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At least 1,279 records · Page 71Linked to original sources
PubMed1983

Moxalactam for the treatment of bacterial meningitis in children.

Increasing resistance to antibiotics in meningeal pathogens has stimulated a search for new antimicrobial agents for the treatment of bacterial meningitis. Moxalactam penetrates well into infected cerebrospinal fluid (CSF) and is highly active against most gram-negative bacteria. The clinical efficacy and safety of moxalactam in the treatment of childhood meningitis caused by Haemophilus influenzae (25 patients) or Neisseria meningitidis (five patients) was evaluated in a random, uncontrolled study. The penetration of the antibiotic into CSF was also evaluated in these patients and in another five children with bacterial meningitis. The clinical results were excellent, with 29 of 30 cases cured. The single adverse clinical reaction noted was the development of a wound hematoma in a postoperative patient; this problem may have been related to moxalactam therapy. The levels of moxalactam achieved in CSF greatly exceeded the minimal bactericidal concentrations for the infecting organisms. Moxalactam appears to be safe and effective as primary therapy for meningitis caused by H influenzae or N meningitidis.

Adolescent↗
PubMed1992

High concentrations of intrathecal interleukin-6 in human bacterial and nonbacterial meningitis.

Interleukin-6 (IL-6) is multipotent cytokine that acts in a network of factors directing the inflammatory reaction of purulent bacterial meningitis (PBM). However, little is known about the role of IL-6 in aseptic or "viral" meningitis (AM). IL-6 was assayed by RIA in cerebrospinal fluid (CSF) and serum samples obtained from patients with AM (n = 65), PBM (n = 8), and lymphocytic bacterial meningitis (LBM, n = 11). Of patients with AM, 89% had detectable IL-6 in CSF, with high IL-6 titers (median, 2160 pg/mL; 95% confidence interval [CI], 1320-2540 pg/mL) compared with 100% in patients with PBM (median, 6575 pg/mL; 95% CI, 450-32,000 pg/mL) and 90.9% in patients with LBM (median, 875 pg/mL; 95% CI, 150-2180 pg/mL). There was a highly symmetrical correlation between IL-6 and the percentage of polymorphonuclear cells in CSF of patients with PBM (r = .97, P = .01) and AM (r = .49, P = .002). In conclusion, this study shows evidence that IL-6 is released into the meningeal space in aseptic meningitis and is correlated with the local acute inflammatory response.

Humans↗
PubMed1984

Management of neonatal meningitis, 1984.

Neonatal bacterial meningitis continues to cause substantial mortality and morbidity despite the advent of new antimicrobial agents and of modern intensive care facilities. In Dallas, the case-fatality rate for bacterial meningitis in newborn and young infants is 17% (40 of 231 patients). Three pathogens, Group B streptococcus, Escherichia coli and Listeria monocytogenes, accounted for 84% of the causative agents. Although new beta-lactam antibiotics have been extensively evaluated in experimental meningitis due to these pathogens, there is limited clinical experience from which to judge efficacy and safety. Currently, conventional therapy with ampicillin and an amino-glycoside should be used as initial empirical therapy for neonatal meningitis. Once the pathogen has been identified and the susceptibilities determined, the most appropriate antibiotic or combination of antibiotics can be selected. Latamoxef (moxalactam) and cefotaxime are highly active agents in vitro against Gram-negative enteric bacilli and may prove useful for therapy of meningitis due to those organisms. Additional experience with these compounds is required before they can be recommended for routine use.

Anti-Bacterial Agents↗
PubMedDate not supplied

Unusual pattern of enhancement in cryptococcal meningitis: in vivo findings with postmortem correlation.

Leptomeningeal enhancement on CT and MR imaging studies secondary to cryptococcal meningitis is an uncommon finding. In immunocompromised patients, this meningitis incites only a mild inflammatory reaction and abnormalities are often absent on imaging studies. We recently encountered two patients with cryptococcal meningitis in whom postcontrast MR imaging showed thick enhancing subarachnoid spaces. Both had cryptococcal meningitis at autopsy. In a different patient with cryptococcal meningitis, postmortem MR imaging and pathologic examinations showed that these areas of enhancement correspond to abundant mucoid material secreted by the yeasts.

