RESUMO
Immune-checkpoint inhibitors (ICIs) targeting cytotoxic T lymphocyte-associated antigen-4 and programmed cell death ligand-1) are associated with several immune-related neurological disorders. Cases of meningitis related to ICIs are poorly described in literature and probably underestimated. Several guidelines are available for the acute management of these adverse events, but the safety of resuming ICIs in these patients remains unclear. We conducted a retrospective case series of immune-related meningitis associated with ICIs that occurred between October 1 2015 and October 31 2019 in two centers: Saint-Louis and Cochin hospitals, Paris, France. Diagnosis was defined by a (1) high count of lymphocytes (>8 cells/mm3) and/or high level of proteins (>0.45 g/L) without bacteria/virus or tumor cells detection, in cerebrospinal fluid and (2) normal brain and spine imaging. Patients were followed-up for at least 6 months from the meningitis onset. Seven cases of immune-related meningitis are here reported. Median delay of meningitis occurrence after ICIs onset was 9 days. Steroid treatment was introduced in four patients at a dose of 1 mg/kg (prednisone), allowing a complete recovery within 2 weeks. The other three patients spontaneously improved within 3 weeks. Given the favorable outcome, ICIs were reintroduced in all patients. The rechallenge was well tolerated and no patients experienced meningitis recurrence. In conclusion, in our series, the clinical course was favorable and steroids were not always required. Resuming ICIs in these patients appeared safe and can thus be considered in case of isolated meningitis. However, a careful analysis of the risk/benefit ratio should be done on a case-by-case basis.
Assuntos
Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/tratamento farmacológico , Meningite/induzido quimicamente , Adulto , Idoso , Feminino , Humanos , Inibidores de Checkpoint Imunológico/farmacologia , Masculino , Melanoma/patologia , Meningite/patologia , Pessoa de Meia-IdadeRESUMO
Immune checkpoint inhibitors (ICIs) have improved the overall survival of many patients with advanced cancers. However, unlike cytotoxic and targeted drugs, ICIs may cause various immune-related adverse events (irAEs). Among these irAEs, autoimmune meningitis is very rare. Here, we report a case of early-onset, atezolizumab-induced meningitis after administration of one dose of atezolizumab. A 56-year-old man with lung adenocarcinoma had received seventh-line treatment with atezolizumab when he experienced dysarthria. Blood examinations, including the measurement of electrolytes, glucose, and organ functions, were unremarkable, but enhanced head magnetic resonance imaging T1-weighted images showed meningeal enhancement. Although cerebral spinal fluid (CSF) examinations revealed elevated lymphocyte and protein levels, no cancer cells were detected in the CSF. CSF cultures and serological tests, including polymerase chain reaction for herpes simplex virus, were negative. The patient was therefore diagnosed with atezolizumab-triggered autoimmune meningitis. With steroid treatment, the patient's clinical and neurological state improved immediately and he recovered to baseline conditions. Prompt diagnosis and therapeutic intervention are essential for the effective treatment of autoimmune meningitis.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Meningite/induzido quimicamente , Glucocorticoides/uso terapêutico , Humanos , Masculino , Meningite/tratamento farmacológico , Metilprednisolona/uso terapêutico , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Chronic enterovirus infections can occur in primary immunodeficiency with hypogammaglobulinemia. They usually associate meningitis and myofasciitis. Such infections have also been described in adults with rituximab-induced hypogammaglobulinemia. CASE REPORT: We report the case of a 33-year-old woman who was given rituximab for immune thrombocytopenia and developed rituximab-induced hypogammaglobulinemia (IgG 4.4g/L). One year after the last rituximab infusion, she developed lower limbs myofasciitis, followed two months later by a chronic lymphocytic meningitis. PCR in the serum and the cerebrospinal fluid at the time of the meningitis and the myofasciitis were positive to the same enterovirus (echovirus 11) while it was negative in the fascia biopsy. Under treatment with intravenous immunoglobulins, all symptoms and laboratory abnormalities improved and enterovirus PCR became negative. CONCLUSION: We report a case of chronic enterovirus infection associating meningitis and myofasciitis in an adult with rituximab-induced hypogammaglobulinemia. Outcome was favorable under treatment with intravenous immunoglobulins.
