Bacterial meningitis in adults - principles of diagnosis and antibiotic treatment.

The emergence of antibiotic-resistant bacterial strains in recent years has necessitated the development of new strategies for empiric antimicrobial therapy for bacterial meningitis. Bacterial meningitis is associated with significant morbidity and mortality despite the availability of effective antimicrobial therapy. The management approach to patients with suspected or proven bacterial meningitis includes initiation of appropriate antimicrobial and adjunctive therapies and decides on the patients survival.

Serum carnitine and acyl-carnitine in patients with meningitis due to tick-borne encephalitis virus infection.

BACKGROUND: Hard ticks are the main vectors of tick-borne encephalitis virus (TBEV). Free carnitine (FC) and acylcarnitines (AC) have the basic role in ß-oxidation as well as the modulation of immune and nervous system. Homeostasis of carnitines in the TBE patients was not studied so far. OBJECTIVES: This study aimed to evaluate FC and AC serum concentrations in patients with meningitis due to TBEV infection before and after 14 ± 3 days of treatment. MATERIAL AND METHODS: The study was performed in 14 patients aged 48 ± 29 years that were divided a posteriori (based on their FC level before and after treatment) into 2 subgroups: 1-8 and 9-14. Diagnosis was based on the neurological, serological and pleocytosis evaluation. RESULTS: The FC level in patients 1-8 before treatment (24.1 ± 8.1) was significantly lower than in patients post-treatment (34.4 ± 8.3), lower than in the control group (40.5 ± 7.6), and lower than in patients 9-14 before treatment (40.0 ± 13.5) but not lower than in the patients 9-14 after treatment (24.7 ± 7.3 µmol/L), respectively, p < 0.05. AC concentration in the patients 1-8 before treatment (4.7 ± 2.2) was apparently lower than in patients post-treatment (9.5 ± 3.9 µmol/L) but the values were not significantly different. In patients 9-14 before treatment the AC concentration (16.3 ± 12.6) was higher than in patients after treatment (5.3 ± 4.0 µmol/L), but the difference was not statistically significant. CONCLUSIONS: FC and AC homeostasis in circulation was disturbed in the patients with meningitis due to TBEV infection patients. The mean levels of FC and AC in 60% of the patients were below the normal range but normalized after treatment whereas in 40% of the patients they were near or at a normal range and significantly decreased after treatment. Explanation of this intriguing finding and its clinical significance is not easy without further studies.

Serum carnitine concentration is decreased in patients with Lyme borreliosis.

BACKGROUND: Lyme borreliosis (LB) is a serious infectious disease. Carnitine plays a crucial role in metabolism and inflammatory responses. Carnitine may be important in improving neuronal dysfunction and loss of neurons. AIM: To evaluate serum carnitine concentration in adult patients with various clinical types of LB. MATERIAL/METHODS: Groups: 1) patients with erythema migrans (EM, n=16), 2) neuroborreliosis (NB, n=10), 3) post-Lyme disease (PLD, n=22) and healthy controls (HC, n=32). Total (TC) and free (FC) carnitine were determined with the spectrophotometric method. RESULTS: TC levels (44.9±10.4, 28.0±8.4, 35.9±15.6 µmol/L) in the EM, NB and PLD patients were lower than in HC (54.0±11.4 µmol/L), p < 0.001. FC levels (32.7±7.7, 23.6±6.8, 26.3±11.2 µmol/L) in the EM, NB and PLD patients were lower than in HC (40.5±7.6 µmol/L), p < 0.001. AC levels (12.2±5.2, 4.4±2.6, 9.6±7.4 µmol/L) in the EM, NB and PLD patients were lower in the NB and PLD patients than in HC (13.5±8.40 µmol/L), p <0.001. AC/FC ratio was 0.31±0.14, 0.18±0.09, 0.39±0.33 in the EM, NB and PLD patients. CONCLUSIONS: LB patients exhibit a significant decrease of their serum carnitine concentrations. The largest changes were in the NB and PLD patients. To prevent late complications of the disease a possibility of early supplementation with carnitine should be considered. Further studies are required to explain the pathophysiological significance of our findings.

Clinical and molecular features of one case of human infection with Anaplasma phagocytophilum from Podlaskie Province in eastern Poland.

The article focuses on the clinical and laboratory diagnosis of human granulocytic anaplasmosis (HGA) caused by Anaplasma phagocytophilum infection in one of 28 patients (3.6%; n=1/28 tested samples) with early Lyme borreliosis. The clinical and laboratory results of a 42-year-old patient fulfilled criteria of confirm anaplasmosis and suggest an acute stage of illness. The described case provides strong presumptive evidence that infection in this patient was acquired with a pathogenic strain of A. phagocytophilum through a tick bite. A positive DNA with PCR for A. phagocytophilum infection was sequenced and analyzed phylogenetically. Physicians should consider the possibility of anaplasmosis in patients with early Lyme borreliosis, and A. phagocytophilum should be considered as a differential diagnosis in all patients from an endemic region of potential high risk factors for tick-borne diseases.

