Assuntos
Abscesso , Abscesso Encefálico , Dermatomicoses , Transplante de Rim , Micoses , Complicações Pós-Operatórias , Scedosporium , Abscesso/diagnóstico , Abscesso/microbiologia , Idoso , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Dermatomicoses/diagnóstico , Dermatomicoses/microbiologia , Feminino , Humanos , Micoses/diagnóstico , Micoses/microbiologia , Paresia/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologiaRESUMO
We report an extremely rare case of Porphyromonas gingivalis causing brain abscess in a patient with recurrent periodontitis. The patient presented with right-sided homonymous hemianopsia and right hemiparesis. Emergent surgical drainage was performed and antibiotics were administered. P. gingivalis was identified from the anaerobic culture of the abscess. The clinical course of the patient improved with full recovery of the neurologic deficit.
Assuntos
Abscesso Encefálico/microbiologia , Hemianopsia/microbiologia , Paresia/microbiologia , Periodontite/microbiologia , Porphyromonas gingivalis/patogenicidade , Antibacterianos/uso terapêutico , Abscesso Encefálico/complicações , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Genótipo , Hemianopsia/complicações , Hemianopsia/tratamento farmacológico , Hemianopsia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/complicações , Paresia/tratamento farmacológico , Paresia/cirurgia , Periodontite/complicações , Periodontite/tratamento farmacológico , Periodontite/cirurgia , Porphyromonas gingivalis/crescimento & desenvolvimento , Porphyromonas gingivalis/isolamento & purificação , Recidiva , Sucção , Resultado do TratamentoAssuntos
Grupo Borrelia Burgdorferi/isolamento & purificação , Neuroborreliose de Lyme/diagnóstico , Rituximab/uso terapêutico , Antineoplásicos/uso terapêutico , Grupo Borrelia Burgdorferi/imunologia , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Neuroborreliose de Lyme/sangue , Neuroborreliose de Lyme/complicações , Linfoma Folicular/tratamento farmacológico , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/microbiologia , Rituximab/administração & dosagem , Vincristina/administração & dosagemRESUMO
A 7-year-old girl with an unremarkable medical history presented to a local paediatric emergency department with a 7-day history of fever, sore throat and vomiting, and a 1-day history of rash. She was admitted to the hospital, with presumed Kawasaki disease. A few hours after admission, the patient had sudden onset of two witnessed tonic-clonic seizures and subsequent decreased mental status. She was transferred to the paediatric intensive care unit and started on broad-spectrum antibiotics. On hospital day 2, cerebral spinal fluid cultures and blood cultures grew Streptococcus pyogenes, and repeat physical examination was consistent with acute streptococcal pharyngitis. On hospital day 3, the patient developed left-sided hemiparesis and had another witnessed seizure. A CT scan was obtained and revealed a subdural abscess. She was transferred to a tertiary care centre and underwent craniotomy with evacuation of her subdural abscess. Surgical cultures eventually grew S. pyogenes.
Assuntos
Empiema Subdural/microbiologia , Faringite/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Criança , Feminino , Humanos , Paresia/microbiologia , Faringite/microbiologia , Convulsões/microbiologia , Infecções Estreptocócicas/microbiologiaAssuntos
Botulismo/diagnóstico , Paresia/microbiologia , Antitoxina Botulínica/uso terapêutico , Toxinas Botulínicas/antagonistas & inibidores , Toxinas Botulínicas/fisiologia , Botulismo/complicações , Botulismo/tratamento farmacológico , Botulismo/fisiopatologia , Clostridium botulinum/isolamento & purificação , Feminino , Humanos , LactenteRESUMO
OBJECTIVE: To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODS: All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed. RESULTS: We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay (p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits (p < 0.001) and reduced consciousness (p = 0.018), and required multiple neurosurgical procedures (p < 0.001), longer stays (p = 0.017), and had greater morbidity at six months (p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities. CONCLUSION: Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.
