Treatment principles for Candida and Cryptococcus.

The yeasts Candida and Cryptococcus spp. are important human opportunistic pathogens. Candida spp. rely on skin or mucosal breach to cause bloodstream infection, whereas Cryptococcus spp. exploit depressed cell-mediated immunity characteristic of advanced HIV infection. The treatment for both organisms relies on the administration of rapidly fungicidal agents. In candidaemia, source control is important, with removal of prosthetic material and drainage of collections, as well as hunting for and tailoring therapy to disseminated sites of infection, particularly the eyes and heart. For cryptococcal meningitis, restoration of immune function through antiretroviral therapy (ART) is key, together with careful management of the complications of raised intracranial pressure and relapsed infection, both pre- and post-ART.

Alternative causes of hypopituitarism: traumatic brain injury, cranial irradiation, and infections.

Hypopituitarism often remains unrecognized due to subtle clinical manifestations. Anterior pituitary hormone deficiencies may present as isolated or multiple and may be transient or permanent. Traumatic brain injury (TBI) is recognized as a risk factor for hypopituitarism, most frequently presenting with isolated growth hormone deficiency (GHD). Data analysis shows that about 15% of patients with TBI have some degree of hypopituitarism which if not recognized may be mistakenly ascribed to persistent neurologic injury and cognitive impairment. Identification of predictors for hypopituitarism after TBI is important, one of them being the severity of TBI. The mechanisms involve lesions in the hypothalamic-pituitary axis and inflammatory changes in the central nervous system (CNS). With time, hypopituitarism after TBI may progress or reverse. Cranial irradiation is another important risk factor for hypopituitarism. Deficiencies in anterior pituitary hormone secretion (partial or complete) occur following radiation damage to the hypothalamic-pituitary region, the severity and frequency of which correlate with the total radiation dose delivered to the region and the length of follow-up. These radiation-induced hormone deficiencies are irreversible and progressive. Despite numerous case reports, the incidence of hypothalamic-pituitary dysfunction following infectious diseases of the CNS has been underestimated. Hypopituitarism usually relates to the severity of the disease, type of causative agent (bacterial, TBC, fungal, or viral) and primary localization of the infection. Unrecognized hypopituitarism may be misdiagnosed as postencephalitic syndrome, while the presence of a sellar mass with suprasellar extension may be misdiagnosed as pituitary macroadenoma in a patient with pituitary abscess which is potentially a life-threatening disease.

[Teaching curriculum about the nervous system infections for general practitioners of family practice].

Poor health-care system of Ukraine was the impetus for radical reform of the industry through the introduction of family medicine as a primary care for population. This led to the necessity for rapid training of the specialists and the development of special training programs in medical universities. Teachers have a problem to form a work model of general practitioners in severe diagnostic cases, which is especially important in the case of septic lesions of the nervous system.

Neurologic complications of anthrax: a review of the literature.

A review of the literature suggests that the major neurologic symptom complex of infection by Bacillus anthracis is a fulminant and rapidly fatal hemorrhagic meningoencephalitis and that the reported initial mode of entry can be via the cutaneous or inhalation route. For febrile patients with acute neurologic deterioration with associated findings of dark necrotic pustules on the extremities, gram-positive rods in the cerebrospinal fluid, and multifocal areas of unexplained intracerebral hemorrhage on computed tomographic scans, anthrax should be considered within the differential diagnosis. A low cerebrospinal fluid glucose level has been reported, with gram-positive rods often noted on the gram stain of the cerebrospinal fluid in severely affected patients. Reports indicate that death usually occurs within a week.

Central nervous system infections in the rainforest zone of Nigeria.

OBJECTIVES: To ascertain incidence rates of central nervous system infections and provide information for health care planners. DESIGN: A two-stage screening through supervised case referrals and diagnostic evaluation at referral centre to establish a register of CNS infections. SETTING: A rural community in the rainforest zone of Nigeria with land area of 186500 m2, average daily temperature of 28 degrees C, annual rainfall of 2080 mm, adult population of 109851 and served by 26 primary, three secondary and twelve comprehensive care facilities. More than two per cent of the populations live in waterlogged areas. SUBJECTS: Adults aged sixteen years and above, constituting incident cases of CNS infections. MAIN OUTCOME MEASURES: Incident CNS infections per 100,000 populations averaged over a two year observational period. RESULTS: Incidence rates were 3.6, 4.1, 2.3, 09, 1.8, 0.9 for acute bacterial meningitis, aseptic meningitis, rabies encephalitis, non-rabies encephalitis, tuberculous meningitis and chronic non-tuberculous meningoencephalitis, respectively. Syphilitic neuroarthropathy had 0.46. CONCLUSIONS: Mortality from acute pyogenic meningitis and tuberculous meningitis remained distressingly high. Aseptic meningitis had the highest incidence rate, yet remained inadequately emphasised. Rabies encephalitis was the third commonest cause of CNS infection in the area.

Central nervous system infections. Basic concepts.

Central nervous system infections have the potential to be very dangerous and life-threatening. Advances in the understanding and care of patients experiencing these infections have aided in their detection and treatment. Caring for these patients requires a thorough knowledge of the diseases as well as a holistic approach which encompasses the patient and family.