First report of two asymptomatic cases of human infection with Babesia microti (Franca, 1910) in Poland.

Human infection by Babesia microti has been recognized as an emerging zoonosis with important public health implications worldwide. In Europe the reported cases of human babesiosis have been attributed mostly to B. divergens infection, with only sporadic cases of the disease caused by B. microti or B. venatorum. This study, based on molecular methods (PCR, R-T PCR, DNA sequencing and phylogenetic analysis), reveals for the first time in Poland, asymptomatic infection with . microti in immunocompetent healthy individuals working in forest ecosystems. Of the 58 professional foresters examined, two (3.4%) were identified as B. microti-positive by specific PCR. The results of this study also provide strong evidence that in eastern Poland, where tick-borne diseases (TBDs) are endemic, there is a potential risk of acquiring human babesiosis due to zoonotic B. microti parasites commonly found in rodents and I. ricinus ticks. The potential public health importance of this finding is discussed.

Detection of West Nile Virus RNA in patients with meningitis in Podlaskie Province.

AIM: The aim of the study was the detection of WNV RNA in cerebrospinal fluid of patients with lymphocytic meningitis. MATERIAL AND METHODS: Samples of cerebrospinal fluid from 24 patients hospitalized in the Department of Infectious Diseases and Neuroinfections between May and September because of meningitis were evaluated concerning presence of WNV RNA. RESULTS: In none of the samples WNV RNA was detected.

Asymptomatic "Candidatus Neoehrlichia mikurensis" infections in immunocompetent humans.

In Europe, human infections with "Candidatus Neoehrlichia mikurensis" have mainly been restricted to immunocompromised patients. We report here the first cases of asymptomatic "Ca. Neoehrlichia mikurensis" infection in immunocompetent humans (5/316 [1.6%] were infected). Due to the potential threats of infections with "Ca. Neoehrlichia mikurensis" in healthy persons to the safety of the blood supply, further study of this phenomenon is required.

[Diagnostics of selected viral infections of central nervous system]. / Diagnostyka wybranych wirusowych zakazen osrodkowego ukladu nerwowego.

Viral infections of CNS are difficult to diagnose, especially in an early phase. In diagnosis, beside the examination of the cerebrospinal fluid, many other diagnostic tools are used, such a serological tests (in cases with TBE suspicion), PCR (in cases with CMV, VZV, HSV, WNV, enteroviruses infection), CNS imaging and EEG (in cases with HSE, VZV infection). Properly chosen diagnostic tools may result in fast diagnosis and proper treatment.

[Peripheral neuropathies in Lyme borreliosis]. / Neuropatie obwodowe w przebiegu boreliozy z lyme.

UNLABELLED: Lyme borreliosis is a multisystem disease and when involves the nervous system it is termed neuroborreliosis. The symptomatology of peripheral neuroborreliosis is rich and varied. The early symptoms are asymmetric polyradiculopathies and paralysis of the cranial nerves (most commonly facial nerve). Thereafter, there are multifocal mononeuropathies and sensory-motorpolyneuropathies. Difficulties in making a correct diagnosis can result from the long time lag between tick bite and the occurrence of neurological symptoms. In the treatment the most important role play antibiotics. CASE REPORTS: We report the cases of three patients with symptoms of damage to various structures of the peripheral nervous system in the course of Borrelia burgdorferi infection. In all cases, clinical improvement was obtained after treatment with antibiotics, which further confirms the diagnosis of neuroborreliosis. CONCLUSIONS: About neuroborreliosis as a cause of peripheral neuropathy we should always think in the case of vague symptoms of peripheral nervous system lesions in patients with potential exposure to tick bites. Peripheral neuropathies may occur a long interval from the tick bite and are not always preceded by other forms of the disease.

[Viral encephalitis in puerperium period--case report]. / Wirusowe zapalenie mózgu u chorej w okresie pologuopis przypadku.

Herpetic encephalitis (HSE) is one of the most severe infections of Central Nervous System (CNS). If not treated, it results in patient's death in 70% cases, although in properly treated cases the mortality rate is 30%. The most endangered group are patients with immunosuppression, including pregnant women and women in the peripartum period. We present a case of a young woman in puerperium period, who developed herpetic encephalitis. Despite proper treatment patient required long term hospitalization in ICU, where she was placed in pharmacological coma. Despite severe course of the disease no neurological sequelae were observed. The aim of this paper was to emphasize the necessity of immediate antiviral therapy with Acyclovir in all cases suspected of HSE. Additionaly HSE may progress rapidly and ICU treatment should be considered.