Assuntos
Agamaglobulinemia/induzido quimicamente , Infecções por Enterovirus/induzido quimicamente , Rituximab/efeitos adversos , Adulto , Agamaglobulinemia/virologia , Doença Crônica , Infecções por Enterovirus/imunologia , Infecções por Enterovirus/terapia , Fasciite/induzido quimicamente , Fasciite/terapia , Feminino , França , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Meningite/induzido quimicamente , Meningite/complicações , Meningite/terapia , Miosite/induzido quimicamente , Miosite/complicações , Miosite/terapia , Púrpura Trombocitopênica Idiopática/tratamento farmacológicoRESUMO
Therapeutic options of leptomeningeal metastases include intra-cerebrospinal fluid (CSF) chemotherapy. Among intra-CSF agents, liposomal cytarabine has advantages but can induce specific toxicities. A BRAF-V600E-mutated melanoma leptomeningeal metastases patient, treated by dabrafenib and liposomal cytarabine, presented after the first injection of liposomal cytarabine with hyperthermia and headaches. Despite sterile CSF/blood analyses, extended intravenous antibiotics were given and the second injection was delayed. The diagnosis of chemical meningitis was finally made. Dose reduction and appropriate symptomatic treatment permitted the administration of 15 injections of liposomal cytarabine combined with dabrafenib. A confirmation of the diagnosis of chemical meningitis is essential in order (1) not to delay intra-CSF or systemic chemotherapy or (2) to limit the administration of unnecessary but potentially toxic antibiotics.
Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Citarabina/efeitos adversos , Carcinomatose Meníngea/tratamento farmacológico , Meningite/induzido quimicamente , Antimetabólitos Antineoplásicos/administração & dosagem , Citarabina/administração & dosagem , Humanos , Injeções Espinhais , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/secundário , Melanoma Maligno CutâneoAssuntos
Anticorpos Monoclonais/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Ipilimumab/efeitos adversos , Neoplasias Renais/tratamento farmacológico , Meningite/induzido quimicamente , Doenças do Nervo Óptico/induzido quimicamente , Radiculopatia/induzido quimicamente , Adulto , Anticorpos Monoclonais/efeitos adversos , Carcinoma de Células Renais/patologia , Substituição de Medicamentos , Feminino , Humanos , Neoplasias Renais/patologia , Meningite/complicações , Metástase Neoplásica , Nivolumabe , Doenças do Nervo Óptico/complicações , Radiculopatia/complicaçõesRESUMO
The ventricular-peritoneal shunt for hydrocephalus is a well-known and established method but is sometimes complicated by shunt malfunction due to several causes. Eosinophilic meningitis is a rare disease, but has occasionally been reported as a cause of shunt malfunction. Here, we report the case of a 74-year-old woman with repeated shunt malfunction and eosinophilic meningitis due to a silicone allergy. Originally, the patient received a ventricular-peritoneal shunt for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. However, shunt malfunction was identified 6 weeks later, and the first shunt revision was performed using a new shunt system from a different company. Further evaluation to identify the cause of the shunt malfunction revealed no abnormal findings, except for eosinophilia in the serum and cerebrospinal fluid. A second shunt malfunction was identified 16 weeks after the first shunt revision. We therefore concluded that eosinophilic meningitis caused by a silicone allergy might be the real culprit and a second shunt revision was performed using a silicone "extracted" tube. Since then, the patient's course has been free from shunt malfunction. In this case, the serum and cerebrospinal fluid eosinophilia were useful markers for identifying the cause of repeated shunt malfunctions. The silicone "extracted" tube may be helpful for diagnosis and therapy.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrocefalia/cirurgia , Meningite/cirurgia , Silicones/efeitos adversos , Hemorragia Subaracnóidea/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Idoso , Feminino , Humanos , Hidrocefalia/diagnóstico , Meningite/induzido quimicamente , Hemorragia Subaracnóidea/diagnósticoRESUMO
Introducción: en 2008 se notificó por primera vez la presencia de Angiostrongylus cantonensis en Ecuador, así como los primeros casos de una enfermedad emergente causada por sus larvas, la meningitis eosinofilica. Métodos: se realizó una revisión de la literatura básica y actualizada sobre aspectos generales de Angiostrongylus cantonensis en el mundo y particulares en Ecuador, que incluyó los hallazgos parasitológicos, clínicos y malacológicos relacionados con la enfermedad. Resultados: se informan los hallazgos iniciales acerca de la aparición del parásito en Ecuador, así como la amplia distribución geográfica de sus hospederos intermediarios en el territorio nacional. Además, se notifican los brotes de meningitis eosinofilica por Angiostrongylus cantonensis y un caso de angiostrongyliosis ocular, informados oficialmente por el Ministerio de Salud Pública. Conclusiones: Angiostrongylus cantonensis es un parásito emergente en Ecuador, cuyo diagnóstico en la actualidad es clínico y epidemiológico, de ahí la importancia de contar con métodos de laboratorio que lo oriente. Por otra parte, es importante que se promuevan campañas de promoción y prevención de salud que contribuyan a romper la cadena de transmisión de la enfermedad.