Assuntos
Abscesso Encefálico/terapia , Empiema Subdural/terapia , Sinusite/complicações , Adolescente , Anti-Infecciosos/uso terapêutico , Afasia de Broca/microbiologia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Criança , Transtornos do Comportamento Infantil/microbiologia , Transtornos Cognitivos/microbiologia , Transtornos da Consciência/microbiologia , Drenagem , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/etiologia , Feminino , Humanos , Masculino , Paresia/microbiologia , Estudos Retrospectivos , Sinusite/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The differential diagnosis of isolated oculomotor nerve paresis ranges from benign to potentially lethal pathologies. Intracranial tuberculosis (TB), as in the case of this patient, carries a high morbidity and mortality. Early diagnosis is crucial to improve patient outcomes. CASE REPORT: We present the case of a 46-year-old man with a chief complaint of 5 days of diplopia. His examination was remarkable for right inferolateral exotropia and weakness of the right medial rectus. Due to the neurologic findings, we obtained a computed tomography brain scan, which revealed a ring-enhancing lesion within the central midbrain with vasogenic edema causing mass effect on the cerebral aqueduct. Further evaluation revealed tuberculosis (TB) as the underlying etiology. He was placed on steroids and a four-drug anti-TB regimen with resultant improvement of his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intracranial tuberculoma can present with an isolated oculomotor nerve paresis in the absence of pulmonary or systemic symptoms. This case emphasizes the importance of maintaining a broad differential when investigating isolated oculomotor nerve paresis.
Assuntos
Doenças do Nervo Oculomotor/microbiologia , Paresia/microbiologia , Tuberculoma Intracraniano/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológicoRESUMO
The frequency of Listeria monocytogenes (Lm) infection of the central nervous system is increasing. We report a patient recently treated with chemotherapeutic drugs for pulmonary adenocarcinoma who suddenly developed hemiparesis, was initially diagnosed with stroke, and was then found to be affected by Lm rhombencephalitis accompanied by a brain abscess. Lm meningoencephalitis mimicking ischemic stroke is rare but must be considered, especially in specific patients.
Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Listeria monocytogenes , Listeriose/diagnóstico , Paresia/microbiologia , Rombencéfalo/microbiologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma de Pulmão , Antibacterianos/uso terapêutico , Antineoplásicos/administração & dosagem , Abscesso Encefálico/complicações , Abscesso Encefálico/tratamento farmacológico , Isquemia Encefálica/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Listeria monocytogenes/isolamento & purificação , Listeriose/tratamento farmacológico , Listeriose/microbiologia , Neoplasias Pulmonares/tratamento farmacológico , Meningoencefalite/diagnóstico , Meningoencefalite/microbiologia , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnósticoRESUMO
BACKGROUND: Most patients with neurosyphilis are considered asymptomatic. The diagnosis is challenging and the role of neuroimaging is not yet well established. The present study was conducted to focus on the clinical findings and further characterize the imaging features of the disease, along with a review of the pertinent literature. METHODS: Six male patients with neurosyphilis based on abnormal cerebrospinal fluid findings, five of whom were asymptomatic at presentation, underwent cranial computerized tomography (CT) and magnetic resonance imaging (MRI). They also underwent a complete physical, neurological, and ophthalmological examination, with special attention paid to atherosclerotic vascular risk factors. In addition, all were examined for cardiac involvement using electrocardiography and cardiac ultrasound. RESULTS: The meticulous neurological and ophthalmological examination revealed abnormalities in five patients, most commonly cranial nerve involvement (three patients) and hemiparesis (two patients). The CT and MRI studies revealed abnormalities in five of the six patients, and in all six patients, respectively. The most common findings were brain infarcts, which were demonstrated in four of the six patients. MRI was found to be more sensitive than CT in detecting these brain infarcts, as expected. CONCLUSIONS: Vascular insult was the most common neuroimaging finding in our patients with neurosyphilis, probably due to meningovascular endarteritis. Neurosyphilis should always be considered in young patients with unexplained brain infarcts.