[Glandular form of tularemia after arthropod bite--cases report]. / Postac wezlowa tularemii po pokluciu przez stawonogi--opis przypadków.

Tularemia is a rare zoonosis. There are a few ways of transmission of F. tularensis known: from the most common: contaminated meat, water, inhalation to rarely considered as insect or tick bite. insect bites are known. The disease may present non specific clinical picture, its course may be acute or chronic. Because of polymorphism of clinical picture specific treatment is often delayed. In our paper we present cases of patients, who were diagnosed with tularemia due to horse-fly or tick bite.

[Influenza A H1N1 v as a clinical and epidemiological problem]. / Grypa A H1N1 v jako problem kliniczny i epidemiologiczny.

In this paper actual information about influenza A H1N1 v were described. Biology of virus, as well as epidemiology, clinical picture, diagnostic methods and prophylactic recommendation of influenza were presented. The pathogenicity and disease spread should be under surveillance of public health and medical services. Vaccination seems to be the best method in influenza epidemiology prevention.

[Presence of antibodies against gangliosides among patients with Lyme borreliosis--preliminary study]. / Wystepowanie przeciwcial przeciw gangliozydom w surowicy chorych na borelioze z Lyme--badania wstepne.

UNLABELLED: THE AIM of the study was the evaluation of autoantibody reaction against endogenous gangliosides in the course of Lyme borreliosis. MATERIAL AND METHODS: Antibodies against profile of gangliosides composed of GM1, GM2, GM3, GD1a,GD1b,GT1b, GQ1b were evaluated in serum patients with early disseminated (neuroborreliosis) Lyme disease (n = 16), patients with long lasting serologic response against Borrelia burgdorferi (n = 32) and in healthy subjects (n = 16). Immunoblot test for IgG was used. RESULTS: Antibodies were detected in all evaluated groups. In group of neuroborreliosis (lymphocytic meningitis with cranial nerve invoIvement) there was no essential difference with control group. It was stated in group of forestry workers with serological features of infection B. burgdorferi lasting for years. CONCLUSIONS: Results of the study do not support the thesis of participation of IgG autoantibodies against gangliosides in pathogenesis early disseminated Lyme borreliosis in form of lymphocytic meningitis with cranial nerves paresis. Antibodies against endogenous glicosfingolipides in Lyme borreliosis probably can lead to affecting nervous system (demielinisation and polineuropathy) but probably require long-term immunization, what is suggested by results of examined group of patients with the multi-annual serological features of infection.

[General paresis in course of previously undiagnosed central nervous system syphilis--case report]. / Porazenie postepujace w przebiegu poczatkowo nierozpoznanej kily osrodkowego ukladu nerwowego--opis przypadku.

Syphilis is relatively rare in Poland at present, but it still must be taken into consideration in differential diagnosis of central nervous system (CNS) disorders. Late symptomatic (tertiary) manifestations of the disease may be difficult to recognize due to their rarity and tendency to manifest after many years of asymptomatic infection, which makes the connection with epidemiologic risk factors and symptoms of the primary infection hardly traceable. We describe a case of patient with a classic presentation of a parenchymal CNS syphilis presenting as general paresis, which was diagnosed with a delay and only after extended serological diagnostics had been prompted by false positive results of screening serologic test for Lyme disease.

[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]. / Obraz neuroradiologiczny imitujacy torbiele pasozytnicze osrodkowego ukladu nerwowego w przebiegu chorób nowotworowych--opisy przypadków.

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

[Blood-brain barrier--function of Mato cells]. / Bariera krew-plyn mózgowo-rdzeniowy--szczególna rola komórek Mato.

Brain because of its functions, is isolated from either external or internal environment. This function is performed by skull, cerebral meninges, cerebrospinal fluid and unique system of mechanisms and barriers restricting exchange of oxygen, soluble substances between blood, nervous tissue and cerebrospinal fluid. Mato cells, located in Virchow-Robin's space play a key role in blood-brain barrier. Mato cells are rich in hydrolytic enzymes. They act as phagocytes in blood-brain barrier by scavenger receptors, which take part in eliminating excess of unfavorable substances from environment. Ageing, hypercholesterolemia and vitamin E deficiency can cause degeneration of perivascular cells and limit their protective function. Mato cells probably are responsible for pathogenesis of various diseases, f.e. Alzheimer disease, diabetic rethinopathy, encephalitis.

[STARI--a new tick borne spirochetosis]. / STARI--nowa kretkowica odkleszczowa.

Southern Tick Associated Rash Illness (STARI), also known as Masters disease is caused by Borrelia lonestari spirochetes and it is transmitted by Amblyomma americanum tick. Early symptoms of STARI are similar to early Lyme borreliosis (skin rash resembling Erythema migrans). In diagnostic of STARI traditional methods are not effective. The decision of antibiotic treatment (similar to Lyme borreliosis) still remain based on clinical picture.