An outbreak of Mycoplasma mycoides subspecies capri arthritis in young goats: a case study.

Mycoplasmosis is a well-known cause of morbidity and mortality in small ruminants. Previously recognized outbreaks have involved arthritis, and pneumonia or pleuropneumonia. Modern bacteriology procedures rely less on isolation techniques that require special media for mollicutes given that these species are notoriously difficult to isolate, and rely more on PCR tests. We report an outbreak of arthritis, pleuropneumonia, and mild meningitis affecting dairy goat kids, spanning a period of 3 y, which had unusual epidemiologic characteristics related to husbandry practices. Lesions were characterized by polyarthritis of the appendicular joints, with copious joint fluid and extension of arthritic exudate beyond the joint itself. The cause remained unknown until serendipitous isolation of a mycoplasma on blood agar. Mycoplasmosis was not detected from synovial samples by a general mycoplasma PCR, despite multiple attempts. Isolated colonies were also negative by this general PCR assay. The isolate was identified as Mycoplasma mycoides subspecies capri, using universal 16S primers and amplicon sequencing. Testing of additional isolates from other diseased goats in the herd confirmed that this was the cause of illness. A failure to recognize the distinct nature of organisms of the M. mycoides group of mycoplasmas meant that a PCR test that cannot detect this group of organisms was utilized at first, and the etiology of the illness was overlooked for a period of time. Veterinary pathologists and microbiologists must be aware of the limitations of some PCR assays when confronted with joint disease and pleuropneumonia in small ruminants.

Coccidioidal Meningitis: A Review on Diagnosis, Treatment, and Management of Complications.

PURPOSE OF REVIEW: This article summarizes the diagnosis and treatment of coccidioidal meningitis (CM) and its complications. An overview of current and prospective pharmacologic treatment options and monitoring parameters is provided. A consensus has not been reached regarding universally accepted therapeutic serum levels for azoles because of insufficient evidence. We describe the preferred therapeutic drug level ranges that our institution uses to monitor azole therapy. RECENT FINDINGS: Ho et al. described the preparation and administration of intrathecally delivered amphotericin B deoxycholate. Thompson et al. described possible benefits of controversial adjuvant corticosteroid therapy for secondary prevention of vasculitic infarction secondary to CM. CM was universally fatal until the advent of intrathecal amphotericin B deoxycholate therapy, the introduction of which changed the natural history of the disease in much the same way as penicillin changed the natural history of bacterial meningitis. Although there was still significant morbidity, survival rates drastically increased to approximately 70%. The introduction of azole therapy has decreased the side effects and burden of treatment but without a significant change in CM-related mortality and morbidity compared with the use of intrathecal amphotericin B deoxycholate therapy.

Neuropatía óptica en un caso de paquimeningitis hipertrófica idiopática recurrente sin respuesta a esteroides e inmunosupresores / Optic neuropathy in a case of recurrent idiopathic hypertrophic pachymeningitis unresponsive to steroids and immunosuppressants

CASO CLÍNICO: Mujer de 38 años con pérdida visual en ojo izquierdo y papiledema bilateral. La resonancia magnética nuclear (RMN) mostraba engrosamiento de la duramadre y la presión intracraneal estaba elevada. Se descartó enfermedad infecciosa, tumoral y autoinmune. DISCUSIÓN: La respuesta inicial a corticoides fue satisfactoria con desaparición del edema de disco óptico, mejoría de la agudeza visual y mejoría radiológica. Después de un año sin tratamiento presentó un nuevo brote, desarrollando una neuropatía óptica izquierda con pérdida irreversible de visión a pesar del retratamiento con corticoides y azatioprina

CASE REPORT: A 38-year-old female patient with bilateral papilledema who presented with loss of vision in her left eye. The Magnetic Resonance Imagining (MRI) showed thickening of the dura mater, and the intracranial pressure was elevated. A cancer, infectious, and autoimmune origin was ruled out. DISCUSSION: The initial response to high doses of corticoids was satisfactory, with disappearance of the optic disc enema, with visual acuity and an improvement in the MRI. However, after one year without treatment she had a new outbreak of the disease. Despite renewed treatment with corticoids and azathioprine, the patient developed a left optic neuropathy and irreversible visual loss

Pediatric lumbar puncture and cerebrospinal fluid analysis.