Introduction: the presence of Angiostrongylus cantonensis and the first cases of eosinophilic meningitis, an emerging disease caused by its larvae, were first reported in Ecuador in the year 2008. Methods: a review was conducted of the basic and current bibliography on general aspects of Angiostrongylus cantonensis both worldwide and in Ecuador, including parasitological, clinical and malacological findings. Results: initial findings are reported about the emergence of the parasite in Ecuador, as well as the broad geographic distribution of its intermediate hosts in the national territory. Information is also provided about outbreaks of eosinophilic meningitis due to Angiostrongylus cantonensis and a case of ocular angiostrongylosis, based on official reports by the Ministry of Public Health. Conclusions: Angiostrongylus cantonensis is an emerging parasite in Ecuador whose diagnosis is currently based on clinical and epidemiological findings. Hence the importance of developing relevant laboratory methods. On the other hand, it is important to foster health promotion and prevention campaigns aimed at stopping the transmission of the disease.
Assuntos
Angiostrongylus cantonensis/patogenicidade , Infecções por Strongylida/complicações , Infecções por Strongylida/diagnóstico , Meningite/induzido quimicamente , Promoção da Saúde/métodos , Prevenção de Doenças , Testes Laboratoriais/métodosRESUMO
Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) is a contrast agent commonly used for enhancing MRI. In this paper, the authors report on 2 cases of postoperative inadvertent administration of Gd-DTPA directly into a ventriculostomy tubing side port that was mistaken for intravenous tubing. Both cases demonstrated a low signal on MRI throughout the ventricular system and dependent portions of the subarachnoid spaces, which was originally believed to be CSF with areas of T1 shortening in the nondependent portions of the subarachnoid spaces, and misinterpreted as basal leptomeningeal enhancement and meningitis. The authors propose that the appearance of profound T1 hypointensity within the ventricles and diffuse susceptibility artifact along the ependyma is pathognomonic of intraventricular Gd-DTPA and should be recognized.
Assuntos
Ventrículos Cerebrais/patologia , Gadolínio DTPA/administração & dosagem , Gadolínio DTPA/efeitos adversos , Erros Médicos/efeitos adversos , Meningite/induzido quimicamente , Síndromes Neurotóxicas/etiologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Ventriculografia Cerebral , Feminino , Humanos , Injeções Intraventriculares/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Meningioma/diagnóstico por imagem , Meningioma/patologia , Meningioma/cirurgia , Meningite/diagnóstico por imagem , Meningite/patologia , Pessoa de Meia-Idade , Síndromes Neurotóxicas/diagnóstico por imagem , Síndromes Neurotóxicas/patologia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia , Tomografia Computadorizada por Raios XRESUMO
Intrathecal liposomal cytarabine (ITLC) has shown prolonged time to neurological deterioration in some patients with leptomeningeal spread of breast cancer. We describe a patient with fulminant chemical ventriculomeningitis leading to cerebral edema and death following ITLC administration. A 56-year-old Caucasian female developed progressive headache, depressed level of consciousness and adventitious movements immediately following ITLC. Neurological examination was normal prior to injection. This progressed to loss of all brainstem function and a head CT scan demonstrated diffuse cerebral edema. Due to the absence of neurological function on examination, the family opted to withdraw care. To our knowledge we report the first patient with fulminant chemical ventriculomeningitis leading to cerebral edema and death following ITLC administration. Adjunctive glucocorticoids are recommended. Treatment options are limited and complicated by the liposomal formulation of intrathecal cytarabine.