AIDS-Related Opportunistic Infections↗
PubMed1978

Non-traumatic gram-negative bacillary meningitis in the Detroit Medical Center, 1964-1974; (with special mention of cases due to Escherichia coli).

Clinical and autopsy records of eight adults with non-traumatic gram-negative bacillary meningitis who were admitted to the hospitals of the Wayne State University--Detroit Medical Center during the years 1964 to 1974 were reviewed. There were five community-acquired cases, and five patients died. Escherichia coli was the causative enteric bacillus in six cases. Community-acquired infections were due to Esch. coli in four of the patients. Each of the patients with a community-acquired infection was a chronic alcoholic. Esch. coli bronchopneumonias, urinary infections, and bacteremias seeding the meninges were usual. Shunting contaminated portal venous blood through the liver in patients with Laennec's cirrhosis, or bypassing the liver with similar infected blood from a genitourinary source by way of Batson's perivertebral plexus draining into the cerebral dural sinuses may be important in the pathogenesis of these infrequent cases of nontraumatic gram-negative bacillary meningitis. Spontaneous gram-negative bacteremias, peritonitis, bronchopneumonias, and now "meningitis" may be a constellation of special complications of the alcoholic. Mortality among 25 patients with Esch. coli meningitis reported from 1922 to 1974 is approximately 50%, and has not changed appreciably during the antibiotic era. Mortality, however, is significantly higher in nosocomially acquired cases. Early and more recent cases have had bloody, xanthochromic pleocytoses indicative of leptomeningeal arterial and venous vasculitis, and far advanced disease. Since causative/enteric bacilli have been susceptible to antimicrobial agents employed, another mode of antibacterial administration, perhaps utilizing parenteral plus intraventricular dosing, particularly for patients acquiring their infections in the hospital, may be required.

Adult↗
PubMedDate not supplied

The effect of protecting guinea-pigs against EAE on the meningeal inflammatory cell-infiltrate.

Guinea-pigs were found to be fully protected from the clinical signs of EAE when they were given spinal cord in FIA either 3, 7. or 14 days immunization with spinal cord in FCA. If the animals were protected by the recruitment of suppressor cells then cyclophosphamide (CY) might break this protection. CY at 300 mg/kg and 20 mg/kg was given either before the protective inoculum to try to eliminate suppressor cell precursors or before immunization to eliminate the suppressors cells themselves. No clinical signs of EAE developed in any of these groups of guinea-pigs. It was found, however, that large numbers of meningeal inflammatory cells could be isolated from the brains of guinea-pigs protected from EAE when the protective inoculum was given only 1 week before immunization. These cell numbers were further significantly increased by giving CY in addition to the protective inoculum. The meningeal inflammatory cells and peritoneal exudate cells (PECs) from guinea-pigs protected against EAE were compared to those isolated from animals with acute EAE. These cells from guinea-pigs with acute EAE responded, in the lymphocyte transformation test, to the mitogen. The PECs also responded to the brain antigen, myelin basic protein (MBP) and to tuberculin (PPD). The meningeal inflammatory cells did not respond to either antigen. The PECs from animals protected against EAE responded to mitogen and PPD, but not to MBP, but the meningeal inflammatory cells did not respond to antigen or mitogen. The percentage of T lymphocytes in the meningeal inflammatory infiltrates of protected and unprotected guinea-pigs was similar, but that of phagocytic cells was significantly depressed in the inflammatory infiltrates of animals protected against EAE.

Animals↗
PubMed1978

Demonstration of cerebrospinal fluid lymphocytes sensitized against virus antigens in mumps meningitis.

Virus-induced proliferation of cerebrospinal fluid (CSF) lymphocytes and blood lymphocytes was studied in patients with mump meningitis and in patients with aseptic meningitis of other etiology. In four out of five patients with mump meningitis the proliferation of CSF lymphocytes after mumps virus stimulation was higher than obtained with the corresponding number of blood lymphocytes. No proliferation was registered when lymphocytes from patients with other aseptic meningitis were stimulated with mumps virus. These data indicate the occurrence in CSF of lymphocytes specifically sensitized against mumps virus in patients with mumps meningitis.