Assuntos
Infarto Encefálico/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neuroimagem , Neurossífilis/complicações , Neurossífilis/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Infarto Encefálico/microbiologia , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/microbiologia , Técnicas de Diagnóstico Oftalmológico , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Paresia/diagnóstico , Paresia/microbiologiaRESUMO
BACKGROUND CONTEXT: Aeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date. PURPOSE: To report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty. STUDY DESIGN: Case report. METHODS: A 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection. RESULTS: Emergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty. CONCLUSIONS: This is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.
Assuntos
Aeromonas hydrophila , Abscesso Epidural/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Complicações Pós-Operatórias/microbiologia , Vertebroplastia/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Descompressão Cirúrgica , Abscesso Epidural/terapia , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Masculino , Paresia/microbiologia , Complicações Pós-Operatórias/terapia , Fraturas da Coluna Vertebral/cirurgia , Vértebras TorácicasRESUMO
Authors report a case of a 35-year-old male with right-sided mild paresis, incontinence, dysexecutive syndrome, short-term memory loss and behavioral changes. Bilateral cerebral infarcts in the region of the caudate nuclei and the adjacent white matter were proved by brain MRI and multiple stenoses of the branches of Willis-circle were confirmed by MR angiography. Elevated protein level and pleocytosis were found in the cerebrospinal fluid with intrathecal IgG synthesis. Serum rapid plasma reagin, Treponema pallidum Particle Agglutination test, Treponema pallidum ELISA, liquor Venereal Disease Research Laboratory tests were positive. Meningovascular neurosyphilis was diagnosed. 24M U/day intravenous penicillin-G treatment was given for 14 days. The patient has vascular dementia due to the bilateral strategic infarcts disconnecting the prefrontal circuits; his symptoms are similar to general paresis. Laboratory and radiologic improvement was observed. Still, the patient have severe residual cognitive decline.
Assuntos
Antibacterianos/administração & dosagem , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/microbiologia , Meninges , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Penicilina G/administração & dosagem , Treponema pallidum/isolamento & purificação , Adulto , Testes de Aglutinação , Transtornos Cerebrovasculares/líquido cefalorraquidiano , Transtornos Cerebrovasculares/tratamento farmacológico , Demência Vascular/microbiologia , Ensaio de Imunoadsorção Enzimática , Humanos , Infusões Intravenosas , Imageamento por Ressonância Magnética , Masculino , Meninges/irrigação sanguínea , Meninges/microbiologia , Neurossífilis/líquido cefalorraquidiano , Paresia/microbiologia , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologiaRESUMO
BACKGROUND AND OBJECTIVES: Neurologic involvement is the most threatening complication of diarrhea-associated hemolytic uremic syndrome (D+HUS). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We report a retrospective multicenter series of 52 patients with severe initial neurologic involvement that occurred in the course of D+HUS. RESULTS: Verotoxigenic Escherichia coli infection was documented in 24. All except two patients had acute renal failure that required peritoneal dialysis, hemodialysis, or both techniques. A first group of eight patients remained with normal consciousness; five of them had protracted seizures. A second group of 23 patients had stuporous coma; five of these had protracted severe seizures, and 18 had a neurologic defect including pyramidal syndrome, hemiplegia or hemiparesia, and extrapyramidal syndrome. A third group of 21 patients had severe coma. Plasma exchanges were undertaken in 25 patients, 11 of whom were treated within 24 hours after the first neurologic sign; four died, two survived with severe sequelae, and five were alive without neurologic defect. Magnetic resonance imaging (MRI) for 29 patients showed that (1) every structure of the central nervous system was susceptible to involvement; (2) no correlation seemed to exist between special profile of localization on early MRI and the final prognosis; and (3) MRI did not exhibit any focal lesions in three patients. The overall prognosis of the series was marked by the death of nine patients and severe sequelae in 13. CONCLUSIONS: Neurologic involvement is associated with a severe renal disease but does not lead systematically to death or severe disability.