Assuntos
Citarabina/administração & dosagem , Citarabina/efeitos adversos , Meningite/induzido quimicamente , Meningite/diagnóstico , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Injeções Espinhais , Lipossomos , Pessoa de Meia-IdadeRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Areca catechu nut extract is a popular folk remedy for the treatment of migraine in Kerala and Tamil Nadu states of India. AIM OF THE STUDY: In order to prove the claimed utilization of plant, the effect of hydroalcoholic extract of Areca catechu nut (ANE) was investigated in nitroglycerine induced inflammation in rat meninges. In these models infusion of nitric oxide donor glyceryl trinitrate (GTN) produces augmented plasma protein extravasation (PPE) in dura mater, provides an important substrate for the development of migraine in rats. MATERIALS AND METHODS: The effect on plasma protein extravasation was assessed in both the models of intravenous and topical GTN application following oral administration of ANE (250 mg/kg and 500 mg/kg) in both curative and preventive treatment and compared with that of control positive. The l-NAME (15 mg/kg, i.v.) was used as reference standard. Plasma protein extravasation was measured using fluorescein as marker and was measured using a Perkin-Elmer LS-30 luminescence spectrometer. RESULTS: Expression of iNOS in the spleen after intravenous injection produced PPE into the dura mater in control positive group was significantly (P<0.01) reduced to 1.553±0.02499 and 1.398±0.01887 by preventive treatment with ANE at the dose of 250 and 500 mg/kg, orally, respectively. The extravasation produced by topical GTN due to expression of iNOS in dural macrophages was also reduced to 1.555±0.03384 and 1.425±0.01204 by preventive treatment with ANE at the dose of 250 and 500 mg/kg, orally, respectively. While ANE do not showed any significant results in curative treatment in both the models of i.v. and topical GTN application. CONCLUSION: These findings collectively indicate that the extract exhibited significant inhibition of iNOS, which may be the probable mechanism for its anti-migraine activity, providing evidence, at least in part, for its folkloric use.
Assuntos
Anti-Inflamatórios/uso terapêutico , Areca , Proteínas Sanguíneas/metabolismo , Meningite/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Fitoterapia , Animais , Anti-Inflamatórios/farmacologia , Modelos Animais de Doenças , Dura-Máter/efeitos dos fármacos , Dura-Máter/metabolismo , Inibidores Enzimáticos/farmacologia , Feminino , Macrófagos/efeitos dos fármacos , Masculino , Meningite/induzido quimicamente , Meningite/metabolismo , Camundongos , Camundongos Endogâmicos , Transtornos de Enxaqueca/induzido quimicamente , Transtornos de Enxaqueca/metabolismo , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico/metabolismo , Nitroglicerina/metabolismo , Nozes , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Ratos , Ratos Sprague-Dawley , Baço/metabolismoRESUMO
Macrophages play important roles in host defense mechanisms. In the brain, besides microglial cells, meningeal macrophages are present. However, the pathobiological characteristics of meningeal macrophages in rats remain to be investigated. In normal meninx, immunohistochemically, macrophages reacting to CD163 (macrophage scavenger receptor) and major histocompatibility complex (MHC) class II-expressing cells (involving activated macrophages or dendritic cells) were sporadically seen without age-dependent changes. Injection of lipoplysaccharide (LPS) (5 microg; Escherichia coli) into the cerebrum increased the number of anti-CD68-positive macrophages (with greater phagocytic activity) in the meninx, with a peak at 12 h during observation period until 48 h; MHC class II-expressing cells showed a gradual increase in number from 3 h after injection; however, anti-CD163-positive macrophages did not show significant change. In in vitro studies, LPS (0, 0.02, 0.05, 0.5, 5, 50 and 100 microg/ml) was added to KMY-1 or KMY-2 cells, both of which had been established from a rat malignant meningioma. KMY-1 originally reacted to CD163, but LPS addition at 0.5 microg/ml and greater concentrations decreased the anti-CD163-positive cell number and instead increased the anti-CD68-positive cell number. LPS-treated KMY-2 increased the anti-CD163-positive cell number at 0.05 and 0.5 microg/ml. By RT-PCR methods, LPS (0, 0.5, 5, 50, and 100 microg/ml)-treated KMY-1 and KMY-2 showed an increase in mRNA of monocyte chemoattractant protein-1 (MCP-1, a chemokine), and LPS-treated KMY-2 increased mRNA of nerve growth factor (NGF, an immunological effecter). Collectively, under LPS treatment, macrophages with heterogeneous functions appear in rat meninx; rat meninx-forming cells may be involved in pathogenesis of meningeal inflammation by expressing different immunophenotypes and by producing regulatory proinflammatory factors such as MCP-1 and NGF.