Adolescent↗
PubMed1992

Expression of epidermal growth factor receptor in human meningiomas and meningeal tissue.

The aim of this study was to examine meningeal tissue under normal, reactive, and neoplastic conditions for expression of epidermal growth factor receptor (EGFR) using an improved histochemical method, namely biotinylated epidermal growth factor. EGFR was found in all the examined meningiomas (12 benign and three anaplastic) and in neonatal rat meninges, whereas normal and injured adult human and rat meninges did not exhibit detectable EGFR. These observations indicate that EGFR is involved in the development of meningeal tissue. Further, EGFR is abnormally expressed in meningeal tumours, indicating a role of EGFR in the neoplastic process of these tumours. The regular expression of EGFR in human meningiomas suggests EGFR as a tumour marker for this tumour type.

Adult↗
PubMed1983

Evaluation of aztreonam in experimental bacterial meningitis and cerebritis.

Aztreonam (SQ 26,776), a new monocyclic beta-lactam agent, was compared with ampicillin, ampicillin plus chloramphenicol, and gentamicin in rabbits with experimental meningitis induced by, respectively, ampicillin-susceptible Haemophilus influenzae, ampicillin-resistant H. influenzae, and Escherichia coli. Aztreonam was also compared with gentamicin in experimentally induced E. coli cerebritis in rats. Doses of the various agents were delivered that produced near-peak concentrations in serum comparable to those attained in humans on standard parenteral regimens. The percent penetration [( concentration in cerebrospinal fluid/concentration in serum] X 100) of aztreonam into purulent rabbit cerebrospinal fluid was 23% (versus 12, 27, and 21%, respectively, for ampicillin, chloramphenicol, and gentamicin). In experimental meningitis in vivo, aztreonam was more rapidly bactericidal than was ampicillin in ampicillin-susceptible H. influenzae meningitis, ampicillin or chloramphenicol in ampicillin-resistant H. influenzae meningitis, or gentamicin in E. coli meningitis. In the therapy of experimental cerebritis, the early stage of brain abscess formation, aztreonam reduced the numbers of E. coli in rat brain as rapidly as did gentamicin. Aztreonam deserves further evaluation in acute gram-negative bacterial infections of the central nervous system in both experimental animals and in humans.

Animals↗
PubMed1984

Cefuroxime treatment of bacterial meningitis in infants and children.

Recently, ampicillin- and chloramphenicol-resistant strains of Haemophilus influenzae type b and multiply-resistant Salmonella strains have appeared in some areas of the world. Therefore, alternative drug therapy for infections caused by these organisms is being sought. We used cefuroxime to successfully treat five children with H. influenzae type b meningitis and two children with Salmonella meningitis. Four H. influenzae type b isolates and one Salmonella isolate were resistant to ampicillin, chloramphenicol, and cotrimoxazole. Each of the patients received 200 to 250 mg of cefuroxime per kg per day in four divided doses for 14 to 21 days. The concentrations of cefuroxime in cerebrospinal fluid at 2 h after intravenous 50-mg/kg doses were 6.4 +/- 1.7 (mean +/- standard deviation) and 3.6 +/- 2.2 micrograms/ml on days 2 and 14 of treatment, respectively. The level of drug in cerebrospinal fluid was 1.34 +/- 1.3 micrograms/ml in children without meningitis. The mean cefuroxime concentration in subdural fluid samples from each of three patients was 12.6, 15, and 25.2 micrograms/ml. Cefuroxime is recommended as an alternative drug for the treatment of H. influenzae type b meningitis, but additional information is necessary before cefuroxime can be recommended for therapy of Salmonella meningitis.

Body Fluids↗
PubMed2006

Comparison of the inflammatory responses of human meningeal cells following challenge with Neisseria lactamica and with Neisseria meningitidis.