Assuntos
Injúria Renal Aguda/microbiologia , Diarreia/microbiologia , Infecções por Escherichia coli/microbiologia , Síndrome Hemolítico-Urêmica/microbiologia , Doenças do Sistema Nervoso/microbiologia , Escherichia coli Shiga Toxigênica/patogenicidade , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Adolescente , Criança , Pré-Escolar , Coma/microbiologia , Diarreia/mortalidade , Diarreia/terapia , Avaliação da Deficiência , Distonia/microbiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/mortalidade , Infecções por Escherichia coli/terapia , Feminino , França , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/terapia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/mortalidade , Doenças do Sistema Nervoso/terapia , Paresia/microbiologia , Diálise Peritoneal , Troca Plasmática , Diálise Renal , Estudos Retrospectivos , Convulsões/microbiologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
Spinal epidural abscess is a rare debilitating disease that if left untreated may result in serious morbidity and mortality. Most cases involve the level of 3 or 4 vertebrae, but in very rare cases may affect the whole spine. The most common pathogen found in spinal abscesses is Staphylococcus aureus, which involves approximately two thirds of cases. The recent introduction of methicillin-resistant strains of S aureus has left physicians with the challenging task of identifying and treating this serious condition.We present the only case reported of a methicillin-resistant S aureus holospinal epidural abscess with subsequent neurological follow-up over a 1-year period.
Assuntos
Dor nas Costas/microbiologia , Abscesso Epidural/diagnóstico , Resistência a Meticilina , Paresia/microbiologia , Infecções Estafilocócicas/diagnóstico , Adulto , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Abscesso Epidural/cirurgia , Humanos , Masculino , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgiaRESUMO
We report an unusual case of a 10-year-old girl with neurocryptococcosis that was diagnosed only after histological examination of the cyst fluid obtained at surgery.
Assuntos
Abscesso Encefálico/patologia , Encéfalo/patologia , Cryptococcus neoformans , Meningite Criptocócica/patologia , Antifúngicos , Biópsia por Agulha Fina , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Criança , Transtornos da Consciência/microbiologia , Craniotomia , Evolução Fatal , Feminino , Humanos , Imunocompetência , Cetoconazol/uso terapêutico , Meningite Criptocócica/complicações , Meningite Criptocócica/diagnóstico por imagem , Nigéria , Paresia/microbiologia , Recidiva , Convulsões/microbiologia , Tomografia Computadorizada por Raios X , Falha de TratamentoAssuntos
Síndrome de Kluver-Bucy/microbiologia , Síndrome de Kluver-Bucy/patologia , Lobo Temporal/microbiologia , Lobo Temporal/patologia , Doença de Whipple/complicações , Doença de Whipple/patologia , Tonsila do Cerebelo/microbiologia , Tonsila do Cerebelo/patologia , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Ceftriaxona/uso terapêutico , Demência/microbiologia , Demência/patologia , Diagnóstico Diferencial , Feminino , Humanos , Síndrome de Kluver-Bucy/fisiopatologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Paresia/microbiologia , Paresia/patologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Doença de Whipple/tratamento farmacológicoRESUMO
We describe a case of encephalopathy in which the clinical picture and triphasic waves in the EEG indicated a metabolic cause. However, the illness was caused by neuroborreliosis. The occurrence of triphasic waves in the EEG is a strong evidence of metabolic encephalopathy, but triphasic waves are not specific for metabolic encephalopathy. Triphasic waves have been described in a number of non-metabolic encephalopaties and structural brain lesions. To our knowledge, this is the first report of triphasic waves in Borrelia burgdorferi meningoencephalitis.