Assuntos
Inflamação/imunologia , Macrófagos/metabolismo , Meninges/imunologia , Meningite/imunologia , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Quimiocina CCL2/biossíntese , Expressão Gênica , Imuno-Histoquímica , Inflamação/induzido quimicamente , Inflamação/metabolismo , Lipopolissacarídeos/toxicidade , Macrófagos/imunologia , Masculino , Meningite/induzido quimicamente , Meningite/metabolismo , Fator de Crescimento Neural/biossíntese , Ratos , Ratos Endogâmicos F344 , Receptores de Superfície Celular/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Intrathecal fluorescein injection has a long history of use by surgeons to determine the exact site of a cerebrospinal fluid (CSF) leak from the skull base. This method, however accurate, is not without complications. We present a case of grand mal and absence seizure after intrathecal fluorescein injection and discuss the possible aetiological factors. We also review the articles in the diagnostic methods for the CSF rhinorrhoea and the complications of the intrathecal fluorescein injection.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Meios de Contraste/efeitos adversos , Epilepsia Tipo Ausência/induzido quimicamente , Epilepsia Tônico-Clônica/induzido quimicamente , Fluoresceína/efeitos adversos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Complicações Pós-Operatórias/diagnóstico , Anestesia Geral , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Meios de Contraste/administração & dosagem , Craniotomia , Endoscopia , Epilepsia Tipo Ausência/diagnóstico , Epilepsia Tônico-Clônica/diagnóstico , Osso Etmoide/patologia , Osso Etmoide/cirurgia , Feminino , Fluoresceína/administração & dosagem , Humanos , Injeções Espinhais , Meningite/induzido quimicamente , Meningite/diagnóstico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Base do Crânio/cirurgiaRESUMO
Tumor necrosis factor-a (TNF-a) inhibition, used in the treatment of rheumatoid arthritis (RA), is associated with central nervous system (CNS) events including new onset and/or exacerbations of pre-existing demyelinating neurological diseases. We describe a patient with refractory RA where adalimumab, a fully humanized IgG1 monoclonal antibody against TNF-a, may have contributed to the development of meningoencephalitis, with brain biopsy suggestive of hypertrophic pachymeningitis, a rare complication of this disease. The patient had recurrence of neurological symptoms upon repeated administration of adalimumab, and resolution of symptoms after withdrawal.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Meningite/induzido quimicamente , Adalimumab , Idoso , Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais Humanizados , Histocitoquímica , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningite/tratamento farmacológico , Prednisona/administração & dosagemRESUMO
HYPOTHESIS: Blockade of tumor necrosis factor-alpha with tumor necrosis factor-alpha antibody will reduce the extent of cochlear injury and hearing loss associated with Streptococcus pneumoniae meningitis. BACKGROUND: Inflammatory mediators play a significant role in the morbidity associated with bacterial meningitis, including hearing loss and labyrinthitis ossificans. Previous studies have shown the attenuation of hearing loss by the nonspecific blockade of such pathways. METHODS: Fifty Mongolian gerbils were divided into four groups. Auditory brainstem response testing was conducted to measure hearing thresholds. Streptococcus pneumoniae meningitis was induced in Groups 1 and 2. Group 2 was then given a single intraperitoneal injection of tumor necrosis factor-alpha antibody, whereas Group 1 received phosphate-buffered saline. Uninfected animals in Groups 3 and 4 were implanted with osmotic pumps that delivered a continuous 8-day intrathecal flow of either tumor necrosis factor-alpha (Group 4) or phosphate-buffered saline (Group 3). After 6 weeks, auditory brainstem response testing was repeated. The cochleas were harvested and analyzed histomorphometrically. RESULTS: Group 2 animals with Streptococcus pneumoniae meningitis that also received tumor necrosis factor-alpha antibody developed significantly less hearing loss than Group 1 animals with meningitis alone. The decrease in the average threshold at 4, 8, 16, and 32 kHz was 31, 30, 25, and 28 dB sound pressure level, respectively (p < 0.0092 for each). Furthermore, histomorphometric analysis showed significantly less damage to the organ of Corti, spiral ganglion, spiral ligament, and stria vascularis in Group 2. Conversely, tumor necrosis factor-alpha induced meningitis animals (Group 3) showed increased hearing loss compared with phosphate-buffered saline controls (Group 4), with p < 0.0001 at all frequencies. CONCLUSION: Tumor necrosis factor-alpha plays an important role in cochlear injury after bacterial meningitis. Blockade of tumor necrosis factor-alpha reduces postmeningitic hearing loss and cochlear injury. Induction of meningitis with intrathecal tumor necrosis factor-alpha also resulted in hearing loss and cochlear injury similar to bacterial meningitis.