BACKGROUND: Lumbar puncture (LP) is a commonly performed procedure in pediatrics. Accurate analysis of cerebrospinal fluid (CSF) profile is essential in diagnosing and managing a variety of infectious and inflammatory conditions involving the brain, meninges, and spinal cord. It can also provide useful diagnostic information in the evaluation of possible subarachnoid hemorrhage and demyelinating syndromes, and aid in the diagnosis and management of pseudotumor cerebri. OBJECTIVES: To review anatomic, physiologic, and pathologic aspects of performing pediatric lumbar puncture and CSF analysis. DISCUSSION: Although still a commonly performed procedure in the outpatient setting, effective vaccines to prevent invasive infection due to Streptococcus pneumoniae and Haemophilus influenzae type b have greatly reduced pediatric bacterial meningitis rates due to these pathogens, resulting in decreased opportunity for physician-trainees to perfect this important skill (among nonneonates) during the 3 years of supervised residency training. Success in performing pediatric LP is augmented by a thorough understanding of medical aspects related to this procedure. This article discusses technical aspects involved in successfully performing a lumbar puncture to obtain CSF, and interpreting a CSF profile in children. CONCLUSION: A thorough understanding of anatomic, physiologic, and pathologic considerations regarding performing lumbar puncture and CSF analysis can augment success in diagnosing a variety of potentially serious pediatric conditions.

Herbal medicine-induced meningitis-retention syndrome.

A 73-year-old woman developed subacute meningitis-retention syndrome (MRS), dermatitis, and latent pneumonitis likely due to the herbal medicines Shinbu-Tou and Rikkunshi-Tou. The responsible site of lesions for urinary retention seemed to be the spinal micturition pathways and, to a lesser extent, the sacral spinal cord. All of her clinical manifestations were successfully ameliorated within three weeks of discontinuation of the herbal remedies.

Management of severe community-acquired septic meningitis in adults: from emergency department to intensive care unit.

BACKGROUND/PURPOSE: To study the clinical features, diagnostic processes, timing of antibiotic administration and outcomes of patients with severe community-acquired septic meningitis at an emergency department (ED), who required intensive care unit (ICU) admission. METHODS: From January 1993 to December 2005, the medical records of patients admitted to the ICU with a diagnosis of community-acquired septic meningitis were reviewed. The clinical characteristics, including causative pathogens, treatment course, and outcomes were collected and analyzed. RESULTS: A total of 40 patients were included, with an overall in-hospital mortality rate of 77.5%. The most common pathogen was Klebsiella pneumoniae (n=20, 50%), followed by Streptococcus pneumoniae (n=6, 15%), and Cryptococcus neoformans (n=5, 12.5%). There was a mean duration of 8.9 hours between ED arrival and initiation of antibiotic therapy. Effective antibiotics were administered for a mean period of 23.8 hours after arrival. Time delay from ED arrival to ICU admission was correlated with time delay of effective antibiotics administration, head computed tomography, and cerebrospinal fluid study (r=0.32, 0.47, and 0.53, respectively; p=0.05, 0.006, and 0.001, respectively). Earlier ICU admission was demonstrated in survivors as compared with those who died (11.1 vs. 38.0 hours, p=0.01). CONCLUSION: Severe septic meningitis remains a disease with high mortality and morbidity. Expeditious diagnostic processes with early appropriate antibiotic treatment and ICU admission at the ED are important in improving the quality of care and patient outcome.

Meningitis neonatal tardía por germen atípico / Atypical germ-induced delayed neonatal meningitis

No disponible

Meningitis por Streptococcus agalactiae en el anciano / Streptococcus agalactiae meningitis in the elderly

La meningitis bacteriana continúa siendo una enfermedad con una alta mortalidad en ancianos, a pesar de la moderna antibioterapia. En los últimos años, la meningitis bacteriana ha cambiado y es frecuente en adultos, especialmente en ancianos. El déficit de la función inmunológica relacionada con el envejecimiento y la mayor propensión a padecer enfermedades agudas o crónicas comórbidas pueden predisponer a la infección por estreptococos del grupo B en el anciano. Las manifestaciones clínicas pueden ser atípicas en la población geriátrica. La fiebre, la cefalea y la rigidez de nuca pueden estar ausentes. Presentamos un caso de meningitis por Streptococcus agalactiae en una mujer anciana sin factores comórbidos. Debemos tener presente esta enfermedad como posible diagnóstico ante un paciente anciano con confusión o bajo nivel de conciencia. (AU)

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.

Celulitis orbitaria en la edad pediátrica. Revisión / Orbital cellulitis in childhood. Review

La celulitis orbitaria comprende dos patologías bien diferenciadas desde un punto de vista anatomoclínico: la forma preseptal y la postseptal. Constituye una enfermedad infecciosa relativamente frecuente en la edad pediátrica que, normalmente, es secundaria a sinusitis. Presentamos una revisión de esta patología haciendo especial hincapié en el cambio etiológico acontecido en la última década tras la vacunación sistemática contra Haemophilus influenzae tipo B. (AU)

First report of Cryptococcus laurentii meningitis and a fatal case of Cryptococcus albidus cryptococcaemia in AIDS patients.

