidence rate of each germen was depending of age. All patients diagnosed of H. influenza type b meningitis were less than 3 years old. H. influenza type b and meningococcus had similar incidence rate during the first year of life (27% versus 31%). During the first three years of life H. influenza type b produced one third of bacterial meningitis. A mortality rate of 5.6% (seven patients: 3 S. pneumoniae, 1 N. meningitidis, 1 H. influenza type b and 2 unknown germen) was observed. Patients who die had lower Glasgow coma score (p = 0.034) and seizures (p = 0.001) at admission. At discharge of PICU, 9 survivors (7.2%) had sequelae: mental retardation in 7 patients and hearing loss in two. One third of patients needed hemodynamic support and a 15% of them ventilatory support. CONCLUSIONS: Age is an important epidemiological factor in the etiology of pediatric acute meningitis. H. influenza type b and N. meningitidis had similar incidence rate during the first year of life. S. pneumoniae had the highest mortality rate (37.5%). The presence of coma and seizures at admission were associated with mortality.

Child, Preschool↗
PubMedDate not supplied

[The assessment of tumor necrosis factor (TNF) alpha and interleukin (IL)-1 beta levels in cerebrospinal fluid (CSF) and serum in patients with purulent meningitis].

The purpose of this work was to detect the concentration of cytokines--tumor necrosis factor (TNF)-alpha and Interleukin (IL)-1 beta in cerebrospinal fluid (CSF) and serum, their diagnostic and prognostic usefulness among patients with purulent meningitis. 25 patients of Centre of Parasitic Diseases and Neuroinfections hospitalized with diagnosis or suspicion of purulent meningitis were studied. The patients were divided into two groups: I-12 persons with diagnosis of purulent meningitis and group II-13 controls where suspicion of meningitis was excluded during clinical procedure. The cytokines were detected by immunometric assay. This examination was performed twice--before and after treatment. In group I-patients with purulent meningitis, TNF-alpha and IL-1 beta CSF concentrations were significantly higher in comparison with group II. After treatment the concentrations of cytokines did not show significant differences between group I and II. In acute phase of meningitis correlations between CSF concentration of TNF-alpha and IL-1 beta and other indexes of inflammation in CSF: pleocytosis, concentration of protein and glucose were found. The serum concentrations of the cytokines were many times lower than in CSF. The detection of TNF-alpha and IL-1 beta CSF concentration can be used to estimate the efficacy of therapy and regression of inflammation in the central nervous system.

Abscess↗