Assuntos
Perda Auditiva Neurossensorial/etiologia , Meningite Pneumocócica/complicações , Fator de Necrose Tumoral alfa/metabolismo , Animais , Anticorpos/farmacologia , Audiometria , Limiar Auditivo , Cóclea/efeitos dos fármacos , Cóclea/patologia , Potenciais Evocados Auditivos do Tronco Encefálico , Gerbillinae , Perda Auditiva Neurossensorial/fisiopatologia , Bombas de Infusão , Meningite/induzido quimicamente , Meningite/complicações , Meningite Pneumocócica/mortalidade , Meningite Pneumocócica/patologia , Fator de Necrose Tumoral alfa/administração & dosagem , Fator de Necrose Tumoral alfa/imunologiaRESUMO
BACKGROUND: High-dose buprenorphine (HDB) treatment began in France in 1996 according to relatively unrestricted prescription rules. Continued heroin injection by patients on HDB maintenance treatment and even HDB injection remain underestimated and may lead to a variety of infectious diseases. OBJECTIVES: Description of infectious complications occurring in patients receiving HDB maintenance treatment. METHODS: Retrospective study of drug addicts receiving HDB maintenance treatment, injecting (or highly suspected of injecting) it, and hospitalized for infections (other than HIV or viral hepatitis) in the department of infectious and tropical diseases in Nancy University Hospital. Data collection covered 1998 through 2003. RESULTS: We identified 21 case reports, 9 concerning infectious endocarditis, 8 cutaneous abscesses, 2 osteoarticular infections, 1 meningitis and 1 Candida retinitis. The sex-ratio was of 1 woman for 2 men, and the patients' mean age was 29.8 years. Globally 13 patients had systemic infections. Nine patients admitted having injected HDB (and no other drugs) (including the case of Candida retinitis), while in the other 12 cases, the patients continued injecting heroin as well. The role of misused HDB was strongly suspected in those 12 infections, but was not clearly confirmed. All patients recovered from the infections. The long-term psychosocial outcome remains unknown. CONCLUSION: The cases analyzed illustrate the dual reality that HDB is often ineffective as a maintenance treatment, since some patients continue to inject heroin, and that its misuse can have infectious consequences. The results of HDB maintenance treatment substitution are mixed. The individual benefit/risk ratio must be improved. Networking is crucial, notably between physician and pharmacist, and the monitoring system must be reinforced.
Assuntos
Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Endocardite Bacteriana/induzido quimicamente , Dependência de Heroína/reabilitação , Abuso de Substâncias por Via Intravenosa/complicações , Abscesso/induzido quimicamente , Adulto , Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Meningite/induzido quimicamente , Osteomielite/induzido quimicamente , Retinite/induzido quimicamente , Estudos Retrospectivos , Dermatopatias/induzido quimicamenteAssuntos
Humanos , História do Século XIX , Anestesia por Condução , Anestesia por Condução/efeitos adversos , Anestesia por Condução/história , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesia por Condução/tendências , Anestesia por Condução , Anestesia Epidural/efeitos adversos , Cefaleia/induzido quimicamente , Dor Lombar/induzido quimicamente , Embolia Aérea/induzido quimicamente , Lesão Encefálica Crônica/induzido quimicamente , Meningite/induzido quimicamenteRESUMO
We present the case of a successful pediatric cochlear implantation that was carried out following bilateral perilingual deafness caused by meningitis during the treatment of a childhood malignant tumor. A rhabdomyosarcoma localized in the frontobasal area was removed from the child at the age of 2 years. He then received 11 months of postoperative cytostatic treatment. A purulent meningitis developed at the end of the chemotherapy, resulting in a major-grade, bilateral sensorineural hearing loss (practically a perilingual deafness). After 6 tumor-free years and a meticulous preoperative assessment, a Nucleus 24 M cochlear implant was successfully implanted in the child's left ear. Two years after the operation, the child shows excellent hearing results and moderate speech development.