We report the first case of Cryptococcus laurentii meningitis and a rare case of Cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin B and flucytosine. The C. laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C. albidus cryptococcaemia, despite the amphotericin B/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C. laurentii, as determined by Etest on RPMI 1640 agar, were 0.25 microg ml(-1) of amphotericin B, 1.25 microg ml(-1) flucytosine, 4 microg ml(-1) fluconazole, 0.50 microg ml(-1) itraconazole and 1.0 microg ml(-1) of ketoconazole. The MIC of amphotericin B for C. albidus was 0.5 microg ml(-1), flucytosine 1.25 microg ml(-1), fluzonazole 4 microg ml(-1), itraconazole 0.5 microg ml(-1) and ketonazole 0.25 microg ml(-1). The agreement of the amphotericin B MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C. laurentii may cause meningitis and may also involve the lungs in AIDS patients.

Rational use of antibiotics in neonatal infections.

Review of the management of neonatal infections is done with the aim of guiding the clinician on appropriate therapy. Minimum investigations should include a white blood cell count including the L:T ratio and a blood culture. The bulk of infections at Kenyatta National Hospital newborn unit are caused by Klebsiela, Citrobacter and Staphylococcus aureus. During the 1990's considerable resistance to gentamicin has developed. Currently, cephalosporins chloramphenicol have the best sensitivity pattern. The diagnosis must be carefully verified at different stages of treatment to ensure that only those requiring antimicrobial therapy get it. Indiscriminate use is thus avoided. This in turn minimises development of antibiotic resistant organisms. Failure of response to antimicrobials sometimes means a non infectious cause of illness or poor supportive management. Continuous surveillance is recommended with emphasis on primary prevention of infection as well as cross infections.

MRI in neurosarcoidosis.

Nine patients with neurological manifestations of sarcoidosis were explored by MRI and, in some cases, CT. The MRI examinations were performed in T1- and T2-weighted spin-echo sequences in all patients, with gadolinium injection in seven. Several non-specific lesions were demonstrated, the most frequent of them showing on T2-weighted sequences as high-intensity signals in the periventricular white matter and the semi-oval centres. Other abnormalities, such as infiltrations of the hypothalamo-pituitary region, granulomatous masses within the brain tissue and meningeal infiltrations, were observed. These findings were in agreement with those found in the literature. Gadolinium injection seems to be important in this pathology, as it demonstrates lesions that are not visible on conventional T1- and T2-weighted spin-echo sequences.

Acute syphilitic meningitis. Its occurrence after clinical and serologic cure of secondary syphilis with penicillin G.

Acute syphilitic meningitis developed in a 36-year-old man three months after apparently successful treatment of secondary syphilis with doses of penicillin G benzathine recommended by the current Centers for Disease Control guidelines. He was then treated with high-dose intravenous penicillin G sodium, with resolution of symptoms and cerebrospinal fluid abnormalities. Although other instances of neurosyphilis following adequate therapy for early syphilis have been reported, in most cases reinfection cannot be convincingly excluded. We believe this patient represents a particularly well-documented example of progression to neurosyphilis, despite recommended therapy with penicillin. A review of recently reported cases suggests that progression of syphilis, despite "appropriate" therapy, is not an isolated event.

Cryptococcal meningitis.

Cryptococcosis is a systemic fungal disease and meningitis is the most serious complication. The purpose of this study is to define problems related to its diagnosis and treatment. This is a retrospective analysis of 25 patients admitted from January 1978 to December 1981. All patients had cryptococcal neoformans meningitis proven by culture of cerebrospinal fluid. One patient had a predisposing illness, being on immunosuppressant therapy after a renal transplant 2 years ago. A progressively severe headache of recent onset was the most striking presentation. Fever was frequently absent as a symptom. Cranial nerve palsies were commonly seen. Impairment of consciousness and areflexia signified a poor prognosis as all four patients who died early in the course of treatment were comatose and two of them were areflexic on admission. In newly suspected cases at least 3 separate lumbar punctures are recommended as initial smears or cultures may be negative. Cerebral CT scans were abnormal in 12 patients and those with cerebral oedema or hydrocephalus had a poorer prognosis. Combined amphotericin B and 5-fluorocytosine therapy was the treatment of choice. If there is no relapse 3 years after completion of treatment, patients are considered as cured. Positive smears may remain for years after completion of treatment and retreatment is only indicated if the cultures are positive. Twenty patients are alive today and none of them have relapsed. One patient had vasculitis of both anterior cerebral arteries as a result of cryptococcal meningitis.

[Current aspects of pseudomonas meningitis]. / Aktuelle Aspekte der Pseudomonasmeningitis.

The article reports on the incidence, the conditions of occurrence, possibilities and successes of treatment with certain (combinations of) antibiotics, in dealing with cases of pseudomonas meningitis. The various possible substances used for treatment are discussed. Rates of penetration and CSF concentrations of azlocillin and cefsulodin are stated. Alternative possibilities for treatment are pointed out.