The rationale for the present study was to determine how different species of bacteria interact with cells of the human meninges in order to gain information that would have broad relevance to understanding aspects of the innate immune response in the brain. Neisseria lactamica is an occasional cause of meningitis in humans, and in this study we investigated the in vitro interactions between N. lactamica and cells derived from the leptomeninges in comparison with the closely related organism Neisseria meningitidis, a major cause of meningitis worldwide. N. lactamica adhered specifically to meningioma cells, but the levels of adherence were generally lower than those with N. meningitidis. Meningioma cells challenged with N. lactamica and N. meningitidis secreted significant amounts of the proinflammatory cytokine interleukin-6 (IL-6), the C-X-C chemokine IL-8, and the C-C chemokines monocyte chemoattractant protein 1 (MCP-1) and RANTES, but it secreted very low levels of the cytokine growth factor granulocyte-macrophage colony-stimulating factor (GM-CSF). Thus, meningeal cells are involved in the innate host response to Neisseria species that are capable of entering the cerebrospinal fluid. The levels of IL-8 and MCP-1 secretion induced by both bacteria were essentially similar. By contrast, N. lactamica induced significantly lower levels of IL-6 than N. meningitidis. Challenge with the highest concentration of N. lactamica (10(8) CFU) induced a small but significant down-regulation of RANTES secretion, which was not observed with lower concentrations of bacteria. N. meningitidis (10(6) to 10(8) CFU) also down-regulated RANTES secretion, but this effect was significantly greater than that observed with N. lactamica. Although both bacteria were unable to invade meningeal cells directly, host cells remained viable on prolonged challenge with N. lactamica, whereas N. meningitidis induced death; the mechanism was overwhelming necrosis with no significant apoptosis. It is likely that differential expression of modulins between N. lactamica and N. meningitidis contributes to these observed differences in pathogenic potential.

Cells, Cultured↗
PubMed1984

Sensitive enzyme immunoassay for early diagnosis of tuberculous meningitis.

Cerebrospinal fluid from patients with tuberculous, pyogenic, and viral meningitis, as well as from appropriate control individuals, were assayed for immunoglobulin G and immunoglobulin M antibody activity to Mycobacterium bovis BCG by an enzyme-linked immunosorbent assay. BCG linked covalently to plastic disks served as the antigen in a classical indirect enzyme-linked immunosorbent assay. A significant difference was found between the tuberculous meningitis group and the nontuberculous meningitis and control groups. All samples from the tuberculous meningitis group gave a positive reaction, and none of the known negative samples gave false-positive reactions. Because of its sensitivity, specificity, and predictive value, this test may be useful in the early diagnosis of tuberculous meningitis.

Adolescent↗
PubMed1998

Microscopic examination and broth culture of cerebrospinal fluid in diagnosis of meningitis.

We reviewed the results of microscopic Gram stain examination and routine culture for 2,635 cerebrospinal fluid (CSF) samples processed in an adult hospital microbiology laboratory during 55 months. There were 56 instances of bacterial or fungal meningitis (16 associated with central nervous system [CNS] shunt infection), four infections adjacent to the subarachnoid space, four cases of sepsis without meningitis, and an additional 220 CSF specimens with positive cultures in which the organism isolated was judged to be a contaminant. Because 121 of these contaminants were isolated in broth only, elimination of the broth culture would decrease unnecessary work. However, 25% of the meningitis associated with CNS shunts would have been missed by this practice. The most common cause of meningitis was Cryptococcus neoformans, followed by Streptococcus pneumoniae and Neisseria meningitidis. In 48 of 56 (88%) of cases, examination of the Gram-stained specimen revealed the causative organism. If patients who had received effective antimicrobial therapy prior to lumbar puncture are excluded, the CSF Gram stain is 92% sensitive. Microscopic examination incorrectly suggested the presence of organisms in only 3 of 2,635 (0.1%) CSF examinations. Thus, microscopic examination of Gram-stained, concentrated CSF is highly sensitive and specific in early diagnosis of bacterial or fungal meningitis.

Cerebrospinal Fluid↗
PubMed1978

Cerebrospinal fluid lactic acid in diagnosis of meningitis.