Assuntos
Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Implante Coclear , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/cirurgia , Meningite/induzido quimicamente , Meningite/complicações , Rabdomiossarcoma/tratamento farmacológico , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Meningite/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Rabdomiossarcoma/fisiopatologia , Rabdomiossarcoma/cirurgiaRESUMO
SURGIFOAM (Absorbable Gelatin Sponge, USP), a new absorbable hemostatic sponge, GELFOAM (Absorbable Gelatin Sponge, USP) or Avitene (microfibrillar collagen hemostat) were evaluated in a three-month tissue reaction and absorption study in rabbits. Bilateral craniotomy was followed by subdural implantation of each hemostatic device. A sham control group was treated in a similar way except that no material was implanted. Implantation of these hemostatic devices for 15, 43, or 92 days did not result in any deaths or clinical neurobehavioral abnormalities, changes in cerebrospinal fluid, or significant macroscopic observations at necropsy. The tissue reaction to SURGIFOAM sponge was characterized by transient granulomatous inflammation that was slightly less intense than that observed for GELFOAM sponge which correlated to slightly longer absorption. In contrast, the tissue reaction to Avitene hemostat was characterized by moderate to marked granulomatous inflammation with an acute inflammatory component indicating a greater degree of tissue irritancy. Sequelae of this reaction were still observed at 92 days post-implantation. The tissue reaction in humans to SURGIFOAM sponge used as a hemostatic agent for neurologic surgical procedures is expected to be comparable to that observed with GELFOAM sponge, resulting in no significant adverse reactions for patients. This animal model was useful to assess the tissue reaction and absorption of biomaterials implanted in contact with the central nervous system, and it was able to differentiate between materials of biologic origin.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Encefalite/induzido quimicamente , Meningite/induzido quimicamente , Procedimentos Neurocirúrgicos/instrumentação , Espaço Subdural/cirurgia , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Encéfalo/fisiopatologia , Encefalite/patologia , Encefalite/fisiopatologia , Esponja de Gelatina Absorvível/efeitos adversos , Esponja de Gelatina Absorvível/metabolismo , Meninges/efeitos dos fármacos , Meninges/patologia , Meninges/fisiopatologia , Meningite/patologia , Meningite/fisiopatologia , Procedimentos Neurocirúrgicos/métodos , Projetos Piloto , Coelhos , Resultado do TratamentoRESUMO
Stimulation of endothelial cells by various inflammatory mediators leads to release of Weibel--Palade bodies and therefore to exocytosis of both P-selectin (adhesion receptor for leukocytes) and von Willebrand factor (vWf) (platelet ligand). The potential role of vWf in leukocyte recruitment was investigated with the use of vWf-deficient mice. We report a strong reduction of leukocyte rolling in venules of vWf-deficient mice. Similarly, vWf deficiency led to a decrease in neutrophil recruitment in a cytokine-induced meningitis model as well as in early skin wounds. In all instances with an antibody that preferentially recognizes plasma membrane P-selectin, we observed a dramatic reduction in P-selectin expression at the cell surface of vWf-deficient endothelium. With confocal microscopy, we found that the typical rodlike shape of the Weibel--Palade body is missing in vWf -/- endothelial cells and that part of the P-selectin content in the vWf -/- cells colocalized with LAMP-1, a lysosomal marker. However, intracellular P-selectin levels were similar in tumor necrosis factor alpha- and lipopolysaccharide-activated cells of both genotypes. We conclude that the absence of vWf, as found in severe von Willebrand disease, leads to a defect in Weibel--Palade body formation. This defect results in decreased P-selectin translocation to the cell surface and reduced leukocyte recruitment in early phases of inflammation.