Disseminated tuberculosis in an HIV-infected child: rifampicin resistance detected by GeneXpert in a lymph node aspirate but not in cerebrospinal fluid.

A 9-year-old HIV-infected child previously treated with inadequate doses of antitubercular drugs based on weight was admitted 5 months after initial tuberculosis (TB) diagnosis with acute hemiplegia and inguinal lymphadenopathies in a rural hospital in Tanzania. He was diagnosed with TB meningitis and lymphadenitis using Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. Rifampicin resistance was detected in the lymph node aspirate but not in the cerebrospinal fluid. His TB therapy was optimised based on available medications and antiretroviral treatment was initiated 6 weeks later. Despite these efforts, the clinical evolution was poor and the child died 12 weeks after admission.

A mucormycosis case presented with orbital apex syndrome and hemiplegia in a renal transplant patient.

Solid organ transplantation is a risk factor for mucormycosis. Mucormycosis is a necrotizing opportunistic fungal infection with high morbidity and mortality. We report a fatal mucormycosis case with rhino-orbital-cerebral involvement in a renal transplant patient, which presented with orbital apex syndrome and hemiplegia.

Participation in age-related activities and influence of cultural factors--comments from youth and parents of children with postnatal post infectious hemiplegia in Stockholm, Sweden.

PURPOSE: To investigate whether children with postnatal post-infectious hemiplegic cerebral palsy, and their parents, felt that participation in activities typical for the child's age and gender was affected. To identify factors, intra- and extra-personal that influenced disability with emphasis on factors related to immigration. METHOD: Interviews with six youths and 15 caregivers regarding the child's ability to participate in age-related activities, the consequences of disability in their home country compared to Sweden, and whether immigration influenced being a parent to a disabled child. RESULTS: All reported large difficulties participating in age-related activities. Positive and negative differences in participation in different cultures were described. War, culture, eating habits, hygiene habits, and school could differ and create difficulties when in Sweden. Language skills and intra personal factors influenced information gathering and participation in parental activities. CONCLUSIONS: Surprisingly large difficulties in participation may separate those with a postnatal post-infectious aetiology from hemiplegia of other aetiologies. High degrees of additional impairments may influence participation more than the physical disability. Language skills and cultural factors influence ability to seek and gain information. A mutual process where both Swedes and immigrants know traditions of care for disabled in both places may create understanding and improved dialogue.

Use of therapeutic plasma exchange in the management of acute hemorrhagic leukoencephalitis: a case report and review of the literature.

BACKGROUND: Acute hemorrhagic leukoencephalitis (AHLE) is a rare, fatal, central nervous demyelinating disease characterized by a rapid fulminant clinical course. Successful management requires early diagnosis, aggressive management of cerebral edema, and immunosuppression. Therapeutic plasma exchange (TPE) is infrequently used and commences after initial management fails. CASE REPORT: A 31-year-old man presented with right arm weakness, whose symptoms rapidly progressed to hemiplegia and aphasia. The patient was initially managed with glucocorticosteroids. Decompressive craniotomy and brain biopsies were performed when his intracranial pressure increased. Brain biopsy findings were consistent with AHLE. Mycoplasma pneumonia immunoglobulin G and immunoglobulin M serologies revealed recent infection. Despite surgical and medical management, he decompensated on Day 11, and TPE was initiated. The patient received a total of 10 TPE treatments. On the fourth day of TPE treatment, he was extubated. Twenty-one days after TPE began, he was ambulating with near normal muscle strength and was discharged. Four months after initial presentation, the patient has normal strength and is working full-time. CONCLUSIONS: AHLE has a fulminant course requiring accurate and rapid diagnosis. Successful therapy requires aggressive management of intracranial pressure and immunosuppression. Two other reports of AHLE document successful management with TPE. Each of these patients survived with minimal neurologic impairments. Given the likely immune-mediated nature of this disease, combined treatment of steroids, surgery, and TPE may lead to shorter hospital stays and improved neurologic outcomes. Clinical studies are needed to further study the effect of TPE on neurologic outcome in AHLE.

Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water.

OBJECTIVE: To evaluate bacterial flora in hemiplegic hands as a possible pathogen of endogenous infection in a rehabilitation unit and to examine the effect of cleansing hands with acidic mineral water on the flora. DESIGN: Case-control study in a university affiliated hospital. Seventy-two patients with hemiplegia caused by cerebrovascular diseases were included in this study. Bacterial flora by the swab method, bacterial frequency on the palm by the stamp method, and skin surface pH were examined before and after single cleansing by immersion in plain or acidic mineral water. RESULTS: The bacterial frequencies of patients with hemiplegia and diabetes were higher than those of normal healthy subjects. After cleansing with acidic mineral water, skin surface pH was decreased and bacterial frequency was markedly decreased. A prolonged decrease in skin surface pH was observed in patients with hemiplegia in contrast to normal healthy subjects who presented a short-term decrease. CONCLUSION: Increased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

Rhinocerebral mucormycosis: case report.

Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.

Delayed contralateral hemiplegia following herpes zoster ophthalmicus: should antiviral therapy be used?

We review clinical virological studies in the syndrome of delayed contralateral hemiplegia following herpes zoster ophthalmicus. Virus could not be isolated from the cerebrospinal fluid (CSF) of the present case, nor was antiviral antibody found in the CSF. There appear to have been no reports of successful virus isolation from the CSF although there are reports of antibody in the spinal fluid. Thus the evidence for ongoing viral replication in the central nervous system is marginal. It is suggested that the sensitive antibody assay against membrane antigens (FAMA) be used in the future as a guide to antiviral therapy.

The skin flora of the hemiplegic hand.

More organisms were found on the paralysed hands of hemiplegic patients than on their unaffected ones. However, both showed considerably higher bacterial counts than did geriatric patients without paralysis. An infection rate for Cl. welchi of 15% was found in the paralysed hands.

Acute hemiphegia of childhood associated with Coxsackie A9 viral infection.

A 16-mo-old girl is described with acute hemiplegia associated with virologic and serologic evidence of Coxsackie A9 infection. Possibilities of pathogenesis are discussed. It is suggested that the present hemiplegia may have been the result of a focal vasculitis due to Coxsachie A9 viral infection in the region of the middle cerebral artery.