Assuntos
Borrelia burgdorferi , Eletroencefalografia , Neuroborreliose de Lyme/diagnóstico , Neuroborreliose de Lyme/fisiopatologia , Meningoencefalite/diagnóstico , Meningoencefalite/fisiopatologia , Potenciais de Ação/fisiologia , Idoso , Animais , Antibacterianos/uso terapêutico , Encéfalo/microbiologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/microbiologia , Doxiciclina/uso terapêutico , Feminino , Humanos , Leucocitose/diagnóstico , Leucocitose/microbiologia , Leucocitose/fisiopatologia , Meningoencefalite/microbiologia , Bandas Oligoclonais/líquido cefalorraquidiano , Paresia/microbiologia , Valor Preditivo dos Testes , Estupor/microbiologia , Carrapatos , Resultado do TratamentoAssuntos
Encéfalo/patologia , Infecções Fúngicas do Sistema Nervoso Central/imunologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Hospedeiro Imunocomprometido/imunologia , Leucemia de Células T/complicações , Leucemia de Células T/imunologia , Antifúngicos/uso terapêutico , Encéfalo/imunologia , Encéfalo/fisiopatologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/patologia , Abscesso Encefálico/fisiopatologia , Edema Encefálico/microbiologia , Edema Encefálico/patologia , Edema Encefálico/fisiopatologia , Infecções Fúngicas do Sistema Nervoso Central/fisiopatologia , Criança , Transtornos da Consciência/microbiologia , Transtornos da Consciência/patologia , Transtornos da Consciência/fisiopatologia , Progressão da Doença , Evolução Fatal , Cefaleia/microbiologia , Cefaleia/patologia , Cefaleia/fisiopatologia , Humanos , Leucemia de Células T/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Neuroaspergilose/imunologia , Neuroaspergilose/patologia , Neuroaspergilose/fisiopatologia , Paresia/microbiologia , Paresia/patologia , Paresia/fisiopatologia , Falha de TratamentoAssuntos
Mycobacterium tuberculosis/crescimento & desenvolvimento , Paresia/etiologia , Tuberculose do Sistema Nervoso Central/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Paresia/microbiologia , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/microbiologia , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/microbiologiaRESUMO
The epidemiological, clinical and laboratory features of 13 cases of neuroparacoccidioidomycosis (NPCM) were analysed. All patients were men, with a mean age of 41.6 years. The lungs were involved in 11 cases (84.6%) and only two cases had mycosis limited to the central nervous system. Co-morbidity was observed in four patients (malignant neoplasm in three and diabetes mellitus in one). The most frequent neurological manifestations were paresis (eight cases), headache (five cases) and gait disturbance (four cases). Neuroimaging diagnosis showed a predominance of multiple round lesions with ring enhancement following contrast medium injection. Lesions were seen in the brain hemispheres (nine cases), thalamus (nine cases), cerebellum (four cases), brainstem (four cases) and spinal cord (four cases). Most cases responded well to therapy. Lesions with enhancement following contrast medium injection persisted in four patients for a period of 6 months to 8 years. These findings emphasize the importance of considering NPCM in the differential diagnosis of brain and spinal cord lesions in endemic areas of paracoccidioidomycosis.
Assuntos
Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Paracoccidioidomicose/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Infecções Fúngicas do Sistema Nervoso Central/complicações , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Seguimentos , Transtornos Neurológicos da Marcha/microbiologia , Cefaleia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/complicações , Paracoccidioidomicose/tratamento farmacológico , Paresia/microbiologiaRESUMO
We carried out a 4-year study of 159 children (ages 1 month-14 years) with pneumococcal meningitis. The study was divided into two periods: the retrospective period (1998-2000: 107 patients), and the prospective period (2001-2002: 52 patients). About 2/3 of the children were under 2 years of age: 72 (45%) were under 1 year of age and 38 (24%) had meningitis during the second year of life. One-third of the patients had signs of otitis media; convulsions were more frequent in patients under 1 year compared with older patients (34.7 vs. 14.9%; P=0.004); 13/159 children (8.2%) died; 93/159 (58.5%) recovered completely, 12.6% had motor sequelae, 6.9% hydrocephalus, 29.8% sensorineural hearing loss; 140/159 (88%) were treated with third generation cephalosporins, yet only 8.7% of the pneumococci identified were completely penicillin-resistant (> or =1 microg/ml); 119/159 were treated with dexamethasone. Four patients had received an injection of heptavalent vaccine. Antibiotics for 1 week prior to admission, shock, abnormal pupils, leukocytes count <6,000 mm(3), and CSF glucose < or =8.5 mg/dl were significantly associated with poor outcome and/or death in the univariate analysis. No patient with leukocytosis >16,000/mm(3) died. Conclusion. Sequelae are very common in pneumococcal meningitis. Poor outcome was associated with pupillary abnormality and a leukocyte count <6,000/mm(3) on admission. Leukocytosis was protective against poor outcome.