Quantitative lactate determinations were performed on cerebrospinal fluids to assess their value in the rapid diagnosis of bacterial and mycotic meningitis and to evaluate their value in assessing the prognosis in these patients. Cerebrospinal fluid lactate concentrations were elevated in all patients with untreated bacterial or fungal meningitis. Lactate concentrations proved very valuable in following patients with mycotic meningitis and in differentiating aseptic from bacterial meningitis. Elevated cerebrospinal fluid lactate is not specific for meningitis. Lactate is also elevated in situations where there is central nervous system ischemia and necrosis and in patients with brain tumors. Lactate concentration is normal in chronic degenerative brain diseases. Thus, the clinical situation must be taken into account when interpreting the lactate concentrations.

Bacterial Infections↗
PubMed1989

Tumour necrosis factor-alpha in infectious meningitis.

During a one year period tumour necrosis factor-alpha (TNF-alpha) was prospectively determined in the cerebrospinal fluid of 49 patients with infectious meningitis. TNF-alpha was found in the cerebrospinal fluid of 15 of 18 patients with bacterial meningitis. In 11 patients who had cerebrospinal fluid positive for TNF-alpha it was detected in only one serum (in low concentration). There was no significant correlation between the concentration of TNF-alpha in cerebrospinal fluid and the patient's age, duration of illness and fever, body temperature, and serum C reactive protein. However, cerebrospinal fluid protein concentrations of greater than or equal to 2 g/l and leucocyte values of greater than or equal to 2.5 X 10(9)/l were more often associated with high TNF-alpha concentrations (greater than or equal to 500 pg/ml). In contrast with bacterial meningitis, none of the 31 samples of cerebrospinal fluid from patients with viral meningitis was positive for TNF-alpha. Thus this investigation supports the conclusion, drawn from animal studies on TNF-alpha in the cerebrospinal fluid, that the presence of TNF-alpha is indicative of bacterial meningitis. Absence of TNF-alpha cerebrospinal fluid, however, was found here not to exclude a bacterial aetiology of the infection.

Adolescent↗
PubMed1981

Cerebrospinal fluid amino acid concentrations in patients with viral and tuberculous meningitis.

Serial measurements have been made of the cerebrospinal fluid and plasma amino acid concentrations in 11 patients with viral meningitis and in four with tuberculous meningitis. A small increase in the concentrations of a few amino acids in cerebrospinal fluid has been found in a viral meningitis in contrast to a marked increase in most amino acids in tuberculous meningitis. The findings are compared with those found in patients with purulent meningitis and the possible causes and the diagnostic significance of these findings are discussed.

Adolescent↗
PubMed1990

Prominent meningeal enhancement adjacent to meningioma on Gd-DTPA-enhanced MR images: histopathologic correlation.

To assess tissue changes responsible for enhancement of the meninges adjacent to meningiomas on magnetic resonance (MR) images, the authors correlated the MR imaging characteristics of meningeal lesions seen before and after administration of gadolinium diethylenetriamine-pentaacetic acid (DTPA) with the appearance of these lesions on contrast material-enhanced computed tomographic (CT) images and with histopathologic findings in four patients. Histopathologic examination of meninges showed increased loose connective tissue, hypervascularity, and dilated vessels. There was neoplastic infiltration of the dura mater in two patients but it was restricted to the immediate junction of neoplasm and dura mater, with maximum peripheral extension within 1 mm of the tumor margin. In both patients the meninges were enhanced far beyond the neoplastic infiltration. The other two patients showed no infiltration of dura mater. These findings suggest that pathologic enhancement of meninges adjacent to meningioma after administration of Gd-DTPA mainly represents reactive changes to the neoplasm and does not necessarily indicate neoplastic involvement.

Female↗
PubMed1990

Quantitation of lymphocyte subsets in cerebrospinal fluid and blood during the clinical course of aseptic and bacterial meningitis.

Mononuclear cell subsets in cerebrospinal fluid (CSF) and peripheral blood (PB) were monitored during the clinical course in 23 patients with acute meningitis using 6 monoclonal antibodies. Significant differences between aseptic and bacterial meningitis mainly consisted of a higher percentage of OKT4-positive cells in PB in the acute phase of bacterial meningitis. Significant differences between CSF and PB are found in the amount of most cell subtypes at all times except the acute phase of bacterial meningitis. The OKT4/OKT8 ratio was always significantly higher in CSF and correlated with the acuity of inflammation in bacterial meningitis.

Aged↗